Women who are pregnant often have many questions about labor and delivery. One question that comes up frequently is how to get admitted to the hospital for delivery. In this blog post, we will provide information on how to get admitted to labor and delivery, as well as what to expect when you arrive at the hospital. We hope that this information will help pregnant women feel prepared for their upcoming birth experience. Thanks for reading!
But first, how do I know all of this? Hi — I’m Hilary — The Pregnancy Nurse 👩⚕️. I have been a nurse since 1997 and I have 20 years of OB nursing experience, I am also the curly head behind Pulling Curls and The Online Prenatal Class for Couples. 🩺 I have seen maybe tens of thousands of patients in triage. I have helped providers make the choice to admit or discharge patients with each of them and I can give you some good insight into how that works.
And, if you’re desperate to get things going… do yourself a favor and join me in here. In just a few minutes I can get you prepared on what to watch for, and what you can do in early labor to keep things going (plus, when to know when you should call or go into the hospital).
Why People are Admitted to Labor and Delivery
People are admitted to labor and delivery because it is the safest place for them.
There are many reasons why people come to labor and delivery. Some common reasons include:
- You are contracting and want to make sure everything is OK
- You are in active labor and need pain relief
- Your water has broken
- You are experiencing vaginal bleeding
- You have a fever
- You are feeling faint or dizzy
- You feel like something is wrong
- Baby isn’t moving
- Your provider’s office says to come in
(this list is, by no means, exhaustive)
Pro Tip: Wonder WHAT should bring you into the hospital and worried you’ll miss something? Chapter 2 in here goes over all of that!
The Difference Between Triage and Labor & Delivery
When you arrive at the hospital, you will be seen by a triage nurse. The purpose of triage is to assess the severity of your condition and to determine if you need to be admitted to labor and delivery or if you can be safely sent home. Triage nurses use a variety of criteria to make their decision, including:
Pro Tip: Triage nurses tend to be some of the most skilled nurses on the unit, so it would be difficult to “fool” them, if that is what you’re considering. I have had patients “fake” contractions…. it wasn’t a smart move.
–Your medical history (we may be able to get access to your prenatal records to learn more about your pregnancy)
-The severity of your symptoms — your nurse will do a thorough assessment and ask many questions when you come to triage, to find out exactly what you are experiencing.
-Your current health status — we will check vital signs to see how your body is doing overall
-How far along you are in your pregnancy — a woman who is 36 weeks pregnant, may be treated differently than someone who is 41 weeks.
Now, just because people COME to labor and delivery, doesn’t mean they are being admitted to “the unit”. Labor and delivery runs like the rest of the hospital. Meaning, people go to the ER. Some of those people have their problems solved there, or realize that they are safe to go home. Some of the people (the minority, actually) end up being admitted to the hospital.
Once your nurse does all those things she will talk to your doctor or midwife to decide if:
- They need to come visit you and do another assessment
- You can receive treatment, or further assessment (like an ultrasound) in triage
- You need treatment in the main hospital (let’s say you’re having breathing issues unrelated to pregnancy)
- You can be discharged
- You should be admitted to labor and delivery
Your triage nurse is certified capable to see and discharge certain things in labor and delivery, and does not need a provider to directly see you if those things are related to your OB condition. These things vary hospital to hospital, but usually a labor nurse can assess:
- If you are in active labor
- If your water is broken
- Bladder Infections
- Preterm labor
Things beyond that usually need a doctor or midwife to come see you in the unit (which can sometimes take a while). Some units have a provider “in house” all the time who is able to see you quickly (sometimes called a hospitalist, or a laborist). Some units require calling that provider in from their office or home to come see you (which can take longer).
People who are obviously in active labor (aka, head is coming out) or have a procedure (like an induction) scheduled, may go directly to a labor room. But, anyone else would be “triaged” to see what is best for them.
Be sure to check out my post with 12 reasons to call L&D.
Why people are NOT Admitted to Labor & Delivery
There are also many reasons why people may not be admitted to labor and delivery. Some common reasons include:
- Your contractions are not yet regular or strong enough
- You are not yet in active labor
- Your water has not broken
- You have no vaginal bleeding
- Your fever is low-grade
- You feel well and have no other symptoms
This is NOT to say that you should not go into triage if you think these things have happened.
Any amount of bleeding can be scary during pregnancy, and it may take an expert to decide if you are safe or not at home.
It can be really difficult to decide if your water has broken, and the hospital has specific tests they can use to see if that has happened or not.
If your baby isn’t moving, we beg you to come in. Fetal movement is your best indicator of fetal well-being — and we want to make sure that everything is OK.
Pro Tip: Do kick counts.
I hope that you can see that triage is a very important step for safety. There is absolutely NO reason to be embarrassed if you came in thinking something was wrong, only to find out that everything is fine and you are safe to go home.
Why that matters to you?
