There are two opposite fears about going into labour and almost everyone has both. One is showing up at the hospital after the first twinge and being kindly sent home in a paper bracelet. The other is that you'll think it's "still early" and end up giving birth in the car park. Both happen. Both are rare. Most labours give plenty of warning, and most maternity units would much rather you ring once too often than once too late.
Healthbooq (healthbooq.com) covers pregnancy, birth, and the early weeks of parenthood.
Things That Happen Before Labour Properly Starts
In the days and weeks running up to labour, your body is doing a lot of unobtrusive preparation. The cervix softens (the technical term is "ripening"), thins out (effacing) and starts to dilate slightly. None of this hurts. What you might notice:
- More vaginal discharge — clearer, slipperier, sometimes more.
- A heavy, dragging pelvic feeling, sometimes with sharp twinges low down. This is normal.
- Braxton Hicks contractions — irregular tightenings that come and go without a pattern. They can be uncomfortable but they don't get longer, stronger, and closer together. Hydrating and changing position usually settles them.
- The baby "dropping" in the last weeks of a first pregnancy — a sense the bump has moved lower, less heartburn, easier breathing, more pelvic pressure. With second and later babies this often happens during labour itself.
None of these mean labour is imminent today. They mean your body is in the right neighbourhood.
The Show
The "show" is the mucus plug that has been sealing the cervix during pregnancy coming away as the cervix opens. It looks like a wodge of jelly, sometimes clear, often tinged pink or brown with old blood, sometimes streaked with a bit of fresh blood. Some women see it on the toilet paper a week before labour starts; some don't notice it at all; some see it once contractions are already going.
A show on its own is not a reason to ring the hospital. It means things are starting to move. Mention it when you next call for something else.
What is not a show: heavy, fresh, bright red bleeding, or anything that fills a pad. That is a "phone the labour ward now" event.
Contractions: How to Tell Real From Practice
Pretty much everyone has Braxton Hicks late in pregnancy and wonders if this is it. Real labour contractions have three features that practice contractions don't:
- Regular. They come at predictable intervals, and the intervals get shorter over time.
- Increasing in intensity. Each one feels stronger than the one before, not the same.
- Increasing in duration. They start at 30 seconds and lengthen towards a minute.
A practice contraction is uncomfortable; a real labour contraction will eventually stop you mid-sentence. If you can comfortably hold a conversation through it, you are still in early latent labour or it is Braxton Hicks. If walking, drinking water, and changing position make them go away, they were not the real thing. Real contractions don't politely vanish when you stand up.
Early labour ("latent phase") feels like period pain, sometimes with backache, sometimes radiating around to the front. It can last hours to a couple of days, particularly with a first baby, and it doesn't need to happen in hospital. Stay home, eat something light, take paracetamol if it helps, get into a warm bath, sleep if you can. The aim is to arrive at the hospital in established labour, not exhausted from a 36-hour latent phase on a labour ward.
When to Phone the Labour Ward
The standard guidance for a low-risk first pregnancy:
5-1-1. Contractions every 5 minutes, lasting 1 minute, for 1 hour.
By the time you are reliably at 5-1-1 you are usually in established labour, and that is the cue to call. The midwife will ask about the contraction pattern, any waters breaking, any bleeding, and how you are coping, and will tell you whether to come in or stay at home a bit longer.
Important caveats:
- Second and subsequent babies often come faster. If your first labour was quick (under six hours, say), call earlier — every 10 minutes is not too soon.
- You live a long way from the unit. Don't wait for 5-1-1 if it's an hour's drive. Call as soon as contractions are clearly regular.
- You're worried. Pain that feels wrong, an instinct that something is off, anything that doesn't fit the pattern in the books — phone. The labour ward triage line is open day and night and would much rather hear from you than not.
- You're feeling rectal pressure or an urge to push. Don't drive — call the unit immediately, and call an ambulance if you can't reach them.
Waters Breaking
Membrane rupture can happen as a dramatic gush — the cinematic version, where you suddenly need to mop the floor — or as a slow ongoing trickle that is easy to mistake for urine or extra discharge. If you are not sure, put on a clean pad, lie down for a few minutes, then stand up. A small gush as you stand suggests amniotic fluid; nothing further usually rules it out.
If your waters have gone, call the labour ward within an hour. They will want to know:
- Colour. Clear or pale straw is normal. Pink-tinged is usually fine. Bright red is not normal — call immediately. Green, brown, or yellow means the baby has passed meconium in utero, which can be a sign of distress and changes the management — call immediately.
- Time. They will note when membranes ruptured.
