Signs labor is near: How to know when to go to the hospital

As your due date approaches, it's normal to analyze every cramp, twinge, and trip to the bathroom. Is this labor? Is it Braxton Hicks? Should I call my provider? Should I be timing contractions? And perhaps the biggest question of all: when do I actually go to the hospital?

In this guide, we'll walk you through the common signs that labor may be approaching, how to tell the difference between early labor and false alarms, and when it's time to call your healthcare provider or head to the hospital.

How does labor progress?

If labor came with a clear roadmap, many parents would likely feel a lot less stressed. Instead, labor is a process, with signs and symptoms that can vary from person to person and change with every birth. While every time is different, labor generally follows a predictable pattern: contractions become stronger (more painful) , longer, and closer together causing  the cervix to soften, thin, and dilate (open) to allow your baby to move through the birth canal. Still, the timeline, (or how long it takes for this pattern to happen), depends on a variety of factors and varies for everyone.

First Stage

Early labor is when the cervix begins to dilate (open) and efface (thin out), typically from 0 - 6 centimeters. Contractions are real but still may feel manageable. They’re irregular at first and gradually become more consistent. For many people, early labor is the longest stage, sometimes lasting many hours or even a day or two.

Active labor picks up where early labor leaves off. The cervix dilates more rapidly from 6 to 10 centimeters. In this stage, contractions grow stronger, longer, and closer together. A common sign that you’ve entered active labor includes the intensity of contractions; they become harder to talk through. This is usually the stage when providers recommend heading to the hospital or birth center. Every labor unfolds differently, though, and your provider's guidance for your specific situation should always take priority over general timelines.

Transition are the final parts of labor for a vaginal delivery. During this time, contractions become very strong and close together as the cervix completes dilation to 10 centimeters [1]. Although transition can feel overwhelming, it is typically one of the shortest phases of labor and often signals that you're getting very close to meeting your baby.

Second Stage: Pushing and delivery

Once fully dilated, you'll move into the pushing stage, which ends with the birth of your baby, followed by the delivery of the placenta. 

Third Stage: Delivery of the placenta

Keep in mind that labor doesn't always unfold this way. Some people are induced, rather than going into labor spontaneously, or have a planned Cesarean birth scheduled in advance. If labor stops progressing or concerns arise about the health of you or your baby, your healthcare team may recommend interventions, such as an assisted vaginal delivery or a Cesarean birth, to help ensure the safest possible outcome [2].

Early signs that labor is days or weeks away

Not every sign of approaching labor means it's time to grab your hospital bag and head out the door. Many of the earliest clues that your body is preparing for birth can appear days or even weeks before labor actually begins. While these signs don't tell you exactly when labor will start, they can be reassuring clues that your body is moving closer to delivering your baby.

Baby dropping or “lightening”

In the weeks before labor, your baby may drop lower into your pelvis, a process called lightening. You might notice you can breathe a little easier (less pressure on your diaphragm) but feel more pressure in your pelvis and more frequent urges to urinate. Some people notice this weeks before labor; others don't experience it until labor begins [3].

Cervix begins to dilate and efface

At your prenatal appointments in the final weeks, your provider may check your cervix for dilation and effacement. (You can also choose not to do this if you’d prefer!) Finding out you're 1 or 2 centimeters dilated doesn't mean labor is imminent, but it does mean your body is getting ready. 

Irregular contractions and back pain

As your uterus and ligaments prepare for labor, many people notice mild contractions or low back pain in the days or weeks before labor starts. This is normal. It's your body rehearsing.  Braxton Hicks contractions, which are irregular contractions that help your uterus prepare for the work of labor. Unlike true labor contractions, Braxton Hicks contractions don't become progressively stronger, longer, or closer together over time. They also often ease with rest, hydration, or a change in position while true labor contractions don’t. If you are preterm these should not be ignored and a call to your provider is warranted [4].

Loss of the mucus plug

The mucus plug seals the cervix during pregnancy. As the cervix begins to soften and dilate, you may notice it pass as a thick, sometimes blood-tinged discharge — called "bloody show" [5]. This can happen days before labor or right as it begins. It can also sometimes happen after a cervical exam by your OB provider. 

Menstrual-Like Cramping

Cramping similar to menstrual (period) pain signifies softening and thinning of the cervix.  

How to tell real labor from false labor

It’s very common to wonder if what you're feeling is true labor, especially when Braxton Hicks contractions (sometimes called "false labor") can feel startlingly intense. Here's how to tell them apart.

The classic test is to change what you're doing. Drink a glass of water, take a walk, rest, or switch positions. If contractions ease up or stop, they're likely Braxton Hicks. If they keep coming (and keep getting stronger), that could be a different story [7].

