Overview

When you have made it through most of your pregnancy and are in the final stretch, you enter the waiting game of waiting to go into labor. This can be nerve-racking for two reasons. First, you do not know when you will go into labor. Second, you may not know how to tell that you genuinely have started labor and that it isn’t just a false alarm. There is a typical path that all labor follows, but the signs of labor, when they happen, and how you experience them will be unique. This episode/article covers labor signs to look out for as you get closer to your due date, what to do in early labor, and when to contact your doctor or midwife.

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Article and Resources

In this episode, we are talking about the start of your labor. There is a typical path that all labor follows, but the signs of labor, when they happen, and how you experience them will be unique for you. This article will go through the signs of labor, what you should be doing in early labor, and when you should contact your doctor or midwife.

Defining a Term Pregnancy

In the past, a baby born between 37-42 weeks was concerned born at term. In 2013 the American College of Obstetricians and Gynecologists revised their classifications for pregnancy terms into four separate categories.

• Early term 37-38 weeks six days
• Full-term 39 weeks-40 weeks six days
• Late-term 41 weeks and 41 weeks six days
• Post-term After 42 weeks

The takeaway here is that your care provider ideally would like to see you go into labor between 39-41 weeks.

The Evidence on Pregnancy Duration

What does the evidence say about how long pregnancy lasts? One study found it was most accurate to add 282 days to the last menstrual period. This study included mothers who had a labor induction. Another study found that the average length of pregnancy was 283 days. There was a difference if it was a woman who already had at least one baby, in that the median gestational age at birth was two days shorter. This study did exclude women who were induced.

Remember, these numbers are averages. Many expecting mothers are having babies past this date, and it is not a deadline.

I could not locate a statistic on how many babies are born on their due date, and most estimates put that number between 3-5%. According to 2018 CDC data:

• 02% of babies were born preterm (before 37 weeks)
• 53% of babies were born early term (37-38 weeks six days)
• 24% of babies were born full-term (39 weeks-40 weeks six days)
• 2% of babies were born late and post-term (41 weeks and beyond)

Keep in mind that in the United States, the cesarean rate is 31.9%, which would affect these figures.

Your Due Date

Due dates can be calculated based on your last menstrual period, date of conception if known, or by measurements on an ultrasound. Any calculation is an estimate, not an exact science. There is room for error in any method of calculating your due date, and not everyone has the same pregnancy length. For a deep dive into the evidence and implications of your due date, see this article.

Induction

An induction can influence when you go into labor. As you get near or go past your due date, this is an intervention your care provider may offer. There are in-depth episodes with evidence on inducing labor naturally and medical inductions.

Signs of Labor

As your baby and body prepare to start labor, you may see one or more of many signs of labor. If you are near your due date, this can be exciting that you are close to meeting your baby. If you still have a ways to go before your due date, these could be signs to watch out for and flags that you should contact your doctor or midwife.

Your Baby Drops (AKA Lightening)

Your baby may drop lower into your pelvis in the weeks or days leading up to birth. The good news is that this gives your lungs more room, so breathing may be more comfortable and can ease up on heartburn. The bad news is that this puts more pressure lower, which can mean more bathroom breaks. For some expecting moms, especially the second time around, this happens right before labor. Please do not worry if your baby is not dropping in the last few weeks of your pregnancy.

Urge to Nest or Restlessness

Some pregnant moms experience an urge to nest right before starting labor. This can be a sudden burst of energy to finish a project around the house. You may feel like you need to organize everything for your baby’s room. It could even manifest as going on a baking or cooking spree. The last days and weeks can leave you anxiously waiting for your baby, making you want to stay busy to pass the time. If labor is truly around the corner, you want to be well-rested when your labor starts. If you feel like you are overdoing it, take a break. Please don’t skip out on sleep to tackle projects around your house.

Your Cervix Dilates and Effaces

Your cervix needs to thin out and widen to allow your baby to pass through. Dilation is measured in centimeters, and effacement is measured in percentages. The only way to tell whether your cervix is dilated or effaced is with a vaginal exam performed by a doctor or midwife. If you opt for this intervention, you may hear that you are 2 cm dilated and 25% effaced. This may lead you to believe you are close to labor. The truth is that there isn’t a concrete timeline on which labor progresses. You could be slightly dilated for days or longer before labor starts. Cervical measurements from a vaginal exam may be instrumental when considering an induction, but there is no evidence that these measurements can predict when labor will start.

