The Right Dilation to Be When You Go to the Hospital

Getting to the Hospital in Active Labor

Doctor examining pregnant woman
Jamie Grill/Getty Images/Tetra images RF

One question that many pregnant people ask surrounds knowing when it is time to go to the hospital or call their midwife. This can mean that some people will call too soon, which is more common than waiting too long. That may lead you to wonder: Is there a right dilation to be when you go to the hospital?

Telling How Far Along You Are in Labor

To understand where you are on the timeline of labor, you must first understand the basics of how labor is divided.

Labor is divided into three stages:

  • First Stage: Labor
  • Second Stage: Pushing
  • Third Stage: Placenta

The first stage has three phases:

Early labor is the longest and least painful. Active labor is when people begin to get serious about having to work with the contractions to cope with the pain and may request pain medication if this is on their birth plan. Transition is the shortest, but most intense part of labor.

A consensus statement from multiple birth related professional groups showed that using the definition of six centimeters to define active labor was one way to lower the rates of unnecessary cesarean sections. 

Arriving at the Hospital

A vaginal exam will be done when you get to the hospital to assess how far dilated you are, how open your cervix is at that time. A change in the cervix is often a measurement that is used to determine if you are indeed in labor.

How far your cervix is dilated can vary widely from woman to woman at the start of labor. Some women find out that their cervix is dilated even before labor begins. There are women who walk around a centimeter and a few women who walk around at five centimeters, so simply being dilated does not mean that you are in labor.

When you decide to go to the hospital in labor, you will be told how far dilated you are when you get to the hospital. Whether you decide to stay at the hospital or go back home to labor can depend on how far dilated you are, as well as other key factors in your labor and medical history.

So if for example, you are less than three centimeters when you get to the hospital and you're not in a lot of pain, you're not planning to use an epidural at all or early in labor, going home might be the reasonable and most comfortable decision for you. But if your water has broken, you are in a lot of pain or require special medical treatment, you may wish to stay at the hospital or be asked to stay by your practitioner. The big question is how much should be dilated to go into labor? The answer is - there isn't one answer, it's more about where active labor starts, which is not three centimeters.​

Generally speaking, once you are past five or six centimeters and having regular contractions, many practitioners are fairly insistent that you stay at the hospital until your baby is born.

Six Ways to Progress in Labor

In general, there are six ways for your labor progress to be measured. These include:

  • ripening of the cervix
  • effacement of the cervix
  • dilation of the cervix
  • cervix moving forward
  • station of the baby
  • rotation of the baby

Despite there being multiple ways to measure labor's progress, we tend to get hung up on how far dilated someone is in labor. This is only one piece of the puzzle. Looking at the whole picture will help you decide how you should proceed. 

Should You Stay or Should You Go Home from the Hospital

Here are some things to consider when making the decision to stay at the hospital or go home:

  • How are you feeling?
  • How are your contractions coming along?
  • How is baby handling labor?
  • Is your bag of water intact? Broken?
  • Is there anything in your medical history that may mean that going to the hospital early is best for you?
  • Do you require antibiotics in labor?
  • Do you want to leave?
  • Do you want to stay?
  • How far away do you live from the hospital?
  • Do you have a doula?

Staying at the hospital prior to being in active labor has been shown to increase your risk of cesarean section. So it should be carefully considered whether you should stay or whether you should go. Going home, even in early labor, will often have you feeling more comfortable and in your own surroundings. You can bathe, eat, drink, and sleep, all in the comfort of your own home.

There are some women who may not be a great candidate for going home in early labor. After answering all of these questions and talking it over with your family and practitioner, make a decision that is best for you.

Sources:

American Congress of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 1: Safe prevention of the primary cesarean delivery. Obstet Gynecol 123(3):693–711. 2014.

Neal, J., et al., Outcomes of nulliparous women with spontaneous labor onset admitted to hospitals in preactive versus active labor. J Midwifery Womens Health, 2014. 59(1): p. 28-34.

Obstetrics: Normal and Problem Pregnancies. Gabbe, S, Niebyl, J, Simpson, JL. Fifth Edition.

Continue Reading