Signs of Labour

The five signs national guidance actually lists

The NHS and Ireland's HSE publish the same short list, which is useful because it tells you what midwives are trained to treat as meaningful. Both name: contractions or tightenings; a "show", when the plug of mucus from your cervix comes away; backache; an urge to go to the toilet, "which is caused by your baby's head pressing on your bowel"; and your waters breaking.

That is the whole list. Everything else circulating online — a burst of energy, a change in appetite, restless sleep — is not something any of the four national bodies below considers a sign of labour, and none of them mentions it.

ACOG in the United States adds one the UK list leaves out: lightening, the sensation that the baby has dropped lower and the head has settled deep in the pelvis. ACOG is careful about what it means, though — "lightening can happen anywhere from a few weeks to a few hours before labor begins." It marks a change of position, not a countdown.

Contractions

The NHS describes the mechanics plainly: "when you have a contraction, your womb tightens and then relaxes." For some people they feel like extreme period pains. Put a hand on your abdomen during one and you will feel it getting harder, then the hardness ease.

The characteristic that matters is not how a single contraction feels but what the sequence does. The NHS: "your contractions tend to become longer, stronger and more frequent as your labour progresses." Practice tightenings do not build in that way — they do not last long, do not happen very frequently, and do not build up.

ACOG adds a detail the UK pages do not: location. "Pain from true labor contractions usually starts in the back and moves to the front", whereas false contractions are "usually felt only in the front." It also notes that true contractions "continue even when you rest or move around" — so if resting and drinking water makes them stop, they were not labour.

A show

During pregnancy there is a plug of mucus sitting in the cervix. The NHS describes what happens to it: "this mucus comes away just before labour starts, or when in early labour, and it may pass out of your vagina. This sticky, jelly-like pink mucus is called a show." It may arrive in one blob or in several pieces, and it is pink because it contains a small amount of blood.

What a show tells you is genuinely limited. The NHS is direct about this: "a show indicates that the cervix is starting to open. Labour may quickly follow or may take a few days. Sometimes there is no show." Treat it as confirmation that something is moving, not as a starting gun.

The exception matters. If you are losing more blood than the streak in a show, the NHS says it "may be a sign something is wrong, so phone your hospital or midwife straight away."

Backache and the urge to open your bowels

Both appear on the official lists and both are easy to dismiss. The NHS describes it as backache or "a heavy, aching feeling". The toilet urge has a mechanical cause — the baby's head pressing on your bowel — which is why it can arrive without any actual need.

Waters breaking

The NHS notes that it is likely your waters will break during labour rather than before it, "but it can also happen before labour starts." If they break naturally, "you may feel a slow trickle or a sudden gush of water you cannot control." Amniotic fluid is clear and pale, and may be a little bloodstained to begin with.

Two practical instructions from the NHS: use a period pad rather than a tampon, so your midwife can check the colour of the fluid, and tell your midwife immediately if the waters are smelly or coloured, or if you are losing blood — "this could mean you and your baby need urgent attention."

What none of the signs can tell you

They cannot tell you how long you have. NICE defines the latent first stage of labour as a period "not necessarily continuous" when there are contractions and some cervical change, including dilatation up to 4 cm. The NHS puts the practical version bluntly: this "can take hours or sometimes days." Established labour, in NICE's definition, only begins when there are regular contractions and progressive cervical dilatation from 4 cm.

So the honest answer to "is this it?" is often that nobody can say yet, including the midwife on the phone. That is why the NHS expects you to stay at home through this part, and notes that if you go in early, "they may suggest you go back home."

When to call, and when to call urgently

Call your midwife or maternity unit for guidance if: you think you are in labour, or you are having regular contractions coming every 5 minutes or more often. You can also call simply because you are unsure or worried.

Call urgently — the NHS says do not wait until the next day, "call immediately, even if it's the middle of the night" — if:

• Your waters break.
• You have vaginal bleeding.
• Your baby is moving less than usual.
• You are less than 37 weeks pregnant and think you might be in labour.
• Any of your contractions last longer than 2 minutes.
• You are having 6 or more contractions every 10 minutes.

Call your local emergency number — 999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if you think your baby is coming now and you have a strong urge to push. In the UK you can call 111 if you cannot reach your midwife or maternity unit.

What is worth letting go of

The idea that you can bring labour on yourself. The NHS states it flatly: "there are no proven ways of starting your labour yourself at home." Hot baths, particular foods or drinks, sex and herbal supplements are all named and all dismissed — "there's no evidence that these work" — and the NHS adds that there is no information about the safety of herbal supplements, which "could be harmful to you or your baby." Sex itself will not cause harm, but should be avoided once your waters have broken because of infection risk.