It is important to time your contractions and see if there is a pattern. You can use Huckleberry’s free contraction timer to keep a record of your contractions, which can be helpful information to give to your healthcare provider.  If you have any questions or hesitations, it’s always good to double-check with your doctor.

Signs of active labor

Active labor is typically when it's time to head to the hospital or birth center. Here's what it may feel like.

Stronger and more frequent contractions

In active labor, contractions last 45 - 60 seconds or longer and come every 3 - 5 minutes [8]. They're hard to talk through. These feel more intense than the Braxton Hicks contractions you may have felt before.

Increasing pain in back and belly

For many people, labor contractions radiate from the lower back around to the front of the abdomen. Back labor (when most of the pain is concentrated in the back) is common when the baby is in a posterior position, facing up instead of down [9].

Cervical dilation progressing

If you're checked by your provider during active labor, cervical dilation will be moving forward and happening more steadily. The timing on this can vary for each person and each birth. More often than not, dilation takes a bit longer for first-time parents [10].

Your water breaking

Your amniotic sac may rupture before or during active labor. (This is your water breaking.) It can feel like a gush or a slow trickle. Sometimes the slow trickle is harder to identify. If you think your water has broken, make a note of when it started, what the fluid looks like, and whether you’re having contractions [11].

Even if contractions haven't started yet, it's a good idea to contact your provider for guidance or go to the hospital. They can help you determine whether it's time to head in for an evaluation and what steps to take next.

How to time your contractions

Knowing how to time contractions is one of the most practical things you can do in early labor. If contractions begin, timing them helps you see whether they're settling into a consistent pattern and whether you've reached the point when your healthcare provider wants you to call or head to the hospital or birth center. Your provider should let you know what contraction pattern they're looking for before labor begins. If you're ever unsure, having the timing and length of your contractions gives you useful information to share so they can help you decide on the next steps.

What to measure when timing contractions

• Frequency refers to how far apart your contractions are. It's measured from the start of one contraction to the start of the next. (Not from the end of one contraction to the beginning of the next.) For example, if one contraction begins at 2:00 PM and the next begins at 2:05 PM, your contractions are five minutes apart.

• Duration is how long each contraction lasts, measured from the moment it begins until it completely fades away. For example, if a contraction started at 2:00 PM and ended at 2:01 PM, it lasted 1 minute. Unlike frequency, which measures the time between contractions, duration measures the length of a single contraction.

When to start tracking contractions

You don't need to time every twinge. Start tracking when contractions feel regular, or when they seem to be coming in a pattern and intensifying over time. Many people use a contraction timing app for this, which does the math for you. This can also be easy data to reference if your provider has any questions for you.

What if you're having a planned C-section?

Not everyone will experience labor before meeting their baby. If you have a planned Cesarean birth, your healthcare provider will typically schedule the procedure before labor begins, often around 39 weeks of pregnancy if there are no medical reasons to deliver earlier.

Even if you're planning a C-section, it's still helpful to know the signs that labor is near. Some people go into labor before their scheduled delivery date or experience signs like regular contractions or their water breaking. If you notice these symptoms before your scheduled C-section, contact your healthcare provider or go to the hospital as instructed. Your care team will determine the safest next steps based on your health, your baby's well-being, and how labor is progressing.

Remember that every pregnancy and birth is different. Whether your baby is born vaginally or by C-section, recognizing the signs of labor can help you know when it's time to seek medical care.

When to go to the hospital

When contractions start picking up, knowing exactly when to leave for the hospital can feel like a high-stakes question. Ultimately, the answer is that your provider will give you instructions about when it's time to head to the hospital or birthing center based on your specific pregnancy risks and conditions. This conversation usually happens throughout your prenatal care, but you can always ask to clarify in your next appointment.

The answer of when to go to the hospital can depend on a few key factors, along with your provider’s instructions. Here's how to think through each one.

When your water breaks before contractions

If your amniotic sac ruptures before contractions begin, you’ll want to call your provider to update them. The fluid can be a dramatic gush like the movies or a slow, intermittent trickle — both count.

• Note the time your water broke

• Note the smell (amniotic fluid should be odorless)

• Note the color of the fluid (Clear or pale yellow is normal. Green, brown, or cloudy fluid needs immediate medical attention.)

• Note whether you are experiencing contractions

When to call your provider first

If you're unsure whether what you're feeling is active labor, call before you drive to the hospital or birth center. That's exactly what the after-hours line is for. (And no, they don’t get annoyed by you calling to ask a question!)

• Describe how far apart contractions are and how long they're lasting

• Note whether your water has broken

• Share any other symptoms

Your provider would much rather talk you through it at midnight than have you sitting at home second-guessing yourself.

