How will I know when I am in Labour?

Labour does not begin suddenly, it evolves gradually. It can take hours, even days, to figure out whether the sensations you're feeling are labour or pre labour (also called false labour). Some subtle signs and symptoms that you are beginning first stage childbirth include a vague backache that may cause restlessness, several soft bowel movements accompanied by flulike feelings, and a nesting urge--an unusual burst of energy, particularly related to cleaning and getting your home ready for the baby.

As childbirth nears, there are some more specific symptoms that may occur. You may pass some blood-tinged mucus, called the bloody show, from the vagina. This is associated with thinning of the cervix, and it can occur days before other signs of labour or not until after labour contractions are progressing. You may notice a leakage of fluid from the vagina, which indicates that there is a small break in the amniotic sac (also called bag of waters) surrounding the baby. This occurs in 10 to 12 percent of childbirths, but it may not be associated with spontaneous labour. Leaking can continue on and off for hours before childbirth begins, and you will not have any contractions

If you're really in labour, one or more of the following things will happen:

• You may have persistent lower back or thigh pain, often accompanied by a cramp premenstrual feeling.
• You will have contractions at regular and increasingly shorter intervals, and they will become longer and stronger in intensity.
• You may find yourself using the toilet a lot. Some women have a need to empty their bladder, others an urge to pass stools!
• You may have a bloody show (a brownish or blood-tinged mucus discharge). If you pass the mucus plug that blocks the cervix, labour could be imminent. It could also still be several days away, but this is a sign that things are moving along.
• Your waters may break with a gush, or they may leak.
• Your cervix will become progressively thinner and softer (also called effacement) and may dilate (up to 10cm).

Each woman's labour is different. And even in the same woman, each labour will be different. Some labours start slowly and then speed up unexpectedly, while others start rapidly and then slow down. Some labours are very fast, lasting only a few hours. Some are very long, lasting a day or two. The average length is about 15 to 16 hours for first-time mothers and 7 or 8 hours for women with previous childbirths. How painful the labour is, and how tired you become, also vary greatly. It's best, then, not to have any specific expectations but to prepare yourself for a wide range of possibilities.

Active phase of labour

In the ‘active’ phase of labour, contractions will be four to five minutes apart and last for a minute or so each time. At this point, it is wise to travel to hospital.

This phase may last for a few hours as the cervix dilates further, between about 4 to 8 cm.

Most women cope best with this stage of labour by moving into whatever position feels best at the time. Sometimes one position will work well for a few contractions and then you may need to move into a different position.

During the active phase of labour, upright positions with hip-swaying movements will help as gravity assists your body move the baby deeper into the pelvis.

Positions with some support are often helpful, like leaning against a wall or leaning forwards supported by a partner, or kneeling on all fours.

In the active phase of labour, most women are not able to walk or talk during contractions and usually want to spend the time between contractions focusing on the labour and preparing for the next contraction ‘wave’ rather than being distracted by other concerns.

Most women find that breathing can help them to manage the flow of the contractions; use deep abdominal breathing through the beginning of the contraction, with sighing-out breathing over the peak of the contraction. Breathe slowly and calmly to relax between contractions

Final phase of labour

The final phase of first-stage childbirth is called transition, and it is particularly intense. This is the time during which your cervix will dilate from 7 to 10 centimeters. You may feel the urge to push during this phase, but you'll be advised to resist. Pushing before your cervix is fully dilated can injure it and the perineal tissues, and it may lead to heavy bleeding.

Pushing and Birth

The second stage of childbirth, the pushing stage, culminates in the birth. This stage lasts from 15 minutes to 3 hours or more. The nature of your contractions may change during this stage. They will likely be spaced farther apart, and they'll be accompanied by a reflex need to strain or grunt, which comes and goes three to five times per contraction. The combination of the uterine contraction and your bearing-down effort pushes the baby closer to the outside. It is hard work and it hurts, but it is also an exciting time. And this childbirth stage comes with a reward: the birth of your baby!

Expelling the Placenta

Your work isn't over, though, when the baby is born. There's one more stage of childbirth, one more job you have to do--and that's expelling the placenta. This stage usually lasts from 5 to 30 minutes. A nurse or other caregiver will keep a hand on your abdomen to determine when the placenta separates from the uterine wall. Then you will be asked to push it out. You may feel some cramps, but the discomfort is usually minimal. Once the placenta is passed, childbirth is over.

Labor pain differs from other kinds of pain in ways that make coping easier. 

How does labour pain different from other types of pain

Labour pain:

Is not a symptom of injury or illness: When pain signals that something is wrong, anxiety can increase painful sensations. Labour pain, however, is simply a sign that your body is working hard and well.

Is self-limiting: Labour rarely takes more than 24 hours.

Is rhythmic: Contractions last no longer than a minute or so and come in a regular pattern with one to several (usually) pain-free minutes in between them. This means you can predict and prepare for each contraction and rest between them.

Intensifies gradually over time: Contractions almost always start off mild and gradually grow longer, stronger, and closer together, thus allowing you time to adapt.