There is nothing more frustrating than to finally head off to the hospital, convinced that you are in active labor, only to be told that you are in false labor and must return home.

Although doctors have certain criteria for judging labor as “false,” it may certainly feel “real” to you. False labor refers to labor that does not result in the birth of your newborn. The contractions may be intense, encompassing your entire belly for 15 to 60 seconds before subsiding, and preventing you from sleeping or doing any other activity. However, these contractions tend to vary in their frequency and severity. They may occur at irregular intervals, and may subside with changes in your position. You may pass your mucus plug at some point; this is a clear, sticky clump of mucus that may fill the opening to your cervix. If you have bloody show, blood tinged cervical mucus, it is more likely to be brown rather than bright red. If you arrive at your hospital’s “Labor and Delivery” to be checked, your cervix may be still closed or opened only slightly. You may be asked to walk around for an hour or more to see if the cervix opens over time. With false labor, the cervix does not change despite the contractions and passage of time.

“True Labor” refers to contractions that do lead to cervical change. The contractions become more intense and increasingly regular over time. Labor pains become increasingly painful in most cases, and are not relieved by changing positions or activities. Often, bloody show becomes pink or blood-tinged as small blood vessels of the cervix bleed with effacement and dilation of your cervix. It may be difficult to determine whether your baby is moving once true labor occurs. All of your energy is more likely focused on your breathing and coping with the discomforts of labor.

If you believe you are having regular, increasingly painful contractions over at least an hour, you should call your practitioner for instructions. If your bag of water breaks—usually a slow continuous trickle or large gush of fluid—you should call your provider. After your water breaks, your baby no longer is contained in a sealed environment and over time the chances for fetal infection increase. Check the color of the amniotic fluid; it’s normal if it is pink or clear. If it is green or overtly bloody, seek medical attention immediately.

If you are unsure whether true labor has started, call your practitioner, even it is in the middle of the night. Remind your practitioner if you’ve already been told your cervix is dilated. Don’t be embarrassed if you arrive at the hospital thinking you are in the throngs of active labor, only to be told that you are barely dilated. It’s impossible to know whether your cervix is changing without being examined, and much better to play it safe and arrive in the hospital before the big event.

Signs of Real Labor
Strong contractions that intensify over time.
Progressively frequent contractions that occur at regular intervals.
Contractions involve the entire uterus and may radiate to the back or legs.
Ruptured membranes—note the color of the amniotic fluid.
Heavy bleeding —go to the hospital right away.