When trying to avoid surgical birth, a woman must consider that the longer she is under the care of medical professionals, the more likely she is to experience intervention in her labor and birth. Most mothers and their partners head for the hospital at the first sign of labor. This is generally true because she has not received enough prenatal education to help her decide whether what she is feeling and seeing in her body is normal. People also learn about childbirth almost entirely from the media rather than from observing their mothers, friends and sisters. The media has successfully convinced the general public that childbirth progresses incredibly quickly and that the only remedy for the frequent, unforeseeable catastrophic events in birth is a crash cesarean. Women need to be re-educated about the trustworthiness of the physiologic birth. This education would ideally begin in elementary school but at the very least, pregnant women should know that they can do their early labor in the comfort of their home and that by taking responsibility for their early labor, they will positively affect the progress of their labor and decrease their overall risk for surgical birth.
Why Stay Home in Early Labor?
There is a recent study that showed how much more likely a woman is to have interventions in her labor and birth when she is admitted in early labor her birth facility (Source). This can also hold true when the midwife arrives at a homebirth too early. Early labor is easily disturbed by the presence of strangers, small talk, direction-giving and medical procedures. Always remember that women are mammals. A mammal must feel safe, private and unobserved to progress well in labor. Believe it or not, this is most important in the beginning or establishment of labor. The body will eventually be at a point of no return, where the labor must progress because it is difficult to stop the momentum created. At a later point in active labor, people talking and touching, lights and medical procedures are less disruptive than when a woman is in early labor.
Try to Rest in Your Own home if You Believe Labor is Starting
The beginning of labor with your first baby could mean that you won’t sleep much or at all between labor itself and care of a new baby for the next 2 to 3 nights or even longer. This is because first-time moms usually have longer early labor patterns and there is rarely a complete break until the baby is born. Frequently, subsequent pregnancies will bring regular contractions that resemble labor. These generally occur at the end of the day when the uterus is tired. This is called false labor sometimes because the contractions are more regular and more uncomfortable than Braxton-Hicks but it never progresses. A pregnant mom will say that she was sure that she was starting labor last night and woke up the next morning still pregnant! Either way, a woman losing sleep because she “might” be in labor is a huge mistake. Take a warm bath or shower, drink a glass of wine or take Benadryl and dive into bed. Use a bunch of pillows and maybe some white noise to relax.
We recently had a client come to the hospital planning a trial of labor after cesarean (TOLAC) who was one centimeter dilated when she first arrived on labor and delivery at about 10pm. She chose to leave the hospital and go to a nearby hotel with her doula for a while. They rested with a sleeping pill for several hours and when she returned, she was 6cm dilated at 5am. From that point, she made steady progress and had her Vaginal Birth after Cesarean at 10am.
Once You Can No Longer Rest, Call Your Doula to Come to Your Home
A doula can speak with the mother on the phone and help her decide where she is in her labor. Some women may be reassured and feel comfortable with just a phone call or the knowledge of her availability but if the woman feels frightened or anxious, she should ask her to come and hang out at her home. The doula will either help the mother relax and make labor move along or help her relax and rest because the doula can reassure her that labor is still early. A doula is most effective when she helps a woman get in the “zone” at home. Then the woman can comfortably make progress at her own pace because the doula is there to advise her when to go to the birthing facility.
Why Might a Woman Need to Contact Her Provider Sooner than Later?
- She is Very Anxious at Home. When a woman is afraid, her body interprets that fear as danger; a reason to not let the baby out. Being at home in labor makes some people very unsettled. She may find that her labor goes better from the very beginning if she is in her birth place surrounded by medical personnel. The medical supervision is very reassuring to some women.
- History of a Rapid Labor. Some women must HURRY or have a car birth!
- Pregnancy Risk Factors. Sometimes a woman requires closer monitoring in labor as with pre-eclampsia, twin gestation or insulin dependent gestational diabetes.
Being Safe at Home
A woman can feel assured that she and her baby are safe if the baby is moving, her water has not broken and she is not bleeding. If there are any concerns in these areas, it is appropriate to notify her provider.
- Baby is Moving. Every hour in labor, take a few minutes to feel the baby move. Fetal movement is the single best indicator of well-being. The movement may be less in labor but it should continue. A mother can help her baby continue to move by staying calm and well-fed. If a woman not feeling the baby move, it is most likely fine but she should be evaluated by her provider.
- No Active Bleeding. Bloody show is vaginal discharge with blood resulting from tiny capillaries in the cervix breaking as the cervix thins and opens. The amount of blood generally looks like mucous with blood in it or light spotting. The blood can be bright red or old brown in color. Women can have a heavy bloody show normally but she should report any bleeding that soaks a pad.
- Bag of Water is NOT Broken. The bag of water provides safety for the baby. When the bag of water is intact there is little concern about infection and compression of the umbilical cord. If the water does break, the woman should look at the color and consistency of the fluid and note whether the baby is moving. If the bag of water breaks when she is not in labor, there is no rush to get to the hospital or birth center. Her care provider will be interested in knowing that the water has broken and that her labor will begin soon. If the woman’s Group B strep culture was positive, she will need antibiotic treatment in the next few hours; if GBS was negative with no contractions, it is often fine to stay home and await an active labor pattern.
Helpful hint: Don’t feel the need to notify every person you know that you are in labor or that your water has broken. The pressure to deliver the baby quickly will be even greater In order to avoid the cascade of labor interventions, with a bunch of people waiting and texting for progress updates.
To Avoid the Cascade of Labor Interventions, Delay Admission Until Active Labor is Established. Here are some Strategies to Consider:
- Ask for a cervical exam in the provider’s office or in the hospital triage. Many women feel more comfortable laboring at home once they know for sure that labor is still early.
- If still in early labor, it may be possible to return home with a sleeping pill or a glass of wine. The woman will benefit from the additional rest and relaxation while awaiting active labor. There is no danger for the Mom or the baby from wine or sedative in early labor. Good progress in labor is often made when a woman can let go mentally and let her body take over. No amount of wine will keep a woman from recognizing a strong, active labor (but it might be more tolerable!)
- Even if labor is beginning to get active, a couple may still choose to delay walking into the hospital a bit by getting something to eat or taking a walk once they are near the birthing facility. It is a good idea to for the woman’s partner to get coffee and a sandwich on the way if they feel like they have a few extra minutes.
- The mother and her partner should feel comfortable going back home or to a local hotel if she is not in active labor. Defining early labor is difficult but if the woman’s cervix is still less than 4 cm and 90% effaced with contractions that are more than 5 minutes apart or less than 45 seconds long, she should consider leaving the labor and delivery unit even for an hour or two. The policies of the hospital are not conducive to the normal progress of labor especially when it is still early. Once a couple knows the baby is not delivering very quickly, they will probably feel confident to do a little more of the labor alone. Sometimes the client is uncomfortable going all the way home, so staying at a hotel would be a good compromise.
There is no additional comfort in the hospital, and many times much less comfort, especially for a woman who wants a physiologic birth. Interventions like IV’s, continuous fetal monitoring and frequent pelvic exams make labor much more uncomfortable and much less natural.