Hospital labor rooms Labor Room Equipment 1. 2. 3. What type of labor rooms are available? Blessed Beginnings has five rooms for labor, delivery and recovery. Four of these have whirlpool tubs for your relaxation. The unit also has two C-Section rooms and three labor rooms. 4. How many people can be in the labor room with me? You can have two adults in the labor room at a time. If you need to have a C-Section, one support person can be with you. 5. What happens to the baby once it is born? The labor nurse will suction the baby's nose and mouth to clear the airway. She will also do a complete physical assessment to check weight, length and head size, put antibiotic ointment on the baby's eyes and give a vitamin K shot in the baby's thigh. At this time, an identification band will be placed on the baby's wrist and foot. The nurse will also put the baby's footprints on the birth certificate. If you have a special page for footprints in your baby album, bring it along and the nurse can do that at the same time. 6. What are the visiting hours and how many visitors are allowed? We encourage family and friends to visit from 2:30 p.m. to 8 p.m. We don't limit the number of visitors as long as they are not disruptive. Siblings of the baby are also encouraged to visit and hold the baby if you approve. You can also have one adult stay with you all day and overnight. 7. What safety precautions are taken to protect babies from abduction? When the baby is born, bands are placed on its wrist and ankle. Mom and her partner or one other adult of her choice also receive armbands. Then, the baby is only released from the nursery or left alone with a person with an armband that matches the baby's. We also have alarm systems and video cameras to monitor activity on the unit. 8. What is the Level II nursery and why would a baby go there? The Level II Nursery is a special area for babies having difficulty breathing or who need close observation due to special health concerns. In some cases, a baby may need to stay at the hospital even after the mother is discharged. If rooms are available, arrangements can be made for the mother to stay longer. 9. How Will I Know I'm In Labor? This is a common question, particularly among first-time mothers. Unfortunately, our perception of the onset of labor has been skewed by popular television sitcoms and movies in which the pregnant woman has one horrific contraction, grips her abdomen and announces to everyone "This is it!" BRAXTON-HICKS CONTRACTIONS Determining labor in real life can often be much more difficult. One reason for this is the fact that toward the end of the pregnancy, the uterus begins to have periodic contractions, or Braxton-Hicks contractions. These contractions, first described in 1872 by British gynecologist John Braxton Hicks, are often cited in references as being "painless, intermittent" contractions, but speak to many pregnant women and they will tell you these contractions can definitely be very uncomfortable. The truth of the matter is that labor contractions and Braxton-Hicks contractions are both just contractions of the uterine muscle. The uterus is simply that, a muscle. Prior to pregnancy it weighs an average of about two ounces. At the end of pregnancy, just the muscles itself -- no baby, no amniotic fluid, no placenta, just muscle -- weighs on average about two pounds! Toward the end of pregnancy, maternal hormones, triggered by no one knows exactly what, cause the uterus to begin contracting periodically. These contractions may hurt, they may not. They may come at regular intervals, they may not. Often, they will just go away. PROGRESSIVE CONTRACTIONS The key to whether contractions could be true labor or not is this: are the contractions progressive? Now this may be a word you aren't familiar with when thinking about contractions, but it is a much better word than "regular". Braxton-Hicks contractions may often start out at regular intervals and then just disappear, but Braxton-Hicks contractions are almost never progressive. So what do I mean by progressive? By that I mean that over time, even a couple hours, the contractions will gradually begin to last longer. They will gradually begin to come closer. They will gradually become more intense. To determine if they are progressive, it will be necessary to time contractions every now and then. TIMING CONTRACTIONS To time a contraction, begin timing at the beginning of the contraction. Time until the end of the contraction. This will give you the duration of the contraction. Then time from the beginning of one contraction to the beginning of another contraction. This is the frequency of the contractions. Now I realize that the phrase "how far apart are the contractions" is often used, and this would seem to indicate the time from the ending of one contraction to the beginning of the next would be used, but that is not how health care providers time them and you will want to use the same method that we use. Once you have timed the contractions for a little bit, set the watch aside. Then come back to it a little later and time some more. Are the contractions closer? Are they lasting longer? You can also use a pain scale to rate the intensity of the contractions. Many places use a pain scale of 0 to 10. Zero would be totally comfortable, no pain at all. Ten would be the most terrible pain ever experienced by that person. By adding a pain scale, over time you can also track the increasing intensity of the contractions as well. If you begin to see a pattern that the contractions are progressive over time, you can have a good idea that this might actually be labor. You want to be sure