When do you recommend going to the hospital?

[teachinmamaof4]

I was reading on another message board about a lady who is searching for a doula (**edited to fix that..just caught my mistake. I had "mw" there insted of "doula"**). She's found one and had some questions. One thing she posted about got me thinking....

The doula of course will not do cervical checks but she knows the signs of transition. She has Mom stay home 1-2hrs at the beginning of transition.

Now I replied to her that that would concern me. With ALL of my labors, I stayed pretty quiet until I was actually pushing. I can't tell you when transition began b/c I didn't feel any different. Once I reached 7cm with all four babies, things went SUPER fast!! I was holding my baby 10-20 minutes later.

So...as a doula....how do you decided when to recommend to leave? If Mom wants to stay home as long as possible to avoid intervention when do you make the judgement call that it's TIME so you can help her follow thru with that wish?

Since I haven't attended any births other than my own I know I don't have a lot to go on as far as how other women labor. lol

I think I had another question but the baby just woke up and is screaming so my brain has just stopped functioning......LOL!

[motherwise]

uh, okay...I'm all for minimizing interventions by getting there as late as possible, but I don't think that staying home for 1-2 hrs in transition is very wise, especially with a multip. I also don't think it's very fair to moms to make them get in the car and drive somewhere during transition...hmmm.

For me, I tell my clients to stay home untill they are climbing the walls I generally follow the 3-2-1 rule of : when cx are 3 min apart, they've been like that for 2 hrs, they are 1 min long and mom can't talk through them, it's a good time to consider leaving for the hospital. When I am with my clients at home, which is almost always, I try to minimize focusing on timing the cx and just watch moms behavior. I do like to do some timing per hr, though and keep a mental tab because I have had clients talk through cx untill they were like 7cm! Not everyone follows the same rules, kwim? So I have a few principles I go by 1) 3-2-1 rule is a good starting point 2) Mom is always right. 3) Never underestimate a multip 3) A watched pot never boils 4) focus on mom

I think you kind of get a 'feel' for it, but there are always exceptions to the rule I always try to set it up with my clients prenatally, and ideally when we get to the hospital she is 6-7/100% just before transition, but usually into a great labor pattern to minimize interventions. I also prepare them for the possibility of things slowing down once you do get there, and what we can do to get re-focused. Seems to work great

[tlcdoula]

Quote:

Originally Posted by teachinmamaof4 I was reading on another message board about a lady who is searching for a mw. She's found one and had some questions. One thing she posted about got me thinking.... The doula of course will not do cervical checks but she knows the signs of transition. She has Mom stay home 1-2hrs at the beginning of transition. Now I replied to her that that would concern me. With ALL of my labors, I stayed pretty quiet until I was actually pushing. I can't tell you when transition began b/c I didn't feel any different. Once I reached 7cm with all four babies, things went SUPER fast!! I was holding my baby 10-20 minutes later. So...as a doula....how do you decided when to recommend to leave? If Mom wants to stay home as long as possible to avoid intervention when do you make the judgement call that it's TIME so you can help her follow thru with that wish? Since I haven't attended any births other than my own I know I don't have a lot to go on as far as how other women labor. lol I think I had another question but the baby just woke up and is screaming so my brain has just stopped functioning......LOL!

Typically I try not to ever tell a mom she must go, but once I did. I don't know why, but I just had that feeling in the pit of my stomach and knew we had a ride to the hospital so I gently coaxed mom into going. Thankfully she went and baby came very shortly after we arrived.

[Luv2bemommy]

I'm not sure when I would recommend.. I guess I would go with her OB/midwife's wishes.. I have always heard to, when you can't talk through your contractions or can't catch what someone is saying to you through them, then its time to go to the L&D.. I don't remember it really well but I think my midwife gave me the 411 thing, thats contrax every 4 mins, 1 min long for an hour then I should head over.. It might be 311 I dont remember. LOL

[DL]

Wow.... A LOT of my moms would've had their babies before 1-2 hrs after transition! Transition is a funny thing....she can jump from 7-10 and pushy in just 2 ctx's, or it can last a couple of hours. I've seen both! If a homebirth was not planned, I would NOT sit at home with a transitioning momma!

Typically.....I tell moms that they should not be able to walk or talk through ctx's that are 3-4 min. apart for 1 hour, with the majority of those lasting approx. 1 min. (So...I guess that would be 311-411 ). She should be exhibiting the "serious signpost". Meaning...no longer in a smiley, jokey mood, may be irritable at times, and needing to focus inward to cope (tuning in to herself).

With that said...there are ALWAYS exeptions to every rule. I had one mom who was really "jokey" right up to the beginning of transition; other moms are very serious by 4-5 cm. No matter what I'm thinking...if mom is adament about going....we go!! Mom is boss.

[Stacie]

I don't really recommend when to go to the hospital. During our prenatal visits we discuss when they feel they will want to go to the hospital. Some want to go when contractions are 5 minutes apart and have been for an hour. SOme want to try and labor longer at home. I never make a decision or give anything that is like advice or suggestions -- I like them to get informational sources for their decisions, like talking to their practitioner and seeing what he/she says, etc.

