Wondering how to get admitted to labor and delivery? You’re certainly not alone!
Actually, the funny thing about labor is that most pregnant women (especially first-time mamas!) frequently ask themselves the question, “Am I in labor?” when they aren’t really in labor. But once you are actually in labor, there is literally zero doubt – 9 times out of 10 you will know!
Follow along with me as I go over specific labor admission criteria, things that might keep you from being admitted, what happens once you are officially admitted to labor and delivery, and explore other reasons you might be admitted to the hospital during pregnancy.
- What happens when you arrive at labor and delivery thinking you’re in labor?
- How to get admitted to labor and delivery: What we’re looking for
- When will you be sent home from labor and delivery?
- What to do if you’re sent home from the hospital?
- How to minimize false trips to L&D
- What does the admission process look like?
- When else might you be admitted to L&D in pregnancy?
- Wrapping up
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What happens when you arrive at labor and delivery thinking you’re in labor?
Most OB practices have an on-call provider that you can contact if you think you are in labor. They can help you determine if you should go in (or what other steps to take to see if labor progresses). However, if you can’t get in touch with them, it feels urgent, or your gut is just saying LABOR, do not hesitate to head right into L&D!
If your labor symptoms begin when your OB office is open, they may tell you come to the office for a “labor check”. This is not always the case and can depend on how busy the office is and/or staffing on that particular day. But just wanted to include it in case you’re advised to do that.
But assuming that you call and they say head to L&D – or you just go in because your gut is telling you to – let’s talk about what will likely happen when you get there!
You arrive at L&D
Believe it or not, we frequently see mamas that think they are in labor when they actually are not – it can be really hard to know if it’s the real deal. I even had a really hard time determining whether or not my water broke with my second!
If you have been evaluated in the office and it’s been determined that you are in labor, you will bypass the triage process and be what we call a “direct admit”. But if this isn’t the case, your first stop will be in triage/the obstetric emergency department (OBED).
During the triage process four main things will happen:
Medical history
Includes discussion of your medical and surgical history, any pertinent family medical history, prenatal records and history, and more.
Vital signs
Includes blood pressure, temperature, heart rate, respiratory rate, and pain level monitoring.
Monitor baby’s heart rate and contractions
Two external monitors will be placed on your belly to monitor your baby’s heartbeat and the presence of any contractions. Typically we leave the monitors in place for 20-30 minutes, and if all is well we can remove them.
If we note anything concerning, the monitors would remain in place longer and your tracing will be reviewed with your OB provider.
Cervical check (if indicated)
Last, but not least, your nurse or provider might perform a cervical exam with their fingers to determine if you are dilated.
Based on the information collected during the triage process, a decision will be made. Often the decision is simply admission or discharge, but sometimes additional monitoring or testing is involved to make that decision.
How to get admitted to labor and delivery: What we’re looking for
Speaking of admission vs. discharge, what exactly are we looking for? That’s sort of a loaded question. I wish I could tell you that if you check these 3 boxes you are guaranteed an admission, but it just doesn’t work that way.
Plain and simple, you should actually be in labor to be admitted. Johns Hopkins defines labor as, “a series of continuous, progressive contractions of the uterus that help the cervix dilate and efface (thin out).”
Cervical exams are key
There are three important things we check during a cervical exam: dilation, effacement, and station.
Dilation, measured in centimeters, is probably the component you are most familiar with.
You can be anywhere from 0 to 10 cm dilated. Some providers feel strongly about patients being a certain number of centimeters dilated before admitting them, but dilation isn’t the only thing to consider.
You may be in early labor
Early labor typically means you are having painful, regular contractions but aren’t dilated past 4 centimeters. I say typically because I have actually seen patients come to the hospital and sit at 4, 5, or even 6 cm dilated and get discharged!
While this particular scenario isn’t common, it does happen. Early labor can last for hours or even days for some women, so as long as everything else checks out okay, I wouldn’t expect an admission if you are in early labor.
