Call first — that is the actual instruction

Every national body here says the same thing, and it is easy to skim past. The HSE: "phone your midwife or maternity unit before going to the hospital." The NHS: "call your midwife or maternity unit for guidance if you think you're in labour." ACOG: "if you think you are in labor (or are not sure), call your ob-gyn or other obstetric care provider."

The call is not a formality. NICE expects your midwife or unit to "carry out an assessment of labour by telephone triage and determine whether a face-to-face assessment is needed" — and that assessment may conclude you should be seen at home, in your planned place of birth, or not yet at all. Skipping it means the decision is made in a corridor instead.

The contraction thresholds

NHS: call for guidance if you are "having regular contractions coming every 5 minutes or more often".

HSE: call your midwife when your contractions are regular and "last at least 60 seconds" and "come every 5 minutes". Its guidance for actually going in is that "your contractions are 5 minutes apart and are getting stronger."

Both measure frequency from the start of one contraction to the start of the next. The HSE adds the qualifier that changes the answer for a lot of people: "you may need to go to hospital sooner if you live a long distance away." ACOG makes the same point from the other end, suggesting you work out in advance how long the journey takes, rehearse it, and allow for rush hour and delays.

Reasons to go in that have nothing to do with contractions

These override any timing rule. The NHS says to call your midwife or maternity unit urgently if:

Your waters break.
You have vaginal bleeding.
Your baby is moving less than usual.
You are less than 37 weeks pregnant and think you might be in labour.
Any of your contractions last longer than 2 minutes.
You are having 6 or more contractions every 10 minutes.

The NHS is explicit about the timing of that call: "do not wait until the next day — call immediately, even if it's the middle of the night."

ACOG's US list of reasons to go to the hospital overlaps and adds one useful item: "you have constant, severe pain with no relief between contractions." Pain that never lets go between tightenings is a different picture from labour, and is worth naming on the phone. ACOG also lists water having broken with no contractions, heavy vaginal bleeding, and the baby moving less often.

Call your local emergency number — 999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if you think your baby is coming now and you have a strong urge to push. In the UK, call 111 if you cannot reach your midwife or maternity unit.

Why going in early often means going home again

This is worth expecting rather than being blindsided by. The NHS: "if you go into hospital before your labour has become established, they may suggest you go home again for a while." The HSE describes the same assessment on arrival — a midwife talks to you about your signs, may offer a vaginal examination to see how labour is progressing, and "if you are still in early labour you may be told to go home until labour becomes stronger."

The reasoning is in NICE's definitions. Established labour requires regular contractions and progressive cervical dilatation from 4 cm. Below that, you are in the latent phase, which the NHS calls "usually the longest stage of labour" and which can run for hours or days. There is nothing a labour ward can usefully do during it that you cannot do at home more comfortably.

The HSE names one exception plainly: "if you live far away from hospital this might not be an option." Say so on the phone — distance is a clinical factor, not an inconvenience.

One thing to check about overnight admission

The HSE flags a policy that catches people out: "if you are admitted during the night your partner might be asked to go home. This is to allow other mothers and babies to sleep. If you are in strong active labour and near to giving birth, your partner will be allowed to stay with you." Policy varies by unit, and this is a fair question to ask at a hospital tour.

What to take with you

The HSE keeps it short: "bring your antenatal card or your pregnancy notes and your bag. Some maternity hospitals now have electronic records." ACOG's advice is to pack in advance and leave the bag somewhere you cannot forget it — a hall closet or the boot of the car — and to have the car seat installed and checked before labour, not after.

ACOG also suggests settling in advance who will look after other children, pets and the house, and agreeing with your team, before your due date, "the right time to call", how to reach them after office hours, and "whether to call first or go directly to the hospital." That last question has a different answer at different units, so it is worth asking yours directly.

If you are planning a home birth or a midwifery unit

The thresholds for calling are the same; where you go is different. NICE expects that if you have chosen home or a midwifery unit, you are given information in advance about "what would happen if you had to be transferred to hospital during labour and how long this would take." The NHS lists the questions worth asking: how long a transfer would take, which hospital you would go to, and whether a midwife would be with you throughout.

Transfer during labour is common enough to plan for rather than fear. NICE's figures for low-risk first-time mothers put transfer to an obstetric unit at 450 per 1,000 for a planned home birth and 363 per 1,000 for a freestanding midwifery unit; for women who have given birth before, the same figures are 115 and 94 per 1,000.

If you get there and it is not time

Being sent home is not a failure and it is not a wasted trip — you have been assessed, and NICE expects you to leave with "a plan of care, including guidance about who she should contact next and when." If you do not have that, ask for it before you go.

When to Go to Hospital in Labour