When do I know when to go to the hospital?

When I am in labor?

when do I start paying attention to this?

If I think I'm feeling contractions,

how do you time contractions,

we wanna look at a picture of what's happening over time, right?

Because real labor is gonna get closer and closer together and stronger and stronger and stronger.

Motherhood is all consuming.

Having babies, nursing, feeling the fear of loving someone that much, and there's this baby on your chest, and boom, your entire life has changed.

It's a privilege of being your child's safest space and watching your heart walk around outside of your body.

The truth is.

I can be having the best time being a mom one minute, and then the next, I'm questioning all my life choices.

I'm Lo Mansfield, your host of the Lo and Behold podcast, mama of four Littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this.

And we're leaning into that truth here with the mix of real life and what the textbook says, expert Insights and practical applications.

Each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the lo and behold podcast.

We are going to answer a question today.

That might be one of the questions that I get asked the most by my students, the most in my Instagram dms or my TikTok messages, and that is the question of.

When do I know when to go to the hospital?

When I am in labor?

And I will be honest with you, and I will tell you that I understand this question and the anxiety around it so deeply because I have felt it four times myself.

This is such a, I don't wanna say confusing 'cause we're gonna break that apart here right now, but it's just one of these things where you wanna get it right, you know, maybe you wanna stay home for a long time 'cause you wanna end mitigate birth, so you don't wanna go home too.

You don't wanna go in too early.

Maybe you have really sper, so you don't wanna have a baby in the car.

Maybe you really want your epidural, and you're like, what if I get in there too late and I won't have time to get my epidural?

There are so many reasons for us to think I really wanna get this right and I wanna know what I can use to get this right.

Now if you haven't listened to it yet, I actually am going to tell you to stop.

I want you to pause this episode and I want you to go back to episode 37 and listen to that episode on the different types of contractions.

I intentionally kind of made these two episodes to be a little bit of a pair, so consider this like your part two, episode 37 is the part one, and it really is super valuable for you to listen to that.

Before you come in here and we answer this question, so if you have not listened to episode 37, pause, go listen to that one first and then come back and get started here with me.

I think it is really important that you understand all the types of contractions that I talk about in that episode, because you're gonna use all of that to make some of the decisions and go through some of the stuff that we're talking about here in this episode.

Now if you skip that episode, if you're refusing to go back and listen to it, you're still gonna pull a ton of good knowledge from this.

So obviously stick around.

But I really think when you put it all together, that's when you're gonna go, okay, deep breath.

Like I have a really good grasp on what my body is doing, what all of this.

Stuff it is doing might mean, and then I can use all of that to make decisions.

So I kind of feel like that episode 37 is like the part one of all the information you might need to then use the info I'm about to give you here and make you know the best decision for yourself.

All right, so let's just start with some really simple, like how do you time contractions, because ultimately, contraction, timing, frequency, that all is gonna play into when to go to the hospital, pretty much for all of us, right?

And so in theory, this is like a very simple.

I'm not even gonna say math equation, but we're simply paying attention to how long the contractions are, how far apart they are, and for how long we've been experiencing them.

Yeah.

There's words we use, frequency, duration, and then, their strength as well, which is not something that you're measuring at home, but essentially you're just paying attention to how long they are.

And so that's why there's all these contraction monitors and.

Press start, you know, some sort of app.

You press start, you let it run, you press stop at the end of it, it will tell you how long that contraction was.

Most of these, contraction apps are also gonna have you record some sort of strength, which you're just like self-reporting as, oh, that was mild, that was moderate, that was severe.

And then as you record contractions over time and you keep doing that start, stop and strength recording, eventually you're gonna get this pattern right and it's gonna show you they're eight minutes apart, nine minutes apart, 12, 7, 6, whatever.

And you'll start to see that in your app.

You can do this on paper as well.

Inside of my birth course of your body, your birth eye include actually a paper print off if you'd rather do that.

And then there's app suggestions and stuff too, of just different apps that people love and have used.

So you can find all of that in there.

You can find it online.

That stiffs really easy to track down.

But essentially that is how you are timing, contractions, frequency, duration, how long they've been going on, and what's their strength.