So when should I head in?
Putting aside any complications, as a first time mama, you actually shouldn’t head to your place of delivery until your contractions are painful, regular (3-4 minutes apart, lasting at least 1 minute, for at least 1 hour), and aren’t stopping.
True labor contractions are regular, increase in intensity, and don’t stop with relief efforts (emptying your bladder, changing your position, changing your activity level, drinking water).
Related Reading: The FOUR Stages of Labor: Nope, It’s Not Just Contractions
What if my water breaks?
And while dilation as part of admission criteria is a bit vague, water breaking is more cut and dry when it comes to admission. If it’s confirmed your water broke then you can expect an admission.
Your gestational age and whether or not you are having true labor contractions will guide your plan of care, but breaking your water is pretty much a guaranteed admission.
Bottomline on admission criteria
Those are the two biggies when it comes to being admitted for labor: your water is broken and/or you are in active labor (roughly 4-7 cm). Though, there are certainly other things that should be considered including:
- How your baby looks on the monitor
- Your vital signs
- Potential complications
When will you be sent home from labor and delivery?
If you are not in labor, you will be sent home from labor and delivery – plain and simple. Again, there’s more to it than just a number, but dilation is a big component.
Along the same lines, if you are suspicious that your water has broken and it is later confirmed that it’s still intact, you can also expect to be sent home.
What to do if you’re sent home from the hospital?
One of every pregnant woman’s worst fears: being sent home from the hospital! I mean, I get it – it’s inconvenient, could be a little embarrassing (not that it should be), and just plain frustrating.
Rest assured that I have some tips to help your labor progress should you find yourself in this situation!
1. Move, move, move
Whether it’s bouncing on a birthing ball, going for a walk, doing a series of squats, or some other type of exercise, there are lots of benefits to movement for labor progression.
Movement allows gravity to work in your favor. When you are up and moving around, your baby’s head puts increased pressure on your cervix and can help you dilate and efface faster.
2. The Miles Circuit
This is a three step sequence that’s designed to get baby into an optimal position for labor and birth. Not only can the Miles Circuit help signal your body to start labor, it can also get a stalled labor going again.
When your baby is positioned optimally, you actually have a higher likelihood of spontaneous labor with less interventions.
Check out how to complete the Miles Circuit below!
3. Sex
Sex can actually trigger your uterus to contract! In addition, semen is a natural source of prostaglandins, which are hormone-like substances that are responsible for helping your cervix efface and dilate.
And while you’re at it, make sure to stimulate those nipples! Nipple stimulation releases oxytocin, which is the chemical responsible for causing contractions.
One word of warning – avoid having sex if you think your water has broken, as it can potentially increase the risk of infection.
If you want to learn more ways to naturally induce labor, make sure to read my article below!
Related Reading: Natural Ways To Induce Labor: Everything You Need To Know!
How to minimize false trips to L&D
At some point you might have wondered, “How can I make sure I won’t be sent home from labor and delivery?”
Well, the best way to minimize false trips to L&D is to be sure that you are actually in labor! Here are some important things to keep in mind to help guide this process for you:
1. Know when to go
As a basic guideline, you should follow the 4-1-1 rule. This means that you are having contractions every 4 minutes, that are lasting 1 minute or longer, and have been going on for at least 1 hour.
Your provider may give different guidance based on your history and/or your distance from your place of delivery, so be sure to follow whatever recommendation is given by them.
2. Check in with your provider first
A lot of OB practices have an on-call provider you can reach out to if needed. Unless you feel like delivery is imminent or you are experiencing complications, the recommendation is usually to call your provider before presenting to the hospital.
They will talk through the symptoms you are experiencing and can develop a plan best for you.
3. Birth education
I cannot stress enough the importance of birth education. Knowing what’s going on with your body during pregnancy and labor can help you differentiate between what’s normal and what’s not.
This in itself can save you a false trip to your labor and delivery unit!
