Pregnancy: When to Go to the Hospital

Fetal kicks; hospital questions

Fetal Kick Count
Important, important, important – this can't be stressed enough! Always be aware of that baby inside of you and its movements. One way to keep track of the baby is through the fetal kick count. The fetal kick count is determined by counting how many times the baby kicks in two hours out of the whole day. Here's how it works. Pick a one-hour window, preferably when the baby is active and count how often the baby moves. Once you count 10 fetal kicks, look at your watch, and if it's been less than an hour, you're done for the day.

If you don't get 10 kicks in one hour, you can extend the time period to two hours. If you still don't get 10 kicks, it's probably a good idea to go into your doctor for an evaluation. The fetal kick count is simply a way for you to do a daily check of your baby's well-being in between doctor's visits. Studies have shown that when mothers don't get their kick counts tallied, it could make a difference in the outcome of the baby's welfare. As you get farther into the third trimester, you may feel as if the baby is taking longer to get its kick counts, but you should still be able to get them. At this point, the baby is moving and active, but not as much.

From the Doctor's Perspective...
Having said this, I always advise my patients that even if they get their kick counts, but perceive that something is wrong, they should come see me. I trust my patients' instincts and will have them come in for an evaluation anyway. Hey, it may look as if everything is going well with the pregnancy on paper, but if the mother feels something is wrong, it's worth respecting. A mother's intuition is usually right.

Get Thee to a Hospital
At any time close to your delivery date, if you think you're in labor, call your doctor or midwife. They will give you explicit instructions on what to do. If they tell you to go to the hospital, here is what will happen.

The hospital will be expecting you because the doctor will call ahead to alert them that you are en route. Go straight to the OB/GYN labor and delivery area where you will be evaluated. A labor and delivery nurse will check you first. She'll (or in some cases he'll) check your vital signs (blood pressure, temperature, pulse, and respiratory rate), and she will put external monitors on your abdomen. The monitors consist of a fetal heart monitor (a Doppler monitor), which measures the baby's heart rate, and a uterine contraction monitor (tocometer), which measures the duration and frequency of your contractions.

After about 15-20 minutes, the medical staff will be able to interpret the tracings from the monitor to determine if you are having real contractions, how many, and how closely spaced apart they are. If you're watching the monitor, you can see the needle trace your contraction pattern.

With the record that the fetal heart monitor provides, the caregivers can determine what the baby's condition is and his or her well-being. For example, if they see the baby's heart rate going down, they will want to figure out the cause immediately. All eyes are constantly watching that fetal monitor for signs of stress. If the baby is in distress, it may necessitate an immediate delivery or C-section.

Questions You'll Be Asked
At this point in your labor, the doctor will take over from the nurse and evaluate your condition. You'll be asked a number of questions, including the following: (I've included my thoughts on these questions in parentheses – sometimes, you just want to kill the hospital staff when you're in labor.)

  1. What is your chief complaint, or what brought you in today? (Like, duh! Resist the urge to tell the doctor or nurse to go jump. She truly needs to know if you're in pain and how much.)
  2. How many contractions are you having in an hour? (I told you they'd ask this question.)
  3. How long are they lasting? (Told ya this as well, so you might as well be prepared and pull out your handy-dandy sheet, thereby blowing them away with your preparation.
  4. Are you leaking any fluid? Did your bag of water break? (If the answer is "My God, I hope not," it didn't. You'll know if it breaks – the big gush of water similar to Niagara Falls is a telltale sign.)
  5. Are you bleeding? (Can't you tell? Look and see. Oh, you mean when I was at home...)
  6. Did you lose your mucous plug? (What is a mucous plug anyway? Oh, you mean that gross thing?)
  7. Are you feeling the baby move around all right? (I can't bloody well feel anything but baby at this point.)
  8. Are you feeling all right otherwise? Do you have any fever or other illnesses? (Who are they kidding with this question? At this point, you feel nothing but sick. In fact, you've never felt worse.)

excerpted from:

Reproduced from Absolute Beginner's Guide to Pregnancy, by John Adams and Marta Justak, by permission of Pearson Education. Copyright © 2005 by Que Publishing. Please visit Amazon to order your own copy.

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