You’d think that something like going into labor to birth a baby would have very noticeable and unmistakable signs. Determining whether or not you are really in labor – or whether it’s time to head to the hospital or birth center- can be a little confusing, especially when it’s your first time around the labor and delivery block.

There are several reasons why it’s so tricky:

• Braxton-Hicks contractions can do a pretty good job of tricking you into thinking you’re in “real” labor.
• Labor presents itself differently for different women.
• Just because you’re in “real” labor doesn’t mean your baby will arrive in the next 24-hours or even 48-hours, depending on what’s going on for your body and your baby.
• It definitely doesn’t happen as it does in the movies.

Going Into Labor Isn’t Like It Is In the Movies

Let’s start with the last point first; in the movies, it’s so obvious. One moment, a woman is arguing with her mate or grabbing coffee with a friend when – – all of a sudden — she crouches down with her arms over her belly and starts exclaiming she’s in labor.

In real life, this is very rarely the case. While your water breaking (more on that later) may be an abrupt surprise, contractions typically don’t move from 0 – 10 in a blink of an eye. They usually start a little more gently. You may think you have gas, indigestion, or diarrhea, or you may notice a slight tightening of your belly or lower back and think, “Hmm. That’s different. Was that a contraction?”

Over time, the contractions will grow a little bit stronger, a little bit longer, and they will come closer and closer together. That is a better model of how “real” labor starts.

Signs You Are Going Into Labor

How Do I Know If I’m In Labor?

Here are some of the signs that you are going into labor. Pretty soon, your “How do I know if this is labor?” will turn to a definite, “I’m going into labor.”

1. Your water breaks. This is the most dramatic and common sign that labor is about to start. It’s unmistakable because you’ll feel like you peed your pants. For some women, contractions begin right away, while it can take a little longer for others. There is no need to rush to the hospital because your water broke. Depending on how things progress, you can still move around and go about your day. However, you’ll want to call your OB/GYN and let them know. Most healthcare providers say to labor at home until contractions progress or until you hit the 24-hour mark, whichever comes first. If 24-hours passes, you need to head in so you and the baby can be evaluated. 
2. Your water leaks. Similarly, a small tear or puncture can cause a leak, where amniotic fluid slowly trickles out. You may think – at first – that you are leaking urine because it will make your panties wet and may even soak through a layer of clothes over time. However, a panty liner will do the trick in the meantime, and, like mentioned above, you should give your healthcare provider a call to let them know what’s going on. They’ll let you know how to proceed.
   
3. You notice a thick, bloody discharge. Attractively named “bloody show” (we jest!), this pinkish or blood-tinged discharge signifies that labor is close. This is a “plug” that helps to seal your cervix and keep the baby in place. Once it’s released, the cervix will continue to dilate, and labor will commence. 
4. A dilated cervix. Once you hit the 36-week mark, your midwife or OB/GYN will want to see you every week. During these visits, they often check your cervix and will let you know if you’re dilated. Keep in mind that a woman near labor –but not in labor – can walk around for days with a slightly dilated cervix. So, while it’s a sign that labor is close – it’s not time to run to the hospital. Going too early may mean they admit you – and you’re more likely to have your labor induced if you don’t go into labor on your own within 24-hours or so. Better to labor at home until it’s really “time,” minimizing your chances of using unnecessary labor interventions. 
5. Contractions – Are These For Real? There are two types of contractions: Braxton-Hicks contractions and the “real” ones that lead to the birth of your baby. The former are like practice contractions, preparing your body, helping the baby position itself correctly, and warming up for the big event. They can feel fairly intense at times, but they will never escalate the same way real contractions do, and they will ease off and stop once you’re sitting, laying down, or relaxing in a warm bath for a while. Click on the hyperlink to read more about Braxton Hicks Contractions.

Now, for the real thing. Real contractions can start out feeling like a bad case of gas or slight indigestion, and you may even have diarrhea. They will then progress to a tightening of the abdominal and/or back muscles. At first, you can talk through them or breathe naturally. As they increase in intensity, you will have to stop what you are doing or interrupt a conversation to be with yourself and breathe through them.

If this is your first baby, keep in mind that first labors are notoriously longer than usual, so although you may be tempted to skedaddle to the hospital, you are better off laboring at home until it’s really time to avoid being strapped to a fetal monitor or risking being pressured to use interventions that aren’t a part of your birth plan.

With “Real” contractions:

—Being active or laying down won’t make a darn difference; contractions happen anyway.

—Changing positions won’t change their behavior.

—They may sometimes start in your lower back and move across to your lower abdomen. Contraction pressure or pain may even radiate down your legs.

—They become more frequent, more intense, and they may even fall into a predictable, timed pattern.

They come on like waves and, as labor progresses. Those waves come faster and faster together and will get stronger and longer. Contact your healthcare provider when your contractions are distinct, requiring more focus and attention than the initial ones.

1. The Contraction 4-1-1. So, if they ARE real contractions – then what? Most healthcare providers use the 4-1-1 rule of thumb. This means you should head to the hospital or birthing center when your contractions are 4 minutes apart, last for one minute, and continue for 1-hour.

 Of course, every woman is different, so while these provide general labor guidelines, it’s always best to contact your healthcare provider if you have any questions or simply want to check in. There’s nothing wrong with erring on the side of caution.

Best of luck! Women’s Health Associates with a safe and happy birthing journey to both you and your baby.