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Q: Do we need more labor rooms? Q: How do you choose medication to induce labor? Q: When do you start medication to induce labor? Q: Is there a difference between premature Labor and preterm labor? Q: How do you define crowning during labor? Q: What are emergencies during the postpartum period? Q: How do you define postpartum hemorrhage? Q: How do you define post-term or post-date pregnancy? Q: What is the minimum age a girl can get pregnant? Q: What is the minimum appropriate age a woman with a spouse should get pregnant? Q: What is the appropriate age range a woman should have children with a spouse? Q: What is the difference between a girl and a woman? Q: When should a girl see a medical doctor or obstetrician/gynecologist for menstrual problems? Q: What is the appropriate weight gain during pregnancy? Q: What pregnancy emergency can happen before 20 weeks of pregnancy? Q: What pregnancy emergency can happen between 32 and 37 weeks of pregnancy? Q: Is there a difference between spontaneous abortion (SAB) and miscarriage? Q: What is spontaneous abortion (SAB) or miscarriage? Q: What are various abnormal presentations during pregnancy emergencies? Q: What is the difference between true labor and false labor? Q: How do you know when you are in labor? Q: What are the three stages of child birth labor? Q: What Causes Labor To Begin? Q: How Do I Know When Labor Will Begin? Q: How Do You Know When Labor is Starting? Q: When does labour begin? Q: What is fetal monitoring? Q: What are the different kinds of monitoring? Q: What are the benefits and risks? Q: Why is fetal monitoring during labor important? Q: When is monitoring done? Q: How Does the Fetal Heart Rate Monitor Work? Q: What About the Old-fashioned Way of Monitoring? Q: Is Fetal Monitoring Beneficial? Q: Is There Any Value in Electronic Fetal Monitoring? Q: Are you really in labor? Q: How do the contractions feel? Q: How strong are they? Q: How close together? Q: How long do they last? Q: Has the pattern changed over time? Q: Does changing your activity affect them? Q: Did your bag of waters break? Q: At what point do you recommend that I come to the hospital/birth center? Q: How soon after I come to the hospital will my health care provider see me? Q: How much time will the health care provider spend with me during labor? Q: If I write a birth plan, will it be honored? Q: How often are vaginal exams performed during labor? Q: Are showering and bathing allowed during labor? Q: Does this birth center/hospital allow water births? What facilities are available for water births? Q: 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? Q: What is the birth center or hospital's policy regarding other children attending the birth? Q: Are eating and drinking allowed during labor? Q: What laboring positions are recommended? Q: Is video taping allowed? Q: How long will I be able to stay in the hospital? Can I leave earlier if I want to? Q: Here are some questions pregnant women need to consider before the going into labor: Q: Is there someone available who can take you to the hospital at any time? Q: How will you get in touch with that person? (Note: many hospitals and birthing centers offer a pager service where you can rent a pager for a few months). Q: Do you have your route to the hospital planned and an alternate if needed? Q: Who will care for your children when it is time to go to the hospital? Q: If you work outside the home, have you discussed your maternity leave with your supervisor? Q: Can You Time Your Pregnancy? Q: Could you please tell me how to induce labor in natural ways? Q: Why would I need an induction? Q: Overdue pregnancy: What to do when baby's overdue Q: Can I wait for labor to begin naturally? Q: Why the concern about two weeks? Q: Can I request an induction? Q: Can I do anything to trigger labor on my own? Q: What will happen during the induction? Q: How long will it take? Q: Will it hurt? Q: How will induction affect my baby? Q: What if the induction doesn't work? Q: What about recovery and future pregnancies? Q: When does the average woman give birth? Q: How do you know when you are in labor? Q: What are the three stages of child birth labor? Q: How will I know if my water breaks? Q: When should I go to the hospital? What will happen when I get there? Q: How long will child birth labor take? Q: What about the pain? Is it really that bad? Q: What's wrong with having an epidural? Why go through the pain if you don't have to? Q: What Causes Labor To Begin? Q: How Do I Know When Labor Will Begin? Q: How Do You Know When Labor is Starting? Q: When does labour begin? Q: What is fetal monitoring? Q: Define the types of fetal monitoring Q: What are the different kinds of monitoring? Q: What are the benefits and risks? Q: Why is fetal monitoring during labor important? Q: When is monitoring done? Q: How Does the Fetal Heart Rate Monitor Work? Q: What About the Old-fashioned Way of Monitoring? Q: Is Fetal Monitoring Beneficial? Q: Is There Any Value in Electronic Fetal Monitoring? Q: Are you really in labor? Q: How do the contractions feel? Q: How strong are they? Q: How close together? Q: How long do they last? Q: Has the pattern changed over time? Q: Does changing your activity affect them? Q: Did your bag of waters break? Q: At what point do you recommend that I come to the hospital/birth center? Q: How soon after I come to