When to Call Midwife in Labor

⏳ When to Call Your Midwife (or Go In): A Real Talk Guide to Timing Labor Right

If you’ve been told to follow the 5-1-1 rule (contractions every 5 minutes, lasting 1 minute, for at least 1 hour), you’re not alone.

But here’s the truth: for most first-time vaginal births, that rule is usually way too early. And for people who’ve birthed before—especially those with fast labors—it might already be too late.

Labor doesn’t always follow a textbook pattern. So how do you know when it’s actually time to call your midwife, go to the birth center, or head to the hospital?

Let’s break it down.

🧡 Birth Timing Isn’t One-Size-Fits-All

Every body—and every birth—is unique. Some labors start with strong, spaced-out contractions. Others begin with frequent, mild ones. What matters most is how the labor feels, how you’re coping, and what your body and baby are telling you.

Here are a few real-life scenarios I’ve seen:

• Every 2–3 minutes, but only 30–45 seconds long, and you can talk through them?
  Probably still early labor—even if they’re close together.

• Every 6–8 minutes, but you’re moaning, can’t speak, and need to stop everything during a wave?
  That’s active labor, even if they’re spaced out.

So, instead of using a stopwatch alone, pay attention to:

• The intensity of the surges

• How you feel emotionally

• Whether you can rest, eat, or talk during them

🏡 If You’re Planning a Homebirth or Birth Center Birth

Stay in regular contact with your midwife. You’ll check in early and then again when things shift. You don’t need to call at the very first signs of labor or your bloody show—especially in the middle of the night.

Unless something feels urgent, it’s okay to wait until morning to connect—so you, your partner, and your team can rest for the journey ahead.

When to Call:

• You feel like things are picking up steadily over time

• You’re feeling emotional, intense, vocal

• You’ve had a previous fast labor

• You feel pushy or like you have to poop

• Water breaks and fluid is green/brown

• You notice less baby movement even after a snack, juice, or some rest

• You’re just not sure and need to talk it out

Your midwife knows you and your history. Often, after just a short phone call, I can tell exactly where a mama is in labor.

🏥 If You’re Planning an Unmedicated Hospital Birth

Unless you’ve had a precipitous birth before (start to baby in under 3 hours), your best bet is to stay home as long as possible in healthy labor—especially if everything is normal and baby is moving as usual.

Why?

Because hospitals are great at managing emergencies—but not so great at supporting undisturbed physiological birth. Their priority is quick, efficient delivery. And that can trigger the cascade of interventions: early admission → more monitoring → less freedom → higher risk of things you may not want.

You labor best when:

• You’re undisturbed

• You feel safe and private

• You can move, eat, vocalize, and ride the waves your own way

If you're coping well, let things unfold at home where your oxytocin can flow.

🌙 What to Do at Night in Early Labor

If you’re in early labor at night:

• Keep the lights off

• Breathe and rest between contractions

• Try to sleep or doze, even for 10–15 minutes at a time

You’ll need your energy later. So will your partner. You’ll be in touch with your midwife when the time is right.

🔔 A More Useful Gauge for Active Labor

Especially for first-time vaginal birthers, look for:

• Contractions every 3–4 minutes

• Lasting 60–90 seconds

• For at least an hour

• You can’t talk through them, you’re moaning, roaring, moving instinctively

And most importantly: They’re getting longer, stronger, and closer together.

If you’re not sure—it’s always okay to call your doula or midwife and talk it through.

👶🏽 If You’ve Given Birth Before

The focus shifts more toward intensity and emotional cues than just timing.

Some mamas have on-and-off early labor for days or weeks, but once things pick up—they can go fast. If you’ve had quick births before, stay in close contact. I often prefer to get there early and wait nearby than risk a car or bathroom baby.

🚗 Don’t Forget the Practical Stuff

Always consider:

• How far away you are

• Traffic and parking

• Time of day or night

• Snow, storms, or anything that might delay travel

Sometimes arriving “too early” is better than rushing—or not making it at all.

