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Labor and Delivery There are several options for delivery • Vaginal delivery with spontaneous labor (labor that starts naturally) or induced labor • Cesarean delivery • Vaginal birth after Cesarean delivery or VBAC Menu — Click on Topic • Is This Really Labor? • Birth Plan • Upon Arrival to the Labor and Delivery Unit • Your Stay While You are in Labor Is This Really Labor? Signs of Labor • Contractions or your abdomen tightens and then relaxes. • You feel contractions at regular intervals and lasting 30-70 seconds. • Contractions keep coming no matter what you are doing. • In labor, contractions will get stronger, last longer and be closer together. • If you think you are having contractions and you are near your due date: • Continue to drink fluids. • Try to get some rest. • Try some of the comfort measures. Call your healthcare provider or clinic at the Center for Women’s Medicine if you have any of the following: • Vaginal bleeding. • Water breaks, note the time, color and amount of fluid. • Contractions that become regular and stronger, and are about 5 minutes apart. • Induction of Labor • Cesarean Delivery • Vaginal Birth After Cesarean (VBAC) • Skin-to-Skin Contact • Father’s /Partner’s Role in Labor If you think you are in labor… Call your healthcare provider or the clinic at the Center for Women’s Medicine. Comfort Measures in Labor Find distractions in early labor. Here are some suggestions: • Take a walk. • Listen to music. • Do light housework. • Try to visualize a pleasant memory. • Focus on counting your breaths, reciting a verse, chanting, moving rhythmically to music or your own rhythm. • Focus on touch, stroking or massage by your partner. • Change position at least every 30 minutes. • Feeling the baby not move as much as it has been. • Keep your bladder empty. • If anything happens that you are not sure of, or you have questions. • Sip on fluids, water or juices. • Take a warm shower or bath. Birth Plan DIRECTIONS: Read this document thoroughly! Print out and complete each section of the Birth Plan handout found at the end of this tab. Please review the information provided below, as it will assist you while you fill out your handout. Please speak to your healthcare provider or midwife to discuss any risk factors in your pregnancy that could affect your birth options. If you have any questions about your baby’s care, please consult with your baby’s healthcare provider. You are encouraged to bring copies of your Birth Plan with you to the hospital. Getting to know you! In order for us to ensure that your birth experience is positive and complies with your wishes, please complete this section of the handout with information regarding you and your partner (if applicable). Please use this section to share information about any previous labor experiences or if you have any special needs. Support People We encourage you to have a support person with you at all times during labor. If you chose to also have a doula present with you during labor, let your healthcare team know when you are admitted. Your support person/doula may walk with you in the hallways. We do ask that the hall not be used as a gathering place to ensure the safety and privacy of both you and other patients. If you have other children, they may be in the labor room with you only if they have another adult to supervise them. Tell us your concerns Please tell us what you are most concerned about, such as the following: • Epidural or no epidural? • Fetal monitoring • IV therapy • Having your family with you in the labor room? Please let us know your concerns so that we may be mindful of your wishes during labor. Labor Preferences Atmosphere: You may have special preferences for your labor, such as soft lighting, relaxing music or peace and quiet. We have done our best to make our labor rooms as comfortable as possible. You may also bring items with you from home that will personalize the atmosphere for you. These items may include: • family photos • iPod • focal points • massage lotion • pillows • any item you feel will benefit you in labor Position Changes: Positional changes as well as movement are encouraged to help facilitate labor. You can try the following: • walking • using a rocking chair • taking a shower • using a birthing ball • pelvic rocking • any position or combination of positions that gives you comfort Occasionally, your healthcare provider, midwife or nurse may ask you to get into a certain position for the benefit of the baby. ▲ Return to Top Relaxation and Comfort Techniques: It is very important for you to be as comfortable as possible during labor. Some relaxation methods may include: • massage • use of counter pressure • imagery • breathing techniques • heat and cold applications • any other relaxation technique you have found that works best for you Labor Support: We realize that the support you receive during labor will have a lot to do with your confidence to give birth. Please let us know if there is anything we can say or do that will help you. Education: Please