Early Labor vs Active Labor – When to Go to the Hospital? (updated 2022)

Early Labor vs Active Labor

Understanding the differences between these two phases of labor will help you to make a better decision about when to head to the hospital, birth location or call the midwife!

What does early labor look like?

Early labor is usually the longest part of labor and can last from a few hours to a few days. Contractions come on slowly and gradually get closer together, longer and stronger. They are relatively mild and may feel like cramps or a low backache. During this phase of labor your contractions could start 20+ minutes apart and eventually get to about 5 minutes apart. They may start around 30 seconds in length and progress to about 45 seconds in length. You will dilate from 0 cm to about 6 cm with some effacement.
At the beginning of early labor most women are still able to talk through their contractions and can distract themselves with other activities. You may start out excited, confident and talkative and will still enjoy the company of others. You may notice some bloody show (a small amount of blood) or vaginal discharge, which is normal. As early labor continues it progressively gets a little bit more difficult to ignore the contractions and you may need to start focusing and using coping methods to get through them. At some point you may not want to talk during the contractions anymore. However, in between the contractions you will still be able to engage and talk to others as usual.

Tips for early labor: 

Be patient and don’t pay attention too soon. Carry on with your normal activities for as long as you can. Ignore the contractions until you cannot any longer. If it is true labor, your body will let you know before too long.

Strategies that you can use at home to help you cope during early labor include:

  • Rest and sleep as much possible to conserve your energy and be ready for active labor.
  • Distraction: cooking, organizing, get a mani/pedi, movie, games. Don’t exhaust yourself but do things that keep your mind occupied.
  • Go for a walk to see if contractions intensify
  • Eating and drinking
  • Hydrotherapy – getting in the tub or shower.

What does active labor look like?

Labor times vary, but active labor averages between 1 – 12 hours. Contractions get closer together and can be anywhere from 5 to 3 minutes apart. During this phase of labor your contractions will get to the point where they are lasting about 1 minute in length or longer. You will dilate from about 6 cm to about 9 to 10 cm with complete effacement.

In active labor you are typically using all of your focus and energy to get through contractions. You are no longer able to talk during contractions and you have a very inward focus. You may feel less social, more serious and lose track of time. Your preference may be to rest and close your eyes in between every contraction to get a break before the next one begins. The intensity and potential pain level during active labor is greater than early labor. You may begin to vocalize, make noise or moan during your contractions which is a natural and helpful reaction. It is not uncommon to have a loss of appetite and sensitivity to smells. Modesty can also fly out the window at this point because what matters most to you is comfort.

Tips for active labor: 

Take one contraction at a time. This is when you need continuous support from your partner, doula or whomever is your support team. Change positions at least every half hour alternating between upright and resting positions to stay comfortable while still encouraging labor progress.

Activities to help you cope during active labor:

  • Breathing, relaxation and visualization
  • Meditations or HypnoBirthing techniques
  • Massage and touch
  • Movement, walking, rocking, swaying and position changes
  • Heat and cold therapy (hot pack, or cold washcloth)
  • Drink and use the bathroom often

When to go to the hospital? 

We often use the 4.1.1. or 5.1.1. rule of thumb as a guideline for when to go to the hospital. This refers to having contractions that are five minutes apart, lasting about one minute long, for at least one hour. While this can be a helpful guideline, it is important to know that timing contractions is only one tool than can be used to determine labor progress. Contractions that are five minutes apart do not automatically indicate active labor or the need to go to the hospital. Looking at the whole picture including the physical and emotional indicators mentioned above is wise.

Studies have shown that women admitted to the hospital in early labor were approximately twice as likely to have their labors augmented with pitocin and other interventions. They also had longer labors and were more likely to give birth by cesarean. Again, labor times vary but early labor can be as long as 20 hours for a first time mother. Hospitals and care providers strive to admit women who are in active labor unless there is a medical reason to admit them sooner. Having a birth doula that you can talk to is very helpful when determining if it is a good time to go. If you are not in active labor you may be discharged to continue laboring at home.

Doulas spend time educating clients on this topic to help you have a smooth transition from home to hospital. We are always happy to talk with you and guide you during early labor to help you make the best decisions for you and your family.

About Christie Collbran

Christie believes in helping women recognize their own inner wisdom, strength and power. Having served as President of the Tampa Bay Birth Network for six years and with ten years serving families as a birth doula, she has a reputation for leadership, dedication and compassion. A childbirth educator, certified lactation counselor as well as a certified doula, she makes a point of ensuring mothers and their partners understand all their birthing options and what to expect on their journey.> keep reading

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