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When To Go to the Hospital When You’re in Labor

Learn about the 5-1-1 rule, what to know if your water breaks, and other labor information so you can get to the hospital at the right time.

Updated June 6, 2024

by Nina Spears

The Baby Chick®: Pregnancy, Birth & Postpartum Expert

Medically reviewed by Stephanie Sublett

Board-Certified OB/GYN, FACOG, IBCLC
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There’s a question that every pregnant woman who plans to have their baby in a hospital has: “When is the right time to go to the hospital when in labor?” Many women get so excited by the first contractions that when those finally start getting stronger and more frequent, they head straight to the hospital — only to get turned away and sent home. Well, I’m about to clear it up for you so you can ensure you’re getting to the hospital at the right time!

What Is the 5-1-1 Rule?

If you were to ask your doctor when you should start heading to the hospital when in labor, the answer they will probably give you is when your contractions are 5-1-1 or if your water has broken. But what exactly is 5-1-1? Let me break it down for you:1

  • 5: When your contractions are five minutes apart
  • 1: When your contractions are one minute long each
  • 1: When this has been a consistent pattern for one hour
labor-diagram

(I recommend downloading a contraction timer app on your phone to keep track of the duration and frequency.)

When women hear this, they wait until they reach that 5-1-1 pattern. Then, as soon as it’s been an hour, and that’s the consistent pattern, they head straight to the hospital. Many women don’t know that 5-1-1 is when you’ve finished early labor and just entered into active labor, and you still have hours to go until you meet your baby.

So, Should I Go to the Hospital at 5-1-1?

Many women also don’t know that their contractions will likely start spacing out once they get to the hospital if they go straight at 5-1-1. Why is that? When you’re at home, you’re in a familiar and comfortable place. Your body feels more relaxed and safe, and labor can progress faster. When you’re in an unfamiliar place, even when trying to relax your body, it tenses up and stalls your labor since it’s in a foreign place.2,3

Unfortunately, I have seen it happen several times. Women think they’re ready to go to the hospital and have reached a certain point in their labor. And their labor slows down or stalls once they’re at the hospital. You can stay home longer to prevent this from happening. This is why I usually recommend that women go to the hospital when their labor is 4-1-1 or 3-1-1.2,3 This will significantly reduce your chances of being sent back home.

What Is COAT?

If your water has broken before contractions have started, that’s a bit of a different story. When your water breaks, you want to remember this acronym: COAT. Here’s what it stands for:4,5

Color: What Is the Color of Your Water?

If your water is clear, that’s a good thing! However, if it has green, black, or brown in it, it means your baby has probably passed their first poop (called meconium).5 This means that baby could be in distress, and you need to head to the hospital to ensure your baby is okay.5,6 If you see pink or pinky-red, that’s normal.5 It means your cervix is dilating, which it needs to do to get you to push.7,8 So, if your water is clear, pink, or pinky-red, you have up to eight hours to get to the hospital (by hospital standards).

If you’re GBS positive, you want to go to the hospital sooner since you will need intravenous antibiotics started before your baby is born.5,9 Penicillin is the most common antibiotic recommended to laboring women who are GBS-positive.23 Penicillin takes about 30 minutes to go through your IV each round, and they administer it every four hours.9 That means you will need to be at the hospital for four hours. They will give you the first round once you check in and another round four hours later. (If your baby comes sooner than that, it’s okay. I’ve had this happen to a client or two. They will treat the baby after birth to ensure everything is okay.)

 Odor: What Does Your Water Smell Like?

Your water shouldn’t have a crazy different smell to it. It should be odorless or have a regular vaginal odor, nothing abnormal. If your water/amniotic fluid smells bad (like a rotten smell, something sour, or anything different that doesn’t smell right), you could have an infection and should go to the hospital immediately.10

Amount: How Much of Your Water Came Out When It Broke?

When you call, the nurse will ask you this question because they want to know if the tear was high or low in the amniotic sac. If there was a big gush when your water broke, the tear in the amniotic sac is low. That makes it closer to the cervix and expels the water around baby’s head, which is a lot more water. On the other hand, if there was just a trickle coming out here and there, there’s a high tear in your amniotic sac. This means a little water comes out every time you move or your baby moves.11

NOTE: Many women don’t know that when their water breaks, water doesn’t stop coming out until after the baby is born. There isn’t just one gush, and it’s done. Once your water breaks, the water keeps leaking and coming out until your baby is born.11

Time: What Time Did Your Water Break?

The nurse will ask you this when you call in. They want to know how much time you have until they need to make some medical decisions. The American College of Obstetricians and Gynecologists (ACOG) recommends that for women who are term (greater than 37 weeks) with prelabor rupture of membranes (meaning your water breaks but labor doesn’t progress) be induced shortly after the water breaks, rather than wait for spontaneous labor in order to decrease the infection risk. It’s acceptable to wait for a short period of time to see if labor begins (up to 12-24 hours). But waiting beyond this timeline isn’t recommended.12,24 That’s because your chances of developing an infection (chorioamnionitis) are much greater after 24 hours of the water being broken.13 Your temperature rising is a sign of this.13,14

This is why they will continuously check your temperature every couple of hours while you’re in labor if your water has broken. If any signs of infection develop (chorioamnionitis), they will treat you with intravenous antibiotics.24

What To Know If Your Water Breaks

There are also two things to look out for when you think your water breaks:

1. Make Sure You Didn’t Pee Yourself

Many women rush to the hospital because they think their water has broken. The nurses then test to make sure it’s amniotic fluid. And the test comes back negative, saying it isn’t amniotic fluid. Instead, it is, more than likely, just urine. If this happens to you, don’t be embarrassed. You aren’t the first woman to have this happen; you certainly won’t be the last.11,16

To make sure that your water truly broke, here’s what you can do:11,16

  1. Go to the restroom and try to empty your bladder.
  2. Then, go to your room and lie completely flat on your bed for a minute or two.
  3. Finally, get up and check to see if any more fluid came out when you sat up.

When you get up, your water should come out more since you’ve moved around and your bladder is empty. If nothing came out, it was probably pee.11,16 So, unfortunately, there will be no need to try and get contractions going or get ready for the hospital.

2. Make Sure Your Baby Continues To Move

The second thing to look out for is that the baby is still moving.17 Call your doctor or midwife if baby isn’t moving like normal, and head to the hospital immediately so they can evaluate your baby. Though rare, the umbilical cord may have slipped through your cervix and into the birth canal (called cord prolapse). This only happens in 1 in 300 births. However, it’s something to look out for because that cord is your baby’s lifeline.18 If you think this has happened, get on your knees and keep your tush in the air and your face to the ground.18,19 This uses gravity to remove pressure off the umbilical cord, which helps keep your baby breathing and their heart beating.20,21 Call an ambulance or IMMEDIATELY go to the hospital.21

The Bottom Line . . .

To recap, here’s when to go to the hospital in labor:3,5,6,22

  1. When your contractions are 4-1-1 or 3-1-1
  2. When your water has been broken, and you’ve developed some contractions (within eight hours of it breaking)
  3. If your water has a foul smell, it has green, black, or brown in it, or if baby stops moving

If this is your first pregnancy, listen to our podcast episode about going to the hospital in labor as a first-time mom. Best of luck, mama!

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Nina Spears The Baby Chick®: Pregnancy, Birth & Postpartum Expert
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Nina is The Baby Chick® & Editor-in-Chief of Baby Chick®. She received her baby planning certification in early 2011 and began attending births that same year. Since then, Nina has… Read more

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