Signs of labour and when to go to the maternity hospital

In the last weeks of pregnancy almost every twinge raises the same question: is this it? Most labours start gradually, leaving time to notice the pattern and travel calmly. Here is how to recognise the signs, tell practice contractions from real ones, and know when to set off for the maternity hospital (tug'ruqxona) or call 103.

Signs that labour is getting close

In the days or weeks before labour your body quietly prepares. None of these signs means labour will start today.

• Lightening. The baby drops lower into the pelvis: breathing gets easier, but there is more pressure on the bladder.
• The mucus plug, or "show". A thick, jelly-like discharge, sometimes streaked pink or brown, comes away as the cervix softens, days before labour or at its start. Bright red bleeding is not a show and needs a call to the hospital.
• Nesting: a sudden urge to clean and finish things; harmless unless you exhaust yourself.
• Loose stools, nausea, low backache and period-like cramps that come and go.

Braxton Hicks or true labour?

Braxton Hicks contractions are tightenings of the uterus that many women feel from mid-pregnancy. The difference from labour lies in the pattern, not in any single contraction. Practice contractions are irregular, stay about the same strength, are usually felt at the front, and ease when you change position, rest, drink water or take a warm shower.

True labour contractions:

• Become regular, and the gaps shorten over an hour or two.
• Get longer and stronger, until you cannot talk through them.
• Keep going whatever you do.

To time contractions, note how long each one lasts (from start to fade) and the interval between them (start of one to start of the next). Time five or six in a row, then rest. A phone timer works well; it is a good job for your birth partner.

When to go to the maternity hospital

A common guide for a first baby is the 5-1-1 rule: contractions about every 5 minutes, each lasting about 1 minute, for at least 1 hour. Your doctor may want you earlier if you live far away or have a condition that needs watching.

If this is not your first baby, go earlier: later labours are often much faster, so set off once contractions are regular and clearly strengthening, for example every 7–10 minutes.

If your waters break:

• Note the time and the colour of the fluid, and use a pad, not a tampon.
• Clear or pale fluid is normal, but go in even without contractions: the risk of infection rises once the membranes have opened.
• Green or brown fluid may contain meconium (the baby's first stool) and is urgent: go straight in or call 103.
• Fluid before 37 weeks is also urgent.

Go in now, or call 103, if

Do not wait for a pattern. Go to the maternity hospital immediately or call an ambulance on 103 (or 112) if you notice:

• Bleeding heavier than light spotting.
• Fewer or weaker movements than usual. Fewer movements are never a normal sign that labour is near.
• A severe headache, blurred vision, flashing lights, or sudden swelling of the face and hands.
• A fever of 38 °C or higher.
• Regular, painful contractions before 37 weeks.
• Constant severe belly pain that does not ease like a contraction.

Early labour at home

If contractions are still irregular, your waters are intact and you feel well, early labour is usually easiest at home.

• Rest between contractions and sleep if it is night: this phase can last many hours.
• Eat light meals and drink regularly.
• Take a warm shower, or lean forward over a ball or chair.
• Breathe slowly out through each contraction and relax your shoulders and jaw between them.

Fear and excitement are both normal. Your birth partner can time contractions, keep you drinking, press on your lower back and speak to staff for you. Decide beforehand who will drive and who will look after older children. Rules on partners vary between maternity hospitals, so ask at your 36-week visit whether your partner may stay with you.

What to expect on arrival

At the admission desk you will show your passport and exchange card (obmen kartasi). A doctor or midwife will check your blood pressure and temperature, feel your belly to confirm the baby's position, and usually examine the cervix to see how far it has opened. A CTG trace of about 20–40 minutes records the baby's heartbeat alongside your contractions.

In established labour you will be admitted to the delivery unit; if it is still early and you are both well, you may go to a pre-labour ward or be advised to go home for a few hours. Both are normal.

Your doctor may also discuss induction of labour: starting it with medicines or by breaking the waters. It is usually considered when a pregnancy passes 41 weeks, when the waters have broken but contractions have not started within about a day, or when a condition such as high blood pressure makes an earlier birth safer. Ask about the reasons, the options and what happens if you prefer to wait.

This article is general information, not medical advice. Talk to your doctor about your own situation.