indicate all of the classes you have taken to prepare for birth and parenting, even those taken or completed outside of the hospital. NOTE: Certain decisions such as epidural anesthesia may limit the above options. Please discuss this with your healthcare provider. Medical Interventions During Labor and Birth If you have special requests, please talk them over with your healthcare provider or midwife during your clinic or office appointments before labor begins. Decisions may need to be made regarding medical interventions. Please indicate whether or not you would like to be involved in the decision making process. You may prefer to leave the decision to your healthcare provider or midwife should an intervention become necessary. Fetal Monitoring: A fetal monitor is one way to determine your baby’s heart rate throughout labor. Your healthcare provider will usually want you to be monitored constantly once you are in active labor. If you are admitted to the hospital when you are in early labor, your healthcare provider may monitor your baby’s heart rate at scheduled intervals. Having a fetal monitor applied typically does not restrict your movements, your ability to walk, change positions or sit in a chair comfortably. We offer intermittent monitoring for low risk moms in labor. Talk with your healthcare provider or midwife to see if this is an option for you. We encourage you to discuss any concerns you may have regarding fetal monitoring with your healthcare provider or midwife before you come to the hospital or with your nurse once you arrive at the hospital. Eating and Drinking/Intravenous (IV) Fluids: You can eat light foods at home while in early labor. Once you are in the Labor and Delivery Unit, eating will be limited to ice chips and snow cones during labor. Most mothers receive IV’s for fluid replacement in labor. They are also used for administration of medications, for IV pain medication, in preparation for an epidural and for Cesarean births. If you choose to receive pain medication or an epidural during your labor, you may want to wait until your labor becomes active so you have the option to walk around, rather than requesting it upon admission. Your IV may also be discontinued from the IV fluid bag and “capped off”, if you are not being induced, receiving an epidural and/or dehydrated, so that you may be more mobile. ▲ Return to Top Induction and Augmentation of Labor: These procedures artificially begin labor or help it to progress by working with your body’s own oxytocin. Your healthcare provider or midwife will discuss these options with you. Vaginal Exams: A doctor, nurse or midwife may do a vaginal exam to see how your labor is progressing. A vaginal exam may be done when you arrive at the hospital and might be repeated periodically to evaluate your progress. Pain Management Please let us know your preferences for pain management. There are many solutions to pain management, besides medication. You may plan on using some alternative comfort measures such as: • relaxation • breathing • massage • movement • shower • the birthing ball Please let our staff know how we can help you. If you are planning on using a doula, be sure her role is clearly defined and she knows your expectations for labor. Second Stage of Labor and Birth Have you thought about what positions you would like to try for labor and when you start to push? We encourage you to share any of the positions that you would like to try with us when you are admitted. Here are some other situations you may want to clarify with your healthcare team: • Would you like to use the birthing ball in labor and the squatting bar when you push? • After the baby is born, do you or your partner want to cut the cord? • Do you want to identify the sex of the baby yourself? • Would you like your baby placed skin-to-skin with you directly after birth? • Are you are planning on breastfeeding? It is recommended that you begin breastfeeding during the first hour after birth. • Do you have any questions or concerns about that first feeding? • Do you want family and friends to be with you directly after the birth or would you prefer some personal time alone as a new family? Phone Calls: In order to protect your privacy, we are unable to give information to inquiring family and friends, so please let your friends and family know our policy beforehand. Recording the Birth: You are welcome to use your camera for still photographs during the first stage of labor. Videotaping is permitted during the first stage of the labor process as well, however, videotaping is excluded during the second and third stages of labor (pushing and delivery), during a Cesarean birth and during immediate transition of the newborn delivered vaginally. The healthcare providers, pediatricians, certified nurse midwives and nurses want you and your baby’s safety to be their primary concern. Videotaping during the above mentioned times may pose a distraction to patient care, potentially impacting the safety of mother and newborn. ▲ Return to Top Here are some things to consider if you are having a