Obstetrics

Obstetrics

Labor and Delivery is probably the happiest place in the hospital. It is here that the excruciating intensity of labor culminates in an event of incomparable celebration: the miracle of new life.

Due to the popularity of childbirth education classes, more parents- to-be than ever before are prepared in advance for the hospital experience. These classes, for which women can obtain a referral from their obstetrician or nurse-midwife, explain the process of pregnancy and the importance of prenatal care, and teach breathing techniques, massage, and laboring and birth positions that can help women cope with contractions and maintain stamina and focus throughout labor. These classes address techniques such as Lamaze and other methods intended to facilitate “natural childbirth” (vaginal delivery without anesthesia), as well as epidural anesthesia and other approaches to pain relief.

Pregnant women attend the classes with their “labor partner,” the person who will actively participate in supporting them during labor. The labor partner can be a spouse or significant other, friend or relative. Labor partners learn how to coach the woman on breathing techniques, to offer massage and encouragement, to provide light nourishment when appropriate, and to communicate with the doctor and nurses.

Hospital Tours

In addition to childbirth preparation classes, many parents-to-be also prepare for their hospital delivery by taking a tour of the labor floor and nursery (often both the regular and neonatal intensive care nurseries) weeks or months before the due date.

Many hospitals also have valuable tours for siblings-to-be. Children enjoy feeling included in the process of preparing for the new arrival, and when they return to the hospital to visit after the birth, they are reassured to have some familiarity with the setting. If your hospital has no regularly scheduled adult or children’s tours, consider requesting one.

Labor Begins

Women who arrive at the hospital feeling that they might be in labor are evaluated by a member of the obstetrics team (either a nurse, midwife or physician) to see if they are, in fact, in labor. In some instances, if a woman is in the early part of labor, she is asked to go home and return later, when contractions are closer together and/or the water breaks and/or there are other indications that delivery is imminent or admission to the hospital is necessary.

You may feel very disappointed if “sent home,” but particularly in early labor you will likely be more comfortable laboring at home where you can move around more easily, take a bath or shower, or eat a light meal. Many women benefit during this phase of labor from the support of their labor partner or doula as early labor can persist for hours to days before the more active part of the process begins. However, if you feel strongly about wanting to remain, speak up. For example, if you have a history of short labors with previous children, or if you live a distance from the hospital and are concerned about the travel, you may be able to stay.

Admission

Once it is determined that you are indeed ready to be admitted, you are taken to the labor floor, where your labor partner can join you. The “prepping” and procedures from this point on depend in large part on your doctor or nurse-midwife’s approach, your own preferences, your condition, and the condition of the fetus(es).

In most hospital settings, you will likely have an intravenous (IV) line placed on admission, usually just to provide hydration but also in case you need medication during your labor. You will also likely have monitors placed on your abdomen that provide information about your contractions and the fetus’ heartbeat (a way to monitor the fetus during the stress of labor and delivery). These monitors may be connected only occasionally or may be used continuously during your labor. Other, less common prepping (preparation) techniques include shaving the pubic area or taking an enema. Which prepping and procedures are done, and when, is a matter to discuss in advance with your doctor. Some couples and their doctors prepare a “birth plan” listing their preferences, and send it to the hospital to keep on file. In addition to prepping and procedures, a birth plan may also cover your wishes as to these matters:

• To have your labor partner stay with you throughout labor and delivery.
• To be in a “birthing room” (a room that resembles a homey bedroom) instead of a standard delivery/operating room, if you have a normal vaginal delivery.
• To breastfeed your newborn exclusively, or to allow limited supplemental formula.
• To have your baby “room in” (stay with you in your room instead of in the nursery, during all or part of your hospital stay).
• Pain Control

There are several techniques (eg. Lamaze) that can help a woman cope with labor pains without medication, but natural childbirth is not for everyone. Women have different pain thresholds; even those who may have intended to avoid pain medication may decide to request it if labor is especially difficult or prolonged. Anesthesia done properly will not hurt the baby and doesn’t mean that you are a failure or a wimp. Labor is not an endurance test or an indicator of courage. It is a strenuous process for which you should obtain whatever support you need.

If you do decide to have pain medication, the most common route of administration is an epidural catheter placed in your lower back, near (but not in) the spinal column. An epidural decreases sensation from the waist down, affording you a great deal of pain relief while still enabling you to stay conscious and aware, push your baby out when the time comes, and—most thrilling of all—see your baby’s birth and hear his or her first cry.

Vaginal delivery is possible in most but not all births. Cesarean- section delivery may be necessary if there are maternal or fetal complications; if a baby is too large to fit through the birth canal; if a woman has herpes or another condition that could be transmitted to the baby during a vaginal delivery; or if labor “fails to progress” and the cervix does not fully dilate (open) despite adequate contractions. Delivery of twins or triplets can be accomplished via either route depending on a variety of factors.

