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Pregnancy: When to Go to the Hospital

pregnant woman waking husband for hospital
Fake Contractions (Braxton Hicks)
Most women will experience "fake" contractions sometime in their pregnancy – not all women, but most. Fake contractions, more commonly known as Braxton Hicks contractions, are real, honest-to-goodness contractions of the uterus. They look real on a uterine contraction monitor. They feel real. But they're not called real. The difference being that they are irregular contractions, and they don't cause your body to go into labor or your cervix to dilate. True labor is contractions with cervical changes.

Usually, you'll start feeling Braxton Hicks contractions sometime in the second trimester, getting more pronounced the farther along you go in pregnancy. They can feel like a tightening of the stomach, as your abdomen (or rather the uterus) gets hard for no reason. You'll know it when you feel it. If you touch the stomach with your hand while one of these contractions is occurring, it feels like a tight drumhead. There is no way to control the contraction. It will usually pass in a few seconds. In the meantime, just breathe your way through it. Or try changing your activity or drinking some water to alleviate the tightness.

Braxton Hicks contractions can be triggered by something as simple as the baby moving or someone merely touching your stomach. Although they are often called practice contractions, they don't actually play a part in dilating or effacing the cervix, like real contractions do.

Typically, Braxton Hicks contractions are not especially painful, but more uncomfortable than anything. These contractions may vary from a few seconds to half a minute, and you can't predict when they will occur. You may have a run of three or four contractions an hour, and then they will just stop for no reason. They might not come back for weeks, or they could come back an hour later. Go figure.

From the Doctor's Perspective...
Since people have different pain thresholds, some women do describe Braxton Hicks as being very painful. When I ask a first-time mother to rate the pain, she may say it's a "10." Because she hasn't experienced labor yet, that pain is indeed a 10 to her. Usually, when that same woman goes into labor, she'll say that it hurts worse than Braxton Hicks, ergo the pain is now off the charts. Be aware that other factors may contribute to the intensity of your perception of "painful" contractions, anxiety being one of those conditions. Try to rest and minimize the stress in your life.

Having said that, the caveat is to always consult your care provider if you're in extreme pain. The pain could be coming from another source, like the bladder, yet feel as if it's in the same location as the uterus. Or it could be coming from a pulled muscle or a gastrointestinal problem and needs to be investigated further. Don't live with unnecessary pain. Make sure that nothing else is wrong.

Real Contractions
In comparison to Braxton Hicks contractions, real contractions are regular in duration and regular in their interval spacing. As labor progresses, they get more intense and last longer. For example, they may start off lasting a few seconds and occurring 10 minutes apart, but every hour they get closer and closer together and last longer. On average, a real contraction lasts from 30 seconds to one minute each. Typically, you'll start off with four to six contractions in one hour. When you have four to six contractions for two hours in a row, it's time to call the doctor. Chances are good that you're in labor!

Real contractions can be anything from a dull ache and a tightening of the uterus (à la Braxton Hicks) to all-out, excruciating, gut-wrenching, eye-popping pain. Believe me when I say that you'll know it's the real thing when you experience them.

When contractions start, you should time them with a stopwatch to see how long they last. Then time them again to see how far apart they are. The doctors, nurses, and hospital personnel will all ask you these questions. "How far apart are they? How long do they last?" Get your partner to keep a chart of the contractions. This will often help the doctor determine over the phone if you need to get to a hospital, and if you're close to delivery. Nobody wants you to have that baby in the car, least of all your partner.

Be prepared for the contractions to change quickly, meaning that they can go from easy and manageable pain to over-the-top and unremitting, wrenching pain in what seems like an instant. When this happens, it means that the baby is progressing down the birth canal.

When Minutes Count
With my second pregnancy, I decided that I was an expert. After all, my first baby had been born one year earlier so I felt as if I knew everything there was to know. Babies took time to be delivered, didn't they? When the contractions started, I calmly informed my husband that I was going to "get clean" for the baby (and the doctor), so I stepped into the shower, figuring I had hours to go before delivery. Within minutes, I was doubled over in pain. My husband screamed at me to get out of the shower, which I did post haste. We barely made it to the hospital before I delivered a baby boy (thankfully in a room). My husband missed the delivery – both he and the doctor were still in the process of walking in from the parking lot. Time from actual first contraction to delivery – 47 minutes. Moral of the story: Make sure it's a quickie – shower, that is.

