When Should I Call the Maternity Unit? Signs Labour Is Starting and When to Seek Help
One of the trickiest things about labour is that nobody can tell you exactly how it will begin.
Some people wake up with regular contractions. Others notice their waters have broken. Many spend hours wondering whether what they're feeling is actually labour.
So, it's no surprise that many parents ask:
"How will I know when it's time to call the maternity unit?"
You may have spent months preparing for birth, attending antenatal appointments, practising your breathing techniques and packing your hospital bag. But when labour actually begins, it's very normal to suddenly find yourself turning to Google for answers:
What are the signs of labour?
Should I call my midwife yet?
How can I tell if my waters have broken?
What if I notice some bleeding?
How strong do contractions need to be before I call?
The reassuring news is that you don't need to work it all out alone.
Your maternity team is there to help, and if you're worried, uncertain or something doesn't feel right, it's always okay to pick up the phone.
Please remember that this article provides general information and is not personal medical advice. Always follow the guidance given by your own midwife, obstetrician or maternity team.
Signs Labour May Be Starting
Every labour is different, but common signs that labour may be beginning include:
Regular contractions or tightenings
A "show" (loss of the mucus plug)
Lower backache
An increased urge to use the toilet
Your waters breaking
One of the things that can make the start of labour confusing is that these signs don't always happen in a predictable order.
You might have a show several days before labour begins. Your waters may break before contractions start. Or you may simply notice contractions gradually becoming longer, stronger and more regular.
Many parents expect a dramatic moment when they suddenly think:
"This is definitely labour."
In reality, labour often starts much more gradually than that.
When Should I Call My Maternity Team About Contractions?
As a general guide, the NHS advises contacting your midwife or maternity unit if you think you're in labour. You may also be advised to call when your contractions are regular and coming around every five minutes or more often. However, your own maternity team may give you different advice depending on your pregnancy and individual circumstances.
During early labour, contractions are often:
Irregular
Manageable
Further apart
Easier to talk through
As labour progresses, contractions usually become:
Longer
Stronger
More frequent
Harder to ignore or talk through
The most important thing to remember is that you don't need to wait until you're completely certain before making the call.
If you're unsure, call.
Midwives speak to parents in labour every day and can help you work out what may be happening and what to do next.
What Should I Do If My Waters Break?
Despite what films and TV would have us believe, waters don't always break in a dramatic gush.
For many people, it can be:
A slow trickle
Occasional leaking
A sudden release of fluid
Amniotic fluid is usually clear or pale in colour.
If you think your waters have broken, contact your maternity team for advice, even if contractions haven't started yet. You may find it helpful to wear a maternity pad if you're unsure whether you're leaking amniotic fluid or urine. Avoid using tampons.
If the fluid is:
Green
Brown
Blood-stained
Unpleasant-smelling
contact your maternity team urgently.
What Is a Show?
A show happens when the mucus plug that seals the cervix comes away.
It often appears as thick, sticky mucus and may be pink or contain a small streak of blood.
A show can be a sign that your cervix is beginning to prepare for labour. However, it doesn't tell us exactly when labour will start.
For some people, labour follows shortly afterwards. For others, it may still be several days away.
A small amount of blood mixed with mucus can be part of a show, but heavier or fresh bleeding should always be reported to your maternity team.
Changes in Your Baby's Movements: When to Seek Advice
This is one of the most important reasons to contact your maternity team.
During pregnancy, you'll become familiar with your baby's usual pattern of movement.
If you notice that:
Your baby is moving less than usual
You cannot feel them moving
Their normal movement pattern changes
contact your maternity unit immediately.
Don't wait until the next day, and don't wait to see whether things improve.
You are never wasting anyone's time by calling about reduced baby movements.
Your maternity team would always rather assess you and your baby than have you sit at home worrying.
What If Labour Starts Before 37 Weeks?
If you're less than 37 weeks pregnant and think labour may be starting, contact your maternity team urgently.
Possible signs include:
Regular contractions or tightenings
Period-like cramps
Unusual back pain
A gush or trickle of fluid
Any other symptoms that make you think labour may be beginning
Your maternity team will want to assess both you and your baby and decide what support is needed.
When Should I Call 999?
Most pregnancy and labour concerns can be discussed with your maternity team.
However, NHS guidance advises calling 999 if you believe your baby is coming immediately and you have a strong urge to push.
If you believe there is a medical emergency, seek emergency assistance straight away.
What Happens When You Call Your Maternity Team?
If it's your first baby, making that first phone call can feel daunting.
Many parents imagine they'll immediately be told to come into hospital. Often, that's not the case.
A midwife will usually ask questions such as:
How many weeks pregnant are you?
How often are your contractions coming?
How long have they been lasting?
Have your waters broken?
What colour is the fluid?
Is your baby moving normally?
Have you noticed any bleeding?
How are you feeling overall?
Based on your answers, they'll advise what to do next.
You may be asked to:
Stay at home for a while longer
Come in for assessment
Call back later with an update
If you go into hospital during early labour, you may even be advised to return home if labour isn't yet established. This is completely normal.
What If I'm Planning a Homebirth?
If you're planning a homebirth, you may be wondering whether you still call the maternity unit when labour begins.
