The 5-1-1 Rule Explained: Signs You Should Head to the Hospital

You’re having contractions. Real ones. And suddenly you freeze, wondering—is it time? Do we grab the hospital bag and go, or is this a false alarm?

Even with all the birth classes, apps, and well-meaning advice from everyone who’s ever had a baby, that moment of “should we go NOW?” is genuinely nerve-wracking. You don’t want to arrive too early and get sent home, but you definitely don’t want to cut it too close either.

Enter the 5-1-1 rule—a guideline most providers use to help you figure out when it’s actually go-time. Today, we’re breaking it down in the simplest way, plus the other signs your body gives you that labor is really happening.

What Is the 5-1-1 Rule?

When contractions are 5 minutes apart, lasting 1 minute each, for 1 hour straight, it’s time to head to the hospital or birth center. At least, that’s what the 5-1-1 rule says. But let’s dig more into what each of these numbers truly means.

• 5 minutes apart: This is the time from the start of one contraction to the start of the next one. If a contraction begins at 2:00, the next one should start at 2:05 (or sooner) to check off this box. “I suggest installing a contraction timer app,” says Kristin Revere, certified birth doula and founder of Gold Coast Doulas. “I encourage you to check some out beforehand and pick one that works best for you.”
• 1 minute long: Each contraction should last about 60 seconds to be considered within the 5-1-1 rule. We’re talking the whole thing here. From the moment you feel a contraction building until it completely fades, it should last 1 minute.
• 1 hour: This consistent pattern above needs to stick around for at least an hour before heading in. A couple of contractions here and there? Not quite there yet. But if everything seems to be consistent for 1 hour, then it’s go-time.

“Of course, that’s assuming you’re ready to go and within reasonable driving distance of the hospital,” says Kristin. “Always check with your medical provider on when they would like to see you, and factor in any additional logistical implications on your end, like sharing a vehicle, dropping off a child, etc.”

P.S. If you’re planning on birthing at the hospital, check out this virtual Preparing for Your Hospital Birth Online Class. You’ll learn how and what questions to ask your provider, what choices and options are available during labor, what common medications may be offered, and so many other good nuggets of birth info.

When the 5-1-1 rule doesn’t quite fit

Here’s the thing—labor isn’t one-size-fits-all. The 5-1-1 rule is a great general guideline, but there are definitely exceptions:

• If this is your second (or beyond) baby: Your labor can progress WAY faster than the first time around. Your body’s been there, done that, and it often remembers what to do. Some providers suggest heading in at the first sign of the 5-1-1 pattern rather than waiting the full hour.
• If you live far from the hospital: Distance matters. If you’re 45 minutes away, your provider will likely want you to come in earlier than someone who lives 10 minutes away. Factor in traffic, weather, and how fast you think your partner can drive (legally, of course).
• If you have a history of fast labors: Don’t wait for the perfect pattern. Some people go from zero to baby in a few hours. If your last labor was quick, trust that experience.

When in doubt, call your provider or doula. They’ll know what to do and should be able to tell you if it’s time to make your way in.

Other Signs of Labor

Your water broke

Whether it’s the dramatic gush you see in movies or a slow trickle that makes you wonder if you peed yourself, call your provider when your water breaks. Note the time, the color, and if there’s any odor. Spoiler alert: Only about 10% of people experience their water breaking before labor starts!

You have a bloody show

This is the pink or brownish mucus that appears as your cervix starts to dilate and thin. You might’ve already been losing bits of your mucus plug for days, but when you see a bloody show combined with contractions, that’s progress.

You have intense pressure or an urge to push

This is a big one. And it sort of feels like you need to have the biggest bowel movement of your life. Do not ignore it—baby might be coming fast.

Your intuition

You know your body better than anyone. If something feels “off” or different from what you’ve been experiencing, trust your gut. We get it—you don’t want to be “that person” who shows up at the hospital too early. But honestly? Better safe than sorry.

When To Call Your Doula

You’ll want to contact your birth doula when contractions first start—much before the 5-1-1 rule kicks in. This way, they’ll be in the loop and can get ready to come help.

Birth doulas are genuinely amazing. Think of them as your wingwoman through the whole birth process. If you contact them early enough, they can help you:

• Determine whether what you’re feeling is early labor or the real deal
• Use comfort measures at home so you can labor longer in your own space
• Decide when it’s actually time to head to the hospital
• Provide continuous support until baby arrives

Your Game Plan

The 5-1-1 rule is a helpful guideline, not a hard-and-fast rule. It’s a tool to help you navigate those final hours before you meet your baby, but it’s not the only thing to pay attention to. “The key is that surges consistently get longer, stronger, and closer together,” says Kristin. Listen to your provider, trust your body, and don’t be afraid to reach out when you’re unsure.

Birth is one of the biggest things you’ll do in your entire life. And that can be nerve-racking to think about! If you want to feel more prepared and supported, an in-person or virtual birthing class taught by certified doulas is an excellent option. You can also grab a copy of Kristin’s book, Supported: Your Guide to Birth and Baby, for a full dive into birth prep, guidance, and postpartum support.

Kristin Revere, MM, CED, NCS, is a certified birth and postpartum doula and the founder of Gold Coast Doulas in Grand Rapids, Michigan. She is also the co-host of Ask the Doulas Podcast and co-author of Supported: Your Guide to Birth and Baby.