In the movies, the water breaks, everyone flips out and the next thing you know mom’s being raced down a hospital corridor on a gurney. But in real life, especially for a first labor, this is very, very rarely the case. Still, expecting women and partners are often shocked to learn that they will be sent home if they “rush” into the hospital at the first contraction or even when the water breaks.
In the absence of any particular concerns—like a preexisting maternal health condition that might require close monitoring—women can do a lot of laboring at home.
The idea of mom being in actual real labor at home, unsupervised by medical personnel, can be a bit disconcerting to those of us raised with The Emergency Birth narrative pummeled into our heads. Partners in particular can feel a bit out of their depth and eager to get a professional on board. I completely understand that feeling.
But there are logical, evidence-based reasons for staying home until active labor has really kicked in.
Before I list them, a quick breakdown of “early” vs “active” labor: Early labor, which can last hours or days, is when the cervix dilates the first three centimeters– contractions can be anywhere from 5 to 30 minutes apart and less than a minute long. These contractions can be mild to difficult– they may be strong enough to require some pain-coping, or easy enough to mostly ignore.
Active labor starts when those contractions move to about 3-5 minutes apart and last about one minute a piece. This is the more intense part of labor when pain-coping techniques need to be put to use and the mother needs more focus. It can still last several to many hours for first time mothers; this is when she dilates the next 7 centimeters. So leaving for the hospital sometime in early to mid-active labor will still get you in to the hospital with plenty of time barring serious commuting distances, in which case talk to your care providers about the best protocol. Now onto the reasons for staying home:
Staying home in early labor….
1. ….reduces the chances of induction and c-section.
At some point it was decided that a woman should dilate about one centimeter per hour. If this were true, most women would labor for precisely ten hours and bam: baby in arms. But that doesn’t happen.
This expectation—based on averages—has led to an increased use of induction drugs to move along supposedly slow labors. But are they really slow? A first labor can be ten hours, but it can be longer, too. Or shorter. Also labors have a normal ebb and flow to them. They can slow down and speed up for any number of reasons.
The averages are useless to almost all of us. And yet they are used to determine how we are “progressing.” If you come in to the hospital in early labor there’s a chance you’ll be declared “failing to progress” and given induction drugs that, while very useful in some circumstances, are not without risks. Induced labors are twice as likely to result in a c-section.
2. …. helps labor progress.
The labor hormone oxytocin requires a little hand-holding to get going. Oxytocin is an incredible hormone, it’s what causes contractions but it’s also responsible for feelings of love and bonding. It’s also released during breastfeeding, orgasm, falling in love, when you give, when you get a massage, when you feel safe and when it’s dark.
Oxytocin is not a fan of adrenalin and logistical maneuverings. It likes intimacy, basically.
This is one reason so many labors start at night. OK, so given this physiological set-up, why “rush” to a fluorescently-lit hospital? Oxytocin will flow a lot faster if you’re at home, in bed, in the dark or in the bath or with someone you love. Once that hormone is really flowing, it’s hard to shut down. But early in labor, it’s a bit more fickle. So give it some nice cozy environment to get that show on the road. Get it ramped up to the point of no return, so you’re labor will be faster and more efficient once you do get to the hospital. You may even meet those one centimeter an hour standards, if you’ve let that oxytocin build up a whole lot.
3 …means you can eat and drink, which is actually good for you in labor.
Hospitals are lagging behind the research in this area. Some places are allowing food and drink in labor wards, but many still offer IVs or ice-chips. Women, especially first time mothers who may be laboring for about a day (or night) can use some sustenance. This is muscular work, after-all. Most women don’t want to eat during very hard active labor—sips of water or Gatorade usually do the trick. But in early labor you can snack all you want.
4 …..gives you more flexibility about pain-coping techniques.
Some hospitals have birthing tubs for labor, but many do not. And water has been shown as effective in reducing pain in labor as a shot of narcotics. Taking a nice long bath during painful contractions can be very relaxing—mentally and physically.
You may also be able to move around more, which is so helpful. Women are monitored for some stretch of time upon entering a birthing facility. This requires being on your back and strapped to various machines. Not so comfortable and not as efficient for labor—changing position is very useful for taking the edge of pain but also for *helping labor progress.” I encourage you to move around the hospital and try different positions on top of and alongside the hospital bed but it’s nice to get some of those moves well established at home first.
5. … means you’re less likely to be sent home.
Women do get sent home if they come in too soon. Some midwives and doctors will want to listen to you have a contraction over the phone. If you are able to talk through it, it’s probably not active labor and probably not time to come in.
The bottom line is that your labor will seem, and possibly even be, shorter if you stay home for the first stretch—this can be hours or even days if it’s a very long early labor. (Some labors take a long time to ramp up.) You can and should call your care-provider once you think labor has started, but you don’t necessarily have to “rush” to the hospital.
So what can you do during all this time? Ignore the labor for as long as possible is usually a good idea. Distract yourself or sleep if you can. Have your partner massage you, watch movies, eat good food, relax, go for a walk, stretch out on the couch with a good book. If contractions become more intense get in the shower, get in the bath or try moving into positions that feel good to you.