When to go to the Hospital

Deciding when to go to the hospital can cause laboring couples a lot of stress. If you get there too early, you may get sent home or you run the risk of labor slowing down or stopping. If you go in too late, you run the risk of not making it. So when is the best time?

Well, for most first time couples the chances of not making it to the hospital in time and delivering in the car or at home are pretty slim. That’s a much more likely scenario with subsequent births, but for most first timers labor is long enough and the signs are pretty clear when it is time to go. Here are the signs to look for:

  1.  Contractions are strong. What does that look like? Mom has to stop during a contraction and pay attention to it. She can’t walk or talk through her contractions very easily and needs to do something to cope with them, like breathe and sway. Most likely at this point she will also not feel very comfortable sitting or lying down during a contraction.
  2. Contractions are long. Contractions can start to be considered long when they last close to 60 seconds. It can be good to get a contraction timer app so you can be accurate with this when it comes time to measure them.
  3. Contractions are close together. You don’t need to worry about timing the contractions with the app until you feel like the contractions are consistently under 6-8 minutes apart. It may make you feel better to start measuring earlier, but you shouldn’t do it if it stops you resting or keeping distracted with other activities until the contractions hit that 6-8 minute mark. Even then, you have time. You’re looking for the contractions to be 4-5 minutes apart and staying that way for at least one hour.

Put them all together and you get a simple formula: You don’t need to think about going to the hospital until after you have seen strong, long contractions that are 4-5 minutes apart for at least an hour. Once you reach that point, it’s time to think about making your move.

Pro tip:  If discussing going to the hospital makes your contractions space back out, wait a little bit before going. If the stress of talking about going is enough to slow them down, then she is probably not quite ready.

Of course if your water breaks, you have a fever, excessive bleeding, sharp pain, or anything else you are worried about, be sure to call your doctor and get their opinion on when to go in.

A VBAC Story

I recently had the experience of helping a wonderful couple achieve their goal of a VBAC (Vaginal Birth After Caesarean). When they hired me, they explained that for their first birth they had not taken any classes and had not prepared for the birth, trusting that the hospital staff would tell them what to do.

The thing is, that isn’t really the staff’s job. They are supposed to keep mom and baby healthy, which of course is extremely important. But they won’t necessarily suggest positions to help baby move down, offer ideas for staying comfortable or strategies for making make labor efficient, although some do all that and more.

So when this first-time laboring mother told the nurse she was feeling uncomfortable and anxious, the nurse advised her to get an epidural, even though it was very early in the labor and the mom wasn’t then able to be up and changing positions to help move baby down. Next, when the mom was fully dilated and couldn’t feel any urge to push, no one suggested to turn the epidural down. Almost inevitably, a C-section followed.

This couple felt that perhaps the surgery was avoidable and so to their credit, when they became pregnant a second time, they spoke with their doctor about a VBAC, took classes, read books, and hired support.

She went into labor a few days before her due date and after a few hours at home contractions were close enough to go to hospital. When we arrived, the couple’s doctor was not on call. The doctor who met them was more conservative and told them that he thought she was not a good candidate for a VBAC and that they should just do another surgery.  They talked about it and because they had done lots of research and had spoken at great length with their OB, who thought they were good candidates, they felt strong enough to say they wanted to proceed with trying for a vaginal delivery.

The mom, who thought she had a low pain tolerance, handled contractions beautifully without any medication and gave birth in 5 hours. The first time she said she didn’t really push because she couldn’t feel any urge and didn’t really know what to do. This time the baby was born with about 20 minutes of pushing that she instinctively did perfectly. After the birth, the doctor told them they had made the right decision.

Being a doula is amazing because I get to help people do the things that they didn’t believe they were capable of doing. With a little bit of support and education couples can access their own strength and realize that they are capable of much more than they might have believed – and that can help them on more than just their labor day.

The Path

At a birth recently, the doctor asked if I’d had unmedicated births myself. I was surprised that I hesitated in answering “yes,” even though I did.

Right after the births of my children, I would have wanted to shout my accomplishment from the rooftops. And then as a inexperienced doula, I felt like everyone could and should follow the same path I did.

But over these 17 years of watching women’s experiences vary in length, in intensity, and in levels of anxiety, I now feel like it is not the avoidance or acceptance of an epidural that defines her accomplishment but the way that an expectant mom experiences her path.

My job at the end of the day is not to check the box that says “unmedicated, vaginal birth” but to help comfort and empower all women with whom I work to make on their own best journey.

Daily activities for easier births

I was recently doula at two very quick, very straight-forward births in a row. What the births had in common, besides me, was that I’d recommended to both women that they practice the daily exercises outlined by Gail Tully on her fantastic website spinningbabies.com.

In the past, I mostly sent people there if their baby was breech, but I’ve since fallen in love with Gail’s recommendations for daily activities for “easier birth with fetal positioning” as something that nearly everyone should try. The basic idea is that the more lined up a baby is, the easier they will descend and the more pressure will be placed on the cervix, making everything faster and smoother.

Spinning Babies’ logo

As a new doula, I saw lots of people with long, slow, posterior-positioned (i.e. where the baby was facing mom’s back) births. When I started advocating for sitting up straight in the last moth of pregnancy, that number dropped dramatically. With the addition of Gail’s daily exercises, I am hopeful that even more of the moms I work with can have quicker and more straight-forward births.




