Signs of Delivery (Labor)

1. Premonitory Signs (Before True Labor Begins)

Lightening (Engagement / Dropping)

• The fetal head descends into the pelvis ("drops")
• The mother feels less pressure under the ribs (easier breathing)
• Increased pressure in the pelvis and bladder (more frequent urination)
• Occurs 2-4 weeks before delivery in first-time mothers (primigravidae); may not occur until labor begins in multigravidae

Braxton Hicks Contractions (False Labor Pains)

• Irregular, painless or mildly uncomfortable uterine tightening
• Do NOT increase in intensity, frequency, or duration
• Relieved by walking or position change
• No cervical change

Cervical Ripening (Nesting / Softening)

• The cervix becomes soft (like a lip), begins to efface (thin out) and slightly dilate
• Detectable only on examination

Bloody Show (Mucus Plug Discharge)

• A pink/blood-tinged mucus discharge from the vagina
• Results from the cervix softening and the mucus plug loosening
• Can appear hours to days before labor starts

Nesting Instinct

• A sudden burst of energy and urge to clean/organize - commonly reported

Backache

• A persistent low backache or pelvic discomfort

2. True Signs of Labor (Onset of True Labor)

Regular, Progressive Uterine Contractions

• Contractions occur at regular intervals (e.g., every 5-10 minutes)
• Intervals between contractions progressively shorten
• Intensity and duration progressively increase
• Pain begins in the lower back and radiates to the front (abdomen)
• NOT relieved by walking or rest
• Associated with progressive cervical changes

Rupture of Membranes (Breaking of Waters)

• A sudden gush or steady trickle of warm clear/straw-colored amniotic fluid from the vagina
• Confirms labor is imminent or underway
• If membranes rupture but contractions have not started, they usually begin within hours
• Important: note the time, color of fluid (clear = good; green/brown = meconium, requires urgent attention), and amount

Progressive Cervical Changes (on Vaginal Examination)

• Effacement - the cervix thins out (measured in %)
• Dilation - the cervix opens (measured in cm; active labor = 4 cm or more)
• Station - descent of the presenting part

3. True vs. False Labor - Key Differences

4. Stages of Labor Summary

5. Signs of Second Stage (Pushing Stage)

• Urge to bear down/push (rectal pressure)
• Perineum bulges
• Anal dilatation
• Crowning of the fetal head

6. Signs of Placental Separation (Third Stage)

• Uterus becomes globular and firmer
• Gush of blood
• Cord lengthens at the vulva
• Uterus rises in the abdomen (as placenta descends)

Signs of Recent Delivery

From a forensic medicine perspective, "recent delivery" refers to within 10-14 days after a full-term delivery. These signs are examined both in the living and in the dead (e.g., in cases of concealment of birth, infanticide, or maternal death).

A. Signs of Recent Delivery in the LIVING

1. General Appearance (Indisposition)

• Woman appears pale, exhausted, and ill-looking for the first 2-3 days
• Dark-colored pigmentation over the lower eyelids; shrunken, languished look
• Pulse is soft and rapid; slight rise in body temperature
• After-pains (intermittent uterine contractions) persist for 4-5 days
• Note: These signs are non-specific and may be absent in strong, multiparous women

2. Breast Changes

• Breasts are full, enlarged, tense, and knotty (hard)
• Nipples are enlarged, surrounded by darkened areola
• Montgomery's tubercles prominent
• Superficial veins over the breast are dilated
• Colostrum can be expressed for ~10 days after delivery; replaced by milk thereafter
• Striae gravidarum on the breasts
• Finding colostrum corpuscles in milk strongly indicates delivery within a few days

3. Abdominal Signs

• Abdominal wall is lax, flabby, pendulous, and wrinkled
• Striae gravidarum (stretch marks) - pink when recent, become white/silvery later = lineae albicantes
• Linea nigra - dark pigmented midline line from symphysis pubis upward

4. Uterine Changes (Most Important - Used to Time Delivery)

• Uterus involutes at a rate of approximately 1.5 cm/day
• Returns to normal weight (~100 g) by 6-8 weeks
• After-pains (intermittent uterine contractions) present for first 4-5 days

5. Cervical Changes

• Transverse laceration of the cervix is a permanent sign distinguishing a parous from a nulliparous woman

6. Vaginal Changes

• Vagina is smooth-walled, relaxed, and capacious
• May show recent lacerations (usually heal by day 7)
• Rugae begin to reappear around the 3rd week

7. Vulvar / Perineal Changes

• Labia majora are tender, swollen, bruised, or lacerated
• Perineum may be lacerated (age of the tear helps fix the date of delivery)
• Fourchette and posterior commissure may be destroyed
• Vulva is bruised and gaping

8. Lochia (Uterine Discharge) - Key Forensic Sign

• Total duration: 2-3 weeks
• Has a peculiar sour, disagreeable odor
• Contains decidual cells, RBCs, white cells, and microorganisms

B. Signs of Recent Delivery in the DEAD

Uterine Size (Post-mortem)

Other Post-mortem Signs

• Uterine cavity: immediately after delivery, lined by decidua; walls 4-5 cm thick
• Placental site: irregular, nodular, elevated area ~15 cm diameter → shrinks to 3-4 cm by 2nd week → 1-2 cm by 6th week
• Ovaries and fallopian tubes congested (normalize within a few days)
• Corpus luteum present in one ovary for 1-2 months
• Peritoneum over lower uterus arranged in folds
• Bladder: hyperemic with submucosal hemorrhages
• Histology: endometrium shows trophoblastic epithelium and chorionic villi; ovary shows a large corpus luteum
• Note: After 2 months, it is not possible to give an exact time of delivery

C. Signs of Remote (Old) Delivery - For Comparison

• Abdomen lax and flabby; lineae albicantes (silvery stretch marks)
• Breasts soft and pendulous; dark areola
• Labia not in apposition (remain separated)
• Cervical external OS is transversely slit-shaped (versus circular in nulliparous women)
• Perineal scars

Sources: Essentials of Forensic Medicine & Toxicology (36th ed., 2026); P.C. Dikshit Textbook of Forensic Medicine & Toxicology; Parikh's Textbook of Medical Jurisprudence, Forensic Medicine & Toxicology