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Early Labor vs Active Labor – When to Go to the Hospital?

Early Labor vs Active Labor

Understanding the differences between these two phases will help you to make a better decision about when to head to the hospital, birth location or call the midwife!

Let’s start with these definitions:
Labor: uterine contractions resulting in cervical change (dilation and/or effacement)
Early labor phase: from the onset of labor to the onset of the active phase

Active labor phase: accelerated cervical dilation typically beginning at 6 cm of dilation.

One study found that 50% of women entered active labor at 4cm, 75% at 5cm and 100% at 6cm dilation.

What does early labor look like?

Contractions come on slowly and gradually get closer together, longer and stronger. At the beginning of early labor most women are still able to talk through their contractions and can distract themselves with other activities. She may start out excited, confident and talkative and will enjoy company. She may have bloody show (a small amount of blood) or vaginal discharge. As early labor continues it gets a bit harder to ignore the contractions and she may need to focus and start using coping methods to get through them. She may not want to talk during some contractions, however in between she will still be able to engage with others.

What does active labor look like?

A woman in active labor is typically using all of her focus and energy to get through her contractions. She is no longer able to talk during contractions. She has a very inward focus and will lose track of time. She will want to rest and close her eyes in between every contraction to get a break before the next one comes. She may request continuous support and comfort measures to help her cope with her contractions. She may make noises or moan during contractions. The intensity and potential pain level during active labor is far greater than early labor. She may experience shaking, nausea and vomiting. She may have a loss of appetite and sensitivity to smells. She may also no longer care about modesty, but will only be concerned with comfort.

When to go to the hospital? 

We often use the 4.1.1. or 5.1.1. rule of thumb as a guideline for when to go to the hospital. This refers to having contractions that are five minutes apart, lasting about one minute long, for at least one hour. While this can be a helpful guideline, it is important to know that timing contractions is only one tool than can be used to determine labor progress. Contractions that are five minutes apart do not automatically indicate active labor or the need to go to the hospital. Looking at the whole picture including the physical and emotional indicators is wise.

Studies have shown that women admitted to the hospital in early labor were approximately twice as likely to have their labors augmented with pitocin and other interventions. They also had longer labors and were more likely to give birth by cesarean. Labor times vary but early labor can be as long as 20 hours for a first time mother. Hospitals and care providers strive to admit women who are in active labor unless there is a medical reason to admit them sooner. Having a birth doula that you can talk to is very helpful when determining if it is a good time to go. If you are not in active labor you will likely be discharged to continue laboring at home.

Strategies that you can use at home to help you cope during early labor include:

  • Distraction: cooking, organizing, get a mani/pedi, movie, games. Don’t exhaust yourself but do things that keep your mind occupied.
  • Ignoring contractions and carrying on with your normal activities until you can’t any longer
  • Continuous support from your partner, doula, motherBreathing and relaxation
  • Meditations or HypnoBirthing techniques
  • Massage and touchMovement, walking and position changes
  • Eating and drinkingHeat and cold therapy (hot pack, or cold washcloth)
  • Hydrotherapy – getting in the tub or shower.

Doulas spend time educating clients on this topic. We are always happy to talk with you and guide you during early labor to help you make the best decisions for you and your family.

Links to studies:

About Christie Collbran

Christie Collbran is the owner and founder of Buddha Belly. Christie believes in helping women recognize their own inner wisdom, strength and power and has more than ten years of experience serving families as a doula.

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