Signs of labour: when to take her to hospital

Signs that labour has begun

Labour rarely announces itself the way films suggest. It usually starts as something ambiguous that builds over hours. The NHS lists five signs, and they do not arrive in a fixed order — she may get two of them, or all five, or the waters may break with nothing else happening at all.

• Contractions, or a tightening across the womb. They may feel to her like extreme period pain.
• A "show" — sticky, jelly-like pink mucus, sometimes with a little blood in it. It may come as one piece or several.
• Backache, or a heavy aching feeling low down.
• An urge to go to the toilet, caused by the baby's head pressing down.
• Her waters breaking.

The show is the one that panics people most and means least about timing. Labour can follow it within hours, or several days later. It is a sign the cervix is opening, not a starting gun.

Source: NHS

Timing contractions: what the five-minute rule means

This is the job that is genuinely yours, and the one most men get subtly wrong. Two different numbers matter and they are easy to confuse.

• Length: how long one contraction lasts, from the moment the tightening starts to the moment it eases.
• Gap: the time from the START of one contraction to the START of the next. Not from the end of one to the start of the next — that mistake makes the gap look longer than it is, which is the direction that delays you.

As labour establishes, contractions tend to become longer, stronger and more frequent. The threshold to act on is regular contractions arriving every five minutes or more often — at that point the NHS says to call the midwife or maternity unit.

Write the times down, on paper or on your phone. You will not remember them, and the first thing the hospital asks is how far apart they are and how long each one lasts.

Source: NHS · NHS

When to call, and when to leave

Calling and leaving are two separate decisions. The call comes first, and it is free — the maternity unit would far rather talk to you about a false alarm than have you sit at home through a real one.

Call when either of you thinks she is in labour, or when contractions are regular at five minutes apart or closer. Call urgently — not at the next convenient moment — if her waters break, if there is any vaginal bleeding, if the baby is moving less than usual, or if she is less than 37 weeks pregnant and this may be labour.

Source: NHS

The latent phase: why waiting at home is not neglect

Before established labour there is a latent phase, in which the cervix softens and starts to open. Contractions in this phase are irregular, and it can take many hours, or even days, before labour is established. It is usually the longest part.

Established labour is defined as the cervix having dilated to about 4cm with contractions that are stronger and more regular. From there to fully dilated typically takes 8 to 18 hours in a first pregnancy, and 5 to 12 hours in later ones.

Knowing this changes how the night feels. Arriving very early usually means being sent home again, so the guidance for the latent phase is to stay home, keep her upright and gently active — which helps the baby move down and the cervix open — and let her eat and drink. A warm bath or shower, breathing exercises and massage may help with the pain.

Source: NHS

If her waters break

Amniotic fluid is clear and pale, and may be slightly bloodstained at first. It can arrive as a gush or as a slow trickle that is easy to mistake for something else.

Two things make this urgent rather than routine: fluid that is smelly or coloured, and any loss of blood. Either one means telling the midwife or maternity unit immediately. Note the time it happened and what the fluid looked like — you will be asked both.

Source: NHS

Premature labour before 37 weeks

Premature labour is labour that happens before the 37th week. Around 8 in every 100 babies arrive this way, so it is uncommon but not rare.

Before 37 weeks, the threshold for calling drops. You are not waiting for a five-minute pattern to establish itself.

• Contractions or tightenings that keep coming back.
• Period-like discomfort.
• A gush or leak of fluid.
• Lower back pain that is not like her usual back pain.

Any of those, before 37 weeks, means calling the midwife or maternity unit. The same guidance adds that you can call if you are simply unsure or worried about anything — uncertainty is itself a reason to call, not a reason to wait and see.

Source: NHS

Your job during labour

The NHS publishes a list of tips for birth partners. Stripped to what actually gets done on the night, it comes to this.

• Know the birth plan well enough to speak for it — and expect it to change at the last minute.
• Know the route, the journey time, the traffic at that hour, and where you will park. Settle this weeks ahead, not on the night.
• Keep your phone charged and on, and pack your own small bag: charger, toiletries, snacks, a change of clothes.
• Help her move and change position, or lean on you if that is easier. Breathe with her through contractions.
• Speak up. You may need to explain to the midwife or doctor what she needs or wants when she cannot.
• Keep encouraging her — and do not take offence if you are asked to stop talking.
• Eat and drink yourself, and take a short break when you can. This can run for many hours and you are no use to her depleted.

Source: NHS

Common questions