Don’t Go To the Hospital Too Soon

If I could give pregnant first time moms one piece of advice about what to do during labor and birth, it wouldn’t have anything to do with a doula, a birth ball, or knowing the risks and benefits of interventions. Though I think all of those things are important, the number one piece of advice I would give all low-risk first time mother is: DON’T GO TO THE HOSPITAL TOO SOON!!!

I have been privileged to be a witness to some exceptionally beautiful natural hospital births.  I have also attended several beautiful medicated hospital births.  I have been fortunate to only see a very few births where the mother has truly suffered.   What I have noticed in my practice overall is the inverse relationship between birth experience and length of time at the hospital.  First time moms are in labor for an average of 20 hours for their first birth, but the active labor portion of that is typically a lot less (less than 8 hours on average).  So, no matter whether you are planning a natural delivery or wanting to get pain medication at some point during your labor, avoiding the hospital during early labor is absolutely essential for the following reasons:

1.  You will be more comfortable in your own home.  In your home you have the freedom to move around and change positions, take a shower or bath, alternate between resting and activity, eat and drink normally, and you will be in the comfort of your familiar environment.

2.  Hospitals are not comfortable places to labor.  Between the technology (IV insertions, electronic fetal monitors, etc), having much more limited ability to move around freely, interruptions of staff coming in and out to check on you, monitor you, and ask you questions, and just being in a sterile, less familiar environment, most women are much less comfortable laboring in the hospital.  If you are having a hospital birth, the hospital is the place you want to be to deliver your baby, but it is still not an environment conducive to laboring comfortably.

3.  You may feel trapped.  Many women who arrive to the hospital too soon feel trapped after 8-10 hours laboring in the same small room or space, especially if confined to the hospital bed.  Though a walk through labor and delivery can help temporarily, there’s really nowhere to go once you’ve been admitted to the hospital and some hospitals have protocols that restrict your movement.  I have had lots of clients tell me that they wish they had stayed home while in labor, but have never heard one say that they wish they had come to the hospital sooner.

4.  You may be given unnecessary and risky interventions to augment your labor or move you along faster, often leading to other medical interventions.  All hospitals are businesses that want women to come in, have a baby, and move on, though some are more this way than others.  Hospital staff that are on call for your birth may have other plans or may just want to sleep in their own bed instead of at the hospital waiting on you to get close to delivery.  Even in a very supportive hospital environment, staff are accustomed to seeing women who are induced or augmented in early labor and have labor patterns that are unnaturally fast or intense, so in comparison, a natural labor seems slow and possibly pathological.  Hospital-based care providers are taught in their training to suspect anything that is not “normal” and rather than judging normal based upon other unmedicated labors (or those with just pain medication), “normal” has come to mean a routine hospital labor.  Even if you plan not to have medical interventions unless a medical necessity is involved, you will often feel pressured to accept augmentation, like breaking your bag of waters or Pitocin to speed things along, even if you and the baby are perfectly healthy.  Though you may imagine prenatally that you will be able to stand your ground if offered these options for non-medical reasons, often, in early labor, you are so excited and anxious to meet your baby that you will agree to anything to make your labor faster or please your care providers.  Unfortunately, there are very real risks and side effects to labor augmentation, including risk of infection, more intense contractions both for you and your baby, and higher rates of fetal distress leading to C-section.

5.  It is the nature of early labor contractions to come and go, so your labor may fizzle out completely for hours or even days.  This is natural, safe and normal.  I have seen so many incidents where a laboring mom has contractions that last for a number of hours, then go away for a while, then come back.  Usually these contractions are not very strong and will space out a bit if you are distracted, lie down, drink water, or sit in a warm bath.  They will intensify if you get up, walk, or connect intimately with your partner.  This can last for several days or even weeks leading up to actual labor.

