Contraction Timings - Will the midwifes care?

[ItsAllGoingToBeFine]

A bit of background - I am a first time mum so please don't laugh too much at all of my naive planning . I have specified in my birth plan that I want no internal examinations unless there is a specific clinical reason for it - have discussed this with one of the random midwives I have seen and she was but I am prepared to fight my corner.

Anyway, as part of avoiding the dreaded internal exam I want to make sure that I am in established labour before I go into the hospital, and wait at home for as long as I can before I need some pain relief. (Told you you were going to laugh!)

I know that when you arrive in hospital they tend to want to give you an exam to check if you are in established labour - would they accept a detailed printout of all my contraction timings, along with other external signs as evidence of this? Or should I leave the printout at home, so they don't hate me from the off?

Are you booked in at a MLU? When I had DS they did not do any VEs - said not necessary - although she did say they did them routinely with first timers (although got the impression this was flexible, and it would have been easy to avoid).

However I suspect that if you end up in a triage situation on arrival (rather than a MLU) its going to be very difficult (see this thread - comments by nwthree link

Its worth making appointment in labour ward etc to discuss in advance - I have just changed hospitals from the RF to elsewhere as I was nervous that the triage system there would result in non friendly midwifes pushing for a VE (and this is DC3) - just like the post in the thread I linked to. The hospital i have changed to allows you to book directly into the MLU and i have a meeting with the midwifes at 36 weeks to discuss birth plan and no VEs is on it right at the top!

An experienced midwife will be able to tell from looking at you how advanced you are... thats what I was told in labour with DS anyway. Bear in mind labour often slows down on the journey to hospital. Ideally you'd hold off until having contractions 5 mins apart - that would demonstrate established labour - if you arrive and they are 10 mins apart then more likely they'll say not established labour so they want to do VE.

No need for computer printouts(!!!!) - not sure I can see any point in this at all - ok though for OH to have stopwatch and roughly time and scribble down if he feels the need.

Get a tens machine and stay at home for as absolutely long as your can manage. More important is how they see you contracting on arrival - ie how long inbetween and how long for. Also you can call midwifes from home to discuss symptoms and they will help advise over phone whether its active labour and whether to come in.

I would say though that with DD I wanted a VE on arrival because I'd been in labour at home for 8 hours and wanted to know what progress had been made - turned out I wasn't dilated at all - but they didn't send me home as it was obvious from my behaviour I was in established labour - also my waters broke during the VE another reason for not having one!

I hope that helps!

If you don't want VEs just say no! The midwives may be able to tell how you are doing from how you behave and "the purple line" which appears on your lower back/bottom as you progress.

Once your contractions are regularly coming every 3-5 minutes and you can't talk during them (other than to swear perhaps) I would say you are getting going.

I'm not laughing at you, BTW, with DD2 I turned up at the hospital fully dilated, just to avoid any meddling! Internals are an intervention and I think any that aren't really necessary should be avoided. You can always ask the MWs "what happens if we don't?" if they suggest anything you are worried about.

This is a really difficult one!
Problem is, it's possible for contractions to ramp up to one every 3 minutes for several hours, then die away again entirely. This often seems to happen if you start getting tired at the end of the day.

But yes, leave it as long as possible. Usually at first it is easy to chat in between contractions, but as you get closer you stop wanting to talk. Course, leaving it too long can also be very distressing - giving birth in the corridor, being refused strong pain-relief, that sort of thing! Be mentally prepared for that.
If you start thinking, hmm I could really do with some G&A, sink deeper into your deep relaxation, have a deep bath, and try to leave it another hour or two.

You might find as well, that you're contracting strongly at home every 3 (and are 5 cm dilate, though of course you don't know this), then by the time you've got into the car and walked into the hospital, you're back to contracting irregularly and your cervix has reversed to 3cm. Entirely possible. Google "cervicle reversal".
That happened to me with dd1 (probably not the cervicle reversal though).

If you are worried about leaving it too long and getting caught out at home or in the car, have a read about what people do when they have (intentional) unassisted births, then you'll be more prepared with what you might have to do (like giving a slow breathing baby a rub, and the fact that you don't have to do anything with the cord).

Not too late to book a homebirth .

i had VE's once every 4 hours, the monitor showed a short period of distress 1hr after an examination i asked MW to repeat exam but she said she 'wasn't allowed' for another 3hrs. i found out 3hrs later (i'd had an epidural) that this distress was the baby crowning, i had been sat on her head for 3hrs!

They cannot tell how far u are just by looking at u, and the MWs dont do the examinations just for fun. If you dont want to go to hosp too early you could try examining yourself, if you cant reach your cervix or its high up/ far back its unlikely your in established labour.

u cant always rely on contraction timings either, i contracted (hard) every 3 minutes from start to finish of my very long 44hr (19 established) labour.

Littler1 - When I had my DS the midwifes said internal exams not necessary because midwifes can tell by your behavior how dilated you are - and they could tell - eg they started filling up the birth pool when they thought I was fully dilated (it took 20 mins to fill) and sure enough I had a break in contractions just after I got in before the pushing contractions started.

I discussed this again with community midwifes and she agreed VEs not necessary (in natural active birth) unless labour is prolonged or baby is distressed.

However I can see that for someone with an epidural they could never tell by looking at you - its not just about timings, also about your behaviour eg I was chatting to midwifes between contractions but as I was fully dilated stopped wanting to talk to them, and just concentrate on what was going on with my body. This would not be apparent in someone who had an epidural.

