What is the normal interval and duration of contractions (labor pains) before delivery is considered imminent?

When to Go to the Hospital: Contraction Timing Before Delivery

For first-time mothers in spontaneous labor, contractions should be regular and 5 minutes apart or less before going to the hospital, as this timing is associated with being in active labor on admission and better outcomes including lower rates of cesarean delivery. 1

Contraction Frequency Guidelines

Normal Labor Contraction Patterns

• Normal uterine activity is defined as no more than 5 contractions in a 10-minute period, averaged over 30 minutes 2
• Recent evidence suggests that 4 contractions per 10 minutes may be a safer upper limit, as exceeding this threshold is associated with worsening fetal outcomes including lower cord blood pH and base excess 3
• The longer contraction frequency remains elevated above 4 per 10 minutes, the worse the measured outcomes become 3

When to Seek Hospital Admission

• Women should labor at home until contractions become regular and ≤5 minutes apart 1
• First-time mothers who wait until this pattern is established are:
  • More likely to be in active labor (6-10 cm dilation) on admission (nearly 4 times more likely) 1
  • Less likely to require oxytocin augmentation 1
  • Less likely to need epidural analgesia 1
  • Less likely to have cesarean delivery 1

Duration of Contractions

• Each contraction should last approximately 60 seconds or longer 2
• Healthcare providers should count fetal heart rate between contractions for ≥60 seconds to determine baseline, and after contractions for 60 seconds to identify fetal response 2

Monitoring Frequency During Labor

Active First Stage of Labor

• Fetal heart rate assessment should occur every 15 to 30 minutes during the active phase of the first stage 2

Second Stage of Labor (Pushing)

• Fetal heart rate assessment should occur every 5 minutes during the second stage with pushing 2

Critical Warning Signs

Excessive Contractions (Tachysystole)

• More than 5 contractions in 10 minutes (averaged over 30 minutes) is abnormal and termed tachysystole 2
• This pattern requires immediate medical evaluation regardless of whether fetal heart rate decelerations are present 2

Inadequate Progress

• If contractions remain irregular or less frequent than every 5 minutes after several hours of labor at home, medical evaluation may be needed to assess for labor dystocia 2

Common Pitfalls to Avoid

• Do not go to the hospital too early - Women who arrive before contractions are regular and ≤5 minutes apart have significantly higher intervention rates including cesarean delivery 1
• Do not ignore the pattern - Regularity matters as much as frequency; sporadic contractions every 5 minutes are different from consistently regular contractions 1
• Do not delay if other concerning signs develop - Vaginal bleeding, decreased fetal movement, rupture of membranes, or severe pain warrant immediate evaluation regardless of contraction pattern 2

Expected Timeline

• First-time mothers who wait for the 5-minute pattern typically labor at home for a median of 5 hours (range 3-12 hours) before admission 1
• Those who arrive earlier labor at home for only a median of 2 hours (range 1-8 hours) 1
• The longer home labor period in the first group is associated with better outcomes, not worse 1