Question about waiting to going to the hospital

[hram]

Sorry about the title, I had my dd talking to me while trying to type it.

I have read advice being given many times on here about if you are going to a hospital to have your baby to wait until the last minute to go. I understand that the longer you stay out of a hospital the less time they have to pressure unwnated interventions and there isnt the fear or anxiety of being in a hospital to slow down labor. But isnt the reason most women go to the hospital is because they feel its the safest for them and their babies? And most women want someone to monitor their babies during labor but I would guess most women dont have the ability or equipment to do that themselves at home. I know some women have no choice on where they give birth due to insurance or money issues, but how is staying out of the hospital with no monitoring of the mother and baby better for them?

I hope I made my point, its kind of a hard question to write out. I was just wondering what others opinions are on it.

[cappuccinosmom]

I went to the hospital because I didn't have any other option and UC was out for us. I didn't go because I believe it's "the safest place" to have a baby.

One of the reasons I stayed *out* of the hospital for as long as possible is the potential for "standard practice" to cause me and my baby problems. Normal early labor contractions should not cause problems for a healthy baby. Pit contractions in early labor, on the other hand, can be a big problem for mom and baby starting the slide down the hill to emergency c-section that would have been unnecessary without pitocin.

When people advise a woman to stay away from the hospital as long as possible, the idea is not to stay out till you're crowning (though, with a combative, knife-happy OB, I might just do that). The idea is not to go in there and get stuck in bed at 2 cm, and then be told "no progress, you need Pit" and so on.

[hram]

I completely understand that natural contractions are not violent like pitocin induced contractions can be and that there shouldnt be any problems but if no one is checking on mother and baby how do you know? Trust me, I dont think mothers should be strapped to EFM or be watched nonstop and wait for something to go wrong. The ideal situation is to have someone who is there for the family and can "check in" on the mom and baby from time to time and not disturb her too much. And an even better situation is if the mother could choose the place she wants to give birth and not be told where she has to. I guess the impression Im getting is that some advice being giving(in general not just on here) is to stay out of the hospital until you feel like the baby is coming. I guess it just seems less than ideal to me, I wouldnt feel comfortable changing locations late in labor. I like to be settled and stay where I am.

But I totally get why people want to stay out of the hospital, I had a very emotionally traumatic birth in a hospital because I got there early in labor after my water broke which gave them lots of time to make me miserable. Thankfully we had the resources to have a homebirth the next time.

I was just wondering what others had to say about why they think its safe to stay out of the hospital and labor with out any monitoring.

[seashells]

Originally Posted by hram

I completely understand that natural contractions are no where near as violent as pitocin induced contractions and that there shouldnt be any problems but if no one is checking on mother and baby how do you know?

What exactly would someone be checking for?

Originally Posted by hram

I guess the impression Im getting is that some advice being giving(in general not just on here) is to stay out of the hospital until you feel like the baby is coming. I guess it just seems less than ideal to me, I wouldnt feel comfortable changing locations late in labor. I like to be settled and stay where I am.

While I've seen the advice to stay out of the hospital as long as possible many times, it's always given to people who do not want to go or who are facing serious risks by going in (such as having a practitioner who is threatening c-section for no good reason). I've never seen this advice given to someone who states she wants to go to the hospital, is comfortable there, and who trusts her care provider. It's always given in the case of "oh no, I'm out of options, what do I do????"

Originally Posted by hram

I was just wondering what others had to say about why they think its safe to stay out of the hospital and labor with out any monitoring.

What is it that you think monitoring does? What complications does monitoring address? How reliable do you think hospital monitoring is?

[hram]

Im just talking about checking fht, to make sure the baby is ok at that time. Not getting vaginal exams every hour to "make sure" she is making progress. I know continuous monitoring increases the risk of a csection and doesnt improve maternal or infant outcomes.

"While I've seen the advice to stay out of the hospital as long as possible many times, it's always given to people who do not want to go or who are facing serious risks by going in (such as having a practitioner who is threatening c-section for no good reason). I've never seen this advice given to someone who states she wants to go to the hospital, is comfortable there, and who trusts her care provider. It's always given in the case of "oh no, I'm out of options, what do I do????""

