If you're birthing at a hospital, how do you decide when to GO!

[Dot-to-Dot]

I know I want to labor at home as long as possible.  I know I should wait for contractions to be consistently 5 minutes apart and lasting 60 seconds.  However...I did that last time and I still wasn't sure if I should go in.  My mom said I should.  I called the doctor on call and they recommended I go ahead in.  I ended up being turned away and had to go home, only to return a couple hours later.  Plus, all of the criteria gets fuzzy and gray when you're actually in labor.  I didn't feel capable of making any decisions.

This time, I won't be so easy to convince to go in.  However, I also assume that this time will go a bit faster since it's my second baby.  But I'm afraid of being a crazy laboring woman in the waiting in the waiting room and the discomfort of laboring publicly.  (Last time, I needed to be naked in active labor and that would be pretty weird to enter the hospital naked!)

So, what are your clear and easy to follow (even while in labor) criteria to know for sure that it's time to go?

[KABB]

Since my youngest daughter was the only one of my children where my labor started naturally I'll answer "When my water broke". However, this time around, knowing that I had several hours to go before she was actually born (water broke 12:30AM-1CM, first contraction that hurt was 2 AM I think, she was born 7:52 AM) I am thinking I'll labor at home much longer. I'm not sure what criteria I'll use to determine when to go, if it comes down to that. 

[jeninejessica]

I was a doula for my SIL, and my husband (her brother) was kind of her go-to phone support person, so the night she went in to labor, we talked to her approximately every hour or more on the phone. And she kept asking us if she should go in yet... yet.... yet....

What we said, and I maintain to be the best 'indicator' is that when it's really, and I mean truly time to go, you won't have to ask anyone. You will know, that NOW is time to go. Anytime before then, is probably too early. Obviously this is in the absence of any complications or medical reasons to go in early, but for the most part, you're just going there to birth. If you show up in active labor or transition, then they'll rush you to a room much faster, and you have less chance of being accosted by staff.

SIL kept calling and asking should I go, and we kept telling her that if she had to ask us if she should be going, then it was too early. Eventually she called back and said "I'm going". I said great, grabbed my stuff, and met them at the hospital. She ended up spending about an hour in triage, and towards the end of that hour the nurses realized she was progressing, we wheeled her down the hall, and she got into the room just in time to push. She didn't have to put up with any interruptions from the nurses, from extra doctors wanted to check her, etc. They didn't even have time to kick her 3yo DD out of the room, who instead got to watch her mama deliver her new baby sister.   I honestly couldn't have asked for better timing. She trusted her instincts that when it was really truly time to go, her mind/body/intuition would just say go... and it worked.

[msmiranda]

I have been pondering this question recently, since the hospital I am going to give birth in is about a 30 minute drive, or longer in rush hour traffic (which here is 5:30 to 9:30 M-F).  With my first I would have had NO IDEA when to go in.  Thank goodness that I had midwives whose clinic wasn't far from the hospital so I was able to go there and be checked before going in.  It was a long, stop and start labor (well, it seemed long to me, 17 hours start to finish, I know plenty of women have much longer ones).  I was at the hospital 4 hours before he was born.

The second time I had a home birth, and I absolutely knew when to call the midwife to come over.  Baby was born 2 hours after she arrived.  I hope it happens similarly this time, if so I will definitely know when to get in the car and head over.  But I do worry because every labor and  birth is different, and someone I know had an oops UC because things just happened faster than she thought they would (her 2d baby).  Not that that would be the end of the world, but I've never really wanted to ride in an ambulance, KWIM?  By the same token, I don't want to go too early and have my labor stall out either.  So it's a conundrum.  Right now I'm just thinking that I will do the best I can and that I will probably know when it is time.

You could always learn how to check your own cervix or  hire a monitrice if you want to be very sure!

[cuddlemama0507]

I fall under the "when my water broke" category.  My contractions started around 9:30 am and grew more and more intense, though not regular.  At 3:00 pm I called the midwife to tell her what was going on, and even though the contractions weren't happening at regular intervals, I still thought I needed to come in.  She told me to wait.  About 5 mintues after I got off the phone with her, my water broke, I had to call her back and then she told me to come on in.  The hospital was about 45 minutes away at the time; so, I got there around 4:00 and had DS at 7:55 pm. 

But, I agree with PP.  When you know, you know.  Trust your gut.

I'm about 5 minutes away from the hospital this time.  Thank goodness!  That was a helluva ride before.

[kcparker]

I'm a believer in the "when the little voice inside your head tells you to go" -- I have seen that with my own births and with my clients, there is an instinct that kicks in that has been pretty accurate. I knew when it was time to head home from work the day I had my second son. In the case of one of my clients, listening to her little voice probably saved her baby's life (despite the mother not having obvious signs that she should head in when she did).

