The signs of true labor

• Lightening: This happens when your baby's head "drops" down into your pelvis. Your belly will suddenly look lower and you'll have an easier time catching breath than you did when your baby was crowding your lungs. The downside, though, is that he's now pressing on bladder, increasing need to urinate. For first-time mothers, lightening usually occurs a few weeks before birth. For veteran moms, it may not happen until labor has begun.
  
• Bloody show: If you have blood-tinged or brownish vaginal discharge, it means your cervix has dilated enough to expel the mucus plug that sealed it for the last nine months. This is a good sign, but active labor may still be days away.
  
• Your baby moves less: Women often notice that their baby is less active the day before labor kicks in. No one is sure why this might be, but one theory is that the baby is simply saving his energy for the big event. If you notice decreased movement, contact your health care provider.
  
• Your water breaks: When the amniotic sac ruptures, you'll feel fluid leak from your vagina in a trickle or a gush. For most women, contractions follow shortly thereafter. But even if they don't, let your caregiver know as soon as you think your water has broken. In about 1 in 10 women, contractions don't begin on their own within 24 hours. If this happens, your labor may need to be induced, since the likelihood of infection goes up once your baby's sterile bubble bursts. For other women, the amniotic sac doesn't rupture until labor is well underway.
  
• Diarrhea: If you feel a frequent urge to empty your bowels and your stools are looser than normal, labor may be imminent.
  Nesting: There's no scientific proof linking it to the onset of labor, but plenty of mothers-to-be are gripped by a sudden urge to "nest" -- to vacuum the entire house at 3 a.m., say, or put those last, finishing touches on the nursery -- right before labor begins.

False Labor

Most expectant mothers feel mild contractions before they're actually in labor. These are called Braxton Hicks contractions. It can be hard to distinguish Braxton Hicks contractions from the real deal, especially if you're near your due date. If contractions aren't causing your cervix to dilate, though, it's known as "false" labor. While true labor contractions get longer, stronger, and closer together as time goes on, false labor contractions tend to be:

• Irregular: Braxton Hicks contractions are sporadic, have no predictable pattern, and usually stop if you rest or change positions.
  
• Felt in your belly and your groin: True labor contractions, on the other hand, usually "wrap around" from your back to your belly. If Braxton Hicks contractions are making you uncomfortable, take a warm bath and drink plenty of fluids to ease discomfort.

Calling Your Caregiver

Alert your caregiver if you feel increasing pelvic pressure, have vaginal bleeding or heavy discharge, or notice a marked decrease in your baby's activity. She can talk you through these changes and decide if you need to come in for an exam.

And, of course, let your health care provider know when regular contractions begin. These may feel like your uterus is "knotting up" and be relatively painless at first, but gradually build in intensity, starting the top of your uterus radiating through your belly and lower back. Your caregiver will want to know what other symptoms you're feeling, how far apart your contractions are, and whether you can talk during them.

Once labor has started in earnest, when should you go to the hospital? Every situation is different, so talk to your caregiver well ahead of delivery day about the best plan for you. In general, though, expectant mothers should head to the hospital when their contractions are too painful to talk through, last 60 seconds or more, and have been coming three to five minutes apart for at least an hour. If you’re not sure, call your health care provider and talk with them about when to come in.

Preterm Labor

Review Date: 2/20/2007
Reviewed By: Douglas A. Levine, MD, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY. Review provided by VeriMed Healthcare Network.

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