🧠 Trust Your Gut, Stay in Contact

You don’t need to overthink this. Stay in contact with your midwife or birth team, and trust that together, you’ll know when it’s time to go or have them come to you.

Call if:

• You’re worried

• Something feels off

• You feel pushy

• Baby isn’t moving normally

• You just need reassurance

We’re here for all of that.

💪 You’ve Got This

No matter where or how you give birth, when you understand how labor works—and what your body really needs—you can rock your birth.

You don’t need to follow outdated formulas.
You don’t need to rush into the hospital too soon.
You do need rest, trust, a supportive team, and the freedom to birth your way.

📘 Want to go deeper?
I dive into all of this—and so much more—in my Online “Love Your Birth” Comprehensive Prep Course, where you’ll learn how to prepare, cope, advocate, and thrive during your birth journey.

Image by Megan Hancock Photography

Don’t forget to check out my LOVE YOUR BIRTH Online Childbirth Education Course! With 10 educational and empowering videos, and many additional bonus materials, it is everything you need to prepare yourself for the birth YOU want, to feel confident and empowered for however your birth unfolds, and not only ROCK, but also LOVE your journey. I have a whole section on what to do if you have a precipitous labor and birth that occurs before your provider arrives or before you get to your birth setting. The section is devoted to you and to your partner about this topic in much more depth, so that you are both prepared for the most exciting adventure of a lifetime. Learn more here.

In adjunct to my course, get my Natural Birth Secrets book second edition - your best childbearing reference for the entire journey to having a baby…..from holistic modalities to common discomforts to in depth discussions on hot topics.

Busting Two Common Hospital Birth Myths

“Thankfully you were in the hospital!”

Unless you are well prepared, have an advocate, and are going to a provider and setting that supports natural physiologic birth, the following are unfortunately the common scenarios. A healthy pregnant mama gets admitted to the hospital in labor, put on the continuous fetal monitor, given an IV, told she can’t eat or drink, put in bed, labor stalled, she was then given Pitocin to augment her contractions which caused fetal distress, resulting in an emergency cesarean. And they tell you, thankfully you were in the hospital. We need to send love to all who still face this prevalent “we saved your baby” after the cascade interventions that proceeded it, that often caused it all.

Another common scenario is a mama is told her baby has macrosomia - is too big (well above 9 pounds for example) and they schedule an induction, which has all the above interventions and their risks, including not creating the necessary ingredients for her to succeed in progressing to have a natural, let alone vaginal birth, and she is told she needs a cesarean for a failed induction; or they just jump to cesarean without a “trial of labor” and baby weighs up to several pounds less than the estimated weight, indicating the induction or cesarean was not even necessary in the first place.

I’ve posted often about each one of these interventions and how they are not evidence based. No animal could labor well with any one of them, so how could a human being? Each one in their own right increases risk and may lead to this cascade of interventions, stress and rescue when nothing wasn’t broken to begin with. Whether you’re planning a birth at home or birth center to avoid this scenario in the first place, or hospital, especially if it’s your first time giving birth vaginally, your excellent preparation is key. Set yourself up for success with my online Guides to Pregnancy, Birth & Postpartum. And in adjunct my Natural Birth Secrets book 2nd edition.

“We just want a healthy mom and baby.”

Heathy to medical providers and hospitals means a mom and baby who are alive without any serious unstable conditions that need immediate or ongoing attention. They are not often concerned with long term effects of their treatment - even medical ones like the disruption of the microbiome from antibiotics - especially concerning when overused and unnecessary, or the short and long term harmful impact of early cord clamping. They are not concerned with the traumatic impact of their type of treatment on mother or baby. Over 45% of mamas in US experience birth trauma - PTSD from their birth experience and how they were treated. I discuss this in depth for mom and babies in my Natural Birth Secrets book 2nd edition.

