Empowered Delivery Preparation - How Do I Know If I'm In Labor? - Getting Checked When You Aren't Sure

By: Aunt Doula (09/30/2023)

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 read about how to know when to go to your delivery place while in labor click here

If you want to learn about all the ways people try to induce labor and if they are effective, click here

Below you will find helpful information about trips you may need to take to the ER if you aren't sure you're in labor, or something is worrying you about your pregnancy.

Inevitably at some point as you reach your due date, whether or not you have read all the books or taken all the classes, you will likely ask yourself "Am I in Labor?" It's a good question, most people feel great worry that they will go to the hospital only to be told to go home - false alarm. Beyond anything that is listed below, the number 0 rule (the rule to supercede all rules) you should always follow when it comes to being unsure about what's happening with your body or your baby and you are concerned - When In Doubt Get Checked Out Your instincts are your best guide, you have been pregnant for many months now, you know your body and you know your baby - Never Hesitate to Trust Your Instincts. If you get sent home because nothing is wrong, that's the best possible outcome! You checked that everything was okay, that is being a solid parent. If you get told you aren't in labor and you feel:

• Disappointed - That's normal and valid! You are excited to meet your baby and it's also okay to be exhausted and ready to be in labor - No one has stayed pregnant forever, and even when these last days and weeks feel like the longest journey, you will meet your baby soon.

• Worried you wasted someone's time - No you did not! It is literally the job title of the healthcare centers you are being check by: Providers. They are there to provide care to you. The care they are providing is to confirm you aren't in labor or nothing is wrong and then help you feel confident that being at home is safe. They should also help you know when to come back if something changes. They are there to provide care, and care includes making sure you do or don't need medical assistance.

• Embarrassed - This is a big one, but ties very heavily into the worry of wasting someone's time. There is nothing with why you went to get checked to be embarrassed about however - you went in to make sure you and your baby were okay - how else were you supposed to know if you are or aren't with something you've never experienced before? If you hear a funny noise coming from your car engine, you take it to a mechanic - they are there to diagnose your car. You trust a mechanic to tell you why the sound is happening, what can be done about it, if it's okay to keep driving the car for a while, or they pull a stick out of the wheel well and get you back on the road - there is no embarrassment to be felt for taking care of a problem you don't know how to fix, or for checking if there is a problem. You are doing the right thing, because you are following rule number 0 - when in doubt, get checked out.

• Overwhelmed/Breakdown/Yell at the sky - All normal, all valid. The concluding weeks of pregnancy are a wild ride, it's okay to want to be at the checkered flag! You can and will do this. It has been quite a build up to get to labor, and to have it delayed can be quite overwhelming!

They want to send me home but I am not okay

If you are in pain, you feel like you shouldn't be going home, you aren't being taken seriously, you aren't reassured - any hesitations for returning back home, I am giving you the proverbial Speak Up Button of Empowerment to refuse to be discharged. Ask questions until things make sense, if you don't understand why you are being sent home ask for a patient care advocate, if you feel like more should be being done - say so. Now, my proverbial Speak Up Button of Empowerment is obviously not going to magically make doctors and nurse listen better, not be understaffed, or make your care suddenly better - that comes from you and some of these tips below to make sure you get the care you deserve. If you are dissatisfied with the care you have been given and you are told to go home and you are uncomfortable doing so, one or more of these may help you get more out of your emergency room stay

• As difficult as it may be, to the best of your ability, remain calm and collected. "Catching fles with honey, not vinegar" goes a long way to receiving what you want and need. Be ready however to use that vinegar as your last resort.

• Whenever possible, have another person with you at all times. Friend, family member, partner, roommate, whoever can be a witness to what happens and how you are treated can, unfortunately, make a significant difference. If you cannot have a person in the room with you, ask someone to be on a zoom call with you. If there is a witness to any behavior and treatment recommendations, it is likely to be more thorough and considered.

• If you are alone and no one can be with you at all, ask for a patient care advocate.

• If your visit is not being performed in your first language and your first language is more comfortable for you, ask for an interpreter - even if you feel you could communicate okay in the other language, you are getting two things - another person to witness your treatment recommendations, and information in your first language may make more sense and reduce confusion so you can go home more confident. Once again, this is a service the care center provides and you deserve to use.

