Charlotte, NC bookings are live! Get early access & book your first appointment.

Book Now
Go Back
06.25.26

Navigating Early Labor: The Oula Roadmap

Casey Selzer, CNM
Casey is a midwife and Senior Director of Patient Programs at Oula.

At Oula, we believe the “secret ingredient” to a satisfying birth experience is autonomy. Feeling like the captain of your own ship during the unpredictable journey of labor leads to a personalized, empowered transition into parenthood.

We’re committed to making sure that the autonomy and personalized care you experience in our clinics translates to your experience on Labor & Delivery. When labor begins on its own and your pregnancy care is medically uncomplicated, we will use a specific Labor Admission & Monitoring Pathway toolkit to help guide your admission care plan. This isn’t just a set of clinical rules; it’s a tool designed to protect the physiologic process of birth and prevent the “intervention cascade” that can lead to unnecessary C-sections. Physiologic labor requires different clinical management than a medical induction. Like all things at Oula, our approach builds on your personal needs and preferences through shared decision making with your care providers.

Care Continuity

It’s important that we stay connected in your final weeks, days and hours of pregnancy and as early labor begins so we can understand your preferences, personalized needs and offer support and guidance. Of course, reach out anytime you have questions or concerns but here are some guidelines for when you should proactively reach out and call your care provider:

When to Call Us:

  • For first time parents, give us a call when contractions are 5 minutes apart, 1 minute long, for 1 hour, and feel moderate to strong. (If this isn’t your first baby, call after 3 strong, regular contractions or if you think your labor has begun. This gives us time to help you arrange childcare if needed and plan next steps.)
  • Water Breaking (SROM): Give a call if you think this happens. Note the time, color (clear is ideal), and amount. We’ll talk about your GBS (group beta strep test results) if we know them.

Warning Signs: Call immediately for heavy vaginal bleeding (more than a “bloody show”), a headache that won’t go away, visual changes such as blurry or spotty vision, if you feel your baby isn’t moving as much as usual or if there’s anything that you feel unsure about.

Early Labor at Home (The Latent Phase)

Early labor (the latent phase) is characterized by irregular contractions that may stop and start and is typically the longest phase of labor, especially for first-time parents.

The Oula Philosophy: In the absence of medical risk factors, the best place to be is at home. Home allows for freedom of movement, your own food, and a familiar environment that keeps stress hormones low and helps natural oxytocin, the labor hormone, flow. If you don’t feel your home environment is conducive to feeling safe or comfortable in early labor, please let your care provider know.

What to Do: The “Labor Test”

  • If you’re 37 weeks, in the absence of any warning signs and you start to feel some uterine contraction activity but you aren’t sure if you’re in “real” labor, try this:
  • If you’ve been active (at work, running errands etc.): Go home, rest, and drink a liter of water
  • If you’ve been resting (asleep, watching TV): Get up, use the restroom and walk around your home or apartment
  • Wait an hour and see how your sensations evolve.
  • The result: If contractions quiet down or stop, your body is just practicing! If it’s night time, go back to sleep and check in with your body (and your care team, if needed) in the morning. True labor could return anytime. If things continue, this is a good time to utilize your comfort tool kit and reach out to your doula or labor support partner.

Comfort & Distraction

  • Distraction is Key: Watch a movie, take a walk around the block, rest or do a puzzle. Ignore labor until labor demands more attention, save your energy and focus on rest, hydration and distraction.
  • Your Toolkit: Use your tools— before you’re full term, come up with a list of passive and active activities that your birth partner can help guide you through to pass the time and keep you comfortable and focused on other things until labor progresses. warm baths, massages, or a living room dance party.

Educational Preparation and Support:

If you plan to labor without medication or want to avoid medical interventions for labor augmentation, or just want to learn more about your options – we strongly recommend a Childbirth Education class, and working with a doula (NYC class & doula recs, CT class & doula recs). Learning the underlying physiology of early labor helps you build a personalized toolkit for movement and comfort tools which help you to allow labor to evolve on its own before admission to the hospital. While your care provider will be available by phone, doulas are invaluable in helping you navigate the early labor phase in the comfort of your own home and understanding how to ease the transition to the hospital.

While you explore those options, check out our Workshops for some great, free educational content from trusted partners and community resources!

Physical Preparation: In the weeks leading up to your labor, check out Oula’s Guide to Labor Preparation and Hormonal Stimulation and Phase Two of the Oula’s At Home Guide for Optimizing Fetal Positioning then speak with your care provider about what methods might be the best fit for you and your preferences.