If the voice isn't guiding you, then as a doula, I say that if dad is making the call because mom isn't capable of talking on the phone, she is probably in active labor, and that's a decent sign that things are probably in a good contraction pattern. You can do the 5-1-1 rule, or wait until they are even closer together (but sometimes it is nice to go in sooner if you want to get settled or use the hospital's jacuzzi tub or something like that). Emotionally, look for receding from the outer world into your own labor mind (not much talking, annoyance at disturbances) - if you can still chit-chat, it's likely too early.

Sometimes if you really tune into your body, you can feel and/or see in your mind's eye what your cervix is doing. I know this sounds sorta hippy-dippy, but your body can give you information about where you are with dilation, and you can always check yourself manually (or have your DH do it for you).

[BarefootScientist]

Since everyone is saying you'll just know, I am going to throw my two cents in and say that it may not ALWAYS work that way. I know my birth story is pretty atypical, but I went into labor at night, called the nurse at my clinic and she said to get some sleep and call again in the morning. So that is what I did. My contractions started out 2-4 minutes apart and never got longer, stronger, or closer together like they say they should. They didn't even hurt. And when I woke up in the morning, they were spaced out FARTHER apart and so mild I could hardly feel them. Until a half hour later when suddenly monster contractions hit me like a ton of bricks and I started pushing. That's when my intuition kicked in which IMO was a little too late. I did make it to the hospital, but just barely, holding him in the whole time. Everything turned out fine, but I just think it's worth considering if you want the last 15-30 minutes of your labor to be a mad and very uncomfortable dash to the hospital followed by complete chaos when you get there because the head is crowning. No triage for me!

But since this is your second, in your case you probably know a little better than I did what to expect, so trusting your instincts will probably work a whole lot better for you! I just like to add my experience for balance.

[annie2186]

What is up with this triage thing?? Here if you are past 32 weeks they just send you right back to the birthing center? I think maybe I was in a "monitoring" part of the birthing center for a minute with my second one (I had a 24 hour barf fest and I think that is what made me go into labor - so I went before I was actively in labor......about as soon as I could drag myself off the couch!! LOL)

Anyways - that would be truamatizing (sp?) to be in the triage area while in LABOR? yeesh! Maybe that is why they have us pre-register.......I should apparently stop complaining about that.

[amaayeh]

With my first I went in after laboring at home about two hours and the contractions were hurting.  Mostly, though, I was just excited and wanted to find out how I was progressing.  I got there at 5cm and then all the interventions started (I didn't have a plan not because I didn't know anything different at that point).  My water was broken by doctor.

With my second, I labored at home a few hours and when I called my midwife the second time that morning, she just asked to talk to me during a contraction.  I guess when I couldn't talk and was just moaning she knew?  We left for the birth center about 20 minutes after that, it took 12-15 minutes to get there, and she was born 20 minutes after walking in the door.  *I* was not the one that thought we should go, it was everyone else around me.  I honestly didn't think the contractions were all that bad and I was still laughing and was STARVING hungry between them.  I guess my point is, it was my second labor (albeit, first one all natural) and I didn't know exactly when to go.  Oh, and water didn't break until I was pushing.  If dh or anyone else around you is looking at you like they really don't want to deliver the baby themselves, it's probably time to go! 

[just__angel]

With 6 of my 7 of my births, the 5-1-1 guideline was too early. Going at 3-1-1 was a better fit. Still had 4 hospital hours to labor thru.

This time Im hoping to homebirth so I wont have that when-do-I-go anxiety. And for me, it really was a severe anxiety producer.

If I were going to the hospital this time Id wait until I just couldnt talk thru a contraction, knowing that for me, I'd still get there with plenty of time.

[Dot-to-Dot]

Hmm, I'm thinking maybe I just don't fit the norm?  I do want to be settled in to the hospital to avoid the "mad dash" but last time there was never a little voice telling me anything.  And also, even during transition I was talking...okay, screaming...but, I was definitely communicating to my mom and husband throughout (explaining that contractions weren't stopping or starting, just on top of each other and stuff like that) right up to when I was pushing and I was definitely talking during the pushing contractionstoo, saying things like, "Everybody, I'm gonna push NOW!"  So waiting until I can't talk doesn't seem like it'll work.  (Last time I couldn't walk after 6 cm at all anyway because I had some hip socket thing that happened, I call it hip labor, so guaging by when I can't walk anymore doesn't feel reliable either).  I'm not worried about getting there too early and running into interventions.  I have the same birth plan as last time and it's been signed and initialed at every bullet point by my WONDERFUL doctor and if anyone so much as thought bubbles an intervention, my husband will be throwing one of many copies of that birth plan to them and inviting them to call our doctor if they want to discuss it further.  Also, we plan to put a sign on the door again this time which asks the nurses to basically stay out so I can do self-hypnosis, but if they do come in to come in quietly and to leave the lights low.  They respected this last time and probably will this time, too.  I didn't have any unnecessary interventions and it was a natural birth.