• Ask questions specifically about what else could be causing your symptoms, why your doctor has decided it isn't those things, and how do you know when something is wrong and you should come back. Ask if there are tests you should have to rule out those other things, or if your doctor is guessing. If they say that the standard testing is a, b, c, but you don't have to do that because x, y, z - get the testing done if the risks are acceptable to you. Doctors, especially emergency medicine doctors, have a way of wording some things such that it sounds like they aren't recommending a treatment path, but you really deserve to choose. Example:

Doctor: "We think that you have A, but it could be B. If it's B, We can get you on your way tonight and back in your own bed with this medicine in your IV - How does that sound?" - Red Flag! What's A? Why is B a better diagnosis? If it is A, does treating for B change things? How do we find out if it's A or B? Why should I try for treating B if we don't know which it is? Is it okay to wait if it's A?

In this example, the doctor has technically given you a choice between A and B, and technically has informed you of both possibilities. However they have slid right on past anything about A, and have suggested treating for B with such confidence that it invites no questions, only an answer of yes/no to treating B and making it sound like the best outcome with getting to go home. Red flag. Anytime you are provided with two or more possible diagnosis' you want to be fully informed of all possibilities, their testing, their treatment, and you should be able to ask any questions you have before you make a decision. Empowerment is about educating yourself so that the decisions you make about your care are actually made WITH your doctor, not by your doctor with you saying okay.

• Take a note pad with you or have an app on your phone to take notes with. Write down your questions, symptoms and your top 2 discussion points as you think of them during your wait. When a doctor does come in to see you, understand that in general, before they can discharge you, they have to examine you with a hands on exam where they at the minimum listen to your lungs and heart. If you do not allow them to examine you prior to answering your questions and discussing what's going on, they will wait. Many doctors try to do the talk while they examine you and run right out of the room. Yes, they are busy, but you and your baby should not be a casualty to the poor management and staffing of the hospital. Your lives matter. Your care matters. Fight for it. Once you have given them your history, asked questions and if applicable covered your top 2 points, allow the exam. They will likely need to do this just to help with figuring out the testing they want to offer, but you got your time with them.

What else should I know?

• You DO NOT disappear behind your pregnancy. Read that again. You are a pregnant PERSON - there are your needs, your medical concerns AND there is your pregnancy. One does not matter more - they matter EQUALLY. Pregnancy is not a diagnosis to be tagged onto your symptoms without looking for other causes. Just because being pregnant could explain your symptoms does not mean it does explain them. You are a person, and you are valid. You get to know what's happening to your body and your baby, and how each affects the other - Bluntly ask your doctor the question "What would you think this could be if I wasn't pregnant?" Pregnancy should never be at the top of a differential diagnosis list (things that could cause what's going on) because it immediately clouds a doctor's mind to just assume that whatever you are experiencing is pregnancy related and look no further. Make them look further with your Speak Up Button of Empowerment.

• Labor, in general, is not fast. There is a type of fast labor known as precipitous labor, and these are labors that progress from early labor to delivery in under 2 hours. This is rare, and is not the norm especially for a first time delivery. Subsequent labors do tend to "go faster" than previous labors, however if your first labor was 36 hours, your next will maybe be 32. So, barring that your body happens to be a precipitous labor body (again, rare) You. Have. Time.

• And take your time you should! As you will read in another part of this the scenes of a panicked father and a chaotic fast drive to the hospital in tv and movies - is not necessary or desirable. If you haven't packed your bags and you are pretty sure you're in labor, pack a bag. Remain as calm cool and collected as you can, drive the normal speeds of the road. Stop at the stop signs. Stop at the stop lights. Eat something before you leave the house, too. Take your time, because you have it. Rushing to a 30 hour wait just gets you to the 30 hour wait faster...and it's still a 30 hour wait. Unless you have been advised otherwise by your care team to arrive quickly and promptly at the first signs of labor, take your time.

• Please see the write up about natural ways to induce labor and all the old wives tales you can imagine - and you bet it includes why you shouldn't do certain ones! It still gets around and so I say it at every educational opportunity: Castor oil is not meant to be in your body, and no routes into your body are going to help you. They will make you miserable, and isn't labor hard enough? Just say no to castor oil.

• Remember rule number 0. When in doubt, get checked out.