Labour: signs, stages and when to call

Call your maternity team if you think labour has started or you are unsure. You don’t need to know which stage you are in before asking for help.

Signs that can come before or during labour

Possible signs include contractions, backache, a mucus “show”, pressure that makes you want to use the toilet, and your waters breaking. You may not notice every sign. A show can happen before labour, and some people have no show at all.

During a contraction, the womb tightens and then relaxes. Labour contractions tend to become longer, stronger and closer together. Practice contractions, called Braxton Hicks, do not build in the same way. You can’t reliably decide whether you need care from the pattern alone. ACOG says an examination may sometimes be needed to tell the difference.

A show is sticky mucus, often pink with a small amount of blood. Call your midwife or maternity hospital straight away if there is more bleeding; use the emergency route below for heavy bleeding or bleeding with severe pain, faintness or collapse. Ask about any bleeding you are unsure of rather than trying to identify it by colour alone.

When waters break

Waters breaking can feel like a slow trickle or a sudden gush that you cannot control. It can happen before contractions begin. Call your maternity unit or obstetric clinician when it happens; use a period pad rather than a tampon so the fluid can be checked.

Tell the midwife immediately if the fluid is smelly or coloured, or you are losing blood. In US guidance, ACOG advises going to hospital if your waters have broken and contractions have not started.

What happens at each stage

In the early, or latent, part of labour, the cervix softens and starts opening. This phase can take hours or days. As labour becomes established, contractions become stronger and more regular and the cervix continues opening. Your midwife checks progress and offers support and pain relief.

The next stage runs from the cervix being fully open to the baby being born. Your team helps you with positions and pushing. After the baby is born, the womb contracts again and the placenta comes out. Your midwife can discuss active management, which uses treatment to help this happen, and physiological management, which waits for it to happen without that treatment.

Active management lowers the risk of heavy bleeding after birth, but can increase nausea and sickness. Physiological management is not suitable in every situation. Ask about these choices before labour if you would like time to discuss them.

Calling advice differs between services

In the UK, the NHS advises calling for guidance when contractions are regular and coming every 5 minutes or more often. It also says to call if you think you are in labour or are worried. Call 111 if you cannot contact your midwife or maternity unit.

In the US, ACOG advises calling your obstetric clinician if you think labour has started or are unsure. Agree your personal calling and hospital-arrival instructions beforehand, including the out-of-hours number. Do not delay calling about warning signs because of a contraction-timing formula from an app or class.

Get help without waiting for a pattern

Call 999 now (UK) or 911 (US), or your local emergency number, for heavy vaginal bleeding, or bleeding with severe tummy pain, faintness or collapse. Also call if you think your baby is coming now and have a strong urge to push.

Call your maternity unit now in the UK, your obstetric clinician in the US, or your local maternity service for waters breaking, vaginal bleeding without the emergency features above, reduced baby movements, constant severe pain with no relief between contractions, or possible labour before 37 weeks. Do not wait until tomorrow, even at night. ACOG also advises going to hospital for constant severe pain without relief between contractions or reduced movements.

Before 37 weeks, possible labour signs can include frequent tightenings that are painless, low backache, pelvic pressure, cramps or a change in discharge. Call immediately or go to the maternity hospital, even if you have no pain.

The NHS also advises an urgent call if a contraction lasts longer than 2 minutes or you have 6 or more contractions every 10 minutes. Tell the team what is happening and follow their instructions about where to be seen.