that you know when your health care provider wants to be contacted by you. Some want to hear from you when the contractions are at a particular interval and have been that way for a particular time frame, say 5-7 minutes apart for 1-2 hours. Sometimes they want you to just go to the birthing center or hospital when you feel like you need to and let the nurses call them. Be sure to talk with your Provider to find out exactly what he/she would like you to do if you think you are in labor. RUPTURE OF MEMBRANES If your membranes should rupture, or your "water breaks" of course, you need to contact your health care provider right away, regardless of the status of your contractions. By the way, if your water should break (I just like that term so much better than "rupture of membranes". It sounds gentler and like something that should just naturally happen.) instead of trying to stop the flow with a towel or a tiny sanitary pad, get one of your baby's diapers. Yes, that's right, a baby diaper. They are made to be highly absorbent, they have that nice hour-glass shape and they are lined with plastic. They are the perfect thing to wear to keep from getting the car, your pants and everything else in sight soaked with amniotic fluid! BLOODY SHOW Many times women are told that if they have "bloody show", a pink or red streaked mucousy discharge, that they should go to the hospital because that is a sign of labor. Bloody show is usually an indication that labor may occur in the next couple of weeks. As the pregnancy nears the end, the cervix has some natural thinning which can occur even without labor. As this thinning occurs, the capillaries in the cervix can rupture causing a tiny amount of pink-tinged or red-streaked discharge. Heavy bleeding like a period, however, is never normal and should be evaluated immediately by your health care provider. THE MUCOUS PLUG Sometimes women are very concerned about "loosing" their mucous plug. This small plug of mucus in the cervix helps to protect the baby during pregnancy by blocking the opening of the cervix. I can't think of anything else in Labor & Delivery which gives pregnant women more concern and is at the same time of such little consequence to obstetric health care providers. The mucus plug sometimes comes out so gradually that a woman never even notices it. Sometimes it comes out more all at once, so it is seen when wiping as a very mucousy discharge, similar to as if one had blown their nose. Really, the whole situation is like a cold. Some people with a cold have to blow their nose all the time and there is alot of mucus to be dealt with. Others seem to have very little mucus issues with their cold. This is sort of the same thing. If you loose your mucous plug, what does it mean? Nothing, or maybe that you might go into labor in a couple weeks. If you don't loose your mucous plug, what does it mean? Nothing, or that it probably came out so gradually that you never even noticed it. Is it important to your health care provider when you come in to the hospital? No, you will likely be asked a multitude of questions about yourself, but the status of your mucous plug will not change anything your health provider does or have any influence on any decision that is made about your care. What to Pack for the Labor Room * Decrease Font Size * Increase Font Size * Send to a Friend * Share o Share / Blog o Digg This o del.icio.us o Newsvine o Facebook o Reddit o Furl It o !Y My Web o Google * Print For mother: * Lip balm for dry, chapped lips * Warm socks * Hand lotion * Lollipops or hard candy * Cell phone or phone card and phone numbers * Toothbrush, toothpaste and other toiletries * Camera or a camcorder * CD player * Nursing bra * Nightgown (with button front if you are breastfeeding) * Bathrobe and slippers * Address book and stationary * Loose-fitting outfit to wear home For baby: * One undershirt (or "onesie") * One outer garment * One receiving blanket * One outer blanket * A hat and pair of booties * If using cloth diapers, bring two diapers and velcro diaper covers * Car seat for baby's ride home. This is required by California state law and many hospitals will check that you have a car seat before releasing mother and baby. Please leave valuables and money at home. Stages of Labor There are three stages of labor. The first stage occurs from the time true labor begins until the cervix is completely dilated and effaced. During the second stage the baby is delivered. The third stage follows the birth of the baby through the birth of the placenta. * First Stage * Second Stage * Third Stage * Labor and Delivery Checklist First Stage The first stage of labor is the longest. There are three phases within the first stage; * Early or latent phase * Active phase * Transition phase At the end of the first stage, the cervix is dilated to 10 centimeters. In mothers having their first child, this stage usually lasts 12 to 16 hours. For women having second or subsequent children, the first stage lasts around 6-7 hours. Early Labor During the early or latent phase, the cervix dilates to 4 centimeters. The duration of the first phase is the longest, averaging around 8 hours. Your contractions may be irregular, progressing to rhythmic and methodical. The pain felt at this early stage may be similar to menstrual pain: aching, fullness, cramping and backache. You will still be able to walk. Walking is usually more comfortable than sitting. Most women spend these hours at home, or they may be checked at the hospital and sent home until labor becomes more active. You may feel eager, excited and social. It is important that you conserve your energy for the work