Signs of labour: how to tell it has really started

Irene · August 7, 2026 · 7 min

In the last weeks of pregnancy, every contraction feels like it could be the one, and most of the time it isn't. Telling real labour apart from practice contractions (Braxton Hicks) comes down to some concrete criteria, not just “a feeling.” Here they are, along with when to head to the hospital without waiting to check them all.

Braxton Hicks or real labour: the concrete differences

Braxton Hicks contractions (often called “false labour”) are irregular, don't get stronger over time, often stop when you change position or drink a glass of water, and are typically felt only at the front of the belly. They don't cause cervical dilation.

Real labour has regular contractions that get stronger and progressively closer together over time, are often felt in the back or across the whole abdomen, and don't stop when you change position or rest. It's these contractions that cause the cervix to thin and dilate.

The 5-1-1 rule (and why it doesn't apply to everyone the same way)

A widely cited guideline internationally (ACOG) is the 5-1-1 rule: contractions every 5 minutes, lasting at least 1 minute each, for 1 hour straight. At that point it's time to call your midwife or head to the hospital.

Italian clinical sources, however, tend to recommend slightly different operational criteria, for example, regular contractions roughly every 3 minutes, because the 5-1-1 rule is designed more for a first labour, while subsequent labours tend to move faster (more on that below). It's not a wrong rule, but it shouldn't be treated as universal regardless of how many pregnancies you've already had.

Your water breaking: what to do right away

If your water breaks, whether with a noticeable gush or a continuous trickle of fluid, call your midwifery unit or go to the hospital right away, whether or not you already have contractions, at any hour. It's worth noting the colour and amount of fluid (clear, streaked, greenish): it's useful information for the medical staff when you arrive.

The mucus plug: less important than you'd think

Losing the mucus plug is often described as the definitive sign that delivery is imminent. In reality it can happen days before real labour, and on its own it's not a reason to rush to the hospital. It only makes sense as a sign when it comes together with regular, progressively stronger contractions; it's the full picture that matters, not a single isolated sign.

First-time mothers and those who've given birth before: different timing, same attention

Those who've already given birth tend to have a faster subsequent labour: that's why Italian clinical sources generally recommend going to the hospital sooner, with less frequent or less intense contractions than the 5-1-1 rule calls for. It doesn't mean the second labour is always easier, it just means the safety margin for getting to the hospital in time is shorter, and it's worth moving earlier.

When to go to the hospital regardless, without waiting on the rules

There are situations where no rule needs checking before you leave:

Your water breaking, with or without contractions.
Bright red bleeding, even without pain.
Very painful, closely spaced contractions, even if they haven't yet reached an hour.
Any strong doubt that something's wrong, regardless of the criteria above.

In all of these cases the rule isn't “check first whether you meet the criteria”: it's simply, go.

In summary

Real labour is distinguished from Braxton Hicks by regular contractions that get stronger and don't stop when you change position. The 5-1-1 rule is a good general reference, but those who've given birth before tend to have shorter margins. Your water breaking and bright red bleeding are always reason to go straight away, with no further checks needed.

Frequently asked questions

How do you tell real labour apart from Braxton Hicks contractions?

Braxton Hicks are irregular, don't get stronger, often stop when you change position or rest, and don't cause cervical dilation. Real labour has regular contractions that get stronger and closer together over time, and don't stop when you change position.

What's the 5-1-1 rule?

It's a widely cited practical guideline (ACOG): contractions every 5 minutes, lasting at least 1 minute each, for 1 hour straight. At that point you call your midwife or head to the hospital. It's not a universal rule that applies the same way to everyone.

Does losing the mucus plug mean delivery is imminent?

No, not necessarily: it can happen days before real labour. It only has meaning as a sign when it comes together with regular, progressively stronger contractions; on its own, it's not enough to go to the hospital.

What should you do if your water breaks?

Call your midwifery unit or go to the hospital right away, whether or not you have contractions and no matter the time of day. Note the colour and amount of fluid: it's useful information for the medical staff.

Should women who have already given birth before go to the hospital earlier than first-time mothers?

Generally yes: those who have already given birth tend to have a faster subsequent labour, so Italian clinical sources recommend more cautious thresholds (less frequent/intense contractions) than the 5-1-1 rule, which is designed more for a first delivery.

When is it better to go to the hospital regardless of the rules?

With your water breaking, bright red bleeding, very painful and closely spaced contractions even before they fit a precise rule, or any strong doubt: in these cases, go, without waiting to check every criterion.