Labor and Delivery

 
 

Healthy Women

Labor and Delivery: What You Need to Know

Regardless of what type of delivery you're hoping for, it is important that you learn about all options-drug-free, vaginal delivery with pain relief and cesarean section.

You should also complete all pre-admission information at the hospital or birthing center where you hope to deliver. Most offer family tours of the maternity unit, which can help prepare older children for a new sibling

And don't forget to pack a bag for the hospital or birthing center. Make sure you include a "coming home" outfit for the baby. One other thing: Make sure you have a car seat properly installed in your vehicle. The hospital won't let you take Baby home without it! You can learn more about car seats and their proper use at www.nhtsa.gov/Safety/CPS.

In the third trimester, you will need to prepare for delivery. In addition to learning what to expect during labor and delivery, there are things you can to do to strengthen your body for the hard work ahead. (There's a reason they call it "labor!")

One of the most important steps you can take is to do pelvic floor exercises, or Kegels. Not only will these simple exercises help prevent post-partum incontinence, but by strengthening the pelvic floor muscles, they can make it easier to push the baby out.

Kegels are easy. First, figure out which muscles to target by stopping midstream when urinating. Those are the ones you want to strengthen. Then squeeze those muscles and hold for a count of 10. Relax, then repeat. Perform at least three sets of 10 contractions a day, two to three times a week throughout this trimester. Once the baby is born and you recover from the delivery, continue your Kegels.

Pregnant Women Ask...

How can I avoid an episiotomy during delivery?

An episiotomy is a cut in the perineum (the bridge of tissue between your anus and vagina) to reduce the risk of tearing as the baby exits. It is typically performed in the belief that controlling the tear by cutting reduces the risk of urinary and fecal incontinence. However, the evidence on this is mixed. Overall, there is no evidence for routine use of episiotomy even though many doctors routinely perform them. If you want to avoid one, make sure you tell your doctor (midwives rarely perform episiotomies unless absolutely necessary). You can also use perineal massage and warm compresses to help relax the perineum during labor to reduce the risk of tearing.

 

Pain Management Options

Here's the thing. Labor and delivery hurt. Any woman who tells you they don't either had good medication or has a poor memory. The key is not to let the pain get out of control. There are numerous medications and other options you can use, most of which are detailed below, to make you as comfortable as possible.

Pain Management Option How It Works Cautions
Narcotics (Demerol, Morphine, Stadol, Fentanyl, Nubain) Given by injection into a muscle or by IV or self-administered pump (depends on the drug). These medications help you relax and take the "edge" off the pain without interfering with pushing or slowing labor. Depends on the drug, but may cause drowsiness or breathing difficulties in babies and nausea and vomiting in you. Nubain, Fentanyl, Stadol and Morphine have minimal effects on the fetus unless used in a spinal block.
Epidural The most common form of anesthesia used during labor and delivery. An epidural is regional anesthesia that blocks pain to a particular part of the body; in this instance, nerves leading to the uterus. You need to have an IV started before you can receive an epidural, usually before active labor begins. The epidural is typically inserted when the cervix has dilated to four or five centimeters. An anesthesiologist or nurse anesthetist usually administers the epidural. After cleaning and numbing the area, a needle is inserted into the area surrounding the spinal cord and a small tube or catheter is threaded through the needle into the space around the spinal cord (the epidural space). Then medication is given through the tube as needed. May result in sudden blood pressure drop and, rarely, severe headache if there is any spinal fluid leakage. May slow labor and make pushing more difficult. May cause some breastfeeding or respiratory difficulties in babies.
Spinal block When narcotics are injected directly into the spinal column. The pain relief lasts about two hours. They are rarely used these days given the availability of epidurals. The medication crosses into the placenta and may affect the baby. May cause low blood pressure, problems pushing during labor and severe headache.
Pudendal block An injection of a local anesthetic such as lidocaine into the pudendal canal in the pelvis to provide quick pain relief to the perineum, vulva and vagina as the baby moves through the birth canal. Typically used in the second stage of labor when you're pushing, just before the baby is delivered. May cross the placenta; slight risk of blood clot or infection.
Local anesthesia Primarily used at the end of labor to provide pain relief for an episiotomy (a cut in the perineum to make it easier for the baby to come out). May also be used after birth for pain relief from episiotomy or perineal tears. Given by injection into the specific area of pain. Rare allergic reactions.
Patterned breathing This nonmedical approach uses breathing patterns to calm and relax you while providing a sense of control during contractions. Must be practiced before labor.
Relaxation techniques Listening to soothing music, surrounding yourself with a scent that soothes and comforts you, having your partner massage, knead or put pressure on various parts of your body and focusing on an item like a candle throughout the contraction can all help reduce the pain and the feeling of being out of control. May not provide the relief you expected. Try to be flexible and ask for help if you need it.
Cesarean Section

The rate of cesarean section in this country has never been higher. Part of the reason is that more women are requesting elective cesarean to avoid the pain of labor. Another is that doctors are more reluctant to let women who had a previous cesarean attempt a vaginal birth, for fear of rupturing the uterus (although the risk of uterine rupture is extremely small). Regardless, there are times when a cesarean is necessary, such as: if labor has slowed; if you experience complications; if the baby is in distress; or if the size of your baby compared to the size of you makes a vaginal birth unlikely.