If this is your only goal YOU are selling yourself short. A live mother and baby without obvious concerning physical complications is baseline, but what about the bigger and long term picture of real health of your mind, body, heart & spirit, the health of your family? What about your experience - is it deeply positive, respectful, empowering, beautiful, sacred, personal, one you will love and treasure forever even if challenging? Do you feel heard, respected, supported? Do you feel safe, comfortable, free to labor as you want? Do you get full informed consent and your decisions and choices honored? Was your partner involved in a meaningful way? This is the most important day of your life - let it be fully and truly healthy and absolutely glorious. Make this happen with my comprehensive online Love Your Birth prep course Guide to Pregnancy, Birth and Postpartum. And compliment it with my Natural Birth Secrets Birth second edition - where I go into both of these topics in more depth, along with the research, and the safety and better outcomes from homebirth with midwives in the healthy population.

I’ve taken everything I’ve learned, trained, and supported women locally for over 28 years in my private practice and I’ve poured all of my love, passion, knowledge, and experience into creating something truly special for you… my new and updated Pregnancy, Birth & Postpartum Guides. Same Beloved Content Plus Over 20 Added Bonus Videos! Buy Here Now!

They can be used via the mobile App or on your desktop! It’s the most up to date combination of Love Your Birth and Walk With Anne for Mamas online courses at a cheaper price! And they have an option for direct access to me for your questions and concerns!!

Whether you’re an experienced or new parent, there are hours of videos, workbooks, and PDFs to answer all of your questions. Everything is searchable, so you can just type or talk and it’ll bring you right to the exact moment in the video where I answer your question. It’ll blow your mind! If English is not your strongest language, you can even change the captions or even the audio to the language you prefer. You can get the Love Your Birth Prenatal, Birth & Postpartum - ALL of the guides for a limited-time offer of 50% off -> RIGHT HERE!

The key to a positive birth is feeling confident, strong, relaxed, and empowered during the entire process, regardless of the twists and turns it may take. I give my full heart and all I know in everything I do to support Mommas.

Eating, Drinking in Labor and IV

Not allowing food or drink in normal labor because of risk of rare aspiration in case you need general anesthesia isn’t evidence based care, but based on outdated hospital policy and is harmful. People in labor need and want to stay well nourished and hydrated if given the choice, instead of being then connected to an IV for at least the fluids. You are running your marathon in labor. The uterus like any muscle requires nutrients to meet its energy needs. According to research from sports medicine, it is well known that for example eating carbohydrates during exercise improves performance, reduces fatigue, and prevents ketosis. Power bars and nutrient dense snacks and hydrating fluids are given out to runners along their journey. No athlete or coach would advise performing while fasting.

When supported to labor normally and naturally, risk of emergency cesarean needing general anesthesia is very low in the healthy population. This policy of fasting before surgery began in the 1940s when general anesthesia was not as safe as today and dangerous aspiration of stomach contents was more common. These days anesthesia and airway management are much more sophisticated and improved, most cesareans don’t use general anesthetics, fasting in labor doesn't guarantee an empty stomach anyway and could lead to harmful acidic stomach juices if aspirated, and aspiration causing severe lung disease & death is extremely rare today in healthy people. Free standing birth centers and homebirth midwives do not have this no intake by mouth ’NPO’ policy.

But if you are healthy and birthing in the hospital, you can absolutely allow yourself the food and drink you need. It's your body, your birth and they don’t have authority over you. Best to discuss your preferences with your provider beforehand, in pregnancy, for if they don't support you, they may not support your other plans and you might want to change providers to those who practice evidence based care & are more in alignment with your philosophies. If you choose to stay with a provider and setting that does not allow food and drink, next option is to sneak it in, and ingest them in privacy (which might mean when you are in the bathroom).

Got to stay well nourished and hydrated in labor like running your marathon.

Best labor foods are basically - whatever you want that’s nourishing and easily tolerated! Mamas tend to prefer more bland foods but not always. But you do need lots of extra quality fuel in your tank for your journey. Some favorites include organic eggs, whole grain toast and dairy or nut butter, whole grain crackers and cheese, whole grain cereal or oatmeal and dairy or nut milk, maple syrup/honey, power and granola bars, nuts and dried fruit, trail mix, dark chocolate, frozen fruit bars, fruit that’s not messy to eat.

