Are you pregnant and wondering what actually happens when you get to the hospital in labor? I’m going to guess you are, especially if this is your first baby. The only reason I knew about OB triage and what was going to happen when I showed up was because I was a labor nurse! But I promise you, all of my friends felt a little bit unsure about the whole process too. So, if you’re curious or a little anxious too, you are definitely not alone.

So, just like I teach my friends, I’m going to teach you what happens when you head to the hospital too. I’m going to focus in on OB triage, because that is where about 95% of you will start the process!

Who is The Labor Mama and Why Am I Here?

Hey friend! I’m Lo – also known around here and social media as The Labor Mama. I’ve spent my nursing career in labor, delivery, and postpartum, have birthed 3 of my own babies, have labored thousands of mamas at the bedside, have taught hundreds of students online, and have even delivered a few speedy little babies with my bare hands (oops).

Here at TLM, I offer online birth classes to empower you the way everyone should be. The education + support I offer gives you experience, evidence, and empathy; you’re getting all of my years of “clinical” RN knowledge, beautifully combined with my real experiences as a mama and a nurse. These are not your hospital birth classes (those won’t do it, I promise), and honestly, birth doesn’t follow a textbook or protocol anyway – you need to know so much more than that.

If you want to connect with me further, head to Instagram. There are hundreds of thousands of us over there learning together daily.

What is OB Triage?

First things first, right? Let’s talk about OB triage. Because like I said, this is where the vast majority of mamas are going to start the process when they get to the hospital.

OB triage is where you go before you get admitted as an inpatient. An inpatient is someone who is staying at the hospital, and if you’re in labor, you won’t be going home until baby is here! When you get to the hopsital, unless it’s very clear that you are in labor and you need to stay, OB triage is where you will be assessed to see if it is the “real deal” or not. At work, a patient in this situation is called a “labor check.”

Some possible signs you are definitely in labor or will be directly admitted as an inpatient:

• Waters are obviously broken
• Urge to push and or you are bearing down
• Baby is crowning/visible on assessment
• Cervical exam that is > 6 cm with contractions present

This list is not all inclusive; there are many reasons you may need to stay! But typically, if there isn’t a very obvious sign that you are absolutely in labor, you will first be assessed in triage.

When should you go to OB triage?

There are so many reasons that you may want to head to OB triage. One of the most common is when you think you are in labor! Typically, the recommendation is that you head into the hopsital when your contractions are about 4 minutes apart, 1 minute long, and have been that way for at least 1 hour. This is also known as the 4-1-1 rule. Some providers feel more comfortable with you following a 5-1-1 rule (5 minutes apart), so you may hear that as well.

Things to consider when going to the hospital

Your contraction pattern is not the only way to know when to head in. The “right” time for you to go to the hospital can actually depend on a lot of things. Here are a few more things I’d encourage you to think about as well:

• your location
• how long your drive is
• what the weather is like
• what time of day/the commute will be like
• what your prior births were like
• what other signs of labor are present (bloody show, pressure, leaking of fluids)
• your GBS status and desire for abs
• what baby this is for you
• emotional signposts

The best way to figure out what is best for you is to chat through it with your provider at a prenatal appointment. Together, you can talk through all of this so you have a better picture of what to be paying attention to and when it may be best to head in. They can also go over the other times they’d like you to call them or head to the hospital (broken waters, bright red bleeding, vision changes or severe headache, etc). If you have a doula when the time comes, they are also a great resource here too.

Are you prepping and still need a birth plan template? I have one I’d love to share with you. You can snag your copy here.

What happens when you get to the hospital?

There are a few different things that will happen in OB triage. How quickly these are done or in what order that are done will be dependent on you and what your RN is seeing as they spend some time with you. It is also possible that you will need other assessments in triage. This process really is dynamic, and it will look a little different for everyone.