Just because it’s hard…

My mother, God bless her, grew up on a farm in Southeast Missouri, picking cotton during the summer. So I never got any traction by complaining about bussing tables or cleaning hotel rooms to make money as a teenager. I stopped trying because I knew the response to expect: “When I was your age, I picked cotton for a nickle a bag.” She wasn’t complaining or shaming, just stating fact. And you can’t argue with facts.

She also loved to say, “you can do anything for a short amount of time.” As much as I have resented her saying that at times, it’s also helped me plow through difficult tasks when all I wanted to do was lay down in a parking lot, cry, and hope that someone would come along, take pity on me, and relieve me of my duties. If I had ever said that to my mother, she would have responded, kindly but firmly, “Well, that is not going to happen, is it?”

I try to bring some of her hard-earned wisdom to the labors I support. This is tough, but you are tougher. Do one more contraction, do one more breath. You are strong and you can do it. The end is in sight, and you will be the one to give birth to your baby.

Ask For What You Want …

No one can read your mind, in childbirth or in the rest of your life. If you don’t ask for what you want, you severely limit your chances of getting it. It seems simple enough, but often we forget.

Now, I didn’t say “demand what we want.” You can always do that later. But start with “ask”, and you have a good chance of receiving it. And it will give you someplace to go later on if you really need to.

Here’s one of the most common scenarios I see in labor: A woman is laboring at home in ways that make her feel comfortable. Most often that means moving around, leaning forward, swaying and just generally doing what she needs to do. Then we arrive at the hospital and the nurse says, “Hop up on the bed and let’s put the monitors on.”

Now, the laboring woman doesn’t usually feel good in the bed, but she grits her teeth and does it.

As the doula, I politely ask, “Can she stand beside the bed?”  The answer is almost always, “yes,” and the mom is hugely relieved because now she can lean and sway again as she was doing. She is much happier and continues to be able to help herself be comfortable.

It is a ridiculously simple question, but sometimes parents-to-be just follow requests without asking if they are really necessary, or if they can comply in another way.

Remember, if you don’t really want to do something, it is always a-okay to make that clear. In labor and in life . . .

Birth needs Supporters not Spectators

Has birth become a spectator sport? asks Jacoba Urist at Today.com.

Apparently, says Urist, “These days, delivery rooms can be rife with drama as grandparents-to-be vie for the best camera angle, or a mother-in-law angles to be the one feeding ice chips between contractions.”

Here’s my take: A woman in labor needs to feel safe emotionally and physically before she can let go and get her birth-enabling hormones to do their work.

On the other hand, adrenalin – a birth inhibitor – is produced by any kind of stress. Whether it is due to worrying about the baby or worrying about your mother-in-law, that will make labor slower and more painful.

So, if a woman is comforted by someone’s presence at the birth, they are a good addition to the birthing room. But if that person makes her feel like she needs to take care of them, then the visitor needs to wait to meet the baby later.

Profile of a Laborer

When you think of a pregnant woman, Alfred Hitchcock doesn’t immediately jump to mind. Although his famous shadow profile makes him look about 10.5 months pregnant, his suspenseful and adrenalin-inducing movies don’t make me think of the ideal laboring circumstances. But it was just those elements that helped one of my recent clients have a almost unbelievably rockin’ birth.

The night before she went into labor, my client and her husband saw an Alfred Hitchcock double feature. Her baby was kicking a lot and because of the tension on the screen, she also felt very tense. She began to realize that her stress was making the baby’s movements seem far more uncomfortable than normal, and she rightly attributed it to her heightened physical and mental state.

The next morning labor began and – thanks to her experience the evening before – she made a commitment to be relaxed; to walk and nap and shower and eat, all in a leisurely, calm way. She actually labored alone at home, without calling either her husband or me until late in the afternoon, because she was worried that we might amp things up. When we arrived, she was handling the very close, long contractions with grace and calm. Since she was also feeling pressure from the baby, we went straight to the hospital where we found she was completely dilated and ready to push. Her baby was born soon after, much to the amazement of all who were there.

It was inspiring to watch a woman relax so beautifully into the process – and in doing so, be able to take control of it so well.

The Arc of Labor

Labor, like any good story, is fun to look back on, see the way it unfolded and make sense of it from a distant vantage.

But when you are in the middle of it, it can feel confusing and unending. So here are some things to try and remember:

  • First, it will end! And at the end you will have an amazing gift: a baby that you created and brought into the world.
  • Second, labor is not always linear. Sometimes it slows down, and you should try to rest when it does so you will be ready when it picks back up, because it will.
  • Third, and maybe most importantly, try not to think of when the end will be. Be in the moment. Just try to worry about the next contraction. It will be about a minute long and you can do anything for a minute. And one of those contractions, you don’t know which one, will be your last.

A nice article on questions about labor

Here is a succinct (just the way we like it) article by childbirth educator Ceridwen Morris that sums up very nicely some of the most common concerns and questions women and their partners have about labor.

I especially like Morris’s no nonsense advice on eating during labor (don’t ask don’t tell) and how to know when to go to the hospital (relax, you won’t have the baby in the cab).