Your body actually starts preparing for labor up to a month before you give birth. You may be blissfully unaware of what's going on — or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
You note more Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens (see below) and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. But if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called false labor.
Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks contractions may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts, but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor is imminent.)
When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that has sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor.
The plug may come out in a lump or as increased vaginal discharge over the course of several days. The mucus may be tinged with brown, pink, or red blood, which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some blood-tinged discharge, even when labor isn't going to start in the next few days.
Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby's more likely to get an infection without the amniotic sac's protection against germs.
How can I tell whether my labor has actually started?It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks.
It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together.
In some cases, though, the onset of strong, regular contractions comes with little or no warning. It's different for every woman and with every pregnancy.
When should I call my doctor or midwife?Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center.
These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — as well as on your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job.
And the truth is, your caregiver can tell a lot by the sound of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, and whether or not you think you might be in labor, be sure to call your caregiver right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, which is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby is less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), constant severe abdominal pain, or fever.
• You start having contractions before 37 weeks or any other signs of preterm labor.
• You have severe or persistent headaches, vision changes, intense pain or tenderness in your upper abdomen, abnormal swelling, or any other symptoms of preeclampsia.
Some women assume that various symptoms are just part and parcel of being pregnant, while others worry that every new symptom spells trouble. Knowing which pregnancy symptoms you should never ignore can help you decide when to call your caregiver.
That said, every pregnancy is different and no list can cover all situations, so if you're not sure whether a symptom is serious, or if you just don't feel like yourself or are uneasy, trust your instincts and call your healthcare provider. If there's a problem, you'll get help. If nothing's wrong, you'll be reassured.