How will I know when to go to hospital in labour?
In our HypnoBirthing course we talk about when to go to the hospital in our 4th session but generally someone asks the question well before that – how will I know it’s time to go to the hospital? It is generally the question that causes the most stress. You’ve probably heard that once your surges (contractions) are 3 minutes apart, it’s time to go. But what if your surges start at 3 minutes apart? What if things feel incredibly strong and intense but surges are only coming every 5 minutes?
There are so many variables we need to take into account and hopefully this article can shed some light on not just what’s happening with the surges but with behaviour too.
We would like to thank Penny Simkin and her 3 R’s of labour for the inspiration in writing this article.
Timing surges is often a job given to the partner and everyone is waiting for the magical ‘3 minutes apart’. But that is just the tip of the iceberg when it comes to actually needing to leave for the hospital.
For some women, surges are 3 minutes apart from the very beginning. But often these surges are very mild, short (15-30 seconds) and easy to manage. 3 minutes apart in this case does not mean it’s time to go.
For other women their surges are strong, lasting a minute or longer but never get closer than 5 minutes. If we see other behaviour changes, this may mean it’s time to go.
So what do we look for?
The 3 R’s or Relaxation, Rhythm and Ritual is an amazing framework to pull information together about where a woman might be progressing in her labour.
In early labour, in-between surges, the woman may use the bathroom, use her phone, have a conversation, ask for something or have a bite to eat. Surges are mild and easy to manage and she may even be able to go about her day.
As labour advances and the cervix opens, relaxation between surges becomes more and more necessary and apparent. Instead of talking, once a surge finishes, she may continue to have her eyes closed, rest her head and even appear to be asleep. Her breathing will settle and she may be very still.
Moving inward mentally and emotionally is a wonderful sign that labour is advancing.
As labour intensifies, many women find comfort in a rhythmic type of behaviour. This could look like hips swaying from side to side, rolling the pelvis on a birth ball or vocalising in a pattern (ahhhh, ahhhh, ahhhh on the exhalations).
These rhythms will be seen during the surge and then will most likely stop once the surges finished and she moves back into that deep relaxation.
Rituals in labour can be taught or can be very instinctive. For example, a woman might find hip squeezes or light touch massage during a surge, a lovely, comforting ritual that the couple were taught in a class. She may also find her own instinctive ritual like stroking her arms, belly or face. She might have a certain position she needs to be in during a surge.
Bringing It All Together
Michelle (HB Educator and Doula) says, “I once witnessed the most incredible example of the 3 R’s. A doula client was in the hospital bathroom, sitting on a shower chair in the shower. In between surges, she looked totally relaxed and was very still except for slowly moving the hand held shower head over her chest and belly. Then came a surge and up she stood. She would drop the shower head (we needed a dedicated catcher or we’d all get sprayed), lean over, stick her butt out and sway her hips from side to side. She also needed light touch massage on her upper back. She was coping beautifully but needed every element in place for it to work. She sat on the toilet for a surge and the difference in how she experienced the surge was like night and day. She seemed very distressed, got teary and was extremely vocal. We quickly got her back to her favoured position and she found her groove again immediately. That surge hadn’t been any stronger than the one before or after BUT she needed her ritual and rhythm to feel more comfortable.”
Awesome Partner Tips
There are some really easy ways support people can help a woman maintain her comfort as the 3 R’s become evident.
- Don’t disturb, change or interrupt the ritual with questions, directions, loud voices or noises or turning on the lights.
- Be part of the ritual if appropriate – holding her, swaying with her, softly encouraging.
- Help her find her rhythm again if it’s lost. Remind her of the ritual and use these tips if she is overwhelmed.
- The same way we get baby in, is the same way we best get baby out! This means that to let go (just like when making love), she needs love, tenderness. So think about how you can love her up and help her let go to the experience.
When To Go
The decision on when to go is generally a decision made in conjunction with your care provider. Together you can decide if going is the right decision. You can share with them what’s happening with surges along with other behaviour you can see.
This might include;
- Can’t talk during surges
- Surges take all concentration
- Turning inward, most conversation stopping
- Surges are regular (coming at the same frequency) and around a minute in length
- Needing certain comfort measure to work through a surge – a noticeable difference in surges where comfort measure isn’t possible
Generally if a woman is questioning if it’s time to leave, then it’s too early. When she announces it’s time to go, it’s time to go! We have our instincts for a reason and if a woman decides that she would feel better at the hospital, or needs something that isn’t available at home (like a bath), then that needs to be listened to.
Feeling private, safe and unobserved in labour really helps for a woman to relax into her birthing, to go within and ride the waves of labour. We recommend our birthing mothers labour at home as long as they can, as labour will likely progress much better in her own environment. If the surges are building in intensity and getting closer together, this is a good sign that she is progressing well.
Once you leave home to go to hospital, there is much more neo-cortical stimulation, which can slow things down and take mum out of her instinctive state, so progressing at home without this stimulation for as long as she feels comfortable to do so, is ideal.
Don’t forget to have the bags packed and ready to go, so they can be grabbed by your birth support team on the way out the door!