What to do when labour pain starts

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Based on solid information from the medical textbooks, here is a comprehensive guide on what to do when labour pain starts:

What to Do When Labour Pain Starts

Step 1: Recognize True Labour vs. False Labour

Before heading to hospital, confirm you're in true labour, not false labour (Braxton Hicks contractions).

Feature	True Labour	False Labour (Braxton Hicks)
Contraction pattern	Regular, increasing in frequency & duration	Irregular, do not escalate
Pain location	Starts in fundus/upper abdomen, radiates to pelvis & lower back	Confined to lower abdomen/groin
Effect on cervix	Causes cervical effacement & dilation	No cervical changes
Response to rest/hydration	Contractions continue	Often stops with rest or fluids

Key rule: If in doubt, external uterine monitoring at a hospital can confirm true labour. — Tintinalli's Emergency Medicine, p. 679; Rosen's Emergency Medicine, p. 2254

Step 2: Immediate Actions at Home

Stay calm and time your contractions — record how long each contraction lasts (duration) and the gap between them (interval).
Hydrate — drink water; this can also help rule out false labour.
Rest between contractions — conserve energy.
Note any warning signs (see below for when to call/go urgently).
Contact your midwife or doctor — notify your birth team. They will advise when to come in based on contraction frequency and your obstetric history.

Step 3: When to Go to Hospital

Go immediately if any of the following occur:

Urge to push or feeling of pressure as if the baby is coming
Baby's head is visible (crowning) — deliver where you are, do not travel
Rupture of membranes (water breaks), especially if cord prolapse is suspected
Heavy vaginal bleeding
Severe or constant abdominal pain (not contraction-pattern pain)
Reduced or absent fetal movements
Preterm contractions before 37 weeks

For uncomplicated labour, the typical rule is the 5-1-1 rule: contractions every 5 minutes, lasting 1 minute, for at least 1 hour — go to hospital.

Step 4: Pain Relief Options

You have several options for managing labour pain, from non-pharmacological to medical:

Non-Pharmacological (Psychoprophylaxis)

Breathing and relaxation techniques (e.g., Lamaze)
Position changes, walking, warm water (bath/shower)
Partner support and massage

Pharmacological Options (administered in hospital)

Neuraxial analgesia (epidural) — the most effective method; reliably reduces pain in both stages of labour, blunts sympathetic surges, and may improve abnormal labour patterns
Systemic opioids — e.g., meperidine (pethidine); used when epidural is not available or refused; cross the placenta, so timing and dose matter
Nitrous oxide (Entonox) — inhaled gas for mild-to-moderate pain relief; minimal effects on uterine blood flow
Paracervical block — local anaesthetic injection near the cervix for first-stage pain; less commonly used now due to risk of fetal bradycardia
Pudendal nerve block — for second-stage/perineal pain

— Barash, Cullen & Stoelting's Clinical Anaesthesia, p. 3485; Morgan & Mikhail's Clinical Anesthesiology

Step 5: Understanding the Stages of Labour

Stage	What Happens	Average Duration
First stage	Contractions cause cervical effacement & dilation (0 → 10 cm); pain from T10–L1	~8 hrs (first baby), ~5 hrs (subsequent)
Second stage	Pushing phase; full dilation to birth; additional perineal pain (S2–S4)	Variable
Third stage	Delivery of the placenta	Minutes to ~30 min
Fourth stage	First hour after placenta delivers; watch for postpartum haemorrhage	1 hour

Warning Signs — Seek Emergency Care Immediately

Cord prolapse (cord visible or palpable): get on hands-and-knees (knee-chest position), do not push, get to hospital urgently for emergency caesarean
Heavy bleeding — may indicate placental abruption
Preterm labour (before 37 weeks) — requires urgent assessment and possible tocolytic treatment
Signs of preeclampsia/eclampsia: severe headache, visual changes, swelling, high blood pressure

Bottom line: Time your contractions, stay hydrated, contact your midwife/doctor early, and head to your birth facility when contractions are regular and strong. Do not delay if you feel the urge to push, membranes rupture, or any warning signs appear.

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