When will I go into labour?

No one knows when exactly a person will go into labour. You will have been given a due date, but the chances of you going into labour on your due date are extremely rare. Only 4% of people go into labour on their due date! Instead it is better to think of a due window sometime between 37 and 42 weeks gestation. The average gestation for mothers to have their babies is somewhere between week 40 and 41, with a smaller number of mothers having their babies at 37 and 42 weeks.

The concept of a due date is credited to Franz Naegele, a 19th-century German obstetrician. He came up with what’s now called Naegele’s rule which estimates 40 weeks (280 days) of pregnancy by:

  • Taking the first day of the last menstrual period

  • Adding 1 year

  • Subtracting 3 months

  • Adding 7 days

Naegele’s rule is simple and useful it it has several built-in problems

1. It assumes everyone has a 28-day cycle
The rule is based on ovulation happening around day 14. In reality, menstrual cycles vary widely. If you ovulate earlier or later, the due date can shift by days or even weeks.

2. It assumes you remember your last period accurately
Many people don’t track this precisely, or have irregular bleeding, which makes the starting point unreliable. Some women are breastfeeding and get regnant on a first fertile cycle without having menstruated first. Other mothers have a loss and then seem to find themselves pregnant and are unsure of period dates.

3. It ignores individual biology
Pregnancy length isn’t identical for everyone. Genetics, age, and whether it’s your first baby can all affect when labor naturally begins.

4. It treats pregnancy length as fixed (280 days)
But normal pregnancies can vary by about ±2 - 3 weeks and still be completely healthy. So the “due date” is really more of a midpoint in a range.

5. It can be misleading in medical decisions
If taken too literally, it may lead to unnecessary concern or interventions (like induction) if the baby doesn’t arrive “on time.”

6. It’s can be less accurate than modern ultrasound methods or conception dating
Early ultrasound dating (especially in weeks 7 - 10 is generally more precise than relying on this rule alone especially if you have an irregular cycle.. However once time goes on, and a mother is getting a dating scan at 13 - 16 weeks, then the scan may be less accurate.

If you know when conception likely occurred (e.g., via fertility tracking or IVF), this is probably going to be as accurate as anything. You can calculate your due date by adding add 38 weeks to your conception date instead of 40.

You can find out more about “due dates” here

Why an inaccurate due date can be a problem?

Due dates become a problem when other clinical evets are irrevocably tied to them. For example, some practitioners are very keen on early inductions of labour, and will use the due date to make inferences about the health of the baby and the placenta, and without any other clinical indication may pencil you in for an induction of labour either before or on your due date. As a result, mothers end up feeling like they are on a clock at the end of their pregnancy, and the one thing that is not going to get you into labour is feeling stressed and worried at the end of your labour. If anything, you need to feel relaxed and free from worries and tension to enable the hormone oxytocin to do its work.

Also, If a first-trimester ultrasound differs significantly from LMP-based dating, many doctors will revise the due date to the ultrasound estimate. Pregnancies without an early ultrasound are also often considered “suboptimally dated” (ACOG), which can affect decisions about induction, growth monitoring, and preterm/post-term classification.

What is an Induction of labour?

Today, the majority of people in Ireland having their first baby are likely to be induced. Historically, induction was regarded as a rare intervention only to be used for clinical need as opposed to being initiated by dates and preferred clinical practice. If you have watched that episode of Call the Midwife when the woman’s husband is dying and they want him to meet his child, you’ll see an in-depth discussion of the ethical dilemmas of the time associated with inducing a pregnancy to term.

Ireland has an induction of labour guideline (October 2023) and you can find that here

The HSE has a basic guide to induction of labour as part of their services is described here

The key components of the guidance are as follows:

  • Timing of Induction: For women with uncomplicated pregnancies, IOL is usually offered at 41+0 weeks

  • Informed Decision-Making: A comprehensive discussion regarding the benefits, risks, and alternative monitoring options must take place, ensuring a shared decision-making approach between client and care giver..