I am very cautious about this subject because to me it is one you could be held liable for, almost like giving medical advice .

[teachinmamaof4]

Thanks!

Quote:

I am very cautious about this subject because to me it is one you could be held liable for, almost like giving medical advice

Good point!

Quote:

I had one mom who was really "jokey" right up to the beginning of transition;

That's pretty much me. LOL! And even between pushing cntx with my last two I was able to smile/laugh a bit.

[~Tranquility~Doula]

I usually say you should go to the hospital when your gut tells you to. That way I can't get blamed for saying to go too early or too late.

[tlcdoula]

Quote:

Originally Posted by Stacie I am very cautious about this subject because to me it is one you could be held liable for, almost like giving medical advice .

I totally agree with this, because we are not medical people and we should not be diagnosing, but when we bring a mom in who is fully dilated then that also raises questions with the staff on whether we influenced them to stay home longer. It really is a catch 22 - you are damned if you do and damned if you don't

Like I said I only once told a mom we were going because I saw that changes in her, heard the grunts coming and even though she didn't want to go I just told her that I do not want to catch her baby.

It is such a fine line we walk.

[susan1]

Quote:

Originally Posted by Stacie I don't really recommend when to go to the hospital. During our prenatal visits we discuss when they feel they will want to go to the hospital. Some want to go when contractions are 5 minutes apart and have been for an hour. SOme want to try and labor longer at home. I never make a decision or give anything that is like advice or suggestions -- I like them to get informational sources for their decisions, like talking to their practitioner and seeing what he/she says, etc. I am very cautious about this subject because to me it is one you could be held liable for, almost like giving medical advice .

Good point.


Susan

[Tiffany]

Because it is a fine line or gray area, it is really like anything in life. It's a judgement call you make when you tell a mom one thing or another. You could be confronted with a situation where you know it's not in your scope to do or say something, but if it's an emergency you would do something to help.

I do think you're *safer* suggesting to a mom that she GO to the hospital, rather than suggesting she didn't. If you suggested she didn't go and she ended up having the baby at home, that would be a problem. If you get to the hospital too early--at least that's not too early. Anyways I just think it comes down to your own judgement in times of need.

[raspberrymoondoula]

i had a primip go from 8 cm to baby in 10 minutes once. i generally suggest we go when mom is clawing the walls so to speak lol i did have one occasion where we got there and she was dilated to like 2cm. we opted jsut to go back home. better safe than sorry. i do carry an emergency birth kit, just in case.

[delilahdr]

It depends on a lot of things. If it's a first time mom vs multip... I get details about previous birth experiences if any, and we bear those in mind.

What mom is hoping for- does she say "I really don't want to go in pushing..." or "I really want to get there just in time to have the baby, but do most of my labor at home?" Does she say, "I want to get there in plenty of time to get my GBS+ antibiotics, which are to be given within four hours of birth"? Or did she say, "I want to minimize interventions and opportunities for interventions." Does she live far from the hospital, or near? How supportive is her care provider?

All these things enter in. Mainly, I want us to be on the same page. My job is to help her get the birth she is hoping for, to the extent I have that power. So I keep her posted on what I observe. "Jane, I notice that you are a lot more serious now, and your contractions are getting longer and are over a minute long now, and you are beginning to vocalize during them, so probably you are well into active labor and getting close to transition. Is that how you feel too?"

If she says "Great, we better go", I say "Fine." if she says, let's wait a few more minutes until we're sure it's close to transition, I say, "fine". It is not my job to see that she gets wherever at any time!! But because she has told me when she is hoping to get there, I can tell her what I observe and let her call the shots. I am the hired help, offering to her what I observe- but it is up to her.

In prenatal appointments when someone is going to a hospital (vs a birth center or homebirth) I encourage them to aim not to be at the hospital before a minimum of 5 cm. To me, 5 cm is active labor and before that may not be- plenty of women walk around dilated to four and NOT in labor, and I have heard too many FTP C/S stories where dilation was arrested at 4cm... they make me want to scream, You were not even *IN* labor, if your labor was less than four and not progressing! That is prodromal labor, if you have contractions that don't cause cervical changes...! Sheesh. And really, I tell them to aim to be GREATER than 5cm if they can.

BUT I also say, if at any time you get a feeling like something is not right, or that you want to go, then we will go- I believe in your ability to give birth, and I believe in your ability to listen to your body and in your intuition about what is going on with your body. Nothing I can tell from OUTSIDE (or any other care provider, frankly) trumps what YOU can tell from INSIDE your body. Tell us what is going on with you... I will honor that!

[jkapheim]

My first client, first baby called at 930 am said my water broke (she was only 1 cm at midnight at hospital) I told her I will be there in 30-45 min. I got a call at 10:30 (as I was pulling in to her apartments) her father had taken her to hospital right away and she was complete and delivered at 1100.
So, I will probably advise someone to go with their instincts as her dad did. But, I was astonished that it went so fast.

[dynamicdoula]

I explain to my clients that the longer she stays home, the more she can eat at will, walk, sleep, poop, get in the tub, etc that she wants, and the less intervention she'll have to deal with at the hospital. I follow that up to say that when she feels safer at the hospital than at home, we leave- no questions asked.