Usually, you'll have a specific homebirth team, community midwife or local maternity service to contact. Exactly how this works varies between NHS trusts, so it's important to find out your local arrangements before your due date.
Your homebirth midwives will usually talk to you about when they would like you to call and ask questions about your contractions, your waters, your baby's movements and how you're feeling.
They can then advise you about what to do next and, when appropriate, arrange for a midwife to come to your home.
Before your due date, find out:
Who should I call when labour begins?
Is there a 24-hour number?
When would you like me to call?
When would a midwife usually come to me?
What happens if I'm not yet in established labour?
What happens if I need to transfer to hospital?
One of the lovely things about a planned homebirth is that your midwives come to you.
For many families, being able to stay in their own familiar environment can feel incredibly reassuring. You can settle into your own space, use the comfort measures you've prepared and allow your birth partner and midwives to support you around you.
If there are concerns about you or your baby, or you need care that isn't available at home, your midwife will discuss transferring to hospital with you and arrange the appropriate care.
A transfer isn't a failure.
Sometimes labour simply needs a different level of care, and your midwives are there to recognise when that is necessary.
What About a Midwife-Led Unit or Birth Centre?
You may also be planning to give birth in a midwife-led unit or birth centre rather than at home or on a hospital labour ward.
Again, find out in advance exactly who you should contact when labour begins.
Depending on your local service, you may be asked to call your birth centre directly, your named midwife or a maternity assessment service.
Midwife-led units and birth centres provide care led by midwives and can offer a more homely environment for labour and birth. Some are alongside a hospital, while others are separate from the main hospital site.
If you or your baby need care that isn't available within the midwife-led setting, you may be transferred to an obstetric unit.
The important thing is to know your own local pathway before labour starts.
Your planned place of birth can make a difference to who you call, when you call and where you'll be assessed.
What Can I Do During Early Labour at Home?
If your maternity team advises you to stay at home during early labour, or if you've chosen to have a homebirth, use early labour to focus on comfort, rest and conserving your energy.
Helpful things to do include:
Resting or sleeping if possible
Eating light, nourishing foods
Staying well hydrated
Taking a warm bath or shower
Moving around and changing positions
Practising breathing techniques or your hypnobirthing techniques
Using massage or other comfort measures
Listening to calming music
Keeping the lights low
Spending time with your birth partner
Early labour can sometimes take many hours.
Rather than watching the clock, try to think of this stage as an opportunity to settle into the rhythm of labour and allow your body to do its work.
When Should I Call My Doula?
If you're planning to have a doula, it's a good idea to talk about this before your due date, so you know exactly what support is available when labour begins.
Every doula works slightly differently, but you should feel clear about:
How and when to contact your doula
Whether they offer support by phone or message during early labour
When they would usually join you in person
What happens if labour begins during the night
How they can support you through early labour
When they'll meet you at home, hospital or your chosen place of birth
One of the lovely things about having a doula is knowing you have someone familiar to turn to when those first signs of labour begin.
If I'm your doula, we'll talk through what happens when you think labour is starting as part of your antenatal sessions, so you won't be left wondering whether you should call, whether it's too early or what you should be doing.
I'll be on call for you from 38 weeks through to 42 weeks, and you can contact me at any point to let me know you think labour may be starting. Whether you're unsure about what you're experiencing or simply want to let me know things are getting going, you can get in touch, and we'll take it from there.
If there's one thing I'd love you to take away from this blog, it's this:
You don't need to be completely certain before asking for help.
If you think you're in labour, call.
If your waters break, call.
If your baby's movements change, call immediately.
If you're bleeding, call.
If you're under 37 weeks and experiencing signs of labour, call urgently.
If something simply doesn't feel right, trust your instincts and seek advice.
The midwives looking after you would much rather you called than sat at home worrying.
Preparing for Labour Before Your Due Date
Before labour begins, make sure you have the appropriate telephone number saved somewhere easy to find.
If you're having a hospital birth, this may be your maternity unit or maternity assessment/triage service.
If you're having a homebirth, it may be your homebirth team or community midwife.
If you're planning a midwife-led birth centre, you may have a separate number to call.
It can also be helpful to ask your midwife:
Which number should I call?
Is it available 24 hours a day?
When do you want me to call about contractions?
What should I do if my waters break?
What should I do if I notice reduced baby movements?
Where should I go if I'm asked to come in?
Is there anything specific I need to know about my pregnancy?
If I'm planning a homebirth, who will come to me?
If I need to transfer to hospital, what will happen?
Make sure your birth partner has these details too.
Having this information ready can make labour feel much less overwhelming when the time comes.
Remember:
Labour rarely follows a perfect timetable.
You don't need to get everything right.
You don't need to know exactly when labour has started.
And you certainly don't need to feel embarrassed about asking questions.
Trust yourself. Trust your instincts. And let your maternity team support you.
As a birth doula based in Berkshire, I support families to feel informed, prepared and confident as they approach birth, whether you're planning a hospital birth, birth centre birth or homebirth.
From talking through your birth preferences to being there when those first contractions begin, you don't have to navigate those early decisions alone.
If you're preparing for birth and would like calm, continuous support throughout pregnancy, labour and the early days of parenthood, I'd love to help. Click HERE to book a free 30 minute consultation with me.