Timing considerations for second pregnancies

Labor tends to move faster the second time around and sometimes significantly. If you've been through this before, your provider may want you to leave earlier than first-time guidelines suggest.

• Many providers recommend heading in sooner for second or subsequent pregnancies

• Ask your provider specifically what threshold they want you to use before your due date

• When in doubt, call. There's no penalty for checking in early.

When to seek immediate medical care

Some symptoms require urgent attention. Don't wait to see if they resolve on their own. Go to the hospital immediately or call 911 if you experience any of the following Urgent Maternal Warning Signs and Symptoms while experiencing contractions: [12]

• Vaginal bleeding

• Baby is moving less than usual

• Constant severe pain (not coming and going)

• Severe headache or vision changes

• Dizziness or fainting

• Fluid leaking

• Fever (100.4°F / 38°C or higher)

• Chest pain, trouble breathing, or racing heartbeat

• Severe abdominal pain

• Pain, redness, or swelling in one leg or arm

Also call your provider right away if:

• You are before 37 weeks of pregnancy

• You have had a previous C-section

When in doubt, you can always call your medical provider to be safe.

What to do when labor starts

1. Start timing your contractions. 

If no Urgent Maternal Warning Signs and Symptoms are present, open a contraction app, paper log,  or use the notes on your phone. Track duration and frequency so you have real data to share with your provider.

Also contact your labor support person (birthing partner, doula, labor coach).

2. Stay calm and practice comfort measures. 

Early labor can last a long time. Rest if you can. (You will need it!)

If it feels helpful for you, take a warm shower, use a heating pad on your lower back, move around, or try breathing techniques. This is not the moment to white-knuckle it.

3. Eat a light snack and stay hydrated.

As contractions get stronger, you may lose your appetite or experience nausea [13]. If you're in early labor at home and feeling OK, have something light and bland like toast, banana, or crackers. Make sure to stay hydrated by sipping water or electrolyte drinks. 

4. Call your OB provider or head directly to the hospital

When contractions are consistent and intensifying, or if your water breaks, make the call or head directly to the hospital. Have your contraction timing notes ready.

5. Gather your things and go.

If your hospital bag is packed (more on that below), this is just a matter of getting out the door. Make sure you also have a car seat to bring your baby home.  

Tips for preparing for labor 

The weeks before your due date are a good time to get a few practical things squared away.

1. Pack your hospital bag or “go bag” early.

Most providers recommend having your go bag ready by 36 weeks. Include items for comfort during labor, postpartum essentials, baby's going-home outfit, insurance cards, and your birth plan if you have one. You will also need to bring your infant’s car seat along, too! Having it installed in the car when you pack your hospital bag can make things smoother when it’s time to deliver.

2. Know the fastest route to the hospital.

Drive it at least once. Know where to park, which entrance to use after hours, and how long it takes at different times of day. This sounds overly practical until you're doing it at midnight in active labor, or until the adrenaline rush is kicking in because the moment you’ve been waiting for has arrived.

3. Prepare your contraction tracking tools.

Download a contraction timing app and know how to use it before labor starts. Some options even sync with a partner's phone so they can track alongside you.

4. Review your provider's after-hours instructions.

Find out what number to call when you think labor has started, and what their specific guidelines are for coming in. Even posting that number on your fridge or a centrally located area can be helpful for your loved ones, too.

5. Talk through the plan with your support person.

Make sure whoever is with you at the birth knows where the hospital bag is and what role you want them to play during labor. There are many ways a loved one can support you during birth.

Takeaway

• Labor typically builds gradually, not all at once. Many signs that labor is approaching — such as baby dropping, increased cramping, irregular cramping, losing your mucus plug, or feeling a burst of nesting energy — can appear days or even weeks before labor actually begins.

• True labor follows a pattern that gets harder to ignore. Unlike Braxton Hicks contractions, true labor contractions become stronger, longer, and closer together over time. They don't stop when you rest, drink water, or change positions. They also become difficult to talk through as labor progresses.

• Knowing how to time contractions can help you make informed decisions. Frequency measures the time from the start of one contraction to the start of the next, while duration measures how long each contraction lasts. Tracking both can help you recognize when labor is progressing and give your healthcare provider useful information if you call for guidance.

• Active labor can be the signal to head to the hospital or birth center. Contractions during active labor usually come every few minutes, last close to a minute, and increase in intensity. If your water breaks, contractions become difficult to manage, or you're unsure what you're experiencing, contacting your provider can help you determine the best next step.

• You know your body best. If you experience any symptoms that just don’t feel right, you are unsure what to do, reach out to your OB provider, If you experience any Urgent Maternal Warning Signs, then seek medical care immediately.

• Preparation before labor starts can make the day feel less stressful. While every birth unfolds differently, having a plan in place allows you to focus more on the experience and less on logistics.