Cesarean birth: Cesarean Birth During the operation, a urinary catheter is required to keep your bladder empty during surgery. For most Cesarean births, spinal anesthesia is used during the surgery. After your baby is born, other medications may be given. These medications may affect your alertness in the recovery room with your baby. Postpartum, your pain may be relieved by medications given through your IV or with the use of a PCA (patient-controlled analgesia) pump. Your support person is welcome to attend a Cesarean birth. She/he does not have to watch the operation, but can sit beside your head during and after the surgery and may hold the baby after the baby has been stabilized. Please note that this is a sterile procedure and they may not cut the cord. Here are some things to consider if you are having a Cesarean birth: • Do you desire to have your support person with you during a Cesarean birth? • Does your support person desire to be present during a Cesarean birth? • Do you have an alternate support person in mind in case your primary support person cannot be present? • Do you want to breastfeed after the procedure? After Your Baby is Born Your Baby’s Healthcare Provider: Have you selected a healthcare provider for your baby? Does she/he have privileges at the hospital where you are delivering? If not, please consult with your healthcare provider before your admission to the hospital regarding a recommendation while you are at the hospital. You will need this information when you are admitted to the hospital. For immediate high risk care of a sick newborn we have specially trained neonatologists (healthcare providers), nurses and respiratory therapists in our Neonatal Intensive Care Unit or NICU. Immediate Newborn Care: Normal newborn care will take place in your labor room following the birth. This includes: • weighing • measuring • checking temperature • pulse • respiration • cord care • physical exam • eye ointment • vitamin K injections We encourage breastfeeding mothers to introduce the baby to the breast during the first hour. Infant Feeding: Do you plan to breastfeed or bottle feed your baby? To facilitate the best start with breastfeeding we encourage early feeding and frequent feedings as soon as your baby shows hunger cues and before she/he starts to cry. Typical feedings occur every 1-3 hours. For those who need additional assistance, lactation consultations and educators are available throughout your hospital stay. ▲ Return to Top Birth Plan Worksheet Name: ____________________________________________________________ My due date is:____________________ My healthcare provider is:_ __________________________________________________________________________ Getting to know you: _ ___________________________ Medical interventions during labor & birth: ______________________________________________ Pain management: ___ Pain Medication ___ Relaxation & Breathing ___ Massage ___ Movement ___ Shower ___ Birthing Ball ___ Other Support people:_________________________________ ______________________________________________ Tell us your concerns: ___ Epidural or no epidural? ___ Fetal monitoring? ___ IV therapy? ___ Having your family in labor room? ___ Use of interventions? Labor preferences: Atmosphere: ___ Family photos ___ iPod ___ Focal points ___ Massage lotion ___ Pillows ___ Other items you feel may be beneficial Position changes: ___ Walking ___ Using a rocking chair ___ Taking a shower ___ Using a birthing ball ___ Pelvic rocking ___ Other Relaxation & comfort techniques: ___ Massage ___ Use of counter pressure ___ Imagery ___ Breathing techniques ___ Heat & cold applications ___ Other Topics to consider during second stage positions and birth: ______________________________________ ______________________________________________ ______________________________________________ In the event of a Cesarean birth, will you have a support person present? ___Yes ___ No After your baby is born: My baby’s healthcare provider is: _____________________________________ ___ I have not chosen a healthcare provider for my baby ___ I plan to breastfeed ___ I plan to bottlefeed ___ I do plan to have my son circumcised ___ I DO NOT plan to have my son circumcised Going home: Special concerns/requests for the care of your baby: ______________________________________________ ______________________________________________ Please be sure to have your baby’s car seat installed in your car prior to discharge. Nurses cannot assist you in installation. Thank you for sharing your Birth Plan with us! We look forward to caring for you and your baby. ▲ Return to Top Upon Arrival to the Labor and Delivery Unit • Perinatal Care area (Triage) is where you will be evaluated to determine whether or not you are in labor. After you are evaluated and it is determined that you are in labor, you will be assigned to a private birthing room. • Once you have been transported to your room, you will most likely have intravenous fluids (IV) inserted into one of your arms and a fetal monitor applied to monitor the baby’s heart rate and your