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?

The 5-1-1 rule is one of the most common ways to track contractions and know when labor has shifted from early to active.

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

(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.

Should You Go to the Hospital at 5-1-1?

While 5-1-1 contractions mean active labor has begun, many moms find staying home a bit longer helps labor progress more naturally.

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 secure, allowing labor to progress more quickly. When you’re in an unfamiliar place, even when trying to relax your body, it tends to tense up and stall your labor, as it’s in a foreign environment.^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.

Related: Hospital Bag Checklist: What To Pack for Labor, Delivery, and Postpartum

What Is COAT?

When your water breaks, the COAT acronym helps you remember what to look for before heading to the hospital.

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?

The color of your amniotic fluid can reveal whether your baby is healthy or in distress.

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 couple of clients. They will treat the baby after birth to ensure everything is okay.)

Related: Signs of Labor: How To Know When Baby Is Coming

 Odor: What Does Your Water Smell Like?

A strong or unusual smell may signal infection — it’s important to get checked right away.

Your water shouldn’t have a crazy different smell to it. It should be odorless or have a normal vaginal odor, with no abnormalities. 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?

The amount can tell your care team whether your water fully ruptured or if there’s a small tear higher up in the amniotic sac.

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 small amount of 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 amniotic fluid continues to leak and flow out until your baby is born.¹¹

Time: What Time Did Your Water Break?

The timing helps determine how long it’s been since your membranes ruptured and whether an induction may be necessary.

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), they be induced shortly after the water breaks, rather than wait for spontaneous labor, 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), you will be treated with intravenous antibiotics.²⁴

What To Know If Your Water Breaks

Not every gush means your water has broken! Here’s how to tell if it’s the real thing and what to do next.

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 experience this; 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 has come out when you sit 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 occurs in only 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 go to the hospital immediately.²¹

When To Go to the Hospital in Labor (Summary)

For a quick recap, here’s when to head in or call your provider:^3,5,6,22

1. Contraction pattern reaches 4-1-1 or 3-1-1. (Every 4–3 minutes, lasting 1 minute, for 1 hour.)
2. Your water has broken and contractions begin. Go in based on your hospital’s protocol and your provider’s guidance.
3. The fluid looks or smells abnormal. Head in right away if it’s foul-smelling, or green/black/brown (possible meconium).
4. Baby’s movements noticeably slow down. Call your provider or go to L&D immediately.

Every pregnancy is unique; if your provider gives different instructions for your situation, follow those first.

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!