the hospital will my health care provider see me? Q: How much time will the health care provider spend with me during labor? Q: If I write a birth plan, will it be honored? Q: How often are vaginal exams performed during labor? Q: Are showering and bathing allowed during labor? Q: Does this birth center/hospital allow water births? What facilities are available for water births? Q: 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? Q: What is the birth center or hospital's policy regarding other children attending the birth? Q: Are eating and drinking allowed during labor? Q: What laboring positions are recommended? Q: Is video taping allowed? Q: How long will I be able to stay in the hospital? Can I leave earlier if I want to? Here are some questions pregnant women need to consider before the going into labor: Q: Is there someone available who can take you to the hospital at any time? Q: How will you get in touch with that person? (Note: many hospitals and birthing centers offer a pager service where you can rent a pager for a few months). Q: Do you have your route to the hospital planned and an alternate if needed? Q: Who will care for your children when it is time to go to the hospital? Q: If you work outside the home, have you discussed your maternity leave with your supervisor? Q: Can You Time Your Pregnancy? Q: Could you please tell me how to induce labor in natural ways? Q: Why would I need an induction? Q: Can I wait for labor to begin naturally? Q: Why the concern about two weeks? Q: Can I request an induction? Q: Can I do anything to trigger labor on my own? Q: How should I prepare for the induction? Q: What will happen during the induction? Q: How long will it take? Q: Will it hurt? Q: How will induction affect my baby? Q: What if the induction doesn't work? Q: What about recovery and future pregnancies? Q: When does the average woman give birth? Q: How do you know when you are in labor? Q: What are the three stages of child birth labor? Q: How will I know if my water breaks? Q: When should I go to the hospital? What will happen when I get there? Q: How long will child birth labor take? Q: What about the pain? Is it really that bad? Q: What's wrong with having an epidural? Q: Why go through the pain if you don't have to? Q: What Causes Labor To Begin? Q: How Do I Know When Labor Will Begin? Q: How Do You Know When Labor is Starting? Q: When does labour begin? Q: What is fetal monitoring? Q: Define the types of fetal monitoring Q: What are the different kinds of monitoring? Q: What are the benefits and risks? Q: Why is fetal monitoring during labor important? Q: When is monitoring done? Q: How Does the Fetal Heart Rate Monitor Work? Q: What About the Old-fashioned Way of Monitoring? Q: Is Fetal Monitoring Beneficial? Q: Is There Any Value in Electronic Fetal Monitoring? Q: What is fetal monitoring? Q: What are the different kinds of monitoring? Q: What are the benefits and risks? Q: Which is right for me? Q: Why is fetal monitoring during labor important? Q: When is monitoring done? Q: How Does the Fetal Heart Rate Monitor Work? Q: What About the Old-fashioned Way of Monitoring? Q: Is Fetal Monitoring Beneficial? Is There Any Value in Electronic Fetal Monitoring? |
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Do we need more labor rooms? How do you choose medication to induce labor? When do you start medication to induce labor? Is there a difference between premature Labor and preterm labor? No, there is not. They means the same. How do you define crowning during labor? What are emergencies during the postpartum period? How do you define postpartum hemorrhage? How do you define post-term or post-date pregnancy? What is the minimum age a girl can get pregnant? What is the minimum appropriate age a woman with a spouse should get pregnant? What is the appropriate age range a woman should have children with a spouse? What is the difference between a girl and a woman? When should a girl see a medical doctor or obstetrician/gynecologist for menstrual problems? What is the appropriate weight gain during pregnancy? You should remember demarcating weeks. What pregnancy emergency can happen before 20 weeks of pregnancy? What pregnancy emergency can happen between 32 and 37 weeks of pregnancy? Is there a difference between spontaneous abortion (SAB) and miscarriage? No, there is not. What is spontaneous abortion (SAB) or miscarriage? Spontaneous abortion (SAB) or miscarriage is the term used for a pregnancy that ends on its own, within the first 20 weeks of gestation. Cephalic presentation is considered normal and occurs in about 97% of deliveries. What are various abnormal presentations during pregnancy emergencies? Breech, footling, hand, prolapsed cord, placenta previa. What is the difference between true labor and false labor? Q: What is labor? Q: Are you really in labor? Q: How do you know when you are in labor? What is labor? Labor is the process by which the fetus and the placenta leave the uterus. Delivery can occur in two ways, vaginally or by a cesarean delivery. Labor occurs in three stages and can actually begin weeks before a woman delivers her infant. The first stage begins with the woman's first contractions and continues until she is dilated fully (10 centimeters, or 4 inches), which means the cervix has stretched to prepare for birth. The second stage is the active stage, in which the pregnant woman begins to push