Signs of labour: when to go in

Labour has a way of starting gradually and then becoming unmistakable. The challenge in the early stages is distinguishing real labour from Braxton Hicks contractions, and knowing at what point to call your midwife or head to the labour ward.

This article covers the sequence of signs, how to tell true labour from false alarms, when to call, and — critically — which symptoms require calling immediately regardless of where you are in the process.

Early signs that labour is approaching

These signs often appear in the days or week before active labour, but not always. Some people get all of them; some get none and labour starts without warning.

Lightening (baby "dropping") — in the weeks before labour, the baby's head descends into the pelvis (engages). You may notice less pressure under your ribs, easier breathing, and more pressure low in the pelvis. This happens weeks before labour in first pregnancies, but sometimes not until labour begins in subsequent ones.

Mucus plug (show) — a jelly-like plug of mucus seals the cervix during pregnancy. As the cervix begins to soften and dilate, this plug can come away as a pink or blood-streaked discharge. It may come away days before labour, or at the start of it. Losing your mucus plug on its own is not a reason to call the labour ward, but mention it to your midwife.¹

Loose bowels — many people experience diarrhoea in the 24–48 hours before labour as the body prepares. Common, normal, and not dangerous.

Irregular contractions — early or "latent" labour often begins with irregular tightenings that come and go. They may feel like period pains or a tightening across the abdomen.

True labour vs Braxton Hicks

Braxton Hicks contractions are practice contractions that most pregnant people feel from mid-pregnancy onward. They are real — they are a genuine tightening of the uterus — but they are not labour.¹²

The reliable test: lie down, drink water, change position. Braxton Hicks usually ease. True labour contractions continue and intensify.

Timing contractions: the 5-1-1 and 4-1-1 rules

Once contractions become regular, start timing them. Two common guidelines for when to head to the labour ward or birth centre:

4-1-1 rule (commonly used for first labours): contractions are 4 minutes apart, lasting 1 minute each, for at least 1 hour.²

5-1-1 rule: contractions are 5 minutes apart, lasting 1 minute each, for at least 1 hour.

Your midwife or birth unit may give you a specific number to work to. Follow their guidance if it differs from the above.

For first labours, the early stage (latent phase) can last hours or days. You are typically advised to stay home during this phase — it is more comfortable, and the cervix is not yet dilated enough for birth to be imminent. Call your midwife for reassurance and advice if you're unsure.

Subsequent labours are faster. The latent phase is usually shorter, and active labour progresses more quickly. If this is not your first baby, call the labour ward earlier rather than later.

When to call immediately — emergency warning signs

The following signs require calling your midwife or labour ward without waiting, at any stage of pregnancy:

Your waters break with green or brown fluid. Clear or pale pink is normal. Green or brown fluid means the baby has passed meconium (their first stool) into the amniotic fluid — a sign of possible fetal distress. Call the labour ward immediately.¹³ Do not wait to see if contractions start.

Reduced or absent fetal movements. You should continue to feel your baby move throughout labour. If you notice your baby's movements have slowed, stopped, or feel different at any point, call your maternity unit immediately.¹³ Do not wait until your next appointment. Do not rely on a home Doppler to reassure yourself.

Bleeding heavier than light spotting. Some spotting after a vaginal examination or after losing the mucus plug is normal. Fresh red bleeding, or any bleeding you're uncertain about, requires a call to the labour ward immediately.¹

Severe headache with visual disturbance. A severe headache, blurred vision, flashing lights, or sudden facial swelling can indicate pre-eclampsia — a serious pregnancy complication involving high blood pressure.³ These symptoms warrant an immediate call to your maternity unit, or calling 999 if you cannot reach them quickly.

Any symptom you are uncertain about. Labour wards are there to advise, not to judge. If something feels wrong, call.

Waters breaking

Your waters (amniotic sac) can break before labour starts, during early labour, or not until well into active labour. It may be a dramatic gush or a slow trickle that is easy to mistake for urine.

If your waters break before contractions start, call your midwife or labour ward.¹ They will advise on timing and what to watch for. Most people go into labour within 24 hours of their waters breaking; if labour does not start, induction will typically be offered due to the infection risk that increases once the membranes are ruptured.²

Note the time, the colour, and the volume. Any greenish or brownish tint: call immediately.

Your hospital bag

If your due date is within a few weeks, your hospital bag should already be packed. There is rarely time to pack calmly once active labour begins. If you haven't sorted it yet — now is the time: Hospital bag checklist.

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Also in this cluster: Hospital bag checklist · Birth plan overview

Sources

1. NHS. "Signs That Labour Has Begun." NHS, 2024. https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/signs-that-labour-has-begun/
2. American College of Obstetricians and Gynecologists. "How to Tell When Labor Begins." ACOG, 2023. https://www.acog.org/womens-health/faqs/how-to-tell-when-labor-begins
3. NHS. "When to Go to the Maternity Unit." NHS, 2024. https://www.nhs.uk/pregnancy/labour-and-birth/signs-of-labour/when-to-go-to-the-maternity-unit/