Written by Beverley Hinton, NCT Doula.
When should I go to hospital, is a question that nearly every pregnant woman and her partner will worry over as the big day draws nearer (or when should I call the midwife if a home birth is planned!).
Women often worry that they will arrive at the hospital, only to be told they are not in labour and should go home, or that they will wait at home for too long and have their baby before it is possible to get to the hospital.
It is normally recommended that women go to hospital when they reach active labour, and try to labour at home before then. This phase before active labour is called the latent phase. When I work with a woman and her partner, I try to help them prepare for latent labour by talking through what they might experience during this stage. The things we discuss are not scientific, or fact based, they are stories and knowledge gained by reading birth preparation books, watching women labour and birth, and sharing stories with other doulas. I always say that most importantly, a woman should follow her instinct. If she feels she needs to go to hospital for any reason then she should go immediately. I also recommend that a woman phones her midwife to discuss what has been happening so far, so that she can first be reassured that staying at home is the best thing to do. If all is well, and it has been decided that staying at home is the best idea, then navigation of the latent phase can begin!
The first thing to understand is that the latent phase can be long. It can last an hour or so, or up to a few days! Because of this possibility, it is important to carry on as normal. Sometimes people feel so excited that labour has eventually begun, that they cosy up in their labouring environment, curtains drawn, candles burning, hypnobirthing CD playing, and after four or five hours they feel that it must be time to go to hospital. The best thing to do if you feel you might have entered into the latent phase of labour is to carry on as normal. Get up, do your jobs, go for a walk, rest when necessary and eat and drink as normal. It can be useful to chat in advance with your partner to discuss a list of things you might want to do, such as watch a funny or romantic film, make a dinner to put in the freezer or do a jigsaw. If you are finding it hard to concentrate on one thing, then it can be useful to have a little circuit to do, for example 30 minutes resting followed by a short walk, followed by leaning over the birth ball watching TV and then back for a rest.
Secondly, the latent phase of labour can be powerful. Women often worry that once contractions become strong they must go to hospital, but this is not always the case. Contractions can seem strong from the onset of the latent phase, or become stronger as the phase progresses. If the woman finds the contractions powerful, then it is important to have comfort measures available to support her. A TENs machine is a great source of comfort to many women. This should be put on towards the beginning of labour, and left on a low setting to gently stimulate the body’s natural endorphin (painkiller) release. Other comfort measures include massage, a hot water bottle on the back and front, relaxing aromatherapy oils, supported lying position or upright positions. Breathing techniques can also be used to help the woman relax through the sensations. A hot bath or shower often offers a break from powerful contractions, and staying at home where she feels safe, and is in familiar surroundings will make getting through this phase much more manageable.
The difference between the contractions of the latent phase and those of active labour is that during the latent phase, in between the contractions, the woman will return to herself and be able to continue a conversation. She might close her eyes and sigh gently or rock on the birth ball during a contraction, but once it has passed she will look up at her partner for reassurance, or to ask for something. When active labour has begun, women will normally not come back to themselves after each contraction. They will stay in the ‘labour zone’ with eyes shut. They will find it hard to communicate and will often wave an arm or grunt as a means of response, or may not respond at all. This is a good sign that she has turned off her thinking brain and is now using the more primitive brain that labours well, but does not talk! It is also a sign that active labour has probably been reached.
The latent phase of labour is the time when a woman’s body is deciding whether it should go into labour or not. It is having a try at labour, but if things don’t feel right, then it might decide not to continue and contractions will cease. Once the active phase is reached, it is like a wave that carries the woman off. She will enter her labouring zone, and it is obvious to her partner that things have changed. She will probably have moved herself to a safe location, for example, the bathroom, which is small and enclosed, or the bedroom where they can snuggle up in the dark and warm. Women often begin to make routine-like movements such as rocking or moaning rhythmically, and usually stop replying if questioned. This is a good indication that labour is progressing.. It is at this point, once the woman has put herself into her safe place that the candles, music and hypnobirthing can come out! These will help the woman to renew her strength and to relax deep inside herself allowing her mind to turn off and move towards active labour! If it is a second or subsequent baby, then probably you might consider heading to hospital reasonably soon, but if it is a first baby then there is most likely time to enjoy the safety and comfort of home. Partners can note the routine movements and sounds the woman is making, and the comfort items that are helping her, and then be ready to set these up at the hospital to create her safe environment again.
The latent phase can be long, and looking at labour as a sequence of ever-strengthening contractions can be a scary prospect. With this mind-set, women often worry that if latent labour has been long, and contractions have felt powerful, she will not be able to cope with the active labour phase, which they imagine will be much harder.
The reality though, in my experience, is that the latent phase is the most challenging to get through. Not because it is always painful, but because your brain has not decided whether to enter the labouring zone, so the woman must think for herself what she will do during this phase. It is this emotional challenge that she finds difficult. If allowed, her mind will wander, looking ahead and worrying about how long it might take and how painful it might be. She can become bored, disappointed, frustrated or hopeless if not well supported. Once the body has made the decision to enter into active labour, then the woman’s primitive brain takes over. She enters the labouring zone, and if she feels safe and supported, her thinking brain will turn off, and her primitive brain takes over. She no longer has to think about what to do, and if undisturbed will enter a daydream-like state in which time will no longer be important.
The latent phase can be a wonderful time. It is a time when a couple can work together to get the woman through. I see the woman and her partner becoming closer, and falling into a rhythm of working together, the woman beginning to rely on her partner more and more.
Hopefully if a woman and her partner are able to navigate the latent phase together, using cues from the woman’s behaviour to guide them as to where they are on their journey, then they will be able to relax and enjoy this early stage of labour. If they feel more comfortable about what to expect, and what signs might indicate that the woman has entered into active labour, and they need to think about going to hospital, then they can focus on each other. They can concentrate on creating a safe, supportive, loving place for the woman to labour in, instead of timing contractions on the iPhone, trying to make sure they don’t miss the correct moment to go to hospital.