When Should I Call?

New Haven 203-562-5181

Madison 203-245-2741

Cheshire 203-272-1811

Branford 2-3-481-7018

Milford 203-877-6652

Guidelines to fit every woman's labor experience are, of course, not possible. However, we can give you general advise based on our years of caring for obstetrical patients, and our philosophy that labor is a normal, healthy event in a woman's life.

There is always a midwife and doctor "on call", and usually the midwife will return your call. You may reach us by calling any office number. If you do not hear back within 10 minutes, call the answering service again. We may be tied up with an emergency. PLEASE DO NOT GO TO THE HOSPITAL WITHOUT SPEAKING TO ONE OF US FIRST! When we do not have a patient in labor, we are not at the hospital to admit or care for you. In addition, many problems may be handled over the telephone, without the inconvenience of a trip to the hospital.

Ruptured membranes (Bag of Water)

Usually, rupture of membranes will occur during active labor, but occasionally your water may break before the start of labor. Increased vaginal discharge is frequently noted by women close to their due date, and can be confusing. True rupture of membranes is almost always indicated by a gush or steady trickling of watery fluid from the vagina. If you are uncertain, put on a sanitary pad for an hour or two and check for wetness.

If you think you have broken your bag of water:

• Note the time
• Check the color of the fluid. Amniotic fluid is sometimes perfectly clear, but often has mucus or specks of vernix, or small blood clots. It may even be slightly pink. If the fluid is green, yellow or brown, or you are bleeding heavily, call the office at once.
• Sit quietly, or lie on your left side for 30-60 minutes to assure yourself that the baby is moving normally.
• If you break your bag of water in the evening, or before the office opens at 8:15 am, you do not need to call unless the fluid is yellow, green or brown, you are bleeding very heavily, the baby is not moving normally, you feel a lot of vaginal pressure or you are in labor. Once you suspect your water has broken, do not take tub baths (showers are fine), use tampons, have intercourse or have a vaginal exam without telling the midwife or doctor that you think your membranes might be ruptured.

Call the office promptly at 8:15 am and tell the secretaries that you have ruptured your membranes, and that you need to be seen that morning.

Labor

Prodromal or false labor is disorganized, uncomfortable contractions which can vary in strength and frequency and can go on for days before the onset of real or active labor. It is easy to become frustrated and even angry if you have been up for several nights, certain that "this is it", only to find that the next day brings more of the same. Prodromal labor is best managed at home with warm baths and a glass or wine or beer to quiet your uterus and let you sleep. Make sure you drink adequate fluids, since being a little dehydrated can also cause this uterine irritability. Stronger mediations are available if the simple remedies don't work. Try to keep a positive attitude by recognizing that this is a common situation and it will end!

First babies take many hours of labor and several hours of pushing to enter the world. We advise women having their first baby to call when contractions are 3-4 minutes apart for at least one hour, are about 45 - 60 seconds long, and are strongly enough that you can't walk or talk through them. Generally, you may still have several hours of labor ahead, so this does not automatically mean that this is time to go to the hospital, but it is time to call the midwife.

Second or third labors tend to be much faster than the first. We advise these women to call when the contractions are 4-5 minutes apart for an hour and are strong and regular. If you have had a fast first labor, or your cervix has already dilated more than a few centimeters, be sure to remind the midwife on call.

Regardless what number labor this is, always call immediately with:

• sudden onset of strong rectal pressure
• sudden onset of very heavy bloody show (like a heavy period)
• sudden decrease in fetal movement
• a strong sense that "the baby is coming"

The above information clearly will not apply to all situations, and if you have any problems or question that the above does not address, please call us. We do not expect you to know all the answers, and we are here to provide the care that you need.

Obstetrics-Gynecology-Infertility Group, PC
203-562-5181