%20(1).png)
Maternity Triage - The part of your hospital birth you are probably forgetting to plan for!
- thesmartdoula
- 3 hours ago
- 11 min read
Planning a hospital birth?
So you've made an informed choice that you feel safest giving birth in a hospital? (Yes, this should be an informed choice, it has both benefits and risks just like any other place of birth!)
You have made your birth plan, maybe you even have plans a, b and c. You have your hospital bag (or three!) packed.
You've done your group antenatal course, perhaps a hypnobirthing course, and hopefully you've also done some evidence-based research, listening to podcasts and reading books!
But there is a big part of your birth you may have missed when planning - and it's really important! It has the potential to stall your birth if you let it, and start a cascade of interventions that may prove hard to escape.
I am talking about maternity triage!
If you are planning to give birth in a midwifery centre inside a hospital, it is likely you will have to go through triage as well!
All Spontaneous Births Start at Home
Unless you are planning an induction, you will begin to labour at home...and there will become a point where you choose to call the midwives, and travel to the hospital.
In most circumstances, you will not be heading straight into the room you will have your baby in; first, you must pass through triage!
If you are wondering about 'when' you should head to the hospital, you should read my blog about contraction timers!
Ringing the Midwife in Labour
At some point during your labour at home, you will decide to call the hospital as you feel it is time for you to head in.
You may well have rang the hospital when your labour started to let them know that things are happening! But this time you are ringing to tell them you are ready to come in, you might not know it, but this phone call is your first clinical assessment!
You may ask your partner or doula to ring for you, but most likely the midwife on the other end of the phone will want to talk to you. This is because they are assessing your labour over the phone to determine if they think you are ready to come into the hospital.
When talking to you, the midwife will try to keep you on the phone for a few minutes. They will take details about your pregnancy so far, and what is happening at the moment. You might think this is a lot of chat, but it actually has another purpose:
They are keeping you on the phone long enough to hear you have a contraction, to see if you can talk through it and the kind of noise you are making during it.
They are keeping an eye on how many contractions you have during the phone call and the timing of them.
This information helps them determine whether they should suggest you stay at home a little longer or head to the hospital.
Whatever they suggest, please know that it is your decision, and you should go with your instincts about when the time is right.
However, we do know from research that the earlier in labour you go into the hospital the more your risk of interventions increases, so staying at home as long as you possibly can does have its benefits!
Your journey to the hospital in labour
This is another key part of your birth story and one you should pay attention to!
The majority of people will be heading into the hospital by car, stepping out of their dimly lit calm oxytocin bubble at home and into either bright daylight or neon streetlights and traffic.
You need to do what you can to protect your bubble. This can look like:
Wearing sunglasses or an eye mask
Wearing headphones with your playlist or affirmations on
Taking with you the coping tools you were using at home, TENs machine, birth comb, etc.
Continuing your hypnobirthing breathing
Leaving the bag, car packing, and navigating to your partner, this is the time to be a passenger princess!
I would also recommend you take a towel and a bowl in case you feel sick or your waters go, wearing a pad in case may be a good idea as well!
When it comes to parking the car, where you are able to park very much depends on your hospital.
Some hospitals may have a few parking bays to enable you to park and head straight into triage. Your partner can go back and move the car once you are settled.
In other places, it may be a case of your partner dropping you at the door and parking, then coming to find you! It depends on how you are feeling, but in some cases, the walk from the car park may do you good. Play it by ear!
Keep your headphones on and your sunglasses for the walk from the car to triage - fluorescent lighting and busy hospital corridors are not going to boost your oxytocin.
Maternity Triage in Labour - Arrival
When you arrive on the ward, how quickly you are seen will depend on the information you gave on the phone and the midwife's clinical assessment.
In some hospitals, you may be asked to wait in a waiting room on a chair, or you will be taken straight to a bay. There will be a pair of eyes on you watching your behaviour and the frequency of contractions, and this will also inform the pathway you are on and how long it will be before you are seen.
