PregnancyWhen to Go to the Hospital During Labor
Knowing when to leave for the hospital is one of the biggest anxieties of late pregnancy. Too early and you get sent home. Too late and you're delivering in the car. Here’s how to listen to your body, use the 5-1-1 contraction rule, and notice warning signs that mean it’s time to go in.
The 5-1-1 Rule Explained
The 5-1-1 rule is the most widely taught guideline for deciding when to go to the hospital. It stands for three things: contractions every 5 minutes, each lasting at least 1 minute, for at least 1 hour. When your contractions hit this pattern consistently, it's generally time to call your provider or head to the hospital.
Here's why those numbers matter. Contractions every 5 minutes suggest active labor has begun — your cervix is likely dilating beyond 4–6 centimeters. Contractions lasting a full minute mean each one is strong enough to do real work on cervical dilation. And the one-hour requirement filters out false alarms, since Braxton Hicks and early labor contractions often feel intense for 20–30 minutes before fading.
Some providers modify this rule. A 4-1-1 guideline is common for women who live far from the hospital or have risk factors that warrant earlier evaluation. A 3-1-1 rule is sometimes used for second-time mothers, whose labor tends to accelerate once active labor begins. Ask your doctor or midwife at a prenatal visit which version they recommend for you.
The 5-1-1 rule applies to uncomplicated, term pregnancies. It isn’t a substitute for clinical judgment. If something feels wrong — even if your contractions don't match the pattern — call your provider. They would rather hear from you unnecessarily than have you wait too long.
Signs You're in Active Labor
Contractions are the headline signal, but active labor involves several other changes that help you confirm what's happening. Look for these signs together:
- Regular, intensifying contractions. Contractions often come at predictable intervals. Contractions usually get stronger with each wave. Unlike early labor, you cannot talk or walk comfortably through active contractions. They tend to demand your full attention.
- Contractions that don't stop with rest. If you lie down, drink water, or take a warm bath and the contractions keep the same intensity, you’re probably past the point where position changes will slow them down. This is a key distinction from Braxton Hicks contractions.
- Increasing pressure in the pelvis. As the baby descends, you may feel heavy pressure low in your pelvis or rectum. Some women describe it as the baby "bearing down" or a strong urge to push.
- Bloody show. A small amount of blood-tinged mucus is normal as the cervix dilates. This is different from heavy bleeding, which is a warning sign (see below).
- Lower back pain that doesn’t let up. Persistent, rhythmic lower back pain — especially if it radiates around to the front — often accompanies active labor. It may intensify with each contraction.
- Your water breaking. This can be a dramatic gush. Or it can be a slow, steady leak. Either way, write down the time. Write down the color (it should be clear or slightly pink). Write down the amount. Contact your provider immediately.
Not all of these signs appear in every labor. Some women experience all of them. Others have only contractions and back pain. The contraction pattern is usually the most reliable indicator. That’s why timing them matters so much. Understanding the stages of labor helps you interpret what your body is telling you.
Warning Signs: Go to the Hospital Immediately
Some situations require immediate medical attention regardless of your contraction pattern. Do not wait for contractions to reach the 5-1-1 threshold if you experience any of the following:
- Heavy vaginal bleeding. Soaking through a pad in less than an hour isn’t normal during labor. Light spotting or blood-tinged mucus is expected; steady, bright red bleeding is not. This could be a sign of placental abruption or placenta previa.
- Your water breaks and the fluid is green, brown, or foul-smelling. Clear or slightly pink amniotic fluid is normal. Green or brown fluid may mean there’s meconium (the baby’s first stool) in the amniotic fluid. Meconium can be dangerous if the baby inhales it during delivery.
- Decreased fetal movement. If your baby's movement pattern changes significantly — far fewer kicks than usual, or no movement at all — go in for monitoring. Don't wait to see if it gets better on its own.
- Severe, constant abdominal pain. Contractions come in waves. If you have severe pain that doesn’t ease up between contractions, something else may be going on.
