True Labor vs. False Labor and the 5-1-1 Rule

?If you are in late pregnancy, it's hard to know when it is 'go' time. You may feel many different sensations and not know if it's true or false labor.
‌If you are in late pregnancy, it's hard to know when it is 'go' time. You may feel many different sensations and not know if it's true or false labor.

If you are in late pregnancy, it's hard to know when it is "go" time. You may feel many different sensations as your body prepares to deliver your baby. It can be difficult to tell true labor from false labor. Your doctor or midwife may have explained the 5-1-1 rule, but you may wonder how helpful that will be when you are really in labor.

In true labor, you'll have regular, strong contractions. Your cervix will begin to open to let your baby be born. This can be a slow, gradual process, although occasionally it happens quickly. Remember that just as you differ from others, your pregnancy and your labor and delivery may be different, too. Contact your doctor or care team if you have questions about true labor vs. false labor.

What are Braxton Hicks or false labor contractions?

Long before you are ready to deliver, you may feel your uterus tighten. These contractions usually begin in the third trimester of your pregnancy. Most of the time, these early contractions are painless. Occasionally, they may cause a sharp pang. They may make you wonder, "Am I going into labor?"

Pregnant women have had to distinguish between true labor and false labor for as long as women have been having babies. In the late 1800s, an English doctor named John Braxton Hicks described the early contractions of false labor and suggested a purpose for them. He believed they improved the circulation of blood and fluid inside the uterus.

Today, many doctors call these contractions " Braxton Hicks contractions" or simply "Braxton Hicks." They may describe them as your body practicing for labor. False labor contractions may improve the muscle tone of the uterus and increase blood flow.

How to tell if it is false labor

Besides being less painful than true labor, Braxton Hicks contractions also:

  • Happen fewer than 4 times an hour
  • Are irregular
  • Don't increase in strength or intensity
  • May start or stop when you change positions

Dehydration may cause Braxton Hicks contractions. You may become dehydrated from the heat, or if you have been fighting a cold, virus, or the flu. Drinking water may make the contractions stop.

You may also have false labor if you have been unusually active, if you have just had sex, or if your bladder is very full. Reducing your activity level, changing your position, and emptying your bladder may help the contractions stop.

The location of the contraction is another clue whether you are having false labor. Often womens feel Braxton Hicks contractions in one small area, or only in the front of the belly. True labor often begins in the back or wraps around the whole abdomen.

Signs that you are in true labor

You may be in true labor if your contractions:

  • Get closer together
  • Get stronger
  • Start in the back and move to the front
  • Don't go away when you change positions or alter your level of activity

Other signs of true labor include:

  • Bloody show. The passing of mucus with or without a pinkish or red discharge can mean that labor is about to begin.
  • Water breaking. If you lose amniotic fluid, either as a gush or a trickle, labor has usually already begun or is about to begin.
  • Sick stomach. Some women experience nausea and vomiting during labor.


Conception: The Amazing Journey from Egg to Embryo See Slideshow

The 5-1-1 rule

The main sign of true labor occurs at the neck of the uterus, called the cervix. When you are in true labor, the cervix thins out and opens up. You won't be able to detect when this process has started. You'll have to rely on other ways to tell when it is time to go to the hospital.

Your doctor may have told you to follow the 5-1-1 rule. This means that you should call your doctor and head to the hospital when:

  • Your contractions are coming every five minutes, or more frequently
  • Each contraction lasts one minute or longer
  • This pattern has been consistent for at least one hour

Once you arrive at the hospital, a member of your care team will check your cervix, and you'll know more about how far along you are in the birthing process.

Going to the hospital

Your goal may be not to go to the hospital until you are in true labor, but trust your instincts. If your body is telling you to call your doctor, go ahead. And definitely call your doctor or go to the hospital if:

If you go to the hospital with false labor, you won't be the first or last to do so. Your doctor may tell you to go home and wait a little longer. But your mind will be more at ease.

Intermountain Health Care: "False vs True Labor: How to Tell the Difference."

Hutchison, J., et al. StatPearls, "Stages of Labor," StatPearls Publishing, 2021.

Lamaze International: "Labor Day: What to Expect."

Nemours Kids Health: "Are You in Labor?"

Obstetrics and Gynecology: "The Uses of Braxton Hicks Contractions."

Raines, D.; D. B. Cooper. StatPearls, "Braxton Hicks Contractions," StatPearls Publishing, 2021.

UT Southwestern Medical Center: "False alarm: Braxton Hicks contractions vs. true labor."