You know the Hollywood version: A very pregnant woman sits up with a start in the dark of the night and shakes her groggy partner awake with the announcement that "it's time." Reality check: Not only is your labor not likely to begin so suddenly (or in the middle of the night for that matter), but even experienced mothers can have a hard time recognizing it.
If you're especially observant, you may pick up on some cues that birth is near days in advance. What should you look for? Lightening, when the baby's head settles or "drops" into the birth canal; weight loss -- many women drop a pound or two the week before delivery; increased discharge that is pink or blood-tinged, or one big release of mucus (the "bloody show") -- the thick seal that has been protecting your cervix; diarrhea, nature's way of emptying your bowels before delivery; and increased lower backache, often a precursor of the menstrual-like cramping that evolves into contractions. In about ten percent of all deliveries, the water (the amniotic fluid) "breaks" before contractions have actually begun. It may be a sudden gush of fluid or a nonstop trickle. Notify your doctor immediately; once the amniotic sac has ruptured, your baby must be delivered within 24 hours to avoid infection. The fluid itself should be pale or clear, and odorless. Traces of green or brown may signal fetal distress.
In the absence of such signs, however, all you'll have to go on will be the contractions. Seems obvious, you're probably thinking, but Braxton-Hicks contractions (false labor pains) increase in frequency near term, complicating the issue. They may become so intense, particularly with second and subsequent babies, that you're almost certain they're the real thing. The only way to tell: careful timing. In true labor, contractions occur at regular intervals, gradually get closer together, feel stronger, last longer, and don't go away if you lie down or take a walk. In false labor, contractions are irregular, don't increase in frequency, and will subside if you lie down or take a walk.
Even when you detect the real thing, you're not likely to run out the door. Most physicians advise women to spend the early part of labor at home, where they can be more comfortable and remain mobile. The general rule of thumb is to head to the hospital when contractions are 5 minutes apart and last about 45 seconds. The average first labor takes 12 to 14 hours, and you may spend as much as the first 8 hours at home waiting for the contractions to progress to this point.
Most pregnant women preregister with the hospital by the third trimester (your doctor will provide you with the forms), so when your arrive, the admissions procedure will be brief. You'll then be taken to labor and delivery, where you'll meet your labor nurse and be given an identification bracelet, a hospital gown, and possibly a stretchy fabric band to wear around your abdomen to hold external monitors in place. An IV hookup may be inserted into your wrist so that it's in place when and if you need fluids or pain medication. Next, your labor nurse or physician will do a quick exam to see how much you've dilated. Then, assuming your labor is progressing normally, you'll probably be told to take a hike -- around the maternity ward, that is. First stop: Go peek at the newborns, for inspiration!