- Sudden severe headache, vision changes, or upper abdominal pain. These can be signs of preeclampsia, a serious pregnancy complication. Call your provider or go to the emergency room.
- Fever above 100.4°F (38°C). Fever during labor may be a sign of infection, especially if your water has already broken.
- Umbilical cord prolapse happens when the umbilical cord slips down ahead of the baby. If you feel something in your vagina after your water breaks, or you can see the cord, call 911 immediately. Get on your hands and knees, and keep your chest low, to take pressure off the cord.
- Preterm labor. If you’re less than 37 weeks pregnant and you’re having regular contractions, pressure, or fluid leakage, go to the hospital. Preterm labor needs immediate evaluation, even if the contractions feel mild.
When in doubt, go in. No nurse or doctor will criticize you for seeking evaluation. Honestly, it’s better to get checked and be sent home than to wait too long at home with a complication.
What to Do Before Leaving for the Hospital
Once you've confirmed a consistent contraction pattern and decided it's time to go, these steps help you arrive prepared and calm:
- Call your provider. Before you leave, call the labor and delivery unit or your midwife’s answering service. Tell them your contraction pattern (frequency, duration, and how long it’s been going on). Tell them if your water has broken. Tell them about any other symptoms you’re having. They may give you specific instructions based on your medical history.
- Keep timing contractions. Continue tracking until you arrive. The triage nurse will ask about your pattern, and having concrete data — rather than "they've been pretty close together for a while" — speeds up assessment. A contraction timer makes this simple.
- Eat a light snack, and drink some water. Many hospitals limit food during active labor. A small, easy-to-digest snack now, like toast, a banana, or yogurt, can give you energy for the hours ahead. Drink water or an electrolyte drink.
- Take a shower. If you have time and your water hasn’t broken, a warm shower can ease early contraction discomfort. It can also help you feel calmer and more in control. It's also practical — you may not shower again for a while.
- Grab your hospital bag. Your bag should already be packed (see the checklist below). Confirm your ID, insurance card, and phone charger are inside.
- Arrange transportation. Have your partner, a family member, or a rideshare lined up. Do not drive yourself if contractions are strong and close together.
- Use your breathing techniques on the way. The car ride during active labor is uncomfortable. Slow breathing exercises — in through the nose for 4, out through the mouth for 8 — help manage contractions and keep you grounded. If you've been practicing hypnobirthing, this is the moment those weeks of preparation pay off.
What to Expect When You Arrive
Knowing the process ahead of time removes one more source of anxiety. Here's what typically happens when you walk through the doors:
Triage. You'll be taken to a triage area where a nurse checks your vital signs, monitors the baby's heart rate, and performs a cervical exam to measure dilation and effacement. They’ll ask about your contraction pattern, when your water broke (if applicable), and your medical history. If you've been using a contraction timer, share your log — it gives them an immediate picture.
Admission or observation. If you're in active labor (typically 4–6 cm dilated or more), you'll be admitted to a labor room. If you’re in early labor, they may keep you in observation for 1–2 hours to see if you progress. Some women are sent home at this point. That's okay — it means your body is doing exactly what it should, just not quite fast enough yet.
Monitoring. Most hospitals use continuous or intermittent fetal monitoring during labor. They’ll strap belts with sensors around your abdomen to track the baby’s heart rate and your contractions. This data helps staff identify any concerns early.
Pain management discussion. Your nurse or provider will ask what you want for pain management. Pain relief options typically include IV medication, nitrous oxide, and epidural anesthesia. Options also include non-pharmacological methods like movement, hydrotherapy, and breathing techniques. Having a birth plan helps, but flexibility is important — labor is unpredictable.
Support and waiting. Active labor can take hours. Between exams and monitoring checks, you’ll usually have some time. Use that time to do breathing exercises, change positions, walk (if allowed), and rest. Your support person matters a lot here. They can hold your hand, remind you to breathe, and speak up for your preferences.