That is true, Im sure this is the case most of the time. But I know of a women who loved her ob's and still rented a hotel and labored there until she was ready to go in becasue she didnt want to get their too soon. It was a first time mom and she still got there at 2cm, she didnt consider she would be the mother who had a longer than "average" labor. Most books, internet sites still say to wait until you feel you need to be in the hospital before you go. I know in first time mothers it can be hard for them to know when to go because they dont have anything to compare it too and they dotn want them coming in at 2cm and being put on the clock so early. Im sure they are just as anxious to get there as I was when I had my first baby.


"What is it that you think monitoring does? What complications does monitoring address? "

Thats a good question, it gives me somthing to research today.

"How reliable do you think hospital monitoring is? "

The question wasnt about being monitorerd in a hospital, I think the informaiton gained from efm is being used to enforce interventions that arent necessary. At least that was what happened in my case. If I were giving birth in a hospital again I wouldnt allow them to hook up an efm. I dont believe they are completely accurate, I would rather have someone with an experienced ear to check heart tones with a fetoscope or doppler. I belive most births are safe for mother and baby and they dont need someone watching them like a hawk, waiting for a chance to say you need to do this for the baby.

How long would you feel comfortable or would you say someone should stay home before going in? Say if a mother was in labor for 12 hours but the contractions were 5 min apart, not close enough to be active labor. Would your decision be different if your water had broke? How long would you stay home?

[jeninejessica]

Originally Posted by hram

How long would you feel comfortable or would you say someone should stay home before going in? Say if a mother was in labor for 12 hours but the contractions were 5 min apart, not close enough to be active labor. Would your decision be different if your water had broke? How long would you stay home?

The last doula client I had starting calling me at 9pm, pretty much every 45 minutes or an hour, always saying she was pretty sure she was in labor, but she was feeling fine, centered, and not ready to push, however she was worried that maybe she was 'supposed to go in now'. Everytime she asked me what I thought, if she should go, I told her to trust HER heart, and that until she felt like she was going to be better in the hospital, then she should stay home. Each time, she told me that no, she didn't feel like she needed to be there, or would rather be there yet, so she would hang up the phone, and then go back to laboring peacefully at home.

Eventually she called me at 4:30 the next morning to tell me that she wasn't sure "what" or "why", but she was ready now, and could i meet her at the hospital in about an hour. I walked in, she was in triage, handling contractions beautifully, being left alone, and within 2.5 hours she was in her room, gently pushing out her second baby girl with big sister and daddy watching on. She said it was an absolutely perfect birth. She had the benefits of 'feeling safer' because she was in a hospital, but she got to do her whole labor at home, alone, unhindered, just her and her instincts. What a powerful thing.

Everybody is different-- if you're the type of woman who is going to be scared and tensed if you're not at the hospital early on and settled into bed, then it's better for you to be there. But it's not impossible to monitor the baby (or mom) at home by checking movement, using a fetoscope or a doppler yourself. Or even better-- you don't usually have to. In most normal cases, monitoring doesn't tell you anything you don't already know-- congratulations, you're in labor, and yes, the baby is feeling it, but he's ok. It's all a normal process- the problems occur when people jump on the little signs too early and start interventions because of it. Often these problems are things that if monitoring wasn't used, nothing would have changed and the baby would have been born just fine.

[Litcrit]

I've been thinking about this too.

I'll be going to the hospital for this birth too, although I've had an unpleasant hospital birth with my first (nothing too horrible, but the usual panic-laden cascade of interventions that ended with a huge episiotomy and fundal pressure).

I'm not comfortable with a UC, and the only HB midwife in my country charges far more than I can afford. The hospital is free and I found one that is reputed to be very natural-birth-friendly.

Even though I'm afraid of interventions, I'd still like to be there as soon as possible. My first labor lasted 6 hours from first contraction to baby, and this hospital is over 30 mins away in good traffic. By the time I realize I'm really in labor with #2, I might be as little as 2 hours away from birth. I don't like the idea of moving anywhere in late labor anyway and I'd like to feel 'at home' there by the time the baby is ready to come out.

I guess when you see the hospital as an inherently dangerous place, it makes sense that the less you spend there, the better it is. I'm not sure I do. Maybe I'm just an incurable optimist.

[philomom]

I arrived at the hospital 9 centimeters both times. I stayed home until the idea of getting in the car made me truly cringe. So, yeah, my triage was quick. My "wait till you can push" thing nonexistent. So, I had joyous quick births, no interventions of any kind. No Iv, no cutting, no dead roach position for pushing. Baby placed on my chest immediatly after birth and no separation. We left each time within 12 hours and were back in our home bed bonding and learning to nurse.


