Laboring at home, going to hospital to push baby out?

[WindyCityMom]

So I'm not getting my homebirth for financial reasons.  I'm being seen by wonderful hospital midwives.  I'm attempting a VBAC.

DD1 was an induced ("postdates" 41w2d  ) vaginal birth with a easy but intervention laden 14 hour labor (I was induced with a foley catheter, then they started pitocin.  I had a *very* unripe cervix!).

DD2 was sectioned at 39w6d for breech after a failed external version (I was in later-early labor at the time, contracting strong and regularly, 3cm dilated). 

I have no idea how this birth would or could go- you never no.

The hospital I'd be birthing at is 10 minutes away from my house via streets.  So 15-20 minutes tops.

There is another hospital, which I'd use if it were emergent (say I was bleeding or had a presenting hand or something crazy suddenly happen during labor) which is 10 minutes north via expressway or 15 minutes north via streets.. so 15 mins expressway tops, 25 mins streets, tops.

When does one "know" when to go into the hospital?  I want to labor at home.  Heck, I want to birth at home, but my DH is not comfortable with UC.  (My DD2 was supposed to be a UC, but I got cold feet after she was said to be breech... even though she was butt first...)

If baby were to come out in the car and be totally cool I'd be fine.  I'd say turn around and go home 

So um.. when do you know to leave the house?

[WindyCityMom]

Anyone?

[Annie Thibodeau]

  i dont know if this will help, but i too chose to labor at home as long as possible and then go to hospital.  i was in labor at home for 20 ish hours, cntx started 12 min apart sat at 230pm... i was up allllll night..., starting around 8 am sunday the cntx started KILLING ME about 6 min apart... so i called the midwives, who told me to hop in the shower and come on up, about a 20 min drive.  i wandered around the house for another hour or so...called my dh to come home from work (i WANTED to be alone)...so we left the house about 1020,  cntx were about 4 min apart in car, got to hospital room about 11, when my midwife checked me i was at 7...and i had a baby in my arms at 108....and i was home from the hospital in 24 hours...i was happy with how everything worked out... so i guess when you start crying and cntxs are about 4-5 min apart...HTH

[MunchiesMom]

I had this same question...VBAC here too. I was told when your contractions are 5 minutes apart. Anyobe have advice on this?

Or maybe you could hire a montrice who can monitor you labor and see how dialated you are. I'm aimibg for 7 cm but will porbably feel "there" at 1!!

[mambera]

Gee, I wouldn't wait, especially if your labor with your first was straightforward and relatively rapid.

I tried to do the '5 minutes apart' thing with my first but it never really happened, they kept varying a lot (from 45 sec to 10 minutes between) and I actually went through transition and into pushing before we left home.  Pushing in the car was absolutely horrible, I would never do that again.  It hurts like 10x as much when you are belted in and can't move around.

My first was also 14 h, and the second time around I had a precipitous labor (somewhere between 1.5-2 h) resulting in an unplanned UC.

I wouldn't play the waiting game with anything other than a first labor, really.  Being strapped down in a moving car during heavy labor is just so unbearably awful.  Plus I really think it is dangerous, I feel lucky I didn't make DH have a traffic accident with all the screaming.

[CountryMommy]

I wanted to labour at home for as long as possible too and was hoping to only have to push at the hospital. It didn't quite pan out as I went in a little too soon both times and ended up labouring in the hospital showers but I did have great, drug free births :) With my 1st baby, I laboured at home until I started to get a little nervous about having an unplanned birth at home. We are a 45minute drive to the hospital so that played into my fears. (it was first time labour/delivery anxiety combined with urging by mother in law to go in) I definately could have laboured at home MUCH longer in hindsight. Went in at 6am, was 4-5cms contractions were about 5mins appart but I wasen't ready to push until 12 noon (pushed for almost 2hrs) With my 2nd baby, I stayed at home much longer but everything happened much quicker as second labours tend to go. Contractions were regular and every 2-3mins appart when I went in at 8pm and I was already 6-7cm with bulging water. The nurses thought I had another hour before Id be ready to deliver though I delivered him 3.5hrs later. I suspect I would have had him much sooner if he wasen't posterior. He kept trying to turn but ended up being born sunny side up :) (pushing only took 6 mins though :) ) If I have another baby, I will try to stay at home for as long as I can again and just hope when I decide that its time to go in, it won't be too soon. I will say though, that the ride to the hospital proved to be very different for each of my labours, I contribute to how far along in labour I was.... baby 1, the ride to the hospital wasen't too bad, not comfortable but not incredibly aweful. ... but with baby 2, OMG, torture! Every little bump on that 45minute ride felt aweful. I remember being so relieved when we got to the hospital just to give my back a break from the drive. I know you don't have as long as a drive to the hospital as I did but I thought I would let you know that part of my experience too since I didn't anticipate such a difference. Best wishes for a quick hospital labour/pushing and a healthy baby. :)

[cat13]

I've always heard the 5 minute rule.

