Labour: signs, stages and when to call

Call your maternity team if you think labour has started or you’re not sure. You don’t need to know which stage you’re in before you ask for help.

Signs that can come before or during labour

Possible signs include contractions, backache, a “show” of mucus, pressure that makes you want to go to the toilet, and your waters breaking. You may not notice every sign. A show can happen before labour starts, and some people don’t have one at all.

During a contraction, the womb tightens and then relaxes. Labour contractions tend to get longer, stronger and closer together. Practice contractions, called Braxton Hicks, don’t build up in the same way. You can’t always tell from the pattern alone whether you need care. ACOG says an examination is sometimes needed to tell the difference.

A show is sticky mucus, often pink with a little blood in it. If there’s more bleeding, call your midwife or maternity hospital straight away. For heavy bleeding, or bleeding with severe pain, feeling faint or collapse, use the emergency advice below. If you’re not sure about any bleeding, ask, rather than trying to judge it by its colour.

When waters break

Your waters breaking can feel like a slow trickle or a sudden gush you can’t control. It can happen before contractions start. Call your maternity unit or obstetric clinician when it happens. Use a period pad, not a tampon, so the fluid can be checked.

Tell the midwife straight away if the fluid smells or is coloured, or you’re losing blood. In US guidance, ACOG advises going to hospital if your waters have broken and contractions haven’t started.

What happens at each stage

In the early (latent) part of labour, the cervix softens and starts to open. This can take hours or days. As labour gets going, contractions get stronger and more regular and the cervix keeps opening. Your midwife checks how things are going and offers support and pain relief.

The next stage runs from when the cervix is fully open until the baby is born. Your team helps you with positions and pushing. After the baby is born, the womb tightens again and the placenta comes out. Your midwife can talk about active management, where you’re given treatment to help this happen. They can also talk about physiological management, where you wait for it to happen without that treatment.

Active management lowers the risk of heavy bleeding after the birth, but can make you more likely to feel or be sick. Physiological management isn’t suitable in every situation. If you’d like time to think about these choices, ask about them before labour.

Calling advice differs between services

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

In the US, ACOG advises calling your obstetric clinician if you think labour has started or you’re not sure. Agree beforehand when to call and when to go to hospital, including the number to use out of hours. Don’t put off calling about warning signs because of a contraction timing rule from an app or a 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, feeling faint or collapse. Also call if you think your baby is coming now and you 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 if your waters break, you have vaginal bleeding without the emergency signs above, your baby moves less, you have constant severe pain with no break between contractions, or you might be in labour before 37 weeks. Don’t wait until tomorrow, even at night. ACOG also advises going to hospital for constant severe pain with no break between contractions, or if your baby moves less.

Before 37 weeks, possible signs of labour can include frequent painless tightenings, low backache, pressure in your pelvis, cramps or a change in your discharge. Call straight away or go to the maternity hospital, even if you have no pain.

The NHS also advises calling urgently if a contraction lasts longer than 2 minutes, or you have 6 or more contractions every 10 minutes. Tell the team what’s happening and follow their advice on where to be seen.