Empowered Delivery Education - How Do I Know If I'm In Labor? - The 411 on the 4-1-1

By: Aunt Doula (09/30/2023)

Ask a friend, a coworker, a family member, a parenting group "How will I know I'm in labor?" and you will inevitably hear "Oh - You'll KNOW." Frustratingly, the conversation usually ends there as if that's supposed to be the only thing you'll need. Here, we will go over a great majority of signs that you are likely in labor, how to know if you should be going to your place of delivery (or calling your midwife for home birth), and what people really mean when they say "Oh, You'll Know"

This is a multi part series on labor preparation

If you want to go directly to the post about learning the possible signs that you are going into labor soon, click here If you want to learn about all the ways people try to induce labor and if they are effective, click here If you would like to learn about getting checked for if you are in labor, click here

What is "Oh, You'll know!" Anyway? Well. In the essence of their statement, they aren't wrong, but what they are forgetting is that labor is not usually witnessed in our everyday lives as it once was when we lived in tighter communities, gave birth in multi-generational homes and when we lived in tribes farther back in history. As a first time experience you have little to no reference for what is going to happen except for perhaps movies and television- which is a terrible representation! As they have experienced it, they have a reference, but often, they can't convey it to you. You have most likely seen some form of dramatic showing as mentioned in television or movie screens but that is not realistic to most of labor in it's early and middle stages that those depictions skip over entirely. When people say "Oh, You'll know" they are also often quite unable to describe the feelings and sensations they experienced due to how our brains process events such as birth.

It is a biological imperative that we continue having more children, and if the memory of labor and birth did not diminish and become something beautiful, or at least tolerable, by recollection in most cases we as a species would stop procreating. When you ask someone about how they knew they were in labor, chances are, they don't actually remember in full detail what happened and what they did for the entire process - this isn't their choice, it's just brain biology. Often, by the time baby is delivered and the wash of emotions and bonding begins, the memories of early labor are quickly moved out of the way and the highlights are what remain and the smaller details just don't stay in long term memory. This combined with any possible negative memories or traumatic events and just general length of time since that person has given birth, all culminate into statements like "Oh, you'll know!" without much follow up.

So here we will go in to what may occur in your early labor and how to know when you should head to the hospital once you've reached what is known as the "5-1-1" or more commonly in the last few years, the "4-1-1" of when to go to your place of delivery along with other signs you may want to get underway.

The 4-1-1 rule to deciding to go to your delivery location is a set of symptoms:

4 : Four minutes between contractions (Counting from the beginning of one contraction to the beginning of the next)

1 : One minute long contractions (at least 60 seconds from start to finish)

1 : Consistent pattern for One hour.

This constitutes one cycle of the 4-1-1 pattern. This gains on average .5 to 1cm of dilation when the pattern is reached and held. You may want or be advised to do multiple 4-1-1 cycles at home before going to your place of delivery. Go easy during these hours! Eat, drink, baths in the evening and relaxation – this is the marathon beginning.

Other signs to ‘Is it time to go to our delivery place?’ If 1 or 2 or more of these are true, it's definitely time to be underway or calling ahead to check in with your provider. If unsure, call your provider or wait 30 minutes and ask again. Still unsure? Wait half an hour and ask again. Your provider should have called back if you got the answering service (babies do love to make you ask this question at 3am or on a holiday) and if you just aren't sure or feel scared that is more than reason enough to head to your delivery place and find out what your delivery team thinks. Rule Number 0 - When in doubt, get checked out! If your pain becomes too much to handle, something feels wrong, or you just want to be checked out or be in your place of delivery - go. Otherwise in general, if 1 or 2 or more of these are true, go.

Waters breaking

• This is often a slow trickle, not a big splash!. It may be pink, brown or green. Note with C.O.A.T: Color Odor Amount & Time.If you aren't sure if your waters have broken, lay down in bed for 30 seconds and then stand back up - if you experience another expression of fluid it is likely to be your waters and you should head to your place of delivery to have it confirmed. Even if there is no question, call if the waters break as this is a sign that stands alone as a reason to reach your place of delivery as directed by your provider and not wait for 4-1-1 cycles.

Bloody show - Loss of mucus plug

• This may appear as a firm piece or pieces of yellow/green mucus with a small amount of blood. There should not be a gush or lots of bright red blood – in the rare event that occurs, call emergency services

Vocalizing

• If the laboring person is moaning, squeaking (remember low and slow is the way to go), is unable to talk during contractions or is needing significant support to make it through a full contraction length it means they are more likely to be in active labor and should be in their place of delivery. You can and should make as much noise as you want, just know it's a sign your contractions are signalling strong signs of reaching active labor!

Intense Downward Pelvic Pressure

• Pressure on bladder and rectum at the peak of contractions can feel like a bowel movement. Once that pressure is constant you may feel like you have to constantly poop or like baby is 'falling out' - don't worry, they usually aren't! These sensations are never felt outside of giving birth, and the pelvic floor is full of many nerves and muscles that have never been stretched like this before. It can feel very strange, very foreign, but try to focus in between contractions if you are feeling nervous on isolating what you are feeling where and it can also help to put your (clean) hands on your abdomen, vulva and perineum to help understand what you're feeling internally and externally.

And yes, you may poop during baby crowning - It's No Big Deal! It's more of a pellet than a big movement. About 20% of women do pass a pellet sized stool. It happens and your labor team is prepared for it to just be swept away.

Contractions Status 2-3 minutes apart (this means 1 minute on 1 minute off)

Laboring person says it's time to go, you go!

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Try not to be scared! You will have an innate feeling to seek safety, watch these signs and stay calm. Partners are usually the ones who panic and get the carrying person to the delivery place too early. 1st time deliveries rarely ever happen in the car. If you get restless, check your bags, go over your lists, take calm and normal breaths, call your family advocate if they aren’t already with you. You’ve got this.

In preparation for going into labor, make sure to ask your provider who you call if it's out of business hours, where you enter your place of delivery to checkin after hours, and if they will be attending you right away or if another provider will be caring for you a while. Ask if parking is different after hours given you may have to check-in at a different entrance.

All of these preparations and answers can go on a list tacked to the fridge so you can just go straight to it if you or your partners minds go blank. An important exercise can be to ask yourself what steps you are going to take when you go into labor - if all you have is "drive to hospital" that might be enough - but ask yourself step by step for business hours and non-business hours if you know who to call if you have questions, where to park, check in, what floor you are supposed to go to, and if you are going to see your provider. Knowing this can mean a much calmer gathering together and trip. Some people keep their bags in the car if they live far from their place of delivery or are potentially not going to be at home when going into labor (such as at work, on a stay-cation, or just take comfort in prepping!)

Lastly, it is important to know that you may get sent home if you are not "far enough" into labor, the birthing facility has no beds available or deem you and your baby stable enough to labor at home. Labor wards are typically at capacity 24/7 and with elective inductions on the rise many of the beds are scheduled months in advance with few rooms left open for spontaneous labor. If you don't feel comfortable laboring at home, you live a significant distance from your place of delivery, or you need pain relief you can always ask the center to call other hospitals nearby to see if they have any open beds. It is important to be ready to pivot to another place of delivery for many reasons, and just knowing it could happen can take the edge of at the time.

You've got this - in lieu of anything else keep telling yourself that you can do this. Say it out loud even if it doesn't fill you with 100% confidence, saying it will help you calm your nervous system down. You have got this.