If you are at term and having contractions that are hard and coming every 3-5 minutes, it is time to go to the hospital. If your water breaks, go to the hospital. Other reasons to go to the hospital include not feeling the baby move or a strange feeling that something is not right.
Contractions are rhythmic tightening of the uterus. The uterus is made of muscle. When the uterus contracts, it will get very hard. Labor contractions last about 30-45 seconds and are painful. Labor often starts as just tightening of the uterus or menstrual like cramps. They gradually get closer together and stronger. If you are at term (greater then 36 weeks) then it is generally safe to wait until the contractions are 3-5 minutes apart and strong enough to take your breath away. At this point. it is time to go to the hospital.
Every doctor has a different arrangement. Some want you to call the doctor before you go in; some want you to call the hospital first; others want you to just go in when it is time. It is important to ask your doctor what your hospital prefers prior to term.
If you are 36 weeks or less far along, a different protocol exists. See Preterm Labor. Other indications that labor is coming soon are known as soft signs of labor. These include bloody show, dropping, and passing the “mucus plug.” See Soft Signs of Labor. You do not need to go to the hospital for these soft signs of labor.
If the water breaks, you should go to the hospital. The bag of water is a protective barrier between the baby and the outside world. Once that protective barrier is gone, it is important that you go into labor and deliver the baby soon. If the baby does not deliver after the water breaks, the uterus will eventually get infected, making the baby sick. How long it takes is variable. 24 hours is an average length, but it can be several hours or even days before an infection sets in. If you do not go into labor shortly after the water breaks, medications such as pitocin or cytotec may be used to help start labor [insert link].
People often ask how you can tell when the water breaks. Sometimes it is obvious with a huge gush of fluid. Sometimes it is more subtle. Once the water breaks, the fluid will continue to leak until the baby is born. If you notice significant watery discharge, enough to soak your underwear and maybe even your pants, this is likely the bag of water. If this discharge continues so you need to change again an hour after cleaning up, this is almost certainly the bag of water. You can also use a pad and walk around. If the pad is soaked in 15-30 minutes this is another good sign that it is your water. If you are not sure, come to the hospital anyway, we have tests we can do to determine if it is really the bag of water.
If the baby is not moving enough, come to the hospital. See Kick Counts to determine if your baby is moving enough. We will put the baby on the monitor to assure everything is OK. If you have a strange feeling that something is not right, even if you can’t identify the problem specifically, it is safest to come in and be checked. It is much better to come to the hospital and be reassured that all is well than to sit at home with a problem and not know it. It is very common and even normal to have some false alarms. Do not be embarrassed if you get sent home from the hospital with a false alarm. I took my wife to the hospital with our second baby, and it was a false alarm. If it can happen to an OB/GYN, it can happen to you.