downward. It begins with complete dilation of the cervix and ends with the actual birth. The third stage, or placental stage, begins with the birth and ends with the completed delivery of the placenta and afterbirth.1 Just as pregnancy is different for every woman, the signs of labor and the length of time it can take to go through the three stages will vary from woman to woman. Some signs indicating that labor may be close (although in fact it might still be weeks away) may include1: "Lightening." This term describes when the fetus "drops," or moves lower in the uterus. Not all fetuses drop before birth. Lightening gets its name from the feeling of lightness or relief that some women experience when the fetus moves away from the rib cage to the pelvic area. This allows some women to breathe easier, more deeply, and get relief from heartburn. Increase in vaginal discharge. Called "show," the discharge can be clear, pink, or slightly bloody. This occurs as the cervix begins to dilate and can happen several days before labor or as labor begins. If you experience any of the following signs of labor at any point in your pregnancy you should contact your health care provider3: Contractions every 10 minutes or more often Change in color of vaginal discharge Pelvic pressure Low, dull backache Vaginal spotting or bleeding Abdominal cramps with or without diarrhea Sometimes a woman's health care provider will recommend inducing labor (using medically supervised methods, such as medication, to bring on labor) if the health of the mother or the fetus is at risk.4 Unless delivery is medically necessary, a woman should wait until at least 39 weeks before delivering her infant to give her/him the best chance for healthy outcomes. During the last few weeks of pregnancy, the fetus is still developing its lungs, brain, and liver. You'll have time to figure things out. The average labor lasts nine hours in first-time mothers and six-and-a-half in women laboring again -- and that's from the onset of regular, painful contractions, occurring five to three minutes apart. Most women have several, if not many, additional hours from the time the first vague twinges begin and this pattern setting in. 1. How do the contractions feel? Labor contractions are felt low in the groin or in the lower back. They may radiate from front to back or back to front or down your legs. They are dull and crampy like menstrual or gas cramps. Prelabor contractions, which you may have been experiencing for months, feel like a tightening across your belly or like the baby suddenly stretched in all directions. 2. How strong are they? A good, business-like labor contraction is strong enough that you cannot walk or talk while you are having it. 3. How close together? To measure the contraction interval, time from the beginning of one to the beginning of the next. You are looking for a mostly regular pattern three to five minutes apart. The usual advice, barring special considerations, is to make your move when they have been this close together for a couple of hours if this is a first baby and an hour if you have given birth before. 4. How long do they last? Contractions should last roughly a minute from start to finish. Sometimes in early labor they may seem to last much longer but that's generally because they are mild enough that it's hard to tell when they begin and end. 5. Has the pattern changed over time? Labor contractions will get longer, stronger, and closer together over time. Often contractions go along at one level and then intensify over a fairly short time period, say, an hour or two, as labor shifts gears from early to active phase. Prelabor contractions can sometimes be quite regular over several hours, but the pattern stays the same. 6. Does changing your activity affect them? Prelabor contractions usually peter out if you get them while you are active and switch to something relaxing such as taking a warm bath. Likewise, if you have been resting and get up and move around, they generally go away. You may be able to get labor contractions to back off somewhat, but with rare exceptions, nothing makes them go away short of having the baby. 7. Did your bag of waters break? If they broke with a pop or gush, the contractions that follow will almost certainly develop into progressive labor. With a slow leak, contractions may or may not lead anywhere. Q: What are the three stages of child birth labor? First stage: Begins from the onset of true labor and lasts until the cervix is completely dilated to 10 cm. Second stage: Continues after the cervix is dilated to 10 cm until the delivery of your baby. Third stage: Delivery of your placenta. Here are some questions pregnant women should consider asking their health care provider about labor and delivery: 1. At what point do you recommend that I come to the hospital/birth center? 2. How soon after I come to the hospital will my health care provider see me? 3. How much time will the health care provider spend with me during labor? 4. If I write a birth plan, will it be honored? 5. How often are vaginal exams performed during labor? 6. Are showering and bathing allowed during labor? 7. Does this birth center/hospital allow water births? What facilities are available for water births? 8. 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? 9. What is the birth center or hospital's policy regarding other children attending the birth? 