of labor. Active Labor Active labor is marked by regular contractions that become longer, stronger and closer together over time. Most providers recommend that you go to the hospital when your contractions are five minutes apart, lasting more then 60 seconds for at least an hour. Measure your contractions from the start of one contraction to the beginning of the next. Your physician will want to know: * How far apart are the contractions? * How long they are lasting, and how intense? * Are you using breathing techniques to manage the pain? * Has your "bag of water" broken? Your provider will want to know the time this occurred, and any color or odor. * Has there been any discharge, such as a bloody show? If you have had previous deliveries, the active phase of labor can proceed more quickly. Your physician may want to be contacted sooner. When you are in active labor, you will be concentrating on the task at hand, and will not feel like doing anything else. Your labor partner's support is important at this phase. Contractions are growing stronger, longer and closer together. Contractions will be about 3-4 minutes apart, lasting 40 to 60 seconds. You may have a tightening feeling in your pubic area and increasing pressure in your back. If you have learned breathing techniques, begin using them now, if you haven't already. Pain medication is often given at this stage. If you have chosen to have an epidural anesthetic, it is usually given at this stage. Please see pain management for more information. Transition Transition is the most difficult phase of labor, and fortunately, the shortest, lasting from 30 minutes to two hours. The cervix is opening the last few centimeters, from 7 to 10 centimeters. The pain may be intense, as the cervix stretches and the baby descends into the birth canal. All of your energy is concentrated on doing the work of labor. Try to remain calm and focused as your uterus works. At the end of transition, you may feel a strong urge to push the baby out. The baby is ready to be born. Back to top Second Stage During the second stage the baby is born. This stage of labor lasts anywhere from one contraction to up to two hours. The baby's head stretches your vagina and perineum (the skin between the vagina and rectum). This may cause a burning sensation. Some women may feel as if they are having a bowel movement, and feel the urge to push, or bear down. The labor nurse or physician will tell you when it is time to push. It is important that you not push until instructed. Pushing too early will cause the cervix to become edematous, or swollen. "Crowning" occurs as the widest part of the head appears at the vaginal opening. In the next few pushes, the baby is born. Mucous and amniotic fluid will be removed from the baby's mouth and nose with a bulb syringe. The baby will take its first breath, and may begin to cry. Immediately after birth, the baby is still connected to the placenta by the umbilical cord. The cord is clamped and cut. Back to top Third Stage The third stage begins with the birth of the baby and ends with the delivery of the placenta. It is the shortest stage, lasting from 5 to 15 minutes. Your contractions may stop for awhile, then resume to deliver the placenta. You will be observed closely for the next few hours to make certain that your uterus is contracting and bleeding is not excessive. The nurse will massage your uterus, or your lower abdomen to check that the uterus is contracting. Take this time to rest and get acquainted with your new baby. Back to top Labor and Delivery Checklist 1. Prior to labor, discuss the following issues with your physician or nurse practitioner: * What do I do if I think I am in labor? * What pain management options are available? * When is an episiotomy necessary? * What are some reasons you might perform a cesarean delivery? 2. If you have not done so, take a hospital tour so you are familiar with the place where you will give birth. 3. Arrange for help to care for you and the baby after birth, if you can. 4. Shop and prepare food for the first weeks when you are home with the baby, and collect take-out menus. 5. Review Preparing for Baby checklist. 6. Make sure you always have gas in the car. 7. Pack your bags. See what to pack for the labor room. Here are a few things to consider as you prepare your home for a baby: 1. Buy a book on newborns and parenting. Most important, you will want to understand your newborn's behavior. We suggest you pick a book or two and become familiar with the newborn's appearance and behavior, and parenting approaches. If you need some ideas for quality baby books, search our "Online Catalog of Resources at PAMF's Health Resource Centers" section under the general topic of parenting and infant care for a list of titles. These items are available in our Health Resource Centers in Palo Alto and Fremont. Your welcome to come visit, browse and find the book(s) right for you. 2. You will need a car seat when you arrive at the hospital to bring your infant home. California state law requires car seats to be federally approved. The baby must always be placed in the car seat, beginning with the first ride home. The safest placement is in the middle of the rear seat, facing backwards. Never place an infant in the front seat of a car with passenger air bags. For more information about car seats visit the National Highway Traffic Safety Administration Web site (accessed October 2007). 