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How to know when to go
I mostly lurk here, but I have a question. I plan to labor at home as much as possible before going to the hospital. My OB is totally on board with my birth plans for going med free among other things, but I still think she'd have me come to the hosp sooner rather than later.
I do not have a doula. I'm afraid I won't know when to go to the hospital. I don't want to go too soon, but I also don't want a baby in the car. How do you know when to go? Sorry if this is a dumb question.
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Re: How to know when to go
Unfortunately, not a Bradley class since I was so sick and looked too late to start. I am taking the 15 hour hospital childbirth class as well as a 7 week natural birth class, but they haven't started yet. I am reading the book by Susan McCutcheon, but I guess I'm not that far yet. Maybe I should have waited to ask until after class and I finish my reading!
I'm probably not the best person to answer this since I haven't gone through labor yet, but in my birthing class our doulas told us to wait until contractions are about 1min long and about 5 mins apart. The mom will generally transition from being excited, chatty and good-humored to becoming very serious, concentrating more, and not being able to talk through contractions any longer. There are probably other signs I'm forgetting as well.
I felt the same way-- "How will I know when to go?" For me, it was when I didn't feel comfortable at home anymore. Instead of being able to relax between contractions and helping them get closer, I started worrying "what if they keep getting closer & we don't make it to the hospital in time." It was an emotional thing-- I just didn't feel right being at home anymore, even though I had only been in labor for 2.5 hours or so, my contractions were coming irregularly at 5-7 minutes, and my plan was to keep staying home.
It's a good thing I went when we did-- we got to the hospital at 1:30, DD was born at 4. I was able to relax and tell myself I could have this baby any time I was ready.
And to ease your mind a little about the hospital, I got checked twice (once when I was admitted at 6 cm, once when I was ready to push!), and the nurse took my blood & put me on the monitor 3 times. Other than that, it was pretty much me and DH alone, the way it would have been at home. They were expecting a much longer labor-- since I got right down to business, DH had to run and get the doctor when my water broke and I told him "I have to push NOW!"
Everything is so exciting when you're one!
Ok, well, I'm in labor right now (early stage).
My doula told me we'd leave for the hospital when I feel the urge to push. (We are only 5 min from the hospital.) BUT...in the case that you are further away, she said you should pay attention to your body. The signs for "transition phase" of labor are irritability, shaking, sweating, nausea, vomiting, and rectal pressure. This is when you should be around 7 or 8 cm.
HTH
Part of staying home as long as possible is understanding how to access you dilation. sooo....
https://www.natural-pregnancy-mentor.com/vaginal-exams.html
^^scroll to the bottom there's a great way to tell how dilated you are without vaginal exams.
also consider these: https://prepforlabor.tripod.com/id14.html and
https://www.gentlebirth.org/archives/novagxms.html
Some of these may be harder to understand as I believe it was written more directed at 'professionals'
External and Observed Signs of Dilation, Descent and Progress? Location of FHT (foetal heart tones) with pinard or fetoscope; good for gauging descent. FHT early deceleration pattern will indicate resistance onto pelvic floor and therefore descent.
? 6cm = cx pattern shifts, flushing over cheekbones.
? 8cm = hot/cold/trembly/irritable/nauseous. Cx seem to not give her a break.
? Near full = increased pressure, vomits, breathing more ragged, ?catch? in breath, deeper, guttural moaning. FHT?s midline and low. Sacrum seems flat and full. Her energy will be acutely aware during cx but she will retreat just as intensely between them. More show, spotting of fresh blood. Feels like pooing, ROM.
? Purple line that creeps up like a mercury thermometer from anus to top of bum crease. When it reaches the top, the woman is fully (increase in intrapelvic pressure affects veins in the sacrum).
? Vomiting and ROM (rupture of membranes) at the same time = 7 cm stretch
? Look at bottom of foot with the toes pointing up. The spot above the heel and in the center will tighten and release as the uterus contracts IF she is at least 5 cm.
? Full = passing stool involuntarily, pouting of anus, instinctive bearing down begins at the beginning of the contraction and not at the height of it.
? The contracting uterus swells upwards as it pulls in the dilating cervix. Before a woman begins to dilate and is about at term, you can get about 5 fingerbreadths of measurement between the fundus and the tip of the breastbone (xyphoid). As she dilates, this measurement decreases at about 2 cms per fingerbreadth. I.e., 1 1/2 fingerbreadths between these two points would be equal to 7-8 cms. dilation. It?s an old trick I learned several years ago. This really works but, like vaginal exams, it takes practice. Unlike vaginal exams, it?s not out of the scope of practice as a doula to do this type of exam because it?s not done internally and not ?really? considered a clinical test.
? Abdominal signs: thin line or crease above/parallel to SP. As baby descends and cervix opens, the line/crease becomes wider from side to side. Near transition = _ across. All the way across indicates that pushing is most likely imminent (bulk of baby?s shoulders closer to SP?)
? When she ?pushes? spontaneously, does it begin at the very beginning of the sensation or is it just at the peak? If it is just at the peak, it is an indication that there is still some dilating to do. The woman will usually enter a deep trance state at this time (we call this ?going to Mars?). She is accessing her most rudimentary brain stem where the ancient knowledge of giving birth is stored. She must have quiet and dark to get to this essential place in the brain. She usually will close her eyes and should not be told to open them.