Best drinks include water, fruit juices, herbal tea with honey, bone or miso soup broth, coconut water, smoothies, organic Gatorade, homemade labor-aid - recipe in my Natural Birth Secrets book 2nd edition.

Many who labor in hospitals that don’t allow food and drink, need IV to prevent dehydration which can cause complications needing more interventions….unless you are sneaking enough food and drinking plenty orally. If you’re pregnancy and labor are healthy are proceeding naturally, IV fluids aren’t at all necessary and may cause harm. Even the American College of Obstetricians & Gynecologists, the American Society of Anesthesiologists and of course the World Health Organization all recommend encouraging oral fluids instead of IV.  Why is this not happening?  Routine IV can over hydrate and decrease newborn weight and blood sugar and cause maternal swelling - even in the breasts which impairs breastfeeding, can be uncomfortable, get inflamed, infiltrated or cause infection. IV restricts needed movement in labor, undermines mama’s confidence and sense of feeling empowered and healthy. I’ve posted before on the harmful practices of restricting needing nourishment and hydration. As long as you are keeping well hydrated by drinking, you can absolutely feel no qualms about declining that routine IV.

There is also no evidence to support the IV access called saline lock for low risk laboring mamas because in case of postpartum hemorrhage. The risk of that in this population is low, & needing treatment beyond natural remedies & medications without IV even lower. An excellent practitioner can start an IV in that rare emergency.

More details in my Online Guide to Pregnancy, Childbirth & Postpartum- sold separately or discounted bundle. I’ve taken everything I’ve learned, trained, and supported women locally for over 28 years in my private practice and I’ve poured all of my love, passion, knowledge, and experience into creating something truly special for you… my new and updated Love Your Birth Pregnancy, Birth & Postpartum Guides. Same Beloved Content Plus Over 20 Added Bonus Videos! Buy Here Now!

They can be used via the mobile App or on your desktop! It’s the most up to date combination of Love Your Birth and Walk With Anne for Mamas online courses at a cheaper price! And they have an option for direct access to me for your questions and concerns!!

Whether you’re an experienced or new parent, there are hours of videos, workbooks, and PDFs to answer all of your questions. Everything is searchable, so you can just type or talk and it’ll bring you right to the exact moment in the video where I answer your question. It’ll blow your mind! If English is not your strongest language, you can even change the captions or even the audio to the language you prefer. You can get the online comprehensive prep course Love Your Birth Prenatal, Birth & Postpartum Guides - ALL of the guides for a limited-time offer of 50% off -> RIGHT HERE!

The key to a positive birth is feeling confident, strong, relaxed, and empowered during the entire process, regardless of the twists and turns it may take. I give my full heart and all I know in everything I do to support Mommas.

Questions to Ask When Interviewing Your Provider, Red Flags and Choosing Your Best Provider

Here are some key questions to ask your midwife or obstetrician if you want a natural birth. Listen to them and within you. You will get your answers about best provider for the birth you want. And do pay attention to red flags.

Do you have training and experience supporting natural physiologic undisturbed birth when all is well?

What’s your rate of primary cesarean?

If I need a cesarean, are you or your collaborative obstetricians experienced and do with gentle/family centered version?

Do you encourage VBAC? What’s your rate?

Are you skilled and supportive of physiologic breech and twin birth? What’s your rates?

Do you support my birth preferences and my right to decline interventions?

Do you advocate for doulas and other support persons I want?

Do you support and have training/skills for vaginal breech and twin birth?

What’s your rate and policy for induction of labor - like going past due date, suspected big baby, water breaking before labor etc.

Is your setting when you practice in alignment with you? What restrictions might be placed on me becasue their protocol?

Most importantly, do support my legal and ethical right to autonomy over my body, birth and baby?

Will my rights to make informed decisions about my and my baby’s care be respected?

If they don't support natural undisturbed health birth or evidence based care, their rate of primary cesarean section is above 10-15%, they don't support your birth preferences & right to decline interventions, they don't advocate for doulas & any other support person you want, they don't encourage VBAC and have rates lower than 70-80%, they have high induction rates for things like going past due date, suspected big baby, water breaking before labor, they don't support and have lots of experience with vaginal breech and twin birth, and/or the setting where they practice is not in alignment with them & they place a lot of restrictions on you because of protocols and policies you have your answer. You can switch providers anytime and hire one that is most in alignment with what you want, who will work collaboratively with you.