I suspect as well in the case of a very long labour they would want to do VEs to assess progress, and I would have agreed to this.

re: crowning - no risk of DS crowning without me knowing! I could feel him move down the birth canal and could recount this to midwife and I could feel him crowning - I told the midwife he was crowning and she told me not to push at all. I didn't - and as a result I didn't tear.

MumNWLondon: How did you NOT push? I had no control over my body pushing and was actively encouraged to push, once the urges had started, by MW.
I had a 2nd degree tear with DS and would love to avoid this next time..
It was a no pain relief waterbirth too btw, tho 'somehow' delivered on my back (again midwifes 'instructions') which probably didn't help...

I'm intrigued..

oh and to OP ( ItsAllGoingToBeFine), I was induced but only with pessary but had contractions every 2 mins (even before induction, tho couldn't feel them) from the beginning, but wasn't dialated or softened AT ALL! That was an awful thing to be told once in what I thought was active labour.

That said things really kicked off once I got in the pool (and therefore relaxed) so can really advocate making sure you are in a relaxed enviroment to help things progress and I'm sure staying at home as long as possible would help this.
Tho, the thought of travelling in a car once in labour does not appeal to me at all and will be hoping to go for a HB next time..

Cazzr: I had torn (2nd degree) with my DC1 (on birth stool born in completely uncontrolled way partly as she was distressed and they just wanted her out), and didn't want that to happen again. I was in the pool, and when I said to the midwife (who frankly couldn't see a thing) that his head was coming (she had encouraged me to push if I felt like it until this point) she said to me to really focus on not pushing. I really focussed on this (by trying to hold him in IYSWIM) and although it really really stung like mad and I just wanted to push I manage to fight the urge to a certain extent - giving me time to stretch. However eventually the urge and stinging got the better of me and I had no choice but to push - and he came out without a tear.

Ok, thanks for the info, will try to remember this next time. DS shot out in one, i.e. not head first then body, which I don't think helped, and he had the cord round his neck..

So essentially, if I get it right, push till nearly crowning and then don't actively push, let the body do the work..

Cazzr - yes, go with body, push until crowning (if you feel urge), and then fight urge as much as possible to allow perineum time to stretch.

Obviously different if baby is distressed then they might want it out quicker - read hypnobirthing stuff on pushing - they say no need to at all!

I think the online contraction timers are great. We used this one. My DP found it a hell of a lot easier and more accurate to just hit the space bar when I called out "here's another one" and "okay that passed" from the bathtub than if he'd been faffing about with stopwatches and bits of paper. He also was able to say to me that they were getting close enough together that we should call the taxi. And yes, we printed it out, and the birth centre midwife was happy to have it.

My DP has been taked with finding an appropriate IPhone App , should keep him occupied, and he gets to use his favourite gadeget...

oops tasked

LOL at idea of contraction timer app!

After a bad experience first time around (long labour etc) I was determined to stay at home as long as possible, and thought I was pretty clued up about at what point to go in to hospital. As it turned out, I spent about a week in slow labour. Each evening contractions would start at about 7pm, and would be about 10 minutes apart, but would either tail off, or disappear if I had a bath, or I'd be able to sleep through them. After six days of this, one evening they seemed to be getting closer together and I was pretty determined that 'this was it' so packed up and got parents over to look after dd. In the back of my mind was thinking maybe second babies are quicker, maybe things would really take off as soon as I got to hospital. As it was they examined me on arrival and I was 2cm, not in established labour, but they kept me on the antenatal ward over night because I wasn't sure I wanted to do the journey home and back in again. As it was spent the whole of the next day with contractions no closer than 10 minutes apart. DH timed them on his visits, and have a lovely notebook filled with them all. Was so frustrating!! Eventually, at 8pm that night I had another VE and was 5cm dilated and whisked off to labour ward. Ds born four hours later. Not really to do with VE's apart from the fact that without the first I wouldn't have known that nothing was really doing, and without the second they wouldn't have known that something was about to happen. With my contractions it isn't really about the timing, its about the intensity. It was only in the last hour that they got closer than 10 minutes apart. I suppose in hindsight I should have waited until that point to go to hospital, and am now pg with #3 so will def. stay at home until I really can't stand the pain rather than set off when I think contractions are fairly frequent in the hope that it means 'something will happen soon'... Timings of contractions don't always reveal the full story I guess is what I'm trying to say!

happynappies - i agree, I had similar experience with number 2 - pre labour for days, but never really got closer than 10 mins apart and not painful - and would stop in the bath or if I lay down...

was not tempted to go to hospital!

went when i really wanted the G&A! no VE and DS born 2 hours later. waters broke within 15 mins of arrival so we really did leave our house at the right time - after waters went suddenly went from 10 mins apart to 3 mins apart!

this time again will not leave the house until:

• i really want the G&A or
• they are more like 4-5 mins apart
• or if my waters go!

Allgoingtobefine,

I'm not laughing and you're not naive.

Very often people go to hosptial too early - by that, I mean, before they are in established labour. The problem with this is that, the very act of moving to a different environment (bright lights, new faces) can scare contractions away before labour is properly established. Them impatience sets in, and before you know it, lots of unnecessary interventions are happening.

So the longer you stay at home, the better.

If you don't want internal exams, this is fine, you just need to say so. You can write it in your birth plan that you don't want them unless a life-threatening event occurs. If you are pressured into it without your consent, this is assault.

Good luck with your birth!

Also to OP - rent a TENS machine - can help to take edge off pain, might allow you to stay at home for an extra few hours?