One of the smartest strategies for a healthy labor and birth for baby and mother is for a low-risk, healthy person to spend a lot of time laboring at home. How long, you ask? This will vary among individuals, as most things do, and will depend on whether or not the laborer is hoping to get the epidural or other pain meds. In general, I recommend laboring at home until the labor gains some good momentum. When this is done, we're strategically positioned for labor to progress in an optimal way because this momentum should help prevent labor from slowing down to an undesirable and unhelpful extent, which tends to happen as a simple result of leaving the safe space of our home and getting in that highly unpleasant car transfer. In general, this means staying at home until it's impossible to speak through contractions, contractions are lasting at least 1 minute and have been that way for over an hour. Let's go over the top reasons laboring at home is a wise idea.
1. First-time labors take plenty of time!
This 100% rocks the boat of everything we see in movies/tv, I know. So much of dramatized birth does, so let's get real here. Did you know that a first-time labor--from start to finish--usually takes an average of 18 hours? (You can read a more detailed breakdown of stage of labor with time estimates here, though it doesn't cover the pushing stage, which for first-time moms can take a while as well. You'll see there's a huge range of normal!)
Before you panic at this lengthy number and look for the quickest escape route, I want to point out that the vast majority of the time we spend in labor is the time spent in what we call "early" or 'latent" labor, which is the time when -- for the most part -- 1) the breaks in between contractions are much longer than the contractions (=the intense part), and 2) the contractions are quite manageable for most of early labor. It's also helpful to realize that, when you hear about the difference between, say, a 6-hour labor and a 26-hour labor, the difference can be attributed to the wide variability of time spent in early labor, when the sensations of labor are pretty manageable. Another factor is how early we notice: perhaps the 26-hour laborer just paid attention sooner than the 6-hour laborer. That 26-hour mama wanted the credit for all that hard work she and her baby did, and I don't blame her one bit! So, it's encouraging to point out that when we get into range of normal time ranges for active labor and beyond (read: when things get intense), the window of variable is much smaller.
Now that's we've established that there's no need to panic or rush when you think you're in labor, let's go over the good reasons to labor at home for a significant period of time:
2. Reduces chance of unnecessary intervention
The longer you can delay putting yourself on what tends to be a fairly arbitrary and impatient hospital "clock"--in which a cervix is expected to dilate at the rate of 1 cm an hour (unrealistic for organic and unique human beings)--the more wisely you position yourself strategically for avoiding unnecessary intervention. Unnecessary interventions are, logically, not healthy for anyone, tend to be unpleasant, and are more costly for you and/or our troubled U.S. healthcare system. There's something called the "Friedman's Curve" that propagates this trend. Read this article from Evidence Based Birth on how Friedman's Curve leads to unnecessary cesareans. Many hospitals -- particularly here in overpopulated NYC -- need to turn beds, too, which compounds the unfortunate sense of impatience.
3. Helps labor progress
In order for labor to progress in a healthy, unhindered fashion, we need to feel safe and have a sense of privacy. This is a physiological / hormonal fact that we go over in great detail in class. We tend to feel these things most readily in our home environment.
In Ina May's Guide to Childbirth, well-known midwife Ina May Gaskin details her hypothesis on the ways in which the cervix--while not technically a sphincter, as it would require having circular muscles to be defined as such--behaves similarly to our anal or vaginal sphincters, and how we need to be strategic toward helping the cervix to open effectively in labor. These points are:
- Sphincter muscles open more easily in a comfortable, intimate atmosphere where a woman feels safe.
- Sphincters do not respond to commands.
- The muscles are more likely to open if the woman feels positive about herself; where she feels inspired and enjoys the birth process.
- Sphincter muscles may suddenly close even if they have already dilated, if the woman feels threatened in any way.
So, because we do see these things occur in labor when a woman doesn't have a sense of privacy, this is another good argument for laboring at home.
4. No one telling you not to eat or drink
We know, we know, we know that it's an evidence-based course of action to eat and drink in labor. For heaven's sake, your body needs fuel for your indeterminate length! No marathon runner would ever not eat or drink for their whole marathon and be able to go the distance, and we know that labor is even harder work for the body. The main reason for restricting food and drink (known as "NPO" -- Latin "Nil per os" meaning "nothing by mouth") for so many years was mostly due to a very small risk of aspiration for anyone going under general anesthesia for a cesarean/surgical birth. This risk has gone down to almost nonexistent due to a) advances in anesthesia and b) the fact that it's rare for a pregnant parent to go under general for a cesarean. You can read the American Society of Anesthesiologists' November 2015 statement indicating laboring individuals should be allowed to have food in labor here. The other reason we commonly hear of withholding food and drink from the laboring woman is the risk that it will cause her to vomit. I believe a) most women will listen to their bodies and only eat when they don't think they'll be able to keep it down and b) if we miss that instinct and do eat and vomit, it actually can help labor progress and baby descend to a lower station, so we can cheer for progress if it happens a time or two! (I wouldn't recommend doing that in an exuberant way, though, partners, or you may get a swift kick to the groin.)
5. More flexibility for pain-coping techniques
You almost undoubtedly have more furniture, tools, food, and space to support you in comfort measures than you will at the hospital or birthing center. Immersion in a tub of water is called "nature's epidural" and can be powerfully effective for handling labor well before the water breaks; many hospitals don't have tubs available. The power and helpfulness of this and other tools you have more readily available at home cannot be underestimated, and can very often lead to reduced or eliminated need for pain medications.
