Common sense disclaimer: This article is written with a first-time mother in mind. It is NOT to be taken as medical advice. Your own labor and delivery may have factors that negate the basics in this article. Your doctor/midwife > that someone on the internet.
It seems suuuper basic to time labor contractions. In fact, most new parents don’t really think about it ahead of time.
You just download an app, hit the “start” and “stop” button, and head to the hospital when your contractions are ____ minutes apart.
Well. In real life, it can be tricky. In fact, this aspect of navigating birth trips up a LOT of new parents. I'm sure you've heard the stories of couples who get to the hospital in labor, only to be sent home again because they aren't in active labor. (It SUUUCCKS to return home. It can be so demoralizing.)
This is likely no fault of the parents. Nope. It's more likely to be a result of misunderstanding contraction timing. Cuz nobody told ‘em what I’m about to tell you.
You aren't going to be that new couple, are you? No, you're going to read this whole article and know exactly how best to time and interpret contractions. You're going to get to the hospital (or birth center, or call your midwife over) when it's REALLY Go Time. You shall be birth experts. You will hold the sacred knowledge in your hands.
There is an art to timing contractions and interpreting what they mean WITHOUT driving. Yourself. nutty.
First, some basics about labor contractions.
A contraction is simply a muscle tightening and releasing. The uterus is comprised of three layers of muscle, one of which has the task to help the cervix (mouth of the uterus) open. You can read more about this muscle action over here.
This muscle action builds from the beginning of a contraction until it peaks about half-way through, and then it ebbs as it relaxes. Then there’s a break. (yay!)
This rise and fall pattern is obvious when contractions are being measured on a monitor at the hospital. (Fun trivia: The monitoring machine is called a Tocodynamometer. Literally birth-motion-meter.)
Geeking out about the contraction pattern on the machine read-out is a nice little reward when you arrive at the hospital. Meanwhile, you can’t see this in a lovely visual representation when you’re still at home. Nope, you have to go with other indicators of the contractions.
How to time contractions:
Now, here’s one of the first betrayals I will bless you with through this article.
The length of the contraction is measured from the beginning to the end. Easy enough. BUT! The FREQUENCY of the contractions is measured from the beginning of one until the BEGINNING of the next.
Soooo, when I say that Susie’s contractions are 45 seconds long and 6 minutes apart, it doesn’t mean she’s getting six minutes of rest. Blergh, she’s only getting about 5 minutes between.
For all of you visual folks:
The old school method of timing contractions involved pen and paper. You would write down the minute every time a contraction started and estimate about how long they were lasting
In fact, when I had my first child in 2005 (13 years ago. Holy hormones.), this is how we knew what was up. I do remember trying to find a website that would serve for this purpose, and I vaguely remember hitting the space bar a few times while in early labor.
Luckily, we now have some fancy technology to make this simple. Contained on your smart phone in your pocket. You just hit the button at the beginning and the end of each contraction. You don’t have to do any math.
So that’s it. You download the app, then you hit “start” and “stop” as appropriate. But what do those contractions MEAN?
What your doctor will tell you:
Unless you have something special going on with your pregnancy or labor, most providers (doctors and midwives) will prefer that you stay at home in early labor and head in when it’s very clearly the Real Deal. They also don’t want to clog up the hospital with patients who aren’t in true labor. And they understand that most parents have a better experience if they are home and comfortable for the latent portion of labor.
Staying at home in early labor is also critical for continued progress. The way the hormone Oxytocin works, labor is shy and easily disrupted until the pattern is well established – like in active labor.
So that’s what we’re going for. Head in when it’s ACTIVE labor, which is about 4-6cm in dilation.
Of course, you likely don’t have anyone around who can check your cervix and let you know where you are in the process. So the simplest way for your provider to help you know when it’s the real thing is through the measurable timing of your contractions.
There are a few common numbers they use as benchmarks.
Some providers will tell you to follow the 5-1-1 rule. When your contractions are
5 minutes apart, lasting
1 minute each for at least
Then give them a call.
USUALLY first time moms are still in early labor at the 5-1-1 point.
If your provider is helping you to avoid extra intervention, or perhaps you’ve expressed that you’d like to avoid intervention or pain medication, then they may suggest the 3-1-1 rule. Which is similar. Call when you’re contractions are:
3 minutes apart, lasting
1 minute each, for at least
In my area, I’ve even heard of a few providers suggesting the 3-1-2 rule. And you know what that means, right, Birth Expert? Yesss…
3 minutes apart, lasting
1 minute each, for at least
These numbers are common benchmarks that doctors and midwives suggest, but they also might be adjusted depending on your particular case. How far are you from the hospital? What are your plans for pain-medication? What is your provider’s approach to managing birth?