Sometimes it becomes necessary to induce labor, meaning the use of techniques and/or medications to stimulate uterine contractions prior to the onset of spontaneous labor. An induction of labor can be required either for a maternal or fetal condition, or because a woman has passed her estimated due date and labor has not begun spontaneously. The decision to induce labor depends on a variety of factors including maternal and fetal conditions, the gestational age of the fetus, and an exam of the cervix to assess its level of “ripening” or preparedness for the onset of labor. If your doctor or nurse-midwife recommends an induction of labor, they will discuss with you the various methods that are commonly used.

Cesarean Delivery

If you have to have a Cesarean delivery, you can still have anesthesia via an epidural (unless it’s an emergency Cesarean that requires general anesthesia), thus enabling you to be awake for the first glimpse of your new son or daughter. You will need to go to a recovery room after the surgery is completed. Depending on the hospital, you may be able to have your baby stay with you there if your labor partner is there to help.

A Cesarean section requires more extensive recuperation time than vaginal delivery, but you can still breastfeed and care for your baby. Some women feel bitterly disappointed that they did not have a vaginal delivery. It is important to remember that the most important goal of birth is to preserve the health of mother and baby, and in certain circumstances, the best or only way to accomplish this is via C-section. Nevertheless, it can be encouraging to know that the phrase “once a Cesarean, always a Cesarean” does not always hold true. In a subsequent birth, you may be able to have a vaginal delivery, depending on a variety of factors.

A few words of advice if you’ve had a Cesarean:

• Try to get up and walking as soon as your doctor advises. You may feel that it’s impossible to stand up straight and take a step, but be assured that your stitches won’t come out and your recuperation will proceed more smoothly the sooner you’re up and around.
• At the same time, don’t rush your recuperation. Sit up in bed, start walking, but don’t try to be a hero. Let people help you. If it’s a strain to reach for the phone, take it off the hook or let someone else answer. If visitors are too much of a strain, ask them to wait until you’ve been home a few weeks before they stop by.
• When you hold or feed your baby, place a pillow across your abdomen to protect your incision. Newborns may look fragile, but it’s amazing how powerfully they can kick!

After the Delivery

As with labor itself, what happens after the birth varies according to the doctor or nurse-midwife, the hospital’s policies, the parents’ wishes, and the baby’s and mother’s conditions. You may be able to cuddle your newborn for quite a while after it is born, or the baby may need to be cleaned and examined immediately. Depending on your history and any potential issues with your baby, including any problems during labor, pediatricians may be present for your delivery to help care for the baby immediately after birth. Mother and baby may be separated, with the mother taken to her room and the baby to the newborn nursery, or may share a room. Some new mothers prefer to “room in” while others wish to have the baby cared for in the nursery in order to get some rest. Some women, for example, ask for the baby to spend the first night in the nursery and to be brought to them every couple of hours for breast or bottle-feeding. Then the baby rooms in for most or all of the rest of the hospital stay.

Some babies born by cesarean, most premature babies, and any infants with cardiac or other problems are admitted to a neonatal intensive care unit (NICU) for monitoring. The need for monitoring or treatment is sometimes known in advance of birth (for example, if it is clear that a birth is quite premature) but may be determined by a variety of physical findings and reflex tests performed by the doctor on all infants to assess their health and maturity.

Length of Hospital Stay

The length of your hospital stay postpartum depends on a variety of factors, most importantly whether you had a vaginal or C-section delivery. Assuming no other complications, women who had a vaginal delivery usually stay 1-2 days postpartum, while following a C-section the usual hospital stay is 3-4 days. This time in the hospital can be valuable for several reasons. Whether you’ve had a vaginal or Cesarean delivery, you need rest to recuperate from the exhausting experience of labor and childbirth; to cope with the physical, hormonal, and emotional postpartum changes; and to help breastfeeding get off to a good start. Once you go home, you may not be able to get the rest you need if you have other children and house¬hold matters to take care of, as well as the newborn. Furthermore, in-hospital classes on how to care for, bathe, and breastfeed your baby are traditionally offered during the three or four hospital days after delivery. If you’re a first-time parent, these classes are great opportunities to learn the basics of baby care.

Getting Help at Home

After any hospital stay, it’s a good idea to arrange for someone to help you when you go home—and after you’ve had a baby, it’s essential. If possible, have your partner take family leave; your parents or in-laws visit for a week or two; ask friends to pitch in; or hire a baby nurse or a doula (a person who assists new mothers at home). That way, someone other than you can help care for other children, prepare meals, do laundry, answer the phone, greet visitors, write thank-you notes for baby gifts, organize the nursery, and deal with other house¬hold responsibilities—thereby freeing you to rest and get breastfeeding established. It is astonishing how much time and energy are required in caring for a tiny baby—and you need someone to take care of you, too, during your recovery and adjustment to new parenthood.