From Door to Delivery: Can Admission Timing Prevent Unnecessary C-Sections?
When you’re in labour, it’s natural to want to head to the hospital at the first sign of contractions. After all, who wouldn’t want to be somewhere safe, with experts on hand? But research suggests that arriving too early—before active labour is truly established—can actually increase your chances of receiving medical interventions you might not need or want. This is part of what many call the “cascade of interventions,” where one step leads to another, often culminating in outcomes like epidural use, instrumental delivery, or even cesarean birth.
For example, if you are a low risk birther with intact membranes, policy at Ksyen is not to admit into the labour and delivery room until you are at least 4cm dilated. Arriving early when contractions are still mild or irregular, staff may offer interventions to reduce pain such as gravel and morphine and send you home to rest. If the labouring person presents with some risk factors, staff may offer interventions to “speed things up,” such as oxytocin augmentation. The stronger contractions from augmentation can lead to more pain, increasing requests for epidurals. Epidurals can reduce mobility and slow labour, which sometimes results in further interventions or assisted delivery.
Multiple studies show that women admitted in the latent (early) phase of labour are more likely to receive interventions. A Cochrane systematic review found that admitting women before active labour significantly increased the likelihood of oxytocin augmentation and epidural analgesia (Kobayashi et al., 2017). The same review showed a trend toward higher cesarean rates in early admission groups.
Longer time in the hospital before active labour also means more monitoring and more opportunities for protocols to be applied, increasing the risk of intervention. In a large multicenter trial, women who delayed hospital admission until active labour had lower rates of oxytocin use and epidural analgesia (Bailit et al., 2005). Importantly, this more intensive management has not been shown to improve newborn outcomes. The Cochrane review and other studies consistently show no difference in Apgar scores or NICU admissions between early and later admissions.
Hospitals are designed for safety and active management, but routine protocols often encourage “doing something” to keep labor moving. When someone is admitted too soon, their contractions may not yet be strong or regular enough for real cervical change. Staff may then define labour as “slow,” even when it’s normal early labour, triggering augmentation, continuous monitoring, or recommendations for epidural.
Instead, many care providers recommend waiting until labour is active before heading in. This might mean waiting for contractions that are regular, strong, lasting about a minute, and coming every 3–5 minutes. Talking with your provider ahead of time about when to go to the hospital, learning about labour stages, and practicing comfort measures at home can all help. By understanding this dynamic, you can plan for a birth that feels more supported, less rushed, and more in tune with your body’s natural process.
Here’s a helpful link to the Canadian best practice guideline for labour. It’s designed to support healthy, full-term women—whether labour is moving along smoothly or slows down at any point. The goal is to help increase the chances of a vaginal birth and ensure the best outcome for both you and your baby.
Key References:
Kobayashi M, et al. (2017). Admission policies for pregnant women in labour for reducing caesarean section rates. Cochrane Database of Systematic Reviews, Issue 8. Art. No.: CD009402.
Bailit JL, et al. (2005). Maternal and neonatal outcomes by labor onset type and gestational age. Obstetrics & Gynecology, 106(3), 501–507.
Neal JL, et al. (2014). Timing of admission and its effect on labor progression. Journal of Midwifery & Women’s Health, 59(2), 147–154.
