You are finally at term and the seconds, minutes and days seem to slow to a crawl. Your mother-in-law is texting you non-stop wanting to know when the grand-kiddo is coming.

It’s hard to work or do your day-to-day activities because the baby is pushing on your pelvic floor so much you have this sense that you are waddling more than walking. You have contractions now and again and the increased discharge makes you wonder if your water broke.

And more so for first time moms, there is an overwhelming anxiety about the labor process, being a new parent, and knowing when to come to the hospital… am I right?!?

I previously wrote blogs about first, second, and third trimester emergencies and when to call or come in to be seen. Let’s now examine when to call when you think you are in labor and when you should come in for an evaluation.

I’m going to preface this by saying ultimately you can come in when you want or feel the need to. Use your maternal instinct. My job on the phone is to do my best to triage you.

If you were to come to the hospital, will you likely be admitted or will you likely be sent back home? It’s not a perfect science. None of us will get upset if you come in for an evaluation and are not yet in labor (sometimes our patients get upset being sent home however).

Not all labors follow the same patterns; some go from zero to 100 in an hour and others take a few days.

Here are the 4 things we should hear from you about at full term (>37wk):

Contractions

Real contractions are unmistakable. If you have to ask yourself, your friends, or Google if your contractions are real, then they are likely not strong enough yet.

When they are intense enough to cause dilation they are usually curse-word-inducing, tear-jerking, huffing and puffing during the most intense part, etc.  They will last a minute or longer. They should be at least 5 minutes apart for at least an hour. (This is the famous 5-1-1 rule…. 5 minutes apart, lasting a minute each for at least an hour.) 

If you get to this point, please call our main line 919-781-6200. If we are open press the “0” option and you will get worked in for a labor check. If we are closed, press the option that lets you contact the on-call MD and we will be sent your information.

We try to respond to calls very fast but sometimes we are in the middle of patient care and cannot. I always tell my patients if you do not hear back and know you are coming in no matter what we tell you, then start heading in. If you are still unsure, you can try to call back and reach out again.  

Now, when you are at the 5-1-1 point that usually means labor has started; however, it does not always mean it is time to come to the hospital.  Especially with your first pregnancy, it can take many hours to get to 4-5cm (which is the least dilation we want you to be to get admitted to the labor unit).

So, we will ask you what your last exam in the office was, etc and try our best to advise you on when to come in. Ultimately, use your mom superpowers and come in when you think it’s time.

Rupture of Membranes… aka Water Breaking

Usually it is VERY obvious when your water breaks, but not always.  Most women describe feeling a pop and then having copious fluid come out.

If you have an increase in thin mucus-like discharge or an increase in moisture after urinating, then it probably is not your water breaking. A good trick to do at home, if you are unsure, is to put on dry undies and pants and a pad and lay down for an hour.

When you then stand up, if your water is broken, you will typically notice a lot of fluid coming out (as it pools in the back of the vagina while laying down).  

If you think your water is broken please call us. This is not a call 911 emergency. Depending on your contractions, the color of fluid, your GBS culture result and other factors, we will give you advice on when to come in.

Now, if you are already at the 5-1-1 on the contractions and feel that pop and water come out, then your labor will likely intensify pretty markedly and you are going to want to call us and come in.

Bleeding

Please call if you have heavy bleeding. It is not uncommon to have some bleeding at term.

If you were examined recently or had recent sexual relations then you could have some bleeding. If your mucus plug is coming out then it often has blood-tinge to it.

If you are at home contracting and just waiting to get to the point to come in, you may experience bloody show on your pad or when you wipe. This is typically a sign of dilation and not worrisome. If you are experiencing very heavy bleeding (I know I know that is a subjective description) please call us.

Decreased Fetal Movement

If you are having a day when you do not feel regular movement, please do a kick count. You should feel 7-10 movements in two hours. I suggest going to a quiet room with a drink and snack and just focusing on baby. If you get the movements, great. If you do not, please call.

Best of luck to you and remember, you are never wrong to come in for an evaluation.  We can only do so well triaging over the phone.