What to Expect: Triage
When planning a hospital birth, everyone should know about the process of triage. Triage is usually a unit of the hospital where someone in labor will be assessed. Some hospitals call it the “Maternity Assessment Unit” or the "OB Emergency Department." Most commonly you will hear it referred to as “triage." Over the years I have found that a lot of parents planning their labor and birth did not know this was part of the process. In triage, a pregnant or laboring mom will be evaluated. Then, there will be the decision to either admit the patient to a different unit (usually the labor and delivery unit), be treated in triage for a short period, or be sent home.
The most common time to go to the hospital and go through the triage process is when a mom feels that she is in labor. During this time, the mom is brought back to a small room with a small bed in it. Some hospitals have a policy that the laboring mom is asked to come back alone first without her support person and/or doula for some time. This is something to ask on a hospital tour so that you are prepared. Most of the time the nurse will instruct a mom to remove her clothes, put on a gown, and then lay down on the bed and the evaluation starts. The nurse will put monitors on her belly to monitor both the baby’s heart rate and to record contractions that might be happening. They will usually also get a blood pressure, a temperature, and do a cervical exam as well. These are all evaluation techniques that will help decide the next steps.
For a mom in labor, the two choices are usually to 1) be admitted to the labor and delivery unit to continue laboring and have a baby, or 2) be sent back home to continue laboring at home as long as possible. Triage can be both physically and mentally difficult in labor. One thing that people do not know is that they have the option to keep their own clothes on. The gown is helpful for the nurses and doctors to be able to do the tasks they need to do a little easier. However, many people prefer wearing their own clothes and you have that as an option! Then, there is the cervical exam. Most people do not enjoy this part, since normally they need to lay on their back which is not the most comfortable position while laboring, and then the exam itself is typically not relaxing. However, there are some benefits to it. It is really helpful to get a baseline for where mom is at in labor. Sometimes if a cervical exam is needed later on in the labor it is helpful to know how much progress has been made or not. The other benefit of getting one during the triage process is to confirm that the baby is head down. There can occasionally be babies who flip to breech position at the last moment and so it is helpful to know that earlier in the process versus later in labor. Although the cervical exams do not tell us when the baby will be born, it does give the woman in labor and her providers a little bit more information to make decisions.
If a mom is in labor, the decision is whether to stay or go. During times of Covid, this is also typically when they will do a Covid test on the mom. They are currently not doing Covid tests on the partner in our Triad area hospitals but of course, things are always changing. Every hospital location is a bit different in their policies on who can be with mom in triage. If the hospital does not already, we encourage our clients to advocate for them to have both their partner and doula in triage with them. Unfortunately, depending on the situation, triage can be a lengthy process. There can be times where the decision to admit mom to the labor and delivery unit takes a while to make. Sometimes a laboring mom comes to the hospital a bit earlier in the process and they decide to wait an hour or two to see if labor progresses before being admitted. While we do not use dilation as an accurate predictor for when a baby is going to come, the research shows if you are admitted to the hospital in spontaneous labor past 4 cm dilated your chances of a cesarean are about 11%. If you are admitted to the hospital before 4 cm dilated in spontaneous labor, your chances of a cesarean are around 18%. So a goal of 4 cm dilated is a great one to have! There is also the possibility of triage not being quick enough! Babies might not wait until mom is admitted to the labor and delivery unit. So this is something we consider when we have a mom that seems to be laboring quickly or has a history of quick labors. Sometimes it might be helpful to get to the hospital a little bit earlier in the process than you otherwise would due to the triage process taking a little bit of time. This is also something you can talk to your care provider about. Some providers offer moms to go to their doctor or midwife's office before the hospital to be evaluated there and to determine if they should go straight to labor and delivery and bypass triage. However, during times of Covid (again), most doctor and midwife offices do not allow a support person to come with mom to an office visit. So this would be something you would want to think about first.
The other function of a triage unit is that it operates as a pregnant patient emergency department. Anyone who is having health concerns and is also pregnant will usually be recommended to go to the maternity triage unit. Some of the common things the department sees outside of labor are dehydration, illnesses, decreased fetal movement, or bleeding. For the majority of these concerns. moms can be treated in the triage unit for a few hours and then sent home. However, sometimes there are non-labor medical concerns where mom would have to be admitted to an antepartum unit for care.
So, what are some ways to handle the challenges of triage? The number one thing is to have a support person with you. If you have a doula, that person will help you remember the ways to advocate for you and also strive to make the triage room as comfortable as possible. One simple thing you can do to make the room more comfortable is to simply turn the lights down. The bright lights in the hospital are not conducive to relaxation. Next, make sure a mother has the freedom to move outside of the laying on her back. Sometimes this requires asking for support with this. You could say to the nurse, “I am struggling to lay on my back. Can I stand next to the bed and then adjust the monitors?” Lastly, bring water and make sure you go to the bathroom if needed! This is a good rule throughout labor, but no need to stop drinking or peeing during triage time! We have found the triage process can distract from a mother’s focus during labor. However, with some knowledge of what to expect, you can feel ready to handle the process and know it can be beneficial!