How to Know if You're in Labor

Although expecting a baby is an exciting time for most people, the thought of going into labor can be nerve-racking. Labor usually occurs about 40 weeks after conception; however, it can happen earlier or later.

Signs of labor intensify as contractions from the uterus help push the baby through the cervix, into the birth canal, and out of the vaginal opening. Labor happens in four stages and varies in time between hours or days.

This article will describe the signs, stages, and complications of labor.

Signs of Labor

Labor symptoms are caused by the rhythmic tightening of the uterus, called contractions. Each contraction helps the cervix to dilate (open). The cervix is the lower portion of the uterus and must open to 10 centimeters (cm) for the baby to pass through it. It can be challenging to know if you are in labor, especially during your first pregnancy.

Contractions

During true labor, contractions need to be effective to dilate the cervix. Here are signs of effective contractions:

• Regular contractions: Contractions should consistently occur every five to 10 minutes. You time contractions from the beginning of one contraction to the beginning of the next contraction.
• Strong contractions: The uterus should become hard and tight during a contraction.
• Length of contraction: Effective contractions will last around 50–70 seconds.
• Uncomfortable contractions: Contractions may feel like mild cramping but should become more painful with time.

Many pregnant people experience Braxton-Hicks contractions throughout their pregnancy, and they are usually mild, last 30 seconds or less, and are irregular. Braxton-Hicks contractions are not strong enough to dilate the cervix and cause true labor.

Mucus Plug

The cervix is firm, about an inch long, and is closed during most of the pregnancy. A mucus collection is inside the cervix, inhibiting bacteria from entering the uterus. Contractions in combination with hormones (oxytocin and prostaglandin) help the cervix become soft so it can open easier.

The mucus plug leaks as the cervix begins to soften, shorten, and thin (efface), and open. Some women may experience the release of a onetime large glob of mucus, while others may have a mucus discharge over several days before labor starts. Although the mucus can be blood tinged, you should never have bright-red bleeding.

Pelvic Pressure

As labor approaches, the baby will drop further into the pelvis; this is called lightening. Having a low backache is also a sign of lightening. Your family and friends may notice that your baby bump has "dropped" when lightening occurs.

Rupture of Membranes

The baby is surrounded by amniotic fluid within the amniotic sac. About 10% of pregnant people will experience spontaneous rupture of the membranes (your water breaking). If your water breaks at home, remember to report a description of this to your healthcare provider, which can be remembered by the acronym "TACO":

• T: Time of rupture
• A: Amount of fluid (gush or trickle)
• C: Color of the fluid (clear)
• O: Odor of the fluid

Stages of Labor

Labor is divided into stages. Here is an overview of the four stages of labor:

First stage: The beginning of labor until the cervix is dilated to 10 cm. During phase 1 of this stage, contractions are mild to moderate as the cervix dilates from 0 to 6 cm. Phase 2 is considered active labor when the cervix dilates 6–10 cm and becomes completely effaced. Contractions are usually intense and very uncomfortable during phase 2.

Second stage: Once the cervix is completely dilated and effaced, you can begin pushing. The second stage ends once the baby is born.

Third stage: After the baby is born, the placenta will detach from the uterine wall and exit through the birth canal and vaginal opening. The expulsion of the placenta concludes the third stage.

Fourth stage: The postpartum period is often referred to as the fourth stage of labor. It can take six to 12 months to recover from childbirth.

How to Induce Labor

Labor is induced in approximately 25% of pregnancies in the United States. Upon considering the safety of the pregnant person and the baby's health, induction is one of the most common obstetric procedures globally.

Home Remedies

If you are within two weeks of your due date or are overdue, here are ways to kick-start labor at home:

• Exercise: Pressure on the cervix from the baby's head can help stimulate labor.
• Foods: Pineapple contains an enzyme (bromelain) that softens the cervix, although there is no medical evidence to support this theory.
• Herbs: Raspberry leaf can increase contractions, and evening primrose oil produces prostaglandins that soften the cervix.
• Castor oil: Bowel irritability from castor oil can induce contractions.
• Sex: Prostaglandins are released during sex.
• Nipple stimulation: Increases oxytocin, the hormone responsible for contractions.

Always check with your healthcare provider before trying natural remedies to induce labor.

Hospital Induction

Your healthcare provider may recommend a hospital induction (helping the uterus to contract before labor) for the following conditions:

• Preeclampsia (pregnancy complication indicated by high blood pressure and high levels of protein in the urine)
• Placenta previa (when the placenta covers the opening of the cervix)
• Overdue by two weeks
• Low level of amniotic fluid
• Uterine infection
• Previous cesarean delivery (C-section)
• Multiple fetuses (twins, for example)
• Concern about the baby's growth or size

Common methods to induce labor at the hospital include:

• Intravenous Pitocin drip (medication to speed up the childbirth process)
• Cytotec administration (oral or vaginal)
• Prostaglandin gel
• Artificial rupture of membranes (amniotomy)
• Foley bulb induction (inserting a Foley catheter into the cervix to promote dilation)

Complications

Although rare, death during childbirth does occur in the United States. In 2020, there were 23.8 deaths per 100,000 live births. In addition, Black pregnant people are over 2 times more likely to die during childbirth than White pregnant people. People over the age of 40 also have higher death rates during labor than those under 25.

Complications during labor can include:

• Failure to progress (delivery is not moving along as it should)
• Fetal distress (signs the baby is not getting enough oxygen)
• Fetal malposition (when the baby is in an unusual position)
• Uterine rupture (rare, spontaneous tearing of the uterus)
• Cephalopelvic disproportion (the baby's head or body is too large to get through the birth canal)
• Postpartum hemorrhage (excessive bleeding after delivery)
• Vaginal tearing (common injury to the tissue around the vagina during delivery)

When to Call Your Healthcare Provider

Call your healthcare provider for the following symptoms during labor:

• Fever or chills (signs of infection)
• Labor has not started within 24 hours of your water breaking
• Brown or green color to the amniotic fluid
• Baby stops moving
• Bright-red bleeding
• Severe headache
  

Summary

Labor occurs approximately 40 weeks after conception. The uterus is a large muscle that contracts and opens the cervix during labor. When the cervix is fully dilated, the baby moves into the birth canal and out the vaginal opening. Symptoms evolve with each of the four stages of labor. Sometimes pregnant people need to have labor induced. It's important to understand what complications can occur during labor and when to call your healthcare provider.

A Word From Verywell

There is no wrong way to deliver a baby. Even the best birth plans don't always go accordingly. Having an open mind and being flexible during labor is helpful. If you're fearful of labor, try taking a birthing class or join a support group for pregnant people. Sharing your thoughts and concerns about labor with your healthcare provider can also be helpful.