First-Time Mothers vs. Subsequent Pregnancies
Labor timing is different depending on whether this is your first baby or a subsequent one. Knowing these differences can help you plan ahead.
First-time mothers tend to have longer labors. Early labor can last 12–18 hours or more. Active labor averages 8–12 hours. The cervix has never dilated before, so each centimeter takes more time. The 5-1-1 rule works well because there’s usually a comfortable buffer between hitting that pattern and when delivery is actually imminent.
Second-time and subsequent mothers often experience faster labor. The cervix has dilated before and tends to open more efficiently. Active labor may last 4–6 hours. Some women go from 4 cm to fully dilated in under two hours. For this reason, many providers recommend using a 4-1-1 or 3-1-1 guideline and leaving for the hospital earlier. If your first labor was fast, your second labor may be faster.
There are exceptions in both directions. Some first labors are quick. Some second labors last longer than the first. The pattern is a general trend, not a guarantee. The safest approach is to talk through your specific situation with your provider at a prenatal visit. Agree on a plan before labor starts.
Regardless of which pregnancy this is, the warning signs in the section above override any contraction rule. Heavy bleeding always means go now. Decreased movement always means go now. A feeling that something is wrong always means go now.
How a Contraction Timer Helps You Decide
Your memory is unreliable during labor. Contractions can hurt a lot. Time can feel warped during contractions. It’s easy to lose track of the intervals. A contraction timer solves this by recording objective data you can act on.
When you press start at the beginning of a contraction and stop when it ends, the timer captures two critical measurements: duration (how long the contraction lasted) and frequency (the gap from the start of one contraction to the start of the next). After several contractions, you have a pattern. After an hour, you can usually tell if the pattern matches the 5-1-1 rule.
This data is also useful for your provider. When you call the labor ward and say, “My contractions have been 4 to 5 minutes apart, lasting 55 to 70 seconds, for the past 90 minutes,” the nurse can usually give a faster recommendation. The nurse will probably feel more confident if you give exact timing instead of saying, “They’re getting closer together, I think.”
The Pregnancy App contraction timer tracks duration, frequency, and count in real time. It works on your phone, calculates averages automatically, and stores your history so you can show it to hospital staff when you arrive. The app sends a notification when your contraction pattern matches the 5-1-1 threshold.
Hospital Bag Checklist
Pack your hospital bag by week 35–36 so it's ready when contractions start. You don’t want to be digging around for your insurance card during active labor. Here's what to include:
- Documents: Photo ID, insurance card, birth plan (printed copies), hospital pre-registration paperwork.
- For labor: Phone and charger, headphones, lip balm (hospitals are dry), hair ties, a focal point or comfort item, massage oil or lotion, and your contraction timer app downloaded and ready.
- For recovery: Comfortable robe or nightgown (that opens in front for nursing), nursing bra, slippers with grip, toiletries, your own pillow if you're particular, and going-home outfit (something loose — you'll still look 5–6 months pregnant).
- For the baby: Going-home outfit, swaddle blanket, infant car seat (installed in the car before you leave).
- For your partner: Change of clothes, snacks, phone charger, cash for the cafeteria.
- Optional comfort items: Hypnobirthing audio downloaded for offline playback, essential oils (check hospital policy), a playlist, LED candles for ambiance, a fan for temperature control.
Skip anything that would stress you out if it got lost or stained. The hospital provides most medical supplies, diapers, baby blankets, and basic toiletries. Focus on what’ll help you feel comfortable and prepared.
TL;DR
- Use the 5-1-1 rule: contractions every 5 minutes, lasting 1 minute, for 1 hour — then call your provider or go to the hospital.
- Some providers use 4-1-1 or 3-1-1, especially for second-time mothers. Confirm your guideline at a prenatal visit.
- Go immediately if you have heavy bleeding, green/brown amniotic fluid, decreased fetal movement, severe constant pain, signs of preeclampsia, or fever.
