Braxton Hicks vs Real Labor — A Partner's Decision Guide

This is the moment you've been preparing for — or the moment you realize you haven't prepared enough. Either way, here's your decision framework.

Braxton Hicks contractions ("practice contractions") are your uterus doing rehearsal runs. They typically start in the second trimester but become more noticeable in the third. They feel like a tightening or hardening of the belly — you can sometimes feel it if you put your hand on her stomach. They're usually painless, though they can be uncomfortable.

Here's how to tell Braxton Hicks from the real thing:

Braxton Hicks are irregular — they don't follow a pattern. If contractions are 8 minutes apart, then 3, then 12, then 6 — that's Braxton Hicks. Real labor contractions develop a rhythm and get progressively closer together.

Braxton Hicks usually stop if she changes position, walks around, drinks water, or takes a warm bath. Real labor contractions don't stop for anything.

Braxton Hicks don't get stronger over time. Real labor contractions intensify — each one is harder than the last, and she'll have increasing difficulty talking through them.

Braxton Hicks are usually felt in the front of the belly. Real labor often starts in the lower back and wraps around to the front.

Your job: be the timekeeper. When she says "I think that was a contraction," open a contraction timer app (download one now — Timer for Contractions, Contraction Timer+, or similar). Record the start time, duration, and frequency. This information is exactly what the doctor or midwife will ask for when you call.

The 5-1-1 rule is the standard guideline most providers use for when to head to the hospital: contractions are 5 minutes apart, each lasting 1 minute, and this pattern has continued for 1 hour.

Some providers use 4-1-1 (4 minutes apart) or even 3-1-1 depending on the circumstances — especially if the hospital is far away, it's not her first baby (second labors tend to progress faster), or she has risk factors like Group B strep that require early IV antibiotics.

Ask her provider at the next appointment: "What's our number to follow?" Having a specific answer removes ambiguity when you're stressed at 3 AM.

Here's what the timing actually looks like: contractions are measured from the start of one to the start of the next. So if a contraction starts at 10:00 and the next starts at 10:05, they're 5 minutes apart. The duration is measured from the start to the end of a single contraction. Early labor contractions may last 30-45 seconds. Active labor contractions last 60-90 seconds.

Important exceptions — go to the hospital immediately regardless of timing if: her water breaks (especially if the fluid is green or brown — this indicates meconium, which requires monitoring), she's bleeding heavily, she feels the urge to push, the baby's movements have decreased significantly, or she's less than 37 weeks (preterm labor needs immediate evaluation).

Don't worry about going in "too early" and being sent home. It happens all the time, the staff expect it, and it's always better to be checked and sent home than to wait too long.

First: it probably doesn't look like the movies. Only about 15% of labors begin with the water breaking. When it does, it might be a dramatic gush — but more often it's a slow, steady trickle that she might mistake for urine or discharge. She may say something like "I think I'm leaking" or "I can't tell if I peed myself."

Here's what to do: note the time the water broke. Note the color and smell of the fluid — this is important. Normal amniotic fluid is clear or slightly yellowish and has a mild or sweet smell (it should not smell like urine). If the fluid is green, brown, or has a foul smell, tell the provider immediately — green or brown fluid suggests the baby has passed meconium (first stool), which can be dangerous if inhaled.

Call the provider or labor and delivery and report: when the water broke, the color and amount of fluid, whether she's having contractions and how far apart, and how far along she is.

Most providers want women to come in for evaluation after the water breaks, even if contractions haven't started. Once the amniotic sac is ruptured, the risk of infection increases with time, and most providers prefer to have the baby delivered within 24 hours of the water breaking.

She should not take a bath after her water breaks (shower is fine). She should not insert anything into the vagina (no tampons). And both of you should avoid sexual intercourse.

In the meantime: put a towel on the car seat, grab the hospital bag, and head out. Fluid will continue to leak — this is normal and can be managed with a large pad or towel.

Contractions before 37 weeks are considered preterm labor, and they always warrant an immediate call to the provider or a trip to labor and delivery. This is not a wait-and-see situation.

Preterm labor signs include regular contractions (every 10 minutes or more frequently) before 37 weeks, menstrual-like cramping that doesn't go away, lower back pain (constant or rhythmic), pelvic pressure (feeling like the baby is pushing down), increase in vaginal discharge or mucus, any vaginal bleeding or spotting, and a gush or trickle of fluid (possible premature rupture of membranes).

If she's experiencing any of these, call the provider immediately or go to labor and delivery. The hospital will monitor her contractions, check her cervix for dilation, and may perform a fetal fibronectin test (a swab that helps predict whether delivery is likely in the next two weeks).

If preterm labor is confirmed, the medical team has several interventions: tocolytic medications can slow or stop contractions temporarily; corticosteroid injections (given to her, not the baby) rapidly mature the baby's lungs in case early delivery can't be prevented; and magnesium sulfate may be given to protect the baby's brain if delivery before 32 weeks seems likely.

The goal is to delay delivery as long as safely possible — every additional day in the womb matters for the baby's development. Even 48 hours (enough time for the steroid injections to take effect) can make a significant difference in outcomes.

As a partner, preterm labor is terrifying. You may feel helpless. But your presence and advocacy matter. Ask questions, take notes, and make sure you understand the plan.

The hospital bag should be packed by 36 weeks — earlier if there are any preterm risk factors. Here's what actually matters, from a partner who's been through it (and the things nobody tells you to pack).

For her: comfortable going-home clothes (maternity size — she won't be back to pre-pregnancy size), nursing bra and breast pads if she plans to breastfeed, toiletries and a hair tie, phone charger (the long cord), a pillow from home (hospital pillows are terrible), lip balm (hospitals are dry and she'll be breathing through her mouth), snacks for after delivery (she'll be starving), and her birth plan or preferences document.

For the baby: a going-home outfit, a car seat (installed correctly — do this weeks in advance, not in the hospital parking lot), a blanket, and diapers and wipes (the hospital usually provides these, but backup doesn't hurt).

For you: a change of clothes, snacks and drinks (the cafeteria closes, and labor can last 24+ hours), a phone charger, a pillow or light blanket (the partner chair is not comfortable), cash or a credit card for parking and vending machines, and a list of people to notify after the birth (so you're not scrolling contacts while sleep-deprived).

Documents: her insurance card and ID, hospital pre-registration confirmation, birth plan, a printed list of her medications and allergies, and pediatrician's contact information (you'll need to choose one before delivery).

One more thing: know where the car seat goes (rear-facing, middle of the back seat if possible) and how to install it. Many fire stations and hospitals offer free car seat checks — do this before week 37.