Roots to life - When should I go to hospital?
Marianne Theuma irons out doubts on the best time to go to hospital when having a baby
Over the last weeks, we have seen what to expect at the onset of labour. In some birth experiences, the mother has a sure sign, for example, the rupture of her waters or perhaps some red blood coming out of her vagina. Both of these are a sure indication that the mother needs to go to hospital to be checked by a midwife and decisions are accordingly taken thereafter. Some mothers do not go through either of these experiences. Some even miss the "show", that is, the pinkish mucus plug that lies in the cervix as a protection during pregnancy, and falls when the muscles in the cervix start to soften, before labour begins. Though a sign that her body has started to work, the show is not a sign that the baby is coming soon. This could happen even a week or more before the baby comes. So waiting for further signs in the mother's body would be a good idea in this case.
If there is no tangible sign, the mother may be at a loss when is the right time for her to go to hospital. Ideally, the mother should not go too early because being in her own surroundings in early labour helps her tremendously. But for obvious reasons, she should neither go too late! In more practical terms, for a first-time mother, when contractions are one minute long, five minutes apart and strong, that will be two to three hours before baby comes. Mothers who have had babies before, know what strong contractions feel like, and usually go by what their body tells them. In a place like Malta with our short distances, a couple of hours before a baby comes is ideal; it is enough time for the mother to settle down in her new hospital surroundings and psychologically feel safe enough to resume having the baby.
It is interesting to point out that this is an extra concern felt only by modern birthing women. When births used to happen in the home, this was not a problem because mothers remained hostesses in their own environment, only needing to call a midwife to check. If she found that labour was still in the early stages, the midwife would probably leave and the mother remained in her own familiar surroundings, usually accompanied by the supporting women she wanted to be with. Keeping busy around the house, resting in her own bed or eating a snack if she chose to do so, offered the ideal surroundings in a situation where simply "waiting" is the name of the game.
The experience for the birthing mother and her partner today is a completely different matter. They feel responsible to be able to move from home to hospital at the "right" time, whatever "right" means. This is one reason why many women are happy to be given an appointment to have their baby at a scheduled time. Unsure of themselves, they are happy to be spared this one responsibility of deciding when to go! It is unfortunate that to avoid the responsibility of making this decision by listening to their body, they usually go to hospital by appointment, which certainly gives no indication what is happening inside them and is more often than not, hopelessly too early, hence the disappointment that follows if a baby takes long to come! It is obvious that the surroundings in a hospital are very different to the home, and the change of environment may psychologically affect the progress of labour. Transition from home to hospital is sometimes known to stop labour completely, with the mother asking herself, "where have all my contractions gone?!"
Let us go back to the question: "When is it the right time to go to hospital?"
A direct answer would be:
When the bag of waters rupture
If there is an amount of red blood coming out of the vagina
If contractions are strong, long and close together.
The first two are obvious as the effect is visible, but the last one does not give the mother a clear-cut indication, so more explanation is called for.
Getting the feel of labour
The cervix is very much like a closed tunnel in front of the baby's head. It has been softening during the last days before the birth. If allowed enough time, this may be happening slowly and surely without the mother's perception. When the mother finally realises that she is in labour, she may be already half way through, and the real work will seem much shorter and easier to her. As the long muscles in the uterus contract, the effect on her cervix will be to thin it out, take it up and completely open it, very much like a circular door in front of her baby.
At first contractions are mild, short and far apart. This may easily be mistaken for gas pains by the mother. As labour progresses contractions get stronger, longer and closer together. The longest contraction to be felt in a natural birth is usually of one minute duration. The gap in between contractions may go from half an hour to five or less minutes. The strength of the contraction could take the mother from dealing lightly with "gas pains", often ignoring them, to the need for consciously using more useful and effective techniques. Massaging, finding favourable positions, doing mental exercises which need practicing in advance and also doing breathing patterns are but a few tools which help her tremendously to be able to cope with the more serious contractions. Her idea of herself, and the perception of what she is feeling has a great effect on the mother's natural ability to cope, as do her environment and her support persons. It is good for her to be reminded that each contraction that comes will take her closer to her baby. This is no time for pity, both by herself or the people around her, but it is the best time to bring out all the potential of her body's ability to make way for her baby. At this point in time, encouragement is what will help her most.
Labour could take quite a few hours, depending on various situations, such as the frequency, the strength and length of the contractions, the size of the baby, the size of the mother, and also if the baby is the mother's first or not. Other effects are caused by the kind of birth management the mother is given, and also by the way she has prepared physically, psychologically and emotionally for the birth.
It is recognised and acknowledged that for various reasons not all mothers want to go through the experience of labour as nature intends. This needs to be respected and perhaps psychological help during pregnancy may be sought to sort out one's individual feelings and circumstances. Unfortunately, this is not automatically catered for during routine pregnancy visits. Most of the time, the underlying problem would be fear which may be addressed in various ways, both during pregnancy and during the birth. Various studies conducted by doctors and midwives show that the screaming and shouting associated with births are caused more by fear than by pain in childbirth. Because of this, the administration of pain-killers to give the mother relief from "pain" may not be the only and best solution. Several studies show that if mothers are given the right kind of psychological and emotional support, labour is relatively shorter, the need for painkillers is drastically diminished, while the rate of birth by Cesarean Section is lowered.
