According to Lamaze, ACOG, and the WHO, it is generally recommended that a person with a healthy pregnancy stay at home as long as possible to minimize unnecessary interventions. Getting to active labor can take a long time. We are much more able to relax and find comfort at home in most cases, especially if we have support from a loved one, family, friends, and/or a doula.
When you get to the hospital in labor, you will likely first go to a triage room. There, it will be assessed whether it is time to stay or not. A nurse will check your vitals and your baby's heart rate; a provider may come see you if needed, and a plan to move forward is made.
Have your doula with you or on the phone so she can help with information, coping, trauma support, and any decision-making.
It can be helpful to prepare yourself for triage and have a triage plan that states your wishes, especially if you wish to decline certain routine procedures. Have your doula with you or on the phone so she can help with information, coping, trauma support, and any decision-making.
Typical routine procedures
Continuous Electronic Fetal Monitoring (EFM)
This is a 20 or 30 minute strip to establish a baseline of your baby’s heart rate and observe this with the contraction pattern. This is done routinely in healthy pregnancies despite the fact that research shows no fewer babies with problems and more births ending in a cesarean section. Crassly put, continuous EFM, including the admittance strip, makes birth riskier for people with a healthy pregnancy with no benefits to babies.
If you wish to decline this and opt for a different kind of monitoring, it may be good to discuss your options with your provider ahead of time during a prenatal visit. Ask your provider to put your preferences in your file and add them to your birth care plan.
If you decide to have the strip, make sure to choose a position that is comfortable for you to stay in during this time. Being on your back on the bed for this can be really uncomfortable.
Cervical exam
This is a routine exam done to assess how the labor you are experiencing is changing your cervix. A cervical exam can provide valuable information but it can also create disappointment if you are not as far along as you hoped to be. It is often quite uncomfortable and it reveals just one moment in time. The main question to ask yourself is, "What will I do with this information?"
One option is to have the exam without being told exact numbers. Not knowing numbers can help you focus on labor being a process and an exam just one moment in time. The numbers may be helpful later on or not be needed at all. You will then either stay because you are indeed in progressed labor or it may be suggested that you go home for little longer. If you stay, do make sure everyone knows that you do not want to know the details unless you ask for them! When a new shift comes on, this sometimes gets lost in translation.Â
Labor is unpredictable and I encourage you to embrace the labor you have and settle into it, accepting what it is demanding of you.
If you do want to know the numbers, it may be good to be aware of a couple of things. For example, if you have not had a recent prior exam, you will not know where you came from, so to speak. You could just be 1-3 cm dilated, and while this may not sound like much, you may have progressively ripened and brought your baby down since things started. This is the work of early labor. All great things, so don’t get discouraged! This part can take time and is sometimes painful.
You can also be 3-4cm dilated and be in transition an hour or two later! Or, you can be 6-8cm and in active labor with hours to go. And every now and then, people get to 9cm without much pain at all! Labor is unpredictable and I encourage you to embrace the labor you have and settle into it, accepting what it is demanding of you.
Either way, an exam is encouraging or it is not. Planning how to work through the latter is important. What will help you stay positive? What do you need if you go home? Is therapeutic rest needed and an option? Do you need pain management? Make a plan with your provider and your support people!
A vaginal exam should not be demanded in order to be admitted. This is a form of coercion. You have the right to practice informed refusal and decline any exam.
Hep-lock/saline lock
This is routinely placed upon admittance. It is a soft small catheter put in a vein in your hand or arm in case fluids or medications are needed later on. It can be painful, uncomfortable, hinder your movement, and be inconvenient in the tub. This is not routinely placed during a home birth or at a birth center where people are low risk, unless wanted for hydration or antibiotics. If you have the same low-risk factors as someone who would qualify for a home birth or a birth center birth, you could logically decline the saline lock. It is within your patient rights to decline this. You can also decide to have it placed at a later time if needed and engage in shared decision-making with your provider ahead of time, prenatally. Declining a saline lock can guide the direction of a low-intervention birth if you are low-risk.
Blood work
Also done upon admittance. Most providers/hospitals will require routine blood work, typically a CBC panel and blood typing, even when this is already on file. They are checking for liver function, platelets, and any maternal-fetal immune response. If you want to know exactly what is being screened, ask so you can consent. Sometimes an STI panel is part of the screening without explicit consent.
Urine analysis and the gown
You may be asked to pee in a cup, like at prenatal visits. This test is to make sure there is no elevated protein in your urine. Combined with taking your blood pressure this can give valuable information.
This is where a hospital gown is usually offered, but you are most welcome to wear your own clothes, something with easy access to your belly, like a special gown or a top and bottom. If you want a low-intervention labor and birth, wearing your own clothes can be a small yet important factor in guiding this for both you and the hospital staff. Your own clothes send the message that you are not sick and that you are not a patient to be managed. You are person, to be supported and honored.
The transition from home to hospital is a big one. You need space, time, comfort, and respect in order for this to happen as smoothly as possible.
It is helpful to discuss your wishes with your provider during prenatal visits and have them be in your records. Use B.R.A.I.N when anything unexpected come up, even for things presented as routine.
The transition from home to hospital is a big one. You need space, time, comfort, and respect in order for this to happen as smoothly as possible. Have a loved one (and doula) guard your space and help advocate for your wishes.
References: Â
Lothian, J., RN, PhD, LCCE, FACCE, FAAN, & DeVries, C., of Lamaze International. (2017). Giving birth with confidence (3rd ed.). Meadowbrook Press.
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