Symptoms for labour pain

Signs that labour has begun

Know the signs

There are several signs that labour might be starting, including:

contractions or tightenings
a "show", when the plug of mucus from your cervix (entrance to your womb, or uterus) comes away
backache
an urge to go to the toilet, which is caused by your baby's head pressing on your bowel
your waters breaking

The early (latent) stage of labour can take some time.

Urgent advice: Call your midwife or maternity unit if:

your waters break
you have vaginal bleeding
your baby is moving less than usual
you're less than 37 weeks pregnant and think you might be in labour

These signs mean you need to see a midwife or doctor.

Latent phase of labour

The start of labour is called the latent phase. This is when your cervix becomes soft and thin, and starts opening for your baby to be born. This can take hours or sometimes days.

You'll probably be advised to stay at home during this time. If you go to the hospital or maternity unit, they may suggest you go back home.

Find out more about the stages of labour and what you can do at home during the latent phase.

Call your midwife if you're unsure or worried about anything.

What do contractions feel like

When you have a contraction, your womb tightens and then relaxes. For some people, contractions may feel like extreme period pains.

You may have had contractions during your pregnancy, particularly towards the end. These tightenings are called Braxton Hicks contractions and are usually painless.

Your contractions tend to become longer, stronger and more frequent as your labour progresses. During a contraction, the muscles tighten and the pain increases. If you put your hand on your abdomen, you'll feel it getting harder; when the muscles relax, the pain fades and you will feel the hardness ease.

The contractions are pushing your baby down and opening the entrance to your womb (the cervix), ready for your baby to go through.

Your midwife will probably advise you to stay at home until your contractions become frequent.

Call your midwife or maternity unit for guidance when your contractions are in a regular pattern and:

last at least 60 seconds
come every 5 minutes or
you think you are in labour

Read more information on when to go to hospital

Backache often comes on in labour

You may get backache or a heavy, aching feeling.

A "show" can signal the start of labour

During pregnancy, there's a plug of mucus in your cervix. 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 come away in 1 blob or in several pieces. It's pink because it contains a small amount of blood.

If you're losing more blood, it may be a sign something is wrong, so phone your hospital or midwife straight away.

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.

What happens when my waters break

It's likely your waters will break during labour, but it can also happen before labour starts.

Your baby develops and grows inside a bag of fluid called the amniotic sac. When it's time for your baby to be born, the sac usually breaks and the amniotic fluid drains out through your vagina. This is your waters breaking. Sometimes when you're in labour, a midwife or doctor may offer to break your waters.

If your waters break naturally, you may feel a slow trickle or a sudden gush of water you cannot control. To prepare for this, you could keep a sanitary towel (but not a tampon) handy if you're going out, and put a protective sheet on your bed.

Amniotic fluid is clear and pale. Sometimes it's difficult to tell amniotic fluid from urine. When your waters break, the water may be a little bloodstained to begin with.

Tell your midwife immediately if:

the waters are smelly or coloured
you're losing blood

This could mean you and your baby need urgent attention.

If your waters break before labour starts, call your midwife. Use a sanitary pad (not a tampon) so your midwife can check the colour of the waters.

If labour does not start after your waters break

It's usual to go into labour within 24 hours of the waters breaking. You'll be offered an induction if you do not because, without amniotic fluid, there's an increased risk of infection for your baby.

Until your induction, or if you choose to wait for labour to start naturally, tell your midwife immediately if:

your baby moves less than usual
there's any change in the colour or smell of any fluid coming from your vagina

You should take your temperature every 4 hours when you're awake, and tell your midwife if it's raised. A raised temperature is usually above 37.5C, but you may need to call before this – check with your midwife.

There's no evidence that having a bath or shower after your waters have broken increases your risk of infection, but having sex might.

How to cope when labour begins

At the beginning of labour, you can:

walk or move about, if you feel like it
drink fluids – you may find sports (isotonic) drinks help keep your energy levels up
have a snack, if you feel like it
try any relaxation and breathing exercises you've learned to deal with contractions as they get stronger and more painful – your birth partner can help by doing these with you
have your birth partner rub your back – this can help relieve pain
take paracetamol according to the instructions on the packet – paracetamol is safe to take in labour
have a warm bath

Find out what happens during labour and birth, and what you can do for pain relief in the early stages of labour.