And of course you aren’t making these decisions all on your lonesome. Your provider will give you a 24-hour number to call before you head in. They will help you sort things out.
If I ended the article here, you might think you’re set. Maybe you’re even saying to yourself, “Cool article, bro. I got it. Imma check facebook.”
Yet, this is exactly the point where most birth education ends, and is what contributes to the epidemic of over-reacting to early labor. So that you’ll be better than that (and have a better experience), let's look at the bigger picture.
Ways to note contraction progress BEYOND timing:
Contractions can progress in other ways besides their length and frequency. Other things to watch for:
Are there obvious edges?
In early labor, contractions are vague and come on slowly. In fact, you may not be certain that it's a contraction. They may just feels like a subtle cramping. Or perhaps you notice you're needing to pee occasionally as a contracting uterus presses on your bladder
As the contractions get stronger, the beginning and end is more apparent. You will go from “not contracting” to very clearly “contracting” without any doubt or confusion.
And then this delineation is clear to your supporters. They will notice obvious changes in your demeanor when a contraction begins and ends.
The Intensity on a scale of 1-10.
It's common for medical professionals to ask you “Where is your pain on a scale of 1-10?”. I watch my clients puzzle out how they're SUPPOSED to answer this question. They don't yet know how intense it WILL get, so how do they know what to scale it as?
And should you give them a high number to impress them? A low number to reassure them? Maybe you're trying to convince them to admit you, so you bump it up a notch or two. Just a fun little mental game to keep it interesting.
It's not a perfect system, but it helps communicate in a rudimentary way how far along you are.
WHERE do you feel them?
Your provider may ask you where you are feeling the contractions to suss out if they are true labor contractions.
In the beginning, contractions are felt low in the front of the belly. This differs from Braxton Hicks Contractions, which are felt as an all-over tightening of the uterus.
The low crampy feeling can indicate labor is beginning. It's the way early labor contractions usually feel.
However! When this sensation begins to expand to the lower back, this is a sign of progress. I always ask my clients where they are feeling their contractions. If it's low in the front and in the back/butt, I know we're moving forward! Hooray!
And that feeds into:
What's helping you cope?
In early labor, you can usually lie down or rest during contractions, But as they intensify on the pain-scale, are getting more clear and especially are radiating to the back, then the coping will change.
Maybe you're needing more hands-on support from your partner, including pressure on your sacrum. Maybe you're feeling the need to walk around or lean forward. Maybe deep breathing and a little moaning are helping you soothe your contraction pain.
The Rate of Change.
Turn on your brain for this one. This is Contraction Timing 401. Grad level.
More important than how far apart your contractions are is HOW LONG did it take you to get there.
If Becky's labor started at 10pm with irregular, light contractions. Then at 5am (7 hours later) they're about 6 minutes apart and she needs to walk through them. Then at 11am (6 hours later) they're 3 minutes apart, lasting more than a minute and she's using a LOT of coping skills. 13 hours of work until she's ready to head to her place of birth. That's a COMMON labor pattern.
But let's say Shawnda's labor also started at 10pm with irregular, mild contractions. But by 2am (4 hours later) they're 3-4 minutes apart, lasting more than a minute and she's really coping (making noise, moving a lot, probably has some bloody show and is shaking from the hormones). 4 hours until she's ready to go. That's probably a FAST labor.
So how long did it take you to get to 5 minutes apart and wrapping around the back? Then how long until they're 3 minutes apart and requiring a lot of focus?
This is called the Rate of Change. It's especially important to be aware of the Rate of Change if you have a family history of fast labors.
The physical manifestation of your contractions.
Can you see your belly changing shape? As labor progresses and the muscle fibers shorten, the top of your uterus (the fundus) will get thicker and square shaped. This is obvious from the outside as labor advances. Read more about this muscle action. Or if you want to get super-nerdy, read this.
Take note of these other changes in addition to the frequency and duration of your contractions. These other qualifiers can really help your doula and medical provider to get a sense of what's going on with your labor. Feel free to speak to them in these terms!
A word about Contraction Timing apps:
You truly don’t need anything fancy. 1. A start/stop button. 2. A way to see changes over time. 3. It’s nice if you can send the data in an email to your doula so she can stay updated in early labor.
But some apps like to add bells and whistles for added value. Perhaps they’ll ask the intensity of the contractions. There’s no need to stress about figuring that out. Because you don’t know how intense it WILL get, it may add confusion to try to scale this in early labor.
Many of the apps will constantly tell you to “go to the hospital”. But an app (like this article’s author) doesn’t know your specific case. Trust your provider over the app. App developers have to cover their tushies, which means skipping nuance and just being safe.
