How do I know labour is getting close?
According to pacjent.gov.pl, the Polish government patient portal, birth may happen from about 14 days before to 10 days after your due date. Your body usually sends signals that announce labour without starting it yet. You do not need to go to hospital with these:
- Your bump dropping, usually 2-3 weeks before birth.
- Irregular practice contractions (skurcze przepowiadające), when your bump tightens and goes hard.
- Pain in your back, groin and thighs in the last few days before birth.
- A change in vaginal discharge and losing the mucus plug (czop śluzowy), a thick, slightly pink mucus. It is a sign that the cervix is shortening, and it can come away even a few days before birth.
The signs that labour is starting, and the emergencies that need quick admission to hospital, are part of the antenatal education programme set out in the Polish standard of perinatal care. If you have a POZ midwife (a primary care midwife funded by the NFZ, Poland's public health insurer), go through these signs with her during pregnancy and ask what rules the hospital where you plan to give birth uses.
Practice contractions or labour contractions: how can I tell?
Practice contractions, also called Braxton Hicks contractions, appear towards the end of pregnancy and can feel like labour. Real labour contractions differ mainly in that they build up over time and make the cervix shorten and open.
| Feature | Practice contractions | Labour contractions |
|---|---|---|
| Rhythm | Irregular, the gaps between them vary in length. | Regular, and the gaps between them gradually get shorter. |
| Strength and length | They do not build up, although they can be long and similar to labour contractions. | Over time they become longer, stronger and more frequent. |
| What happens next | According to pacjent.gov.pl they usually ease after 1-2 hours. | They do not go away but get stronger. They often come with backache. |
| Pain | According to pacjent.gov.pl they can be painful. The UK NHS describes them as uncomfortable but usually painless. | The pain builds with each contraction. |
| Cervix | They do not make labour progress. | They shorten and open the cervix, which a midwife or doctor checks in an examination. |
Under the Polish standard of perinatal care, the start of labour is diagnosed on the basis of contractions that make labour progress, telling practice contractions apart from real labour contractions. At home you cannot check your cervix, so the best guide is to watch: write down the time each contraction starts and how long it lasts. After an hour you will see whether they settle into a regular rhythm.
How far apart should contractions be before I go to hospital?
Official Polish sources do not give a single numerical rule. Pacjent.gov.pl advises going to hospital when labour contractions start or your waters break, and the standard of perinatal care does not say how many minutes apart contractions should be. Hospitals may give their own guidance in materials for patients, so check it with the hospital you choose.
For comparison, the UK NHS advises contacting the maternity unit when contractions are regular and come every 5 minutes or more often. You should call urgently if a single contraction lasts longer than 2 minutes or you have 6 or more contractions in 10 minutes. This advice is for the UK system, where you phone the maternity unit before setting off, so treat it as a rough guide.
- Before 37 weeks of pregnancy, do not wait for a regular rhythm. Regular contractions or tightenings, period-type pain, fluid leaking from the vagina or backache that is unusual for you are, according to the NHS, a reason to contact the maternity unit urgently.
- If you feel a strong urge to push or that your baby is about to be born, call 112.
- If you live far from the hospital or your previous labour was quick, agree with your midwife or doctor in advance when to set off.
Pacjent.gov.pl reminds you to arrange in advance for someone to look after you on the way to hospital. Do not drive yourself when you are having labour contractions.
I have lost my mucus plug: do I need to go to hospital?
The mucus plug on its own is not a reason to go in. It is a thick, sticky mucus that can be pink or streaked with blood and may come away a few days before birth. If you have no regular contractions, your waters have not broken and your baby is moving as usual, you can calmly wait and see what happens next.
It is different when there is more blood than mucus with streaks of blood. According to the NHS, losing more blood may mean something is wrong and you should contact the hospital straight away. Any bleeding like a period is a reason to go to the admissions room (izba przyjęć) without waiting for contractions.
My waters have broken: what should I check and when should I go?
Your waters breaking, that is the amniotic fluid coming out, is according to pacjent.gov.pl a sign that labour is starting. The waters may break suddenly in a gush or leak slowly. If you notice fluid leaking, go to hospital, even if you have no contractions yet. Before you leave home, check a few things:
- Time: write down when your waters broke. According to the NHS, if more than 24 hours pass between your waters breaking and labour starting, the risk of infection for you and your baby goes up.
- Colour: normal fluid is clear and pale, and at first it may be slightly bloodstained.
- Warning colour and smell: green, brown or clearly bloodstained waters, or waters that smell unpleasant, are a reason to go straight away.
- A pad, not a tampon: wear a sanitary pad so the midwife can check the colour of the fluid. The NHS advises against tampons.
- Baby's movements: check that your baby is moving as usual.
If your group B streptococcus (GBS) swab was positive, say so on admission. The standard requires the hospital to establish whether you need GBS infection prevention during labour and to provide it. The UK NHS advises women with GBS to contact their midwife as soon as their waters break or labour starts.
A rare but urgent complication after the waters break is umbilical cord prolapse. According to the UK Royal College of Obstetricians and Gynaecologists (RCOG), it happens in 1 in 200 to 1 in 1000 births, more often when the baby is not head down or the waters break before 37 weeks. If you can feel the cord in your vagina or see it, call 112, do not touch it and do not try to push it back. Until help arrives, kneel down with your elbows and hands on the floor and lean forward.
When should I call 112 and when should I go to hospital straight away?
