When to Go to the Hospital for Labor: Signs It's Time

Should I Call Before Going to the Hospital?

Yes, you should always call your healthcare provider or birthing facility before heading to the hospital for labor. They can help you determine if it's time to come in based on your specific symptoms, medical history, and how far along you are. This call also helps the staff prepare for your arrival and ensures a smoother admission process.

When you call, the healthcare provider will ask you several questions to assess your situation. They will want to know about your contractions - how far apart they are, how long they last, and how intense they feel. They will also ask if your water has broken, whether you've had any bleeding, and how the baby has been moving. Based on your answers, they can advise whether you should come in right away, wait a bit longer at home, or go directly to the emergency department.

Most birthing units prefer that you call ahead even if you're confident it's time. This allows them to check bed availability, prepare your room, and review your medical records before you arrive. Some facilities may be particularly busy and could direct you to a partner hospital if necessary. Calling ahead eliminates surprises and helps ensure you receive the best possible care upon arrival.

If you're unsure which facility to contact, speak with your prenatal care provider before your due date. They will give you the phone number for the labor and delivery unit where you plan to give birth, along with instructions for what to do if you go into labor outside of regular office hours. Keep this information easily accessible - perhaps in your phone contacts and on your refrigerator - so you don't have to search for it when the time comes.

What Information Should I Have Ready?

When you call the birthing facility, have the following information ready to share:

• Your name, date of birth, and healthcare provider's name
• Your due date and how many weeks pregnant you are
• How often your contractions are coming and how long they last
• Whether your water has broken and what the fluid looked like
• Any bleeding or unusual discharge
• How the baby has been moving
• Any complications during your pregnancy
• Whether you've given birth before and how those labors went

How Do I Know If My Contractions Mean It's Time?

True labor contractions are regular, progressively get closer together, last 30-60 seconds each, and don't stop when you rest or change positions. When your contractions follow the 4-1-1 pattern (4 minutes apart, lasting 1 minute, for at least 1 hour), it's typically time to head to the hospital. False labor contractions (Braxton Hicks) are irregular, don't get closer together, and usually stop with rest or hydration.

Understanding the difference between true labor and false labor (Braxton Hicks contractions) is one of the most challenging aspects of late pregnancy. Braxton Hicks contractions can begin as early as the second trimester and become more frequent as you approach your due date. They're often described as a tightening sensation in the abdomen that comes and goes irregularly. Unlike true labor contractions, Braxton Hicks typically don't become progressively stronger or more frequent, and they often subside when you change positions, rest, or drink water.

True labor contractions, on the other hand, follow a predictable pattern of increasing intensity and frequency. They typically start in your lower back and wrap around to the front of your abdomen like a wave. Each contraction will have a clear beginning, peak, and end. Over time, these contractions will become longer, stronger, and closer together - a progression that Braxton Hicks contractions don't follow.

The best way to track your contractions is to time them consistently. Note when each contraction starts and how long it lasts. Measure the interval from the start of one contraction to the start of the next. Many smartphone apps are available specifically for timing contractions and can help you identify patterns. When contractions consistently follow the 4-1-1 or 5-1-1 pattern for at least an hour, it's time to call your healthcare provider and prepare to go to the hospital.

The 4-1-1 and 5-1-1 Rules Explained

Healthcare providers commonly recommend using either the 4-1-1 or 5-1-1 rule to determine when to go to the hospital:

Your healthcare provider may give you specific guidance based on your individual circumstances. For example, if you live far from the hospital or have had a previous fast labor, they might recommend coming in earlier using the 5-1-1 rule. Conversely, if you live very close to the hospital and this is your first baby, they might suggest waiting until contractions are 4 minutes apart.

Signs of True Labor vs. False Labor

Distinguishing between true and false labor can be challenging. Here are the key differences:

• True labor contractions: Start irregular but become regular, get progressively stronger and closer together, don't stop with rest or position changes, often start in the back and move to the front
• False labor (Braxton Hicks): Remain irregular, don't increase in intensity, often stop with rest, hydration, or position changes, usually felt only in the front of the abdomen

What Should I Do If My Water Breaks?

If your water breaks, note the time, color, and smell of the fluid, then contact your healthcare provider immediately. Clear or slightly yellow fluid is normal. Go to the hospital right away if the fluid is green, brown, or has a foul odor, as this may indicate meconium (baby's first stool) or infection. Even without contractions, most providers recommend coming in within 12-24 hours of water breaking.

When people talk about "water breaking," they're referring to the rupture of the amniotic sac - the membrane filled with fluid that has surrounded and protected your baby throughout pregnancy. This can happen as a dramatic gush of fluid, a slow trickle, or something in between. Not everyone's water breaks before labor begins; for many women, it happens during active labor or is artificially ruptured by a healthcare provider during delivery.