Other Symptoms of Impending Birth
Besides the obvious contractions, you may feel increasing pain or pressure on the lower back, as well as the abdomen, as the baby moves down into the birth canal and into position. You might also think you need to have a bowel movement when you don't really have to go to the bathroom, or you could feel like pushing (don't go with that feeling quite yet).

Emotionally and mentally, you may feel distracted or distraught and unable to focus. You might be supersensitive emotionally and feel like crying a lot. You could also experience extreme fatigue, or the opposite, tons of energy. Swings of emotions can be attributed to many reasons. They could be caused by a lack of sleep, your diet not being as good as it is normally, stress, or even the fear of the unknown (for example, a first-time mother might be worried about the upcoming pain of labor and delivery).

You could act differently for any number of reasons or just from the daily problems of living. Most of the time, these feelings are quite normal. Usually, what helps is to have a good conversation with someone whom you trust and love who cares about you. Talk to that person and ask him/her to listen. A sympathetic ear goes a long way.

With questions specific to pain, you should talk to your physician or midwife so that your fears can be allayed. In modern obstetrics, the overwhelming majority of women will receive some form of anesthesia, so the pain of labor and delivery is much less intensified and not a cause for concern.

From a Mother Who Has Been There...
The worst time for me was always right before the baby came. I got tense, irritable, and asked my doctor nonstop when the baby was coming. I worried about everything from whether the house was clean to how I'd handle my in-laws to what to pack for the hospital. I worried about my body – would I be "fat" forever, would I still be attractive and normal after the baby was born, would my breasts sag, would I have stretch marks, etc. What I didn't do was stop to take a breath and calm down. I'd strongly advise that. Just an FYI – once the baby is born, all those pressures and tension are gone magically and instantly. It's a wonderful thing.

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.)
Answers to the above Questions (or Why They Are Important)
Believe it or not, the medical personnel do have valid reasons for asking you all these questions. Here is the information they can glean from your answers.
  1. The doctor wants to rule out any problems or potential complications that could occur with the labor and delivery. Be very specific about everything that has happened to you thus far.
  2. The number of contractions will give them some clue about how close you are to delivery.
  3. Again, they will be able to tell if you're close to delivery. Labor and delivery can be straightforward or extremely complicated. The doctor is always looking for any potential signs of problems.
  4. Sometimes, you may think you've broken your bag of water, but you haven't. You might just have urine leaking out from the pressure, which is normal. When most women break their bag of water, it's an obvious thing. You'll look down and a pool of water will be under you, and you can't do a thing to stop it. However, some women only leak a small amount of fluid when their water breaks. This might occur in cases where the amniotic fluid volume was low before the bag broke, or the baby's head could have sealed off the leakage and most of the fluid is still behind the baby in the uterus. It's important to know if the bag of water has broken because there is an increased risk for infection and there is less fluid cushioning the baby inside the uterus. Usually, if the water has broken, the doctor will deliver the baby within one to two days.
  5. Bleeding might indicate a problem with the placenta or in most cases, if the bleeding is minor, it could just indicate dilation of the cervix.
  6. The mucous plug sort of acts like a loose cork in the neck of a bottle, the neck of the bottle being the cervix in this case. As the cervix dilates or softens, the cork tends to fall out. What does it look like? Doctors say it kind of looks like snot. It's mucousy, thick and/or runny, stringy, and sometimes pink-tinged. Some women mistake it for their bag of water breaking.
  7. Usually, there is a perception that the baby is moving around less than it was, which is probably due to the fact that there is less available room for the baby. This is because the amniotic fluid, which keeps the uterus from squeezing the baby too tightly, tends to decrease towards your due date.
Horrors – If You're Not in Labor
After you and the baby have received a thorough evaluation by the doctors and nurses, and it is determined that you are doing fine, but you're not in labor, then you will likely be sent home and given directions as to when to come back. OK, this may be the lowest point in your whole life. All that excitement and phone calls to assorted friends and family for nothing. Go home with your tail between your legs and rest up, because be assured that you'll be going back to the hospital sooner or later.

Occasionally, if you're just on the verge of going into labor, the doctor may advise you to stay in the hospital and walk for several hours, up and down the hallways, hoping that it will induce labor. Often, physical activity and gravity (and the baby's head bouncing up and down on the cervix) can push a woman over the edge into labor if she is on the verge. After a period of walking, the doctor will recheck your cervix and see if you've made any further progress. If you have, you'll be admitted into the hospital with a diagnosis of labor, and eventually a baby should make its appearance.

