Adriana Lozada explains the process of triage, which happens before you’re admitted to the hospital to give birth. She covers it all, from the steps to confirm you’re in labor, to potential inconveniences and discomfort, to concrete ways to advocate for yourself and your birth plan from the moment you step into the hospital.
Have you experienced triage while in labor? Do you have a lingering “Why did they do that?” question about which you’re wondering? Join in the conversation on Instagram @birthfulpodcast.
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Related Birthful episodes:
- Know What You’re Up Against When Giving Birth at a Hospital, with Mimi Niles
- Insider Tips from a Labor and Delivery Nurse, with Mandy Irby
- Hospital-Based Triage of Obstetric Patients, from The American College of Obstetricians and Gynecologists (ACOG)
- Decisions that medical care providers make during triage are complex. That said, care rationing is an ethical quandary that has become even more pronounced during COVID-19, with members of marginalized communities most affected. Check out the campaign #NoBodyIsDisposable and their website nobodyisdisposable.org, to learn more about your rights for care and how you can advocate for systemic change.
A Quick Guide to Triage
Adriana Lozada: I’m Adriana Lozada and you’re listening to Birthful, and just like every other week, today I’m on my own, taking about 10 minutes or so to talk to you one-on-one about a topic that is gonna help you out tremendously as your birth approaches. This week, I want to talk about what happens during triage, and triage is basically the place you go to when arriving at the hospital where basically your fate is decided as to whether you’re in labor enough to be admitted.
So, if we look at the medical definition of triage, it is the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties. So, from the eyes of the hospital, what they’re trying to figure out is are you worth giving a room to and having you there for who knows how many hours? I did a little bit of research and I found that the American College of Obstetrics and Gynecology has a committee opinion that says that obstetric triage volume typically exceeds the overall birth volume of a hospital by 20 to 50%. So, that is to say there are more people waiting to see if they get admitted to the hospital because of being in labor than how many rooms they have. And which is why it’s so crucial for them to determine whether you are moving along fast enough to deserve a room.
Now, in terms of you, you’re thinking you’re in triage because… Well, first, you’re in labor most likely. There are other reasons why you might be in triage and that’s if you’re experiencing preterm labor, or signs of preeclampsia, the baby’s not moving as much as they would like them to be or is expected, vaginal bleeding, acute abdominal pain, and maybe because your water has broken early and your care provider sends you in to confirm if the water has broken or not. In that case, you’re probably not even gonna take up a room, right? If it’s early, early, early, you might just go home.
Lozada: So, in terms of what triage looks like, it’s gonna vary from hospital to hospital, but usually it is not a cozy, private space. It’s more… I’ve seen hospitals where it’s a big room that has say seven beds in it, and there are curtains dividing, sectioning off the beds into sort of cubbies, and those are not very private at all. You can hear what the person on the other side of the curtain is saying. Other places, they’re also a big space, but it’s divided say by glass walls that have curtains to give visual privacy, and those tend to be more private.
Now, what happens at triage? The first thing, like I said, is assessing if you are gonna be admitted or not. And to do that, they look at you, they look at baby. So, for baby what they do is a 20-minute baseline monitoring strip of their heartbeat, and that’s done through an electronic fetal monitor, and they want 20 minutes of that baseline, continuously usually, so if it gets chopped up because you moved or baby moved, it might take longer than 20 minutes to get that, and you might have the strip on for longer
Another thing that happens is that you’ll be checked for dilation, and that you can decline, but usually it’s how they measure whether you’re in active labor or not. Active labor is defined as being 5 or 6 centimeters dilated, so if you’re 3 or 4 or less, the options are… Well, you can just go home if you’re feeling like, “Okay, I’m here too early.” Or you could go and walk around for an hour and come back and get checked again, and if there’s a difference between the first check and the second check it shows progress, and that will probably get you admitted.
If you’re thinking, “Should I go home or not?” Check in with your gut. Trust your gut. Birth is not linear, and I’ve seen people be 2 centimeters along and then suddenly in an hour, change to 6 centimeters, and then have a baby a couple hours later. So, yeah, check in with your gut, but then decide whether you stay or go home. Other things that happen at triage is they’re gonna ask you a bunch of questions in terms of your history, if you’re GBS positive. They’re gonna also assess your contraction pattern, and that they do with another electronic fetal monitoring, so you’ll have two of them on your belly.