  • Management at 41+0 Weeks: If a woman declines IOL at 41+0 weeks, a management plan (which may include expectant management or a different date for IOL) should be developed in consultation with a senior clinician (midwife or obstetrician) and documented.

  • Consent: At no point should women feel that they MUST be induced, that they are under DURESS to accept an induction or that they have no other supported options. women must be given the option to decline an induction of labour. An induction of labour has to be consented to as it is a choice and women must be given the option to decline As with any test, procedure or treatment in the Irish Health Service the recommendation for induction of labour falls under the remit of the National Consent Policy.

  • Respectful Care: The guidelines emphasise care that is non-judgmental, supports maternal autonomy, and facilitates trust between parents and providers.

Induction of labour - Is it for me?

There are many viewpoints on induction. Your clinician will give you their opinion which will be based on hospital policy and the HSE guidance, but if there are clinical issues involved in your case, they will also be factored in along with your own personal circumstances and those of your baby (ies)

The current guidance on induction was informed by a study called the ARRIVE trial, you can find out about that here.

There have been many hundreds of critiques of the the ARRIVE trial and you can find one of them here

Evidence Based Birth has evaluated all of the published research on inducing for dates and you can find them here

Hannah Dahlen has published many studies looking at the long term safety of routine induction. You can find one of her studies here

Sara Wickham has also published a lot on the topic of routine induction for “over due” babies. You can find her here

If you like a podcast, the Krysia Lynch’s Doulaverse podcast discusses routine induction at 39 weeks here

You can read research about women’s experiences with induction of labour here

You can read recent research about people’s experiences in decision making surrounding induction in Ireland here

You can read research about the duress people have felt in Ireland with respect to induction of labour here

10 things you should know about Induction of labour by Sara Wickham

  1. Induced labour is not the same as spontaneous labour

  2. Some women find induced labour more painful

  3. Induction of labour generally comes as a package deal (includes other interventions and pain management)

  4. Stretching and sweeping is not benign

  5. Natural induction of labour is an oxymoron

  6. Induction of labour is not a legal requirement for a post dates or at dates pregnancy

  7. Its not just a trickle or sniff of syntocinon

  8. Women don’t fail, inductions and systems fail

  9. The risks of not inducing are lower, less presentable and kick in later than most people think

  10. The risks for older women, women who took IVF and women who have “big babies” are not as clear cut as often presented

Find out more about Dr Sara Wickham’s thinking here

If you are being offered induction she suggests you ask the following five questions:

  1. Why are you suggesting this process for me? What is the indication that this will be a good thing for me?

  2. What is the evidence to suggest that this will benefit me and my baby?

  3. What is the absolute risk of me not doing this (not the relative risk)?

  4. What are the downsides or side effects of induction of labour?

  5. How when where what and whom?

You can read more about this here

How do I know I am in labour?

When do I go into the hospital or call the home birth midwife ?

Labour will be experienced differently by every person. There are no two same experiences. Even the same person having several babies will experience labour differently each time. It is what makes it a great unknown! Generally labour starts with surges or contractions felt in the back or the lower tummy .

For other women labour starts with a bloody show which can look like light spotting along with a mucous discharge

And for others labour starts with a releasing of their amniotic fluid, usually called breaking of the waters.

Labour usually starts of slow and then gradually picks up momentum (active labour). For first time parents the early part of labour might last hours or even days coming and going. All of which is a variant of normal. So some people get surges every 15 to 20 minutes for a few hours and then it all peters out only to start again the following night. Often this means that the baby is seeking a better position. For other women contractions start and then they just get very strong and very close together very quickly.

If it is your second baby you will probably be advised to come into hospital when your contractions are regular about five minutes apart lasting a minute, for an hour and getting stronger. If it is your first baby, then you will probably be advised to come in when your contractions are 3-4 minutes apart lasting a minute for one to two hours and getting stronger,.

