Pregnancy and Birth Sourcebook Part 40

Inducing Labor * Giving the hormone prostaglandin to help ripen the Giving the hormone prostaglandin to help ripen the cervix: A gel or v.a.g.i.n.al insert of prostaglandin (often the drug Cervidil) is inserted into the v.a.g.i.n.a or a tablet is given by mouth. A gel or v.a.g.i.n.al insert of prostaglandin (often the drug Cervidil) is inserted into the v.a.g.i.n.a or a tablet is given by mouth.

This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out, or dilated) for delivery. Administered alone, prostaglandin may induce labor or may be used before giving oxytocin.

* Giving the hormone oxytocin to stimulate contractions: Giving the hormone oxytocin to stimulate contractions: Given continuously through an IV [intravenous line], the drug (often Pitocin) is started in a small dose and then increased until labor is progressing well. After it's administered, the fetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labor that's going slowly or has stalled. Given continuously through an IV [intravenous line], the drug (often Pitocin) is started in a small dose and then increased until labor is progressing well. After it's administered, the fetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labor that's going slowly or has stalled.

What will it feel like?

Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so. You may also have some intense cramps and spotting for the next day or two.

It may also be a little uncomfortable to have your water broken.

You may feel a tug followed by a warm trickle or gush of fluid.

With prostaglandin, you may have some strong cramping as well.

With oxytocin, contractions are usually more frequent and regular than in a labor that starts naturally.

What are the risks?

Inducing labor is not like turning on a faucet. If the body isn't ready, an induction may fail and, after hours or days of trying, a woman may end up having a cesarean delivery (or C-section). This appears to be more likely if the cervix is not yet ripe.

If rupturing the amniotic sac doesn't work, your doctor may need to induce labor a different way. Why? Because there's a risk of infection to both you and your baby if the membranes are ruptured for a long time before the baby is born.

When prostaglandin and/or oxytocin are used, there is a risk of abnormal contractions developing. In that case, the doctor may remove the v.a.g.i.n.al insert and turn the oxytocin dose down. While it is rare, there is an increase in the risk of developing a tear in the uterus (uterine rupture) when these medications are used. Some other complications a.s.sociated with oxytocin use are low blood pressure and low blood sodium (which can cause problems such as seizures).

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Pregnancy and Birth Sourcebook, Third Edition Another potential risk of inducing labor is giving birth to a late pre-term baby (born between 34 and 36 weeks). Why? Because the due date (also called the expected delivery date, or EDD) may be wrong.

Your due date is 40 weeks from the first day of your last menstrual period (LMP).

If you deliver on your due date, your baby is actually only about 38 weeks old-that's because your egg didn't become fertilized until about 2 weeks after the start of your last menstrual period. Women who have irregular periods or first trimester bleeding may be mistaken regarding when their last menstrual period was. Although ultrasounds can help to narrow it down, the estimated date of conception may still be off by a couple of weeks.

Babies born late pre-term are generally healthy but may have temporary problems such as jaundice, trouble feeding, problems with breathing, or difficulty maintaining body temperature.

Even though inductions do come with risks, going beyond 42 weeks of pregnancy can be risky, too. Many babies are born "post-term" without any complications, but concerns include: * a v.a.g.i.n.al delivery may become harder as the baby gets bigger; * the placenta that helps to provide the baby with nourishment is deteriorating; * the amniotic fluid can become low or contain meconium-the baby's first feces.

Old wives' tales abound about ways to induce labor. One of the old-est involves the use of castor oil. It is not safe to try to artificially start labor yourself by taking castor oil, which can lead to nausea, diarrhea, and dehydration. Breast stimulation can cause uterine contractions by causing the release of oxytocin. However, the safety of this practice has not been well studied. Earlier studies had suggested that the baby might have abnormal heartbeats after breast stimulation. Several recent studies looked at whether having s.e.x in late pregnancy can induce labor, but there is no conclusion on this yet.

Talk to your doctor before doing anything to try to encourage your little one to come out. Inducing labor is best left to medical professionals-you may cause more harm than good.

As frustrating as it can be waiting for your baby to finally decide to arrive, letting nature take its course is often best, unless your doctor tells you otherwise. Before you know it, you'll be too busy to remember your baby was ever late at all!

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Chapter 66.v.a.g.i.n.al and Cesarean Childbirth Chapter Contents.Section 66.1-The Stages of v.a.g.i.n.al Childbirth ...................... 520 Section 66.2-v.a.g.i.n.al Birth after a Previous Cesarean Delivery or Repeat Cesarean Section ................ 526 Section 66.3-Cesarean Sections ............................................... 536 519.

Pregnancy and Birth Sourcebook, Third Edition Section 66.1 The Stages of v.a.g.i.n.al Childbirth This section contains text from "Stages of Childbirth: Stage 1," 2007 American Pregnancy a.s.sociation (www.americanpregnancy.org); "Stages of Childbirth: Stage 2," 2007 American Pregnancy a.s.sociation; and "Stages of Childbirth: Stage 3," 2006 American Pregnancy a.s.sociation.

Reprinted with permission.

Stages of Childbirth: Stage 1 Going through the birth of your child is a wonderful and unique experience. No two deliveries are alike and there is no way to tell how your delivery is going to be. What we can tell you is the stages you will go through during this process and what you can generally expect. Childbirth can be broken into three stages: * First stage: First stage: Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm. Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm.

* Second stage: Second stage: Continues after the cervix is dilated to 10 cm until the delivery of your baby. Continues after the cervix is dilated to 10 cm until the delivery of your baby.

* Third stage: Third stage: Delivery of your placenta. Delivery of your placenta.

