Belly Up

* bellies * birth * babies * breastfeeding *

Tuesday, July 12, 2011

Is It Time? (To Go To The Hospital)

Your baby's birth place? 
It is a common concern to worry about delivering
on the way to the hospital
I think it crosses the mind of most expectant parents, particularly dads, that the baby may arrive before everyone is comfortably (so to speak) situated at their chosen place of birth.  TV has certainly not done anything to alleviate this fear.  It also crosses the mind of most expectant parents, particularly moms, that she may arrive at the hospital only to be told to go home because what she is experiencing isn't really labor.  Both scenarios leave expectant couples with the looming question of when is the right time to make a like a baby and head out* (to the hospital).  The answer will of course depend on a lot of things, traffic included, however the odds are much better that a couple will arrive at the hospital way too early than too late. 

The rule of thumb most childbirth educators teach first time parents is the 5-1-1 rule.  In other words, don't even think about going to the hospital until contractions are every 5 minutes, lasting a minute and all that fun has been happening for an hour.  Usually this pattern signifies that labor has progressed through most of the latent, or early, phase and perhaps even into the beginning of active labor, ie 3 to 4 centimeters dilation.  I don't suggest disregarding the 5-1-1 rule, but I would suggest some ways to personalize and improve upon it, especially if your goal is natural childbirth or holding off on an epidural until the risks of it use are somewhat reduced.   Keep in mind that if an average 1st time mom arrives at the hospital based on 5-1-1 alone she probably has 7 to 12 hours before baby's think of 5-1-1 as the minimum suggestion of when to leave your house, not a mandatory requirement of when to show up at the hospital.

So why not go in?  This is a fair question with a good answer.  A woman is usually more comfortable (and generally safer) at home and her body will give recognizable signs as labor progresses-or at least before the aforementioned backseat delivery.  The protocols at many hospitals can make labor less efficient, more painful and, for low risk mothers and babies, these protocols often carry more inherent risk than benefit.  The longer a woman labors at the hospital the greater the odds are that she will receive one or more of these interventions and their sequela.  (the most common of these interventions are restrictions on mom's mobility and her food and drink intake and labor augmentation with pitocin).  Obviously some hospitals are better than others and at the more mother-friendly facilities the question of when to go the hospital may be more of a practical matter as opposed to the difference between a vaginal birth or major abdominal surgery.

In addition to the 5-1-1 guideline, there are other signs to look for before heading out the door.  A laboring woman will go through emotional changes, often referred to as emotional signposts.  During the early phases of labor mom is happy.  She keenly feels the contractions but is excited that labor has started.  Other than complaints about the contractions, mom is her normal self and this is not the time to go to the hospital even if contractions are at 5 minutes apart.  As labor progresses mom interacts less with those around her.  She will usually not want to deal with issues that do not pertain to her labor. This change will be noticeable during and between contractions.   As the end of labor approaches, she will be consumed with her contractions and may only speak comments that involve few words.  When mom is no longer engaged with the world around her, that is an emotional signpost stating that it is time to get her in the car.

Mom will also have physical changes.  During the later stages of labor most women get shaky and may feel like they will vomit.  They will feel hot, they will feel cold and mom may appear flushed around 6 or 7 cm.   As labor progresses moms may moan through contractions and contractions will consistently last over a minute.   Many women will have bloody show during early labor and it will get progressively heavier.  Mom may mention that she feels pressure in her bottom during contractions. This usually means the baby is descending through the pelvis during the active stage of labor and unless there is also involuntary pushing it is probably not the pushing stage quite yet (though if mom is experiencing back pain as well it may indicate a posterior baby).  Certainly theses changes should not be seen as a checklist with each one having to be observed.  However, if none of these signs have occurred, you can feel confident in your choice to stay home a bit longer if everyone is comfortable otherwise.

Of course there are other factors to keep in mind. I suggest that couples labor where they feel most comfortable, both mentally and physically.  In some situations this is going to be at the hospital, but for most it will involve laboring for a time in their own home.  For those who don't live close to their place of delivery, a park, a friend's house or hotel close to the hospital might be a happy medium.  If a couple does arrive at the hospital only to find they are not as far along as hoped, the nurses won't laugh at them and the couple can even choose to not be admitted and perhaps go walk someplace close until some of the physical or emotional signs I mentioned do start to show up. 

And if you do happen to be that person who is a friend of a friend that we all hear about who had a baby on the side of the road in the backseat of a least it makes a great story!

*I deeply apologize for the lame joke.  I just couldn't help myself.