contractions. • Lehigh Valley Hospital is a teaching hospital. The members of your care team are your healthcare provider, nursing staff, midwives, residents, medical and nursing students. • Anesthesiologists, neonatologists (healthcare providers who specialize in newborn care), maternal fetal medicine perinatologists (physicians who specialize in taking care of high risk maternal issues) are available 24 hours a day if you or your baby should need them for care. Your Stay While You are in Labor While you are a patient in Labor & Delivery, you will be cared for by a registered nurse specifically assigned to your care along with your healthcare provider and a resident healthcare provider. Who will be present when I deliver my baby? At the time of delivery, a registered nurse, technical partner, your healthcare provider and a resident healthcare provider will likely be present. An anesthesia healthcare provider or nurse and specialty staff for your baby, healthcare providers, nurses and a respiratory therapist from the Level III Neonatal Intensive Care Unit (NICU) are available if needed. Lehigh Valley Hospital is a teaching hospital. The resident physicians work closely with your healthcare provider. You may have medical students and nursing student asking to participate in your care. Can I eat while I am in labor? We do not feed you while you are in labor. Ice chips and snow cones are available for mouth comfort. Coffee, juice and soda are available for your partner. Can I bring my birth plan/wishes? Be sure to discuss any birth plans or special wishes you may have with your healthcare provider prior to your delivery. A birth plan and a worksheet to complete are located in this tab. The baby’s footprints Bring your baby book for the delivery. We love to put footprints in the books! ▲ Return to Top Help your labor progress Change your position at least every hour. Keep your bladder empty by urinating every hour. Walk, sit in a rocking chair or use the birthing ball. During contractions, lean on your partner or over the bed, rock in a rocking chair or in bed, sway with the birthing ball or sway while leaning over the bed. You can also “slow dance” with your partner during contractions. What are the visiting guidelines while I’m in labor? For your comfort, respect for your privacy and infant safety, visiting in Labor & Delivery supports family presence. Your family will be permitted based on your needs and safety. Can my partner cut the cord after delivery? Your partner may cut the cord after a vaginal delivery. If there is an emergency with your baby, the healthcare provider may quickly cut the cord and hand the baby to the awaiting infant support team. Due to a risk of infection, your partner can not cut the cord during a Cesarean delivery. Can we take pictures of the delivery? No audio-video/still photography/cell phone cameras will be permitted during patient care, during delivery, stabilization of mother, infant or during any procedure. Photography must not interfere with patient care. No photography of any healthcare provider is permitted without first obtaining written consent from that provider. Failure to comply with these rules may result in removal from the clinical unit, as well as from the hospital setting. The OB providers, pediatricians, certified nurse midwives and nurses want you and your baby’s safety to be their primary concern. Who will notify my baby’s healthcare provider about our birth? The staff on the Mother Baby Unit will notify your baby’s healthcare provider when your baby is born. Your baby will be examined by his/her healthcare provider within 24 hours. Can my baby stay with me after birth? Your baby will stay with you in Labor & Delivery after a vaginal delivery so that you can spend time together. If you had a Cesarean delivery, you will see your baby right after birth then the baby will go to the nursery for observation until your surgery is completed. Your partner can go with the baby to the nursery and take pictures. When you are settled in the recovery room, the baby will spend time with you in the recovery room. There may be times when the baby will need to go to the Neonatal Intensive Care Unit for closer observation and specialty care. We will take you to the NICU as soon as possible after delivery to see, touch and bond with your baby. Do I stay in the labor room after I have my baby? After the birth of your baby, you may have up to a two hour recovery time in Labor & Delivery. You will be transferred to the Mother Baby Unit after your recovery time. ▲ Return to Top Induction of Labor What is induction of labor? How long will my induction take? Stimulating labor before your labor begins naturally. • Time from induction of labor to delivery of infant is unpredictable. When is your baby considered full term or ready for delivery? Your baby may come 2 weeks before or after your due date. Overdue or post dates are 2 weeks after your due date. • Generally, inductions may take a long time, 18 to 24 hours, or more. Are there risks to induction of labor? Yes, any medicine or procedure has risks: Why