How do you know when you’re in labour?

As your pregnancy draws to its happy close, you’ve no doubt been eagerly anticipating the day you’ll bring the beautiful little human being you’ve been carrying so carefully around into the world. Can you guess when it will happen? What should you expect? And most importantly, how will you know it’s finally time? Here are some signs of labour to look out for.

Pre-Labour

Vaginal discharge and your mucus plug
In the days leading up to labour, you might notice a change in your discharge – it gets thicker and heavier. If discharge is extremely thick and is bloodstained, it means you’re passing your mucus plug. This is “the plug of mucus which blocks the opening of the cervix during pregnancy. It is released as the cervix softens and dilates. With early labour, contractions are often associated with the release of the mucus plug, which appears as a blood stained mucus discharge called the ‘show’,” says Dr Kelly Loi, obstetrician and gynaecologist at the Health & Fertility Centre for Women, at Paragon Medical.

The mucus plug can come away anytime from a few days to a couple weeks before you go into real labour. Dr Watt Wing Fong, specialist in Obstetrics and Gynaecology & Consultant at Raffles Women’s Centre adds that sometimes the passing of the mucus plug may not be noticeable.

Some women worry about how much blood they see, and if you feel the need to call your doctor, go ahead. Be rest assured however that the plug usually is blood-stained.

Your baby “drops”

According to Dr Watt, the baby “dropping” is also known as lightening. It can begin from days to weeks before labour. “Your baby drops when the head begins to enter into position in your pelvis. You may be able to breathe more deeply and eat more, but you’ll also need to pee more frequently, and walking may be more difficult,” adds Dr Loi.

Braxton Hicks

Many women confuse Braxton Hicks contractions with the onset of labour. What exactly are Braxton Hicks contractions? According to Dr Loi, “Braxton Hicks refer to tightenings of the uterine muscles which tend to occur sporadically, usually from mid-pregnancy onwards, especially after 28 weeks.

As the pregnancy progresses, Braxton Hicks tend to become somewhat more often, but are characteristically painless and irregular, occurring several times throughout the entire day.”

However, Dr Watt adds that closer to term, Braxton Hicks contractions can get a little uncomfortable. “It is believed to be like “warm up” contractions. Sometimes it can be confused with early labour contractions.”

True Labour: Contractions

So how do you know if you are truly in labour or if it’s our friend Braxton crying wolf? Dr Loi tells us that, “One can recognise the onset of true labor when the contractions are painful and regular, occurring every 15 minutes. “Real” contractions are also associated with dilation of the cervix. Unlike the earlier painless and sporadic Braxton Hicks, which caused no obvious cervical changes, these contractions may help the cervix thin out (efface) and open up (dilate).” The key here is regular contractions that are likely tobe causing quite a bit of pain.

Dr Watt agrees, saying also that, “labour contractions are often progressive, with increasing intensity and frequency despite resting.

Sometimes labour contractions can be associated with other symptoms of labour like bleeding or rupture of the water bag.”

One thing to note is that Braxton Hicks can be difficult to distinguish from early signs of preterm labour. “If the pregnancy has not yet reached 37 weeks and contractions are starting to occur at regular intervals with more than four contractions an hour, or if there are any other signs of preterm labour such as show or watery discharge, let the doctor know immediately so that he or she can examine you for cervical dilation,” cautions Dr Loi.

Your water breaks

Your “water breaking” is essentially the amniotic sac rupturing. The amniotic sac is what has been protecting your baby during the pregnancy. Although the movies may have given us the impression that this is the defining moment when you realise you’re in labour, for a lot of women, all the other signs would have already tipped you off. Often, the water breaks when the woman is already in labour – although it is possible for it to happen before or as it is starting.

“Some women may have the water bag breaking without any contraction pain. In such a situation, it is still advisable to go to the hospital because there is an increased risk of foetal infection if the water bag has ruptured, and it may be necessary to stimulate labour. Some women will have contraction pain without the water bag breaking. This may be artificially ruptured by the doctor if you are in active labour,” says Dr Watt.

Her advice is, if your water bag breaks to put on a pad and make your way to the hospital. “If you have pain as well, or if you have been told that you have Group B streptococcus infection, or if the colour of the amniotic fluid is not clear, you should may your way to the hospital as soon as possible.”

WHAT TO PACK

You’ll need an overnight bag with a few essentials for your stay at the hospital. Have one packed and ready a couple weeks before you’re due just in case.

Some things to bring:

1. Appointment card, Admission form and IC.
2. Socks: Your feet might get cold during labour.
3. Toiletries: You’ll want to have some of your own essentials for after the baby is born. Don’t forget the toothbush!
4. A set of clothes or two: Don’t forget you’ll need something to change into to go home.
5. Clothes for the baby: You don’t want to be bringing him home butt-naked. Bring clothes, swaddling cloth, mittens and booties.

Note: Hospitals differ on what they provide. Many provide toiletries, pads, disposable panties, baby diapers and wet wipes.