You Lose Your Mucus Plug, AKA bloody show

When you are pregnant, you have a thick plug of mucus in your cervix that keeps bacteria from getting in there. When your cervix starts to thin and dilate, that plug may fall out. You will likely notice this when you go to the bathroom, and it could be pink or reddish and looks like a thick discharge. Again, this doesn’t happen for everyone. If you start losing your mucus plug, you could be days or hours away from starting labor, but it is a sign labor is coming. Keep in mind that discharge does tend to increase toward the end of your pregnancy. You are looking for a sudden change in color or consistency.

Nausea

When you go into labor, digestion stops as your body focuses energy on labor. It is thought that your body will want to clear out your digestive system before going into labor for some expecting moms. It is possible you will be nauseous and even vomit in the early stage of labor.

Diarrhea

Your body releases prostaglandins, which will help your cervix soften. These prostaglandins can also trigger contractions in your bowels, which can mean loose stools or diarrhea before labor. A bright side of this is that some people believe this will prevent you from having a bowel movement during labor. Many women indeed do poop during labor. For more information on the possibility of pooping during labor, see this article.

Your water breaks

In the movies, labor almost always starts with someone’s water breaking and always somewhere very public and embarrassing. Only actually about 8% of labors start with water breaking. For the majority of expecting moms, this is something that happens during labor. It can be a sudden gush of fluid or a slow leak. There are a few things you want to pay attention to when your water breaks, and you can use the acronym COAT to remember them:

• Color
• Amount
• Odor
• Time

You will likely want to let your care provider know when your water breaks and any details about it. Your water breaking may set a clock for your care provider. See this episode for information on the 24-hour rule.

It is also possible that your water never breaks. It is rare, but some babies are born en-caul, which means they are born still inside an intact amniotic sac. Some providers in a hospital setting may offer to rupture your membranes to speed up labor.

Cramping and Lower Back Pain

Some expecting moms will feel crampy before labor starts. Think of this as period cramps or milder. You may also have some lower back pain. This can be the early stages of contractions and could be a sign you will be in labor soon.

Contractions

Contractions are the hallmark that you are in labor. The key to differentiating between real labor contractions and Braxton Hicks contractions is that true contractions will continue to get longer, stronger, and closer together. For more in-depth information on Braxton Hicks contractions, see this article.

Intuition

Intuition isn’t scientific or evidence-based. Anecdotally, many women have some intuition about when they will go into labor. With my first baby, I had it in my head that he would be born on a specific day. It was a full moon, but otherwise, there was nothing unusual about that date. I just felt like that would be the day for months before. My son was born on the exact date I thought he would be, a week before my due date. Maybe you have a feeling about a particular day, or perhaps you just feel like you will go into labor. Trust your gut. We cannot always explain these feelings, and they may not be accurate, but they are worth paying attention to.

You may have heard that you will know when you are really in labor, and you will. I know if this is your first baby and you haven’t been through labor before, this is hard to imagine, but you will know when you are going into labor.

When Should You Call Your Doctor or Midwife?

You and your partner should have contact information for your doctor or midwife programmed in your phones. You should also know how to get in touch with them after hours. If you are debating whether or not to call your care provider if you think you are in labor, just call. You should trust your gut on this one. A call will give your doctor or midwife a heads up that you may be going into labor or save you a trip to the hospital or birth center if it is a false alarm. If you are not near your due date and have any labor signs, please let your care provider know right away.

When Should You Go to the Hospital or Birth Center?

Your doctor or midwife should give you specifics on when they want you to call or come in during labor. They will generally advise that you do not go to the hospital or birth center until you are in active labor. This could be hours or days from when you start to see the signs of labor covered in this article. Get clear on when you should plan to come in and any red flags you should keep an eye out for.

If you plan a home birth, it is nice to give your midwife a heads up that you may be going into labor since they are on call for your birth. If you are going into a birth center or a hospital, call ahead if you think you are in labor to give your care provider a heads up. Often they will be able to tell a lot just from talking to you on the phone whether you should come in or wait it out at home longer. Worst-case scenario, you go in early, and it is a false alarm. Then it was a good practice run. You certainly would not be the first expecting mom to go into the hospital or birth center early.

Things to Do in the Earliest Stages of Labor

If you have some signs that labor may be coming soon, there are some things you and your partner can do to prepare for the work ahead. The first is to try and rest. If you can get some extra sleep or take a nap, do it. Labor is a marathon, and you want to go into it well-rested. Next, try to eat something and stay hydrated. As your labor progresses, you may be less interested in food. Labor is hard physical work, and you will be burning a lot of calories. You do not want to be expending a lot of energy without having the fuel you need. See this article for more information on eating and drinking during labor.

Talk ahead of time with your partner and set expectations for what they should be doing when you go into labor. If you need to notify family or make arrangements for someone to care for other children or pets. Any tasks you can delegate to your partner,

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