Recognizing Labour Pain: Key Signs You're Going Into Labour

Surbhi had been feeling off all day, with a dull ache in her lower back and some cramping in her belly, similar to period pain. "Is this it?" she wondered. The cramps were irregular, and while she knew real contractions come in waves, the pressure in her pelvis and tightening in her belly felt different.

She sat on the couch, timing the cramps, unsure if it was Braxton-Hicks or the start of labour. "Maybe it’s just another false alarm," she thought, but couldn’t shake the feeling, "What if this is the real thing?"

Labour pain can be tricky to identify, especially when it feels like third-trimester discomfort. But certain signs signal your body is preparing for delivery. Let’s dive into these signs and changes that indicate your baby is on the way.

As your due date approaches, it’s natural to wonder if every little twinge or sensation could mean that labour is starting. To help you feel more prepared, here are some of the early signs that might signal your baby is on the way:

• Contractions: You might notice regular, painful contractions that gradually get stronger and closer together. These contractions are helping your cervix thin out and open up to get ready for delivery. They often feel like abdominal tightening, lower backache, or pain radiating down to your thighs.
• Lower back pain and cramping: That familiar cramping in your lower back and belly, much like period pain, could be an early sign that labour is on its way. It might just feel like a dull ache at first but can intensify over time.
• Pelvic pressure: As your baby drops lower into the birth canal, you may feel increased pressure or heaviness in your pelvis. You might also feel the urge to go to the toilet more often as your baby presses down on your bladder.
• Mucus plug discharge: Losing your mucus plug, which seals the cervix throughout pregnancy, is another sign that labour could be near. This mucus plug is removed through discharge, which can be clear, pink, or slightly bloody. You may notice this jelly-like discharge days, or even weeks, before labour kicks in.
• Water breaking: One of the sure-shot signs that labour is starting is when your water breaks. This could be a sudden gush of fluid or a slower trickle. If you think your water has broken, it’s important to contact your doctor or head to the labour room straight away.

Keeping an eye on these signs can help you feel more confident about when labour is starting. And remember, if you're ever unsure, don't hesitate to reach out to your healthcare provider for advice!

Changes in Cervical Dilation and Effacement

As labour approaches, your cervix prepares by thinning (effacement) and opening (dilation). Effacement is measured from 0% to 100%, while dilation ranges from 0 to 10 cm. Contractions help with effacement, making it easier for the baby to move through.

Early labour sees slow dilation, while active labour speeds up the process. You'll likely be in active labour when your cervix is 80-100% effaced and 4-10 cm dilated. Your healthcare provider will monitor these changes during check-ups.

In addition to the early signs of labour and changes to your cervix, there are a few other signals that your baby might be getting ready to make an entrance. While every woman’s experience is different, here are some other indicators that labour might be just around the corner:

• Nesting instinct: You may suddenly feel like cleaning every inch of your home, organising baby clothes, or even rearranging furniture. This surge of energy is commonly known as the nesting instinct. Quite cool, huh?
• Loose bowel movements: As your body gets ready for labour, it releases hormones that relax the muscles, including those in your digestive tract. This can lead to loose stools or even diarrhoea. It's one of those subtle but telltale signs that your body is preparing for birth.
• Increased Braxton Hicks contractions: You might notice those familiar practice contractions—Braxton-Hicks—ramping up. These are the abdominal tightenings you’ve likely felt before, especially when the baby moves around. They can feel like Surbhi’s off-and-on cramping. While they’re typically irregular and less painful than true labour contractions, they may become more frequent and intense as the big day approaches.
• Emotional changes: Your emotions might start to feel like a rollercoaster. From excitement and nervousness to moments of irritability and anxiety, it’s completely normal to experience a range of feelings. After all, your body and mind are both preparing for a major life event.

Note that every woman's labour experience is different, and not all of these signs may be present. 

False labour, or Braxton-Hicks contractions, are common in the third trimester and can confuse expectant mothers. Unlike true labour, these contractions are irregular, short (less than 60 seconds), and don’t increase in frequency or intensity.

Surbhi described them as mild uterine tightening, which made her question if she was in labour.