Here are some red flags, but here are so many others, especially when all is well with mama and baby such as:

They don’t support natural physiological birth.

They don’t care to read your birth plan or respect your birth preferences.

They don’t do VBAC.

They don’t do vaginal breech or twin birth.
They advise frequent ultrasound, routine multiple tests and procedures without discussion.

They perform weekly internal exams at 36 weeks.
They induce everyone at 41 weeks or sooner.
They do not believe in or practice natural physiological birth.
They don’t like or support doulas.
They do routine episiotomies on all first time vaginal birthers.
They do immediate cord clamping, or rush clamping without waiting until it is limp, white and pulseless.

Their cesarean rate greater than 10-15%.
scheduling a cesarean because they tell you your baby is too big

Unless you are planning to birth in an out of hospital freestanding birth center or at home with authentic midwives, most maternity care practitioners and the settings they work have not seen natural undisturbed birth - and they are trained and quite used to disturbing it. They think it’s necessary to fix what isn’t broken when all is well. It’s like everyone trying to interfere with your heart beating or your lungs breathing when it’s doing just fine on it’s own. It is a sad state of affairs with what’s going on in most modern hospitals especially in the US. I’ve had obstetricians, nurses and even medwives (midwives who practice more medically like many OBs) tell me they have never seen a natural undisturbed birth. Some actually want to shadow me to see one! I love when I do hospital shifts and the med students follow me - it may be their only chance to see natural undisturbed normal physiological birth. That’s the vast majority of what I see and I don’t get how it can be otherwise. Why is this happening as if it were some cool freak show, when the research supports it, when it’s evidence based care, when this is how birth occurred for thousands of years since the beginning of time, and still is the way it happens for the majority worldwide.

Here is a wonderful testimony sent to me from a mama who took my online Guide to Pregnancy, Birth and Postpartum, prepared, informed and empowered herself to tell her obstetrician (the only provider in her rural area) who never saw natural birth, to do nothing but be a fly on the wall, just in case of emergency. He said he never did that, does mostly inductions, medicates births and cesareans. But she respectfully spoke up and he finally agreed. And who was touched to tears, crying the most at her beautiful natural birth? Think of the ripple effect that has on his care for other mamas? If you want a natural birth without disturbance-ask your provider if they’ve seen one. You’ll get your answer whether you should run or not, to a provider and setting where it’s the norm.

“I want to thank you for your online course. Because of it I was able to do a home waterbirth in Nicaragua where it is not common at all. I live abroad so it was my dream to have a natural birth in my home. Little did I know there are no doulas or certified midwives in the country. Your course helped me through it! My father-in-law who is an OBGYN in Brazil caught the baby and also has never done a home or natural birth. He only does cesarean. What a special moment for the family! Thank you again for the knowledge I was able to achieve online!!! Here’s a video of our special day :)
”

— — Brittany S, Nicaragua

If you choose to stay with such a provider with so many red flags, you have to prepare even more, fight even more for what you want, make sure to have an advocate, and know your legal rights to autonomy and informed refusal so you don't allow anyone to dictate you to do anything against your will or manipulate you with playing the fear of dead baby card when there is nothing wrong. Dig deep - is this what you want to be doing during your pregnancy and such a sensitive time as labor?

For more information on how to best prepare for having your baby, feel well educated and informed , confident and empowered, bust through fears and trust the process, and have the most beautiful birth of your dreams take my online signature comprehensive prep course - Anne’s Guide to Pregnancy, Birth and Postpartum and read my Natural Birth Secrets 2nd book edition. I created them for you to do just that, based on over two decades of holistic nurse midwifery experience and attending over 1000 births.

I’ve taken everything I’ve learned, trained, and supported women locally for over 28 years in my private practice and I’ve poured all of my love, passion, knowledge, and experience into creating something truly special for you… my new and updated Love Your Birth Pregnancy, Birth & Postpartum Guides. Same Beloved Content Plus Over 20 Added Bonus Videos! Buy Here Now!

