The big question, “When should I go to the Hospital?” Even before COVID-19 this was an important thing to know. The moment a birth person chooses to go to the hospital has the potential to drastically change a birth experience. Now, with COVID-19 taking another hit on hospitals, it’s importance is amplified even more and the answer is not black and white.
Benefits of Staying Home There are many benefits to laboring at home for a long time – other than avoiding the cons of being turned away from the hospital for being too early in labor or labor stalling from the change of scenery. The benefit of your own environment is that it tells your body you’re ok and your body relaxes more in response. The more a person is able to distract themselves (cooking, watching a movie/series, reading a great book) and finding peace and safety in early labor, the faster they will progress and the more manageable their sensations will be. The comfort measures at home are countless, as the environment alone can help you get closer to meeting your baby. Also, the longer you labor at home, the more you are reducing any risk of interventions at the hospital. Evidence for Friedman’s Curve was debunked long ago, yet once you get to the hospital, your labor is on the clock. In a hospital setting, the most patient and nonintrusive OBs and Midwives around still want you to have your baby sooner, rather then later. They won’t hesitate to offer labor management options if progress seems to have stopped. It’s wise to hold out at home as long as possible and safe of course. Below are some of the different factors which can change and affect when you should be heading in.
Put the timer away! Its all about the intensity Many families learn from childbirth education, or from reading, some kind of version of the 4-1-1 rule, feeling sensations every 4 minutes lasting 1 minute for at least 1 hour. Its a good starting point, but unfortunately 4-1-1 is only one-fourth of what you need to know. Most who follow the 4-1-1 or 5-1-1 rule and dutifully time the contractions wind up at the hospital early, long before active labor has started. This is linked to how the intensity, rather then the frequency is what give us a clue to where you are in labor. As a general rule we tell our clients to avoid the timer. Not only does it interfere with finding distraction, calm, and relaxation in early labor but it will have you second guessing yourself and what you should do. Not helpful in labor. Of course if you’re just curious and want the stats then by all means, go for it. Just don’t spend hours looking at your phone when that time could be better spent doing things that could pleasantly occupy you. The true way to know active labor has hit or around the corner is the intensity. Active labor becomes so intense conversation becomes impossible. A laboring person begins to go inward, breath becomes louder and sensations are vocalized. A laboring person will know, without a smidgen of doubt, it is time to go. Examples of earlier labor include:
- You are finding yourself feeling uncomfortable but you’re still managing with breath. Stay home.
- You are able to talk through a sensation. Stay home
- You are able to have a full on conversation in-between contractions, able to outwardly express yourself in conversation. Stay home.
- You and your partner are both discussing whether or not you should go to the hospital. Stay home.
If it’s your first birth there is no denying the excitement, anxiety and newness to the sensations and the fact you will be meeting your baby! The challenge of reining that in is often more difficult than anticipated. It is just a matter of taking it moment to moment. You will get there.
Have you given birth before? While the average length of a first time labor is 18 hours, subsequent labors have an average of 8 (emphasis on average here as ALL labors have the potential to be upwards to 18 hours). A faster labor of a subsequent pregnancy can catch someone who’s first labor was rather long, by surprise! The rule in intensity still stands and even more so. Sometimes families are tempted to try and stick it out longer, remembering their past experiences, but its important to still take notice of intensify, even if it’s right away. If you have some long (at least a minute) and incredibly intense sensations close together, trust your instincts. Go to the hospital if you know what you are feeling couldn’t possibly be early labor. Likewise, if in your first labor you dilated quickly, know that this time is likely to be even faster so plan accordingly. Those third babies though, they can throw some curveballs, often called the wild card. Always keep intensity as your cue.
Are you Trying for a VBAC? A trial of labor after a cesarean doesn’t change when you should go to the hospital, it simply puts emphasis on staying at home as long as possible to avoid additional management or unnecessary intervention. Try to stay home well into active labor to help your body progress and your mind stay at ease. Be sure to know the facts about VBACs and look at websites such as VBAC Facts and VBAC Link to be informed with your options.
What is your plan/vision for pain management? If you are someone who is looking to get an epidural as soon as possible then you might decide to go a bit earlier to the hospital and that is ok. Most hospitals may hold off on giving you one until you are having consistent sensations so you may benefit from at least waiting to go to the hospital until sensations are consistent and you need to breath through them. Ask your provider what your hospital policies are on when epidurals are given.
What if my waters break? Management for Premature Rupture of Membranes (PROM) differs by provider. We encourage families to know the facts on the different types of management by taking a look at this Evidenced Based Birth article. Some providers may check to confirm it was your waters and send you home, and others may choose to manage with induction. If you are someone who would like to avoid an induction then know your facts about PROM. When your waters break at home, labor is imminent. 45% of people will go into labor within 12 hours and between 77% – 95% will go into labor within 24 hours. As long as your fluid appears clear, and you feel baby moving, you are ok to stay home and wait for labor to begin. Check your temperature periodically to assure you are not getting a fever and up your intake of water to avoid any dehydration and to resupply your body with fluids.
I am GBS positive, and I want to get the antibiotics. Should I go to the hospital sooner? Antibiotics for GBS (often a mixture with penicillin ) is most affective (85%) given at least four hours before birth and about 38% if given two hours before birth. First know the facts surrounding GBS and the actual risk of you or your baby getting an infection. It might surprise you. Short answer, is typically you don’t need to change any of your labor at home plans if you are GBS positive. There is generally still plenty of time to get your first dose. If your water breaks, your infection risk does go up however, so after looking at evidence around GBS do what you are most comfortable with.
Hire a doula! Not just writing this because we are doulas 🙂 A doula isn’t able to tell you exactly when to go to the hospital (because the person in labor knows best) but they can tell you when it’s too early. A doula can give you a plan of action when you are looking for the next step in distracting you from getting in the car. A doula can also be the one to say, “its time to get in the car… now” when it’s clear that labor is progressing faster then you expected 🙂 A doula may even come to your home when you know you are ready for the extra support to help you feel comfortable staying home longer. There is much to navigate through when making this decision and a doula will help you sort it out.