As your due date nears, you might be wondering how your body decides one day that it is time to give birth. What exactly kicks things off, and why do some women give birth on their due date while others seem to stay pregnant forever until they are induced?

The exact physiology behind the labor and how it occurs isn’t totally understood. But we do know a few key facts about how labor can start, and why it isn’t the same for everyone.

During your pregnancy, your body is actively trying to prevent an early delivery. Certain hormones like progesterone, nitric oxide, and a few others keep your uterus from contracting and delivering too early. Some things can override this and activate labor prematurely. These include certain infections, a severe illness in the mother such as the flu, and bleeding from a placental abruption. Still others deliver early because their cervix is too short or weak, and for some women who are prone to preterm delivery, we have no good reason to explain why it happens.

We have a theory that labor begins with an activation phase. Think of this as your body’s switch being given the green light to go into labor. Estrogen is thought to play a part in this: it makes the uterine cells that contract activate and be put on high alert. These cells are also now receptive to oxytocin, which is the hormone that makes them contract.

The next phase is called the stimulation phase. This is when labor really gets going. Uterine contractions now happen because the hormones oxytocin and prostaglandins are released in your body telling the contraction cells in the uterus to get to work—and voila!—contractions begin!

Your baby might have a role in starting labor too, though we aren’t completely sure. Certain hormones released by your baby eventually get converted to a form of estrogen, which helps with the activation phase mentioned earlier. In animals such as sheep, the role of the baby is much more certain when it comes to starting labor, but in humans, we still need to do more studies.

So while we might not be totally sure when labor will begin and why it starts so early for some women and later in others, a few clues exist that show the important role of certain hormones. Another interesting fact is more women go into labor at night. It has been proposed that this is a holdover from our distant ancestors. Think of the cavewoman in labor. It is much easier for her to hide away and give birth (when she is much more vulnerable to an attack) in the dark of night. Therefore, something associated with the circadian rhythms of our bodies may be the reason labor starts more often when it is dark out!

What are signs that labor is approaching?

Signs that labor is approaching can vary from person to person. However, some common signs include:

• Contractions: This is the most common and obvious sign of labor. Contractions are regular, painful uterine contractions that help to open the cervix and push the baby down the birth canal.
• Water breaking: This is when the amniotic sac surrounding the baby ruptures and releases amniotic fluid. This can happen before or during labor.
• Increased vaginal discharge: As the cervix dilates and thins out, the amount of vaginal discharge may increase. This can be clear, pink, or slightly bloody.
• Pelvic pressure: Many women experience a feeling of pressure in the pelvis as the baby descends and the cervix dilates.
• Back pain: Some women experience lower back pain as labor approaches. This can be due to the pressure of the baby’s head on the pelvis, or to the release of hormones that relax the ligaments in the pelvis.
• Nausea and vomiting: Some women experience nausea and vomiting as labor approaches. This can be due to the increased hormone levels and the physical stress of labor.
• Diarrhea: Many women experience diarrhea just before or during labor. This can be due to the release of hormones that relax the muscles in the intestines.

Sources:

• Gabbe SG et al
• Obstetrics: Normal and Problem Pregnancies
• 5th ed
• Normal labor and delivery.

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