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Video: How will I know I am in labour?

In this video, a midwife describes the signs that mean labour may be starting.

Media last reviewed: 1 November 2019
Media review due: 1 November 2022

Community content from HealthUnlocked

Early signs & symptoms of labor: What to watch for

As you approach the end of your pregnancy, your excitement is probably reaching its peak. And it’s easy to wonder if every unusual sensation in your body is a sign that the big day is right around the corner.

The signs and symptoms of labor are unique for just about every mom-to-be. But as you get closer to welcoming your little one, it helps to be prepared and know what physical symptoms to expect and when.

Below, we’ll go over some symptoms that labor is coming soon but hasn’t started yet. And we’ll provide some tell-tale signs that it’s time to grab your bags – because labor is about to begin.

Signs that labor is coming soon but hasn’t started yet

A normal pregnancy lasts about 37 to 42 weeks from the date of your last period, so once you enter the later 30s, your body is starting to gear up for the main event. The following changes don’t necessarily mean it’s time to go to the hospital, but they are signs that the big day is approaching:

Dilation and other cervical changes

Some of the biggest changes your body goes through before labor may be identified during cervical exams. As you get closer to labor, your cervix can start to soften and efface (get thinner). These changes allow your cervix to then dilate (open and grow wider), which will be necessary to deliver your baby.

Starting around week 36, your doctor or midwife may check for changes to your cervix and the position of your baby. It’s important to remember that these changes progress differently for everyone. Progress might start slowly and then increase rapidly just before labor, or vice versa.

It’s also normal to begin labor and not have a lot of changes yet. Once labor truly begins, your cervix will continue to dilate until you reach 10 centimeters and are considered fully dilated. Full dilation is what’s needed to start delivery.

Braxton Hicks contractions

Braxton Hicks are mild contractions that happen irregularly and become more common in the third trimester of pregnancy. You might experience Braxton Hicks contractions well before other signs of approaching labor show up. They tend to become stronger and more frequent as you get closer to your due date. But is this cramping a sign of labor? Not in the same way that regular contractions are (we’ll get to that below). And not everyone notices Braxton Hicks contractions.

Aches, pains and looser joints

Throughout your pregnancy, the hormone relaxin will loosen the ligaments in your body, particularly those in your pelvis. This will help your body stretch and flex during delivery, but you may feel discomfort or pain in your pelvic area. As your due day approaches, it’s also common to feel a bit wobbly, particularly in your hips and lower back. This is because the muscles around your joints now need to work harder to keep those areas stable.

Stomach issues

Stomach trouble isn’t out of the ordinary at any point during pregnancy. But it could intensify late in your third trimester, leading you to wonder, “Is nausea a sign that labor is approaching?” The answer is, sort of. Your baby is still growing and competing for space with everything else in your abdomen. As a result, you may experience indigestion and heartburn. But these issues can be with you for weeks or months.

However, a bout of diarrhea at the end of pregnancy can often be a sign that labor is 24 to 48 hours away. But those numbers can vary.

Lightening

As mentioned above, one of the things that doctors may check for during cervical exams is the position of the baby. This is in part because as you get closer to your due date, your baby will most likely settle into your pelvic area, which is referred to as the baby “dropping” or lightening.

Lightening often takes place two to four weeks before labor for first-time mothers. Mothers who have given birth before may not experience lightening until much closer to labor.

Your baby’s new position may put added pressure on your pelvis and bladder. So you may be used to frequent urination as a pregnancy symptom, but even more frequent urination is a potential sign of labor to come.

However, lightening sometimes makes it feel easier to breathe. And it could also reduce heartburn thanks to less pressure on the stomach and organs.

Nesting instincts

Many mothers-to-be experience a burst of energy in the weeks before they deliver and an urge to get things done along with it. The science isn’t clear on why, but there are theories that it could be instinct or the result of peaking estrogen.

