When to Go to the Hospital: Signs of True Labor vs. False Alarms

One of the most common questions I hear from first-time parents: "How will I know when it's time to go to the hospital?" It's a valid concern—you don't want to arrive too early and be sent home, but you also don't want to wait too long.

Here's your guide to recognizing true labor and timing your arrival just right.

True Labor vs. Braxton Hicks

Braxton Hicks Contractions

Often called "practice contractions," Braxton Hicks are your uterus rehearsing for the big day:

• Irregular and unpredictable
• Don't get closer together over time
• Vary in intensity but don't progressively strengthen
• Stop when you rest, change position, or drink water
• Feel like tightening or hardening, usually painless
• Start in the front of your abdomen

True Labor Contractions

Real labor contractions have distinct characteristics:

• Regular and predictable pattern
• Get closer together as time passes
• Intensify progressively
• Continue regardless of rest or position changes
• Feel like cramping or aching that builds and peaks
• Start in your back or lower abdomen and radiate

The 5-1-1 Rule

The classic guideline for when to head to the hospital:

5 - Contractions are 5 minutes apart (measured from start of one to start of the next)

1 - Each contraction lasts about 1 minute

1 - This pattern has continued for at least 1 hour

Timing Your Contractions

To time contractions accurately:

1. Note when a contraction starts
2. Note when it ends (this gives you duration)
3. Note when the next one starts (this gives you frequency)
4. Track for at least an hour

Many apps can help with this, or use a simple stopwatch and notepad.

When the 5-1-1 Rule Doesn't Apply

Go to the hospital earlier if:

• You live far from the hospital (30+ minutes)
• You've had a previous fast labor
• Your provider has given different instructions
• You're GBS positive and need antibiotics
• You have other risk factors

Other Signs It's Time

Beyond contractions, watch for:

Your Water Breaks

If your membranes rupture:

• Note the time it happened
• Observe the color (should be clear or slightly pink)
• Note any odor (should be odorless)
• Call your provider immediately

Most women go into labor within 24 hours of their water breaking. Your provider will likely want you at the hospital relatively soon to reduce infection risk.

Bloody Show

A mucus plug tinged with blood signals cervical changes. It doesn't mean labor is imminent, but it's a good sign things are progressing. Usually, labor begins within days.

Intense Pressure

Significant pressure in your pelvis—like baby is very low—can indicate advanced labor, especially if combined with contractions.

When to Call Your Provider

Contact your healthcare provider if:

• Contractions fit the 5-1-1 pattern
• Your water breaks (any amount)
• You have heavy bleeding (more than spotting)
• Baby is moving less than usual
• You have severe headache, vision changes, or swelling
• You have fever or feel unwell
• Something just feels wrong

Trust your instincts. If you're worried, call.

When to Go Immediately

Head to the hospital (or call 911) right away if:

• Heavy vaginal bleeding (soaking a pad quickly)
• Severe abdominal pain that doesn't let up
• You feel the urge to push
• You can see or feel the cord
• Baby is coming and you can't make it
• Decreased fetal movement with other symptoms

What to Expect When You Arrive

Triage Assessment

When you get to the hospital, you'll be assessed in triage:

• Vital signs checked
• Baby's heart rate monitored
• Cervical exam to check dilation
• Contraction pattern observed

Three Possible Outcomes

1. Admitted: You're in active labor (usually 5-6cm dilated)
2. Sent home: You're in early labor and better off at home
3. Observed: They want to monitor you before deciding

Being Sent Home

If you're sent home, don't feel embarrassed. It happens to many women and is actually better for your comfort and labor progress. You'll be given guidelines for when to return.

First-Time vs. Subsequent Pregnancies

First Pregnancy

• Labor typically takes longer
• You have more time between contractions starting and active labor
• The 5-1-1 rule generally applies
• Early labor at home can last many hours (6-12+ hours)

Second or Later Pregnancies

• Labor is often faster
• Consider heading in sooner
• Some providers suggest 7-1-1 (contractions 7 minutes apart)
• Have a backup plan for childcare for older children

Preparing for the Trip

Have ready before labor starts:

• Hospital bag packed
• Car seat installed
• Route to hospital mapped (and an alternate route)
• Phone numbers programmed (provider, hospital, support people)
• Plan for pets and other children

When contractions start:

• Stay calm
• Time contractions for an hour
• Eat a light meal if you're hungry
• Take a shower if it helps you relax
• Call your support people when you're heading in

Labor at Home

Early labor is often best spent at home where you can:

• Rest in your own bed
• Take a warm bath or shower
• Eat and drink freely
• Move around comfortably
• Avoid unnecessary interventions

What to Do in Early Labor

• Time contractions periodically (not obsessively)
• Rest between contractions
• Stay hydrated
• Distract yourself with movies or activities
• Practice breathing techniques
• Call your doula to give them a heads up

The Bottom Line

Knowing when to go to the hospital is part science, part intuition. The 5-1-1 rule is a helpful guideline, but it's not absolute. Every labor is different, and you know your body best.

When in doubt, call your provider. They'd rather hear from you ten times with questions than have you arrive too late.

And remember: even if you arrive at the hospital and get sent home, that's okay. It means you're paying attention, and your time will come soon.

Document your hospital and provider contact info in your birth plan so everything is ready when the time comes.