False labour can be triggered by dehydration, constipation, or activity, and often subsides with rest, hydration, or a change in position. Timing contractions can help distinguish false labour from the real thing.

Did You Know?

The time between contractions in early labour occurs 15 to 20 minutes apart and lasts 60 to 90 seconds each. As labour progresses, these contractions become more frequent and intense, eventually occurring 3 to 5 minutes apart during active labour.

When labour really kicks in, here’s what you can do to stay calm and prepared:

• Track Contractions: Begin timing your contractions from the start of one to the start of the next, noting their duration and frequency. True labour contractions will become more frequent and longer-lasting over time. Had Surbhi timed her contractions, she would have realised that she was indeed going into labour and that her contractions weren't Braxton-Hicks.
• Contact Healthcare Provider: Inform your healthcare provider when you are in labour or in doubt. Even if you are in doubt about labour pain, it's honestly best to contact your doctor. Based on your situation, they will advise you on when to head to the hospital.
• Prepare for Hospital: Pack any necessary items, such as clothes, insurance cards, previous records, scans, and any other important documents, along with other essentials you may need during your hospital stay. Having a pre-packed bag can help you feel more prepared and reduce stress.
• Stay Hydrated and Comfortable: Drink plenty of water to stay hydrated and try to rest as much as possible. Taking warm baths or showers can help alleviate discomfort during early labour stages.
• Monitor Other Symptoms: Be aware of additional signs of labour, such as the loss of the mucus plug, water breaking, or a change in vaginal discharge. If you experience any concerning symptoms, contact your healthcare provider immediately.

When to Head to the Hospital

Knowing when to leave for the hospital during labour can be a bit tough, but there are a few general guidelines you can follow.

If your water breaks, you should head to the hospital right away. Otherwise, the 5-1-1 rule is often recommended. Head to the hospital when contractions are 5 minutes apart, last for 1 minute each, and have been consistent for 1 hour. If you live far from the hospital or have a history of fast labour, your healthcare provider may advise leaving sooner.

Trust your instincts and don't hesitate to call your provider with any concerns about how labour pain starts or progresses.

As you approach the third trimester, it’s important to be aware of the possibility of preterm labour, which can occur before 37 weeks. Recognizing the signs early can help you act quickly and avoid complications for you and your baby.

Common symptoms of preterm labour include frequent uterine contractions, menstrual-like cramps, lower back pain, pelvic pressure, and changes in vaginal discharge. If you experience any of these, contact your doctor immediately. They may perform a pelvic exam, ultrasound, and use a CTG (cardiotocogram) to monitor your baby’s heart rate and overall well-being.

If preterm labour is confirmed, don’t panic—there are treatments to slow down labour or prepare your baby for an early arrival. Medications and corticosteroids (steroid injections) are often used to enhance your baby’s lung maturity. You may receive 2-4 doses of steroids to help their lungs develop faster in case of early delivery.

Having a hospital plan ready can ease stress. Pack necessary documents and ensure support is in place. Be prepared for the possibility of your baby needing care in a neonatal intensive care unit (NICU). Choosing a hospital equipped to handle preterm births is crucial.

Being informed and mentally prepared will help you navigate this challenging time if preterm labour arises.

As labour begins, things can get a little overwhelming. But, don't worry, there are plenty of ways to ease the discomfort and help you feel more in control.

Consider these soothing options:

• Enjoy a warm shower or bath to relax your muscles.
• Use a birthing ball to find a comfortable position.
• Lying on your side with a supportive pillow may help ease contractions.
• Avoid lying flat on your back, as it can increase discomfort.
• Listen to your favourite music and watch something light to distract yourself.
• Practice deep breathing or visualisation techniques to stay calm.
• Ask a family member for a gentle massage to relieve tension.
• Apply heat or cold packs to your lower back or abdomen.

Labour pain varies for each woman—some experience intense pressure or burning, while others feel a dull ache. The intensity can shift unexpectedly, as one moment of calm may quickly give way to a strong contraction, as Surbhi found while questioning whether her cramps were real labour.

Trust your instincts and listen to your body as labour progresses. If you're unsure, reach out to your healthcare provider for guidance. They will help you navigate pain management options and provide support.

Being informed about the signs of labour can ease anxiety and give you a sense of control.