Contractions signal the start of labor, often bringing anxiety about when to proceed to a hospital or birth center. Determining the right time to leave home is a common concern for expectant parents. Healthcare providers use the simple, easy-to-remember 5-1-1 rule to standardize this decision. This guideline helps distinguish between early labor, which can be managed at home, and active labor, when medical support is generally recommended.
Decoding the 5-1-1 Rule
The 5-1-1 rule is a three-part measure that tracks the pattern of uterine contractions to indicate progression into active labor. Each number represents a specific criterion involving the frequency, duration, and consistency of the contractions. Meeting this pattern suggests the cervix is likely beginning to dilate and efface more rapidly, moving beyond the earliest phase of labor.
The first “5” refers to the frequency of the contractions: they are occurring every five minutes. Frequency is measured from the start of one contraction to the start of the very next one, including the rest period in between. This five-minute interval is accepted as a sign that the body is establishing a strong, regular labor pattern.
The first “1” indicates the duration of each contraction, which should last for one full minute. Duration is timed from the moment the uterus begins to tighten until it fully relaxes. A one-minute length signifies a contraction strong enough to be effectively changing the cervix and contributing significantly to the progression of labor.
The second “1” requires that this pattern—contractions five minutes apart, each lasting one minute—must be consistent for at least one hour. This consistency factor is important because it filters out “false labor” or Braxton Hicks contractions, which are typically irregular and fade away. A sustained pattern for 60 minutes confirms that the labor is progressive and established.
Practical Application: Timing Contractions
Accurately tracking contractions is necessary to determine if they align with the 5-1-1 criteria. Expectant parents must distinguish between the two measurements: duration and frequency. Duration is the length of time a single contraction lasts, measured in seconds, from the initial tightening until the moment of complete release.
Frequency is the interval between contractions, timed from the beginning of one contraction to the beginning of the subsequent contraction, measured in minutes. For example, if a contraction starts at 1:00 PM and the next one starts at 1:05 PM, the frequency is five minutes. Using a stopwatch, a clock with a second hand, or a dedicated timer application is an effective way to keep an accurate record.
It is helpful to focus only on contractions that feel strong and purposeful, rather than milder sensations. Braxton Hicks contractions, considered “practice” contractions, usually remain irregular and may go away if you change position or activity. True labor contractions will continue regardless of movement and will progressively increase in intensity, duration, and frequency.
Next Steps and Special Considerations
Once the pattern of five minutes apart, one minute long, for one hour has been consistently met, contact the healthcare provider immediately. It is recommended to call your doctor, midwife, or the hospital labor and delivery unit first, rather than traveling directly to the facility. The provider will assess the situation over the phone, confirm the contraction pattern, and give specific instructions on when to leave.
The 5-1-1 rule is a general guideline for low-risk, full-term pregnancies. Some providers may use a slightly different threshold, such as a 4-1-1 or 3-1-1 pattern, especially for those who have given birth before. Labor for subsequent babies often progresses more quickly, meaning a faster response time may be necessary, so always follow the personalized plan given by your care team.
There are several exceptions to the 5-1-1 rule that require immediate contact with a medical professional, regardless of the contraction pattern. If the amniotic sac ruptures (water breaking), call right away to report the time, color, and odor of the fluid. Similarly, if there is bright red, heavy vaginal bleeding—more than just pink or brown “bloody show”—or a significant decrease in the baby’s movement, immediate medical evaluation is necessary.