During a cesarean, the baby is delivered through an incision in the abdominal wall and uterus. Other things you should know:

  1. Anesthesia. Unless there is no time, you are usually given an epidural or spinal as anesthesia for a cesarean. That means you can stay awake for the delivery, although the doctor will screen the surgical field from view. If things are going too fast for an epidural, you may need general anesthesia.
  2. Recovery. A cesarean section is major surgery; expect a longer hospital stay and recovery time.
  3. Blood loss. You lose more blood during a cesarean section than with a vaginal delivery. You may require a transfusion, although the risk that you'll need one is low. At the very least, the blood loss may leave you more tired than if you'd had a vaginal delivery.
  4. Scar tissue. Scar tissue called adhesions may form in the pelvic region from the surgery that may affect future pregnancies and deliveries.
  5. The baby. The baby may have some breathing problems because it did not come through the birth canal. It may also have low APGAR scores (a way of evaluating its health right after birth) because of anesthesia or problems during labor and delivery. But don't worry; the delivery room staff will rub the baby to restore color and movement and/or provide some supplemental oxygen to help it breathe.

Cord Blood Storage

When you complete your preadmission paperwork, don't be surprised if you're asked what you want to do with your newborn's cord blood. Cord blood is jammed with valuable cells called stem cells that can be used in transplants for diseases like leukemia and that may one day play a role in "building" new tissue. You can store the blood at a private cord blood "bank," where it will be available for your family only; or you can donate it to a public cord blood bank, which matches stem cells to patients who need transplants. If you choose the latter, the cord blood will not be available to you in the future if you or someone in your family needs it. A major issue is cost; private cord blood banks charge about $2,000 for collection and about $150 a year for storage. Public banks charge nothing for collection or storage. Cord blood banking requires advance planning. To learn more visit www.cordblood.org.

Circumcision

It's a boy! After choosing a name, you and your partner need to have another discussion: to circumcise or not to circumcise. Discuss the benefits and risks with your health care provider. If you do decide to circumcise your son for religious or health reasons, make sure you insist on anesthesia which the American Academy of Pediatrics notes is "safe and effective in reducing the procedural pain associated with circumcision." Studies find the most effective pain relief is a dorsal penile nerve block, kind of like an epidural for circumcision. Many hospitals also give newborns a sugary solution to suck on, which studies find can further reduce pain. Also, only healthy infants should be circumcised.

Pregnant Women Ask...

How will I know I'm in labor?

That's a very good question, particularly since you may have been experiencing "false" contractions, known as Braxton Hicks contractions, for weeks. To tell if it's the "real" thing, time the contractions (which feel like strong menstrual cramps in the beginning) from the start of the one to the start of the next. If they come consistently, with about the same amount of time in between and become progressively closer and stronger, you're probably in labor. Other signs that labor is imminent include:

  • Loss of your mucus plug, also called "bloody show." This is the thick plug of mucus that seals off the cervical opening from bacteria. As the cervix thins and lengthens, the plug falls out.
  • Trickling or gushing of amniotic fluid. If you think you just wet your pants, but the liquid is odorless, your water just broke.

If any of these signs of labor occur, call your health care professional immediately.

Before Labor: Thing to Watch For in Your Third Trimester

If you experience sudden, rapid weight gain of more than five pounds a week and facial and hand swelling, with or without headache, contact your health care professional immediately. You may be showing signs of preeclampsia, which used to be called pregnancy-induced hypertension. It occurs when your blood pressure suddenly rises after 20 weeks of pregnancy, but typically occurs in your third trimester. Your health care professional should be screening you for it at every prenatal visit by taking your blood pressure and checking for protein in the urine.

Also contact your health care professional immediately if you haven't felt the baby move in 24 hours or if you start bleeding vaginally.

Smart Advice: Unless directed by your health care provider, do not take aspirin during your pregnancy. It could harm the baby and increase the risk of bleeding in you and the baby during labor. If you need to take a pain reliever, ask your health care provider about the options.

© 2014. National Women's Health Resource Center, Inc. All rights reserved. All content provided in this guide is for information purposes only. Any information herein relating to specific medical conditions, preventive care and/or healthy lifestyles does not suggest individual diagnosis or treatment and is not a substitute for medical attention.

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