I didn't even know women gave birth at home. My kids are teens. I thought I was being clever and cutting edge to have a midwife at the hospital and have natural childbirth. My parents and in laws strongly disapproved and kept begging me to "get a real doctor".

And though I am an ideal candidate for home birth... I'm married to a "just in case" kind of guy. I respect his wishes on that.

[Astraia]

You're asking for a peek into an entirely different world view.

You're coming at this from the side that monitoring is important and necessary, that things can go wrong, that there's no way for us to know if something isn't right.

People who believe in getting to the hospital last-second are either A. plain scared of what they're facing in this hospital, and believe that at home with no monitoring is safer or B. have the belief that birth is a normal, straight-forward process that is best when approached unhindered and unafraid, and that mama instinct tells you a LOT about if things are going properly or not. Or some combination of the two (or some other option that I haven't thought of).

I'm UCing, but IF I was going to the hospital, I would labour at home until the last possible second because I believe that a hospital would be detrimental to my labour process due to fear issues and their protocols, but also because I believe that birth is overall healthy and safe and that if something goes wrong or is in the process of going wrong, I'll know by instinct.

MY SIL thinks that's the most stupid thing she's ever heard. She's overall understanding and open minded, but she sees the hospital as a good place to be when you have a baby, so no amount of explaining is going to make it make sense to her.

[hram]

Originally Posted by Astraia

You're asking for a peek into an entirely different world view.

You're coming at this from the side that monitoring is important and necessary, that things can go wrong, that there's no way for us to know if something isn't right.

People who believe in getting to the hospital last-second are either A. plain scared of what they're facing in this hospital, and believe that at home with no monitoring is safer or B. have the belief that birth is a normal, straight-forward process that is best when approached unhindered and unafraid, and that mama instinct tells you a LOT about if things are going properly or not. Or some combination of the two (or some other option that I haven't thought of).

I'm UCing, but IF I was going to the hospital, I would labour at home until the last possible second because I believe that a hospital would be detrimental to my labour process due to fear issues and their protocols, but also because I believe that birth is overall healthy and safe and that if something goes wrong or is in the process of going wrong, I'll know by instinct.

MY SIL thinks that's the most stupid thing she's ever heard. She's overall understanding and open minded, but she sees the hospital as a good place to be when you have a baby, so no amount of explaining is going to make it make sense to her.

I do think monitoring is important and things can go wrong, but in a very small small group of women if unmedicated and with someone who will let them give birth in their own way instead of by policy. I do believe instincts play a part, but not as much as common sense. I have read/heard stories where women feel something wrong and come to find out there is soemthing wrong. I have also read stories of births going perfectly fine until there is a cord prolapse or something, and the mother would have never known if the baby wasnt checked every so often. My babies didnt move around at all during labor. Not once do I remember feeling them move. (my midwife checked my second dd only once the entire labor and birth and I was perfectly fine with that)

My personal opinion is women dont need to be bothered nonstop during labor but it is to their advantage to check on the baby every once in a while.But if people think birth is straight forward and safe why even go to the hospital?

Please dont think my opinion is in line with the medical model of care, it is far from it! I was just wanting to find out how long others would go with out checking FHT and why.

Do we have the same SIL? I have a sil who wont even talk to me about either of our births, she would never consider hb (she had 2csections)

[etsdtm99]

if this is something that a mother worries about, she can buy a doppler for 100$ .. not a huge expense as you can resell them on ebay for very near the same price - might loose a bit in shipping (i have one i planned to use if my water broke before labor/early labor like it did w/ my first - it is just like the one my OB used - i've heard of several obs that were willing to teach patients how to use their doppler so the would know what to look for etc)

[Bluegoat]

Well, it seems to me that even hospitals do not want the average patient in there in early labour. They always seem to tell women to come once they are in active labour, so at 4 or 5 cm. So I do not think they think monitoring during the early part of labour is all that important either.

I do see good reason to suggest women might want to come in before transition, but that has more to do with comfort. A drive of any length during transition can be very uncomfortable.

So, for someone who had really good hospital care available, some time during active labour might make good sense from the point of view of getting settled and so forth before transition. And intermittant monitoring at that point wouldn't be a bad thing.

THe tendency among first time moms is often to get there much too early, so people often emphasize waiting.


The other difficulty is, in many cases the risks posed by the hospital practices really outweigh any benifits to monitoring, and even make women want to wait almost until second stage before they get there, which is certianly not the most convienient time for moving locations!

