How Do I Know When Labour Has Really Started?
The signs of true labour vs Braxton Hicks contractions, the 5-1-1 rule, and exactly when to head to hospital in Singapore.
Signs of Early Labour
Labour rarely begins with a single dramatic sign. Most women experience a combination of early signals over hours or even days before active labour begins. These early signs tell you the process is starting, but do not necessarily mean you need to go to hospital yet.
- Bloody show (pink or blood-streaked mucus discharge)
- Mucus plug passing (thick jelly-like discharge)
- Loose stools or diarrhoea (bowel emptying before labour)
- Lower back ache that comes and goes
- Pelvic pressure as baby moves lower
- Nesting instinct (sudden urge to clean and organise)
This is unambiguous. You may feel a gush or a slow trickle. Amniotic fluid is usually clear and slightly sweet-smelling. Even if contractions have not started, you should call your hospital's labour ward.
Waters breaking before 37 weeks: go to hospital immediately. At term (37+ weeks): call the labour ward and go in within an hour even without contractions. Labour usually begins within 12 to 24 hours.
True Labour vs Braxton Hicks
Braxton Hicks contractions ("practice contractions") are normal from mid-pregnancy and increase in the third trimester. They can feel very convincing. Here is how to tell the difference.
| Feature | Braxton Hicks | True Labour |
|---|---|---|
| Pattern | Irregular, unpredictable | Regular intervals that gradually shorten |
| Intensity | Stay mild, do not get stronger | Progressively more intense over time |
| Duration | Varies, often 30 seconds | 60 seconds or longer, becoming consistent |
| Response to movement | Often stop when you walk or change position | Continue regardless of position or movement |
| Location | Usually front of abdomen only | Often felt in lower back and radiates to front |
| What to do | Rest, hydrate, time them | Time contractions, apply 5-1-1 rule |
The 5-1-1 Rule: When to Go to Hospital
For most first-time mothers without complications, the general guideline used in Singapore and internationally is the 5-1-1 rule. It means:
If you meet the 5-1-1 rule, call the labour ward and head in. For women who have given birth before, active labour often progresses faster, so the threshold is typically 7-1-1 or even earlier. Your gynae will advise you on your specific situation at your 36-week appointment.
You can use a contraction timer app on your phone to track frequency and duration. Time from the start of one contraction to the start of the next.
When to Go to Hospital Immediately
Do not wait for the 5-1-1 rule if any of the following apply. Call your hospital or 995 and go immediately.
- Waters have broken and the fluid is green or brown (meconium present)
- You are less than 37 weeks pregnant and are having contractions
- You notice heavy bleeding (more than a light show)
- Baby's movements have significantly reduced or stopped
- You have sudden severe headache, vision changes, or upper abdominal pain (pre-eclampsia warning signs)
- You feel the urge to push
- You simply feel something is wrong. Trust your instinct.
- KKH Labour Ward: 6294 4050
- NUH Labour Ward: 6779 5555
- Thomson Medical Centre: 6252 5933
- Mount Alvernia: 6347 6688
- Gleneagles: 6470 5688
Contact numbers are subject to change. Save your hospital's number in your phone from 36 weeks.