Whatever their cause, these “nesting instincts” may take the form of planning for labor, organizing or cleaning house, and doing other activities that help prepare for the baby’s arrival. If you experience this, just be sure not to spend all your energy on it. You’re going to want as much energy as possible going into labor.

Questions or concerns about labor signs? Our 24/7 BabyLine is free for our members and patients.

The first signs that labor may be starting

While signs that labor is approaching can vary a lot from person to person, some of the signs that labor is actually beginning tend to be more universal.

You start to experience real contractions

Uterine contractions are your body’s way of getting your baby into position so you can push the baby out. The first stage of labor is generally defined as when you start experiencing true contractions.

What do contractions feel like?

Early labor contractions are mild and irregular, lasting for hours or days. But as you progress towards active labor, true contractions become more intense. They’re often compared to menstrual cramps or the severe gut pain that might be related to gas or an intestinal issue.

One of the main ways to tell true contractions apart from Braxton Hicks contractions is that normal contractions happen at regular intervals that become more frequent over time. You can track your contraction intervals either by using an app or phone, or by using a stopwatch and charting the start time and duration of each contraction on a piece of paper.

False labor vs. real labor

These key differences can help you tell when to go to the hospital for contractions.

True labor	False labor
Contractions happen at regular intervals	Contractions happen irregularly
Contraction intensity increases	Contraction intensity is relatively consistent
The time between contractions shortens	The time between contractions doesn’t shorten
Discomfort remains regardless of position or movement	Changing position or moving around often relieves discomfort

You feel consistent pain in your belly and lower back

Once contractions have truly begun, you’ll feel pain in your abdomen as a result. In addition, your baby’s head may put pressure on your lower back. So is this back pain a sign of labor? It can be. When labor is starting, pain can move in waves from your back to your front.

You lose your mucus plug and experience “bloody show”

What does losing your mucus plug mean? The mucus plug is a protective accumulation of mucus in the opening of the cervix, and as your cervix dilates, this “plug” may be passed into the vagina and discharged before labor starts.

Vaginal discharge containing this mucus may be thicker and have a pink or red color to it. This is due to bleeding from the cervix as it changes. When mucus and blood are discharged together, it’s referred to as “bloody show.” It’s worth noting that the mucus plug is often lost in the days leading up to labor, but it can also happen earlier or later depending on when you actually start to dilate and efface.

Your water breaks

During pregnancy, your baby is surrounded by amniotic fluid, which helps protect them from bacteria. Around the beginning of labor, the sac containing this fluid often ruptures. This can take the form of a sudden gush or a slow trickle of fluid from your vagina, but it isn’t always obvious. So if you suspect that your water may have broken, call your care team or head to the hospital. It may take contractions or your baby applying pressure before your water breaks.

What to watch for: Signs of preterm labor

Labor is considered preterm if it starts three or more weeks before your due date. If you haven’t reached week 37 and you believe that you may be experiencing signs that labor is starting, call your care team immediately.

What to do if you suspect that you’re in labor

The most common signs that it’s time to go to the hospital are water breaking or regular contractions that are five minutes apart for at least an hour (if it’s your first baby). If you live farther away from the hospital or this is not your first baby, your doctor or care team may give you other instructions.

Labor is yours alone. Listen to your body and don’t be afraid to go to the hospital early if you have any concerns. And in the meantime, if you have any planning left to do, we’re here to help.

Give birth with pleasure? Yes! - articles from specialists of the clinic "Mother and Child"

Why does it hurt to give birth?

There are two types of pain during childbirth.

The first is pain associated with uterine contractions and cervical distension . It occurs during the first stage of labor, during contractions, and intensifies as the cervix opens. It should be noted that it is not the unpleasant sensations themselves that increase, but their perception by the woman in labor, due to fatigue. Such pain is dull in nature, and the exact location of its localization cannot be determined. It is often felt not at the place of origin, but in the lower back or sacrum.

The second type is pain that occurs before the birth of a child, during attempts . This painful sensation is caused by stretching of the tissues in the lower part of the birth canal during the advancement of the fetus, has an acute character and is precisely localized in the vagina, rectum, perineum.