I will tell you, I know I already mentioned to you that strength is something that is self-reported, right?

when you come to the hospital as a triage nurse, we're gonna say, how strong are your contractions?

You know, we're gonna see what your vibe is and how you're feeling about 'em.

A nurse or a doctor, a provider, can also lay their hands on your belly and get kind of an indication of how strong things might feel.

This is not like a clinically perfect indication, but certainly with your hands, you can tell the difference between a really.

I'll say like really strong, maybe transition type contraction versus some of the milder ones that are happening when we're maybe in early labor and two to three centimeters long or something like that.

So you can also measure strength by hands and a provider you might see they do that and kind of lay their hands on your belly while they're admitting you or chatting with you.

And then ultimately, to truly know the strength of a contraction, you would actually have to use something called an IUPC, which is an intrauterine pressure catheter.

This is not really relevant to the conversation, but I'm just dropping that in your ear.

We get into that more inside of the course too, but it's an internal monitor and that is what can actually say this contraction.

Is this strong?

And that information can be used particularly like in an induction or an augmentation when Pitocin is being utilized or onboard.

And it can help us kind of turn up the Pitocin appropriately because we know exactly what's going on inside the uterine environment.

So we'll stop right there with that.

But that IUPC could be part of a labor conversation.

It's not used super commonly, but just tuck that away in case it pops up in your story.

All right, so that's a how to time contractions.

But what about just when do you start tracking, right?

Because if our ultimate question is when do we go to the hospital?

Then the next question is like, when do I start paying attention to this?

If I think I'm feeling contractions, I am someone who leans towards the idea of like ignore for as long as possible.

And that obviously comes with the caveat that like when everyone's healthy and everyone's well, and I'm.

Air quoting here, you're allowed to, to ignore and just let labor happen.

We don't have to think about something else or some other health thing that might be going on.

So if you're just laboring at home and all is well, I think that one of the best things we can do is just ignore it.

So don't go to pick up that tracker.

Don't start writing something down on your paper and just continue through your day.

Early labor is typically long.

Sometimes we're gonna run into false labor, prodromal labor, and those are things that I talk about in episode 37.

so if none of this is real, I don't see the point in really getting kind of really focused on, okay, I need to track, I need to pay attention.

That can lead to also some like anxiousness, anxiety, obviously excitement as well, which is not a bad thing, but sometimes that's a setup for us kind of wanting to intervene or do something too soon when really we're just in early labor.

We're contracting and that's kind of exciting and we can keep doing what we're doing while those hours pass.

So I lean towards the when to start tracking question.

My answer is kind of like when you have to pay attention, when your body is demanding that you pay attention, you're saying, okay, these are every few minutes and I am not able to ignore them.

Bake cookies, go on a walk.

Take a nap, whatever.

Then yeah, maybe it's time to start paying attention and start to look for the rhythms and patterns and frequencies, especially those that, the things that we were talking about in episode 37 and putting all of that together.

So let's say you are at a point where you're tracking, you're paying attention, and you're starting to ask the question of yourself, like.

This is the real thing.

I think this is the real thing.

I do want to know when should I go in, or maybe it's getting close or what, how do we kind of cross that barrier across that border?

And this is where I think one of the most common things that you're gonna hear initially is that 4 1 1 rule or the 5 1 1 rule.

And essentially what that means is that's going back to that frequency and duration I was talking about.

So that's what these numbers are gonna apply to.

But let's say for 4 1 1, what that means is that you are having contractions every four minutes and they're about one minute long.

And that's been happening for an hour.

So every four minutes, about one minute long, that's been happening for an hour, obviously.

5, 1, 1, 6, 1, 1, 3, 1, 1. It's all the same things.

We're just talking about a different duration, that different front number.

so essentially a lot of providers, if you're sitting in your prenatal appointment and you ask them, when should I come in?

They're gonna start here with one of these kind of 4, 1 1 or 5, 1, 1, and they'll, you know, they may fudge it a little, or you might be different than your best friend because of your history or something like that, but it's probably gonna be something like that, that I would say is your baseline.

So you go, okay, here is a frequency that often is indicative of.

Labor.

I don't even wanna say normal labor, active labor, but just like labor that we are paying attention to often is happening like this for this law.

