When Should I Call My Doctor or Midwife in Labour?

Something we talk about a lot in prenatal classes is what to expect in early labour. This is totally understandable! Especially if it’s your first birth there can be a lot of questions, a lot of excitement and sometimes a bit of anxiety.

One thing you can do to prepare is to come up with your plan for calling your care provider and going into the hospital during labour.

Chat With Your Doctor or Midwife

In the weeks leading up to your due date, your care provider – your doctor or midwife – will probably give you guidelines about when to call or page during labour.

It’s common in early labour for contractions to be sporadic (e.g. 15 minutes apart, then 10 minutes, then 20 minutes…or to stop altogether and pick up again later). You might be advised to notify your provider when you’re experiencing this sporadic pattern of early labour. As you move into real deal (active) labour, contractions will probably fall into a consistent and measurable pattern as they become longer, stronger and closer together.

If you’re having an uncomplicated pregnancy and contractions are your first noticeable sign of labour, your care provider will likely advise you to use a guideline of 4-1-1 or 5-1-1. This would mean it’s time to go to the hospital when your contractions are four or five minutes apart (your provider will tell you which one), each lasting about one minute, for one hour straight. You’ll likely be advised to call the doctor/midwife and/or hospital before heading in. Your personal plan might vary a bit if you’re located farther from your birthing location.

Timing Contractions

In the smartphone age, we no longer have use a pen and paper or do mental math to time contractions. There’s an app for that! Search “contraction timer” in your app store and you’ll have lots of options.

If you’re using an app to time contractions, all you’ll have to do is tap at the beginning of the contraction and again at the end of the contraction and the app will do the math for you, updating you as you go about average length and frequency. You might prefer that your partner or doula do the timing so that you don’t get caught up in scrutinizing the numbers but it’s totally your call.

The Basics

The length of one contraction is from the time it begins to the time it ends.

The time from the beginning of one contraction to the beginning of the next contraction is how “far apart” they are (frequency).

Practical Example: What 4-1-1 Looks Like

At 4-1-1 contractions begin, last for one minute, and then there is a three minute break from the end of one contraction to the beginning of the next. When this is happening consistently for one hour, you’ve reached 4-1-1.

Side note: if you time contractions for a while and you don’t see a pattern, take a break! Come back later if you sense that things are changing. 

What’s The Number?

Here’s how to get in touch with Labour and Delivery at our Halton, Hamilton and Mississauga Hospitals:

Oakville Trafalgar Memorial Hospital:  905-338-4688

Milton District Hospital: 905-878-2383 ext.7030

Georgetown Hospital: 905-873-0111 ext. 8245

Joseph Brant Hospital: 905-632-3737 x 4109

McMaster Hospital: 905-521-5050

St. Joseph’s Hospital Hamilton: 905-522-1155 x 33251

Credit Valley Hospital: 905-813-3950

If you’re with one of the local midwife groups (Community Midwives of Halton, Midwifery Care of Peel and Halton Hills. Burlington and Area Midwives, Midwives of Mississauga, East Mississauga Midwives, Access Midwives, Community Midwives of Hamilton, Hamilton Midwives, or Mountain Midwifery Care), you will have been given a pager number to request a call from your primary midwife when you are in labour. 

 

What To Expect When You Call

When you call your doctor/midwife/hospital, you’ll be asked to describe your contractions and answer a few other questions. If you have your partner make the call, don’t be surprised if they’re asked to hand you the phone so your provider can talk through a few contractions with you to see how you’re managing.

Your provider will advise you about next steps. If you’re not in active labour, you might be asked to check in again later.

Exceptions to Note

Rupture of membranes (water breaking) is more likely to happen when you’re already in labour but for some women, the waters break before labour contractions begin. If your water breaks, whether it’s before contractions begin or after contractions begin but before you go to the hospital, your provider will want to know and will advise you from there. You’ll be asked to describe the appearance of the fluid and answer some other questions.

Depending on the circumstances, you might need to go in to the hospital or clinic to be assessed or you might be asked to check in again by phone after a period of time. The reason for monitoring closely after the waters break is because the amniotic fluid (the “water”) protects your baby from outside bacteria. Once the amniotic membranes (the “bag of waters”) rupture, there is a small risk of infection that increases over time. Your care provider will discuss next steps with you if labour contractions don’t begin after your water breaks. It’s a great idea to discuss this during your prenatal visits.

If you’re not sure if your water has broken, you’re not alone! Toward the end of pregnancy some women experience an increase in vaginal discharge and some women experience urinary incontinence (lose control of their bladder), all of which can be a bit confusing. If you’re not sure if your water has broken you can try using the toilet, then lying down on your side for 10 to 15 minutes, then standing back up. If fluid has pooled in your vagina and comes out when you stand up, your water has probably broken. If you’re still not sure, check in with your provider.

Other Red Flags

There are some other “red flags” that warrant calling your doctor or midwife right away:

• If you notice vaginal bleeding
• If you have pain or pressure in your lower back that won’t go away
• If you see or feel your umbilical cord slip through the cervix or vagina after your water breaks. This is a rare condition called cord prolapse that can be dangerous for your baby because it can cut off blood supply. If this happens, get down on your knees and brace yourself with your arms while lowering your chest to the ground, then call 9-1-1.

A final note: it’s ALWAYS best to listen to your intuition if it’s telling you to call.
I know your care provider will agree!