At What Point in Pregnancy Do You Go to Labor and Delivery vs the ER?

When you show-up at the hospital as a pregnant patient, how do you decide if you should go to the ER or to labor and delivery?  This post will tell you a tried and true rule for what you should do when you’re confused.

But first, how do I know so much about this topic?

Hi, I’m Hilary — many people know me as The Pregnancy Nurse 👩‍⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind this website Pulling Curls and The Online Prenatal Class for Couples. 🩺​ After working L&D in 3 different states and several hospitals I have a really good idea of when hospitals want you to go to the ER or to labor and delivery.

Before we get started, grab my labor checklist so you can be aware of what to look for as far as labor:

When should I go to labor and delivery instead of ER?

This differs depending on the hospital.  The best answer is to ask your provider, but when you’re in doubt you can always go to the ER — they can always direct you to where is best to obtain care.  BUT, let’s talk more about why this is and what to expect as you go into the hospital.

Hey, if you’re considering what to do when you go to the hospital have you gotten your prenatal class in yet? This is the easiest way to get prepared for birth — you can both do it at home on your own time and be feeling confident before you know it!

Why not to go to the ER in Pregnancy

Labor and delivery is basically the ER for pregnant people.  We aren’t as equipped for big disasters — crazy car accident or heart attacks.  But we are the best place for most other things if you are pregnant.  So, even if you come into the hospital with like a bladder infection they will likely send you to labor and delivery.

Why does the ER not see pregnant patients?

They do see pregnant patients, like I mentioned above, but most hospitals have their malpractice guidelines that allow them to see people up to a certain number of weeks, and then the patients need to go to labor and delivery.

So, most ER’s will see you up for things like bleeding, cramping, etc up til’ 13-20 weeks, and after that they will send you to labor and delivery.

And, pretty much anything after 13 weeks you’ll need to see a labor and delivery nurse (or someone trained to do similar things) during your stay.  The hospital would be required to check on baby.  The nurse will either listen to baby using a doppler, or perform an NST to make sure baby is doing OK during your stay.

The reality is that ER nurses just aren’t trained for labor.  They don’t like it, and it scares them.  Just like a car accident scares me.  I am trained to do labor, they are trained to do other things, and it’s a good thing that we each have our own separate skills.

What information do I need when I go to the hospital?

I always recommend knowing your basic lab work — just in case you go to a hospital that isn’t where they have your records (or the ER where they wouldn’t have access to them anyways). I have a whole podcast about that.

You’ll always want to know your due date, and it’s helpful if you know how many weeks you are.

If your mom alarm bells are going off, I always recommend a hospital visit but it’s not a bad idea to call your doctor on your way so you can discuss with them what’s going on.  

Can I just go to the ER?

Absolutely.  In fact, if you’re in rip-roaring labor and you’re afraid baby is going to come out and ER is on your way I might stop there. You definitely don’t want to be stuck in an elevator alone in those situations.  Labor and delivery can run down to the ER to get a patient (or deliver a baby) when necessary.  It is a safe spot for you, it’s just not where all our stuff and skills normally reside.

I should say that when L&D walks into a room where someone is having a baby imminently, you see all the ER staff give a HUGE sigh of relief.  It is NOT their thing.

The reality is that labor and delivery can be really complicated for professionals (although it can be really easy to understand otherwise). So, that’s why you want to be sure to take your pregnancy, birth and postpartum advice from a real expert.

What happens when you go to labor and delivery?

While every hospital is a bit different — here are 5 things that most-always happen:

1. They’ll ask your name and some basic information to get you in the computer system (or find you in the system if you’ve already bene there before) 
2. You’ll go to a room or a triage area (sometimes just uses curtains instead of doors) where they will have you possibly put on a gown to check you out if you’re ok with that.
3. They may also want a urine sample depending on what’s going on.
4. They’ll put baby on the fetal monitor as well as a contraction monitor and get some basic info about you (sometimes they will check your cervix at this point too)
5. They will call your provider, or, if your provider doesn’t go to that hospital they will talk with the provider on call.

That provider will then give orders as to what they should do next.  

I actually go through this WHOLE process (even including some stuff they can’t do) in The Online Prenatal Class for Couples and in the reviews I often get people saying how comforting it was to know what to expect as they go to the hospital. 🤩

When to go to the hospital in labor

When to go to the hospital in labor can vary depending on the individual and their specific circumstances (which is why your own provider is your best reference for this).

Generally, it is recommended to go to the hospital when you are experiencing active labor, which is characterized by regular contractions that are getting closer together and increasing in intensity. However, for first-time moms, it is important to note that early labor, which is typically characterized by irregular contractions and milder discomfort, can last for several hours or even days before progressing to active labor.

It is generally advised to stay at home during early labor and only go to the hospital when the contractions become more consistent and intense. Additionally, there are other signs of labor to look out for, such as when the water breaks or if there is bleeding.

It is always best to consult with a healthcare provider during prenatal visits to discuss individual circumstances and receive specific instructions on when to go into labor, especially when planning for a vaginal birth or considering the use of an epidural.

It is worth noting that Braxton Hicks contractions, which are irregular and generally painless, are common throughout pregnancy and should not be mistaken for true labor.   But always talk with your provider if you have ANY questions about what you are experiencing.

When you see people saying they have the “magic formula” for when to go to the hospital that still may not apply to you — so make sure you’re talking with your provider based on your specific needs and circumstances, as to when to go to the hospital.

Labor & Delivery FAQ’s

Is it better to labor at home or in the hospital?

As I said above, I often recommend doing early labor at home, and heading into the hospital once you’re more in active labor.  I talk more about this in my signs of labor post on my sister site.  BUT, any questions always ask your provider.  The longer you do labor and delivery the better you get at triaging people over the phone as to their labor status. 🙂

What is the most common week to go into labor with the first baby?

40 weeks is the best guess — that’s all it is.  First babies are often a bit later than subsequent babies — but that is an overall statistic and doesn’t really mean anything for YOUR birth.

When should I go to the hospital during labor and pregnancy?

I have a whole post on when to go to labor and delivery that will help you understand that question really well.

When to Call Labor and Delivery

Some labor and delivery units will answer questions, and some will not.  I always recommend people call their provider first, and then call labor and delivery if they can’t get hold of them.

Remember that when you call labor and delivery they don’t know you or your individual circumstances at all and most often they have to say “just come in if you think you need to” — due to liability issues.

How do you count contractions?

Contractions are counted from the beginning of one contraction to the beginning of the next one.  The length of contraction is how long it lasts for you.  So, a contraction may last 45 minutes, but they are 5 minutes apart — meaning you get about 4 minutes break between contractions.

I explain this all much more in depth in The Online Prenatal Class for Couples — I have a whole chapter on contractions.

Yes, all of this can seem complicated, but it doesn’t really have to be. Be sure to get expert advice to prepare you from bump to bassinet. And when in doubt, go to the ER. That’s always your best bet to be the safest. 🙂

Or, if you’re not quite ready for the full class? Check out my free prenatal class — It’s your first step towards getting in the drivers seat of your birth!