Signs of Labor: 8 Early Indicators You Should Know

The last days before birth - noticeable hormonal changes

You are on the most exciting journey of your life - a new family member will soon come into the world. Certainly, emotions are running high, ranging from anticipation to nervousness and even fear, all emotions are possible and above all quite normal. Even a planned cesarean section evokes the same feelings before birth, while with a spontaneous delivery, questions about the "when" and "how" arise. Long pregnancy blog articles and birth forums about possible signs of labor are studied, and conversations with other mothers are sought to find out what experiences they have had at the onset of labor. However, it should be noted at this point: Just as no pregnancy is the same as another, so is each birth and its onset a very individual, standalone event. Therefore, how you feel just before birth and what signs you will have on the day of delivery cannot be predicted in detail.

However, it is a fact that a hormonal change takes place shortly before birth, which is noticed by many women through physical signs. Here, among others, the following hormones play a major role, which always act in a complex interplay on the female body:

• Progesterone, also known as the corpus luteum hormone, inhibits uterine muscle activity during pregnancy to prevent premature contractions. Shortly before birth, the progesterone level decreases to stimulate contractions. Progesterone has a calming, sometimes tiring effect during pregnancy. The decrease in this hormone before birth could have an invigorating effect on pregnant women, which may manifest, for example, in a certain restlessness or a desire for activity.

• The level of the "female" hormone estrogen reaches its peak at the end of pregnancy; this is also considered the greatest stimulus for birth, as it increases sensitivity to the hormone oxytocin. Estrogens signal to the body that it is ready for contractions and thus for delivery. Many women also feel the increased estrogen level through swelling in the feet and mood swings before birth.

• Oxytocin, also known as the bonding hormone, triggers contractions of the uterus during birth. The oxytocin level rises sharply during birth. At the same time, the hormone promotes the release of prostaglandins, which as effective signaling molecules intensify the spasmodic contractions of the uterus. During birth, the release of oxytocin can help with pain management and promote positive feelings, while after birth, it plays a major role in strengthening the mother-child relationship.

• Prolactin is responsible, among other things, for stimulating milk production after birth; it also rises sharply towards the end of pregnancy and prepares the expectant mother for breastfeeding.

• The hormone relaxin loosens ligaments and tissues in the pelvic area throughout pregnancy. It is also the cause of loosening of the symphysis, which causes some pregnant women uncomfortable but harmless pain in the pelvic area. Symphysis loosening is particularly noticeable before birth or can worsen in the days leading up to it. At the end of the third trimester, relaxin loosens the cervix to facilitate the birthing process. Shortly after birth, the relaxin level decreases again so that ligaments and tissues can return to their original state.

Finally, the change in hormone levels is also responsible for a variety of possible signs of impending birth. These can manifest in various physical symptoms, which some women perceive as very strong, while others hardly notice these changes. Possible signs of labor are perceived differently by women expecting their second child than by first-time mothers embarking on the journey of birth for the first time. The gynecologist's office as well as your attending midwife are the first choice for discussing changes and possible discomforts before delivery and clearing up any uncertainties.

The 8 most common signs of birth

In the following, we would like to discuss 8 symptoms or signs that many expectant mothers have clearly noticed shortly before birth and often indicate an imminent birth.

1. Braxton Hicks Contractions

Braxton Hicks contractions, also known as false labor, are responsible in the last trimester of pregnancy for the baby moving deeper into the pelvis and into the correct position for birth. They soften the cervix, but do not open it. When the belly drops depends on whether it is the first pregnancy or a subsequent pregnancy. While first-time mothers may feel Braxton Hicks contractions from the 36th week of pregnancy, women who have already had one or more births usually feel Braxton Hicks contractions much later, as the baby sits lower than in first-time mothers. From the first Braxton Hicks contractions to birth, several more weeks can pass.

The symptoms of Braxton Hicks contractions are often described as menstrual-like cramps, radiating from the groin area. For many women, the preparatory contractions are also associated with more frequent urination. To distinguish Braxton Hicks contractions from real contractions, or labor contractions, it is important to pay attention to the intervals and intensity of the Braxton Hicks contractions. False labor contractions are always irregular, so they do not repeat in a specific pattern and also vary in their intensity of pain. While some women feel Braxton Hicks contractions several times a day, others notice the preparatory contractions only occasionally. A relaxing bath or a break on the sofa usually calms the Braxton Hicks activity. This is also a good test to find out whether it is Braxton Hicks contractions or real contractions. Braxton Hicks contractions do not start labor, but gradually prepare the body for the impending delivery and thus signal the end of pregnancy.

Assessment of this sign of labor: Possible sign of impending labor. Prepares for birth in the last trimester, but birth may still be days or weeks away. In a resting position, it can be determined whether it is just Braxton Hicks contractions or already real contractions.

2. Stabbing in the vagina or on the cervix

Many women feel a stabbing sensation in the vagina or on the cervix towards the end of pregnancy. Often, this is related to the lightening that occurs around the 36th week of pregnancy, when the baby is moving more into the correct position, namely from the sacral promontory towards the pubic bone, putting pressure on the cervix. During this time, cervical ripening also occurs, the tissue becomes softer, and the cervix gradually shortens.

Just before birth, the stabbing sensation on the cervix often increases and also radiates to the back. These symptoms can be an indicator of an impending birth, as in addition to the stabbing sensation, regular contractions often occur, which can be clearly distinguished from irregular contractions.

Assessment of this sign of labor: Possible precursor to labor. Associated with lightening.

3. Diarrhea & Nausea

Many women report experiencing diarrhea and/or nausea and vomiting a few days before or on the day of giving birth; often, contractions start shortly afterwards. Midwives also refer to this process as a cleansing process, as the body wants to get rid of unnecessary burden before birth. However, diarrhea is not always a definite sign of an imminent birth, as some women in the third trimester generally tend to have loose stools or diarrhea due to the increased activity of the uterus.