? Does she ?push? (that is, instinctively grunt and bear down) with each sensation or with every other one? If some sensations don?t have a pushing urge, there is still some dilating to do. Keep the room dark and quiet as above.
? Are you continuing to see ?show?? Red show is a sign that the cervix is still dilating. Once dilation is complete the ?show of blood? usually ceases while the head molding takes place. Don?t mistake another gush of blood which may be vaginal wall tears at the point that the head distends the perineum.
? Watch her rectum. The rectum will tell you a good deal about where the baby?s forehead is located and how the dilation is going. If there is no rectal flaring or distention with the grunting, there is still more dilating to do. A dark red line extends straight up from the rectum between the bum cheeks when full dilation happens. To observe all this, of course, the mother must be in hands and knees or sidelying position.
?I think it?s a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm.
?The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet. Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 finger widths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.
?What?s in the centre of that opening space is the membranes (bag of waters) that are covering the baby?s head and feel like a latex balloon filled with water. If you push on them a bit you?ll feel the baby?s head like a hard ball (as in baseball). If the waters have released you?ll feel the babe?s head directly.__?It is time for women to take back ownership of their bodies.?
Some of my own advice from experience: (these aren't always the rule, there are exceptions, just the most common)
1-4cm - may be chipper/excited, able to talk and walk through your contractions (still able to talk on the phone, type on a blog/facebook/etc). most describe them as irritating. smiles with contractions, smiles in between contractions.
4-7cm - concentrated during contractions, but increasingly focused during them. Unable to talk during contractions. Asks others in the room to be quiet during contractions. In between communicable, smiles, interacts with others, decreasing with progression. Vocalizations, grinding teeth, clinched fists may begin during this stage, continues into next. Become increasingly tired, need to put your head down, preference to sitting, lying or resting positions due to need to rest.
7-10cm - inward focused. not responsive during and little in between. responses to questions are often in forms of nods, grunts, pointing and single word responses. less concern of others presence in the room. Distracting noise (talking, clinks and clangs, etc) very irritating, may be snappy. statement's like 'i can't do it anymore' 'i give up' 'i want an epidural' 'i can't go on' (and similar) are very common. May be come very vocal, 'lion' and 'elephant' and 'cow' like noises are very common (I refer to it as singing). or moaning sounds. May get a 2nd wind, increased energy, toward the end.
My best advice: ditch the idea of 'timing' contractions. I've seen women 1cm dilated contracting 5 minutes apart 1 minute long for well over an hour. (5-1-1) BUT, I've also seen women 9cm contracting at the same rate. Wait and watch for more physical cues.
AS ALWAYS: trust your instincts, they'll take you far as a woman, wife and mother. If you feel like you need to go, just GO! Most women, again from experience, instinctively seek out a place where they feel safe to give birth between 5-7cm.
Our Bradley instructor told us to go when I could no longer talk through a contraction. And we'll be driving about 40 minutes assuming no traffic. Contractions can be totally irregular. I'd also recommend the "emotional" signposts as a PP said.
I would not recommend checking for dilation as PP mentioned - the risk of infection (if your water has broken or leaked) is too high, not to mention it's all based on finger measurement and you can go from a 3 to a 7 in a few minutes - there's no regular pattern that you necessarily will follow.
IMO the emotional signposts and not talking are better signs of progression.
sorry - just read that PP had said other things about knowing how far along you're dilated - my tired brain just skipped some of that and went to the sticking your fingers in and sitting on the toilet part. There was a lot of good info in there!
***My best advice: ditch the idea of 'timing' contractions. I've seen women 1cm dilated contracting 5 minutes apart 1 minute long for well over an hour. (5-1-1) BUT, I've also seen women 9cm contracting at the same rate. Wait and watch for more physical cues.***
This exactly. ?GO WITH THE PHYSICAL (ESPECIALLY EMOTIONAL) CUES!!! ?I started with contractions at 4-8 minutes apart that lasted a minute. ?That went on for a few hours and then my contractions went to 20-30 apart for the rest of the day. ?We thought that labor was stalling and that it wasn't time. ?All of a sudden they went to 1-2 minutes apart. ?I was there for 4 hours before DS was born and would have made it to the hospital 10 minutes away if needed. But I did a homebirth and couldn't imagine being in a car during that time because I couldn't stand sitting during a contraction. ?
However, I went through each and every one of those cues at each stage. My DH had a paper that told him about how I would be behaving during each stage, and he would go read it and come back and say, "ok, you should be this now or you should be that now." ?lol
when you are really, really uncomfortable is when I'd say to go. I wouldn't wait until you have the urge to push, I almost had my second in the elevator because I didn't want to go too soon.
Our midwife told us the 5-1-1 rule too. She also said, "go to the hospital when you feel like you can't take it anymore"
We also factored in that we had a 30minute drive, and we'd run out of hot water in our shower.
The, "you won't be able to talk through the contractions" rule may or may not work. I'm very stoic with pain. I never once complained through labour. When talking to my midwife on the phone I was laughing and joking. She said, "come now if you want, but you won't be having a baby tonight"
When we got to the hospital I was 5cm and we had our baby 4 hrs later.
This was perfect timing for us, because we had time to "settle in" with the surroundings and not feel rushed.
Trust your instincts, they are very important.
Elizabeth 5yrs old Jane 3yrs old