If your waters have gone however, you will be advised to come into hospital or contact your care provider so that an assessment may be made of whether it is indeed your waters, and if it is, that you and your baby are well. Most people will be scheduled for induction of labour if their waters have released and they have not started getting contractions within 24 hours. For mothers planning a home birth, this means that they will not labour at home with their midwife, but will have to transfer their care to hospital based services. It may also be the same for those who have booked for DOMINO care or MLU care or community midwifery care within a hospital setting, these women may now have to birth within an obstetric setting in the same hospital.

Your care provider will have told you when you should come into hospital or call them if they are your home birth midwife.

What kind of birth experience you are looking for will also determine when you go into the hospital. If you plan to have an epidural and a more medicalised approach you will go in earlier, if you plan to have a more physiological experience you will probably go in later. If you arrive in hospital and you are not in active labour you will either be offered an option to stay on the antenatal ward which is usually shared with other women, until your labour becomes more active, or you will be offered the option of coming back home and going back n when your labour is more active. Telling the difference between active and early labour and how long it will be before early labour becomes active labour can be difficult if you have never done it before, so often people might not quite judging quite right, getting to the hospital whilst they are still in early labour or arriving later than they wanted to and not getting a chance to settle in before the baby arrives.

Hiring a doula will help in making this decision as they will be familiar with your birthing preferences and also know from experience when labour is becoming more active. They will help you time your departure with respect to the traffic too so that you get to hospital at the right time for you.

Seek help from your midwife or go into the hospital straight away when any of the following occur

  • Waters Break: If your waters break or leak, and the fluid is green, brown, or red.

  • Reduced Movements: Any change or reduction in your baby's movement patterns.

  • Bleeding: Any bright red vaginal bleeding (other than a "show" of mucus).

  • Pain/Sickness: Severe, constant abdominal pain, or symptoms like blurred vision/headache.

  • Premature Labour: If you are less than 37 weeks pregnant and have symptoms of labour.

“When you have a contraction, your womb tightens and then relaxes. For some people, contractions may feel like extreme period pains.

As labour gets going, your contractions usually become longer, stronger and more frequent. During a contraction, the muscles tighten and the pain increases. If you put your hand on your stomach, you’ll feel it getting harder. When the muscles relax, the pain fades and you will feel the hardness ease.

The contractions are moving your baby down and opening the entrance to your womb (the cervix). ”
— HSE

What happens when I arrive at the hospital in labour?

When you arrive you will be assessed to see how far progressed you are in your labour. This is usually done with an internal vaginal examination to assess how open your cervix is.

If you are very progressed, you will go straight to the delivery suite / labour ward / birthing rooms and the rest of the assessment will be completed there.

If you are less progressed, the wellness of your baby and your own wellness will be assessed in a triage room (sometimes called the ER and sometimes called the Assessment Room. This will be done by offering you a continuous electronic fetal trace of your baby’s heart beat for 20 minutes, taking your blood pressure, your temperature, respiration rate and checking a sample of your pee. If you do not want to have a continuous monitoring admission trace done you can decline this and ask fir intermittent monitoring of your baby over the 20 minutes. Once a labour room becomes available you will be able to go there and be assigned a midwife. In many teaching hospitals you will be assigned a midwife and a student midwife. You may also be asked if you would like to have a student doctor present. It is up to you whether you would like to have students present at your labour and birth.

If you are assessed to be in early labour and not yet in active labour you will be offered the option of staying in the antenatal ward until you progress further or you may prefer to come home.

What interventions might I be offered in labour and birth?

1.Augmentation of your labour (making it go faster)

It is expected that you will labour according to a graph called a partogram. This assumes that all women will labour at the same speed For each vaginal internal examination your progress (meaning the dilation of your cervix) is plotted on the partogram along with the time it was assessed. , If your labour is slower than the parogram expects then your labour will be made go faster. Methods include:

  • Artificial Rupture of Membranes (ARM): If your waters have not gone, a midwife or doctor uses a small hook to break your waters to speed up labour.