Furthermore, with good support for the mother, babies are born with better apgar scores, and as an added bonus, it is found that good support also enhance the maternal instinct shown in the mother towards her baby after the birth.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.
If there is no tangible sign, the mother may be at a loss when is the right time for her to go to hospital. Ideally, the mother should not go too early because being in her own surroundings in early labour helps her tremendously. But for obvious reasons, she should neither go too late! In more practical terms, for a first-time mother, when contractions are one minute long, five minutes apart and strong, that will be two to three hours before baby comes. Mothers who have had babies before, know what strong contractions feel like, and usually go by what their body tells them. In a place like Malta with our short distances, a couple of hours before a baby comes is ideal; it is enough time for the mother to settle down in her new hospital surroundings and psychologically feel safe enough to resume having the baby.
It is interesting to point out that this is an extra concern felt only by modern birthing women. When births used to happen in the home, this was not a problem because mothers remained hostesses in their own environment, only needing to call a midwife to check. If she found that labour was still in the early stages, the midwife would probably leave and the mother remained in her own familiar surroundings, usually accompanied by the supporting women she wanted to be with. Keeping busy around the house, resting in her own bed or eating a snack if she chose to do so, offered the ideal surroundings in a situation where simply "waiting" is the name of the game.
The experience for the birthing mother and her partner today is a completely different matter. They feel responsible to be able to move from home to hospital at the "right" time, whatever "right" means. This is one reason why many women are happy to be given an appointment to have their baby at a scheduled time. Unsure of themselves, they are happy to be spared this one responsibility of deciding when to go! It is unfortunate that to avoid the responsibility of making this decision by listening to their body, they usually go to hospital by appointment, which certainly gives no indication what is happening inside them and is more often than not, hopelessly too early, hence the disappointment that follows if a baby takes long to come! It is obvious that the surroundings in a hospital are very different to the home, and the change of environment may psychologically affect the progress of labour. Transition from home to hospital is sometimes known to stop labour completely, with the mother asking herself, "where have all my contractions gone?!"
Let us go back to the question: "When is it the right time to go to hospital?"
A direct answer would be:
When the bag of waters rupture
If there is an amount of red blood coming out of the vagina
If contractions are strong, long and close together.
The first two are obvious as the effect is visible, but the last one does not give the mother a clear-cut indication, so more explanation is called for.
Getting the feel of labour
The cervix is very much like a closed tunnel in front of the baby's head. It has been softening during the last days before the birth. If allowed enough time, this may be happening slowly and surely without the mother's perception. When the mother finally realises that she is in labour, she may be already half way through, and the real work will seem much shorter and easier to her. As the long muscles in the uterus contract, the effect on her cervix will be to thin it out, take it up and completely open it, very much like a circular door in front of her baby.
At first contractions are mild, short and far apart. This may easily be mistaken for gas pains by the mother. As labour progresses contractions get stronger, longer and closer together. The longest contraction to be felt in a natural birth is usually of one minute duration. The gap in between contractions may go from half an hour to five or less minutes. The strength of the contraction could take the mother from dealing lightly with "gas pains", often ignoring them, to the need for consciously using more useful and effective techniques. Massaging, finding favourable positions, doing mental exercises which need practicing in advance and also doing breathing patterns are but a few tools which help her tremendously to be able to cope with the more serious contractions. Her idea of herself, and the perception of what she is feeling has a great effect on the mother's natural ability to cope, as do her environment and her support persons. It is good for her to be reminded that each contraction that comes will take her closer to her baby. This is no time for pity, both by herself or the people around her, but it is the best time to bring out all the potential of her body's ability to make way for her baby. At this point in time, encouragement is what will help her most.
Labour could take quite a few hours, depending on various situations, such as the frequency, the strength and length of the contractions, the size of the baby, the size of the mother, and also if the baby is the mother's first or not. Other effects are caused by the kind of birth management the mother is given, and also by the way she has prepared physically, psychologically and emotionally for the birth.
It is recognised and acknowledged that for various reasons not all mothers want to go through the experience of labour as nature intends. This needs to be respected and perhaps psychological help during pregnancy may be sought to sort out one's individual feelings and circumstances. Unfortunately, this is not automatically catered for during routine pregnancy visits. Most of the time, the underlying problem would be fear which may be addressed in various ways, both during pregnancy and during the birth. Various studies conducted by doctors and midwives show that the screaming and shouting associated with births are caused more by fear than by pain in childbirth. Because of this, the administration of pain-killers to give the mother relief from "pain" may not be the only and best solution. Several studies show that if mothers are given the right kind of psychological and emotional support, labour is relatively shorter, the need for painkillers is drastically diminished, while the rate of birth by Cesarean Section is lowered.
Furthermore, with good support for the mother, babies are born with better apgar scores, and as an added bonus, it is found that good support also enhance the maternal instinct shown in the mother towards her baby after the birth.
• Ms Theuma is a qualified childbirth educator and school teacher. A mother of three children and a grandparent, she directs a school for parents, In the Family Way, based at Marsascala.
The school offers courses and support for parents, covering various related subjects, from pregnancy to primary and early secondary school age.