It is not difficult to imagine the mechanism of pain development. With strong fear or stress, a person, as a rule, reacts with muscle tension , "compresses". When during childbirth the muscles of the vagina are constantly clamped, they prevent the child from passing through the birth canal - as if pushing him back. Because of this, both the baby and the woman in labor suffer, in which the attempts are delayed. In addition, they become more and more painful, because the fetus must “break through” through the clamped muscles.

As a result of the interaction of many chemical reactions in our head, pain acquires an emotional coloring, and, as a rule, negative.

Cross the threshold

Pain can vary in severity from mild discomfort to unbearable pain. After all, our feelings are very individual , just like ourselves. Each person has their own threshold for pain sensitivity. In “thick-skinned” people, it is high: only a significant irritation of the receptors (for example, with a severe injury) causes a sensation of pain. And for people with a low threshold of sensitivity, even a slight scratch makes them suffer.

Who sets the pain threshold in our body? A kind of "anti-pain system". In fact, our pain is a complex biochemical process. In response to an injury, information from irritated pain receptors along the nerve fibers enters the brain and spinal cord, is processed - and the central nervous system responds with a counter nerve impulse . This is pain.

Fortunately, the human body is very intelligently arranged and there are always systems in it that compensate or do not allow excessive activation of the mechanisms of pain.

Even for the same person, the pain threshold can change depending on the situation. For example, at night it decreases so that in a dream a person does not miss the danger. During the day, when a person is awake, it rises. If a person is obsessed with an idea, the pain threshold also rises. In such cases, the emotional mood is also of great importance. Anger and rage, for example, increase the pain threshold: temporarily the pain is simply not felt. But fear, on the contrary, reduces the threshold to almost nothing and pain occurs almost out of the blue.

It is no coincidence that they say that 70% of labor pain depends on fear, and only 30% on actual physical discomfort. Therefore, it is important that childbirth takes place in a calm, friendly atmosphere. And the expectant mother should relax, rest as efficiently as possible between contractions and know that childbirth is a temporary phenomenon.

What is the salvation

Hormones - endorphins - are the main part of our pain relief system. They regulate the formation of different emotions. They are much better known to us as hormones of pleasure.

The study of endorphins began with the appeal of Western experts to the secrets of Eastern medicine. In China in the 1970s, local surgeons demonstrated to astonished American doctors the possibility of performing surgery without the use of painkillers. And from that moment began an active study of substances that are released in human blood during pain or stress and are close in chemical nature to morphine.

Then scientists noticed that endorphins are produced in the human body not only during pain exposure. For example, a high concentration of endorphins has been found in the blood of people doing hard physical work. And the release of the hormone increases even more if such work is accompanied by high motivation and pursues a valuable and meaningful goal. For women, an example of such work is perhaps the most highly motivated action - the birth of a desired child. For us, this is one of the most important moments.

Endorphins are released into the blood during contractions and have analgesic and tonic effects.

Why? Because at the cellular level, these hormones interrupt the transmission of a pain impulse from one nerve cell-neuron to another. And the amount of this natural anesthetic is such that it is possible to help the expectant mother relax, reduce pain and discomfort, and positively affect the course of the birth itself.

REFERENCE

How to promote the production of endorphins?

In addition to drugs, natural pain relief methods are also used during childbirth.

Breathing exercises and auto-training help eliminate one of the important mechanisms for the development and maintenance of pain - a negative emotional reaction.
Acupuncture activates the components of the “pain relief system”.
Some types of massage also have a relaxing, calming, distracting effect. During childbirth, you can massage the sacrum, lower back, lower abdomen, dissipating and reducing pain.

It is the release of endorphins that provides the feeling of happiness and satisfaction that occurs after childbirth. Childbirth can be the most powerful and positive memory of your life.

Harbingers of childbirth - How to understand that it is time to go to the hospital?

January 10, 2017

Alekseeva Inna

Obstetrician-gynecologist, Doctor of the highest category

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Every pregnant woman with excitement and joy awaits the upcoming birth. The closer the cherished date, the more attentively the expectant mother listens to the changes taking place in her body and in the behavior of the baby. Of course, the expectant mother wants to know by what signs it is possible to understand that childbirth is just around the corner.