If you think your water has broken, the first thing to do is note the time and characteristics of the fluid. Normal amniotic fluid is clear or pale yellow and has a mild or no odor - different from urine, which has a distinct ammonia smell. The fluid should not be green, brown, or have a foul smell. These could be signs of meconium (the baby's first bowel movement) in the fluid or an infection, both of which require prompt medical attention.

After your water breaks, there's an increased risk of infection because the protective barrier around your baby has been breached. For this reason, most healthcare providers recommend coming to the hospital within 12-24 hours of water breaking, even if you haven't started having regular contractions. If labor doesn't begin on its own within this timeframe, your provider may recommend induction to reduce the risk of infection.

How to Tell If Your Water Really Broke

Sometimes it's difficult to tell whether your water broke or if you're experiencing increased vaginal discharge or urine leakage (which is common in late pregnancy). Here are some ways to help determine if it's amniotic fluid:

• Amniotic fluid is typically odorless or has a slightly sweet smell, while urine smells like ammonia
• Amniotic fluid continues to leak over time, while urine leakage typically stops
• Try emptying your bladder, then lie down for 30 minutes and stand up - if fluid gushes out, it's likely amniotic fluid
• Amniotic fluid may contain white specks (vernix) from the baby's skin coating

If you're unsure whether your water broke, it's always better to call your healthcare provider and get checked. They can perform a simple test to confirm whether the fluid is amniotic fluid.

What Factors Determine When You Should Go?

Several factors affect the ideal timing for going to the hospital: whether you've given birth before (second labors are often faster), how far you live from the hospital, whether your water has broken, any bleeding, whether you're having continuous pain without breaks between contractions, and any special instructions from your healthcare provider based on your pregnancy history.

Every pregnancy and labor is different, and the "right" time to go to the hospital can vary based on your individual circumstances. Understanding the factors that might affect your timing can help you make an informed decision when labor begins. Here are the key considerations:

First Baby vs. Subsequent Babies

If you've never given birth vaginally before, your labor is statistically likely to be longer. First labors average 12-18 hours from the start of active labor to delivery, giving you more time to labor at home before heading to the hospital. However, if you've had a previous vaginal delivery, especially a fast one (less than 3 hours), your subsequent labors are likely to progress more quickly. In these cases, it's wise to head to the hospital earlier than the standard 4-1-1 guideline suggests.

Distance from the Hospital

The time it takes to get to your birthing facility should factor into your decision. If you live an hour or more from the hospital, you'll want to leave earlier to ensure you arrive with time to spare. Consider traffic patterns, weather conditions, and the time of day. It's better to arrive a bit early and potentially be sent home than to risk delivering in transit.

Special Circumstances

Your healthcare provider may give you specific instructions based on your pregnancy history or any complications. You may need to go to the hospital earlier if you have:

• A history of fast labors
• Group B streptococcus (GBS) positive status requiring IV antibiotics
• Gestational diabetes or high blood pressure
• Twins or other multiples
• Breech presentation or other positioning concerns
• Previous cesarean section planning for vaginal birth (VBAC)
• Any other high-risk conditions

What Are the Warning Signs That Mean Go Immediately?

Go to the hospital immediately, regardless of your contraction pattern, if you experience: heavy vaginal bleeding (more than spotting), constant severe abdominal pain without relief between contractions, green or brown amniotic fluid, fever or chills, significant decrease in fetal movement, severe headache with vision changes, or regular contractions before 37 weeks of pregnancy.

While most labors progress normally and the timing guidelines above work well, certain warning signs indicate you should get to the hospital immediately. These symptoms could signal complications that require urgent medical attention:

If you experience any of these symptoms, don't wait to time your contractions or call ahead - go directly to the hospital or call emergency services. These situations require immediate medical evaluation and potentially rapid intervention to protect you and your baby.

What Is Normal Bleeding vs. Concerning Bleeding?

It's normal to have some bloody discharge (often called "bloody show") as labor approaches. This happens when the mucus plug that has sealed your cervix comes away, and it's often tinged with pink or brown blood. This is a normal sign that your body is preparing for labor.

However, bright red bleeding that's heavier than a period or soaks through a pad is not normal and requires immediate medical attention. This could indicate placental problems like placenta previa (where the placenta covers the cervix) or placental abruption (where the placenta separates from the uterine wall prematurely). Both conditions can be serious for you and your baby.

What Happens When You Arrive at the Hospital?

When you arrive at the hospital, you'll be taken to a triage area where a midwife or nurse will check your vital signs, monitor the baby's heart rate, and perform a cervical examination to see how dilated you are. If you're in active labor (typically 4-6 cm dilated), you'll be admitted to a labor room. If you're in early labor, you may be sent home to continue laboring there with instructions on when to return.

