There are a few strong indicators that it’s time:
You’re having regular contractions: every four minutes, lasting one minute, happening for at least an hour; remember 411).Your water broke (check with your provider for their advice).You are experiencing bright red vaginal bleeding.You have symptoms of pre-eclampsia, such as dizziness, headache, or blurred vision.
The stages of labor you’ll experience at home are early labor and the beginning of active labor. The early stage is the longest stage, and this is when you will begin to experience contractions. But you won’t want to head to the hospital just yet. Once you start to notice signs that you are transitioning into active labor (your contractions are getting stronger and more frequent, for example), then it’s time. After your water breaks, the time it will take for your labor to progress to delivery can vary. But the risk of infection increases if you do not give birth within 24 hours. Once your water has broken, the amount of time you have to get to the hospital safely will depend on many factors, such as how long it will take you to get there, how quickly your labor is progressing, and the overall health of your pregnancy. If it’s not your first pregnancy, things may move along faster than they did the first time. Your previous labor experience might offer some clues about what to expect, but don’t let it be your only guide—you may not have as much time as you think. In addition to knowing when to go to the hospital with contractions and when to stay home, it’s also a good idea to discuss the signs of preterm labor or complications like preeclampsia with your doctor or midwife. Here’s an overview of the signs of labor, the differences between false labor, true labor, and Braxton Hicks contractions, as well as the symptoms to watch for in the final weeks of your pregnancy. These guidelines, as well as your doctor or midwife’s advice, can help you feel more confident about deciding when to go to the hospital when you’re having contractions.
True vs. False Labor
As your due date nears, trying to figure out whether what you’re feeling is false labor or the real thing can be frustrating, confusing, and overwhelming. It helps to keep in mind that your body knows what it’s doing, and it will give you the information you need—you just need to pay attention and learn how to interpret the signs. When you’re trying to determine whether you’re in true labor, ask yourself: How far along am I? The closer you are to your due date, the more likely it is that you’re in true labor. Still, if you experience any symptoms that you feel unsure about at any point in your pregnancy, let your doctor or midwife know. How strong are my contractions? In false labor, you might feel tightness or discomfort as your uterus “practices” contractions, but these spasms usually don’t hurt and let up when you move or change positions. When you’re in real labor, you’ll feel pain—often in your back, as well as the front of your belly and pelvis. How frequent/far apart are my contractions? In true labor, you’ll feel your contractions getting increasingly closer together. They’ll be regular, and you’ll be able to time and anticipate them. When it’s not the real thing, you’ll feel mild contractions that don’t come in any kind of pattern. How intense are my contractions? The contractions of false labor, like Braxton Hicks contractions, usually aren’t painful. You’ll still be able to walk around, talk, and sleep through them. The contractions of real labor start out mild but get more intense as your labor progresses. These contractions will hurt, and the pain will increase. How long do the contractions last? In false labor, contractions will be short (around 15 to 45 seconds). Real contractions can start out short but will get longer as your labor progresses. Do the contractions change when I move around? When you’re having false contractions, they may go away if you change position or start moving around. In true labor, your contractions will continue to progress regardless of what you do. Am I having other symptoms of labor (back pain, water breaking)? It’s probably not the real thing if you’re not having any other signs of labor, but those practice contractions are a sign that you’re getting closer! Is my pregnancy considered high risk? To be on the safe side, if you have health conditions or are carrying more than one baby, let your doctor or midwife know if you are having contractions or any other signs of labor—especially if you are less than 37 weeks along.
Braxton Hicks Contractions
If your baby is full term and you start feeling contractions irregularly, but your water has not broken, you could be experiencing Braxton Hicks contractions. As you get closer to delivery, your uterus prepares for labor by mildly contracting from time to time, without causing the cervix to dilate. When your uterus makes a trial run for real labor, you may feel a tightening or spasming sensation in your abdomen.
