When to go to the hospital: contractions, the 5-1-1 rule, and other signs

The third trimester comes with a single recurring question: is this it? Every twinge feels like it might be the start of labor. Most of them aren't. Here's a clear-headed guide to telling the real thing apart, when to time things, and when to stop timing and just get in the car.

What a contraction actually is

A contraction is a coordinated tightening of the uterine muscle. The uterus is one continuous muscle wall, and during a contraction the fibers pull together in a wave that starts at the top (the fundus) and travels downward. From the outside, your belly will feel rock-hard. The sensation ranges from "weird tightness" to "I forgot how to speak English."

There are two kinds: Braxton Hicks (practice contractions) and true labor contractions. Telling them apart is the whole game.

Braxton Hicks vs. true labor

The five-test rule of thumb:

• Pattern. Braxton Hicks are irregular. True labor contractions are rhythmic and progressively closer together.
• Intensity. Braxton Hicks plateau or fade. True labor contractions get stronger over time.
• Duration. Braxton Hicks are shorter and unpredictable. True labor contractions are 30-70 seconds and growing.
• Location. Braxton Hicks usually felt at the front. True labor often radiates from the back, around to the front, or down the thighs.
• Reaction to movement. Braxton Hicks often stop with rest, water, or a change of position. True labor doesn't care what you do.

The 5-1-1 rule

The standard rule of thumb for first-time parents: head to the hospital when contractions are

• 5 minutes apart — measured from the start of one contraction to the start of the next.
• 1 minute long, each one.
• For at least 1 hour.

The 1-hour part matters: a few strong contractions can fizzle out. An hour of consistent 5-1 contractions usually means you're in active labor.

For second and later babies

Subsequent labors can move faster. Many providers suggest 7-1-1, or even just "call when contractions are regular and getting stronger." Talk to your provider about their rule — it should be in your prenatal care notes.

Don't time these — just go (or call)

Some signs override the rules. Get checked immediately if any of these happen:

• Your water breaks. Even if no contractions yet. Especially note color: clear or pinkish is normal; green or brown can mean the baby has passed meconium and warrants a faster check.
• Bright red bleeding. Some pinkish "bloody show" is normal; bright red is not.
• Decreased fetal movement. If your baby's usual pattern stops or slows dramatically, call.
• Severe constant abdominal pain — different from contractions, which come and go.
• Severe headache, vision changes, or upper-right belly pain — possible signs of preeclampsia.
• Contractions before 37 weeks — if regular, get evaluated.

When in doubt, call

Labor and delivery units field these calls all day. They want you to call. They would much rather tell you to wait at home than have you wait too long. If you're unsure whether to head in, that's exactly what the phone is for.

A word about timing

Don't get so absorbed in timing contractions that you forget to be in labor. Use a simple timer (like the one on this site), let your partner or support person watch the clock, and focus on breathing, moving, and staying loose. The rule of thumb exists to support your judgment, not replace it.

Open the contraction timer →