- GBS status. If you tested positive for Group B Streptococcus or had it in a previous pregnancy, the team will usually want you in fairly promptly to start antibiotics. GBS-negative women are typically given up to 24 hours for labour to start spontaneously before induction is offered, because infection risk rises with time.
- Movements. Has the baby been moving as usual since?
If contractions don't start on their own, induction is offered, partly because of infection risk, partly because waters being broken doesn't on its own make a baby come.
Cord Prolapse — Rare but Genuinely Urgent
Cord prolapse is when the umbilical cord slips down ahead of the baby after waters rupture, which can compress the cord against the cervix or vagina and cut off the baby's blood supply. It is rare — a few per 1,000 births — but it is a true obstetric emergency.
Symptoms after waters have just broken:
- A feeling of something in the vagina
- Visible cord
- A pulsating sensation low down
If any of these happen, call 999, get into a knee-to-chest position with your bottom up in the air, and do not push. Tell the call handler "suspected cord prolapse." Stay in that position until the paramedics arrive.
It is much more likely if waters break before the baby is engaged in the pelvis, in twin pregnancies, with a transverse or breech baby, or in preterm labour. Engaged head, term baby, normal scan: very unlikely.
Things That Override the 5-1-1 Rule and Need an Immediate Call
Phone the labour ward (or 999) now, regardless of contraction pattern, for any of these:
- Heavy fresh bleeding (more than a show)
- Green, brown, yellow, or bright red waters
- Reduced or absent baby movements
- A severe headache with blurred vision, flashing lights, sudden facial or hand swelling, or upper abdominal pain (signs of pre-eclampsia/eclampsia)
- A seizure (eclampsia)
- A suspected cord prolapse
- Sudden severe pain that doesn't ease between contractions
- Feeling that the baby is "kicking" the perineum, or any urge to push
- Anything you genuinely feel is wrong
A good general rule: the labour ward triage line wants you to ring for these things. They would rather have a five-minute reassurance call that turns out to be nothing than a delay that turns out to be something.
When to Stay Home a Bit Longer (and How to Cope)
If contractions are clearly happening but irregular, and you are otherwise well, early labour at home is usually more comfortable than early labour on a ward.
A few things that genuinely help:
- A bath or shower — warm water reduces the perception of contraction pain in most women
- Walking, leaning, swaying, or rocking on a birth ball — upright movement encourages progress
- TENS machine if you have one
- Paracetamol (avoid ibuprofen near term)
- Eat something light — labour is endurance work
- Sleep if you can; this might be the last sleep for a while
- Have your partner time contractions on a phone app for a stretch — actual data beats "they feel close together"
The Bag
Have a bag packed by 37 weeks. Realistic contents:
- Documents: maternity notes, birth plan if you have one, any medication list, ID and parking change
- For labour: comfortable nightwear that you don't mind ruining, slippers, dark dressing gown, lip balm, hairband, water bottle, snacks, phone charger with a long cable, headphones if you want them
- For after: maternity pads (these are bigger than supermarket ones — buy specifically), big "throwaway" pants, a couple of comfortable nursing bras, basic toiletries, a going-home outfit (your bump-mid-pregnancy clothes are usually right)
- For the baby: newborn-size nappies, two or three sleepsuits and vests, a hat, a blanket, going-home clothes, a fitted car seat in the car (don't forget to actually fit it before the day)
- Useful but optional: flannel for the back of the neck, snacks for your partner, a fan if it's summer, eye mask and earplugs
The single most often forgotten thing is the car seat correctly fitted in the car. Without it, the hospital won't discharge you home.
A Word on Confidence
Most first labours are slow. Most second labours are quicker. Almost no one mistakes established labour, once they're in it, for anything else. The midwives who answer the labour ward triage line do it dozens of times a day; they are not annoyed when you ring; and the worst thing that happens if you call too early is they suggest you take a paracetamol and try a bath. The worst thing that happens if you don't call when you should is much more serious. When in doubt, ring.
Key Takeaways
Real labour is regular, painful contractions that get longer, stronger, and closer together. The standard rule for a low-risk first baby is 5-1-1: contractions every 5 minutes, lasting 1 minute, for 1 hour — that's when to ring the labour ward. Waters breaking before contractions: ring within an hour, note the colour. Show (jelly with a streak of pink/brown): normal, no rush. Heavy bright red bleeding, green or brown waters, reduced baby movements, severe headache with visual changes, suspected cord prolapse, or anything that feels suddenly very wrong: call the labour ward or 999 now, not later. Second babies often come faster — call earlier.