10. Are eating and drinking allowed during labor? 11. What laboring positions are recommended? 12. Is video taping allowed? 13. How long will I be able to stay in the hospital? Can I leave earlier if I want to? Here are some questions pregnant women need to consider before the going into labor: * Is there someone available who can take you to the hospital at any time? * How will you get in touch with that person? (Note: many hospitals and birthing centers offer a pager service where you can rent a pager for a few months). * Do you have your route to the hospital planned and an alternate if needed? * Who will care for your children when it is time to go to the hospital? * If you work outside the home, have you discussed your maternity leave with your supervisor? Can You Time Your Pregnancy? Could you please tell me how to induce labor in natural ways? Inducing labor: Your questions answered Sometimes it's better to deliver sooner rather than later. Here's what you need to know about inducing labor. Nature controls most aspects of labor. But sometimes, nature needs a nudge. If your health care provider decides you and your baby would benefit from delivering sooner rather than later, he or she may suggest inducing labor. And you'll be in good company. In the United States, an estimated one in five labors is induced. Why would I need an induction? Your health care provider may recommend inducing labor for various reasons — primarily when there's concern for your health or your baby's health. For example: * You're one to two weeks beyond your due date, and labor hasn't started naturally. * Your water has broken, but you're not having contractions. * There's an infection in your uterus. * Your baby has stopped growing at the expected pace. * There's not enough amniotic fluid surrounding the baby. * Your placenta has begun to deteriorate or separate from the wall of your uterus. * You have a medical condition that may put you or your baby at risk, such as high blood pressure or diabetes. Rarely, inducing labor is a matter of practicality. If you live far from the hospital or you have a history of rapid deliveries, a scheduled induction may be best. There's an important caveat, however. If you've had a prior C-section, you may not be a candidate for labor induction. After a prior C-section, inducing labor increases the risk of uterine rupture. This rare but serious complication — in which the uterus tears open along the scar line from a prior C-section — can cause life-threatening blood loss, infection and brain damage for the baby. MORE ON THIS TOPIC * Overdue pregnancy: What to do when baby's overdue Can I wait for labor to begin naturally? Up to two weeks after your due date, a wait-and-see approach may be preferable. Nature prepares the cervix for delivery in the most efficient, comfortable way. However, if your health care provider is concerned about your health or your baby's health or your pregnancy continues two weeks past your due date, inducing labor may be the best option. Why the concern about two weeks? The longer your pregnancy continues, the larger your baby is likely to be — which may complicate a vaginal delivery. In a few cases, aging of the placenta may compromise your baby's ability to thrive in the womb. An overdue baby also is more likely to inhale fecal waste (meconium) during childbirth, which can cause a lung disease. Remember, there's no right or wrong way to have a baby. If complications make an induction necessary, don't consider it a sign of failure. Though you may not welcome the news, it may simply be what's best for you or your baby. Can I request an induction? If you're interested in an elective induction, discuss it with your health care provider. Some health care providers may agree to a requested induction if it's your second or third baby, the baby's lungs are mature and your cervix has begun to prepare for labor. Keep in mind, however, that unnecessary intervention may pose unnecessary risks — such as a possible C-section, especially for first-time moms. Trust your health care provider to help you make the best decision in your case. Can I do anything to trigger labor on my own? Probably not. Nipple stimulation — either manually or with a breast pump — may release the hormone oxytocin, which can lead to contractions. But the cervix must be ready to open for labor to actually begin. Nipple stimulation is unlikely to work unless labor was about to begin anyway. It may even be dangerous. Sometimes nipple stimulation can lead to contractions that are long and hard enough to harm the baby. Other techniques for inducing labor — such as having sex or eating pineapple or spicy food — aren't backed by scientific evidence. If you want to try a certain food, go for it. Sex is OK, too, as long as your water hasn't broken. But get your health care provider's OK before trying any other home remedies, herbal supplements or alternative treatments for inducing labor. How should I prepare for the induction? Before the induction, your health care provider may help prepare your cervix for labor. If your cervix is beginning to thin and soften, your health care provider may gently separate the amniotic sac — which surrounds and protects your baby — from the rim of the cervix during a physical exam. This procedure, known as stripping the membranes, may encourage labor to begin on its own. If your cervix isn't thinning or softening, your health