Okay.

so that's like the immediate kind of bell ringing in the head.

And when you have that, when you're experiencing that, and when this is going on, you can go, okay.

Like, this feels pretty real.

This is the numbers that they told me to pay attention to.

Like, are we getting to that point?

And so I don't even, I don't wanna call that a step one because we might talk about this a little more later, but for some people they never even hit, you know, one of those 4 1 1 patterns and they are an active labor and they need to get in the car and go or whatever.

But overall, we will say like, that's kind of like step one or a baseline thing to think about and hold onto.

Is this the.

4 1, 1 5, 1 1, 1 of those patterns like that.

I've also seen this broken down, and this gets into kind of the other things to consider conversation, and we are getting there as well, but the idea of how far apart your contractions are relative to how far you live from your birth center or your hospital.

so what I mean by this is, let's say I live five minutes away and someone else lives 60 minutes away.

Well, I think that we have a different decision here.

Purely just based on the numbers and how far apart might be the contractions are, and so some people will say something and I'm.

You know, you can write this down.

I'm kind of loosely throwing this out here as a guideline, but like if you live 15 minutes away, so that in theory to me or closer is like I live close to the hospital, right?

Then you are someone who probably could wait until your contractions are a bit closer together, 5, 1, 1, maybe not for you.

So maybe more like three minutes apart, three to four minutes apart.

Like that's when you should think, oh, I need to get to the hospital.

I live pretty close.

I can wait until they're closer together.

30 minutes away, you may be more like that four minutes apart person, so that 4 1 1 applies to you 60 minutes away.

More like 5 1 1 might apply to you and 90 minutes away, which that is a long haul to get to a hospital birth center.

But I know some of you do have to drive that far sometimes simply to get to the biggest, you know, birthing hospital around you.

Maybe because you're going try and get to a VBAC friendly hospital around you, so you have a bit of a drive, whatever the reason might be.

Someone in that situation, it might be more like, Hey, if my contractions are six minutes apart.

Six, seven minutes apart, I should probably get on my way as well.

so you can see how something as simple as where you live and how far you need to drive should play into this as well.

And we're gonna come back to that.

'cause that's not the only other thing that should play into this decision too.

Another thing that I wanna talk about here though, with this 4 1 1 5 1, all these patterns is it's not just about numbers, right?

And so we wanna look at the other things.

That are changing in your body along with this rhythm.

So let's say this rhythm, these frequencies, they are getting closer together.

We're getting excited.

We're thinking it's real, but I also would be asking you how are things changing over time?

And so for some people they start out at, you know, contractions every five minutes apart, right away, and they sit there for hours and it's not changing, right?

The pressure's not increasing, nothing's changing.

This could actually be something like prodromal labor or false labor again, which we chat about in the prior episode 37, but.

Essentially we wanna look at a picture of what's happening over time, right?

Because real labor gets, typically is gonna get closer and closer together and stronger and stronger and stronger.

So that too ignore, you know, how far apart it is for a minute, but just that idea of, wow, this is increasing in intensity, this is increasing in that frequency.

That alone can be a good indicator that something real is going on and that we also need to be paying attention to.

So how are things changing over time?

Another thing I think is really important is the idea of changes in pressure.

And typically you're gonna notice more intense pressure when you're closer to the end, right?

Because baby's descending.

They're putting a lot of pressure on your anatomy down there, and you're gonna notice.

So is it likely that you're gonna blow all the way to the end of this and then think, oh my gosh, I have so much pressure, like how did I ignore it all the way up to this time?

Probably not.

It can happen.

But I do think he.

You might notice while you're home a little bit of change in pressure, and I can tell you personally speaking.

That even with my first baby, which I say it like that, you know that even with, because I didn't have any wisdom from the prior times that I was pulling forward, like with babies two, three, and four, even with my first baby, we were laboring at home, staying home, kind of doing some of this textbooky type stuff that I'm talking about.

Just, wanting to stay home, not wanting to go in.

We were at a point where we were tracking.

And I did hit a point where I had a contraction that felt different because of the pressure.

And I looked at Kelvin, my husband and I said, I think we need to go.

And he said, are you sure?

Like you're doing a great job.