should I have my labor induced? • Side effects from the medications used for the induction. When the benefit of delivery for your baby is greater than the risk of continuing your pregnancy. • Risks when the healthcare provider or midwife breaks your water. What are the different types of inductions? • Induction may lead to episiotomies, vacuum, forceps or Cesarean delivery to help the baby deliver. Induction may be necessary when there is some reason to end the pregnancy such as: • You are past your due date. • Your water breaks. • Your medical condition worsens: • Diabetes • High blood pressure • Baby is not growing properly (Intrauterine Growth Restriction). • There is not enough amniotic fluid around the baby. • There is an infection. • Elective inductions: • Your last labor only took a couple of hours. • You live a great distance from the hospital. • You have a valid family problem such as your husband/partner is about to be deployed. Who will decide if induction is right for me and my baby? • You will discuss your options with your healthcare provider or midwife. • Induction of labor, compared to natural labor, has a risk of operative delivery: vacuum, forceps or Cesarean delivery. • Baby may not tolerate a long labor. • With prolonged use of pitocin, there is a risk of increased vaginal bleeding, uterine muscle fatigue or excess water retention. What are the risks of induction of labor after I have my baby? • Depends on the length of labor. • Infections may be related to long labor. • Uterine muscle may not contract after delivery which may result in increased bleeding that may lead to anemia. Induction of labor is not without risks for you or your baby. Discuss the need for induction, risks and procedures with your healthcare provider or midwife. Ask questions and discuss the issue thoroughly until you understand. • The healthcare provider or midwife should explain the reasons for induction, the risks, the procedure and alternatives to induction. • The office will schedule your induction. • Inductions may be postponed or rescheduled if the need arises. ▲ Return to Top Cesarean Delivery or C-Section Cesarean delivery • Baby is delivered through the mother’s belly. What are the risks of having a Cesarean delivery? • The incision is either from side to side (transverse) or up and down (classical). • Infection • The cut on your skin may be different than the cut on your uterus. • Injury to nearby organs • Ask your healthcare provider what type of cut is made on your uterus. If the cut on your uterus is side to side or transverse, you may be able to delivery vaginally with your next delivery. • Cesarean delivery is a major surgery so you will be in the hospital for 3 days after your delivery. • Breastfeeding after Cesarean delivery is normal. Why do some women need a Cesarean delivery? Cesarean deliveries may be planned for several reasons: • Breech presentation with the baby’s buttocks or feet coming first • More than one baby • Placenta is over the cervix • Active vaginal infection such as herpes Most Cesarean deliveries are unplanned. • Baby does not fit through the mother’s pelvis. • Baby does not tolerate labor. • Labor fails to open the mother’s cervix. • Bleeding • Reaction to anesthesia If you are admitted for a scheduled Cesarean delivery: • Do not eat or drink after midnight. • Arrive 1½ hours before your scheduled Cesarean delivery time. • While you are being prepared for a Cesarean delivery, visitors may be limited prior to going in the operating room with you. What is the procedure after delivery? • At the time of delivery, your healthcare provider will hand your baby to the staff for drying, warming and to check the baby’s breathing and heart rate. You may hear the infant cry but some babies are quiet. • Your support person may be called to the crib when the baby is stabilized. The support person may take pictures of the baby in the crib. Videotaping is not allowed in the operating room. Your baby will be brought over to you for a visit. Your baby and support person will go to the nursery together. • High blood pressure • Following the surgery, your nurse will be pressing down on your uterus to keep it firm. This may be uncomfortable but it will help decrease your bleeding following the surgery. • Other medical problem • You will stay in the recovery room for about an hour. • Mother’s worsening medical condition. • Diabetes Baby has special needs. • If the baby is stable, the baby will come to the recovery room for bonding and breastfeeding. We try to maintain our schedule as much as possible. If an emergency arises with another mother or her unborn baby, please be patient as we continue to provide care for our families. ▲ Return to Top Vaginal Birth After Cesarean (VBAC) What is a VBAC? • You had a Cesarean delivery for a prior birth and you want to have a vaginal delivery for the birth of this child. Are there risks to having a VBAC? • There are risk to the mom and her baby if the uterine scar from the previous Cesarean delivery opens or ruptures during labor and delivery. What are the advantages of