They can be used via the mobile App or on your desktop! It’s the most up to date combination of Love Your Birth and Walk With Anne for Mamas online courses at a cheaper price! And they have an option for direct access to me for your questions and concerns!!

Whether you’re an experienced or new parent, there are hours of videos, workbooks, and PDFs to answer all of your questions. Everything is searchable, so you can just type or talk and it’ll bring you right to the exact moment in the video where I answer your question. It’ll blow your mind! If English is not your strongest language, you can even change the captions or even the audio to the language you prefer. You can get my Love Your Birth Prenatal, Birth & Postpartum Guides - ALL of the guides for a limited-time offer of 50% off -> RIGHT HERE!

The key to a positive birth is feeling confident, strong, relaxed, and empowered during the entire process, regardless of the twists and turns it may take. I give my full heart and all I know in everything I do to support Mommas.

Tearing at birth

Worried about tearing at birth? If so, you are not alone. Although no guarantees (for example baby can come out with their hand by their head - compound presentation, that can result in lacerations), there are things you can do to help prevent tearing during pregnancy and at birth, even if you tore or had episiotomy previous birth. I have helped many mamas not tear or not tear enough to need stitching repair, despite the most serious of tears last time.

First off, say NO to routine episiotomy, in which the provider cuts your perineum and vagina at birth. It is is not only one of the most harmful, painful and unnecessary routine obstetric procedures, but also can lead to more serious tearing extending to the anus (third degree) and even the rectum (fourth degree). Make sure you maintain excellent nutrition, take in low glycemic foods and drink (especially if previous tear was related to baby’s large size - white four, fruit juices and sugar foods tend to grow bigger babies), avoid toxins like smoking, encourage baby anterior as you get close to term to prevent posterior positioning - I go into all this in more depth in my Natural Birth Secrets book 2nd edition. Research is conflicting about benefit of simple perineal massage to prevent tearing. What is more clear according to the research are devices specifically made to stretch vaginal and perinal muscles. In the last three to four weeks of pregnancy, you can prepare the muscles of your birth canal with one of the researched effective, pelvic floor medical training devices like Epi-no, or Aniball (easier to get in the US) as athletes and dancers stretch before working out or performing to prevent injury. They are like a balloon of sorts, that you insert into your vagina and gradually inflate 15-20 minutes daily, over a period of time to the size of baby’s head. They not only significantly reduce the risk of tearing or episiotomy, they also help you feel more prepared physically and mentally (and get a sense of what it feels like to have your birth canal stretch to the size of baby’s head so you relax into it), they ease childbirth, prevent stress urinary incontinence and been demonstrated to have other important benefits from reduced length of second stage of labor to improved Apgar scores - less fetal distress during the pushing phase. Incorporate the practice into your love making and have fun with it. Many mamas in my practice and midwives around the world swear by them, and urge first timers as well as mamas who have had more severe tearing or episiotomy previously to use them because of their successful results.

At the time of birth, to try to prevent tearing, you can honor the resting phase of labor, between end of transition and before feeling the urge to push. Wait for that powerful instinctual urge to bear down, when the baby descends low enough in your birth canal to elicit your natural fetal ejection reflex, and then use soft blowing breaths, to gently allow the emergence of your baby without forced coached pushing or pushing before you feel the urge, especially just because you are told your’e fully dilated. Gentle grunts to work with your body’s natural urges are not the problem. Avoid birthing positions like lithotomy (lying on your back with legs in stirrups, a flat surface or held wide open) or deep squatting. Use more upward, forward leaning, hand and knees or side lying, standing or dangling high squat positions, and if you are concerned, ask for perineal support by your attendants or have a water birth. I discuss this more comprehensively in my Love Your Birth Online Guide to Pregnancy, Childbirth, Postpartum, Breastfeeding and Newborn Care - mega prep course.

You make plans for the best outcome, then surrender to the journey. Lean into the wondrous intensity of it all.