Between 5-1-1 and Admission

Are you wondering what, exactly, is going to happen once you know you are in labour? Does it seem like there is a suspicious lack of details about what happens after “5-1-1, let’s go to the hospital”? What happens between 5-1-1 and admission?

It is normal to be feeling unsure! After all, even if you ask friends who have given birth, they don’t usually talk about arriving at the hospital; they are usually pretty focused on the end result! So, while every hospital is different and will have their own policies, many of those early hospital experiences are the same across the region.

Let’s take a look!

While every hospital has their own policy, most follow some version of the 5-1-1 rule. So we are all working from the same definition, this means that contracts are about 5 minutes apart, they are at least 1 minute long, and this has been the pattern for at least 1 hour. Some hospitals will recommend that first-time individuals wait longer. You may be told to follow 5-1-2. Or 5 minutes apart, for 1 minute, over 2 hours. Once you have reached this point in labour,  you should head to your birthing location. This is the time between 5-1-1 and admission.

Registering

Regardless of which hospital you are giving birth at, you will register when you arrive. This process can be different depending on the time of day. For example, if registration is closed on the 15th floor at Mount Sinai, you will register on the main floor. At other hospitals, you register when you arrive in the labour and delivery triage.

During registration, you will be asked about insurance coverage. While most care is covered by provincial insurance, many extended benefits plans cover semi-private or private rooms.

Assessment

Depending on your hospital, time of day, and how busy it is, you may be taken directly into a triage room, or you may be directed to a waiting room. When a bed is free you will be moved to a triage assessment room or bed. Once settled, a nurse will place two monitors on your belly; the first monitors the baby’s heart rate and the second monitors any contractions you may be having. The nurse will also do a blood pressure check and ask you a lot of questions!

Once the nurse has asked her questions, they will likely leave the room, while you remain attached to monitors. This can seem uncomfortable as monitor straps may be tight, you may feel ‘stuck’ on the bed which can be difficult during contractions. There is also very little space in triage and it can feel crowded if you want to move! While the wait in triage is generally not too long, on busy days it may be hours before you see a doctor and are moved to a labour suite.

The main assessment that needs to be done before you can be moved to a labour room is for a doctor to do a cervical exam (CE). This determines how dilated you are, if your waters have ruptured, or if there are any other reasons why you should be admitted.

Generally, doctors are looking to admit individuals who have dilated to 3-4cm with consistent contractions that are five minutes apart and about a minute long. However, there are other reasons why someone who does not meet those parameters to be admitted. The doctor on call is skilled in making that determination and will give the nurse instructions for your care.

The Fork In The Road

This is where your path might take one of several paths. Let’s look at the options:

The Waiting Game

This can be one of the hardest moments between 5-1-1 and admission. If you are not dilated enough for admission, the doctor may make one of a few suggestions. It can be especially hard to hear you are not "dilated enough" if you have been in labour for a long time or your contractions are intense.  If things have completely slowed or stalled, including the frequency and intensity of your contractions, the doctor may suggest you return home until labour picks up again. After all, that start-and-stop labour pattern can happen for days (or weeks!) leading up to the big event, and it even has a name – prodromal labour.

If your contractions are indicative of labour (that 5-1-1 rule again!) but your cervix has simply not caught up, the doctor may recommend you go for a walk around the hospital for 1-3 hours and return after. In this scenario, they will also give you a number of criteria for which you should return, such as bleeding.

Admission

The doctor may also decide that you are ready for admission. This means your cervix has dilated to at least 3-4cm. It may also mean your waters have been ruptured for too long, or you have been found to have some other reason why you need to be admitted.

You will be directed to collect your things and follow your nurse to a room where you can get changed into a hospital gown if you wish and settle in. If you are being induced, planning an epidural, or are GBS positive, this is when your nurse will place an IV. Your nurse will also give you an allergy alert band if you have any allergies.

Although it can feel like events in labour are sweeping you along, it doesn’t have to be that way. Don’t be nervous to ask questions or have frank, but polite, conversations with your medical care providers during this time. The hours between 5-1-1 and admission are their own kind of transition, but it can be a smooth one.