And if your water has broken, they’ll also verify that that indeed has happened. How they verify that can be through a vaginal swab and because amniotic fluid has a different PH, it will turn blue quite rapidly to say, “You have some amniotic fluid. Your water broke.” If that’s not so clear, they might then do a slide check. They put a slide in a microscope with amniotic fluid on it or what they’re trying to determine if it’s amniotic fluid, and when that dries, if it’s in a beautiful ferning pattern, then it is amniotic fluid, because that’s how beautiful things are. I think it’s fascinating, personally.
Lozada: They may also ask you if you want to change into a gown or they might wait until you’re admitted to suggest the gown. Know that you don’t have to at any point change into any gown. You can wear your own clothes, but if you want to, it’s there for you. And things that you can ask while you’re in triage in terms of a little preparation for maybe being admitted is to ask if you can be matched with a nurse that is a good fit for you. That’s a good time to do it, before you’re admitted, and before somebody has been assigned to you.
So, how long does triage take? And it’s really gonna depend on how close you are to giving birth and if there’s any rooms available. Usually, though, the process that I just mentioned takes about 45 minutes, but it can be longer, even several hours if you are not visually close to delivering and the rooms are quite full, or if for example you got to triage right around shift change. They’re not gonna want to put you in a room and have a nurse learn about you and then switch you, so you can ask about shift change and avoid going to the hospital at that time if that works for your labor.
So, say you, ta da, are in active labor, you are admitted, you’re going to a room. Now what? So, before you go to a room, if they haven’t offered a gown, they’re gonna offer you to change your clothes. You’re gonna have a labor and delivery nurse assigned to you and then they’re gonna do a blood draw, which it’s really important for you to know that your veins during pregnancy might be a difficult stick. For some reason, that might take more than one pricking with a needle to get the hep-lock or the IV port in. And just know to expect that. Know also that in terms of where to place that hep-lock, it is more comfortable on your forearm than on your wrist, and it’s also more comfortable on the back of your hand than on your wrist, because you’re gonna want to move that hand and you don’t want to be pinching or occluding the catheter.
This doesn’t mean that you need IV fluids going in through there. You don’t, but it’s more of having the access to it. You don’t even… If you want to, you can refuse that altogether, and then they’ll just do the blood draw. But they tend to want to put the hep-lock in, so understand if that’s a fight you want to have.
Other things they’ll do is they’ll check your vitals, they’ll have you sign a bunch of forms, ask you a bunch more questions, like when did you eat last, what’s your GBS status, and they might touch your belly to see baby’s position, because they want to make sure that baby is head down, and if they can’t quite tell just by doing a hands-on touching of the belly or through the vaginal exam, then what they might do is bring out an ultrasound, a portable ultrasound machine, just to double check that your baby is head down.
This is a perfect time to give them your birth plan to share any wishes that you might have, and then in terms of when you’re taken to your room, you can either walk or get rolled in a wheelchair. Whatever you prefer.
Now, can you skip triage? So, I have had a client that she has the best luck, and for some reason she skipped triage the three times she was in labor and I was her doula for that. But I think it was because she was so in labor when we got to the hospital that it was very clear that she was delivering. That is not always the case and there’s no guarantees, but if you’re feeling like really, I’m clearly having a baby, baby is coming, just ask. Say, “Can we skip triage? Baby is coming.” If they say no and you go to triage, you go to triage.
Another reason why you might skip triage is if you’re coming in for an induction. It’s a foregone conclusion that you’re gonna be admitted, you’re here to have a baby, so you’ll just most likely just go straight into your room.
Regardless of how it happens, I hope you have a wonderful triage experience.
Lozada: Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Virginia Lora is the managing producer. Cedric Wilson is our lead producer. Kojin Toshiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Amazon Music, Spotify, and everywhere you listen. Come back next week for more ways to inform your intuition.
Lozada, Adriana, host. “A Quick Guide to Triage.” Birthful, Lantigua Williams & Co., November 17, 2020. Birthful.com.
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