It is customary to call the harbingers of childbirth external, really tangible changes in the body, which are direct preparation for the onset of labor. The tissues of the birth canal - the cervix, vagina, vulva, perineum - become quite elastic, extensible, but at the same time - very strong and resistant to tearing. The cervix is located in the center of the vaginal vault, shortens by almost half its normal length and softens significantly. The cervical canal - the lumen of the cervix connecting the uterine cavity with the vagina - opens slightly, as a result, the diameter of the cervical canal is approximately 2-2.5 cm. Of course, such a significant "perestroika" takes more than one day.

Female sex hormones are responsible for preparing for childbirth. During the nine months of pregnancy, progesterone "reigns" in the body of the expectant mother. It ensures the normal tone of the uterus (relaxed state of the muscles), the production of cervical mucus - a mucous plug in the cervix that protects the fetus from infection. The amount of progesterone during pregnancy largely determines the normal development and growth of the fetus, the necessary concentration of nutrients and oxygen in the mother's blood, as well as their timely and uninterrupted delivery to the baby.

Shortly before childbirth, the production of progesterone decreases markedly, it is replaced by estrogens - female sex hormones. The increase in estrogen in the blood is caused by the need to prepare the body for the upcoming birth. It is these hormones that are responsible for the elasticity and patency of the birth canal. The rate of cervical dilatation in the first stage of labor depends on them. In the second period, when the cervix is fully opened and the fetus passes through the birth canal, it is also very important how elastic and extensible the walls of the vagina are - this will largely determine the duration of the straining period. Finally, the onset of labor itself depends on the level of estrogen: contractions occur as a result of a nerve impulse that is caused by a certain level (“peak”) of estrogen accumulation.

These changes are normal and do not require an unscheduled visit to the doctor or hospitalization. Harbingers of childbirth are manifestations of a planned restructuring in the body of a future mother, the “finishing touches” of preparation for the upcoming joyful event.

The absence of clearly perceptible changes on the eve of the expected date of birth is also not a pathology. Not all expectant mothers note those changes in well-being that are commonly called harbingers. However, this does not mean that there is no preparation. In some cases, the “final preparations” go unnoticed by the pregnant woman. Therefore, do not worry or urgently contact a specialist.

The appearance of any of the "harbingers" indicates the likelihood of the development of regular labor activity over the next two hours - two weeks. None of the sensations described gives a 100% guarantee that a woman will become a mother within the next 24 hours. Hormonal changes before childbirth begin approximately two weeks before the expected birth. Theoretically, during these two weeks, at any time, a pregnant woman can notice certain changes in her state of health. Consequently, the absence of labor activity an hour, a day, or even a week after the first noted changes is not a pathology and does not require special medical advice.

Scarlet discharge from the genital tract in any amount.
Severe abdominal pain.
Increased blood pressure (above 130/80 mmHg).
An increase in body temperature to 37.5 ° C and above.
Increased heart rate (more than 100 beats per minute).
Severe headache, vomiting, blurred vision.
Significant increase in edema.
Absence, sharp decrease, sharp increase in fetal movements.
Suspicion of amniotic fluid leakage.

Weight loss . Shortly before the expected date of delivery, the expectant mother may notice some “weight loss”. Weight loss during this period is associated with the removal of excess fluid from the body, that is, a general decrease in edema. The more pronounced the fluid retention during pregnancy, the more mass the pregnant woman will “lose” on the eve of childbirth. During pregnancy, water is retained in the body of all expectant mothers to a greater or lesser extent. The reason is progesterone - a hormone whose main function is to support the processes of pregnancy. Before childbirth, progesterone is replaced by estrogen. It is estrogen that removes excess fluid from the body. The first results are visible on the hands, feet and legs. Depending on the severity of edema, weight loss before childbirth varies from 0.5 to 2.5 kg.

Change of stool. Increased frequency and change in the consistency of physiological functions on the eve of childbirth is also associated with an increase in estrogen levels and the removal of fluid from the body of the expectant mother. Similar changes in the body of a non-pregnant woman are observed during menstruation. The chair can become more frequent up to 2-3 times a day, at the same time there may be some liquefaction of the feces. More frequent urge to defecate, a sharp change in the color and smell of feces, combined with nausea and vomiting, is a reason for consulting a doctor - food poisoning can be masked under such "harbingers".