Understanding what to expect when you arrive at the hospital can help reduce anxiety and make the experience smoother. The process typically follows these steps:

Triage Assessment

When you arrive at the labor and delivery unit, you'll first be taken to a triage area for assessment. A midwife, nurse, or doctor will evaluate your condition to determine whether you're in active labor and should be admitted. During this assessment, they will:

• Check your vital signs (blood pressure, temperature, pulse)
• Monitor the baby's heart rate using external monitors
• Time your contractions
• Perform a cervical examination to check dilation and effacement
• Review your medical history and birth plan
• Confirm whether your water has broken

Admission Criteria

Most hospitals will admit you to the labor ward when your cervix is dilated to 4-6 centimeters, which indicates you're in active labor. If your cervix has dilated less than this, you're likely still in the latent (early) phase of labor, and you may be advised to return home or walk around the hospital for a while before being reassessed.

Being sent home from the hospital during early labor is common and shouldn't be discouraging. The early phase of labor can last many hours, and you're likely to be more comfortable at home where you can move around freely, eat and drink, take a shower, and rest in your own bed. The healthcare team will give you clear instructions on when to return.

What to Bring to the Hospital

Having your hospital bag packed and ready by 36 weeks can reduce stress when labor begins. Essential items include:

• Identification and insurance information
• Your birth plan (if you have one)
• Comfortable clothes for labor and after delivery
• Toiletries and personal care items
• Phone charger
• Going-home outfit for baby (including car seat)
• Snacks and drinks for your support person
• Items for comfort (pillow, music, etc.)

Does Labor Go Faster If I've Had a Baby Before?

Yes, labor typically progresses faster for women who have previously given birth vaginally. Second and subsequent labors often take about half the time of first labors, sometimes even less. If your previous labor was particularly fast (under 3 hours), called precipitous labor, you should head to the hospital much earlier than standard guidelines suggest - as soon as you're confident you're in labor.

The experience of having given birth before changes your body in ways that can make subsequent labors faster and often easier. Your cervix has already dilated fully once, making it more efficient at dilating again. Your pelvic floor muscles have stretched before, and your body "remembers" the process of labor. While first labors average 12-18 hours, second labors average 6-8 hours, and subsequent labors may be even shorter.

If you had a particularly fast first labor (under 3 hours from start to finish), you're at higher risk of having an even faster second labor. This is called precipitous labor, and while it means less time in pain, it also means less time to get to the hospital. Women with a history of precipitous labor should discuss a plan with their healthcare provider and consider heading to the hospital at the first signs of labor rather than waiting for contractions to follow the 4-1-1 pattern.

However, it's important to note that not all second labors are faster. Various factors can affect labor duration, including the baby's size and position, how long it's been since your last birth, and your overall health. Each labor is unique, and past experiences are just one factor to consider.

How Does Distance from the Hospital Affect Timing?

If you live far from the hospital (more than 30-60 minutes away), you should plan to leave earlier than standard guidelines suggest. Consider leaving when contractions are 5-6 minutes apart rather than waiting until they're 3-4 minutes apart. Factor in traffic, weather, and time of day. Discuss a specific plan with your healthcare provider based on your distance and birth history.

Living far from your birthing facility adds an extra layer of complexity to deciding when to leave for the hospital. Traffic conditions, weather, and road conditions can all affect travel time. A 30-minute drive in ideal conditions might take an hour during rush hour or in bad weather. Having a plan in place well before your due date can help reduce stress when labor begins.

If you live in a rural area or far from the hospital, consider the following strategies:

• Plan multiple routes to the hospital in case of traffic or road closures
• Consider staying with friends or family closer to the hospital as your due date approaches
• Ask your healthcare provider if they recommend coming in earlier based on your distance
• Have backup drivers identified in case your primary support person isn't available
• Know the location of hospitals along your route in case of emergency

Some healthcare providers recommend that women who live more than an hour from the hospital consider staying nearby (with friends, family, or at a hotel) once they reach 38-39 weeks, especially if they have a history of fast labor or other risk factors.

How Can I Participate in My Care During Labor?

Active participation in your labor care leads to better outcomes and satisfaction. This includes understanding your options, asking questions, communicating your preferences through a birth plan, staying informed about what's happening, and speaking up if something doesn't feel right. Good communication with your healthcare team is essential for a positive birth experience.

Being an active participant in your care during labor and delivery can significantly improve your experience and outcomes. This starts long before labor begins - during your prenatal appointments, ask questions about what to expect, discuss your preferences, and learn about your options for pain management, positions during labor, and other aspects of care.

Creating a birth plan is one way to communicate your preferences to your healthcare team. A birth plan outlines your wishes for labor and delivery, including pain management preferences, who you want present, and your preferences for interventions. While labor doesn't always go according to plan, having documented preferences helps your care team understand what's important to you.

During labor, don't hesitate to ask questions and seek clarification about what's happening and why. Healthcare providers should explain procedures before performing them and give you the opportunity to ask questions. If you need more information or time to make a decision, it's okay to ask for it. Your comfort and understanding are priorities.