Every pregnant woman at some point in her pregnancy will begin to wonder if she is in labor. Most women have a few false starts. Braxton-Hicks contractions can be confusing and can become frequent and regular – at least for a short time – before going back to their irregular pattern. Women frequently have physiologic discharge or will urinate and wonder if their water is broken. So how can you tell real labor from false labor?

The answer is time. Real labor is progressive in every way, but you won’t be able to see this until some time has passed. If you’re having some regular contractions, the best thing to do is to see what happens over the next two to three hours. If you are really in labor, your contractions will become more frequent (maybe going from every six to seven minutes apart to every three to four minutes apart), last longer (going from, say, 30 seconds in length to 45 or 50 seconds in length), become more painful, regular, predictable, and persist. False labor, on the other hand, may start strong but will lose steam and wane over two to three hours.

If it’s your first baby, you have plenty of time. Labor will likely last many hours and you will have plenty of time to arrive at the hospital. If it’s your fourth baby, then you already know what to expect. If you are reading this anyway, your labor probably won’t last that long and you should head to the hospital a little sooner.

In some cases, your doctor may ask you to come to the hospital a bit earlier; for example, if you’re positive for group B Strepococcus, then you will need four hours of IV antibiotic therapy in addition to however long it takes to get to the hospital, get admitted, and get an IV started before the baby is born.

If your water breaks, you should probably head to the hospital. This may be a sign that your labor is already very advanced, since water tends to break on its own at an average of about 8 cm. If your water is broken and you’re not already in labor, then you should still go to the hospital because your labor likely needs to be augmented or induced. If you have had a previous Cesarean delivery, then you should come to the hospital much sooner because you do not want to risk laboring at home. A trial of labor after Cesarean is a good idea for most women, but because of the risk of uterine rupture, that trial of labor should happen at the hospital to maximize the safety for mom and baby.