  • Syntocinon drip: An artificial form of oxytocin given intravenously to strengthen contractions and make them come more frequently.

You may choose to decline augmentation of your labour/

2. Monitoring and Assessments

  • Vaginal Examinations: These are offered every 2 - 4 hours to check the dilation of your cervix.

    Fetal monitoring

  • Intermittent Fetal Monitoring: The baby is listened to every 15 minutes during the first stage of labour and ever 5 minutes during the second stage of labour. Either a sonic aid or a pinard can be used. This is not continuous or invasive

  • Continuous Electronic Fetal Monitoring (CTG): A machine that constantly records your contractions and the baby's heartbeat by a transponder being held close to your abdomen and picking up your baby’s heart beat and the strength of your contractions.

  • Internal Fetal Scalp Electrode: If external continuous monitoring is difficult, a small wire clip may be clipped / screwed onto the baby's head to get an accurate heartbeat reading.

You may choose to decline continuous monitoring either external or internal and you may also choose to decline internal vaginal examinations. Or you may request a different form of monitoring than that which was originally offered to you, or you may request longer gaps between internal vaginal examinations.

3. Pain Relief Interventions

  • Gas and Air (Entonox): A mixture of oxygen and nitrous oxide you breathe through a mouthpiece. The effect only lasts for as long as you are inhaling the substance

  • Pethidine or Diamorphine Injection: This is given during the early first stage of labour and is given with anti vomiting medication. Some mothers say it makes them feel sick and woozy. Research shows it can have an impact on baby’s respiratory system.

  • Epidural Analgesia: An anaesthetist places a fine tube in your lower back to deliver analgesia. It requires continuous fetal monitoring and the insertion of a catheter. It may require augmentation of your labour too as sometimes it can slow a labour down. It will be effective for most mothers but may cause side effects in others and may not fully numb the pain in all mothers. It will impact the birthing process as upright positions and standing positions will be more difficult to effect. It may be harder to deliver the baby without assistance due to being unable to feel how and where to push.

You may choose to decline narcotic based pain relief and opt for other methods such the shower, birthing pool, massage, hypnobirthing, TENs machine

4. Assisted Birth and Surgical Interventions

If labour is slow (kindly called "failure to progress") or the baby is distressed, you may be offered:

  • Episiotomy: A surgical cut in your perineum to widen the vaginal opening.

  • Instrumental Delivery (Forceps or Ventouse/Vacuum): Using surgical instruments to help you deliver your baby vaginally.

  • Caesarean Section: Surgical birth, performed in about 35-50% of first births in Ireland. This is usually performed with epidural anesthesia, so you should be awake to see the birth of your baby. If there is a category 1 c section then you may need to have a GA as there may be a pressing need to deliver your baby immediately.

You may choose to decline an episiotomy or to ask for more time to birth your baby yourself. You will have to weight up the risks and benefits of taking more time and whether this might or might not impact your baby.

5. Managed third stage (Delivery of the placenta)

  • Active Management: An injection of Syntometrine/Syntocinon is routinely offered to speed up the delivery of the placenta and reduce blood loss.

Can I opt for planned caesarean section?

Yes you can. As c section is major abdominal surgery, your care giver will want to speak to you about what your reasons are for wanting to have major abdominal surgery and will counsel you on the increased risks if you are an otherwise well and healthy person with a straightforward healthy pregnancy. However, it is still your right to request and have a planned c section. There are many reasons women elect to have a c section. These include:

  1. Previous difficult experience in childbirth

  2. Lack of control in previous experience

  3. Anxiety or other perinatal mental health condition that makes dealing with the unknowns of natural labour difficult

  4. History of abuse or sexual abuse

  5. Fears or concerns that cannot be allayed about vaginal birth