Have you considered getting a doula? It might be nice to have another person who could come by earlier and help you figure out if it's "time."

[fruitfulmomma]

This is my first planned hospital birth... I am sure my ob handbook said when I was supposed to come in, probably the 5 minute mark everyone is stating, but we are 30 to 45 minutes out from the hospital, so... If we end up going with the hospital I want to there is a hotel 2 minutes away (we timed it already, there is like a field between the two) and I am going to go early and get a room to labor in. We will head in whenever I feel like I need to. Hubby is totally prepared for an oops if I mistime it.

I agree with the pp's that laboring in the car is excrutiating, I've done it in early labor and a transport less than 2 hours before birth and it sucked both times, which is why I'd rather be 2 minutes away in late labor than 45 in mid-labor. I also *don't* want to go in too early to the hospital and end up with interventions, as I know my body tends to piddle around for awhile before it gets going.

[Youngfrankenstein]

I'm going to be the odd man out here and ask you to think about the hospital where you want to birth.  Can you have a room for as long as you need and not be on their schedule?  Can you have a doula?  Do you have a HCP who is supportive of the way you want to birth?  I ask this because I HATED riding in the car while in heavy labor.  I had barely any labor all day and my water broke at home and after that it was "on".  The ride was horrible, the admissions time was horrible, etc.  If I thought I could have labored at my pace in a comfortable pace in the hospital, I would do it that way.  My last baby was a homebirth but if I had to go to the hospital, I'd do it differently than last time.

[illiterati]

The  closer hotel idea is genius, as long as you'd still feel relaxed with laboring however you wanted to (vocalizing and such).  We had a similar plan in place as our doula lived a short walk from the hospital and we were a good 30 min drive. As it turned out we won the birth lottery and showed up to the hospital where I was declared 9 cms and ready to have a baby!  Although my GBS posed a little complication. Another thing is that the 5 min rule would never have applied to me since from the very first one they were less than 4 min apart (for 24 hours... Ugh). Nor will you for sure just know because I thought I was having false labor the whole time. By you have the advantage of having done this before and knowing sort of how your labors work. Good luck !!

[ilovetchotchkes]

I would find an experienced doula who can tell without a vaginal exam about how far along you are and then she can suggest when you can hop in the car. :) 

[WindyCityMom]

Originally Posted by mambera 

My first was also 14 h, and the second time around I had a precipitous labor (somewhere between 1.5-2 h) resulting in an unplanned UC.

You have a really, really great point... labor may just fly by.

However.. I tend to have weeks and weeks of prodromal labor.. the real-deal feeling contractions, back labor (well, they were both posterior...) the works! 

Active labor wasn't that much harder with DD1, and I was on pit!  Transition was pretty bad but they tricked me into an epi so I really didn't feel much of it.

I guess I really shouldn't be too scared of a longer hospital labor.  I'm in the hands of awesome midwives who will go to long lengths to see that a vaginal birth happens... I guess it's just fear.  I'm okay with an IV hep-lock just in case, and they do continuous EFM (not sure if they use telemetry or not!) but if they don't use telemetry I feel like it dooms me :( 

[Monkey Keeper]

I'll have to be the dissenter on the 5 minute rule.

I had contractions 2-3 minutes apart and 45s-90s long for 19 hours before my VBAC DS was born. If I had gone in by following the rules, I fear I'd have been deemed FTP. As it was, we went in when I started acting "transitiony"--crying, saying I couldn't do it, asking for c/s--and was stretchy to 6cm+ and 90% effaced in triage.  I still didn't deliver for 9.5 hours! My DS was badly positioned, though, and I was desperate for some pain relief (his head was ramming my hip with each ctx, and nothing we did could get him moved out of there) so I'm sure the epidural had something to do with things taking a bit longer.

