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

Surbhi had been feeling off all day. It started with a dull ache in her lower back, something she’d been dealing with on and off throughout her third trimester. But now there was a bit of cramping in her belly, kind of like period pain. "Is this it?" she wondered.

The cramps weren’t regular, and she'd read that real contractions come in waves. But she couldn’t help but notice the pressure in her pelvis was stronger than usual, and her belly seemed to tighten every now and then.

She sat on the couch, timing the cramps, trying to figure out if these were Braxton-Hicks again or the start of labour. "Maybe it’s just another false alarm," she thought, but a little voice in her head kept asking, "What if this is the real thing?"

The signs that labour pain is starting vary from woman to woman. It can be difficult to tell the difference between the pain from the initial days of the third trimester and the end of the third trimester of pregnancy. But while every woman's experience is unique, there are several common indicators that your body is gearing up for the big day.

In this article, we'll explore the signs of labour and other key changes that signal your little one 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

It's super interesting to know how your body physically prepares for labour. Let's talk about what happens to your cervix, which is the canal that connects your uterus to your vagina.

The cervix thins and shortens in preparation for childbirth as labour approaches. This is called cervical effacement or effacement of the cervix. When you get contractions, you are helping this cervical effacement, making it easier for the baby to come out. Cervical effacement is measured in percentages from 0% to 100%.

Another thing happens to your cervix. It dilates. Cervical dilation means the relaxation and opening of the cervix. It is measured in centimetres from 0 to 10 cm. In early labour, your cervix may dilate slowly, while active labour is characterised by more rapid dilation. Your healthcare provider will monitor these changes during prenatal check-ups to assess your progress.

When the cervix is 80-100% effaced and around 4-10 cm dilated, it is likely that you are in the active phase of the first stage of labour.

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. 

You've probably heard of the term "false labour" in movies or shows. False labour, also known as Braxton-Hicks contractions, can be misleading for expectant mothers during the third trimester of pregnancy. These contractions are irregular and do not follow a consistent pattern, unlike true labour pain symptoms. For Surbhi, they felt like a mild tightening or hardening of the uterus, causing her to second-guess whether she’s truly in labour.

One of the things that makes false labour different from actual labour is that it usually doesn’t lead to any changes in the cervix—no effacement or dilation. These contractions may be triggered by factors like dehydration, constipation, a full bladder, or even just being active throughout the day. It’s not uncommon for women to find relief by sipping some water, passing stools, resting, or simply changing positions.

The main thing that sets false contractions apart is the duration of the contractions. Timing them can help you figure out whether it’s a false alarm or the real thing. Typically, Braxton-Hicks contractions are shorter than labour contractions, lasting less than 60 seconds, and they don’t increase in frequency or intensity over time.

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 as soon as you suspect you are in labour. Even if you are in doubt about labour pain, it's honestly best to contact your doctor. They will advise you on when to head to the hospital based on your specific situation.
• 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 head into the third trimester, it's important to keep in mind the possibility of preterm labour, which can happen before 37 weeks of pregnancy. While we all hope to reach full term, being aware of the signs of preterm labour can help you act quickly and potentially avoid complications for your baby.

Many women report seeing signs like frequent uterine contractions, menstrual-like cramps, lower back pain, pelvic pressure, and changes in vaginal discharge. If any of these symptoms pop up, you should contact your doctor right away. They might perform a pelvic exam or an ultrasound to check how your cervix is doing and monitor your contractions. A vaginal examination and a CTG (cardiotocogram) will also be used to assess your baby’s heart rate and overall well-being.

If preterm labour is confirmed, don’t panic—there are treatments available to either slow down labour or help your baby get ready for an early arrival. You might be given medications and corticosteroids (steroid injections) to boost your baby’s lung maturity. Typically, you’d receive 2-4 doses of steroid injections to help their lungs develop more quickly, just in case they need to come early.

Having a hospital plan in place can really help reduce stress if preterm labour becomes a concern. Make sure you’ve got all the necessary documents packed and support lined up. It's also useful to be aware that preterm babies may need special care in a neonatal intensive care unit (NICU), so being mentally prepared for this possibility can make things a bit easier to manage during such a challenging time.

Staying informed and prepared is key to navigating the uncertainties of the third trimester, especially if preterm labour becomes a reality.

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.

It’s important to keep in mind that delivery pain can be different for everyone. Some women feel it as intense pressure or even a burning sensation, while others experience more of a dull ache. Like Surbhi, who was trying to figure out if those cramps were the real deal, you may find that the intensity of labour pain shifts throughout the process. One moment you might feel relatively calm, and the next, a strong contraction takes your breath away.

As labour progresses, just remember to trust your instincts and listen to your body. We know this is easier said than done, but if you’re ever unsure about what you're feeling or how things are progressing, don’t hesitate to communicate with your healthcare provider. They’re there to guide you and help you navigate your pain management options, so you can make decisions that feel right for you.