[hram]

Originally Posted by Bluegoat

The other difficulty is, in many cases the risks posed by the hospital practices really outweigh any benifits to monitoring, and even make women want to wait almost until second stage before they get there, which is certianly not the most convienient time for moving locations!

Thats sad.

[katelove]

At the hospital where I did my mid degree we did not admit people to Birth Suite if they were less than 4cm (unless it was an induction or something particularly high risk was happening). If someone came in and was less than 4cm we would strongly encourage them to go home. If they lived a long way away or really didn't want to go for some reason then we would admit them to the ward but they did not stay in Birth Suite. In the ward they would be encouraged to sleep or walk around depending on the circumstances and would have a set of vital signs (including foetal heart by doppler) about every 4hrs.

Now, as a first time mother I am planning to stay at home as long as possible for a number of reasons (and by "as long as possible" I mean that, ideally, I would get to hospital at about 8cm)

- it is where I feel most comfortable and I do not want the adrenaline rush of going to hospital to slow things down. This is less likely to be an issue the further advanced I am.

- the hospital I am going to has a strong midwifery model of care and I have a comprehensive birth plan which has been well received. However, they have their policies and I understand that, even if I don't agree with them all. If I'm not there then there's no need for anyone to get het up about policies.

- it is possible that my baby may get distressed in the first stage of labour and I would miss it at home as I will not be monitoring FHR. However, if nothing in my antenatal period raises any flags for me then I am willing to take that chance as I think the risk is very low. If I had mec liquor I would go in. Cord prolapse is very unlikely if the head is well down when my waters break. If I had a high mobile head and a big gush of fluid then I would be more concerned and reconsider.

- How long would I wait after my waters broke? If I was in labour then there wouldn't be a time limit. I would still go when I felt ready (hopefully 8cm-ish). If they broke and I wasn't in labour I would keep an eye on my temperature and go in if it went up. I would maybe start to think about going in after 48 hours if I wasn't in labour but I would have tried some natural methods of stimulation first.

- I would also go in if my DH was very anxious about anything as I feel very strongly that this is about both of us. But, he is an ED NP with a lot of ICU and NICU experience as well and he is educating himself on the birth process (at the moment he is reading Ina May's Guide to Child Birth). Also, I wrote my birth plan as it is my area of expertise but there is nothing in it that we haven't discussed and agreed upon. So, I feel fairly confident that he will be comfortable at home as long as I am.

I hope all that made sense and answered some of your questions. From one person's perspective anyway.

Oh and BTW I am having a hospital birth as a home birth would cost us about $5000. The hospital costs nothing for all antenatal care (including any tests I choose to have), birth and postnatal care (including home visits from the midwife if I leave hospital early, which I plan to do) and I feel confident that I will get the birth I want there. If I was having a home birth I would call the midwife earlier than 8cm and I would imagine that she would plan to arrive earlier than that so she had time to get herself oriented before the birth.

One more thing and then I'll stop - really We have a *very* small hot water service. If I need the shower it just won't cut it. I would go to hospital earlier in that case but still not until I was in active labour.

[wombatclay]

Hmmmm... honestly, I prefer to birth in a hospital setting. But I tend to have complicated births and I simply feel more comfortable at a hospital. I'm not interested in the standard "hospital ride" but I also grew up with a lot of medical professionals and so never felt a real "awe" of doctors... I treat them like any other specialist (plumber, mechanic, teacher, clergy) and include their advice with all the other data I use for decision making but I know my rights and am comfortable calling the shots as a patient. And I've spent a lot of time in medical settings so they really don't phase me....I even like the food most of the time!

Anyway, I'm crunchy and determined and informed and I'm perfectly happy birthing in a hospital setting. That said... I don't see a benefit to early monitoring and I generally don't go till I feel like I'm in active labor. Yes, there are some conditions you simply can't plan for (and I've had a few of them). And yes, there are some emergencies where being at the hospital already can be crucial. But those are pretty rare. Many of the serious complications happen in active labor/pushing/shortly post partum (failed descent, uterine rupture, cord compressions/prolapse, shoulder dystocia, complicated presentation, tears, pph, retained placenta, etc). Early monitoring just isn't worth the risk of the "just in case" interventions IMO.

So on one hand, I would suggest waiting because the risk/benefit balance doesn't support getting to the hospital "too soon".

