Signs of labor: Know what to expect

On television, babies are often born with a rush of emotion and swift action. The mother doubles over from the pain of a single contraction, and the baby appears before the commercial break.

In reality, labor usually begins less dramatically.

No one knows for sure what triggers labor — and every woman's experience is unique. But understanding the typical signs of labor can help you know what to expect as your due date approaches.

Effacement: Ripening of the cervix

One of the first signs of labor is your cervix softening and thinning, or effacing. You won't feel this preparation for labor happening. Instead, your health care provider will check for signs of cervical change with vaginal exams.

Effacement is often expressed in percentages. When you're 50 percent effaced, your cervix is half its original thickness. Your cervix must be 100 percent effaced, or completely thinned out, before a vaginal delivery.

Dilation: Opening of the cervix

Another of the early signs of labor is your cervix beginning to open, or dilate. Your health care provider will measure the dilation in centimeters from zero to 10.

At first, these cervical changes may be very slow. In fact, some women are dilated 2 to 3 centimeters for days or even weeks before labor actually begins. Your progress isn't a good indicator of when labor will begin, but rather a general sign that you're getting ready for labor. Once you're in active labor, expect to dilate more quickly.

Bloody show: Loss of mucous plug

During pregnancy, a thick plug of mucus blocks the cervical opening to prevent bacteria from entering the uterus. When your cervix begins to thin and open, this plug may be discharged. You may notice stringy mucus or a thick discharge. It's typically brown and sometimes tinged with blood.

Losing the mucous plug is among the telltale signs of labor, but it's not a guarantee. Labor may still be days away.

Nesting: Spurt of energy

You might wake up one morning feeling energetic, raring to attack dust bunnies under the couch, set up the crib and arrange your baby's outfits according to color. This urge to clean and organize is commonly known as nesting. No one knows for sure, but it may be a primal instinct that hearkens back to a time when physical preparation was necessary for a safer childbirth.

Nesting may begin months before your due date, but the instinct is usually strongest just before delivery. Do what you must, but don't wear yourself out. Save your energy for the harder work of labor ahead.

Rupture of membranes: Your water breaks

The amniotic sac is a fluid-filled membrane that cushions your baby in the uterus. Sometimes the sac leaks or breaks before labor begins. If this happens, you may notice a trickle of fluid or a more obvious gush.

If your water breaks at home — or if you're uncertain whether the fluid is amniotic fluid, urine or something else — consult your health care provider right away. He or she will evaluate you and your baby to determine the next steps.

If the amniotic sac is no longer intact, timing becomes important. The longer the membranes are ruptured, the greater the risk of developing an infection. If labor doesn't begin on its own, your health care provider may need to induce your labor.

In the meantime, don't do anything that could introduce bacteria into your vagina. Sex isn't a good idea if you think you might be leaking amniotic fluid.

Contractions: When labor pains begin

During the last few months of pregnancy, you may experience occasional, painless contractions — a sensation that your uterus is tightening and relaxing. These are called Braxton Hicks contractions. They're your body's way of warming up for labor.

As your due date approaches, Braxton Hicks contractions may become stronger or even painful. Eventually, Braxton Hicks contractions will be replaced by the real thing. To tell the difference, ask yourself these questions:

• Are the contractions regular? Time your contractions from the beginning of one to the beginning of the next. Look for a regular pattern of contractions that get progressively stronger and closer together. The contractions of false labor will remain irregular.
• How long do they last? True contractions last more than 30 seconds at first and get progressively longer — up to 90 seconds. The contractions of false labor vary in length.
• Can you stop the contractions? True contractions continue regardless of your activity level or position. In fact, they often grow stronger with increased activity, such as walking. With false labor, you may be able to stop the contractions by changing your activity or position, lying down or taking a walk.

Expect false alarms

The boundary between your body's preparation for labor and the actual process of labor isn't always clear. Some women have painful contractions for days with no cervical changes. Others feel only a little pressure or a backache as the cervix gradually dilates.

Don't hesitate to call your health care provider if you wonder whether you're in labor. Preterm labor can be especially sneaky. If you have any signs of labor before 36 weeks — especially if they're accompanied by vaginal spotting — see your health care provider for an exam.

At term, labor will nearly always make itself apparent. If you arrive at the hospital in false labor, don't feel embarrassed or frustrated. Think of it as a practice run. The real thing is sure to be on its way!