Phase 3: Arriving at the Hospital (Triage)

Triage is the welcoming space at the hospital where we gather the data needed to make a shared decision about your next steps. Think of it as a specialized “check-in” station where we assess three main areas: your holistic health, your baby’s well-being, and your progress in labor.

Once we’ve gathered this information, we’ll discuss your options—which usually involve being admitted to the hospital, walking for an hour or two for a re-evaluation (ambulation), or returning home to continue laboring in your own space.

The Three Pillars of Your Triage Assessment

  1. Holistic health of the birthing person – We start with you. We’ll take a full set of vital signs (blood pressure, temperature, and a urine test) and discuss how you are feeling. This is the time to check in on:
  1. Fetal well-being – Next, we ensure your baby is navigating the “healthy stress” of labor well. This includes:
    • Fetal Monitoring: 20–30 minutes of baseline monitoring to track the baby’s heart rate.
    • Ultrasound (if needed): To assess the baby’s position and amniotic fluid levels.
  1. Phase of labor & reason for arrival – To understand the “Big Question”—Are you in Active Labor?—we look at your clinical progress:
    • Cervical exam: We check for dilation (how open), effacement (how thin), and station (how low the baby’s head is). Active labor is typically defined as >6cm dilation with regular, strong contractions.
    • Contraction pattern: We use a monitor called a tocometer to track frequency and length, while also “palpating” (feeling) the top of your uterus to assess the true strength of your contractions.

Hospital Tip: If you are admitted, you and your partner will move from Triage to your private Labor & Delivery room. For more specific details on your location, please refer to our resource: Your Guide to Birthing at Your Hospital (Mount Sinai West, Stamford Health).

Phase 4: Shared Decision-Making Pathways

Based on our findings, we will navigate one of three paths together:

Pathway
Description
Why We Recommend It

A: Home for Now (Latent Labor)
Returning home if you are <6cm, medically stable and coping well with pain
Protects physiologic birth and reduces early intervention. This is for patient who prefer unmedicated labor and there are no medical complications

B: Admission (Latent Labor) 
Moving to your labor room for medical support of latent phase
Admission in this phase without medical complication, is to manage pain or exhaustion. This usually involves active management with medication for pain and to allow rest (epidural, nitrous or IV medication) and to augment labor, such as Pitocin, to keep labor progressing.

B: Admission (Active Labor)
Moving to your labor room if you are >6cm.
You are in active labor! We will discuss your pain management and monitoring preferences based on our findings in triage.

C: Latent Labor Management
“Active Management” or “Therapeutic Rest” for slow or no labor progress
To prevent exhaustion or infection. May include Pitocin or medication to help you sleep and reset your labor course, such as morphine or an epidural.

Use your “BRAIN”: During any conversation about interventions, ask about the Benefits, Risks, Alternatives, Intuition, and what happens if we do Nothing.

Phase 5: Monitoring & Pain Management

Once admitted, movement remains a core Oula value—both to support your sense of agency and to help your baby navigate the pelvis. While fetal monitoring is a central safety element of hospital care, it can be adapted to meet your specific goals. Regardless of your monitoring path, your care team will partner with you to ensure movement remains a priority.

We determine your fetal monitoring path based on your clinical needs and preferences:

  • Intermittent Monitoring: For low-risk births. Provides maximum freedom to walk, squat, and use the tub.
  • Wireless/Telemetry: For those needing closer tracking. High mobility via wireless pods.
  • Continuous Monitoring: Required for Epidurals, Pitocin, or medical risk factors. Bed-based, but we still encourage “active rest” positions like side-lying.

Pain Management Your Way: We provide non-judgmental support for all paths, whether you choose an unmedicated birth (relying on your toolkit and movement), Nitrous/Morphine (middle-ground options for rest), or an Epidural.

Childbirth Education classes remain the best way to understand the risks, benefits, timing and other nuances of pain medication options.

The Oula Promise

Even if labor requires a “jumpstart,” our goal is to make it feel like a physiologic birth. Your values and informed consent remain our compass. We are here to partner with you every step—and contraction—along the way.

Planning your birth? Review these key resources and be sure to sign up for a Childbirth Education class!

Oula Resources: 

Unlock Oula’s complimentary guide
Get Oula's Guide to Preconception & the First Trimester