Many clients want guidance on when to go to hospital during labour, especially if they wish to do most of their labour at home or don’t want to get there too early. Doulas don’t talk people out of going to the hospital. However, many people chose to stay home longer if they are being supported and can be reassured that they are still early in the process.
One little trick is to ask the labouring person if they feel like eating. If the answer is yes, then it’s likely still early in the birth process. Most people will not feel like eating once they’re in active labour!
Sometimes we urge our clients to get going!
When to go to hospital:
- When labouring client feels safer/better there
- Any concern about pregnant person or baby
- Can’t walk or talk through sensations (combined with other signs in this list)
- Decrease in fetal movement
- 311 (prime) or 411 (multip); longer with a history of fast birth
- Lots of pressure / pushing sensations
- When waters release?
- Want pharmaceutical help coping with pain
- If we hear grunting at the end of a contraction or any sounds that indicate labour is progressing into stage-2 (a.k.a. bearing-down, pushing)
Before Leaving Home
- Provincial Health Card or Insurance docs
- Prenatal records with Birth Plan
- Prescription medications
- Have a snack or juice - good blood sugar
- Notice fetal movement
Tips for Hospital Arrival
- Need health card
Assessment / Triage in Birth Unit
- Health card, prenatal records & birth-plan
- Lots of questions; no one should ask / talk during contractions
- 3 questions:
- Labour pattern - show app
- Amniotic fluid - ROM? Colour?
- Is Baby moving normally?
- Cervical check - pee first
- Can wear own clothes but be ready for maternal physical assessment
- No need to lay on bed until staff is ready to do physical assessment immediately; stay in positions that feel good.
Warning signs (during labour or anytime in preg):
See your BWI Doula Training Manual or local health region’s list of warning signs. Below are some signs that doulas must know.
- Frank (flowing) red bleeding or clots - 911
- Sudden / severe / intense / sharp pain that doesn’t pass - 911
- Cord prolapse - 911
Seek medical attention today and in a timely manner but drive calmly:
- Decreased fetal movement = seek medical attention TODAY
- Visual disturbances
- Maternal fever
- Coloured/smelly waters; may = meconium, infection
Here is this cheat sheet as a downloadable PDF. Do you have tips to share on knowing when clients should go to the hospital?