You wanna be home.

He did all the right things right?

Because one of the things that a partner should do in that scenario is kind of, you know, explore things with you a little bit before they immediately just.

Do what you want or suggest something.

It was kind of like, you're safe, you're good.

And you know, he's stabilizing me.

I had another contraction and felt just this difference in pressure.

It was like the baby had moved down or something.

so I was combining that with, Hey, you know, I'm contracting every three to four minutes.

I have all this, this change in pressure, it's time to go.

And so I, it wasn't like my baby was imminently delivering all this sudden, we did get to the hospital.

I was about seven to eight centimeters, and you can, you can actually listen to this first birth story.

It's my very first episode.

So go back to episode one.

And you can hear this in and it's entirety.

But it, I do think that maybe I had made the change from Mike.

Active labor to more of a transition or that was coming.

And so I felt a change in pressure and that factored into my decision making.

So we have the, how are things changing over time?

I mentioned changes in pressure and then other signs of labor that your body might show you too.

And so that can be things like bloody show, which can come as the cervix is dilating, which obviously goes along with real labor too.

And then things like nausea, vomiting, shaking, often that stuff coincides with transition or when you're getting pretty far along.

So I would say if you're experiencing those things, it's probably definitely time to get in the car and go.

Probably pretty likely that most people won't wait until that point.

But certainly those are things to pay attention to.

So those are all some of the other things that your body might be doing, aside from just contracting, that can be an indicator of things are moving along here and it's.

Probably a good time to get going.

A few other things that are more, not like as specific to what the body's doing, but just to think about in your big, in the big picture is we already talked about how far you live from the hospital, right?

So I won't go through that whole thing again, but overall, you may wanna head in sooner than someone else.

The farther away you live, right?

So that's kind of an obvious thing, right?

Another big thing is what birth this is for you.

Because repeat births often move a lot quicker.

If you haven't heard it said, I'm gonna assume you probably have.

But second babies often, typically they come much faster than your first baby.

And third babies and fourth babies.

I have different theories about this.

'cause we used to say on the unit third babies would kind of be this like crapshoot and you thought, oh, they're gonna come so fast.

You know, she's had two prior really fast deliveries.

And then sometimes that third baby left us, like scratching our heads what's going on?

But in general, I think a consensus would be that second babies like to come pretty quickly, and so that's something to factor in, right?

Second baby, third baby, fourth baby probably gonna move faster than a first.

And so that's another thing that is part of your decision making process.

The other thing that's kind of part of that too is the history of your prior birth, right?

So not just first, second, third, fourth, fourth, but also do you have a history of quick labors or do you typically labor faster than normal?

So my first baby came in less than 10 hours from start to finish.

That is.

Kind of faster than normal.

And so I've assumed my second baby was likely going to come quickly as well based on both my history and the fact that it was my second baby.

And then I continue to assume I'm going to have fast labors 'cause I continue to have fast labors.

And so while none of those are absolutes, it's certainly can play into your decision making process, particularly with.

Babies beyond that first baby when you have kind of some stuff to go off of.

Another thing of course is, is your water broken?

It's not super common for your water to break to start labor.

That's only happening to about 10% of us.

And so if you're waiting for that to be your sign, I would tell you to stop waiting for that to be your sign and know all this other stuff that we're talking about.

' cause more than likely these are gonna be.

The things that indicate that labor is here and it's time to head in, but obviously if your water's broken at some point that indicates you're gonna head to the hospital or your birth center and you're gonna have your baby.

Another thing here is also GBS status, so I'm not going to get into the whole GBS conversation.

Essentially the GBS status, this is something that we check on around 36, 37 weeks prenatally.

It's a swab that's done, from vagina to rectum, and it's looking for the presence or like the colonization of GBS in the birth canal.

If you are GBS positive.

The recommendation is that you receive antibiotics to protect baby as they deliver through the birth canal.

From picking up any of that kind of like active colonization that's going on with the GBS.

There is a whole conversation there about antibiotics, what it means, what it means for you, how to decide why the recommendation exists, how it lowers risk.

I'm not going to have that.

It's fully outlined inside of the birth course of your body or birth.

And so you can definitely listen to that, or you can dig into that more.

