Timing Arrival to the Hospital During Labor 

Many clients hire doulas because they want to avoid unnecessary intervention, and we all know the best way to do this is to arrive at the hospital at the “right” time. A doula’s job is to balance the ever-evolving needs of the birthing family, their care provider, and our scope of practice. This includes taking care of ourselves as people and professionals navigating a complex system of conditions. Heading to the hospital is determined by three factors: contraction pattern, care provider recommendations, and most importantly when the birthing person feels ready to go.  

Let’s look at the doula’s role in these deciding factors.  

Doulas know that the best time to arrive at the hospital is Active Labor; for a first-time birthing person, this could look like contractions that are 4 minutes apart, lasting at least a minute for at least an hour, but probably more like 3 hours, if we are being honest. For a multip or a person who has given birth before, heading to the hospital might be as soon as they see a regular labor pattern or feel that first strong contraction. As a doula, your role is to pay attention to the contraction pattern by timing the contractions or having the partner time the contractions. One thing to look out for is that a fixation on timing contractions can actually be a distraction for you, the birthing person, and the other support people present. One way to avoid getting fixated on the clock is to time contractions for just 30 minutes to one hour. If the contractions are irregular or far apart, put the clock away and reassess when something changes in the labor pattern. A change might look like stronger, more intense contractions for the birthing person and a shift in demeanor like using lower, longer vocalizations to cope. 

Most importantly, you might notice a feeling within your own body as you feel pulled into your support role. Surprisingly, your own body and felt sense may be your most incredible tool as a doula. Felt sense is defined as a bodily awareness of a situation or person or event. When you are fully present, you will notice the shift in labor in how you relate to your client’s way of coping. In early labor, you may feel a little more detached, sitting back and observing your client; maybe you are snacking or taking a rest with one ear open. When things get more active, so do you. Your body pulls you in; you are also feeling the flow of oxytocin. How cool is that? 

Now, what if the contractions are 5-1-1 or 4-1-1, or 3-1-1? Does that mean it is time to head to the hospital? That depends on the other two factors: provider recommendations and client preferences.  

The causes and conditions that inform care providers include your client’s specific pregnancy and the hospital’s policy and procedures. Understanding this dynamic is key to helping your clients form realistic expectations for their birth. The doula’s role is to help your client prepare for a conversation with their provider that includes information about their pregnancy, birth options, and potential limitations. Hopefully, your client feels aligned with their provider, and if not, you can help your client explore any wiggle room; for example, regarding when to arrive if the water breaks or when labor is still in the early phase.

Finally, your client is ultimately the deciding factor. Your client may have planned to stay home as long as possible in early labor, and then they suddenly find themself having more anxiety than anticipated. Sometimes heading in a little early is just what they need to move their labor along. Other times, a client who planned to have an epidural when labor starts may find they’re coping well and feel better relaxing in the bathtub at home. The key here is to hold a spirit of flexibility that balances well with your client’s intentions. Our job as doulas is to help our clients understand what they are experiencing in their bodies, balancing their desires, current mood, and relevant medical circumstances. It may come as a relief to learn that you aren’t the deciding factor here but rather a receptive ally for helping your clients discern the ever-changing aspects of birthing a baby. 

About the Author

Kristy Zadrozny offers the only Childbirth and Postpartum Professional Association (CAPPA) Labor and Postpartum doula training in NYC. Weaving together her passions as a doula instructor, mindfulness teacher and Marriage and Family Therapist, Kristy will teach you how to apply basic mindfulness techniques, multicultural and systemic theory, to your personal life as well as your work as a professional doula. Kristy incorporates storytelling, humor, and interactive practices to create a fun, inspiring, and soulful workshop experience. You’ll walk away with a grounded and multifaceted approach to your doula work.

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