I think it’s important to remember that triage is meant to decide if you are safer/ better-off to be at home or at the hospital.
Just being at the hospital can have risks. They might be small ones like not moving as much as if you were home, not relaxing in the comforts of home, or larger ones like infection or needless interventions to hurry your labor.
It is important that you and your healthcare team make these choices together after they explain the risks and benefits of staying at the hospital.
That being said, our healthcare system does require a doctor’s order for you to stay at the hospital. If your provider does not think the hospital is the best place for you, and does not provide an order, you can not be admitted to the hospital.
Even if you were not using insurance, it still takes a doctor to write orders for the nurse to be able to do anything.
So, How Do You Get Admitted to Labor and Delivery?
You have something occurring that is safer to have taken care of at the hospital, than at home.
I know you may hear that if you come in saying you have a headache and you’re swollen, they will keep you.
In reality, they will take lab work to see if you actually have preeclampsia and then assess from there.
You may hear that if you’re screaming in pain they will keep you. If that’s the cases, they will likely check your cervix and do a thorough assessment for what is wrong, but if you aren’t in active labor (meaning your cervix is not actively dilating) you will likely get sent home.
Every hospital and provider will have their own conditions & policies in which they keep patients.
Why Won’t Labor & Delivery Admit You?
Frankly, they just don’t have room or resources to admit every patient that comes in wanting to stay at the hospital.
A lot of people who are 39 weeks come in thinking that if they are contracting now and then we will just induce them, but that is not the case (especially if the unit is busy).
Remember that staying at the hospital does have risks associated with it, so we have to weigh those risks (both for you and the hospital/other patients) before making a choice for you.
Honestly, I have always tried to make this choice with the patient. When I explain the reasoning behind your provider’s choice, as well as very thorough discharge teaching (when to come back to the hospital) almost all of my patients have realized they were better off at home than in the hospital.
And honestly, many came back a few hours later when their body was actually in active labor (but had a few hours at home that were more comfortable than they would have been at the hospital).
What to Expect When You Arrive at the Hospital
When you arrive at the hospital, you will be asked to check in at the front desk.
If you are in labor, or bleeding or having unstable issues admitting should allow you to just go to a room where they will follow-up with you later. They will ask for your name and some basic information to get you into the system.
I have a whole podcast on what happens at admission:
Once you have checked in, you will be escorted you to your labor and delivery triage room (if you’re being directly admitted you would skip triage and go straight to a labor room). The nurse will listen to the baby’s heart rate and watch for contractions with fetal monitoring. They will take your vital signs, and will proceed to ask a lot of questions about what brought you in as well as your health history. They may also ask to check your cervix if it is indicated. They will call your provider and make a plan of care after that.
In some cases, you may be asked to walk around the labor and delivery unit for a short period of time. This is called “ambulation” and is often recommended for women in labor to help progress their labor. This also helps us to see that over the hour between cervical checks, did your cervix open more?
After a bit of time, they will decide if you are staying to be admitted, or possibly being watched further, or going home.
If you are sent home, your provider will go over discharge teachings sharing their findings about you that day, as well as when you should come back to the hospital and anything else to watch for.
It is important to pay attention to the discharge teaching, so you are aware when you should head back into the hospital.
How can I Make Labor & Delivery Admit Me?
You should be aware that the hospital only has the resources to take the people who need to be there.
The hospital is a very high level of care that should not be taken for granted. I have a whole post about how a hospital differs from a hotel.
That being said, you can ask your provider to help you with a specific problem.
If you’re hurting a lot, ask them what you can do about that. Could you see a phsyical therapist, a chiropractor or wear some pregnancy straps? Are there any pain mangement options for you?
If you’re done being pregnant, ask your provider when they could possibly schedule you an induction.
If you’re waiting to be induced, and the unit doesn’t have room for you, you really just need to be patient. Be aware that the unit could be facing serious emergencies and life-threatening situations that may require additional attention at this time.
And I know you’d want to put the health of another mom or baby ahead of needing to be induced ASAP. Hopefully they will get to you soon. My best advice is to be kind and understanding when you call. The nurses do understand how painful it is to be waiting. They’re just stuck in a hard place.
Understanding risks vs benefits is one of the hardest parts of pregnancy, and frankly — adulthood (but the stakes do seem higher with pregnancy). I recommend taking The Online Prenatal Class for Couples to learn more about you, your pregnancy, and what to expect as you go to the hospital to have your baby.
- It can be done in just 3 hours
- It is taught by a highly experienced RN
- Starts at just $35
Use coupon code PREGNURSE to save 10%
And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.
- About the Author
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A nurse since 1997, she has worked in various fields including pediatrics, geriatrics & hospice.
She has 20 years of labor and delivery experience in the San Jose, CA and Phoenix, AZ areas.
She is also the curly head behind the website Pulling Curls and is the creator of The Online Prenatal Class for Couples — the #1 hospital-based prenatal class on the internet.