When to Go to the Hospital for Contractions — Signs of Active Labor

Signs That Labor Has Started

Labor does not always announce itself with a dramatic water break or instant intense contractions. For many people, it begins gradually. You might notice a low backache that comes and goes, or tightening in your abdomen that feels different from the Braxton Hicks you have had for weeks. Here's the thing, the key is the pattern. Real labor contractions get longer over time. Real labor contractions get stronger over time. Real labor contractions get closer together over time.

Early labor can last hours, or even a day or two. Contractions may start 15 to 20 minutes apart. Contractions may last 30 to 45 seconds. As labor goes on, contractions may shorten to 5 to 7 minutes apart. Then contractions may shorten to 3 to 5 minutes apart. Understanding the stages of labor helps you know what to expect. If you are unsure whether what you feel is real labor, start tracking your contractions. The numbers will tell you whether a pattern is forming.

Some people feel a burst of energy right before labor. Some people feel a nesting urge right before labor. Others lose their mucus plug or notice a bloody show—pink or blood-tinged discharge. These signs can suggest labor may be near. But they don't always mean you should leave immediately. From what I've seen, contraction timing is usually the clearest guide.

The 5-1-1 rule explained.

The 5-1-1 rule is a simple guideline many providers use. It says contractions come every 5 minutes. It says each contraction lasts about 1 minute. It says this pattern has continued for at least 1 hour. In most cases, that's usually when it's time to head to the hospital or call your midwife. The rule gives you concrete numbers instead of guesswork.

Your healthcare provider may give you different numbers. If you live far from the hospital, have had a fast labor before, or have certain risk factors, they might tell you to come in earlier. For example, they might say to come at 7 or 8 minutes apart. If you're a first-time parent, labor tends to be slower. Your provider might suggest waiting until contractions are a bit closer. For a deeper dive, see our guide on the 5-1-1 rule for contractions.

Other Signs to Watch For

Contraction timing is important, but it is not the only signal. Your water breaking is a clear sign to call your provider and head in. It can be a sudden gush, or a steady trickle. If you are unsure whether it is amniotic fluid or urine, call anyway. Providers would rather you come in for a check than stay home with ruptured membranes.

A bloody show—pink or blood-tinged mucus—often appears as the cervix begins to change. Light spotting is normal. But heavy bleeding, like a period, is not okay. If you have more than light spotting, call immediately. Intense back labor—severe pain concentrated in the lower back—can be a sign of a posterior baby. It does not always mean you must leave right away, but if the pain is overwhelming or you cannot cope at home, call your provider.

Trust your instincts. If something feels wrong, even if you can't name it, reach out. Labor and delivery staff are used to questions. They would rather you call and come in for a check than wait when you are worried.

When to Call Immediately

Some situations require an immediate call to your provider or a trip to the hospital, regardless of contraction pattern. Vaginal bleeding heavier than light spotting is one. So is reduced fetal movement. If your baby's kicks or movements have slowed or stopped, call right away. Your provider might want you to come in so they can monitor you.

Cord prolapse happens when the umbilical cord slips into the birth canal before the baby. Possible signs include feeling something in the vagina. Another possible sign is a sudden gush of fluid with a visible cord. This is rare but serious. If you suspect it, call 911 or go to the hospital right away. If your water breaks and you're not yet 37 weeks, that's preterm premature rupture of membranes. Call your provider right away.

Severe headache, vision changes, sudden swelling, or pain in your upper abdomen can be signs of preeclampsia. If your contractions are unbearable before you reach 5-1-1, call. When in doubt, call. It's always okay to ask.

What to Bring and What to Expect at Triage

Pack your hospital bag in advance so you can grab it when it is time. Bring your ID, your insurance card, and any birth plan you've written down. A phone charger, comfortable clothes, toiletries, and snacks for you and your support person are useful. Don’t forget any medications you take regularly.

When you arrive, you’ll usually go to triage first. Triage is a separate area where staff check whether you're in active labor. A nurse will check your blood pressure, temperature, and the baby's heart rate. They may do a cervical exam to see how dilated and effaced you are. Based on that check, they’ll either admit you to a labor room or send you home to labor longer. Getting sent home can feel disappointing, but it’s common. Early labor can last a long time. In most cases, staying home until you’re further along means a smoother experience once you’re admitted.

Labor breathing techniques can help you stay calm during contractions, whether you are at home or in triage. Having a contraction timer or app running gives you data to share with the nurse if they ask about your pattern.

How a Contraction Timer App Helps Before You Leave

When contractions start, it is easy to lose track of time. A contraction timer app records each one as you tap start and stop. It calculates average duration and frequency automatically, so you can see at a glance whether you have reached the 5-1-1 pattern. No pen and paper, no mental math.

Some apps track your contraction pattern and send an alert when they detect active labor. This doesn't replace your provider's advice. But it can help you feel more confident that you're not heading in too early or waiting too long. When you arrive at the hospital, you can share your contraction history with the triage nurse—helpful context for their assessment.

First-time mothers often have longer early labor, so providers may suggest staying home until contractions are closer together. People who've given birth before may progress faster. Some providers advise coming in when contractions are 7 or 8 minutes apart. Your provider will tailor their guidance to your situation. A timer helps you follow that guidance with real data.

First-Time Mothers vs. Subsequent Pregnancies

Labor tends to move differently depending on whether you have given birth before. First-time labors often last longer. Early labor can stretch to 24 hours or more. Contractions may take longer to settle into a clear pattern. Providers often suggest waiting until contractions are consistently 5 minutes apart (or whatever number they told you) before you head in.

If you’ve had a baby before, labor may progress more quickly. The cervix may dilate faster. Contractions may intensify sooner. Many providers tell you to come in earlier, for example, when contractions are 7 to 8 minutes apart. They do this to avoid a roadside delivery. If your last labor was very fast, your provider may give you even more conservative instructions. Always follow the guidance they gave you at your last prenatal visit.

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Limitations

This guide is for informational purposes only. It is not medical advice. Contraction patterns vary between individuals. Some people experience prodromal labor—real contractions that do not progress for hours or days. Only a healthcare provider can check for cervical change. Only a healthcare provider can tell you if you’re in active labor.

A contraction timer records what you input; it does not detect contractions automatically or diagnose labor. If you have bleeding, fluid leakage, decreased fetal movement, or severe pain, contact your provider right away, no matter what the timer says. Always follow the exact instructions your doctor or midwife gave you for your pregnancy.