First Stage The first stage of labor is the longest and is broken down into three phases: * Early labor phase: Early labor phase: Starts from the onset of labor until the cervix is dilated to 3 cm. Starts from the onset of labor until the cervix is dilated to 3 cm.

* Active labor phase: Active labor phase: Continues until the cervix is dilated to 7 cm. Continues until the cervix is dilated to 7 cm.

* Transition phase: Transition phase: Continues until the cervix is fully dilated to 10 cm. Continues until the cervix is fully dilated to 10 cm.

Each phase is full of different emotions and physical challenges. It is one big adventure you are about to take and we would like to give you a guide for it.

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v.a.g.i.n.al and Cesarean Childbirth Early Labor Phase What to do: During this phase you should just relax. It is not necessary for you to rush to the hospital or birth center. It will be more comfortable for you to spend this time at home, in familiar territory.

If early labor is during the day you should do simple routines around the house. Keep yourself occupied but still conserve some of your energy. Drink plenty of water and eat small snacks. Keep track of the time of your contractions.

If early labor begins during the night it is a good idea to try and get some sleep. If you can't fall asleep, do things that will distract you like cleaning out your closet, packing your bag, or making sack lunches for the next day.

What to expect: * Duration will last approximately 812 hours.

* Your cervix will efface and dilate to 3 cm.

* Contractions will last about 3045 seconds, giving you 530 minutes of rest in between contractions.

* Contractions are typically mild, somewhat irregular, but progressively stronger and closer together.

* Contractions may feel like aching in your lower back, menstrual cramps, and pressure or tightening in the pelvis area.

* Your water may break; also known as amniotic sac rupture (this can happen any time within the first stage).

When monitoring contractions observe the following: * Growing more intense * Following a regular pattern * Lasting longer * Becoming closer together When your water breaks (amniotic sac ruptures) note the following: * Color of fluid * Odor of fluid * Time rupture occurred 521.

Pregnancy and Birth Sourcebook, Third Edition Tips for the support person: * Practice timing contractions.

* Be a calming influence.

* Offer comfort, rea.s.surance, and support.

* Suggest activities that will distract her.

* Keep up your own strength; you will need it!

Active Labor Phase What to do: It is about time for you to head to the hospital or birth center. Your contractions will be stronger, longer, and closer together.

It is very important that you have all the support you can get. Now is also a good time for you to start your breathing techniques and try some relaxation exercises for you to use in between contractions. You should switch positions often during this time. You may want to try walking or taking a nice bath. Continue to drink water and remember to urinate periodically.

What to expect: * Duration will last about 35 hours.

* Your cervix will dilate from 4 cm to 7 cm.

* Contractions during this phase will last about 4560 seconds with 35 minutes rest in between.

* Contractions will feel stronger and longer.

* This is usually the time that you head to the hospital or birth center.

Tips for the support person: * Give your undivided attention.

* Offer verbal rea.s.surance and encouragement.

* Ma.s.sage her abdomen and lower back.

* Keep track of contractions (if she is being monitored, ask how the machine works).

* Go through the breathing techniques with her.

* Help make her comfortable (prop pillows, get her water, apply touch).

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v.a.g.i.n.al and Cesarean Childbirth * Remind her to change positions frequently (take her for a walk or offer her a bath).

* Continue with distractions (music, reading a book, playing a simple card game).

* Don't feel badly if she is not responding to you.

Transition Phase What to do: During this phase you will rely heavily on your support person. This is the hardest phase but it is also the shortest. Think "one contraction at a time." This may be hard to do if the contractions are very close together, but just think about how far you have come.

When you feel an urge to push, tell your health care provider.

What to expect: * Duration will last about 30 minutes2 hours.

* Your cervix will dilate from 8 cm to 10 cm.

* Contractions during this phase will last about 6090 seconds with a 30-second2-minute rest in between.

* Contractions are long, strong, intense, and may overlap.

* This is the hardest phase but thankfully the shortest.

* You may experience hot flashes, chills, nausea, vomiting, or gas.

Tips for the support person: * Offer lots of encouragement and praise.

* Avoid small talk.

* Continue breathing with her.

* Help guide her through her contractions with encouragement.

* Encourage her to relax in between contractions.

* Don't feel hurt if she seems to be angry; it's just part of transition!

Stages of Childbirth: Stage 2 The second stage of childbirth is pus.h.i.+ng and delivery of your baby.

Up until this point your body has been doing all the work for you. Now that your cervix has fully dilated to 10 cm it is time for your help. Time to pus.h.!.+

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Pregnancy and Birth Sourcebook, Third Edition Pus.h.i.+ng and What to Expect * The entire process of the second stage lasts anywhere from 20 minutes to 2 hours.

* Contractions will last about 4590 seconds with a 35 minute rest in between.

* You will have a strong natural urge to push.

* You will feel strong pressure at your r.e.c.t.u.m.

* You will likely have a slight bowel or urination accident.

* Your baby's head will eventually crown (become visible).

* You will feel a burning, stinging sensation during crowning.

* During crowning you will be instructed by your health care provider not to push.

Pus.h.i.+ng and What to Do * Get into a pus.h.i.+ng position (one that uses gravity to your advantage).

* Push when you feel the urge.

* Relax your pelvic floor and a.n.a.l area (Kegel exercises can help).

* Rest between contractions so you can regain your strength.

* Use a mirror so you can see your progress (this can be very encouraging).

* Use all your energy to push.

* Do not feel discouraged if your baby's head emerges and then slips back into the v.a.g.i.n.a (this process can take two steps forward and one step back).

Tips for the Support Person * Help her to be relaxed and comfortable (give her ice chips if you can and support her in her position).

* Encourage, encourage, encourage.