3. Prepare a place in your home for the baby. 4. Essential nursery equipment includes: * A crib or bassinet with slats no more then 2 3/8 inches apart. If you buy a used crib, make sure it meets safety standards. (National Safety Council, accessed October 2007) * Large tote or diaper bag packed with diapers, receiving blankets, a change of clothes, a plastic bag for soiled diapers, and a washcloth or baby wipes * Diaper pail or garbage can * Place to change diapers * Storage area for baby clothes and diapers * If you are using cloth diapers, contact the company to begin delivery. The initial delivery should be 90 for the first week. * Purchase disposable diapers, if you are using them. You will need about 350 for the first month. 5. Feeding * Breast-feeding mothers require no special equipment. See breast-feeding classes for more information. * If formula-feeding you will need to discuss with your baby's doctor which formula is appropriate, and whether sterilizing is necessary where you live. In addition you will need bottles, nipples and brushes for cleaning both. 6. Other items to have on hand include: * T-shirts or "onesies," 5 to 10 sets * Booties/socks, 3 to 5 pairs * Hat, 1 or 2 * Sleepers or gowns, 5 to 7 sets * Cold weather sleeper, 1 or 2, depending on the weather or temperature of the child's bedroom * Receiving blankets, 5 to 7 * Thermal blankets, 1 to 2 * Crib sheets, preferably fitted, 3 to 4 * Soft wash clothes, 3 to 5 * Burp cloths or cotton diapers, 3 to 5 * Baby nail scissors or nail clippers * Baby thermometer * Baby brush * Mild soap 7. Consider buying used baby clothes. 8. Wash all clothing, bedding, towels and wash cloths before baby arrives. 9. Begin baby-proofing your home. Questions to Ask About Labor and Delivery # At what point do you recommend that I come to the hospital/birth center? # How soon after I come to the hospital will my health care provider see me? # How much time will the health care provider spend with me during labor? # If I write a birth plan, will it be honored? # How often are vaginal exams performed during labor? # Are showering and bathing allowed during labor? # Does this birth center/hospital allow water births? What facilities are available for water births? # How many people are allowed to be with me during labor and delivery? How many people are allowed to be with me during a cesarean delivery? # What is the birth center or hospital's policy regarding other children attending the birth? # Are eating and drinking allowed during labor? # What laboring positions are recommended? # Is video taping allowed? What defines true labor vs. false labor? Ultimately, labor is defined as having regular contractions and showing cervical change. People get confused on this because they may be having regular contractions but there is no change to the cervix. False labor is characterized by contractions that may come and go with change in activity, discomfort felt in the front of the abdomen, and no cervical change. True labor is characterized by contractions coming at regular intervals and continues to come regardless of activity. The intensity of the contractions increases as along with their frequency and duration. Typically, they are felt in the lower back and radiate around to the front. Cervical change is made. Email Question How often will I see my nurse and doctor during my labor? The nursing staff will be seeing you on admission and at regular intervals throughout your labor. It is not uncommon to see several nurses during your labor process especially if you are having a long labor or an induction. The need to see them more frequently will be dictated by mom’s, and baby’s, response to labor, includingthe need for pain medications, trips to the bathroom, and baby’s tolerance of contractions. Physicians may be seen at admission, but if not, they will come periodically to check on progress of labor. If nursing is concerned about something they are seeing on the monitor about baby or with mom, the physician will be notified to come and evaluate the situation. Email Question What happens to the baby after it is born? Following a vaginal delivery, your baby may be placed directly on mom’s chest and the cord will be clamped and cut. The physician or midwife will offer to let dad to cut the cord, or mom may also cut the cord. The babies are wet and slimy and will be dried and wrapped up and a hat placed on them to maintain their temperature. Vital signs will be taken and the baby will be banded with identification bands that match both mom and dad. Sometimes it is necessary for the nursing staff to place the baby on the care center immediately following delivery instead of being placed on mom’s chest. This would occur if it was a difficult delivery and the baby is slow to respond. It is necessary to suck out baby’s nose and mouth with bulb syringe and dry baby thoroughly. It may be necessary to administer oxygen to baby with a mask and sometimes necessary to deep suction the baby as well. This is all done in the birthing room. Apgar scores will be assigned at one minute and five minute intervals by the primary nurse taking care of baby. If the baby is transitioning well to the outside world, babies will stay in the room and mom can start to breastfeed if she desires. If baby is not transitioning well, we may take the baby to the nursery or special care nursery to be further evaluated. Policies of the delivering facility will dictate exactly what happens to mom and baby after recovery time is completed. Email Question Do I need to have a birth plan and how valid is it? Making a birth plan is an individual choice. It is very important to discuss a birthing plan with your doctor and go over it with them. Some physicians do not accept birthing plans and will recommend you transfer care to someone who shares in your same philosophy. The most important