See if you can find a doula who will donate her services. Having that support and someone with a clear head and judgement based on experience will help you know when to go.

[dovemama]

Hi. I have only had one birth, but I guess I just knew that the baby was coming. After my water broke, I tried to take a shower, but I could barely stand and my cntrx were about 3 minutes apart (didn't listen to the five minute rule, as I really wanted to just show up and birth). I pretty much planned on getting ready and going but didn't make it. I had to go with my hair wet. Made it to the hospital, and although my dd wasn't born for another 4 hours (for different reasons) I know if I would have stayed at home I might have had an unplanned UC.

Good luck with your next birth!!

[Quinalla]

I didn't do it on purpose, but I labored at home and was basically in transition in the car for the 20-30 minute drive (not sure how long it actually took as I was in the zone). My contractions felt very mild, to the point where I don't think I felt them at first, so I didn't leave until they started getting serious, to the point where I had to stop everything and just relax into them. Honestly, it was a good thing I had bloody show or I might have had an unintended birth at home, I was thinking at first it was just BH contractions since I was only 38 weeks and they were never super close together timing-wise. For me, the best way to tell was how well I could deal with the contractions, I knew when they were "serious" (ie what looking back I think was the start of transition).

[GoBecGo]

The thing to remember about a VBAC is that all the nerves and fibres have been cur and healed up, which makes for a real wild card. For some uteri it can take many hours of strong, long, serious feeling contractions for everything to get synched up right and even dilation and descent to begin. For others it's almost like the surgery never happened and you get a more typical second labour. And of course the baby's size and position can change things up to (as in any labour).

I have a lot of prelabour and then precipitate labours. DD1 my waters went at 3am, contractions followed but with little effacement and no dilation until after 4.20pm when a VE revealed 50% and 2-3). I spent from 5pm to 6pm trying not to push as i "wasn't in labour" according to my midwife. At 6.10pm i was sent to try and pee and her head crowned on the toilet, dazed and labourbrained i waddled back to the bed for my "any progress?" VE. I pushed once, she was born at 6.20pm. DD2 i niggled here abd there all night. A self-VE revealed dilation and a bulging bag but contractions were 3-4 an hour and anything from 20-90seconds long. At 6.50am with contractions still 6-11mins apart i begab grunting at peaks and summoned my midwife. DD2 arrived at 7.55am after 55mins of regular contractions (5mins apart) and 6 mins (2contractions) pushing.

I would either plan a homebirth or find a hospital i feel good about labouring in, or do as suggested and find a doula who could do VE's (though for me they are a poor marker for imminence of birth). I really wouldn't want to VBAC in a car.

[justKate]

I wouldn't attempt a first VBAC in the car either.  (Not that this is your plan!)

I live about 40 min away from the hospital where I'm VBACing and I want to labor at home as long as possible too.  I'm having a doula this time with more experience, primarily so that she can help us decide when its "time." 

What about going to the hospital when you feel like you're halfway--and I know you'll just have to see what feels right--and having them check you?  With DD, I arrived at the hospital, got checked and was found to be only 3 cm.  I started getting ready to go home to labor longer, but then my water broke so I decided to stay.  Maybe you could get checked and go home if you don't feel far enough along?  Or go walk the hospital grounds a bit? 

[fruitfulmomma]

Here is an article that may be helpful in deciding when to head to the hospital... http://wonderfullymadebelliesandbabies.blogspot.com/2011/07/dilation-how-to-check-without-checking.html

[dogmom327]

When I was pregnant with DS, I interviewed a hospital MW who told us about her internship at a very rural hospital. The old MW there would tell the partners to bring the laboring woman in when she "started taking her clothes off". This hospital was too small and rural to have epidural options so there was no point in having someone labor there. Those who followed the advice generally came in ready to push. Obviously that probably wouldn't work with everyone but it's a thought 

[dovemama]

Originally Posted by dogmom327 

When I was pregnant with DS, I interviewed a hospital MW who told us about her internship at a very rural hospital. The old MW there would tell the partners to bring the laboring woman in when she "started taking her clothes off". This hospital was too small and rural to have epidural options so there was no point in having someone labor there. Those who followed the advice generally came in ready to push. Obviously that probably wouldn't work with everyone but it's a thought 

LOL! I love it!!!