Andrea Lythgoe

Knowing when to go to the hospital reminds me a bit of the Goldilocks story.

If you go too early, you risk being sent back home or admitted and having more interventions.

If you go too late, you risk birthing on the side or the road or at least having a really difficult drive.

So when is just right? How do you find that sweet spot for you and your situation?

The 5-1-1

A good rule of thumb for most situations is 5-1-1:

• Contractions that are 5 minutes apart from the start of one to the start of another.
• Contractions that last 1 minute from start to end.
• The contraction pattern has been like that for an hour.

Other Considerations

The 5-1-1 Rule of Thumb assumes a couple things that may not be true for you. You’ll need to adjust to go sooner or later if:

• You live farther from the hospital and about 20-30 minutes. If you live a great distance from the hospital, you might consider coming closer and staying in a hotel or with a friend closer to the hospital until you’re at 5-1-1.
• There is a big storm or event in your area that might mean it takes longer to get there.
• Your water breaks and your care provider advises you to come in when that happens.
• You have a condition that means you need treatment or monitoring earlier. For example, if you need antibiotics for GBS.

On TV and in movies, people often rush to the hospital after 1 contraction, but in real life, most people spend the majority of early labor at home. Since early labor can last a while, you might feel anxious about what to do to fill that time. Here are some ideas:

Sleep/Rest

Because spontaneous labor often starts during the night, doing what you can to get sleep in between contractions is important so that you’re not too tired later in labor. If you can’t sleep, try to get some good body rest. Relaxation exercises and water can help with that.

• Sleep or nap if you can
• Rest in a well supported position
• Do relaxation exercises
• Take a shower
• Listen to an audiobook

Distract Yourself

Sometimes paying too much attention to your labor early in the process can cause something I like to call “Watched Pot Syndrome”. Best to stay occupied with things that divert your attention. If you can, just continue with whatever you would be doing normally. But if the contractions are mild and annoying, you can do other things, like:

• Bake cookies
• Make a meal
• Watch TV or a movie
• Go for a walk
• Meet up with a friend
• Spend time with your partner and/or older kids
• Write a letter to your baby about how you feel

Be Active

On the flip side, you can spend some time being active. Don’t exhaust yourself trying to make labor happen, but if you feel like it you can:

• Go for a walk
• Do some prenatal yoga
• Dance your heart out

Eat and Drink

Remember that early labor can be quite long. While hospitals sometimes ask patients not to eat or drink after they’re admitted, in early labor at home you can eat and drink if you’re hungry or thirsty.

Drinking throughout labor is a good way to stay hydrated, and clear fluids like juice and electrolyte drinks can help with that and provide a few nutrients and calories for the exertion of labor. Later in labor, it’s better to sip liquids often, but in early labor you can drink normally.

Don’t force yourself to eat if you’re not hungry, unless you’d like to see it again later in labor. But if you feel hungry, go ahead and eat any of these things:

• Whatever sounds good to you
• Any food in your fridge that isn’t moldy or suspect
• What you have handy in your pantry

Take Care of Business

While you don’t want to wear yourself down doing a whole lot of work in early labor, there’s no reason you can’t take care of a few things before your baby comes. Avoid driving yourself if the contractions are moderate or strong.

• Grab a few things at the grocery store
• Tidy up a bit
• Call your birth team
• Lay out your postpartum supplies
• Call into work and fill them in

Finalize Plans

If there is anything you need to do to be ready to go to your birth place or get your home ready for your birth, now is the time. Once contractions are well established you can:

• Arrange for care for older children and pets
• Pack any remaining things you’ll need for your birth place
• Set up anything you might need for a home birth

The days of a “labor coach” following someone around in labor with a stopwatch are, thankfully, over. It’s really not necessary to time every single contraction when you are in labor. It’s enough to time 5-10 contractions in a row to get a good idea of what’s going on, and then put away the timing for a few hours, or until you feel like something has changed. Paying too much attention to the timing constantly can cause watched pot syndrome.

Most people will use an app for timing labor contractions, there are many free ones available for all kinds of smartphones, and I’d suggest playing around with one or two of them to make sure you know how they work.

Most of the apps will simply ask you to tap when a contraction begins, and tap again when it ends. Which works great, if you always remember both. Some apps let you go back and edit with an estimated time if you forget. I think that’s a useful feature.

I also think it’s helpful if an app lets you pause the timing for a few hours without thinking you’re taking a REALLY long break between contractions.

Most of the apps will calculate two important things for you:

Frequency – (Sometimes called “interval”) this is how often the contractions are coming. It’s the time from the start of one to the start of another, and it’s the first thing most midwives, doctors or nurses will ask you when you say you’re in labor. The app will calculate the average interval in a series of contractions.

Duration – this is the time from the start of a contraction to the end. Again, the apps will calculate the average in a series so you get an overall idea.

Some of the apps will also let you rate an intensity for each contraction, but I honestly think that’s a bad idea and not very helpful.

Keep in mind that the timing doesn’t have to be exact, and slight variations are very, very normal. If you think the contractions are coming in pairs, read more about coupled contractions

If you don’t want to use an app, it’s fairly simple to do the same thing yourself, just write down start and stop times and do a little math. The key is remembering that when we talk about how far apart they are (frequency) it means start to start, not the break in between.

When you’re having a home birth, you might think there’s nothing to pack! But….there are things you can organize and buy to make for a better experience.

Many midwives will give you a list of the supplies they recommend, so I’m not going to try and cover those, but I do want to address some of the preparations you can do outside of the supplies for the birth itself.

Decide what you might want to wear in labor – big flowy nightgown? pants? a robe? Nothing?

Things to keep you occupied during early labor – Maybe a new movie or show you haven’t seen yet, baking a birthday cake for the new baby, making cookies for your birth team, knitting a baby blanket, doesn’t much matter as long as it keeps you busy and doesn’t take much mental or physical energy.

If there will be older siblings there, activities to keep them distracted can be useful as well. You might want to buy some inexpensive new things and keep them hidden away until the big day.

Similarly, make a plan for child care and pet care. You can have someone come and attend the birth with their primary role to support siblings, or you can have them go to a friend or family member’s home. Pets can also go somewhere or stay in another area as needed.

Make a sign for your door to let people know what’s happening and that they should stay away or quietly enter, whichever you prefer.

Food – You may want to have a super simple meal ready to go. Something someone can take from the freezer and throw in the oven after the baby is born that will be done an hour or so later. Your birth team may still be there, so plan extra to share. If it doesn’t get used, leftovers are great to have, too. You can also make and freeze postpartum meals or set up a system for friends and family to bring meals in for a while.

Snacks – Have some grab and go snacks that you can use in labor as needed. Crackers, granola bars, bowl of cereal etc.

Drinks – Sometimes drinks go over easier than food when you’re laboring in earnest. Have some full sugar electrolyte drinks, juices and premade smoothies on hand.

Last Minute To Do List – Some things can’t be done that far ahead. Make a list of the last minute things, like setting up the birth tub and putting the double bedding on the bed, so that nothing gets forgotten and you can just direct your support people to the list to know what needs to be done.

That’s all I have for now, what do you have to add?