How to Know When You're in Labor

Signs That It's Time to Head to the Hospital

Doctor examining pregnant woman
Jamie Grill/Getty Images/Tetra images RF

One of the main concerns expecting parents have as they approach the end of the third trimester is knowing when it’s time to go to the hospital or call the midwife. While it's not uncommon to think that the first contractions are your cue to leave, it's usually not the case. Early labor can sometimes last for days, and, in some cases, may not even be true labor contractions.

By understanding the stages of labor —and the measures by which we mark them—you can greatly reduce your stress and avoid multiple trips to the hospital.

Stages of Labor

The birth of your child is a unique event. No two deliveries are alike, and there's often no way to know how long it will take or what it may entail. With that being said, childbirth will invariably progress in three clearly defined stages.

Stage One

The first stage begins with the onset of true labor and continues until the cervix is fully dilated to 10 centimeters (cm). The first stage is further divided into three additional stages:

It's during the second of these three mini-stages—active labor—when you can start making the move to the hospital or birth center.

Stage Two

Once the cervix is fully dilated (10 cm), you'll have to actively push, similar to the sensation of pushing through a bowel movement, until the baby's head is visible from the vaginal opening ("crowning"). If this is your first pregnancy, this stage can take anywhere from 30 minutes to two hours.

Stage Three

The third stage, the delivery of the placenta, takes just a few minutes but can sometimes take up to 30 minutes.

Knowing When It's Time to Go to the Hospital

Early labor is the least painful but longest of the three stages, usually lasting up to 20 hours for first-time pregnancies and 10-12 hours if you've previously given birth. Contractions will occur every five to 30 minutes and typically last 30 to 45 seconds. In most cases, doctors will advise you to stay home until the contractions are closer together and longer-lasting.

Active labor roughly begins when the contractions come every three to four minutes over an hour-long period and last for roughly 60 seconds. The stage will typically last for three to five hours. If this is your first baby, you would go to the hospital now. If you've had a child before, you may be asked to come earlier when the contractions occur every five to seven minutes.

You should also go to the hospital if your water breaks—no matter the stage—so your doctor can check the health of the pregnancy and proceed with assisted labor, if necessary. Show, a thick mucus with some blood expelled from the vagina, may also be a sign that you're about to go into labor.

Arriving at the Hospital

Despite what some may tell you, the dilation of the cervix alone does not determine when you are in a labor. In some cases, a woman may only be dilated 1 cm but experience strong and frequent contractions. Others may experience dilation even before labor begins.

To this end, once you've arrived at the hospital, you would be given a pelvic exam to determine how dilated your cervix is. In addition, the doctor would look for the characteristic shortening and thinning of the cervix, known as effacement. Effacement is the process, along with dilation, that allows the baby to move into the birth canal.

Effacement is measured in percentages, with 0% meaning no thinning of the cervix, 50% meaning half the normal thickness, and 100% meaning fully thinned.

The doctor uses this and other information to recommend whether you stay at the hospital or return home. Other considerations may include:

  • The position of the cervix (generally tilted forward prior to labor)
  • The position and rotation of the baby
  • Your medical health and history

In the end, there are no hard and fast rules. For example, if you're less than 3 centimeters when you arrive, are not in a lot of pain, and are not planning to use an epidural, going home may be the most reasonable and comfortable option.

However, if your water has broken, you're in a lot of pain, or have special medical needs, staying may be the better choice even if you're less dilated.

Generally speaking, once you are past 5 or 6 centimeters and having regular contractions, most practitioners will be fairly insistent that you remain in the hospital until your baby is born.

True or False Labor

Sometimes a contraction may not be the sign of true labor. If a contraction is erratic in frequency and strength, it may be something called a Braxton Hicks contraction, also known as false labor. Here's how to spot the differences between the two:

  • True labor contractions: These are regular, increase in strength and frequency, do not change if you move or shift position, and originate in the lower back before moving to the front of the abdomen.
  • Braxton Hicks contractions: In contrast, these false labor contractions are irregular, do not increase in strength or frequency, and often stop when you walk, rest, or switch positions. Unlike true labor contractions, Braxton Hicks contractions are constrained to the lower abdominal or pelvic region. They can develop as early as the second trimester but are more common during the third.

While it's easy to mistake a Braxton Hicks contraction for a real one, always watch the pattern to decide whether you're experiencing true labor or a false one. Knowing the difference can save you a wasted trip to the hospital.

Was this page helpful?

Article Sources

Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hanley, G.; Munro, S.; Greyson, D. et al. Diagnosing onset of labor: a systematic review of definitions in the research literature. BMC Preg Childbirth. 2016;16:71. DOI: 10.1186/s12884-016-0857-4.

  2. Stanford Children's Health. Overview of labor.

  3. Penn Medicine. The three stages of labor. Updated August 20, 2019.

  4. American College of Obstetricians and Gynecologists. How to tell when labor begins. 2011.