Fundal prolapse. Shortly before delivery, the baby presses the presenting part (most often the head) against the lower segment of the uterus and pulls it down, pressing against the entrance to the small pelvis. The fetus "groups", taking the most advantageous position for itself at the time of the onset of contractions. As a result of such "preparations" from the side of the fetus, the uterus "sags", and its upper part - the bottom - ceases to exert pressure on the internal organs. After lowering the bottom of the uterus, the pregnant woman has no shortness of breath (it becomes easier to breathe, there is a feeling of a full breath). If in the last month the expectant mother had belching, heartburn, a feeling of heaviness in the stomach after eating, these phenomena disappear when the bottom of the uterus descends. However, lowering down to the pelvic area, the uterus will put more pressure on the internal organs located there. The pelvic organs, in particular, include the bladder. It is located directly in front of the uterus, in its lower part. Behind the uterus, at a distance of several centimeters, there is an ampulla of the rectum - the output section of the intestine. It is not difficult to guess what the result of pressure on the bladder and rectum will be: the urge to go to the toilet before childbirth can become noticeably more frequent.

Isolation of the mucous plug. During pregnancy, the glands of the mucous membrane of the cervical canal (the lumen of the cervix) secrete a special secret. It is a thick, sticky, jelly-like mass that forms a kind of cork. The mucous plug completely fills the cervical canal, preventing the penetration of bacterial flora from the vagina into the uterine cavity. Thus, cervical mucus, or the mucous plug of the cervix, protects the fetus from ascending infection. Before childbirth, when the cervix begins to soften under the influence of estrogen, the cervical canal opens slightly and the cervical mucus contained in it can be released. In this case, the expectant mother may find small clots of yellowish-brownish mucus, transparent, jelly-like, odorless. The mucous plug can stand out at once or depart in parts during the day. In the latter case, slight discomfort is sometimes noted in the form of "sipping" in the lower abdomen, reminiscent of sensations before or during menstruation. However, most often, the release of the mucous plug is not accompanied by tangible changes in the well-being of the expectant mother. After the discharge of the mucous plug, it is not recommended to visit the pool, swim in the reservoirs and in the bath. When immersed in water, it fills the vagina; thus, in the absence of a mucous plug, the risk of infection of the fetus and membranes through the ajar cervix increases.

Training contractions. Training or false contractions are called such contractions that appear shortly before childbirth and are not actually labor activity, since they do not lead to the opening of the cervix. A contraction is essentially a single contraction of the uterine wall; this contraction usually lasts a few seconds. At the time of the contraction, the expectant mother feels a gradually increasing and then gradually decreasing tension in the abdomen. If at this moment you put your hand on your stomach, you can notice that the stomach becomes very hard, but after the contraction it completely relaxes and becomes soft again. In addition to involuntary tension of the uterus, other changes in the well-being of the expectant mother during false contractions are usually not noted. It is not difficult to distinguish training fights from real ones. In most cases, false contractions are weak, painless, irregular or alternating at a significant interval (30 minutes or more). Labor pains, on the contrary, are distinguished by regularity and a gradual increase in intensity. Unlike false contractions, real contractions lead to a visible result - the opening of the cervix. In doubtful cases, a simple obstetric examination will be enough to make an accurate diagnosis. In other cases, training contractions, like all harbingers of childbirth, do not require a visit to a doctor or hospitalization. False contractions may recur for several hours and then stop. Most often, they disturb a pregnant woman in the evening and morning hours for several days.

Discomfort. In the last weeks before giving birth, many pregnant women report discomfort in the lower abdomen and in the area of the sacrum (the area slightly below the waist). Such changes in

the well-being of the expectant mother is caused by sprain of the pelvic ligaments and increased blood flow to the pelvic organs. Usually these minor sensations, described as a feeling of "light languor" in the lower abdomen, are comparable to similar phenomena in the period before or during menstruation.