If your cervix hasn't changed, then the medical personnel feel more reassured that you won't deliver in the very near future (i.e., on the highway going home), so they'll send you home. Let's face it – your doctor would feel pretty bad if she turned on the news and found out you'd delivered on the highway. Other factors that may cause a doctor to follow this "walking" procedure are if the patient lives far away (ergo, might not make it back in time) or if she's had several babies in the past (subsequent births tend to go quickly, leaving no time for the drive back and forth).

If you are sent home, the doctor will advise you to continue monitoring the progress of your labor. Here are a few precautions to watch out for:

If any of these conditions occur, call the hospital or your doctor for advice, or simply go back to the hospital. Otherwise, if you're not having any of these symptoms, try to get some rest and be sure to mention your experience to your own doctor at your next appointment (assuming that he wasn't at the hospital).

From the Doctor's Perspective...
When I asked John how common false labor was? His response was a hearty laugh and this insightful message, "Pretty darn common!" (OK, he used a slightly more forceful expletive.)

From a Frustrated Mother's Perspective...
I walked for hours once in that scary hospital gown and those stupid pieces of cardboard they call slippers. Up and down the hallway, past the women who were having babies, up and down, talking to the relatives, up and down, with nothing ever happening. I felt like some kind of freak who didn't have enough sense to get the labor going. Needless to say, I was pissed when nothing happened, and I was sent home.

The Need to Clean
There's an old myth that if you clean your house or scrub the floors, you'll go into labor. If you feel like cleaning the house and getting it in order, by all means, go ahead and do so. While some people may say it doesn't work, my experience is that it is a great indicator of an impending birth. Hey, if you don't go into labor, you'll still have a clean house and feel better. No loss there! Mr. Clean would be proud.

What to Pack – Just in Case
Packing a suitcase for the hospital is not as tricky as you might think. After all, if all goes well, your stay there will be limited to a day or two. You'll probably be wearing those god-awful gowns most of the time, at least during the labor and delivery, which doesn't leave a lot of room for any other clothes. For a detailed list from an experienced mom, watch this video from CloudMom for tips and ideas to make packing easier.

For the Mother
First, pack the amenities: personal soap (if you want it), shampoo, toothpaste, toothbrush, makeup, brush, comb, whatever – the things from home that make you feel like yourself. Second, you'll need a gown of some sort, a robe, and slippers (or sandals if you'd prefer) since you will probably be spending one night there, and really, really don't want to wear their version of a nightgown anymore. If you're nursing, make sure that you pack a nursing bra and a gown that is easily opened or accessible to the baby. If you're not nursing, pack a bra that fit you while you were pregnant, making sure that it has lots of support. The milk will still come in, and your breasts will feel very, very heavy.

You'll need some kind of outfit to wear home. Believe it or not, you won't be wearing your favorite prepregnancy clothes when you leave the hospital. Most of that weight will still be with you for a while, so you might want to wear a loose fitting dress or even maternity pants and tops. That will probably rub you the wrong way, because no one wants to wear maternity clothes after delivery; however, ya gotta do what ya gotta do. You need to be clad in something to escape the hospital confines.

For the Baby
Packing for the baby is a lot more fun than packing for you. If you know the sex, you can obviously choose something that is a suitable color (if you put boys in pink, don't be offended when they're mistaken for girls). It's good to have some kind of gown or sleeper set for the baby. The hospital will supply you with diapers until you leave. An undershirt is a necessity, and they're so cute and tiny. Booties are fun. Forget shoes – babies at that age don't do shoes. If the weather is bad, make sure you have the appropriate attire to wrap the baby in (what's that bundling thing called?). It's always good to bring some baby blankets to wrap them up like a baked potato.

Most importantly, take a car seat. You can't take the baby from the hospital without one. Oh, and don't forget your camera or video cam. By the way, if your husband or significant other is even marginally competent, he can bring anything you've forgotten to the hospital.

The Absolute Minimum
When your first baby's birth is imminent, every little change in your body becomes a "real" (at least in your mind) symptom of birth to an expectant mother. In truth, there are some pretty decisive ways to tell whether or not you're in labor. If you match any or all of the criteria listed in this chapter, then you should be having a baby fairly soon.

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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