And it just so happens that I have online birth classes that are tailored to your specific birth plan and goals. Choose the option that best aligns with your wishes!
- Birth It Up: The Natural Series – for mamas who are hoping to birth without an epidural
- Birth It Up: The Epidural Series – for those who definitely want an epidural, or aren’t totally sure what they want
- Birth It Up: The C-Section Series – for my planned C-section mamas. You deserve birth education too!
And just remember – at the end of the day, getting sent home from labor and delivery is not the end of the world and is something that happens all the time. We would much rather you come to the hospital for evaluation then sit at home and worry.
What does the admission process look like?
It’s official, your provider has admitted you…so what happens next? In this section, I’m going to walk you through what the admission process looks like.
If delivery is imminent, you can expect an abridged version of the admission process followed by a more thorough admission after delivery. Although it happens, this is not the typical scenario.
The next steps might vary based on your place of delivery. But generally, once it’s been deemed that you are in labor, we will:
- Start an IV
- Draw blood
- Get you settled into a labor and delivery room
- Discuss your birth plan
When else might you be admitted to L&D in pregnancy?
Labor is one of the biggest reasons for an admission in the pregnancy world, but there are other things that might warrant one as well.
The hospital where I work actually has a dedicated antepartum unit. On this unit, we monitor women that have some kind of issue complicating their pregnancy. This can be for less than a day or up to several months depending on the complication.
Below is a list of other reasons why you might be admitted to the hospital during pregnancy.
Preterm premature rupture of membranes (PPROM) and preterm labor
This is one of the more common admissions to our antepartum unit. PPROM occurs when your water breaks before you are full term (37 weeks). Depending on your gestational age and whether or not you are laboring, the goal might be to keep you pregnant until a certain gestational age.
If you are 34-35 weeks or less, you can expect to be admitted to the hospital for close monitoring until your baby is born. While in the hospital, we will monitor your baby, watch your vital signs, and monitor for any signs of infection or labor.
If you are more than 34-35 weeks and your water breaks, your provider will likely recommend to augment your labor if it hasn’t started on its own.
Depending on your gestational age, you may receive steroid injections to help your baby’s lungs mature, antibiotics for infection prevention, and/or medications to slow down and stop your labor.
Preeclampsia or elevated blood pressure
Sometimes preeclampsia is severe enough that immediate delivery is recommended, regardless of your gestational age. But more times than not, it doesn’t warrant delivery and a watch and wait approach is recommended instead.
Milder cases can usually be monitored with outpatient care that includes frequent check-ins with your provider and close monitoring of your blood pressure and symptoms at home.
If your case is more severe, you may be admitted to the hospital for closer monitoring. This includes frequent blood pressure checks, monitoring your baby, and lab work to look for any changing trends.
To learn more about gestational hypertension and preeclampsia, be sure to read my article below!
Related Reading: An L&D Nurse Discusses Gestational Hypertension and Preeclampsia
Vaginal bleeding
Bleeding at any point during pregnancy can be super scary. Our human instinct is to assume the worst, or at least this was the case when I experienced heavy bleeding during one of my pregnancies.
And while I won’t go through the full list of causes here, keep in mind that some are more concerning than others and may require closer monitoring that could involve a hospital admission.
Uncontrolled diabetes
If you have diabetes during pregnancy and are not able to successfully control your blood sugars, your provider might recommend a hospital admission to help get things back on track.
This definitely isn’t one of the more common reasons for admission, but I wanted it to at least be on your radar.
Related Reading: What is Gestational Diabetes Mellitus: An L&D Nurse Explains
Wrapping up
I hope you have a much better understanding of exactly what we are looking for when you present to the hospital in suspected labor after reading this article.
And if you are interested in other pregnancy resources I have to offer, make sure you check out the links below!
Cheers to an even better birth, mama!
- Mommy Labor Nurse Online Birth Courses
- How to Get Your Partner Excited about Pregnancy
- Baby Shower Games and Activities: Your Guide to the Perfect Day!