But in general, if your GBS status is positive, when you are screened prenatally, then you want to get to the hospital early enough to receive two doses of antibiotics.

And what typically happens is you get there and.

As soon as you have an IV started, 'cause this is given iv, we go ahead and we give you your first dose and then usually depending on the medication, but most commonly your next dose comes about four hours later.

So you, if you are GBS positive, you want the antibiotics and you want that protection from them, then you are going to want to be at the hospital like four to five hours before your baby's born, which I understand, you know.

Babies aren't pizzas and you can't just order them at the right time, but that would factor into decision making is hopefully getting there to receive both of those before they're born.

The last thing I would say is the emotional signpost can be another indicator of what's going on in how things are changing, and I actually mentioned these in that part one episode 37 I mentioned.

But essentially this is the way your behavior is going to change as you move through labor and as things get more real.

And so this is an especially cool topic for your birth partner to know and be aware of as well.

I actually have a quick episode on an episode 10 where I go through what these signposts are, how they kind of relate to the stages of labor, and just give you like a really simple way to.

Look at them and be aware of them and use them to make decisions.

So you might notice some emotional changes in yourself.

Your birth partner might notice them.

Kelvin, my husband, going back to some of our birth stores has definitely noticed changes in me and they've been pretty.

Perfectly indicative of my like movement through the stages of labor.

So it's always been really cool for us to reflect back and say, oh, like we went to the hospital right at that point where you were behaving in X, Y, Z way and that indicated that you were in active labor transition.

Like it all.

Makes sense.

And so obviously there's some hindsight there and we always got to look back and reflect and see how all the pieces went together, but it was really, it's always been really cool to see how that has tracked in all of my births.

So emotional signposts, another way for both of you to pay attention to what's going on and particularly nice for that birth partner because they don't know what you're feeling physically, right.

But this is a way they can kind of be present and be paying attention.

Okay, so that's what I have for you.

Did we answer the when to go to the hospital question?

I'm not sure, but ultimately what I think we've done is I want you to see that you should have a, like a more holistic, fuller picture.

Of how to answer this question now, especially if you've listened to 37 and now this one is that you can see there's different types of contractions and paying attention to how often they're happening and how strong they're like.

All of that matters because you know the answer you're gonna get most often is oh 4, 1, 1 5, 1 1.

That's when you go in.

But there is a lot of nuance there, I think that you'll find as you move through your birth or any birth that you have, is that that isn't always enough.

And I think that's why so many people still continue to feel really anxious about how to answer this question or when to go in is because 4 0 1 1 or 5 1 1 leaves.

Leaves you with, it's leaves you lacking, for lack of a better word, it isn't enough information, I don't think, and I've never felt to make this decision to feel really confident in it.

So ultimately, those numbers can help, right?

But I don't think they're everything and you need more.

And I also wanna end with this idea of, you might get it wrong, and that's okay.

That's what OB triage exists for.

And I actually.

Remember that I ended part one in a similar way because I think there's a lot of anxiety around, I don't wanna go in too early and they send me home.

I don't wanna be annoying.

I don't wanna cause a problem, like we've said, also, you know, I don't wanna go in too late and have something, you know, miss something or miss my epidural or have a baby in the car.

So we're just, don't wanna get this wrong.

But I think it's important to say we might and that's okay.

That's, that's part of birth, right?

Birth is.

Predictably unpredictable, I like to say.

And so sometimes we're gonna get this wrong and maybe they're too early or maybe they're too late and we're gonna adjust.

And all of your education and all the stuff you've done is gonna help you understand what's going on, why decisions are being made, why what is happening is happening, and then you're gonna be able to move forward from there.

So ultimately, don't let the fear of getting this wrong keep you ever from going in and getting some clarity and some support, or making you feel like you have to stay home 'cause you're bothering someone.

I would just never want that to be your situation and your story.

OB Triage exists to support patients in labor or to send them home until they come back in labor.

And so feel free to utilize that resource when you are unsure.

Go in, get the reassurance that you might need, and then go from there.

Thank you so much for listening to the Lo and Behold podcast.

I hope there was something for you in today's episode that made you think, made you laugh or made you feel seen.

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