Once in Labor

What to Expect at the Hospital

At the hospital, you should proceed directly to the Labor and Delivery suite. Your partner may be asked to stop at the admitting office to complete necessary paperwork. Once at the hospital, your baby will be monitored, an intravenous line may be placed, and your cervix will be examined for dilatation. If the obstetrician on-call is at the hospital when you arrive, he or she will examine you. Otherwise, you may be examined by a labor room nurse, a Physician Assistant, Nurse Midwife, Nurse Practitioner or an OB/GYN resident (a physician completing their specialty training in obstetrics). However, rest assured that no decisions regarding your care are made without the involvement of an attending physician (that is, one of us or one of our colleagues). The hospital staff is in frequent contact with us during early labor, and one of the covering OB’s is present once active labor begins. If any abnormalities are present, one of the members of the coverage team will make themselves immediately available for you.

In early labor, we generally allow you to drink clear liquids. Once active labor begins, (when cervix is approximately 5 centimeters dilated), only ice chips are allowed; you will not have any solid foods during labor.

Most women will be allowed to walk in early labor. This can be a comforting alternative to being restricted to bed. If you are walking, we will ask you to return to bed periodically so that we can monitor your baby. Once active labor has begun, women generally remain in bed, so that their baby can be continuously monitored.

Monitoring of the baby’s heart rate and of contractions is performed by using either an external or an internal monitor. The external monitor is like a belt that is wrapped around your belly, which senses your contractions and the baby’s heartbeat. The internal monitor is a wire or catheter that is inserted through the birth canal. It is not painful when it is inserted and most women barely notice it once it’s in.

In most cases, a catheter will be inserted into your bladder to keep it empty. This is usually necessary in women who have an epidural, since they can’t feel their bladder filling, and therefore, have difficulty urinating voluntarily. The catheter can be slightly uncomfortable, but is usually removed prior to delivery.

The Course of Labor

During labor, uterine contractions will dilate the cervix to allow the baby to pass through. When the cervix is fully dilated (10 centimeters), your pushing will help the baby to make its way through the birth canal.

The early part of labor, before the cervix is 5 centimeters dilated, can be very time-consuming. Once the cervix is 5 centimeters dilated, dilation usually progresses at least once centimeter per hour. If your labor is particularly slow, a medication called Pitocin may be used to give you more effective contractions. Pushing the baby out can take up to 2 to 3 hours; although for most women, it takes considerably less time. By carefully following our instructions, pushing is made as easy and quick as possible.

What pain meds can you have during labor?

As your doctors, we would like to take all safe steps to make your labor as comfortable as possible. Two kinds of medications can be used to make you comfortable.

• Intravenous (IV) medications, like Stadol or morphine, can be used to lesson the pain of contractions. These have a tendency to make you groggy or sleepy, and, if given close to the time of delivery, can make your baby sleepy at birth also.
• An epidural block, often called an epidural, may be used instead of IV meds. In this case, a catheter is inserted into your back to allow us to deliver anesthetic medicine around the spinal cord. This makes you numb from the waist down, but doesn’t make you sleepy.

We will work with you to determine which kind of medicine is best.

Will I need an episiotomy?

An episiotomy is an incision that is made at the front of the vagina to allow the baby’s head more room to deliver. It is difficult to determine whether you will need an episiotomy before the moment of delivery. If you have strong feelings about episiotomy, please let us know. We will make every effort to respect your wishes. Remember, though, that our goals are the same as yours: we want a healthy mother and a healthy infant after delivery. For those of you who are ambitious enough, you may attempt “perineal massage” to reduce the chance of needing an episiotomy. Feel free to research the technique on-line.

Will I need a C-section?

Like episiotomy, it is difficult to predict which women will need to deliver by Cesarean section. Years ago, doctors even went so far as to X-ray women in labor to see if their pelvis was large enough to allow the baby through. After years of trying different strategies, doctors have accepted that for most women the only way to know for sure if labor will be successful is to allow women to labor and judge the results. If your labor is not progressing well, or if the baby does not tolerate labor, a cesarean section is sometimes performed for the well-being of both mother and baby.

Courtesy Counts

Please be kind and courteous to the staff at the hospital. Although you may be very nervous and uncomfortable, remember that they are trained professionals and are often handling several patients at once. Treat them with respect and they will respond in kind.