In some circumstances, if your contractions are very regular, intense, or you feel pressure or the urge to push, you may be taken straight to the labour ward or birth centre.
Maternity Triage - Admission Assessments
This will be the first time your birth plan and advocacy skills are put to the test!
The NICE guidelines state that every woman should have a face-to-face assessment of early labour, which is one hour of one-to-one midwifery care. This would be ideal, but I am sorry to tell you that with the short staffing we are seeing all over the country, it is very unlikely this will happen.
What will happen is someone will take your history, talk to you about the length, frequency and strength of your contractions and carry out a number of assessments, including:
Abdominal palpation to assess the baby's position and engagement
Blood pressure, pulse, temperature and respiration rate
Ask for a urine sample.
All of these things are optional, and should require little or no engagement with you, as you are attempting to stay 'in the zone', let your partner do the talking, don't feel too much pressure to produce a urine sample, simply give one when you need to go!
The problem with the admission CTG
The NICE guidelines state that to assess early labour, the midwife should 'auscultate the fetal heart rate for a minimum of 1 minute immediately after a contraction; palpate the woman's pulse to differentiate between the heartbeats of the woman and the baby', but in my experience, this seems to have been replaced with an 'admission CTG'
Replacing one-to-one care with a midwife with a machine is problematic in so many ways. If you are pregnant, I seriously recommend you do a deep dive into the CTG and the evidence (or lack of evidence) surrounding it. For the purpose of this blog, though, I will direct your attention to this article, which discusses the use of an admission CTG and concludes:
'the admission CTG in low-risk women increases the incidence of minor obstetric interventions, may increase the incidence of cesarean sections, but has no impact on other important outcomes. The prognostic values are poor, and the reliability varies from good to poor. There is no evidence showing that the admission CTG is beneficial, and the test should not be offered to low-risk women'
Do I need a vaginal exam for admission?
Before I go any further, I want to say that vaginal exams are ALWAYS optional, and that withholding care or pain relief because you decline one is coercion and assault. There was a recent court case in Australia where a woman was awarded substantial damages due to this very situation.
The NICE guidelines are actually kind of on your side for this one! They state:
if there is uncertainty about whether the woman is in established labour, a vaginal examination may be helpful after a period of assessment, but is not always necessary
if the woman appears to be in established labour, offer a vaginal examination.
They go on to say:
When conducting a vaginal examination:
be sure that the examination is necessary and will add important information to the decision-making process
recognise that a vaginal examination can be very distressing for a woman, especially if she is already in pain, highly anxious and in an unfamiliar environment
explain the reason for the examination and what will be involved
ensure the woman's informed consent, privacy, dignity and comfort
explain sensitively the findings of the examination and any impact on the birth plan to the woman and her birth companion(s)
Advise the woman that she can decline the examination before it starts, or ask to stop at any stage during the examination
So it's fair to say that it isn't mandatory.
A cervical check is not the only way to determine if you are in established labour, as the guidelines state. If you have one-to-one midwifery care for an hour, it will be obvious to the midwife if you are in established labour.
Let's pause for a moment and reflect on what has just happened.
You have gone from your lovely, calm, quiet oxytocin bubble at home, got in the car, walked yourself into the hospital, had a conversation with a stranger and potentially spent some time strapped to a machine, and someone has performed an intimate examination on you.
No matter how much you prepared, your oxytocin levels and stress levels will probably have been impacted in some way. Regardless of what the next steps are at this moment, you MIGHT experience a 'stall'.
Labour stalls in the triage unit
If you know about this, you can plan for it and not let it shake you!
If things start to slow down as soon as you get into the hospital, it can be at best disheartening and at worst the start of a cascade of interventions,
Take a breath, understand that this makes sense physiologically, and know that there is no reason to act if all else is well, and give your body time to get back into the zone.
What if they say I am not in labour
This is a tough one! The reason you headed in was that YOU felt like it was time, but as we chatted about earlier, going into the hospital too soon can increase your risk of interventions.