VBAC? • Cesarean delivery is a major surgery. Vaginal delivery is not. • Less risk for infection, bleeding and other complications. • You will have a shorter recovery time. Talk to your healthcare provider to see if a VBAC is right for you. • What is the position of your baby? Your baby must be head down. • Why did you need a Cesarean delivery with your last baby? • Do you have health problems that would prevent VBAC? • Do you have pregnancy issues that require Cesarean delivery? • Twins or triplets • Low lying placenta or placenta over the cervix • Baby in Breech position Call your healthcare provider or the clinic at the Center for Women’s Medicine when your labor begins. ▲ Return to Top Skin-to-Skin Contact for You and Your Baby What is “Skin-to-Skin”? Skin-to-skin means your baby is placed belly-down, directly on your chest, right after the baby is born. Your healthcare provider dries off the baby, puts on a hat, covers the baby with a warm blanket, and gets the baby settled on your chest. The first hours of snuggling skin-to-skin let you and your baby get to know each other. They also have important health benefits. If the baby needs to meet the pediatricians first, or if you deliver by Cesarean delivery, you can unwrap the baby and cuddle shortly after birth. Newborns crave skin-to-skin contact, but it’s sometimes overwhelming for new moms. It’s ok to start slowly as you get to know your baby. Babies who have skin-to-skin get to: • smell you • hear you • feel you • nurse from you • stay warm • be calmed and loved by you Breastfeeding Snuggling gives you and your baby the best start for breastfeeding. Eight different research studies have shown that skin-to-skin babies breastfeed better. They also keep nursing an average of six weeks longer. The American Academy of Pediatrics recommends that all breastfeeding babies spend time skin-to-skin right after birth. Keeping your baby skin-to-skin in the first few weeks makes it easy to know when to feed the baby, especially when the baby is a little sleepy. It’s my birthday, give me a hug! A Smooth Transition Your chest is the best place for your baby to adjust to life in the outside world. Compared with babies who are swaddled or kept in a crib, skin-to-skin babies tend to stay warmer and calmer, cry less, and have better blood sugars. Bonding Skin-to-skin cuddling may affect how you relate with your baby. Researchers have watched mothers and infants in the first few days after birth, and they noticed that skin-to-skin moms touch and cuddle their babies more. Even a year later, skin-to-skin moms snuggled more with their babies during a visit to their pediatrician. Skin-to-Skin Beyond the Delivery Room Keep cuddling skin-to-skin after you leave the hospital– your baby will stay warm and comfortable on your chest, and the benefits for bonding, soothing, and breast-feeding likely continue well after birth. Skin-to-skin can help keep your baby interested in nursing if he’s sleepy. Dads can snuggle, too. Fathers and mothers who hold babies skin-toskin help keep them calm and cozy. Multiple studies over the past 30 years have shown the benefits of skin-to-skin contact. In all the studies described here, mothers were randomly assigned to hold their babies skin-to-skin or see them from a distance. For more information, see Anderson GC, GC. Moore, E. Hepworth, J. Bergman, N. Early skin-to-skin contact for mothers and their healthy newborn infants. [Systematic Review] Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2005. Massachusetts Breastfeeding Coalition / www.massbfc.org| © 2005 MBC and Alison Stuebe ▲ Return to Top Father’s/Partner’s Role in Labor Take care of yourself • Do not skip meals • Drink fluids • Rest when she rests Try these activities if she is agreeable: • Massage, gentle rhythmic massage • Counter pressure at the base of her spine • Encourage rhythm to movements such as rocking or swaying • Encourage rhythm to breathing, moaning or chanting • Wipe her face and neck with a cool damp cloth • With a soft gentle voice offer words of encouragement and praise Note: Some women do not like to be touched when they are in pain. Follow her cues. • “Good job!” • “You did great with that contraction!” • “You can do this!” • Speak in a soothing low rhythmic tone of voice • Breath with her during the contraction- using slow deep breaths • Let her know when the contraction is at the midpoint and almost over. • Match your voice to her rhythm. • “You are half way through this contraction.” • “It’s almost over.” • Assist her getting into more comfortable positions or positions to enhance labor, even if the position last only through a few contractions • Offer ice chips to cool and moisten her lips • Offer chapstick • Keep room dimly lit • Keep room quiet with only soothing sounds • Use music she finds relaxing • Avoid loud sudden noises • Allow only the visitors she wants present • Help her maintain privacy • Provide the comfort of touch • Stroking • Backrubs • Hand-holding Simkin, P. & Ancheta, R. (2005). The Labor Progress Handbook 2nd ed. Blackwell Publishing ▲ Return to Top