Getting longerGetting strongerGetting more frequent and closer together
If you’ve never been pregnant before, it’s easy to mistake practice contractions for the real thing. Braxton Hicks contractions:
Are not especially painful (you can talk and sleep through them)Are felt mostly in the front of the uterus (rather than in your back)Last less than 30 seconds eachDon’t go on for longer than one hourAre occasional or irregular and do not come close togetherStart out weak and remain weak (they don’t get progressively more intense)Subside on their own or go away when you move around, use the bathroom, or having something to eat or drink
The contractions of true labor can start any time day or night. Braxton Hicks contractions are more common at the end of the day—especially after you’ve been busy or physically active (including sex, which can also trigger Braxton Hicks).
The 411 Rule for Active Labor
Your doctor or midwife might recommend using a particular method of timing your contractions to help you decide whether it’s time to go to the hospital. These methods vary in specifics but generally follow the same principle: You keep track of how often your contractions are coming, how long each one lasts, and how long they have been following the defined pattern. According to the “411 Rule” (commonly recommended by doulas and midwives), you should go to the hospital when your contractions are coming regularly 4 minutes apart, each one lasts at least 1 minute, and they have been following this pattern for at least 1 hour. You may also hear about the 511 rule. The only difference between the 511 and 411 rules is the first number, which stands for how many minutes apart your contractions are. Depending on your health history, particularly if you have given birth before, your provider may recommend that you follow the more conservative 511 rule.
When to Go to the Hospital
As you approach your due date, your doctor or midwife will give you guidance on when to call them or go directly to the hospital. Depending on your medical history and what your pregnancy has been like, you may have special rules to follow. In general, the goal is to head to the hospital when you’ve reached the stage of active labor (spending the hours of early labor at home). There are a few ways that your body will signal that you’re heading towards active labor.
You’re Having Contractions
When your contractions start as mild and irregular cramps but slowly progress to more painful and regular occurrences, it’s a hint that true labor has begun. Unless your doctor or midwife says otherwise, you can probably rest at home while you’re in the early phase of labor. Contractions start out mild and infrequent during this stage but get stronger, more frequent and regular, and come closer together as your labor continues. The amount of time it takes to progress from early to active labor varies from person to person and pregnancy to pregnancy, but it can be helpful to know that early labor is the longest phase of labor and, particularly for first-time moms, can last upwards of 20+ hours. The labor timeline can be different from one pregnancy to the next, and it’s not unusual for second or third babies to come more quickly than first babies. You’ll know you’ve transitioned into active labor when your contractions are regular in their strength and frequency. Each contraction will be as strong or stronger than the last, and they will reliably arrive less than 5 minutes apart. You’ll also likely sense a shift in your mood and behavior as your focus turns inward and you have to work through your contractions. If you have a high-risk pregnancy, your doctor or midwife may want you to head for the hospital as soon as you are in active labor. If your pregnancy has been normal, you may not have to rush—your midwife and doctor will give you guidelines based on your most recent prenatal exam (such as the position of your baby and cervix). Paying close attention to your baby’s movement during a contraction can also help differentiate between true and false labor. The contractions of real labor move your baby down on the cervix, toward the birth canal. Your baby’s head pushes against your cervix, which serves to slowly thin out (efface) and open it (dilate) to prepare for delivery. The practice contractions of false labor don’t dilate your cervix. In real labor, you might feel like your baby has “dropped” lower into your pelvis. This is known as “lightening,” and it’s how you know that your baby’s head is getting into position for birth.
