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Recognizing the Onset of Labor

Osher Ben-Or, Certified Midwife
23 July 2024

If you are getting close to the end of your pregnancy, you are probably trying to determine the exact day of delivery. Although it is hard to predict the exact day, there are some signs that labor is getting close:

  • A sense of relief because of the fetus descending in the pelvis.
  • Uterine contractions.
  • The mucus plug in the uterine cervix may come loose days or hours before or during childbirth.
  • A surge of energy, restlessness, and a wish to do things before childbirth.
  • Breaking of waters, indicating the breaking of the amniotic sac membranes.
  • Gastrointestinal discomfort.
  • Changes in the uterine cervix: when it begins to open, flattens, shortens, and advances.

If one or more of the following conditions happens, you must go to the obstetric emergency room: regular, lengthy labor; fresh bleeding; amniotic rupture or fear of amniotic rupture; if you have been instructed to go to the obstetric emergency room by a physician.

If you are nearing the end of pregnancy, you, like many other women, may be trying to understand exactly when the birth will happen. While it is not possible to predict the beginning of spontaneous childbirth with any precision, many women experience telltale signs and symptoms that childbirth is approaching. It’s important to know that these signs are normal and that every birth progresses in its own manner and at its own pace.

Telltale signs of childbirth approaching

  • A sense of relief because of the fetus descending in the pelvis
  • Uterine contractions
  • Mucus plug
  • Surge of energy
  • Breaking of the waters
  • Gastrointestinal discomfort
  • Changes in the uterine cervix

At about week 36, the fetus starts to descend in the pelvis. At this stage, you may feel some relief in breathing (because the pressure exerted on the diaphragm by the uterus decreases) and on the other hand you may experience urinary frequency, new or worsening of edema in the legs, worsening hemorrhoids, worsening venous insufficiency, owing to the increased pressure in the pelvis and on the surrounding organs. This sign is a common harbinger of childbirth mainly for the primigravida (a woman giving birth the first time).

You may feel contractions of the uterus days or even weeks before childbirth. They do not intensify, are not regular and do not affect the uterine cervix, but sometimes they are a preceding sign of imminent labor. Labor, in contrast, can begin like mild menstrual pain (which comes and goes), and will intensify, get longer and will be more frequent and regular as the birth approaches.

The plug is formed at the beginning of pregnancy from discharges of the uterine cervix, sealing the cervix and serving as a protective barrier. It can detach days to hours before childbirth starts, or just before birth, as labor intensifies. You can identify the detachment of the mucus plug if you see clear, pink or brown mucous discharge. Attention: if you have fresh red bleeding, it is important to seek medical examination immediately.

A few days before birth, you may suddenly feel restless or have a surge of energy and a wish to do things. The phenomenon is well-known and known as nesting because it is akin to birds who line their nest before laying eggs. The phenomenon describes an intense urge to tidy up the house before birth, prepare the room and organize clothes and objects for the infant who is about to come into the world.

This is effectively rupturing of the amniotic sac membranes. Amniotic rupture occurs before childbirth begins in 8% of pregnancies. In 95% of cases, after amniotic rupture, birth will begin within 72 hours. Breaking of the waters may occur as a drip or surge. If you think that you have experienced breaking of the waters, it is important to seek medical examination immediately. If the examination reveals that it is indeed amniotic rupture, you must be admitted to hospital for fetal monitoring, temperature monitoring and making a decision on continuing to manage the birth according to the conditions, the state of the fetus and to the extent possible according to your wishes too.

Owing to hormonal changes that occur before birth, you may experience increased intestinal activity, nausea and vomiting. This discomfort may not be an immediate sign of childbirth, but it an occur a few days before.

Before the end of pregnancy, your cervix will undergo a maturation process:

Dilation: vaginal examination reveals opening (measured from 0 to 10 centimeters).

Flattening: the uterine cervix shortens and becomes thin until it disappears (measured in percent, up to 100%).

Softening: initially the cervix is hard, and softens before childbirth.

Forward movement: initially the cervix is in a rear position and towards birth it moves to the center and then forward.

If you are about to have your first delivery, the uterine cervix is likely to be more closed, in a posterior position and to have a moderate to hard texture until before delivery starts. If you have already given birth before, the changes may occur during the last weeks of pregnancy.

This is how you will know that it is time to go to the obstetric emergency room

If one or more of the following conditions happens, you must go to the obstetric emergency room:

  • If you feel regular, lengthy labor:
    First birth: when regular, painful contractions begin and last more than 45 seconds each, with an interval of 3-5 minutes in between, it is recommended to wait an hour or two, if the situation allows it, to make sure that they intensify rather than decaying. If they intensify, this indicates genuine labor that is advancing childbirth. As a rule, the more frequent, regular and longer the contractions (as stated, 1-2 hours), and the longer each contraction lasts, the greater the chance that this is true labor that is advancing childbirth.
    Subsequent birth: unlike the first birth, in a later birth, the process may be faster. Wherefore, when regular painful contractions start, you should go to the obstetric emergency room, particularly if the previous birth was rapid.
  • If you have bleeding: if fresh menstruation-like bleeding occurs, you should go to the obstetric emergency room.
  • If you have breaking of the waters: if your waters break or you have suspicion of breaking of the waters, whether a large quantity or a drip, you should go to the obstetric emergency room.
  • If you have received a medical order: if your physician has instructed you to go to the obstetric emergency room.