How do I know I am in labour?

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Virtually every first time mum-to-be spends some time wondering how, or whether, they will know that they are in labour.  As someone who spends lots of time online I am often fascinated by the number of women on various groups asking one another whether they are in labour or not.  But the actual answer to “how do I know” is a little tricky and the reason is that midwives and obstetricians really are only able to ‘diagnose’ labour from what happens as things progress… how your cervix opens and how your baby descends.  Labour is not about contractions it is about getting your baby out of your body.  Midwives and doctors consider labour to START when your cervix is open about 4-6 cms (out of 10 cm) so this is not really obvious to the mum or dad.  Therefore it is important to try to give you a few signs and changes that may reflect that the process is underway.

Many women have had signs, even for weeks, that labour is getting closer.  A mucous “show”, which may even contain some blood, demonstrates that your cervix is changing.  Your cervix moves forward, becomes softer and thinner, and then starts to open.  Some women have this happen in this order, especially with their first baby but some don’t.  The show is a sign that these things are underway.  Other strange things can be that your bowel habits change a little and that you become emotional, or have a significant change in emotions.  Other late pregnancy changes that will lead into early labour are lower back pain as your cervix changes, periods pains and tightening of your uterus that come and go.  How this feels to the woman and what happens next often depends on where your baby is lying and how many babies you have had before.

Midwives however give their clients lots of information about when it is likely that labour has started.  The most significant indication is that you have regular tightening or surges (contractions).  Contractions or tightening feel like your whole abdomen is tight and hard, and it is accompanied by discomfort or pain in the lower abdomen or lower back, like a period would feel.  The next most important element is that the tightening’s and surges progress. This means that the tightening’s become more regular – you can time them – they are, closer together, feel stronger and you find that they start to need your focus.  Most women, especially with your first baby, have many hours where they know they are in labour.  There are pleasant exceptions from time to time where labour is shorter than a first time mum expects, but this is rare.

Once the contractions are around 3 minutes from the beginning of one contraction to the beginning of the next contraction (midwives will say the contractions are 3 minutes apart) and the period of the contraction or surge lasts around a minute, it is a great time to call your care provider.  This is where the benefit of a known care provider, either a continuity of care midwife or an obstetrician are really useful.  Women who have any history of problems in pregnancy or quick labours or problems from a previous pregnancy or birth will have usually been advised of a plan and may need to go to hospital as soon as contractions start.  But for most women, particularly with your first baby, there is no rush, babies are not born on the roadside often, you are more likely to be at hospital too early and be sent home, than be there too late.

Labours progress in their own pace, sometimes even slowing or stopping when a change occurs.  Women may get into the car and the labour may slow down a lot.  This is often a result of a surge of adrenaline which has an impact on labour hormones.  Usually if labour is already started and going well, this is less likely to have an impact so it is VERY important to check in with your care provider before leaving for hospital.

My advice is don’t stress, do try to relax and let things happen, keeping things as simple as you can for as long as you can!!  Good luck!!

Liz Wilkes has been a midwife for 24 years and is the Managing Director of My Midwives.  My Midwives provides midwifery continuity of care to women in Brisbane, Melbourne and Toowoomba.  Liz is presenting a special short form antenatal class series at the Baby To Toddler Show 

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