You’re probably reading this wondering what the final stretch will be like for you. You’ve read about labour in pregnancy or seen it played out in movies, often in exaggeration. But the real deal will always be different for everyone.
To help you shake off some of the jitters, we’ve answered some of the common concerns expectant moms have about labour. This includes how it feels like, how long it will last and how to know if it’s the real deal or a false alarm.
1. Does labour mark the beginning of the end?
Labour marks the final stretch of pregnancy that can be an exciting or an anxiety-provoking experience for expectant moms. It is a unique experience that warrants a good amount of preparation.
So let’s start with the basics. Typically, a full-length pregnancy is 280 days or 40 weeks. Most women give birth between 38 to 41 weeks of pregnancy. However, one can never predict precisely when labour will start. That being said, even your due date has some wiggle room of about two weeks.
2. What happens during labour?
Labour has three stages. Your cervix opening up marks the beginning of this pregnancy milestone, which is a process called dilation. It is also how the doctor or midwife tracks the progression of labour and it can be quick or slow depending on how long it takes for the cervix to open.
When you feel regular uterine contractions, your abdomen will feel hard to the touch and the cervix will start to dilate. Full cervical dilation is at 10 centimetres, which is enough to accommodate the passage of the baby’s head into the vagina.
The first stage has three phases, which is defined by the following changes:
The latent phase occurs when the cervix is softening and shortening (effacing). The contractions can be quite irregular and only occasionally vigorous. There may not be much cervical dilation change in this phase and it can last for hours to days especially in a first time mother.
The active phase is usually the most prolonged phase of labour. This is when patients are in established labour with cervical dilation of more than 3-4 cm with regular contractions and the cervix is progressively dilating with the contractions.
The transition phase is when contractions are powerful, lasting about 60 to 90 seconds, and you likely will feel the urge to push as the head descends further down the pelvis. The cervical opening is about 8-10 centimetres.
The first stage is the longest one. For first-time mothers, established labour can last from 12-18 hours on average from the active phase. For women who have given birth before, labour typically lasts 8-10 hours. This experience will be different for every woman. Also, it may be different for every pregnancy you will have.
In the second stage of labour, the cervix has fully opened and ends with the baby’s birth. This is called the “pushing stage” because it is when you will be involved in pushing the baby through the birth canal. This stage is shorter than the first, usually taking about 30 minutes to two hours for a woman’s first pregnancy.
You enter the third and final stage of labour when you deliver the placenta, which is the organ that nourishes the baby inside the uterus. This stage only lasts for a few minutes.
Keep in mind that each labour experience is different and the amount of time will also vary. For example, it may take longer for first-time mothers but it will be generally shorter for subsequent pregnancies.
3. What are the early signs of labour?
Before all the action, specific changes occur which signal the beginning of labour. You will notice some of these subtle physical signs hours or days earlier and these will indicate that labour is coming soon. These changes include:
• Passage of a mucus plug
• Your bag of water breaks
4. What is lightening?
Towards the end of the third trimester the baby settles or lowers into your pelvis. This is called lightening and can relieve the pressure from your diaphragm, allowing you to take deeper breaths. Consequently, it can also increase lower pelvic pressure. It can start a few weeks to a few hours before active labour begins.
5. What is a mucus plug?
When you become pregnant your cervix is sealed by a mucus plug, much like a cork barrier. It prevents bacteria or infections from entering the uterus and reaching the baby.
The cervix begins to dilate days before active labour starts and the plug is pushed out of the vagina, sometimes as a single blob of pinkish jelly or in blood-tinged pieces. Your doctor may call this a “bloody” show. It’s your body telling you that your cervix is starting to open!
However, if you observe that you’re losing more blood, it may signify that something is wrong. If that happens, call your doctor immediately.
6. What happens when your bag of water breaks?
Your baby grows inside an amniotic sac in the womb. When the sac breaks, the fluid comes out, observed as a sudden gush of liquid or a trickle. When this happens, call your OB’s clinic and follow their instructions. If you have tested positive for Group B streptococcus in your pregnancy, you will need head to the hospital to be administered antibiotics given through the vein (intravenous) to reduce transmission to the baby as it is exposed to the vaginal bacteria once the membranes have ruptured.
