Knowing the difference between early signs that labour (or labor, if you are in the US) is approaching and the signs that it has actually begun can feel overwhelming — especially with a first baby. This guide walks through what to look for at each stage, when to pick up the phone, and what to expect when you arrive at your birth centre or hospital.
Early signs that labour may be approaching
These signs can appear days or even weeks before labour begins. They are your body's way of preparing, not a signal to rush to hospital.
A "show" (loss of the mucus plug). Throughout pregnancy a thick plug of mucus seals the cervix. As the cervix begins to soften and open, this plug is released as a pink, brown, or blood-streaked jelly-like discharge. A show can happen anywhere from a few days to a few hours before labour starts, or sometimes not until labour is already underway.
Engagement (lightening). In the final weeks, your baby's head drops lower into your pelvis — a process called engagement or "dropping." You may notice it is suddenly easier to breathe but harder to walk comfortably. In first-time pregnancies this often happens two to four weeks before birth; in subsequent pregnancies it may not happen until labour begins.
Nesting instinct. Many people describe a sudden surge of energy and an urgent need to clean, organise, or prepare the home in the final days of pregnancy. This is sometimes called the nesting instinct. It is harmless, but try not to exhaust yourself — you will need your energy soon.
Loose stools or digestive changes. Prostaglandins — the hormones that trigger uterine contractions — can also affect the bowel. Loose stools or diarrhoea in the day or two before labour is common and is your body's natural way of clearing out before the birth.
Backache and pelvic pressure. A persistent low backache, similar to premenstrual pain, or increased pressure in the pelvis and hips can signal that your baby is moving into position. This is different from the sharp round ligament pain common earlier in pregnancy.
Signs that labour has started
Once you notice any of the following, labour is likely underway.
Regular contractions. True labour contractions follow a pattern that becomes progressively longer, stronger, and closer together. They typically last 30–70 seconds each. Unlike Braxton Hicks contractions (practice contractions), they do not ease off when you change position or drink water.
Your waters breaking. The amniotic sac surrounding your baby may rupture as a sudden gush or a slow, steady trickle of clear or pale straw-coloured fluid. This is commonly called your "waters breaking." It happens before contractions begin in around 10–15% of labours.
A show at the onset of labour. If you have not already had a show, you may notice one when contractions start or shortly before.
Contraction patterns at a glance
| Type | Frequency | Duration | Intensity |
|---|---|---|---|
| Braxton Hicks | Irregular, no pattern | Under 30 seconds | Mild; eases with rest or hydration |
| Early labour | Every 5–20 minutes | 30–45 seconds | Moderate; does not ease with rest |
| Active labour | Every 3–5 minutes | 45–60+ seconds | Strong; requires focus to breathe through |
NHS guidance and the American College of Obstetricians and Gynecologists (ACOG) both define active labour as beginning when the cervix is around 6 cm dilated and contractions are regular and strong. Before that point — the early or latent phase — most people are advised to stay at home where they are most comfortable.
When to contact your midwife or go to hospital
The 5-1-1 rule is a widely used guideline for first-time mothers: call your midwife or maternity unit when contractions are coming every 5 minutes, lasting at least 1 minute each, and this pattern has continued for at least 1 hour. If you have given birth before, contact your midwife or OB earlier — around the 10-1-1 mark — because labour tends to move faster.
Call immediately — do not wait — if any of the following apply:
- Your waters break and the fluid is green, brown, or has an unusual smell (this can indicate meconium, which requires prompt assessment)
- You have heavy vaginal bleeding (more than a light show)
- Your baby's movements have slowed significantly or stopped
- You have a severe headache, sudden swelling of your face or hands, or changes in your vision (possible signs of pre-eclampsia)
- You have a fever above 38°C (100.4°F)
- You feel that something is wrong — always trust your instincts
In the UK, your midwife or the maternity triage line is your first point of contact. In the US, call your OB-GYN or the labour and delivery unit directly.
What happens when you arrive at the hospital or birth centre
On arrival you will be assessed by a midwife or nurse. They will:
- Review your birth plan and notes.
- Monitor your baby's heartbeat, usually with a handheld Doppler or a cardiotocograph (CTG) machine.
- Take your blood pressure, pulse, and temperature.
- Perform an internal examination to assess how dilated your cervix is.
If you are in early labour (under 4–6 cm dilated) and everything is well, many units will encourage you to return home to rest and labour in familiar surroundings. This is not a dismissal — staying at home in early labour is associated with lower rates of intervention. You will be advised on when to come back.
If you are in active labour, or if there are any concerns, you will be admitted and a care plan agreed with your team.
How to track contractions
Timing your contractions helps you know when to call. You need to record three things:
- Frequency — how often contractions start (from the beginning of one contraction to the beginning of the next)
- Duration — how long each contraction lasts
- Intensity — how strong they feel on a scale of mild, moderate, or strong
A simple pen-and-paper log works perfectly, but most people find a contraction timer app more convenient — many are free and available for both iOS and Android. Look for one that lets you tap to start and stop each contraction and shows you the average frequency and duration over the last hour. This information is also useful to share with your midwife or OB when you call.
Once you know your signs of labour, it is worth making sure your due date estimate is as accurate as possible — accurate dating affects your care pathway and when your team will consider induction. Read our guides on how to calculate your due date and ultrasound dating vs LMP: which date should you use? for a full explanation of how pregnancy dates are worked out.