Many hospital-based care providers that I have worked with recommend a simple formula for when to come to the hospital: 5-1-1.  In other words, come to the hospital when your contractions are 5 minutes apart, lasting one minute in duration consistently for one hour.  Unfortunately, just like everything else in birth, a simple formula does not work.  I have had clients who had contractions that fit the 5-1-1 formula, but were not even in officially in labor (no change to the cervix).  I have had a client who had consistent contractions every 5 minutes that dilated her cervix to 4 cm and then stopped completely for two weeks before beginning active labor.  In most of these cases, I suspected, based on experience, that active labor was not yet established.

My recommendation for first time moms is to go to the hospital in active labor, ideally arriving when you are dilated to at least 5-6 cm.  Typically, at that point your labor has intensified to the point that it is consistent and will not be as effected by your moving environments.  Often, at that point in your labor, the consistency of your contractions looks more “normal” to hospital staff.  If you have been planning to have pain medication during labor, active labor is the best time to get good pain relief and some rest without slowing down your labor or requiring additional augmentation.  Moreover, at that point in labor, if you have been coping well with labor at home, you usually will have lots of coping techniques to bring with you to the hospital, will be losing some inhibitions about being observed, and will be less effected by the goings on around you.

So, how do I know at home when I am in active labor?  Unfortunately, there are no formulas as simple as 5-1-1 to know when you are truly in active labor and should be considering going to your birth location unless you have hired a midwife or monitrice to check your cervix at home.  Every labor pattern is different and every laboring woman feels things differently, but here are some good landmarks to consider:

1.  When you have been having contractions that are coming at least every 3-4 minutes, lasting at least 1 minute, are getting stronger and more intense and are consistently that way for a few hours.  These contractions do not change no matter what you do (change of positions/level of activity, hydration, being in the bath/shower) and are often accompanied by bloody show when you go to the bathroom.

2.  When your doula (experienced labor support professional) suggests that it may be time to go.  Your doula is not omniscient and does not check your cervix, so she cannot know for sure where you are in labor, but she has the benefit of experience, especially if she has seen dozens or even hundreds of births.

3.  When you feel signs of transition like an onset of nausea or a feeling of losing control or if you have intensifying rectal pressure or an urge to push.

4.  When your intuition (not excitement or impatience) tells you it is time to go.  These feelings can be hard to differentiate in labor, but if you have a really strong voice in your head saying it is time to go in, it probably is.

5.  If you are not coping well with the sensations of labor at home and want pain medication.

6.  If your bag of waters releases and contractions have not begun within a certain amount of time (typically 12 hours, but speak about this with your care provider prenatally).  In this case you are not in active labor, but most care providers agree that you should go to the hospital anyway to be monitored.

Obviously there are specific high-risk situations where going to the hospital early is absolutely necessary, but those cases are extremely rare.  In those rare cases, the risks of staying home are greater than the risks I’ve mentioned in going to the hospital too soon.  Make sure to talk to your care provider about whether you have a health condition that necessitates you coming to the hospital in early labor, why that is recommended, and what will happen when you arrive, so that you know what to expect and can plan for it.  Many care providers agree that women having a VBAC should be treated just like first time moms, but others prefer extra monitoring.  Make sure you consider your care provider for a VBAC very carefully.  For second time moms, things are a little bit different as second time labors are typically shorter and more efficient.  For that reason, the 5-1-1 rule is often more appropriate for second time moms.  Also, it is a good idea to become educated about warning signs to look for when your labor begins (such as excessive bleeding, meconium stained amniotic fluid, or sharp intense stabbing pains that do not go away between contractions) that would indicate that an earlier trip to the hospital might be a good choice.

Of course, one option is avoiding a hospital all together by birthing with a midwife in a birth center or at home.  However, I have found that women are equally if not more likely to go to a birth center too early in labor or request that their home birth midwife come over very early in labor, since there aren’t as many down sides (hospital interventions, labor augmentation, etc).  I still think labor works best if you stay in your own environment, resting, but going through your normal routines as much as possible in early labor.  No matter your birth location, it may be a good idea to contact your care provider and support people when you think you might be in labor, but it is usually not a good idea to move to your birth location or have your support people arrive until your birth is more imminent.

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