These signs apply to late pregnancy and labour. If you are not sure which group your symptom belongs to, choose the more urgent one.
| What to do | Symptoms |
|---|---|
| Call 112 | Heavy bleeding, when a pad is soaked soon after you put it on, especially with strong tummy pain, dizziness or fainting. The cord can be felt or seen in the vagina. A strong urge to push and a feeling that your baby is about to be born. Seizures or loss of consciousness. |
| Go to hospital straight away, without waiting for contractions | Any vaginal bleeding beyond streaks of blood in mucus. Green, brown, bloodstained or unpleasant-smelling waters. Weaker, less frequent or changed baby movements. Strong tummy pain that does not ease between contractions. Fever or feeling unwell, especially after your waters have broken. A severe headache that does not go away with painkillers, blurred vision or flashing lights, pain below the ribs, sudden swelling of the face, hands or feet. Contractions or leaking fluid before 37 weeks of pregnancy. |
| Go to hospital | Regular labour contractions that are getting stronger. Clear waters breaking, even without contractions. |
| Watch at home | Irregular contractions that weaken or go away. Losing the mucus plug without bleeding. Back and groin pain without other symptoms. |
Your baby's movements should not slow down towards the end of pregnancy. The RCOG stresses that babies move right up to labour and during it too, and that you must not wait until the next day if their movements change. Do not rely on a home fetal heart monitor instead of going to hospital.
According to the NFZ, in a direct threat to life or health you call 112 or 999. Remember that when you call an ambulance, you do not choose the hospital: the emergency team will take you to the nearest hospital emergency department (SOR) or to the hospital the dispatcher indicates. If worrying symptoms appear after birth, read our article on when to call a midwife and when to go to hospital after giving birth.
What should I do at home in early labour?
The first, latent phase of labour is the time when contractions already hurt and the cervix shortens and slowly opens. According to the WHO it lasts until the cervix is 5 cm dilated, and its length varies a lot with no set norm. The NHS says it can take many hours, sometimes even days, and that you usually spend it at home. The active phase starts at 5 cm according to the WHO and at about 4 cm according to the NHS, when contractions become stronger and more regular.
- Eat and drink: the NHS advises having something to eat and drink early in labour, because you will need the energy later.
- Rest: if labour starts at night, try to sleep or at least lie comfortably. During the day, stay upright and gently active.
- Ease the pain: according to the NHS, breathing exercises, massage and a warm bath or shower may help at this stage.
- Time your contractions: the start time and length of each one will help you, and later the staff, judge the rhythm.
- Get ready to go: check that your documents are in your bag and agree with your birth partner who will drive.
Some families book a private midwife who stays with them at home in early labour, checks how it is progressing and helps decide when to go to the hospital, where the baby is then born. This is called partly home birth (poród częściowo domowy). On MyMidwife you will find midwives who offer it, and we describe the details on the birth midwife service page.
What should I bring to hospital and what happens in the admissions room?
- An identity document, for example an ID card or passport, and your PESEL number (Polish personal ID number). The hospital uses them to check your right to NFZ care in the eWUŚ system.
- Your pregnancy record (karta przebiegu ciąży, also called książeczka prowadzenia ciąży), with notes from your appointments and tests.
- Your blood group result, GBS swab result and a recent full blood count. Pacjent.gov.pl reminds you about these documents.
- Your HBs and HIV test results from weeks 33 to 37. The standard requires the hospital to verify them and, if they are missing, to do the tests straight away.
- Your birth plan (plan porodu), if you have one. If not, staff will ask about your preferences on admission.
- Things for you and your baby packed in advance, as pacjent.gov.pl advises.
If the system does not confirm your insurance, you can sign a written declaration or bring a document confirming your right to care. If that is not possible straight away, you have 14 days from the start of treatment or 7 days from the end of hospital treatment to do it. A woman who is pregnant, giving birth or in the postpartum period, has Polish citizenship and lives in Poland has the right to free NFZ care even if she is not insured.
On admission, the midwife or doctor listens to your baby's heart, takes your history and reviews your pregnancy, checks your blood group and test results, and assesses your baby's position and size, your contractions and your general condition. In an obstetric examination they check how far labour has progressed and whether the amniotic sac is intact. An enema and shaving are done only if you ask for them.
If it turns out labour is only just starting, staff may suggest observation or going home for a while. The NHS describes this as a typical situation in the latent phase. Ask which symptoms should bring you back. How to write down what you expect from your birth is covered in our article on the birth plan.
Which hospital should I go to, and is there a catchment area?
There is no catchment area (rejonizacja). Under the standard, you are admitted for birth by going to the hospital of your choice that provides perinatal care, and choosing where to give birth is one of your patient rights. Pacjent.gov.pl adds that the chosen place must have an NFZ contract for that type of care. According to the NFZ, you can go to the emergency department (SOR) or admissions room without a referral, regardless of where you live. You need a referral from the doctor looking after your pregnancy for a planned caesarean section.
It is worth basing your choice on a risk assessment. The standard says the place of birth should match the documented assessment of perinatal risk factors, except in emergencies, and the person looking after your pregnancy should discuss them with you so you can choose a hospital in an informed way. With some conditions and complications they will recommend a hospital with a higher referral level, that is one that provides more specialised care for you and your baby.
At the end of pregnancy you still have appointments with tests, including the GBS swab and, after week 40, a CTG (KTG). According to pacjent.gov.pl, if your pregnancy is going normally you can usually stay at home for up to 7 days after your due date, and if it goes on longer, see a doctor. We cover the details in our article on end-of-pregnancy checks.
