| Obstetrics - Labor |
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CENTER FOR WOMEN’S HEALTH LET’S TALK ABOUT LABOR … Congratulations! You’re in the home stretch. In not too many more weeks you’ll experience the miracle of birth firsthand. This sheet is intended to supplement your learning by letting you know of some of our preferences. Below are some of the more commonly asked questions and answers. When should I call if I think I am in labor? The definition of labor is contractions that cause dilation and effacement (thinning) of your cervix. If you think you might be in labor please call before going to the hospital. By calling first we will be able to assess what is going on and help you decide if it is time. If you call during office hours we usually prefer to see you in the office. FYI: Some common times you might experience dysfunctional uterine contractions or false labor are in the evening, after exercise, after intercourse, or if you are dehydrated. If this is the case, a warm bath and some fluids might help. What can I do if I think I’m in early labor, but it’s not time to call or go to the hospital? Whatever helps you to stay relaxed is always good; a bath or shower is great. Other things to consider are resting if you are tired and remaining hydrated. Don’t wear yourself out walking for hours on end, and you should be drinking about a liter of fluid every hour. Your labor will be easier and less likely to be prolonged if you stay hydrated. Do I have to have an IV? Maybe. Most women will have an IV or buffcap (a cap on the end of an IV instead of a tube with running fluids). This decision will be made by your doctor or midwife possibly before labor or sometimes during labor. If you have an IV, it should not encumber your activities, and it will be removed a few hours after delivery if you are doing well. Some of the most common reasons for having an IV are: Do I have to be stuck on the fetal monitor? Stuck - we hope not. Since labor can be a stress on the baby, it’s prudent to use technology (the electronic fetal monitor) to assess its well being upon admission for labor. Once we are reassured, then we don’t think that continuous monitoring is necessary, and would prefer you to be able to move about. You might want to let your labor nurse know when you would like to get up and walk. Internal monitoring is reserved for problem labors- either baby heart beat problems, inadequate progress, or previous cesarean sections. Who will be involved in my care? Besides your provider, there will be labor and delivery nurses and possibly resident physicians involved in your care. We hope you see the presence of these professionals as being supportive and helpful, acting as our eyes and ears when we’re not present. You and your baby receive much more attention because of them, and we believe that is directly translated into a better overall outcome. If you would prefer not to have a resident physician involved in your care, please let us know of your wishes. Do I have to have an enema? No. However, we know that whatever is in your rectum has to come out before baby’s head will. Try sitting on the toilet before coming in for labor. If desired, you may request an enema. Do I have to have an episiotomy? Probably not, but no one has a crystal ball to predict things. To help avoid an episiotomy, we may stretch your perineum or apply warm compresses to this area while you’re pushing. The decision for an episiotomy is made only at the time of crowning. How long do I have to stay in the hospital? This varies and obviously depends a great deal on what time of day you deliver. Most moms want to spend at least one night to take advantage of the nursery and regain some strength and rest. Some moms prefer to spend two nights, and a few want a very short stay of only a few hours after delivery. Usually the limiting factor is how well your baby is doing for these early releases. Please let us know if you desire a short stay so your prenatal record can be marked accordingly. You might also discuss this with your baby’s doctor to get their opinion and let them know your desires. What about pain medication? Our hope is that through childbirth classes you will gain familiarity with what is available. We also hope that you will come to labor with an open attitude about these options. We will support you in whatever you decide. Please understand that if we offer or suggest something for pain relief, we are not forcing anything on you, and you may always decline. The medicine we typically use is fentanyl, a narcotic-like compound with a short activity. We give this to you through your IV or buffcap. It will help you to rest, relax, and cope with your labor. We usually don’t give it to you early in labor because it can prolong things. We also try not to give it to you close to delivery because there is the potential for breathing depression in the baby, although rare. Epidural anesthesia is available and we believe it is safe and effective. Though most women don’t require this form of pain relief, some electively choose it; if this is your desire we will be happy to arrange it. The effect is to take away your labor pain by blocking the pain nerves as they enter your spinal column. In general you would be numb from your belly button down and would be able to sleep and/or reserve energy for pushing. An epidural is very helpful for long labors or if you’ve gotten behind in your sleep and are having trouble coping. Who should be my baby’s doctor? Your choice may be influenced by your insurance, friends, convenience to office, etc. In general we ask you to consider 2 questions: 1) Would you prefer a pediatrician (specialist in the care of infants and children), or a family practice physician?, and 2) Would you prefer a group practice or solo practitioner? Once you have pondered these questions we can assist you with specific recommendations. It also doesn’t hurt to ask around; family, friends, and