Is This Really Labour?

birth

Oct 26

*Note that this post only covers unmedicated labour. If you are having a medical induction, you might experience these signs a bit differently.

Recognizing the signs of labour can be an elusive and vague target. Until you’re actually in it. Then it’s pretty unmistakable. But only if you know what you’re looking for.

So what are the signs of actual labour?

First, let’s start with what’s not.

There can be quite a few indications that you are heading towards labour, or that your body is preparing to go into labour. These are all signs of “pre-labour”, but none of them require any action on your part. You can notice these signs as an acknowledgement that your body is getting ready for the big day, but they don’t convey any specific timeline. You might see some of these signs weeks before you actually begin labour, or maybe not until the same day. It’s different for everyone.

Pre-Labour

Pre-Labour is the part that sometimes gets called “False Labour”. I don’t love this term, as it implies that you’re wrong and that your so-called labour is just in your head. But you’re not imagining things. Your body really is shifting and gearing up for the adventure ahead. What you’re feeling is real. But this part of the journey is a warm-up, and not yet the actual, measurable labour that you’re waiting for.

Few people experience all of these signs. Most people get a random handful, so don’t worry if you skip some. Individual variation is one of the normal qualities of labour.

Signs of Pre-Labour

Loose Bowel Movements: Some people get diarrhoea, some just get softer stools, and some people experience no difference at all.
Trouble Sleeping: Feeling twitchy and unsettled in the final weeks of pregnancy is very common.
Frequent Braxton Hicks: Not everyone feels these. These are your uterus flexing, pre-labour, as a warm-up exercise to tone and strengthen for the big event. It might feel like your belly tightens, or it might be indistinguishable from the baby stretching. Don’t worry if you can’t recognize these–not everyone does.
Nesting Urge: An over-the-top compulsion to get everything ready before the baby arrives. This can be an almost manic feeling, and often makes you want to do stuff that is in no way necessary, like washing the sidewalk, or pre-folding all the kleenex in the house.
Baby Descending: Towards the end of pregnancy, the baby engages in the pelvis. This is sometimes called ‘dropping’, although the baby doesn’t so much ‘drop’ as push downwards, or ‘lightening’, although few would describe their overall feeling as ‘lighter’ when the baby is so low in the pelvis. Many people feel heavier, more uncomfortable in the lower back and hips, and more like they’re waddling instead of walking.
Irregular Cramping: This is the one that sends people racing to the hospital in the movies. But irregular cramping is just another pre-labour thing you may or may not feel as the cervix starts subtly shifting in preparation for labour. The cervix responds to rising hormones in your body and starts softening and thinning before you are actually in labour. It may feel like mild but irregular menstrual cramps, or you may not feel it at all.
Mucous Plug: As your body starts this shift, it may cause the mucous membrane that covers the cervix to separate, and you may see evidence of mucous when you go to the bathroom. Some people see tiny bits of translucent, grayish mucous, sometimes with spots of blood, some people see big globs of it, and some people never see any. This is a normal sign that labour will begin at some point, but it doesn’t tell us when. It could still be hours, days, or even weeks away.
Spotting: Similarly, spotting is a sign that your cervix is starting to prepare for labour. As the cervix softens and thins, sometimes capillaries pop and you may see little spots of blood (“bloody show”) when you go to the bathroom. This is just a sign that your body has started getting ready, and it doesn’t give us any indication of when labour will actually begin.

None of these are signs of labour. These are all signs of pre-labour, or indications that you are getting closer. None require you to do anything or go anywhere, and none tell you exactly when your labour will actually start.

Waters Breaking

In popular media, the first sign of labour is often the waters breaking: a tremendous flooding gush, which happens in a dramatic and public moment. In reality, only about 10 percent of people experience the waters breaking prior to contractions, whereas for the other 90 percent, the waters break later on, once labour is already well underway. Very rarely, the waters don’t break at all, and the baby is born in an intact amniotic sac. This is very uncommon.

Sometimes it can be hard to tell if your waters have actually broken, because it is not always a big splash. Depending on where the amniotic membrane ruptures, and the size and shape of the tear (big gash or tiny pinprick), you might just get a small trickle or even a light drip. If you’re unsure, you can ask your caregiver to test the fluid.

Even if your waters break first, it is not an actual sign of labour.

Sometimes the waters break many hours, or even a couple days, before labour begins. If your waters break first, prior to the onset of contractions, you want to alert your caregiver, and follow their instructions. Depending on whether the fluid looks murky or clear, and depending on your relative health and medical profile, they might want you to come in and be checked, or they might tell you to stay home and keep in touch if anything changes. For most people, the waters breaking is not an emergency, and no action is required other than to wait until contractions begin. In other words, get comfortable, and carry on.

Early Labour

The first and only sign of actual labour is regular, strong contractions.

Some people start with the light, cramping sensations described earlier, and these evolve into actual regular contractions. Other people don’t feel the cramping at all, and only tune in when early labour contractions are already in progress.

It can be hard to distinguish which is which. Pre-labour cramps are irregular, whereas labour contractions follow a pattern. Labour contractions occur at consistent intervals and very gradually get closer together. The pre-labour cramping can be like a mild version of actual contractions. So how do you tell them apart? Believe it or not, you don’t have to, because it doesn’t really matter.

If they feel mild and manageable, they may be pre-labour, or they may be very early labour. Either way, this could go on for a very long time before it gradually, slowly, incrementally escalates. If you can ignore them, do so. You don’t need to do anything or go anywhere until you’re in active labour, and there is no guesswork around that. If you’re at all unsure, then it is still pre- or very early, and this might go on for many hours, a few days, or even a week before it becomes anything serious. So go about your business and (unless your caregiver gives you different instructions) ignore it until you can’t. When it’s active labour, you will know.