Your Water Breaks
If your water breaks, you may not have to rush to the hospital. Call your doctor or midwife first. They may ask you to come to the office, hospital, or birthing center so they can confirm that the amniotic sac has ruptured, but it’s more likely you’ll be able to stay at home for a while longer. However, there are some circumstances where you’ll need to go to the hospital or birth center right away to prevent infection or complications. These include being positive for group B strep or having discharge that’s stained brown (which could be meconium—your baby’s first poop). If your water breaks but you aren’t having contractions, your doctor or midwife may tell you it’s OK to stay home for a while longer to see if your labor progresses. This waiting period is sometimes called “expectant management.” In some cases, it can last up to 24 hours. Usually, contractions will kick in between 12 and 24 hours after the amniotic sac has ruptured. If your labor has not started, your doctor or midwife may want you to come to the hospital or birthing clinic to be induced. The reverse can also occur: If you’re having contractions and your labor is trying to progress, but your water hasn’t broken, your doctor or midwife may need to rupture the amniotic sac for you at the hospital or clinic. If you think that your water has broken, but you are unable to reach your healthcare provider, it’s OK to err on the side of caution and go to the hospital or clinic. If you’ll be staying at home a while longer after your water breaks, the first thing you’ll want to do after talking to your doctor or midwife is get cleaned up and comfy. You can start with a warm shower (not a bath) and change into fresh clothes. You may continue to leak some fluid after your water has broken. Once you decide where you want to rest at home (the couch, your bed, the floor), throw a towel down to protect whatever is underneath. Disposable bed pads also work well and can be tossed in the trash (rather than making extra laundry). If your water broke in your bed or on your carpet, try to get it cleaned up as soon as possible to prevent staining. Amniotic fluid is much easier to remove from a surface or fabric before it dries. Some gentle laundry detergent mixed with water will usually do the trick. If you have pets, the products made to clean up after them also work well.
You’re Bleeding
Vaginal discharge is common throughout pregnancy and can give you important clues about how close to delivery you are. If your due date is near, you might notice a discharge that’s tinged pink or brown with a little blood (often called a “bloody show”). This is a normal response as your cervix begins to thin out, widen, and stretch open (effacing and dilating), and is a sign that you’re going into early labor. Once you’ve seen the “bloody show,” you’ll probably start to experience contractions soon. For some people, labor kicks in right after they see the discharge. For others, it might take several days. Around this time, typically before the bloody show, you may also notice a much larger chunk of clear to light pink mucus when you wipe or in the lining of your underwear. This is the mucus plug, which keeps your cervix closed until your body begins to prepare for delivery. When it comes out, the mucus plug can look like a big glob or dislodge in several long strands. It doesn’t always dislodge in one piece—if it breaks apart and comes out a little at a time, it’s possible that you’ll pass it without even noticing. The mucus plug helps keep bacteria out of your cervix and therefore protects your baby (and you) from infection. Losing it too soon in your pregnancy puts you and your baby at risk. Certain things, like sexual intercourse or having a vaginal exam at your doctor’s office, can sometimes dislodge the mucus plug early. For some people, the thick, jelly-like plug dislodges in the final weeks of pregnancy, but it can also happen right as you’re going into labor. If you are considered term (37 weeks or more), losing the mucus plug is not a reason to go to the hospital—it’s just a sign that your body is preparing for labor.
Your Pregnancy Is High-Risk
You might need to seek medical care sooner in labor if you have a high-risk pregnancy. For example, if you are carrying twins or higher-order multiples, or you have a health condition that makes your pregnancy higher risk, you’ll want to call your doctor or midwife at the first sign of contractions—even if you aren’t sure that you’re in labor. Early in your pregnancy, your doctor or midwife should explain how to recognize the signs of complications, as well as make sure you understand what to do if you experience these symptoms. If they don’t provide this information, ask!
You’re Having Symptoms of Preeclampsia
Preeclampsia is a serious condition of pregnancy where your blood pressure gets too high (hypertension). Preeclampsia requires close medical treatment, as it can cause life-threatening complications during labor and delivery. While your blood pressure is a sign that your doctor or midwife can measure, you may not be able to tell (or feel) when it is elevated. Another sign of preeclampsia is protein in your urine—again, something that you might not be aware of, but that a healthcare professional can test for. You may not have symptoms of preeclampsia. Even if you do have symptoms, you might think they are just a normal part of pregnancy. The following symptoms can be a sign of preeclampsia:
Swelling in your face and handsSudden weight gain (three to five pounds in one week) from fluidBlurred visionDizzinessHeadacheSevere abdominal pain (can be worse on the right side and/or spread to your shoulder)Nausea and vomitingFeeling short of breathIncreased levels of anxietyChanges in your reflexesLoss of consciousnessSeizures
If you have symptoms of preeclampsia, call your doctor or midwife immediately. If you can’t reach them, call 911 or go to the emergency room.
