How do I know if I am in labor?

Dr. Carlos Monsalve, Creafam maternal care expert, teaches us how to identify the signs of true labor, clarifying some myths and advice for the 8th month of pregnancy.

Before starting, remember that the first recommendation is to take a birth preparation course.

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Something that happens to many new mothers is that just when the eighth month begins, something suddenly clicks and they realize that there is very little left until delivery, then all the excitement and joy of pregnancy turns into anxiety. . Any slight pain or strange sensation makes them think that they are already in labor. Please take a deep breath. We are going little by little and we are going to see the clearest signs to identify true labor. Remember that #KnowledgeIsPower.

Surely your doctor has already given you a calculated due date. If you don’t have one, the first step would be to go to the page and write down your last period date so that you know the due date. Even though only 5% of women give birth at exactly 40 weeks, having this date will give you a clear idea of roughly when your baby will arrive.

Symptom 1: Your baby's position

Around week 36 the baby adopts a prone position and his head fits into the mother’s pelvis. Once he adopts this position everything is ready to trigger labor, however, it is important to know that if the baby is already face down before week 36 does not mean that it is already going to be born. Throughout the pregnancy the baby is going to move and change position a lot but reaching week 36 it will stay in that position… Whatever position it is in, the ideal is for it to be face down and it will no longer move. to change position. Now, how do you know if she is already in position? Well, usually moms report that they can suddenly breathe a little easier or that they can feel like their baby is lodged in the lower part of the pelvis, some moms may start to feel brief stings or pricks in the vagina, some It gives them the feeling that the baby wants to come out. They will feel this especially when they walk or when they stand for a long time, but as a doctor, I would obviously recommend performing an ultrasound to confirm that the baby is positioned well.

If it is past week 36 and the baby is still not face down, it is very unlikely that it will be able to turn again, so the most likely thing is that the baby will already remain in that position until it is born, then, we have We must be prepared for a breech birth, which is currently not recommended; what would be recommended would be to be born by cesarean section.

Symptom 2: The mucous plug

Symptom number 2: Expulsion of the mucous plug. During pregnancy, the cervix is covered by a mucous layer. This layer insulates the inside of the uterus, protecting it from infections and any harmful elements. Each woman is unique and in some it is a very thick and dense layer, in others it is a little thinner and lighter, but if in the last month of pregnancy they notice that they expel a little mucus, it is probably this plug that is released. To prepare the birth canal, don’t worry, the cervix will remain completely closed for a few more days. There are even many mothers who never notice this symptom because it happens just when they are showering or when they go to the bathroom or until the day of delivery.

Symptom 3: Contractions

Symptom number 3: Contractions. Uterine contractions are one of the best-known signs of labor, but they are also one of the symptoms that can most easily be confused with another type of contractions called “Braxton Hicks contractions.” Braxton Hicks contractions can appear from the beginning of the third trimester, you feel that your belly becomes hard, very hard, especially in the lower part of the abdomen, perhaps like a cramp or colic.

These false contractions can last a long time but they only occur sporadically and there is no need to be alarmed, it is the uterus exercising and preparing to give birth. The true contractions of labor are not felt only in the lower abdomen but radiate towards the back and legs, enveloping the entire belly, which becomes as hard as the forehead. At first they last a short time, about 5 or 10 seconds, maybe 20 at most, but little by little they last longer and the period between one contraction and another also becomes shorter. At first you may feel one or two per hour, when you already feel one every ten minutes or the pain is very intense, it is time to go for an evaluation with your gynecologist.

Symptom 4: Water Break

Symptom number 4: Water breakage. Thanks to movies and television series, the vast majority of us are familiar with that moment when a jet of liquid suddenly comes out and that’s it! The mother and everyone around her realize that the time for delivery has arrived, but in real life it is not always so obvious. Usually rupture of membranes occurs during labor but on some occasions it can occur before this period and this would be an indication to perform an induction of labor.

The most common thing is that the membrane has a sudden rupture, that is, it bursts like a balloon and they become wet up to their ankles, but on other occasions the rupture is high and can be confused with a flow or spotting.

That’s why moms, as I have already said in several videos, no bleeding is normal during pregnancy. From the eighth month onwards, if you have a clear and constant flow, even if it is very slight, there is a possibility that the uterine membranes have ruptured and that this flow is actually amniotic fluid that is leaking from the uterus. If you notice fluid leaking continuously or if it has been appearing and disappearing for a couple of days, you should go to the doctor immediately.

