So, you are going to have a baby. As excited as you are, picturing your baby in your arms, you are likely somewhat anxious about what you will experience in order to get there! That is natural. It can be hard to picture how your baby will get from “in there” to “out here.” But don’t worry; your body was designed for this. You are tougher than you know! And the rewards at the end of the journey are greater than you have imagined. I will try to answer some questions that may be going through your mind right now:
“What should I do in preparation for that day?”
Make sure you know which hospital your doctor would like for you to go to, and preregister there. Also, find out how your doctor would like for you to contact him or her. Some hospitals offer tours, so that you will know exactly where to go when that exciting time comes. Have your bags packed with all the things you may need during your hospital stay. Make sure you have a car seat available for bringing your baby home, and decide on a pediatrician or family physician who will begin caring for your baby in the hospital. Then, take a deep breath and enjoy the quiet activity of your unborn child as you wait for “labor day” to arrive.
“How do I know if labor is getting close?”
Signs your time may be near may include feeling like your baby has dropped in position, your joints may feel looser, and you may have more cramps and back pain. Signs of early labor may include increased vaginal discharge (it may come out in a clump commonly called the “mucus plug”), faint streaks of pink or brown blood, or irregular or infrequent contractions. You do not need to call your doctor for these early signs unless you have concern about your baby’s movement or are experiencing severe pain.
“How do I know when I am progressing into real labor?”
In labor, contractions will continue to get stronger, despite moving about or changing position. Pain usually starts in lower back and moves to the lower abdomen or legs. Contractions become more frequent, more painful, and fall into a regular pattern lasting 30 to 45 seconds, ultimately occurring every two to five minutes.
“How do I know when it is time to call my doctor and head to the hospital?”
Call your doctor when contractions are occurring consistently every five minutes for an hour, when your water breaks (it may not be an obvious “gush,” but your pants will feel continuously wet), if you experience bright red or heavy bleeding, if you experience visual changes, headache, or sudden, severe swelling (which can be signs of pregnancy induced hypertension), or if you experience concerns about your baby’s movements.
The earliest stage of labor occurs over hours to days. Don’t be discouraged if it feels like it takes forever to reach a dilation of 3 to 4 cm. Things happen more predictably in the active phase of labor as you progress from 4 cm to 10 cm. The transition phase from 7 to 10 cm may happen extremely rapidly. Descent of the baby begins when you reach the pushing phase, which may take minutes to several hours. Once your baby delivers, you have reached the third phase of labor, which involves delivery of the placenta. This usually happens within a few minutes but may take up to half an hour.
“What sort of interventions might I expect on L&D?”
Doctors usually would like for you to have IV access or IV fluid, so that medications can be administered quickly in case of emergency. Because sometimes labor can last a long time, the IV fluids are useful to keep you and your baby from becoming dehydrated. Sometimes, they will allow ice chips or popsicles to keep your mouth from becoming dry, but usually, food is avoided during labor due to the tendency to become nauseated. The doctor will want to make sure your baby is tolerating labor well, so he or she will perform intermittent or continuous fetal monitoring. This may be done with external belts or internal monitors.
Options for pain control include breathing techniques, a support person such as a doula, epidural or spinal anesthesia, IV narcotics, or local anesthesia.
Your doctor may artificially break the back of water (amniotomy) during labor if it has not occurred spontaneously. This helps to hasten the progress of labor and allows the doctor to evaluate for the presence of meconium (when the baby has a bowel movement before delivery) in the amniotic fluid. Sometimes, if labor is progressing slowly, he may give Pitocin augmentation to increase the strength and frequency of contractions. If there is an indication to induce your labor before your cervix is fully ready, the doctor may also use a ripening agent to soften the cervix, such as Cervidil or Cytotec.
“What other events might happen at delivery?”
On occasion, if there is a need to hasten your baby’s delivery, your doctor may recommend the use of a vacuum or forceps. The vacuum is a suction cup shaped like a bell or mushroom that is placed on your baby’s head to allow for greater descent than your pushing alone can accomplish. Forceps are an instrument shaped like a spoon that are placed alongside your baby’s head to allow the doctor to help your delivery. Although these may look a little frightening, remember the doctor would not be recommending them if he or she were not experienced in their use, and if he or she did not think there was a good reason to recommend them. You always have the option to tell the doctor you would rather have a cesarean section if you feel uncomfortable with vacuum or forceps.
There is a possibility that your doctor may recommend that you deliver by C-section. One out of three deliveries in our country is performed this way. The most common reasons for C-section are malpresentation (baby is not coming head first), arrest of dilation or descent despite adequate contractions in labor, and non-reassuring fetal testing in labor. Your doctor will explain to you the reasons why if he feels you need a C-section, and you will have the opportunity to ask questions to make sure you understand. Even if it turns out you need to deliver by C-section, don’t be discouraged. The most important thing is making sure you and the baby remain healthy during delivery.
When you deliver vaginally, particularly with a first baby, there is a chance the doctor may need to make a small cut called an episiotomy to make room for the baby’s head, or you may have a small tear. These are usually repaired with absorbable sutures, and this area usually heals very quickly.
“What sort of things should I expect to happen to my baby?”
When the baby delivers, the doctor may allow extra time for the maximum amount of blood to drain from the placenta into the baby (usually 30 to 60 seconds, called “delayed cord clamping”). Some women may elect to have the doctor collect and save the extra cord blood in case the baby should have need for it in the future (although this can be fairly expensive). The doctor or nurse may place the baby immediately on your chest (“skin to skin contact”) or allow you to begin breastfeeding right away.
An Apgar score will be assigned at one minute and five minutes of life, evaluating baby’s heart rate, breathing effort, color, tone, and response to stimulation. Most state laws require antibiotic ointment be placed in the baby’s eyes to prevent blindness from some infections, and a vitamin K injection is given to help the baby’s blood clotting system to function effectively.
Later in the nursery, the baby will be given his or her first bath and evaluated from head to toe by the pediatrician or nurse practitioner. A heel stick test will be performed to screen for various types of inherited illnesses. This varies from state to state but usually includes phenylketonuria, hypothyroidism, sickle cell anemia, and sometimes other disorders. The baby may receive a hepatitis B shot in the nursery, and if you have a boy and choose to have him circumcised, this is often done one or two days following delivery by your pediatrician or obstetrician.
Finally, when your doctor and your baby’s doctor feel you are both healthy enough to leave, you will be able to take your baby home!
Hopefully, you now feel better prepared for what lies ahead, as you bring your baby into the world. If you have more questions, don’t hesitate to ask your doctor. That is his or her job, to help you be as knowledgeable and prepared as possible. But don’t forget that a woman’s body is uniquely designed to give birth to new members of the human family. You don’t have to study to pass this test. Your body will know what to do!
By Ingrid Skop, M.D.