Fatigue.
Increasing bloody show.
Rupture of the membranes (if they haven’t earlier), or they might be ruptured artificially now.
Emotionally, you may feel restless and find it more difficult to relax; or your concentration may become more intense, and you may become completely absorbed in your labor efforts. Your confidence may begin to waver (“How will I make it through?”), along with your patience (“Will this labor never end?”), or you may feel excited and encouraged that things are really starting to happen. Whatever your feelings, they’re normal—just get ready to start getting “active.”
During active labor, assuming all is progressing normally and safely, the hospital or birthing center staff will leave you alone (or stay out of your way, but in your room), checking and monitoring you as needed, but also allowing you to work through your labor with your coach and other support people without interference. You can expect them to:
On to the Hospital or Birthing Center
Sometime near the end of the early phase or the beginning of the active phase (probably when your contractions are five minutes apart or less, sooner if you live far from the hospital or if this isn’t your first baby), your practitioner will tell you to pick up your bag and get going. Getting to the hospital or birthing center will be easier if your coach is reachable anywhere, anytime by cell phone or beeper and can get to you quickly (do not try to drive yourself to the hospital or birthing center; take a taxi or ask a friend to drive you if your coach can’t be reached); you’ve planned your route in advance; are familiar with parking regulations (if parking is likely to be a problem, taking a cab may be more sensible); and know which entrance will get you to the obstetrical floor most quickly. En route, recline the front seat as far back as is comfortable, if you’d like (remember to fasten your seatbelt). If you have chills, bring along a blanket to cover you.
Once you reach the hospital or birthing center, you can probably expect something like the following:
To get registered: If you’ve preregistered (and it’s best if you have), the admission process will be quick and easy; if you’re in active labor and in no mood to answer questions, your coach can take care of it. If you haven’t preregistered, you (or better yet, your coach) will have to go through a more lengthy process, so be prepared to fill out a bunch of forms and answer a lot of questions.
Once on the labor and delivery floor, a nurse will take you to your room (most likely a labor, delivery, and recovery room, or LDR). Sometimes, you may be brought first to a triage (assessment) room, where your cervix will be checked, your baby’s heart rate assessed, and your contractions monitored for some time to see if you’re actively in labor or not. In some hospitals or birthing centers, your coach and other family members may be asked to wait outside while you are being admitted and prepped. Speak up if you’d rather your coach stay by your side; most hospitals or birthing centers are flexible. (Note to the coach: This is a good time to make a few priority phone calls or to get a snack if you haven’t brought one. If you aren’t called into the room within 20 minutes or so, remind someone at the nurses’ station that you’re waiting. Be prepared for the possibility that you will be asked to put on a clean gown over your clothes.)
Your nurse will take a brief history, asking, among other things, when the contractions started, how far apart they are, whether your membranes have ruptured, and, possibly, when and what you last ate.
Your nurse will ask for your signature (or your spouse’s) on routine consent forms.
Your nurse will give you a hospital gown to change into and might request a urine sample. She will check your pulse, blood pressure, respiration, and temperature; look for leaking amniotic fluid, bleeding, or bloody show; listen to the fetal heartbeat with a Doppler or hook you up to a fetal monitor, if this is deemed necessary. She may also evaluate the fetus and its position.
Depending on the policies of your practitioner and the hospital or birthing center (and, ideally, your preferences), an IV may be started.
Your nurse, your practitioner, or a staff doctor or midwife will examine you internally to see how dilated and effaced your cervix is (if it wasn’t already checked). If your membranes haven’t ruptured spontaneously and you are at least 3 or 4 cm dilated (many practitioners prefer to wait until the cervix has dilated to 5 cm), your membranes may be artificially ruptured—unless you and your practitioner have decided to leave them intact until they break on their own or until later in labor. The procedure is generally painless; all you’ll feel is a warm gush of fluid.