With crystallography, which is a study in which the fluid is allowed to dry and we observe it under a microscope, we can confirm if it is amniotic fluid. If so, labor may already have begun or we may need to induce it, don’t worry, at Creafam you are in good hands.

The best way to prevent premature birth and early rupture of membranes, that is, a rupture before the 37th week of pregnancy, is to avoid infections. Remember that the general urine test is a simple and inexpensive study that must be performed regularly and if an infection is detected, it must be combated by following the doctor’s instructions to the letter.

Symptom 5: Dilation of the cervix

Throughout pregnancy the cervix closes completely, but at the time of delivery it begins to dilate or open. Usually the doctor performs a vaginal examination to measure the dilation, when this dilation is three centimeters we affirm that the mother is in labor, although we still have a little time. The neck dilates one centimeter per hour more or less and if the mother wishes to receive anesthesia, that is, an epidural from 3-4 centimeters of dilation could already be placed, assessing the pain that each patient feels.

Some myths regarding childbirth

Now that we have seen the symptoms of labor, I want to take the opportunity to clarify some myths regarding labor.

  • If I get to the hospital and it’s a false alarm, will they take my baby out by force? No, of course not, calm down. If you get to the hospital and it’s a false alarm, nothing happens! They will examine you and through vaginal examination we can determine if you are already going into labor or not. What is vaginal examination? With the vaginal examination we are going to check the cervix, when there is still no labor it will feel very long, it will feel towards the back and it will be very hard, when you have already started labor, that cervix It will become soft and dilation will begin and it will become central, then there we can determine when you will start your labor.
    Are there massages, exercises or techniques for the baby to change position? Ok, currently only certain exercises are recommended, certain positions for the mother, that is, getting into a crawling position often helps the baby change position. What is no longer indicated at all are the external versions, what midwives used to do: Moving the baby to try to place it upside down when it was actually sitting, that is now prohibited and these types of maneuvers are not allowed to be done.
  • Can I induce labor if I have already reached 40 weeks? Yes, it can be induced but personalizing each patient, because there will be women who are in induction conditions and there will be women who are not in induction conditions. What will it depend on? How she feels clinically, how the baby feels and very important: How the cervix is located to see if the induction is really going to work or not, this assessment will be done by your gynecologist by means of a physical examination. There are other ways to induce labor naturally. One would be nipple stimulation, when you stimulate your nipples, you will release the hormone oxytocin, which is responsible for causing contractions, so reaching week 38, 39, 40 you could start with this type of exercises to favor the induction of labor naturally. There are other myths such as eating spicy food, it will not necessarily induce labor. Sexual relations could induce it but it is not recommended. Why? Because it can cause premature rupture of membranes. Exercise is something natural, going for a walk, going out to do a little exercise can favor these contractions.
  • How to avoid an episiotomy? The episiotomy is the cut that the gynecologist has to make to help the birth of the baby. When is this episiotomy done? This cut is made once the head is about to be born, which is when we call it “it is crowning.” There are times when we as gynecologists can avoid it by doing certain maneuvers, but there are times when it cannot be avoided and it is better to perform an episiotomy than have a tear.
    Since I am a heavyweight, my delivery is going to be easy or vice versa. Don’t worry, the important thing is not whether they are strong or not. Of course, a woman who has more hips will surely have a larger pelvis and then she could have an easier birth, but this is not always the case. There are times where the woman has a wider hip and it is not a good pelvis for the birth of the baby and also many times it will depend on the size of the baby if it is a small baby or it is a very large baby for the pelvis of each woman. .
  • Should I do anything before going to the hospital? Yes, there are certain things that are recommended to get to the hospital. One is, if they started labor at home, that their diet was not with a lot of fat or a lot of flour, especially for the moment of pushing so that there is not going to be a major accident during birth, then if the enemas so that your intestine is cleaner so that at the time of birth your baby will not be contaminated. Shaving, shaving is something optional, it is not necessary, it is not essential, although it is very good for the moment of birth of the baby, to be able to make, if a cut is made, everything is cleaner and prepared for that cut. 15 days before the estimated date of birth, I would recommend that you go to the hospital, especially so that they can tell you what papers you have to bring, so that you don’t get caught in a rush, and have a suitcase prepared in the car so that you don’t get caught in a rush either. .

“Mommies, I hope this video has helped you better recognize the symptoms of true labor. See you at the consultation or until the next video”

Dr. Carlos Monsalve
Dr. Carlos Monsalve
Specialist in gynecology and obstetrics

Perinatology, invasive techniques and obstetric ultrasound.
Hospital Universitario La Fe, Valencia, España.

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