Many express an interest in staying home "as long as possible" especially those who desire a natural birth. But how long is that exactly? And how do you know when its REALLY time to go?
In order to answer these questions to best serve the needs of the individual mother, the first thing I need to find out is how strong is her desire to birth naturally? I use a 0-10 scale, but I have also seen a -10 to +10 scale used. The top of the scale is an unrealistic desire to feel no pain at all, to have medication begin before labor does. The bottom of the scale is an unrealistic desire to not use pain medication at all, even if there is an emergency.
If a mother answers that her desire to for a natural birth is at a 1-3, I will recommend she stay home longer than the hospital tends to suggest, especially if it is her first baby. Hospital policy used to be the 5-1-1 rule, but recently I've heard it being replaced with the 4-1-1 rule, especially for mothers who do not want interventions.
The rule means that when your contractions are four minutes apart, lasting at least one minute each, and have been that way for at least one hour, the hospital would like you to come in.
The problem is that, especially with a first baby, this 4-1-1 usually doesn't mean you are close to giving birth. It just means that active labor is well established. If a mom expressed a desire to stay home as long as possible before labor started, I will remind her of that when she is laboring well at home and has reached 4-1-1. Of course she can change her mind, and if she truly wants to go in, we will. I remind moms at their prenatals that I am not the hospital police!
A great compromise that can happen when a mom feels that she couldn't possibly bear the car trip with contractions any stronger than the ones she is experiencing now, but maybe isn't quite as far along as she planned to be, is lobby labor! This is exactly what it sounds like.
She gets the car trip out of the way, but instead of checking into the hospital,
just starts walking around the hospital's lobby. Many hospitals have beautiful
fountains to look at, or if it's a nice day, she can walk outside on the grounds. This way, she is not on the hospital's clock yet, but if something were to suddenly change, she is already right there and ready to check in.
Just to be clear, lobby labor is not the same as going in, getting checked at triage and then being told to walk for an hour. This is what happens when a mother shows up to the hospital too early in labor even for the hospital's standards. In most hospitals, it's usually defined as four centimeters. Lobby labor is driving to the hospital, but not alerting the staff or your care-provider of your presence until you feel that you are ready to check in. It's like you're still at home, but a lot closer. For many mothers, this option can offer peace of mind.