Woman in labour

The early signs of labour can be hard to pick up on, especially if you've been dealing with Braxton Hicks contractions for months.

Is that niggling pain a contraction or just backache? Oops, there's another one! And was that strange discharge really 'the show'?

Perhaps your due date is drawing near – or more likely, it's past history. Something is happening 'down there', your back is aching, you have period-pain cramps and you feel emotional and unsociable. You may be experiencing early labour, but you're just not sure.

Despite the fact you've waited for this day for many months, now that it appears to be here you're racked with indecision. And there's another sign of labour: indecision.

FIRST, ANSWER THESE QUESTIONS…

  1. Are the pains coming at fairly regular intervals? It may be 10 minutes one time, 15 the next, then 10 again, but that still counts as regular.
  2. Do the pains persist, regardless of whether you're moving or lying down?
  3. Have you had a 'show'? This is when the mucous plug that has sealed off your womb during pregnancy comes away. It appears as a thick, sticky, often blood-tinged discharge.
  4. Have your waters broken? In about 15 percent of pregnancies this happens before labour starts, but for the remaining 85 percent of women labour is already underway.

A combination of the above signs indicates that labour has begun. But the real clincher to knowing you're in labour is having increasingly strong and regular contractions.

IS IT TIME TO GO TO HOSPITAL?

When the pains start coming every five minutes or fewer, it's time to make tracks. Remember, however, that this doesn't mean they have to come at five minutes exactly each time.

Look at the overall pattern and then call your hospital or birth centre. As a general rule, if you can't talk through your contractions or focus on anything else, it's likely you're in established labour and it's time to go to hospital.

WHAT DO CONTRACTIONS REALLY FEEL LIKE?

Generally, they start slowly and feel a bit like a period pain, sometimes with backache as well. The pain rises like a wave to reach a crescendo, then subsides and disappears. You may feel pain in the legs, back and abdomen, or from around the groin and bottom.

As contractions become more frequent, they generally become stronger and more intense. It's a good idea to time your contractions before calling the hospital as the midwife will ask you questions about how often and how instensely they're coming. In actual fact, she's also listening closely to how you sound when you are talking to her.

WHAT IF LABOUR DOES NOT START?

Sometimes labour needs to be artificially started, or helped along if it has slowed down. There are several methods of induction to choose from, often used together.

– MEMBRANE SWEEP

This is done during an internal vaginal examination to encourage labour to start. With gloved fingers, a doctor or midwife makes sweeping, circular movements around the cervix to separate the amniotic sac from the uterus. It may feel uncomfortable.

– PROSTAGLANDIN GEL

The hormone prostaglandin is produced by your womb to stimulate contractions and ripen the cervix. A gel form is usually inserted into your vagina using a pencil-like applicator. Most women will have gentle contractions that gradually get stronger, followed by a normal labour.

– ARTIFICIAL RUPTURE OF THE MEMRBRANES

Your waters are broken with an instrument that looks like a crochet hook. It goes in through the cervix to make a small opening in membranes so your waters can escape.

– OXYTOCIN OR SYNTOCINON

This hormone makes your uterus contract. It's given via a drip and the dose is slowly increased. Contractions may be longer and more painful than usual, not peaking for an hour.

IF YOUR WATERS BREAK AT HOME

Your membranes may rupture before labour starts with contractions, but they can also stay intact until you are well advanced in labour.

Sometimes there's a dramatic gush of warm amniotic fluid (you may even feel or hear a 'pop'); other times it's just a slow leak. If you're still at home and think your waters have broken, call your doctor or midwife to let them know. You may be asked to go to hospital so you and the baby can be checked.

Green or brown staining in your fluid means your baby has passed meconium (the first poo) and could be in distress. He may need help to get out quickly, so if you're not in hospital already, try to get there as soon as possible.