The contractions will very gradually get stronger, longer, and closer together. They often begin low in the belly and light in sensation, and bit by bit they evolve into stronger, more powerful surges, reaching higher in the torso, until you can feel them throughout your whole belly and back.

For most first time parents, this is a long, slow process. You might be labouring at home for many hours before you are in active labour. A full day is very common, a full two days is also not unusual. For some people, early labour can be even longer. Be prepared to labour at home for a long, long time before heading to the hospital or calling your midwife to your home. The movies have done us a terrible disservice by creating the impression that the baby is on its way after 3 contractions. In reality, it is much more common to head to the hospital too soon and be sent home again, because early labour is usually very slow to gather momentum and build speed

Active Labour

For most people, active labour is what we’re looking for. Unless you have specific instructions from your doctor or midwife to do otherwise, most people are encouraged to stay home until they are in active labour. How do you tell? There are two ways.

Timing: In active labour, the contractions are getting quite close together, usually 3 - 5 minutes apart. An easy way to check is to set a stopwatch for 10 minutes and note how many contractions you have within the 10 minutes. If you consistently have 2 - 3 contractions within each of 4 or 5 timed 10-minute sessions, it might be active labour. But this alone isn’t definitive. The best litmus test is the intensity.
Intensity: As stated above, ignore it until you can’t. When you are in active labour, the contractions will be so strong that they take over your body and brain. They are not a similar sensation to sneezing, having an orgasm, or throwing up, but they are a comparable experience in the sense that the autonomic physical urge takes over and we can’t stop it or ignore it or do anything else at the same time–we have to pause and ride the wave until it passes. Contractions are like this too–they rush through our body and brain like a surge of power and there is no way in the world to ignore them or prevent them.

What Does Active Labour Look Like

Most people in active labour gradually sink into a state we call “labourland”, which describes the trance-like state that is created by the combination of the rising hormones and the intensity of the physical experience. Over the long, slow course of early labour, the birthing person will shift into this altered state and start to display many of the following signs. Don’t worry if you don’t see all of these, but this gives a general sense of what active labour looks like to the partner or support persons.

She might have:

Glazed, unfocused eyes, maybe closed
Breathing heavily or moaning during contractions
Sleepy or quiet in between contractions
Trance-like, foggy, “stoned” demeanour
Forward leaning, or swaying, or moving rhythmically during contractions
Nesting, seeking dim lights, dark rooms, quiet corners
Unaware of her environment, out of it
Unaware of passage of time
Minimal ability to communicate

Basically, the labouring person will go from looking like someone who’s in the first kilometre of running a marathon, to someone in the last few kilometres: Internal focus, no breath or words to spare, deep in the zone, breathing heavily, entirely in the present. If you’re concerned you might not be able to recognize the distinction, having a doula present is a really good solution. Doulas can see the difference easily, and through their years of experience of observing births, can provide a lot of support and expertise as you navigate these determinations.

These are all things that people can observe from the outside, but for the labouring person, there are signs you can observe internally, too.

What Does Active Labour Feel Like

In early labour, we tend to feel nervous excitement: a similar mix of emotions as we would feel if we were about to try skydiving or bungee jumping for the first time. We might talk a lot, want to reach out to people, plan & prepare, describe what we’re feeling. But as labour progresses, the demands of the physical experience combined with the rising hormones creates an increasingly hypnotic state. We start to feel more like nesting. We crave privacy and comfy / cozy dark spaces. We no longer feel like talking or explaining. Our brains slow down so that we lose all sense of thinking, time passing, or communicating. We inhabit a dreamy, blurry, zoned-out state where we are existing only in the present moment, entirely focused on doing.

For the birthing person, it’s like the first 15 minutes versus the final 15 minutes of the Grouse Grind. At the beginning you might be thinking ahead, planning, chatting, enthusiastic and nervous, but by the end you are just one-foot-in-front-of-the-other. Nothing else exists except the rhythmic motion of one-foot-in-front-of-the-other. This is your universe. This is active labour.

If you still have the mental acuity to wonder if you're in early or active labour, if you still have the capacity to even remember the signs, you are probably still in early labour. In active labour, your thoughts are fuzzy, dreamlike, and distant. You descend deeper and deeper into a primal, mammalian state where you are just being, rather than thinking. It’s similar to the foggy mental state when you’re almost asleep, and your thoughts are floating away, cloudy and disconnected. Or the mental zone you slide into when you’re on a long run, bike ride, or hike, and you’re no longer thinking, just hypnotically, repetitively doing. This is “labourland”.

Labourland

When you are pretty sure you see the traits of labourland, then you may as well time a few contractions to determine if they are getting sufficiently close together. But there’s little point timing them prior to that, because if the birthing person is wide awake and coherent, and the sensations are still weak, then it is clearly early labour. It doesn’t matter how close together the contractions are in early labour. There is no need to time them. First wait until you suspect you’ve entered labourland, and then you can use the frequency and regularity of contractions as a secondary proof. But occasionally a labour will never fall into an entirely regular pattern, even in active labour. So the more reliable indicator is labourland itself: the birthing person’s behaviour and mental state.

So even though recognising the signs of labour can be an elusive and vague target, it’s pretty unmistakable once you’re actually in it, or once you actually see it. But only if you know how to recognize the signs of labourland.