In general, here is a list of things you can expect in OB triage:

1. A 20+ minute monitoring session of baby and your contractions: This is often referred to as an NST, which stands for non-stress test. The RN will place continuous monitors on your belly (one for baby’s heart rate and one for contractions). They will then be able to assess your contraction pattern and how baby is doing with those contractions. Tip: This is often a time when the RN says “it’s time to lay down” – but if you’re in labor? That’s not so easy. But guess what? You can stand/use a ball at the bedside. Just say “I need to stand please;” this is totally okay.
2. A head to toe assessment: This includes things like vital signs, listening to your lungs, checking for swelling, etc.
3. The “interview:” Think of this like a “what’s going on?” conversation. Questions like those below can help the RN quickly establish a baseline of what’s going on.
   • Are you feeling baby move?
   • Any bleeding?
   • Do you think your waters have broken?
   • What are your contractions like?
4. Give a urine sample: The main things that are looked for are leukocytes, which can indicate infection, and protein, which could indicate a high blood pressure problem.
5. Have a cervical exam: An admitting cervical exam is really typical for a labor check, as this is often (but not always) the way the team can assess if you are truly in labor and/or should stay. Sometimes the RN does this, sometimes the doc or midwife does. I do teach and preach that a cervical exam should be an informed choice (always), but in this specific scenario, it is an important tool for establishing labor. You can head to this post for a lot more on cervical exams.

Want more about what happens at the hospital? Check out 11 Things to Know Before Your Hospital Birth.

Will you get sent home from the hospital?

There are a lot of things that go into deciding if you’re really in labor. Sometimes, it can be totally based on your behavior. Other times, the cervical exam indicates that this is the real deal. There can also be other things that come up in the triage assessment that say “yes, this mama needs to stay!” Sometimes, that initial NST also indicates a need for you to stick around or get some extra monitoring before the team feels right deciding. It is also possible that after they do the full admit assessment, the team feels that you are not in active labor and they send you home with instructions to return when something changes or intensifies.

I want to share one other common scenario with you too, so it does not feel unfamiliar if it happens. It is very normal to get to the OB unit, have them assess you and your cervix, and then they ask you to walk around/use the birthing ball for an hour or two and then they recheck your cervix. Typically, this is done if you are having contractions but your dilation is not very advanced (like 1-3 cm or so). When the team asks you to do this, they are wanting to see if your cervix is actively changing with your contractions. That is why they do the second cervical check after those 1-2 hours. At that time, they will usually then make the decision to send you home or to keep you!

Tips about going to OB triage

I wanted to share a couple last thoughts and tips with you about heading to the hospital. OB triage can feel exciting, scary, nerve-wracking or frustrating – there are a lot of feelings here! I was triaged (at the hopsital I worked at ?) and I was super mad at them for wasting my time because I knew I was in labor! But I also knew there was a process – and now you do too! Ok, here are those tips:

• If safe to do so, try laboring at home for as long as you are able to. Going to triage and getting admitted earlier on in the process can sometimes lead to extra interventions.
• If they aren’t totally sure whether or not you should stay, you can speak up and ask to go home and come back when things change. I know this feels weird, but like I just said, being home is often the best place for you until you are sure you are in active labor.
• It is very common to be triaged with your first baby (like my story), but triage might be a little less likely with subsequent babies. This is because that 2nd, 3rd, 4th time many mamas are very sure of when it’s real labor and when they get to the unit, it’s clear that it’s real. The best thing to do is always expect the OB triage process, but it’s possible that it may get skipped too.
• There is NO shame in going to triage and getting sent home. This happens all of the time – and it’s partly why triage exists! Don’t be embarrassed if it happens to you. It can be hard to figure this all out sometimes!

The takeaway on OB triage

It is very normal to have your birth story include at least one pass through OB triage. Unless you are a planned procedure or you are very obviously in labor or delivering, most hospitals will triage you before deciding whether or not you need to stay. This is a really normal part of the process and it can feel exciting, scary, and nerve-wracking. If you end up in triage, don’t be afraid to ask lots of questions and to speak up when you want to or need to. This is a chapter of your story and your voice matters!

Did you have to go through triage? How did it go? Let me know in the comments! xx – Lo

More resources for you to take a peek at:

• Comprehensive Birth Plan and Birth Priorities templates
• A complete Third Trimester Checklist
• The RN + mama of 3 Ultimate Packing List
• The Labor Mama online birthing classes for every family

A note: This post may include affiliate links. This means if you make a purchase after clicking a link, I will earn a small commission (thank you)! Rest assured, this comes at no additional cost to you. You can read TLM’s full disclosure here.