care provider may use synthetic forms of prostaglandins — the natural chemicals that trigger contractions — to get things started. Sometimes, the medication is given the night before a scheduled induction. It may be applied as a gel to the cervix, inserted as a vaginal suppository or tablet, or swallowed in pill form. As another option, a small balloon-tipped catheter may be placed in your uterus. Water is injected through the catheter to expand the balloon. This irritates the uterus, causing it to soften and open your cervix somewhat. Another technique is to place small cylinders of dried laminaria, a type of seaweed, in the cervix. The cylinders draw in water and get thicker, which slightly dilates the cervix. Your health care provider will tell you when to report to the hospital for the actual induction. You may be asked to avoid eating or drinking for several hours before your arrival. What will happen during the induction? If your amniotic sac is still intact, your health care provider may start by making a small tear in the sac with a thin plastic hook. You may feel a warm gush of fluid when the sac breaks open. The rupture will increase prostaglandin production, which typically leads to contractions. In addition to triggering and often shortening labor, breaking your water gives your health care provider a look at your amniotic fluid. If it contains traces of fecal waste, your labor may be monitored more closely. Medication is often used to provoke contractions as well. The most common choice is a synthetic version of oxytocin — a hormone your body produces at low levels throughout pregnancy and at higher levels during active labor. Oxytocin is given intravenously, through a catheter inserted into a vein in your arm or on the back of your hand. Your health care provider will use an infusion pump to control the dosage of medication you receive. The dosage may be adjusted throughout the induction to regulate the strength and frequency of your contractions. How long will it take? That's tough to predict. It depends on how your body responds to the medication. If your cervix needs time to ripen, the induction may take two to three days. If you simply need a little push, you may be holding your baby in your arms in a matter of hours. Induction typically takes longer for first-time moms and women who aren't full term. Will it hurt? The procedures to induce labor don't hurt. However, induced contractions typically become more regular and frequent from the beginning than do those of a naturally occurring labor. If relaxation and breathing techniques aren't enough to control the pain, ask for relief. Your health care provider may recommend narcotic analgesics, an epidural block or other options. How will induction affect my baby? Medications used to induce labor may cause strong contractions. Your health care provider will keep a careful eye on your baby's heart rate throughout the induction. If contractions are too frequent or last too long, the dosage will be decreased. What if the induction doesn't work? That depends. Rarely, an induction may be discontinued and attempted again in a few days. But once your water has broken, there's no turning back. If your health or your baby's health is at risk, a C-section may be needed. What about recovery and future pregnancies? The issues that led you to have an induction may require special care during recovery. Otherwise, you'll experience the same physical and emotional adjustments to life after pregnancy as you would with a natural labor. If you have a successful vaginal delivery, there are no implications for future pregnancies. If the induction leads to a C-section, your health care provider can help you decide whether to attempt a vaginal delivery with a subsequent baby or to schedule a repeat C-section. Question: When does the average woman give birth? Answer: A woman's due date is determined to be 40 weeks after her last menstrual period, which is about 280 days. Most women go into child birth labor very near their due date, but anywhere from 38 weeks to 42 weeks is normal. Question: How do you know when you are in labor? Answer: When child birth labor starts, you have strong (generally more painful than period cramps) contractions, five minutes apart, which last for a full minute. Question: What are the three stages of child birth labor? Answer: The first stage of child birth labor is the longest and that is when your cervix dilates from 0 to 10 centimetres and becomes thinned out (or "effaced"). The second stage of child birth labor is the pushing stage, which begins after you are fully dilated. The third stage of child birth labor is after your baby is born and you deliver the placenta. Question: How will I know if my water breaks? Answer: The bag of water, (the membrane that surrounds the fetus and protects it during your whole pregnancy), contains amniotic fluid. It sometimes breaks at the beginning of child birth labor (mine did); however that only happens about 10% of the time. It does not hurt. You may not even know it has happened, but you may feel warm water on your legs. You feel a tiny "Pop!" and then a little fluid trickles out. It's not a huge gush - I think this is because the baby's head is acting like a cork. If you are afraid that your water will break all over the supermarket, don't worry; this would be very, very unlikely. And if it were to happen, just get back in your