How your body prepares and tricky false labor
As labor approaches, your body starts to prepare itself for the task ahead and you may notice various physical symptoms and signs that labor is about to start. Not every woman experiences labor in the same way, and certain signs can occur either before labor starts or during labor.
Common physical symptoms
Toward the end of your pregnancy, you may experience a sensation of building pressure or cramping in your pelvic or rectal area. This pelvic cramping can feel very similar to monthly menstrual cramps. A dull pain in your lower back that comes and goes is common too. You may also notice an increase in heartburn (acid reflux) and gassiness. Unless you have a high-risk pregnancy, there is no need to go to the hospital or call your doctor if you experience any of these symptoms in the later stages of your pregnancy.
Your emotional state
This is a time of waiting and many women busy themselves with household tasks. These bursts of activity are often thought to be instinctual, as the mother prepares the home for the new arrival, referred to as "nesting." The anticipation of what will happen during labor can give rise to a mixture of emotions, from fear and anxiety to excitement and impatience. Women may feel fearful about how much pain they will feel or how uncomfortable they will be with bodily functions. Nothing can prepare you fully for how you will feel in labor, but the more you understand about pain relief options beforehand, the more confident you will feel about your ability to manage. It's also thought that by being informed and prepared, you are likely to reduce your anxiety during labor, which in itself can enable you cope better with the pain of contractions.
Braxton Hicks' contractions
One of the most common symptoms of approaching labor is an increase in the strength and frequency of Braxton Hicks', or practice, contractions, which may be occurring up to four times an hour. The purpose of these practice contractions is to prepare your uterus to deal with real labor contractions so that labor progresses smoothly. Some women find Braxton Hicks' relatively painless, while others find these practice contractions fairly uncomfortable, especially if the baby is quite low and contractions cause increased pelvic pressure.
Apart from the level of pain, one of the main ways to distinguish Braxton Hicks' from real contractions is that Bracton Hicks' are irregular and they fade away, whereas labor pains occur at regular intervals and gradually become stronger, more intense, and closer together. The other main difference between Braxton Hicks' contractions and real ones is that, unlike Braxton Hicks', real contractions cause your cervix to dilate, which indicates that labor is beginning.
More signs of approaching labor
Engagement of the head
With a first baby, dropping down of the baby's head into your pelvis, known as engagement, usually means that labor is likely to start soon. In second and subsequent pregnancies, engagement may not occur until the start of labor.
You can usually tell that your baby's position has changed in two ways. First, you may notice that you have less discomfort in your upper abdomen or around your ribs because the downward movement releases some pressure. Second, you may notice increased pressure or pain in your pelvic or vaginal area as the baby's head moves into position. Your walking may become more of a waddle and you may have to use the bathroom more frequently than before. In some cases, your baby's head may pinch some of the nerves that run through your pelvis and you may experience sciatica, a sharp electric pain that runs down the outside of your leg to your outside toes.
The "bloody show"
In pregnancy, a plug of mucus forms at the end of the cervix to prevent infection from entering the uterus. At the end of pregnancy, as the cervix softens and widens, this plug is dislodged and comes out through the vagina. When this occurs, you may see a discharge known as the "bloody show"; although some women don't notice anything. The discharge may appear as a thick, clear or yellow clump that looks like mucus from your nose. It's common for small amounts of blood to be present due to small tears in the cervix as the plug comes away.
Losing the plug of mucus usually means that labor will begin soon and you should make plans to leave for the hospital in the near future (within 12 hours). However, if loss of the plug is accompanied by other symptoms, such as painful, frequent contractions, heavy bleeding or leaking fluid (indicating your water has broken), you should call your doctor or hospital immediately.
Water breaking
Rupture of the amniotic membranes, called the water breaking, usually occurs once labor has started, but it can happen earlier. If this happens, it often means that labor is imminent. For some, a big gush of fluid is a clear sign that their water has broken, while for others there may be a trickle and it can be hard to determine if the amniotic fluid is leaking. Also, since many women have trouble controlling their bladder in pregnancy, telling the difference between urine and amniotic fluid can be hard. One way to tell is to wear a sanitary pad. If the pad quickly becomes soaked, your water has probably broken. Amniotic fluid also has an odor that is different than urine, even to nonprofessional noses.
Monitoring after the water breaks
If you think your water has broken but contractions haven't started, contact your doctor or the hospital for advice. If you're due, there are no complications, and your baby's head is engaged, you may be advised either to stay at home for a while to see if labor starts, or will be asked to be seen at the hospital. This is because, once your water has broken, your baby has lost the protective membrane surrounding him or her, which means there is an increased risk of an infection reaching your baby. The doctor should check your file to see if you're Group B Strep (GBS)-positive, and if you are, you'll be admitted and started on IV antibiotics. She may also monitor your baby's heartbeat to check that your baby isn't distressed. If you're GBS-negative and all is well, you may be able to return home, or stay at home, for a set amount of time and an appointment will be made to see how you're progressing. If labor doesn't start within 24 hours (the timeframe may be shorter in some hospitals), the hospital may suggest an induction.
Early contractions
As your body prepares to go into labor, you will start to experience mild and irregular contractions. These differ from Braxton Hicks' since they build gradually and will soften and dilate the cervix.