6. “Safe” bacteria vs. “mean” bacteria
It's wise to minimize your exposure to the meaner bacteria that resides in the hospitals. Your body has built up antibodies against the meaner bacteria that exists in your home. Not so of the meaner bacteria in hospitals.
7. Save unnecessary trip(s) to hospital
The longer you labor at home, the less doubt there will be that you're in labor and the less likely it is you'll be sent home. You can skip the super un-fun experience of showing up a time or more and being sent right back home because you're not actually in labor or it's too early!
I repeat: First-time moms have plenty of time!
Just repeating that again for reinforcement...since the opposite (falsehood) is so ingrained in us through our westernized culture. Those stories you see in the news about people having babies in a cab/car, on a bridge, on the sidewalk are almost NEVER first-time moms! It drives me crazy that the news always omits this important detail.
Exceptions?
This won't be an exhaustive list, and you will want to check with your care provider for your specific case, but here are a few:
- If you get to a point in your labor when you feel that you won't relax into labor until you're at your birth place, maybe you should go. This will a safer bet if you're with both a patient care provider, and one you fully trust to not pressure unnecessary use of technology (monitoring and the like) or medications.
- If you have a deep gut instinct that something is wrong, definitely listen and heed this instinct. The trick here is that we first-time parents tend to not know the vast range of normal so that we tend to get that wise instinct mixed up with simple fear of the unknown (but most likely healthy). This is where professional labor support (aka doula) can really help to normalize the scary and identify if there really is some reason to call your care provider or go to the hospital/birthing center sooner.
- Along similar lines, the last thing we want to do is to make any decision (including laboring at home longer than is right for you) based in fear. We want to make decisions based out of a place of peace, trust and love, whatever that means for you. Aligning yourself with a care provider and birth place in which you have a high level of trust and sense of calm -- specifically, in terms of not pushing unnecessary interventions or being impatient. This is critical toward reducing fear about unnecessary interventions. Aligning yourself with a measured, calm provider who trusts birth as a healthy, normal process also could mean that the laborer doesn't necessarily need to labor at home quite as long.
- There will be other exceptions in which it's not advisable to labor at home for long. A few of the more common examples: if your water breaks and a) you are GBS+ (in the U.S. they'll want you to get 2 minimum rounds of IV antibiotics spaced 4 hrs apart to reduce the very small risk of harm to the baby), b) there are specks in the fluid, or c) if the fluid had a foul odor. Any of these would be indications to head to the hospital. Your care provider should give you a heads up in advance about anything that would be an indication to come to the hospital. You can always call your care provider to ask if you're unsure in the moment.
Okay, but HOW do I labor at home patiently?
"How in the world will I confidently labor at home as long as possible," you might ask, "when I've never done this before and every little thing seems scary?" I totally get it as I've been in your shoes! Let's talk specific strategies as we wrap things up.
- Ignore it (until you can't). Are you serious? Yes. Of course, ignoring labor is often easier said than done, but at first the contractions will be fairly mild (unless you ignored it and didn't realize it, which is pretty ideal!). You can plan ahead some "early labor activities" to have at the ready when the big day comes to help take your mind off labor. Make a list of half restful, half active things to do. Think along the lines of the more "normal" pastimes/hobbies -- i.e. things you like to do on the weekends or in your free time -- and prepare whatever items you'll need to have on hand for this. I will write a post on this in the near future, but here are just a few examples: taking a walk, walking the dog, some gentle yoga or exercise, making out or having sex if you're in the mood and waters haven't broken, cooking, baking (take treats for the nurses!), watching tv/movies (comedy would my top recommendation to promote oxytocin/endorphins, both of which help labor progress), etc. Oh, and if you wake in the middle of the night and think you're in labor, I highly recommend not waking your partner (if applicable). That's the quick route to not ignoring labor. Instead, do everything you can to go back to sleep--while you can!
- Build trust in and educate yourself on the process and the wide range of normal by taking birth classes (if you are in NYC, check out my birth classes!), reading or listening to positive birth stories (please note this podcast includes all kinds of birth stories, so judge for yourself based on the title whether or not it might build trust and calm for you). I also have several positive birth stories on my blog, so check those out (a couple of examples are here, here and here). Please note: "Dr. Google" is not your friend and will not build trust/calm for you! Find the trustworthy and evidence-based online resources and only refer to those.
- Consider hiring a doula, who can normalize the process, help you relax and boost the labor-promoting hormone, oxytocin, help you successfully surrender to the good work your body and your baby are doing toward birth, and ultimately labor at home much longer (read here to see the many more reasons this is a good idea!). A very smart investment toward a healthy birth.
Remember that you'll always be able to, if it helps you feel calmer laboring at home, interface with your care provider periodically. They'll probably appreciate having a heads up that you're in early labor. They will also appreciate that they don't need to come to the hospital or birthing center as early and should be happy to support you by phone to some extent. And, if they say to come to the hospital or birthing center before you feel ready--and in the absence of some legitimate medical reason to do so--you can simply say, "Thanks, but I think I'll stay home a bit longer." Your body, your baby, your call!
Patience, my friend. You can do this!
