Signs of Labour: When to Go to the Hospital

In the last weeks of pregnancy almost every mother asks the same question: how will I know it is really labour? The honest answer is that it is not always obvious. Some women have a sudden gush of water, others feel only a backache that slowly builds. Knowing the common signs, and the ones that should never wait, takes away much of the worry.

This guide explains the usual signs of labour, how to separate practice contractions from the real thing, and when to leave for the hospital.

The Common Signs of Labour

• Regular contractions that grow longer, stronger and closer together
• A “show”, a pink or slightly bloody jelly-like discharge, which is the mucus plug that sat in the cervix
• Backache or period-like cramps that come and go
• An urge to open your bowels, as the baby’s head presses down
• Waters breaking, as a trickle or a gush of clear or pale fluid

You may notice only one or two of these, and the order differs from woman to woman. A show can appear days before labour begins, and some women never notice it.

Braxton Hicks or True Labour?

Braxton Hicks contractions are practice tightenings of the womb that can start well before the due date. The NHS describes them as usually painless or only uncomfortable, short, infrequent and not building up in strength. True labour contractions follow a pattern: they become longer, stronger and more frequent, and they do not ease when you change position or drink water.

• Time them. Note when each contraction starts and how long it lasts, and the gap from the start of one to the start of the next
• Change what you are doing. Walk, rest or have a warm bath. Practice contractions often fade, while real ones carry on
• Watch the pattern. A steady pattern that builds is the sign that matters

What Happens in Early Labour?

The first stage is called the latent phase. The cervix softens and starts to open, and contractions may be irregular and mild to fairly painful. According to the NHS this can last hours, or even a day or two, particularly with a first baby. It is usually the longest part of labour and it is often spent at home.

Established labour begins when the cervix has opened to about 4 cm and contractions are regular and strong. The NHS gives rough timing of about 8 to 18 hours for a first baby, and about 5 to 12 hours for later babies, but every labour is different. Pushing, the second stage, generally lasts up to three hours for a first baby and up to two for later ones. Read more about the choices in our guide to normal delivery and C-section.

Looking after yourself at home in early labour

• Eat light snacks and keep drinking fluids to keep your energy up
• Rest if it starts at night, and stay upright and gently active during the day
• Try slow breathing, a warm shower or bath, massage and a change of position
• Keep your bag, documents and antenatal file ready, as in our hospital bag checklist

When Should You Go to the Hospital?

Rules differ between hospitals and doctors, so follow the advice you were given at your antenatal visits. As a general rule, the NHS suggests contacting your maternity unit when you think you are in labour or when contractions are coming every 5 minutes or more often. If your hospital is far away, or you live in a village with a long journey, it is sensible to leave earlier than the textbook says and to discuss this plan with your doctor beforehand.

Call or go in urgently if:

• Your waters break, whatever the time of day. Note the colour and smell. Green, brown or foul-smelling fluid needs immediate attention
• You have vaginal bleeding that is more than a small show
• Your baby is moving less than usual
• Any contraction lasts longer than 2 minutes, or you have six or more in 10 minutes (per the NHS)
• You think you may be in labour before 37 weeks
• You have a severe headache, vision changes or severe pain, which can signal a problem such as pre-eclampsia (see our warning signs guide)
• You have a fever, or you feel strongly that something is wrong

Tip: If you feel a strong urge to push, or the baby’s head is visible, call an ambulance (108 or 112 in India) rather than travelling, and do not try to hold the baby back.

What If My Waters Break but Labour Has Not Started?

Waters usually break during labour but sometimes before it. Wear a clean pad (not a tampon), keep clean, and contact your doctor straight away. Your team will check you and the baby. According to the NHS, if labour does not begin within about 24 hours after the waters break, induction is usually offered because the risk of infection rises over time. Watch your temperature if advised, and report a fever.

Pain Relief in Labour

Options usually range from breathing, movement and warm water to gas and air, injections and an epidural, depending on what a hospital offers. The NHS notes that an epidural can give strong relief but may limit leg movement and lengthen the pushing stage. Discuss your preferences with your doctor before labour, because what is available differs between hospitals.

A Few Common Worries

• “I came in and was sent home.” This is common in early labour. It is not wasted effort: staff check you and the baby, and you return when contractions are established
• “What if it is faster than expected?” Some labours are quick, especially in later births. Have your transport plan ready and do not delay when contractions are strong
• “What if I need a caesarean?” Sometimes a plan changes for safety. It is a normal part of childbirth planning, not a failure

Plan Ahead Before Your Due Date

• Decide who will take you and have a back-up person and vehicle, because labour does not wait for convenient timings
• Keep contact numbers handy: your doctor, the hospital, and an ambulance service
• Keep your antenatal file, scan reports and blood group details in your bag
• Arrange care for older children and for things at home
• Talk to your family about your birth preferences and about who will stay with you

Having a plan removes much of the panic when the moment arrives, and it lets your support person help you more calmly. Our antenatal care guide explains how late-pregnancy visits prepare you.

When to Call or Visit

If you are unsure whether it is labour, call rather than wait. Chaitanya Hospital in Kadapa provides delivery and emergency care 24/7. Call +91 944 103 0587 to speak to the team, or book an appointment for a birth-planning visit before your due date. Read about normal and C-section deliveries.

This article is for general education only. It is not a substitute for a doctor’s advice, diagnosis or treatment. Please talk to your own doctor about your situation.