When to go to the hospital in labor: contractions and other signs

Maybe it’s the middle of the night and the tightening has settled into a rhythm, or maybe you’re reading ahead so the plan is clear before you need it. The decision mostly comes down to the pattern of your contractions. A short list of warning signs means you call right away, whatever that pattern looks like.

For a first baby, many care providers want to hear from you once contractions are about 5 minutes apart. Each lasts about a minute, and the pattern has held for at least an hour (Lamaze International). ACOG’s advice is to contact your provider whenever you think you’re in labor or aren’t sure. If you’re not sure labor has started at all, begin with signs of labor.

How far apart should contractions be before you go?

What hospitals look for is a regular pattern of strong contractions that has kept going for a while. Kaiser Permanente tells patients to time how long each contraction lasts. Kaiser also says to count the gap between contractions from the start of one to the start of the next.

For a first baby, the cutoffs differ a little from one hospital to the next:

• Lamaze International says many care providers use the 5-1-1 rule. That means about 5 minutes apart, about 1 minute long, for at least an hour. Our guide to the 5-1-1 rule explains where it comes from and how its variants differ.
• Kaiser Permanente says to come when contractions arrive every 3 to 5 minutes over an hour. Each lasts at least 45 to 60 seconds.
• Boston Medical Center uses 4-1-1. A new contraction starts at least every 4 minutes and lasts about a minute, nonstop for at least an hour.
• UC San Diego Health uses a longer window. Regular, painful contractions about a minute long come at least every 5 minutes, for more than two hours.

Strength counts as well. Boston Medical Center suggests you start timing once you can’t talk or laugh through a contraction. Contractions that slow down or stop when you rest, drink water or walk are probably not active labor yet, it adds. Braxton Hicks contractions explains how practice contractions behave. Whatever number your own hospital gives you is the one to follow, so ask at a prenatal visit and write it down.

Some signs mean you go in without waiting for a pattern. Boston Medical Center says to come in right away if your water breaks and the fluid is green, yellow or brown. The same applies if you carry group B strep (GBS) and need antibiotics. A little pink or brown blood when you wipe can be normal. Bleeding as heavy as a period, running down your legs or with clots means going in right away. The NHS adds that you shouldn’t wait until the next day, even if it’s the middle of the night. For what to watch for once your water has broken, see water breaking.

Doing this math between contractions is hard, especially at night. The free online contraction timer shows the interval, the duration and how close you are to 5-1-1. The Contraction Timer app lets you set your hospital’s own rule and alerts you when it’s reached, with a button that calls the labor ward. How the app calculates explains how it checks the rule. If you’re new to timing, start with how to time contractions.

Your second baby may come faster

ACOG puts a typical first labor at 12 to 18 hours and later labors at 8 to 10 hours. NICE, the UK guideline body, puts the established (active) first stage at 8 hours on average in a first labor. In later labors it averages about 5 hours.

Both Kaiser Permanente and Boston Medical Center set an earlier cutoff for second and later babies. Kaiser suggests coming in when contractions are every 5 to 7 minutes and last 45 to 60 seconds. Boston Medical Center says to come when they’re five to six minutes apart. If your last labor was very quick, bring it up at a prenatal visit so your plan takes it into account.

Factor in the drive

Before labor, ACOG suggests that you:

• work out how far you live from the hospital and how long the trip takes
• do a practice run
• allow for traffic, rush hour and delays on your usual route

If the drive is long, ask your provider whether you should leave earlier than the standard rule.

ACOG also recommends packing your bag ahead of time and keeping it somewhere handy, such as a hall closet or the trunk of your car. Make sure the car seat is properly installed, too. Our hospital bag checklist helps with the packing. Decide early who will look after older children and pets, so leaving doesn’t depend on last-minute phone calls.

Call before you get in the car

Ask your hospital how it wants you to arrive. Kaiser Permanente asks patients to call before they come so the team can help them avoid extra trips. ACOG suggests settling these with your care team well before your due date:

• the right time to call
• how to reach your provider after hours
• whether to call first or go straight to the hospital
• any special steps for your situation

In the UK, NICE asks maternity units to assess labor by phone first and then decide whether you need to be seen in person.

The person on the phone will want to know how you and the baby are doing. NICE’s early assessment includes asking how you are, what you want and what worries you, and whether the baby’s movements have changed. If your water has broken, NICE adds when it happened and asks about risk factors. These include discolored or bad-smelling fluid, bleeding, reduced movements, constant abdominal pain, feeling unwell and GBS status. Have this ready before you dial:

• how many weeks pregnant you are and whether this is your first baby
• when contractions started, how far apart they are and how long each one lasts
• if your water broke, the time and the color and smell of the fluid
• any bleeding, and how the baby is moving
• your GBS result and any conditions your care team already knows about
• how long the drive will take

What happens if you get there in early labor

At the hospital, the team checks on you and the baby and examines your cervix to see how far labor has progressed. Hospitals draw the admission line in different places. UC San Diego Health admits you above 4 centimeters and may send you home below that. Boston Medical Center asks you to stay once you’re at least 5 to 6 centimeters. NICE defines established labor as regular contractions with progressive dilation from 4 centimeters.

Before that point you’re in early, or latent, labor, the first phase of the stages of labor. The NHS says this phase can take hours or sometimes days, and Kaiser Permanente notes that early labor can last for days. If you and the baby are fine, NICE recommends encouraging you to stay at home or go back home. The exception is when that would risk giving birth without a midwife present or leave you distressed. Boston Medical Center may suggest a walk near the hospital and another check later, or going home to rest.

Going home at this stage is part of normal care and doesn’t mean you misjudged anything. Keep timing, rest when you can, and call again when the pattern changes or a warning sign shows up.