co-workers with small children may also be helpful in finding a doctor for your baby. When you have decided on your baby’s doctor, we encourage you to make a new parents appointment (frequently at no cost) with him or her to see how well your beliefs and personalities mesh. Topics for discussion may include breastfeeding, circumcision, and nursery routine in the hospital. What is an ultrasound? An ultrasound (sometimes called a sonogram) is a diagnostic test that uses sound waves to look inside your body. The handheld wand or transducer emits a sound wave of a very high frequency that bounces off of the tissues. The echoes that return are measured and turned into a picture by the computer in the ultrasound machine. The denser a tissue is, the brighter the echo will be. Water-filled spaces have little for the sound to bounce off of, so they will look black. Bone is very dense, so it will have a bright white echo. Everything in between will be a shade of gray. With ultrasound we are able to look deep into your body and get a picture without having to perform surgery or expose you to x-rays. Is ultrasound safe? Ultrasound has been used in obstetrics for over 30 years. No harmful effects have been found to be caused by ultrasound. The sound wave is strongest as it leaves the transducer and enters the gel. It is immediately absorbed by the tissues it passes through, so very little of the sound actually reaches your baby. But, since ultrasound does introduce a sound wave that is exceeds the normal range of sound, it is suggested that its use be reserved for diagnostic purposes over a short duration. What will happen at my ultrasound visit? If you are not pregnant, or are less than 12 weeks pregnant, you will probably have a vaginal ultrasound. You will be asked to undress from the waist down and a transducer will be placed in your vagina. This allows us to use a higher frequency of sound that will give us much clearer pictures. It also allows us to avoid looking through your stomach muscle, in order to get closer to the area of interest. The transducer will be gently moved to see different structures in your pelvis. Later in pregnancy this higher frequency of sound cannot penetrate deep enough to “see” your baby. If you are more than 12 weeks pregnant, or your healthcare professional has asked that the vaginal approach not be used, we will ultrasound you from the top of your tummy. We will first apply gel to your abdomen to give the sound waves something to travel through. The transducer will be moved around to see your baby from different angles. We will take measurements and pictures of specific features. We will also try to take pictures for you to take home as keepsakes. Do I need to prepare for my ultrasound? If you are having an abdominal ultrasound (for pregnancy past 12 weeks) you will be asked to drink a glass of water within one hour of your ultrasound. You may not empty your bladder until after your ultrasound is completed. This allows your full bladder to help push your baby up out of your pelvis so we can get a better look at him or her. If your bladder is empty when you arrive for your scan you may be asked to reschedule for another time. Since our patients are patiently waiting to use the restroom after their procedure, we ask you to be on time so as not to make those scheduled after you have to wait any longer than necessary. We try very hard to stay on time with our ultrasound appointments. Emergencies do occur, but we ask you to do your part by not arriving late. If you are more than 5 minutes late for your appointment there may not be time to perform a complete scan and you may be asked to reschedule. We also will not wait for friends or relatives who are not at the office when your scan is scheduled. Please be considerate and be on time! Why do I need a prenatal ultrasound? Ultrasounds are performed for many reasons. Every patient will have one ultrasound between 20 and 24 weeks to determine the general well-being of their child. The following will be examined:
At other times during pregnancy an ultrasound may be ordered. Some reasons may include:
If you are having twins, you can expect to have an ultrasound every 4 to 6 weeks to check on the growth and condition of your babies. Ultrasounds are also done for gynecological reasons. These ultrasounds are usually done with the transducer placed in the vagina. Reasons for a gynecological ultrasound include:
During a gynecological ultrasound we will be looking at the following:
We will not be evaluating your bowels, gallbladder, kidneys, etc. Excessive bowel gas or constipation may interfere with ultrasound results. If you are prone to these conditions please speak to your nurse or doctor for advice prior to your ultrasound. A stool softener and avoiding gassy foods may be recommended. Does a normal appearing ultrasound guarantee my baby won’t have problems? Ultrasound performed by a well trained individual can give us a lot of information. However, some conditions cannot be detected by prenatal ultrasound. Some conditions may develop later in pregnancy after an ultrasound has already been performed. Some conditions may not be seen due to baby’s position, the position of the placenta, or the mother’s weight. Even the most experienced sonographer cannot detect all abnormalities. There are never any guarantees that your child will be perfect, but with ultrasound there is a much greater chance of finding a problem before birth. Why are my pictures not as clear as others I have seen? The acuity of ultrasound pictures depends on how well the sound waves penetrate the body and how well they are reflected back to the transducer. Each woman’s body is different. Some allow sound waves to pass easily; others absorb the sound before it reaches its target. Bowel gas will scatter the sound waves so the echoes are not directed back to the transducer in a straight line. Different machines will have different capabilities. |