When to Call a Doctor
If you’re not sure whether or not you’re going into labor (or you think you might be but are worried that it’s too soon), call your doctor or midwife.
Signs of Preterm Labor
If you experience these symptoms, seek medical attention right away. One of the main signs of preterm labor is contractions before you reach 37 weeks. The contractions might start out as only a tightening sensation but become painful and more frequent (more than five in one hour). Other signs of preterm labor that can occur before 37 weeks include:
Start bleeding (especially if it’s bright red and a large amount)Notice that your baby isn’t moving as much as they normally doHave an increased amount of discharge or fluid (especially if it is brown, green, or mixed with blood)
Vaginal bleeding (bright red blood)A sudden gush of clear, watery fluid from your vagina Dull or sharp backache (may come and go or get progressively worse)Intense pelvic pressure and cramping (can feel like menstrual cramps) which may radiate to your groin and thighsNausea and vomiting, diarrhea, and an overall feeling of being unwell
If you are having symptoms of preterm labor, call your healthcare provider right away. If you can’t reach your doctor or midwife, go to the emergency room. Preterm labor can be risky for you and your baby. The sooner it’s identified, the better. In some cases, preterm labor can be stopped, or at least stalled, which can help reduce the risks. Whether this is your first pregnancy or you’ve given birth several times, it’s normal to have questions about labor and delivery. Every birth experience will be unique, but there are some questions that are common during this special time. Can I take a shower and have something to eat while I wait to go to the hospital? Unless your doctor or midwife advises against it, taking a warm shower, having a snack or light meal, and making sure that your hospital bag is packed are all good uses of your time while you’re laboring at home. When (and how) should I time my contractions? You can start timing your contractions (or what you think might be contractions) as soon as you feel them. In fact, timing the contractions you’re feeling is one way to tell the difference between false labor and the real thing. There are different methods of timing contractions, but the basic goal is keeping track of the pattern. Paying attention to how the pattern changes (for example, having more contractions that last longer and are coming increasingly closer together) can tell you a lot about how your labor is progressing. Your partner, a friend, or a family member can help you time your contractions, or you can even use an app to time them. Can I prevent preterm labor? Some causes of preterm labor are out of your control, such as genetic risk factors, having a high-risk pregnancy, and physical problems with your uterus or cervix. However, doing everything you can to have a healthy pregnancy can help reduce the risk of preterm labor. Should you go into preterm labor, taking care of yourself throughout your pregnancy also supports you and your baby’s health. You can promote a healthy pregnancy by quitting smoking, avoiding alcohol, eating well, getting enough sleep, taking steps to prevent infections, and regularly going to your scheduled prenatal appointments. Can I reduce my risk of developing preeclampsia? As with preterm labor, there are risk factors for preeclampsia that you can’t change or prevent (such as a family history of the condition or preexisting problems with your blood pressure). If you know that you are at risk for preeclampsia, your doctor or midwife will support you in taking steps during your pregnancy, labor, and delivery to reduce the risks to you and your baby should the condition develop. For example, you may need to have more frequent prenatal visits to monitor your blood pressure and urine. Or you may be put on bed rest. I think I might be in labor, but I can’t reach my doctor or midwife. Should I go to the hospital? If you’re having any symptoms that concern you, it’s better to go get checked out, get reassurance, and get sent home from the hospital with false labor than to wait and risk complications if something isn’t right. What if I wait too long to leave for the hospital or my labor goes faster than I expected? If you are still at home or are on your way to the hospital and the birth of your baby is imminent, call 911. First responders and emergency dispatchers are trained to safely deliver babies outside the hospital, if necessary. If you are with a partner, friend, or family member, they can help. If you’re by yourself, stay calm and follow the instructions given to you by the dispatcher.