Seek medical help immediately if:
• you’re bleeding heavily
• you’re less than 37 weeks pregnant
• your bag of water breaks and the colour is green
• your baby is moving less than usual
7. How does pregnancy contractions feel like?
Pregnancy contractions cause discomfort or a dull ache in your back and lower abdomen accompanied by pressure in the pelvis. Some describe it to be like strong menstrual cramps or waves of diarrhoea cramps.
Contractions are triggered by the hormone oxytocin which stimulates the uterine muscles to tighten and relax. It’s your body’s way of helping you to push the baby down the birth canal.
However, having contractions doesn’t always mean driving right down to the hospital or birthing centre. Generally, your doctor may advise you to stay at home until your contractions become frequent. Heading to hospital is advisable in the following instances:
• your contractions are in a regular pattern and increasing intensity
• your contractions last at least 60-90 seconds
• your contractions come every 5 minutes regular for an hour
8. What are Braxton Hicks contractions?
Braxton Hicks contractions are tightening in your belly, starting at the top of your uterus and spreading downwards. These sporadic contractions and uterine muscle relaxation often last for about 30-60 seconds, sometimes as long as two minutes. It is sometimes mistaken as labour pains but it’s more like “practise contractions” that can range from an uncomfortable tightening to a sensation that can be very painful.
Some women feel Braxton Hicks in the second trimester, while others notice it in the third trimester. But it occurs more frequently as you near your due date, and it usually causes false alarms.
Braxton Hicks contractions are triggered by the following:
• A full bladder
• Sexual intercourse
• Increased activity level by the mother
You can alleviate these contractions by
• Changing positions
• Taking a warm bath for 30 minutes or less
• Ensuring that you are well hydrated
• Taking a break and getting enough rest
Check the table below to know if the sensation you’re feeling is false labour or the real deal. But if you’re unsure of the symptoms, it’s always best to talk to your doctor right away.
9. What is preterm labour?
Preterm labour starts before 37 weeks of pregnancy. Going into preterm labour doesn’t necessarily mean that you will have a preterm birth. This situation requires immediate medical attention.
In some cases, preterm labour can stop on its own. Some treatments can delay the birth or reduce the risk of complications in preterm births in cases where it still progresses.
10. Who is at risk for preterm labour?
Preterm labour can happen to anyone but some factors may increase the risk. It may include the following:
• Preterm birth in a previous pregnancy
• Having a short cervix early in pregnancy
• Current pregnancy complications or multiple pregnancy (twins/triplets)
• Past gynaecological conditions or surgeries to the cervix
• Lifestyle factors
11. How should I prepare for labour?
Preparing for labour can be part of your birth plan, which outlines the care you prefer when the baby comes. In it, you can detail the following items:
• The instances when it should be suitable to call your OB-GYN or other obstetric care providers
• How to reach them
• Whether to call first or go directly to the hospital
• And what special steps to take if labour has begun
Travel time is also an essential consideration as you plan for labour. Start by determining how far you live from the hospital and how long it will take for you to get there. It is better that you rehearse going to the hospital to get a good sense of how long it will take you to get there. Take note of rush hour traffic and alternative routes.
Make sure that you have already prepared the essentials. The American College of Obstetricians and Gynecologists (ACOG) suggests the following:
• Pack for the hospital and leave your bag in a handy place.
• Plan for who will care for your other children, pets and home while in the hospital.
• Make sure that you have a car seat for the baby that is installed properly.
• Already plan your leave for work.
12. How do you cope with labour pains?
Pain is the hallmark of labour. But how much you will feel is hard to predict because everyone is different. Our tolerance also varies. Even if you’ve had previous pregnancies, it might be different this time around.
There are several ways to manage labour pains. But to be safe, talk it over with your doctor so they will know what you want and you will know the options you have.
You can read pain management techniques that can help labour to be more bearable in our blog here.
The last stretch can be one of the most challenging parts of this journey, but it’s one that you can prepare for. If you have related concerns or have not started your prenatal sessions yet, you may schedule a consultation with Dr Pamela Tan.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.