So those are the basics. THAT'S how you avoid showing up too soon. Annnd keep in mind these common…
1: Trusting contraction timing to be the most important marker of progress in labor.
Reliance on the timing of contractions as the clearest indicator of where you are in labor will f**k you up. I have had clients BEGIN their 2-3 day labors with contractions that were 3 minutes apart. I have had clients never get closer than 5 minutes apart, then push their babies out. A few never get an established labor pattern. Some will have a lovely pattern but no change in the cervix.
Bodies are less like machines and more like chaotic organisms, and they rarely line up neatly to fit our machinistic expectations.
Contraction timing is just ONE factor in the whole story. Don’t fixate.
You’re also watching for other signs of progress like: the mother needing to move around and lean forward, deep breathing or moaning noises, bloody show, growing focus and concentration during contractions, becoming non-verbal, contractions being felt in the front AND the back, etc.
2: Thinking that just because you have a couple of contractions that are five minutes apart, it's time to GO!
Early labor is wracked with irregularity. Contractions are usually unpredictable. You might see something like this:
5 minutes apart
3 minutes apart
12 minutes apart
4 minutes apart
8 minutes apart
You have to look at the overall picture. Don’t forget that last number of the metric: 3 minutes apart, 1 minute long, FOR AT LEAST ONE HOUR. It also helps to have realistic expectations about how long labor, especially early labor, lasts. For a first time mother, it’s easily 12 hours of contractions. It can vary wildly, however. Read more about Early labor (and how to cope) here.
So, watch for regular, close and a CONSISTENT contraction pattern
3: Exhausting yourself with timing when you could be resting or staying distracted.
(Again, read that article about how to get through Early Labor.You can even)
If labor has begun in the middle of the night, which occurs 80% of the time, and you can still doze or sleep, DO NOT TIME CONTRACTIONS. Sleep and rest should ALWAYS trump contraction timing. You won’t do anything with the information just yet anyway, and a rested body serves you more than contraction data.
I’m going to repeat that. It’s important:
SLEEP > DATA
I'm a big fan of denial in early labor. If you can’t rest, at least distract your managerial brain from over-analyzing and trying to figure out where you are.
It’s an impossible task, anyway.
You won’t know where you are in the journey until you can look back over your shoulder at it, usually when you’ve reached your destination. Then you’ll be able to reflect and say “Oh, yeah. That was early labor.” Or “Ha! I didn’t know anything then. I had my baby a WEEK later.”
The odds are dramatically high that you will NOT miss labor. You read about those crazy births on the side of the road because they are rare. (And they’re usually second timers. It’s a different sort of pattern for subsequent babies.)
Distract yourself with cleaning, a project, a walk, a task, a book, sex. Whatever helps you get out of your head. Find that flow and immerse yourself in something else.
4: Spending the ENTIRE labor as a slave to your contraction app.
Several women I’ve worked with were annoyed that their supporters were more focused on the phone (or the monitors at the hospital) instead of focusing on the SOURCE of the contractions (the mother, duh.). The contraction timer is meant to serve you, not the other way around.
Instead, use it to gather info at turning points. Time ten contractions, then put the app away. If labor seems to have picked up a few hours later, time ten again. Then put it away. You will get the lay of the land with just a few bouts of this over 12-24 hours.
If you get some useful information in just 5 contractions, then go ahead and table the phone.
So here are my guidelines for effective, sane contraction timing.
(want all of this on a handy pdf? Sign up!)
Do not time if you can sleep or rest (or go about your day).
Do not time until there is a clear start and stop to the contractions. In early labor, the edges of the contractions are vague. As labor progresses, the beginning and end will be obvious.
Do not time until a pattern emerges on it’s own. Maybe you are noticing they are more predictable and regular, so you get the app out.
DO TIME when you’re going to call your provider. They will ask about contractions, so it’s good to have recent, specific data. (If you are calling because your water broke, you have a concern or anything other than just contractions, just call without timing.)
What you're watching for:
- Duration (how long they are)
- Clear stops and starts
- Feeling them in the front AND back
- Growing Intensity
- Needing to really cope
Watch the Rate of Change. How long did it take to get from irregular, mild contractions to five-minutes apart and really needing to move around and cope to three-minutes apart with bloody show and LOTS of physical coping? Was that just a few hours? Might be a faster labor.
Look at the big picture. What else is going on? What other behaviors are shifting? Did your water break? What time of day is it and do we need to consider rush-hour traffic?
Navigating labor and birth is an art and a journey. You can learn as much as you want on the front end, but so much of learning happens IN the process. My hope is that these realistic guidelines give you a starting point in YOUR journey.