- A contraction timer gives you objective data to share with your provider and removes guesswork.
- First labors are typically longer (8–12 hours active). Second labors are often faster (4–6 hours). Plan accordingly.
- Pack your hospital bag by week 36 so it's ready when labor starts.
- When in doubt, go in. No one at the hospital will fault you for arriving early.
Limitations & Safety
This page provides general educational information about labor and when to go to the hospital. This isn’t medical advice, and it doesn’t replace guidance from your doctor, midwife, or healthcare provider. Every pregnancy is different. Your personal risk factors can change what “safe timing” looks like.
The 5-1-1 rule is a widely used guideline. It isn’t a universal standard. Your provider may recommend different criteria. They base it on your medical history. They also factor in your distance from the hospital. They consider gestational age. They look at the specifics of your pregnancy. Always follow your provider's instructions over general guidelines.
Contraction timing data — whether from an app, a clock, or a written log — is a decision support tool. It does not diagnose labor, predict complications, or replace clinical assessment. Cervical dilation can only be determined by a physical exam.
If you’re not sure whether to go to the hospital, call your provider. If you can't reach your provider, go to the hospital. Trust your gut. If you feel like something's wrong, that's a valid reason to get checked out, even if you can't name a specific symptom.
Frequently Asked Questions
When should I go to the hospital during labor?
Most providers recommend going to the hospital when your contractions follow the 5-1-1 pattern: every 5 minutes apart, each lasting 1 minute, for at least 1 hour. If your water breaks, you have heavy bleeding, decreased fetal movement, or severe pain between contractions, go immediately regardless of contraction timing.
What is the 5-1-1 rule for labor contractions?
The 5-1-1 rule is a guideline that helps you decide when to head to the hospital. It means contractions are coming every 5 minutes, each contraction lasts at least 1 minute, and this pattern has continued for at least 1 hour. Some providers use a 4-1-1 or 3-1-1 version. This is especially common if you've given birth before.
How can I tell if my contractions are real or just Braxton Hicks?
Real labor contractions get progressively stronger, longer, and closer together over time. They do not stop when you change position, walk, or drink water. Braxton Hicks contractions are irregular, do not intensify, and usually fade with rest or hydration. Timing contractions for one hour makes the difference clear.
Should I go to the hospital if my water breaks but I'm not having contractions?
Yes. If your water breaks, call your provider and go to the hospital, even if you don't have contractions. Your provider needs to confirm the rupture, check for infection risk, and monitor the baby. Most providers want you evaluated within a few hours of your water breaking. Write down the time it happened, the color, and how much fluid there was.
What happens if I show up at the hospital too early?
If you arrive in early labor, the hospital may monitor you for a short time and then send you home so you can labor somewhere more comfortable. This is common, and you don't need to feel embarrassed about it. Early labor can last many hours. Most women cope better at home during this phase. The staff will give you clear instructions on when to return.
Is labor faster with a second baby?
Generally, yes. Second and later labors tend to move faster than the first. Active labor for a first baby averages 8 to 12 hours. Active labor for later births may be 4 to 6 hours or less. Many providers recommend the 4-1-1 or 3-1-1 rule for second-time mothers. They may also tell you to leave for the hospital earlier.
How can a contraction timer help me figure out when to go to the hospital?
A contraction timer tracks the duration and frequency of each contraction. It removes guesswork by giving you concrete numbers to compare against the 5-1-1 rule. When you call your provider or arrive at the hospital, a log of your contraction pattern helps staff assess your labor stage quickly.
What should I pack for the hospital when I go into labor?
Pack your ID and your insurance card. Essential items include your birth plan. Essential items include your phone and charger. Essential items include comfortable clothes and a nursing bra. Essential items include toiletries. Essential items include a going-home outfit for you and baby. Bring an infant car seat. Toss in a few comfort items, like a pillow or a music player. Pack your hospital bag by week 36 so it is ready when labor begins.