The only thing you can do here is really listen to your instincts, not cervical dilation values.
If things feel very intense for you, but your cervix is saying you aren't '4cm', so 'technically' not in labour yet, you can choose to stay. Depending on how busy the hospital is, they may allow you to labour in triage for a while or move you into the labour ward.
Cervical dilation isn't linear, so you could go from 3cm to 10cm in a few hours, or a few days. What your cervix is telling them now doesn't give a timeline for how the rest of your birth may go!
If you do start to feel like you have perhaps come in too soon, I would encourage you to head home for some rest, a takeaway and a movie. Being at home is going to do you wonders compared to being in a busy ward.
For some women, however, perhaps you have a lot of responsibilities at home that you can't get away from, the labour ward may provide more rest opportunities - it really depends on the situation!
The Bit Most People Miss
No matter how long you are going to be in triage, I encourage you to make that space your own.
At the top of your hospital bag, have a few easily accessible things that will help you feel at home / comfortable in triage, this could be:
A room spray
Some electric tea lights
A comfy blanket
You will also have with you the coping tools you were using for the journey, your eye mask, headphones, TENs machine, birth comb ect - keep these with you, keep using them!
I cannot emphasise this bit more, keep off the hospital bed! It can be so tempting to get into bed and stay there, especially if you have consented to the admission CTG and a vaginal exam. I have a number of issues with the hospital bed:
It puts you in a subservient 'patient' mindset immediately, with everyone towering above you.
The semi-reclined position is perhaps one of the worst for optimal patient positioning. Spending time leaning backwards could encourage the baby to move into a back-to-back position, which in itself is not a big problem, but if this isn't the position your baby wants to be in, it is best avoided.
It isn't an instinctual position; it's most likely going to make things more painful.
It leaves you vulnerable to further examinations.
In reality, though the bays are small in triage, there probably isn't much room for much else! You could request a birth-ball, or perhaps you have brought your own, or you can make use of the bed, without lying on your back!
You could raise the bed high and stand, leaning forward on it, put the back upright and kneel on the bed over the backrest or be on the bed on all fours.
Below is a video of me doing just this in Triage!
Advocacy Is Your Partners Most Important Skill
It may be busy, there may be an emergency, there may be no room in the birth centre or the labour ward, your job is to stay in the zone - your partner's job is to make sure YOU stay a priority.
This needs to be done in a professional, calm way, gently making sure you aren't forgotten about, asking for things you need and questioning anything that is suggested.
You can also make sure you aren't forgotten about by making yourself visible - yes, I have just told you to stay in your bubble BUT, there is no harm in the occasional walk to the toilet past the triage desk.... and if you HAPPEN to have a rather intense and loud contraction as you pass the desk.... well that is going to remind peope you are there! Nope, I'm not telling you to fake it, just put it to good use!
The walk could help with positioning and progress things, toilet breaks are important, and so is making sure you remain at the forefront of their minds!
Don't stifle any noises you want to make, either!
If you feel as though something is wrong, or if the baby is almost here, do not hesitate to make use of the emergency buzzer. If you are dismissed, ask for the person's name and PIN, and ask for their dismissal of your concerns to be documented in your notes.
Time to move on!
There will come a time when it is decided you are ready to move into the space where you will give birth.
This transition time can be a risky time for your birth plan. Make sure you are going where you wanted to go, that the room has everything you need, and no random additional extras are thrown in without informed consent, 'cough CTG'.
When you get into your birth space, your partner should already know how you want it set up, so leave them to it!
Congratulations, you bossed triage - now for the rest of your birth story!
Who am I?
I am Charlotte, a Virtual Doula, providing bespoke evidence-based pregnancy support to families who want an empowering birth.
With 10 years + of clinical research experience, a biomedical science degree, and two hospital births under my belt, I use my knowledge to provide pregnancy support to help you make informed decisions about your pregnancy, birth, and postpartum.
I provide pregnancy support for all types of births, including hospital births, helping you to navigate NHS guidelines and have an empowering, positive birth.
Comments