I recently took a tour of Alta Bates Labor and Delivery. I’ve been there dozens of times as a support person, but I was curious to see it through the eyes of an expectant family.
About 12 couples gathered on the first floor in a big room where the tour guide answered questions and walked us through what to do when labor starts. Always call your doctor or midwife first!
Every provider may make a different plan with an individual patient, but as a general rule of thumb, Alta Bates encourages first timers to come in when contractions are coming every four to five minutes, lasting a minute, and that pattern has been in place for two hours. This is colloquially known as 4-1-2, and is a change from the old 4-1-1, with the pattern only lasting for one hour.
As the tour guide explained, “you are better of staying at home for as long as you can” because “birth is not a medical event” and it’s more comfortable to labor at home.
For a second baby (or more), they want to see you when you have been having contractions four minutes apart, lasting one minute, for half an hour. (I am often set up and waiting at the house of a second baby earlier in labor than that - second babies can come quickly!)
Our guide recommended parking in the garage and walking to labor and delivery (third floor) if labor isn’t too advanced. Once you are through triage and admitted, someone can go back out and exchange the parking slip for a $20 flat rate ticket with which the car can come go for 72 hours.
Although our tour guide said that she has “never heard of it being full in 29 years”, I have twice been told when calling to bring in a home or birth center transport that they were too full and we really should go elsewhere. They can’t refuse to see someone in labor but I have seen patients have to wait in triage for a very long time to get a room.
When we moved up to the third floor to check out the labor and postpartum rooms, a loud moan from triage sent a thrill through the group of mostly first-timers. Later on we heard a newborn’s cry, equally exciting.
(Once, when I was working at a birth center, a woman was birthing down the hall from a full prenatal class. She screamed many times, at high volume, “Pull it the *@$# out of me! Just pull it out of me!” She did a great job birthing her own baby and did not need anyone to pull it out of her, but the shocked faces filing out at the end of class were a sight!)
They have three telemetry units (portable monitoring so that you can have more freedom to move away from the bed), which doesn’t sound like very many, but most people are on continuous monitoring due to pitocin or epidurals. I’ve never seen anyone not be able to get a telemetry unit who wanted one. They will do intermittent monitoring for low risk pregnancies, which to them means 20 minutes out of every hour on the monitors. I will add that sometimes getting what they consider an adequate strip takes more than 20 minutes.