I don't know...I guess I just need to go with the 5-1-1 (or if I'm brave enough, the 3-1-1).  I feel like I'd probably be a doula's nightmare because I am making this so difficult.  I wish I had that instinct, but seriously, I've come to accept that I don't ever have "gut feeling"s about stuff.

Annie2186:  Traige, at least in the hospital I went to, was a special laboring triage so it's not like I was among burn victims or people with gunshot wounds or anything.  And they want to check your dilation before putting you into a delivery room because if they sent you straight there and you were, say, 3cm dilated and not progressing very quickly you might end up staying in that hospital bed for a couple days waiting for baby!  Hospitals can do some pretty scummy things to keep costs down or to make a buck, but this is one procedure that I do not mind.

[jeninejessica]

Originally Posted by Dot-to-Dot 

Annie2186:  Traige, at least in the hospital I went to, was a special laboring triage so it's not like I was among burn victims or people with gunshot wounds or anything.  And they want to check your dilation before putting you into a delivery room because if they sent you straight there and you were, say, 3cm dilated and not progressing very quickly you might end up staying in that hospital bed for a couple days waiting for baby!  Hospitals can do some pretty scummy things to keep costs down or to make a buck, but this is one procedure that I do not mind.

That's basically what it is here. Once you get to the hospital, you go straight to triage, and that's where you are intaked, and then they monitor you for usually an hour or two until they're convinced that you're truly in labor. Or sometimes unfortunately, it's because they don't have beds in L&D. You're given a 'private' cublicle, but there's up to about 6 or 8 laboring moms in there at any given time, separated by only a curtain, and you all share one bathroom. It's pretty poor conditions.

[Dot-to-Dot]

Aw man!  I had my own triage room with comfy seating for my mom and husband.  Only a curtain between you and other moms and sharing a bathroom is counterproductive to labor progression considering humans and animals tend to labor better in private conditions.  I totally would have clammed up!

[jessica_s]

The first time I went when things got into really really active labor. I labored at the hospital for quite awhile, he also took a really long time to push! I however was very vocal and just walked into the hall bypassing triage and they gave me a room. I sounded like I was in labor for sure (5cm when checked in). 

The second time I wanted to wait longer, I had been in active labor for about an hour and a half, my doula said maybe we should think about going to the hospital. I had two transition type contractions while they were getting things in the car and on the second one my water broke and I could feel his head move alllllll the way down. I was in my living room! We're 5 minutes away from where we were going. I got there and my DH wheeled me very quickly to a room with a nurse behind us directing the way. I had him about 10 minutes later. 

For reference my first was 15 1/2 hours and the second was 2 1/2 hours!

[Dot-to-Dot]

Originally Posted by jessica_s 

For reference my first was 15 1/2 hours and the second was 2 1/2 hours!

Now, THAT's the kind of improvement I'm hoping for!!!!  I can handle anything for a couple hours!

[scottishmommy]

Have your dh or support person talk to you during a contraction. If you yell "shut up!" then it's time to go in!

[Buddhamom]

I am the last person you should ask *LOL*  My contractions don't tend to be any more uncomfortable that menstrual cramps.  That being said, with my last my contractions were 3 min. apart and we were an hour away from my MW so she told us to head in.  I wanted to stop and walk around on the way and DH said we probably should keep going.  I got there and was still laughing and they were shocked that I was comfortable and 8.5 cm.  She broke my water and I had the sudden urge to push and DD came out within 20 min. of getting there so this time I am planning on doing it the same way or maybe UC.

[erigeron]

My midwives said I should call them when I start having contractions and from then on we'll check in periodically by phone until we agree it's time to go in... their goal is similar to mine in wanting me to spend the least amount of time there necessary. I'm thinking it won't be until I'm a lot closer to the point of active labor... although I admit I hate the idea of driving all the way across town in active labor. Ick. I like these midwives but I have to admit it's too bad they do not deliver at the hospital 10 mins from my house! This is my first, so I'll just play it by ear.

[penstamon]

With my first, I labored at home until I was hitting transition.  I have no idea how far apart contractions were but both DH and my MW all of a sudden noticed a change in my appearance and demeanor.  Our birth center is 20 min away at best, so I spent the first part of transition in the car.  When I arrived, I was sent straighth to my own room and DS was born less than 2 hours later.  My advice is to have your birth team on the ball to notice changes in you since it is so hard to decide these things yourself.  I was happy to leave for the hospital, but if we had waited 20 minutes more they never would have gotten me out of the house which would have been fine by me too.

[kriket]

Originally Posted by scottishmommy 

Have your dh or support person talk to you during a contraction. If you yell "shut up!" then it's time to go in!

This is what I was going to go off ;) My DH will want to go as soon as I say anything about a ctx (I had PROM last time and was induced) Once he stuffs me in the car I will go!