5 MYTHS about Hospital Labor and Delivery
By Kyra Brookover, BBCD
1.)You should go to the hospital as soon as you think labor has begun.
Hollywood often portrays labor as a broken water, instant intense pain, a mad rush to the hospital, and imminent delivery of what appears to be a three month old baby! Fortunately, this is not the case. The length of labor is extremely varied between every mother and every pregnancy. Labor can stretch gently over several days, or fly by in under an hour.
If you think you may be in labor, but it isn't so intense so that you have to close your eyes and breathe/work through contractions, then it is probably too early to go to the hospital. Going to the hospital too early can cause a number of problems, so it is important to wait until the right time to go.
Going to the hospital too early could result in you being sent home. Many hospitals will not admit a laboring woman until she is well into active labor. Another risk of going to the hospital too early is that contractions may stop! Early labor is controlled by a delicate balance of hormones. Often times, exposure to the stress and even excitement of going to the hospital can cause a release of adrenaline that interrupts oxytocin. Oxytocin is vital to labor progress, if it is interrupted, especially in early labor, contractions may become ineffective or even stop all together!
Sometimes, being in the hospital too long can also result in other interruptions to this delicate cycle. Things such as fetal monitors, bright lights, and vaginal exams can all tell your body to put on the brakes. If contractions stop or become ineffective, you may need other interventions to help move things along such as Pitocin or breaking your water. If you need labor augmentation, you may also need continuous fetal monitoring and have restricted movement. These restrictions may increase the amount of pain management you need. Especially if your goal is an unmedicated delivery, it is usually best to wait to go to the hospital until you're sure active labor has begun.
So when should you go to the hospital?
The first course of action is always to ask your care provider when they want you to come. Your care provider will know if there are any special circumstances that mean you should come to the hospital earlier.
Many care providers use the 5-1-1 or 4-1-1 rules. These rules describe contraction patterns, and can be a great place to start if you're feeling unsure. They mean you should pack up and head to the hospital when your contractions are at most 4-5 minutes apart, lasting at least 1 minute, and have kept that pattern for one hour.
That being said, there are exceptions to every rule. Some women will not have consistent, timeable, contractions clear through delivery! Other women will have small contractions every few minutes for several days or even weeks before labor begins. One of the most sure-fire ways to know active labor has begun is when you need help coping during contractions. When you need to stop what you're doing and focus on each contraction, and rest in between, active labor has probably begun and it's probably time to start thinking about moving to the hospital. That being said, some women prefer to labor at home for as long as possible for their own comfort. A good doula or montrice can help you decide when it's time to go.
If you have tested positive for the bacteria "Group B Strep" and have decided to receive antibiotics during labor, you may need to go to the hospital in early labor.
If you are being induced, you will likely need to be at the hospital for your entire labor.
If your waters have broken and contractions do not start fairly soon after, it may be time to go to the hospital to get help starting contractions. If your water is broken for a long time, the risk of infection increases.
If you want and are ready for pain medication, you will need to go to the hospital to receive it.
If baby's movements decrease, if there is a chance of cord prolapse, or if something just doesn't feel right, it's time to get things checked out, even if things are fine and you choose to return home to labor.
Finally, if your care provider tells you to. Ultimately, your doctor knows you and your pregnancy best. Please discuss when you should head to the hospital with your care provider prenatally. If you don't agree with your care provider, try to find a resolution. If this isn't possible, it may be time to get a second opinion from another pregnancy care provider. If you still have differing opinions after getting a second opinion, it may be time to switch to different care provider.
2.)You should not eat and drink while you're in labor
In very urgent situations, a laboring person may need to be quickly placed under general anesthesia. If this emergency situation occurs, there is a small risk that the laboring person could vomit and inadvertently inhale this down into the lungs. This risk is very small, and most care providers would agree that eating in early labor is healthy! Labor consumes a lot of energy. Your body needs fuel to birth your baby! Many hospitals even provide snacks for laboring people, though some hospitals still prefer that they stick to clear foods and drinks after they have been admitted to the hospital. If you think you may be in early labor, it may be wise to eat a snack or meal to prepare for the work to come. Drinking in labor is supported and encouraged by nearly all care providers. When you are laboring and sweating during labor, it can be easy to forget to drink or wonder if you're allowed to. You can become dehydrated quickly, especially if you choose not to get IV fluids. It is very important to drink a few sips of water every few contractions, especially during pushing. A great job for birth partners and other support persons is to help remind the laboring person to keep drinking!
3.)You have to have IV fluids, have your water broken, have vaginal exams, have continuous monitoring, and stay in or near the bed.
In short, this is false. You always have a right to decline any medical procedure for any reason. You have body autonomy. Care providers are required to obtain informed consent before performing any procedure. However, care providers are not bad guys! They are doing their best to make sure that you and your baby are safe. That being said, it is very wise to have a birth plan in place and have a birth plan discussion with your care provider prenatally so that everyone is on the same page during your labor. No one wants to be flustered in labor. Let your care provider know in advance that you'd like to discuss your birth plan so that they can schedule you an appointment of the appropriate length. Discuss what routine interventions you want and which you would rather decline. You and your care provider should work together as a team to choose what path will be best for you and your baby. Your care provider is a great source of information on the risks and benefits of any procedure! If your care provider isn't interested in having this type of discussion with you, or if you simply cannot agree on a plan, it may be time to look for a provider who will work better for you.
4.)You must only lay on your back after getting an epidural.
False! There are a wide variety of things you can do to keep your body moving after an epidural. Epidurals affect every woman a little differently, but very very rarely is a laboring person confined to their back. A doula can be instrumental in helping you find epidural safe positions that work for you. Most people can flip from side to side in extended side lying positions for rest. Most people can sit upright or in a throne position, especially with the help of the bed. Some people can even squat on the bed with the help of the squat bar, lay in a child's pose, or come to their hands and knees (with or without a birth ball)! It is important to make sure that you have help changing positions with your epidural for safety. Don't assume that you're confined to your back because of an epidural.
5.)You must deliver while laying in bed
Women around the world deliver in upright positions every day. Much evidence even suggests that this is the natural and most effective way to deliver. While some women enjoy pushing in a reclined position in bed, many more find that they are more effective and comfortable on their side, hands and knees, squatting, or even standing. Some women also enjoy the use of tools such as a rebozo, squat bar, or a birth stool. Every day, women around the world even deliver in pools of warm water. The possibilities are endless! Discuss what kind of delivery positions your care provider is comfortable accommodating and make sure to find the care provider to that is right for you.