The 5-1-1 Rule for Contractions — When to Head to the Hospital

What the 5-1-1 Rule Is

The 5-1-1 rule is a labor guideline. Many hospitals and midwives use it to help pregnant people decide when to head in for delivery. The three numbers stand for: contractions every 5 minutes apart (from the start of one to the start of the next), each lasting about 1 minute, and this pattern continuing for at least 1 hour.

The rule has no single documented origin. It emerged from clinical practice as a way to identify active labor—the stage when the cervix is dilating and labor is progressing toward birth. Before 5-1-1, many people are in early labor, which can last hours or even days. Showing up too early can mean you get sent home. It can also mean you wait in triage. The 5-1-1 rule tries to time your arrival. It’s meant to be when admission is more likely to make sense.

It’s a guideline, not a law. Your healthcare provider may give you different numbers. They may base them on your pregnancy, your distance from the hospital, or your medical history. Some are told to come at 7-1-1 or 6-1-1; others at 4-1-1. Always follow your provider's instructions. For more on labor stages, see our guide on the stages of labor.

How to Apply the 5-1-1 Rule

Applying the rule requires tracking two things: duration (how long each contraction lasts) and frequency (how far apart they are). A contraction timer or app does this for you. So here’s the process, step by step.

Step 1: Start timing when you notice a pattern.

When your contractions come and go at somewhat regular intervals, start timing them. Early labor may have contractions 15 to 20 minutes apart. You don’t need to wait for intense pain. Use our guide on how to track contractions for the basics.

Step 2: Record each contraction start and end

Press start when a contraction begins and stop when it ends. Duration is start to end. Frequency is the time from the start of one contraction to the start of the next. A contraction timer app calculates both automatically.

Step 3: Track at least five to six contractions

One or two contractions do not establish a pattern. You need several contractions to see whether you're approaching 5-1-1. The app will show average duration and frequency in real time.

Step 4: Check if the pattern holds for 1 hour

The "1" in 5-1-1 refers to 1 hour of consistent pattern. Contractions should be roughly 5 minutes apart, about 1 minute long, for a full hour before you consider heading in. Brief spikes don't count.

If your numbers match 5-1-1 for an hour, it's generally time to call your provider or head to the hospital. If you're unsure, call. Labor and delivery staff prefer you ask rather than wait too long. For more signs to watch for, see when to go to the hospital for contractions.

But what if your contractions don't match the pattern?

Not everyone follows a textbook 5-1-1 pattern. Two common situations are prodromal labor and irregular contractions.

Prodromal labor

Prodromal labor is real contractions that do not progress for hours or days. They may come every 5–7 minutes, last 45–60 seconds, then stall or space out again. You may feel like labor is starting, but the cervix does not dilate. It is frustrating but normal. Keep timing. If the pattern holds consistently for an hour or more, call your provider. If it comes and goes, you may be in prodromal labor. In most cases, resting, hydrating, and waiting is the move. Breathing techniques can help you cope while you wait.

Irregular patterns

Some people have contractions that are 6 minutes apart, then 4, then 5. The 5-1-1 rule assumes your contractions are regular. If your pattern is close but irregular, keep tracking. A contraction timer helps you see the trend. If contractions are painful and you are uncertain, call your provider. They can help you decide whether to stay home or come in for a check. Distinguishing prodromal labor from early labor is easier with data—see our Braxton Hicks vs. real contractions guide for how timing reveals the difference.

Variations: 4-1-1, 3-1-1, and Provider-Specific Rules

Hospitals and providers sometimes use different numbers. The 5-1-1 rule is the most common rule people hear about. But you may hear other rules too.

The 4-1-1 rule

Some facilities use 4-1-1: contractions every 4 minutes, 1 minute long, for 1 hour. This is stricter and may reduce early admissions. If your hospital uses 4-1-1, follow that instead of 5-1-1.

The 3-1-1 rule for second or later pregnancies

Labor often progresses faster in second and subsequent pregnancies. Some providers advise a 3-1-1 rule: contractions every 3 minutes, 1 minute long, for 1 hour. If you’ve had a baby before, ask your provider which guideline they recommend. You may need to leave sooner than 5-1-1.

Distance and special circumstances

If you live far from the hospital, your provider may tell you to come earlier—for example, at 7-1-1 or 8-1-1. High-risk pregnancies can change the rule. Multiples can change the rule. A history of fast labor can change the rule. Write down your provider’s instructions, and keep them handy. Use our due date calculator to know your timeline, and plan your route in advance.

When to Ignore the Rule and Go Anyway

The 5-1-1 rule is for typical, full-term labor. In some situations, go to the hospital immediately regardless of contraction timing.

Your water breaks

If your membranes rupture (water breaks), call your provider and go in. You may or may not feel contractions. Infection risk increases once the sac is broken. Do not wait for 5-1-1.

Vaginal bleeding

Bright red bleeding or heavy bleeding is not normal. Go to the hospital or call 911. Light spotting after a cervical exam is different. If you’re not sure, ask your provider.

Decreased fetal movement

If you notice less movement or kicks, contact your provider right away. They may have you come in for monitoring. Use our baby kicks counter to track movement daily.

Preterm labor (before 37 weeks)

If you are before 37 weeks and have regular, painful contractions, go to the hospital. Preterm labor needs prompt evaluation. Do not wait for 5-1-1.

Severe pain or something feels wrong

If pain is unbearable, you cannot talk through contractions, or something simply feels off, trust your instincts. Call your provider or go in. The rule is a guideline—your judgment and your provider's advice matter more.

How a Contraction Timer App Tracks 5-1-1 Automatically

A contraction timer app records each contraction's start and end, then calculates duration and frequency. A lot of apps can ping you when your contraction pattern matches 5-1-1 (or whatever rule your provider uses).

You tap when a contraction starts and when it ends. The app does the math: average duration, average frequency, and how long the pattern has held. Some apps send a notification when you have met 5-1-1 for an hour. That way you can focus on coping instead of watching the clock.

Accuracy depends on your input. If you tap late or early, the numbers will be off. But for most people, an app reduces errors and gives a clear view of whether labor is progressing. The free Contraction Timer app on iOS and Android includes this feature, along with shareable reports for your care team.

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Limitations

The 5-1-1 rule is a general guideline. It doesn't account for individual differences. Some people dilate quickly with contractions that never quite hit 5-1-1; others reach 5-1-1 and are still in early labor. Only a healthcare provider can assess your progress.

A contraction timer records what you input. It does not detect contractions automatically or diagnose labor. Use it to complement professional care, not to replace it. If you have severe pain, call your provider immediately, even if the timer looks normal.

It's not medical advice. Always follow your healthcare provider's instructions for your specific pregnancy.