Labor and Delivery Triage Education and Information

 Labor and Delivery Triage

What is labor and delivery triage?

It’s really a labor and delivery emergency room. If during pregnancy you come to the hospital for any pregnancy related concerns, you will be brought to Labor and Delivery Triage.

Some common things patients come into the hospital for are, but not limited to, contractions, vaginal bleeding, hasn’t felt their baby move, blood pressure concerns, water broke, fell on your stomach, car accident, etc.

What happens during this process?

Depending on why you have come in, things may happen differently. But for the most part, triage is evaluating you and baby that allows your provider and/or the provider on call at that time to make an informed decision on admitting you to the hospital, treating you for a short period of time in triage, monitoring you and baby for as long as they see fit, or sending you home.

As you are being taken to triage and in triage, a series of questions will be asked to get a better understanding of what’s going on, when whatever it is started, what pregnancy is this for you, when your due date is, who is your doctor, whether or not you are GBS positive, any current or past pregnancy problems, drug/alcohol abuse, whether you’ve vaginally or C-section delivered before, etc.

In triage you may be asked to give a urine sample and to change into a gown. Once back in bed you will be hooked to the monitors to watch baby and you, your vitals taken frequently. This is the time we may or may not decide, depending on the factors and your permission, check your cervix for any dilation.

If you may think your water has broken, there are a couple different ways to tell. Nurses can take a swab called a nitrazine as a less accurate way to assess. I say less accurate because urine, semen, and lubricant can make this a false positive. An amnisure is a more accurate swab that is sent to the lab to be analyzed. A FERN test is another more accurate, if not most accurate. This is done by the physician. They will, usually, put you into stirrups and do a speculum exam. This is when they swab the fluid right at the cervix, transfer it to a slide, and go examine it underneath the microscope. Fun fact: it’s called a FERN test because underneath the microscope your amniotic fluid looks just like a fern plant.

It is important to note that when your water breaks, it’s not always a big gush like movies make it out to be. It could be a slow trickle. If you are not sure if it is your water or urine - Go empty your bladder and put a pad on. Start monitoring whether or not your pads are still starting to get wet or if you start soaking them. If you are still unsure, notify your clinic or be seen on labor and delivery. If your water has broken, you are at a higher risk for infection. That amniotic fluid that surrounds baby can become infected called chorioamnionitis. This can make you and/or baby sick if not treated appropriately in a timely manner.

Also important to note that you don’t necessarily have to be in labor in order for your water to break. Things just happen and it needs to be addressed, the sooner the better.

Decreased fetal movement - if you have come in because you haven’t felt your baby move in quite some time, we are going to skip most all mentioned steps above and immediately get you onto the monitor. We want to make sure we have a documented heart rate and make sure baby is doing okay.

• If you have had a busy day, finally sit down to relax, and maybe realize you haven’t felt baby move much if at all. Always come in to be evaluated or contact your physician for recommendations or further instruction, but during that time try drinking some cold ice water, drinking a soda or sugary drink like apple juice. See if that helps baby have more noticeable movements.
• The American Congress of Obstetrics and Gynecologists (ACOG) recommends that you time how long it takes to feel 10 movements from baby. Typically beginning around 28 weeks and beyond. Ideally, you want to feel 10 movements within a two-hour period. This is referred to as fetal kick counts and is best to do after a large meal or something sugary when baby is most active.

You know your baby and their movements best. Any concern with decreased movement, no movement at all, or maybe even just odd movement patterns - seek professional advice and/or help.

Contractions - this is when the muscles of uterus tightens up like a fist and then relaxes. May feel as if baby is bawling up. There are 2 types of categories that contractions fall under.

Braxton Hicks Contractions and True Labor Contractions.

You may find, especially being a first-time mother, asking yourself “well how in the world am I supposed to know which is which and when to go into the hospital?”

Let’s start off by discussing Braxton Hicks Contractions.

• Braxton Hicks Contractions are mini contractions that are preparing your body for labor. Kind of like a practice run. These can begin happening as early as first trimester, but you typically don’t notice them until the third trimester.

First Trimester - conception to 12 weeks
Second Trimester - 13 to 27 weeks
Third Trimester - 28 to 40 weeks

Braxton Hicks are irregular, unpredictable, and are not painful. They may be slightly uncomfortable, but not painful. Kind of like mild menstrual cramping.

1. What can cause them? Not only can nothing cause them, but they are just simply your body preparing itself. Other causes include sexual intercourse, dehydration, exercise, a full bladder, bladder/kidney infections, walking around all day whether that includes shopping, walking around the block, cleaning your house all day, at a fair. Whatever the reason may be, you’ve been on your feet all day. Or just existing, sounds like huh? 🥴
   
   
2. Can I stop them? If they’re Braxton hicks - you can try taking some Tylenol, drink lots and lots of water, take a warm bath, relax, change positions. Typically, this will stop them from happening for the time being.

Let’s discuss True Labor Contractions

These are the contractions of the uterus, that despite all efforts/remedies/DIYs. They. Are. Not. Stopping. These contractions will begin to dilate and efface your cervix.
They’re becoming regular, more painful as the time passes by, and you may even see some blood-tinged spotting. Your cervix is a very vascular organ. When it begins to dilate and efface, it usually will begin to bleed also.

