Labour is one of those events that people describe as unmistakeable once it happens — but spend considerable time before it happens worrying they will either go to hospital too early and be sent home, or miss the window and give birth in the car park. Both concerns are understandable and both reflect real experiences that happen to real people.
The key insight is that early labour is slow and that most people have more time than they fear. Contractions are not a single event; they start mild, irregular, and manageable, and build gradually. Unless circumstances warrant earlier contact — waters breaking, heavy bleeding, reduced movements, or a very rapid labour following a previous fast delivery — the standard guidance is to wait until contractions are five minutes apart, lasting a minute, for an hour before heading in.
Healthbooq (healthbooq.com) covers pregnancy, birth, and early parenthood.
Prelabour Changes
In the days and weeks before labour begins, the cervix gradually softens, thins (effaces), and begins to dilate. These changes are not felt as pain but may cause increased vaginal discharge, a feeling of pressure in the pelvis, and Braxton Hicks contractions (irregular, often painless tightenings that do not increase in regularity or intensity — these are practice contractions and not labour).
The "lightening" or "dropping" that many women describe in late pregnancy — a sense that the baby has moved lower and breathing is easier — reflects the baby engaging in the pelvis, which can happen weeks before labour in first pregnancies.
The Show
A show is the discharge of the mucus plug that has sealed the cervix during pregnancy. It appears as a jelly-like discharge, sometimes clear, sometimes tinged with pink or brown blood. It can occur several days before labour begins, or during early labour itself. A show on its own does not mean labour is imminent — it is a sign that the cervix is changing.
Heavy, bright red bleeding is not a show. This requires immediate contact with the maternity team or emergency services.
Contractions
Early labour contractions (the latent phase) are often irregular, mild, and may feel like period pains or backache. The latent phase can last many hours or days, particularly in first labours.
Active labour is generally defined as contractions occurring regularly every five minutes or less, lasting around 45 to 60 seconds, and progressively intensifying over an hour or more. The 5-1-1 rule (every five minutes, lasting one minute, for one hour) is a commonly used heuristic for when to contact the maternity unit.
Second and subsequent labours typically progress more quickly. Women who had a rapid first labour should call the maternity unit earlier in the process.
Waters Breaking
The rupture of membranes (ROM) can occur before contractions begin (premature or pre-labour ROM) or during labour. The fluid may be a large gush or a slow trickle. Leaking fluid should always be reported to the maternity team — it is not always easy to distinguish amniotic fluid from increased vaginal discharge or urine.
When membranes rupture before labour, the standard guidance is to contact the maternity team within an hour. The team will advise on the colour of the fluid (blood-stained = worrying; green-stained with meconium = worrying; clear = normal), check for signs of labour beginning, and discuss the plan for induction if labour does not start within a defined period (usually 24 hours for Group B Strep-negative women, earlier for those who are GBS-positive).
Cord prolapse (the umbilical cord coming out ahead of the baby) is a rare emergency that can occur when membranes rupture, particularly if the baby is not engaged. If there is a sensation of something in the vagina, or an unusual pulsating sensation, call 999 immediately, adopt a knee-to-chest position, and do not push.
When to Call Immediately
Contact the maternity unit immediately (not the GP) or call 999 for: heavy fresh bleeding, fluid green or brown with meconium, suspected cord prolapse, a seizure or fitting, severe headache with visual disturbance (possible eclampsia), reduced or absent baby movements in late pregnancy, or any sudden severe pain.
Hospital Bag
Packing a hospital bag before 37 weeks is advisable. Standard contents include: maternity notes, birth plan, nightwear and dressing gown, slippers, comfortable clothes for after birth, toiletries, snacks and drinks, phone charger, baby clothes and car seat, nappies, and any medications.
Key Takeaways
The signs of labour include regular contractions that increase in frequency and intensity, a show (blood-stained mucous plug discharge), and waters breaking. Not all of these need to occur, and their order varies. The general guidance for low-risk first-time mothers is to contact the maternity unit or labour ward when contractions are regular, lasting about a minute, and coming every five minutes for an hour. Waters breaking before contractions (premature rupture of membranes) requires contact with the maternity team within an hour, as there is a small risk of cord prolapse and a time-limited window before infection risk increases. Certain symptoms require immediate emergency contact: heavy bleeding, suspected cord prolapse, baby not moving, or fitting.