thing to remember about a birthing plan is to be realistic. This is one time in your life where you have no control over how the baby is going to tolerate labor and we as caregivers have to do what is best for baby’s and mom’s health, even if it does not fit into her plan. The ultimate goal in childbirth is healthy mom, healthy baby, so if that is all kept in perspective, the medical staff will do their best to ensure a positive experience and to achieve the common goal. Email Question Can my partner stay with me after the baby is born? Your significant other will be allowed to stay with you and baby during your initial recovery, which is usually one hour after your delivery. Delivering facilities’ policies vary from place to place, so be sure to check with the hospital you are delivering at for more specific rules. Email Question Will I have to stay in bed for my entire labor? There are many factors to consider when it is decided as to whether or not a patient needs to stay in bed during labor. They include maternal health, fetal wellbeing, and the patient’s desire for pain medication. If there are no medical contraindications for mom or baby, you will be allowed to ambulate during your labor, but you will be given timeframes to allow us to reevaluate yours and baby’s status. Some facilities also have telemetry monitoring, which gives mom’s the ability to move around and still monitor the baby and contractions. Email Question I have several body piercings; do I have to remove them before coming to the hospital? Depending on where the piercing is, your doctor will recommend they be removed at some point during your pregnancy. However some people decide to keep their piercings in place. If that is the case, we do ask that they be removed prior to delivery to prevent any damage to the pierced area. What are the health risks affecting the fetus if delivery is preterm? Preterm is defined as delivering before 37 weeks. The closer you are to that date health risks are reduced. issues that may arrise with a preterm delivery include:respitory difficulty,infection, feeding problems,Gastrointestinal problems. If someone were to deliver early, a NEONATOLOGY consult would be ordered and the neonatologist would come and discuss what they would expect to see in that specfic newborn based on gestational age at time of delivery. They would allow for questions and answer your questions at that time. What happens to the baby after it is born? Following a vaginal delivery, your baby may be placed directly on mom’s chest and the cord will be clamped and cut. The physician or midwife will offer to let dad to cut the cord, or mom may also cut the cord. The babies are wet and slimy and will be dried and wrapped up and a hat placed on them to maintain their temperature. Vital signs will be taken and the baby will be banded with identification bands that match both mom and dad. Sometimes it is necessary for the nursing staff to place the baby on the care center immediately following delivery instead of being placed on mom’s chest. This would occur if it was a difficult delivery and the baby is slow to respond. It is necessary to suck out baby’s nose and mouth with bulb syringe and dry baby thoroughly. It may be necessary to administer oxygen to baby with a mask and sometimes necessary to deep suction the baby as well. This is all done in the birthing room. Apgar scores will be assigned at one minute and five minute intervals by the primary nurse taking care of baby. If the baby is transitioning well to the outside world, babies will stay in the room and mom can start to breastfeed if she desires. If baby is not transitioning well, we may take the baby to the nursery or special care nursery to be further evaluated. Policies of the delivering facility will dictate exactly what happens to mom and baby after recovery time is completed. Will I have to stay in bed for my entire labor? There are many factors to consider when it is decided as to whether or not a patient needs to stay in bed during labor. They include maternal health, fetal wellbeing, and the patient’s desire for pain medication. If there are no medical contraindications for mom or baby, you will be allowed to ambulate during your labor, but you will be given timeframes to allow us to reevaluate yours and baby’s status. Some facilities also have telemetry monitoring, which gives mom’s the ability to move around and still monitor the baby and contractions. What can I expect when I get to the hospital? Depending on the facility, you may be placed in a triage room or may be taken directly to a labor room. You will be asked for your medical history, vital signs will be taken, and you will be placed on an external fetal monitor to monitor the baby’s heart rate and your contractions. We will be looking at the baby’s heart rate and how it responds to contractions as well as timing of contractions and their duration. Either your physician, O.B. resident, or nursing staff will evaluate your cervix by performing a vaginal exam to check how far dilated and effaced it is in addition to the station and position of the baby. Depending on the exam, we will determine if you will be admitted or observed and reexamined after an observation time. Once it has been determined that you’re in labor, you will be moved to a labor room (if you are not already in one) and the remainder of the admission process will take place. If you have no cervical change and fetal testing was reassuring, you will be sent home with labor precaution instructions. http://www.webmd.com/baby/guide/labor-delivery-faq http://www.destinationmaternity.com http://www.pamf.org/pregnancy/during.html