1. What can cause them? Labor. You are going into labor because your body said so.
   
   
2. Can I stop them? You, no. Doctor/nurses, maybe. I say maybe because if you are less than 37 weeks (term) and your body has decided it’s time for labor. Your doctor may try to stop it in a couple different ways. One of those ways is a small, tiny shot given in the fatty tissue on the back of your arm called terbutaline or brethine. Common side effects from this medication you may feel very jittery, feeling like your heart is beating really fast, but this doesn’t last very long. You may be started on a medication called Procardia. This is a pill taken. Determined by your physician and risk factors, this medication may be prescribed for the rest of your pregnancy and may be prescribed to take once or twice a day.
   

Another way to maybe stop preterm labor contractions requires admission and started on IV magnesium sulfate. Magnesium Sulfate can help with several things. This is sort of like an IV muscle relaxer. Very common side effects include feeling extremely HOT and flushed, tired, etc. Determined by your physician, you may be on this medication for 12 hours or 24 hours. Being on this medication requires to either have a Foley catheter placed or STRICT observation and measurement of urine output. It is extremely important to monitor how well your kidneys are functioning and producing urine. Don’t be alarmed if you are told you cannot eat while on this medication. The reasoning behind that is since this is basically a muscle relaxer medication, guess what your stomach is? A muscle. Eating regular solid food while receiving this medication will possibly cause you to be very nauseous and vomit.

Now what do I mean when stated above that it is used for several things?

• Not only can magnesium sulfate be used to hopefully stop preterm labor, but it may also be prescribed to prevent eclampsia - a symptom of sudden new onset of seizures caused by untreated high blood pressure of Preeclampsia. Magnesium Sulfate also acts a neuroprotection agent for your unborn baby. Meaning decreasing the risks for brain injury commonly found in underdeveloped newborns born too early, such as cerebral palsy.

Despite all efforts to stop labor when needed, sometimes it doesn’t work. When your body has decided it’s time for labor, then it’s time for labor.

3. How will I know when to go into the hospital for contractions? If you have started to notice you may begin to have contractions. Kind of treat them like Braxton hicks at first. Try all the things mentioned above about Braxton Hicks and see if they stop. If they do not stop, start timing them.

• How to time your contractions:
• Write down the time your contraction starts.
• Time the duration: note how many seconds each contraction lasts; from the time it starts to the time it ends.
• Note how many minutes are they apart. How many minutes was it from when the one contraction started to the start of the next one?

For first time mothers:

Come in to be assessed when your contractions are about every 2-3 minutes apart, lasting for about 60 seconds or longer for an hour or longer.

• follow the 3-1-1 rule. Every 3 minutes (or less) apart, last 1 minute or longer, and this has been consistent for 1 hour or more.

For previous time mothers:

Come in to be assessed when your contractions are about every 4-5 minutes apart, last for about 60 seconds or longer for an hour or longer.

• follow the 5-1-1 rule. Every 5 minutes (or less) apart, last 1 minute or longer, and this has been consistent for 1 hour or more.

*And of course, come in if your contractions rapidly become more painful and you cannot talk through them.

It’s always a good idea to have your hospital bags packed in the car, car seat properly strapped in, and car seat base ready to go before or around 35 weeks.

I’ve always loved this demonstration of how contractions work in changing the cervix. https://www.tiktok.com/t/ZTNqwdttY/

Mucus Plug

What exactly is a mucus plug? This is a ball of mucus that’s literally plugged (naturally) into the opening of your cervix. It helps protect baby by keeping bacteria out of inside the uterus.

• Losing your mucus plug does not always mean you are in labor or going into labor at that moment. But it could indicate labor may be soonish. Could be several hours or several weeks so just stay prepared to start monitoring for symptoms of labor. But losing your mucus plug alone with no other indication of labor does not indicate a trip to labor and delivery triage.

Why, when, what to expect?

• Why: Because as your cervix begins to dilate and/or efface (thin) your plug may come out as one big glob or in pieces over several days. In simpler terms, think of your uterus as a bathtub and that mucus plug is the drain plug -What happens when you unplug the drain of a bathtub? Things start to go down it.
  
  
• When: when your cervix begins to dilate and/or efface. Ideally, 37 weeks or later (third trimester) You could start losing it at the start of labor or even days before. Start preparing. Have things packed and things in place just in case.
  
  
• What to expect: Usually you make your routine bathroom visit and you either wipe or see a glob of mucus on the toilet paper or in the toilet. You may even see small spotting of pink-tinged blood. This is normal as the cervix begins to dilate and/or efface.

Fell On Your Stomach

If you ever find yourself in the incident that you have fallen onto your stomach or you hit your stomach really hard. It’s always best to come get checked out in triage. Be prepared to stay on the monitor for quite some time. 6 hours or so. Maybe more, maybe a little less. But hours for sure. 

Many complications could arise from hitting your belly hard and it’s always best to just come make sure every thing is okay.

 Car Accident

This is another one of those things to just come get checked out in triage. Just about goes hand in hand with falling on your stomach mentioned above, if not worse depending on the accident. Be prepared to stay on the monitor for quite some time. 6 hours or so. Maybe more, maybe a little less. But hours for sure.

Triage can be a short or long trip. We never know and it is up to the physician to make that call. Our main priority in triage is making sure you and baby are safe and addressing the concerns that brought you in. So, plan to spend 30 minutes or maybe even 4 hours or MORE. We just don’t know yet.

And typically, you will not be allowed to eat or drink during a triage visit because we need to make sure you and baby are safe because your visit could turn into admission and delivery very quickly.