Another reason to wait is VBAC. Hospitals with VBAC bans, hospitals that have de facto bans, hospitals or providers with 50%+ c/s rates... a mother who is birthing after a prior cesarean has a lot of extra hurdles if she also wants a hospital birth. Which really stinks for a woman like myself who prefers the hospital setting but has that scarlet c/s on their records. EMTALA only applies to a woman in active labor, and even active labor doesn't prevent potential strong arm techniques. In many cases a vbac mama knows she'll have to fight just to have a birth with minimal interventions. IV, EFM, restrictions on birth location (since hospital birth centers often don't accept vbac mothers), a delivery clock, etc are common even at hospitals that "allow" vbac. At banned hospitals a mother may have to show up crowning to avoid a repeat surgery, court order, or CPS call.

So for a vbac mother who prefers a hospital setting or who has to birth in a hospital for whatever reason, waiting till the last minute (with any risks associated with that choice) may be the only way to birth vaginally.

[wombatclay]

Oh... water breaking....

With my first child I had sPROM a day before contractions began. My family practice care providers were ok with my staying home and remaining active. They asked for an hourly temp and bp and wanted me to do a lot of fetal kick counts. Their personal comfort zone was 24 hours without contractions.

My second child again started the show with my water breaking but contractions were more or less immediate. My vbac OBs (they're in Ina May's book actually) were ok with PROM by as much as a week or two though they asked mamas to chech into the hospital after 24-48 hours with no contractions. They wouldn't induce but they wanted to keep a closer eye on the babe via doppler and a close eye on mama with regular blood work in addition to temp/bp.

My third birth actually had an AROM... but it was an intervention I was comfortable with and requested in that specific situation. That birth was only 4.5 hours from start to finish and I could tell I wouldn't be on a clock despite ROM.

So I'd be comfortable monitoring from home for 24-48 hours. After that I'd probably want blood work to monitor for infection.

[Girlprof]

Not an expert, but a mom who showed up at 9cm here.

For me, it made total sense to do it that way. My understanding is that the "risks" in early labor are pretty rare. Also, I wasn't really without monitoring, I just wasn't having EFM. But I was in phone contact with my midwife. We talked every few hours about how things were going and what I was feeling. She listened to the sounds I made during a contraction. She could tell a lot from that. For awhile, we "negotiated" as she encouraged me to stay home. It was all new to me as a first time mom, but as an experienced MW listening to my reports (and those of DH), she could tell that we were laboring well at home.

At some point the "negotiations" ended as I said, I am coming in NOW. She laughed and said, that's what I've been waiting to hear - and as I said, I showed up at 9cm. But clearly, she was doing a kind of "monitoring" and a very effective kind over the phone.

Now, I don't think this approach makes sense in a higher risk situation. That was me the second time around and I probably would have gone in sooner except that I ended up needing an induction.

[erin_brycesmom]

hram - I totally get where you are coming from. I created a similar thread on another site a while back. It's really hard for me to understand the idea behind going in at the last second, FTMP.

[katelove]

Originally Posted by erin_brycesmom

hram - I totally get where you are coming from. I created a similar thread on another site a while back. It's really hard for me to understand the idea behind going in at the last second, FTMP.

I didn't see your previous thread so please feel free to just point me to it if you've already answered this question.

In a perfect world, at what point would you like to get to hospital and why?

[erin_brycesmom]

Originally Posted by katelove

I didn't see your previous thread so please feel free to just point me to it if you've already answered this question.

In a perfect world, at what point would you like to get to hospital and why?

The other thread was on a private board outside of MDC but I can PM you the group if you are interested.

For my natural hospital birth, my ideal time to get there would have been about 1-2 hours before transition. Of course, that's hard to predict, lol. I didn't want to be in a car during transition. I wanted to be able to check in, triage, and get to my room with as much peace and calm as possible. The idea of going in pushing with people rushing towards me to "help" and a frantic scene with baby trying to come out while I'm checking sent my anxiety through the roof. I really need time to adjust to new surroundings/people and especially to hospital surroundings. I didn't want to the staff to feel rushed either. I wanted them to have time to find out what I wanted for the delivery and immediate after. It's really really important to me to feel safe, secure and calm during second stage so I wanted to do what I could to facilitate that. Homebirth sounded great, but car birth sounded really unappealing.

Figuring out when to go in is definitely one of the downsides to hospital birth. I had a homebirth the next time around and I really loved not having to worry about that.