Assessment of this sign of labor: Possible sign of impending birth. In case of severe diarrhea without contractions, medical advice should be sought.

4. Back Pain

Back pain during pregnancy is well known. However, some women report an increase in back pain shortly before birth. Responsible for this can be, on the one hand, the hormone relaxin, and on the other hand, the steadily increasing weight of the child. Back pain as a precursor to birth is often associated with the descent contractions and later with the actual contractions – especially when expecting the first child and the perception of pain from contractions has not been properly assessed yet.

Assessment of this sign of labor: Possible precursor to birth, especially when they turn into real contractions or contractions are mistaken for back pain.

5. Strong fetal movement or suddenly calmer baby before birth

Restless nights are not uncommon before birth and are often related to stronger movements of the baby in the womb. Some women feel particularly strongly the activity of their offspring in the weeks or days before birth. Reasons for this can be:

• Decrease in amniotic fluid: Around the 38th week of pregnancy, the amount of amniotic fluid decreases and fetal movements can be felt more strongly as a result.

• Change in position: Some children only turn into their birth position shortly before birth.

• A high birth weight can also lead to increased activity of the unborn child.

Often, the days before birth are characterized by a rather calm baby in the womb. This is mainly due to the lack of space in the mother's womb and the birthing position: when the baby's head is firmly in the pelvis, the baby automatically has less room to move. It is also assumed in research that the baby calms down before birth to conserve energy. However, this has not been proven.

Assessment of this sign of labor: Possible sign of impending birth - a change in the child's movement pattern may indicate an imminent birth. However, sudden and very intense fetal movements or the opposite should always be discussed with the attending doctor.

6. Mucus plug is released

The mucus plug has an important protective function: it protects the uterus from bacteria and germs that could migrate from the vagina. This helps to prevent possible infections for both mother and child during pregnancy. In the final stages of pregnancy, the mucus plug can detach, for example, when the baby is already deep in the pelvis and ready for birth. For many pregnant women, the mucus plug detaches just before or on the day of birth, accompanied by contractions. However, not all women notice the detachment of the mucus plug, as it often presents itself as a light spotting (also known as show) and can therefore be easily overlooked. Nevertheless, some women also experience that after the detachment of the mucus plug, contractions may still take a few days to start, indicating that birth is not imminent.

Assessment of this sign of labor: Safe precursor to birth when contractions start afterwards. If the mucus plug is released without contractions or pain, it is advisable to wait, as the birth could still start several days later. You and your child are still protected after the mucus plug is expelled. However, to avoid possible infections, many doctors and midwives recommend refraining from having sex and swimming from this point onwards.

7. Amniotic sac ruptures

For many women, the amniotic sac only ruptures during labor, when contractions have already started. However, if it ruptures before contractions begin, many women are unsure whether it is really amniotic fluid or just urine, as the bladder often feels pressure in the last trimester. Only a few report a dramatic gush of amniotic fluid pouring onto the floor when the baby has spontaneously decided to come into the world.

Here it is: While urine has a certain odor and is slightly yellowish, amniotic fluid is always odorless and transparent. If the amniotic sac has ruptured, labor begins for nine out of ten women, as contractions usually start at that point. Occasionally, contractions may be delayed. However, prompt action is still necessary, as the absence of contractions after the rupture of the amniotic sac can lead to a dangerous infection for both mother and child.

Assessment of this sign of labor: Safe sign of impending birth, as the rupture of the amniotic sac definitely signifies the beginning of labor, in case you are not already in the midst of it. If your water has broken, you should promptly contact your midwife and preferably be brought lying down to your birthing center or place of birth.

8. Real contractions or just practice contractions?

There is a strong pulling sensation in the back, a clear pressure on the cervix, and the intervals between the contractions are getting shorter - are these already real contractions? Especially first-time mothers wonder before the upcoming birth how real contractions feel and how they start. One thing in advance: You will definitely notice real contractions. Here is a brief overview:

• Practice contractions or Braxton-Hicks contractions: I am experiencing Braxton Hicks contractions in the 2nd and 3rd trimester at irregular intervals. A tight belly and slight pulling are the symptoms. These "minor" pregnancy contractions subside in a resting position. Between four and ten Braxton Hicks contractions per day are considered normal.

• Braxton Hicks contractions or false labor contractions: From the 36th week of pregnancy, when the child assumes its birth position - also at irregular intervals. Here too, breaks and rest have an effect on the intensity of these contractions - they become significantly less.

• Labor pains or contractions & pushing stage contractions: Usually between the 38th and the 42nd week of pregnancy, in increasingly shorter and regular intervals. The intensity of the pain also increases when lying down.

Real contractions indicate the beginning of labor. If they occur before the 36th week of pregnancy, they are also referred to as premature contractions or preterm labor - in this case, action is needed to prevent a possible premature birth. From the 38th week of pregnancy, the onset of real contractions is a normal process, they can start suddenly, for example, at night, or gradually build up. The feeling of real contractions is described differently from woman to woman: While some pregnant women compare them to very strong menstrual cramps, others feel real contractions more in the back and groin area.

However, real contractions always have one thing in common: their regularity. A good guideline at this point is the 3-1-1 or the 5-1-1 rule. They are a reliable indication of when a woman in labor should go to the hospital when real contractions begin: if contractions occur every 3 or 5 minutes and last at least 1 minute, and this pattern remains constant for about 1 hour, labor has started and the hospital or birthing center should be visited.

Assessment of this sign of labor: Reliable signs of impending birth when they occur regularly and follow a specific pattern for a certain duration.