car and drive home. No one has to know. Most commonly, about 90% of the time, your water breaks when your cervix is fully dilated. Sometimes your midwife or doctor may break it. When that happens, prostaglandins are released, and contractions become stronger and more regular, and the progress of labor generally picks up. Question: When should I go to the hospital? What will happen when I get there? Answer: Your doctor or midwife will educate you about what they want you to do during child birth labor. Some may want you to phone the hospital as soon as anything happens. Most want you to wait to see if child birth labor is well established. A midwife usually comes to your house, so you don't have to plan so much as you would with a doctor. When you get to the hospital, you will need to register at the Maternity Department. Usually you can do this a few months prior - call the hospital where you will deliver and find out. Depending, again, on whether you have a doctor or midwife, a lot of different scenarios can take place. Also what kind of doctor you have: is he or she someone who believes that your body knows what to do during child birth labor? Or will he or she insist that you are given an IV and hooked up to a monitor constantly? You do NOT have to labor this way, but you need to decide before you choose a doctor what is important to you and how you want your experience to be. (A birth plan would be a good option. If you present your birth plan to your doctor and he or she laughs at you - get another doctor!) Question: How long will child birth labor take? Answer: That's a hard one to answer, because every child birth labor is so different. Generally speaking, first labors take about 12 to 24 hours. My first labor was about 10 hours but my midwife said that I was only in "active" labor for 5 hours, which I disagree with because the first 7 hours were not spent sitting around comfortably! Question: What about the pain? Is it really that bad? Answer: I am not going to lie about it, it is painful, but your body is an amazing machine. I did not take anything for the pain during my labors, but I was very fortunate to have a wonderful doula and husband who supported me throughout. Studies have shown that continuous support during labor decreases the need for pain relief by 60%. See my article entitled "What would I do without my Doula?" here. Question: What's wrong with having an epidural? Why go through the pain if you don't have to? Answer: (This is simply my opinion - I am not a doctor, but I have done the research) For me, I was not trying to be a martyr by having a natural child birth. I just wanted my baby to have the very best chance of being healthy. Generally, it is true to say that epidurals are a safe and effective method of relieving pain in labor, but safe does not mean risk free. There are risks; I would be lying to say there are "none". See Thorp, J.A. & Breedlove, G (1996) Epidural Analgesia in Labour: An evaluation of Risks and Benefits 23(2) 63-83. In terms of risks for your baby, epidurals can cause maternal fever and this can potentially harm your baby. Newborns sometimes also exhibit poor nursing behavior for up to one month. Many newborns exposed to epidural anaesthesia in labor are very sleepy and they would rather sleep than nurse, which can be problematic because the more you nurse at the beginning, the faster your milk will come in and the better your experience will be. It's shocking to me that most women take such exceptional care of their babies while they are pregnant, i.e. no alcohol, no Tylenol, etc., but they willingly expose their babies to drugs during childbirth without fully educating themselves of the risks. Here's something you may not want to know: Hospital-employed childbirth educators encourage epidurals because they WANT you to have an epidural. Hospitals make a lot of money from epidurals. The nurse often comes into your room and says, “Are you ready for your epidural now?†In the U.S.A, an epidural costs from $500 to $2500, depending on the hospital. The United States spends more money on birth ($50 Billion a year!) than any other nation in the world, without necessarily getting the best results. The average hospital birth costs $8,000 - $10,000 and that doubles for caesareans, providing very nice profits for obstetricians, anaesthesiologists and drug companies. Hospital policies are routinely set based on financial goals. This is a fact, and if you don’t believe it, you are being duped. Just hear me out on this one: It makes sense, doesn't it? Since midwifery care and doula care reduces the rates of intervention, they also reduce the profit for doctors and hospitals. Of course, they will try to convince you that midwives are dangerous. They want your money!!! That is why, in Canada, where we have arguably the best government-run medical insurance system in the world, governments realised that by allowing midwives to deliver in hospitals, they are saving millions of dollars. Ok, I am finished my rants now, I think. Back to epidurals (which I am not completely against, by the way!) If you have an epidural, you must also have a urinary catheter inserted to empty your bladder. Epidurals can cause your blood pressure to decrease, so a nurse will check your blood pressure very often. The nurse or doctor will also periodically rub your abdomen to make sure there is enough paralysis but not so much that your breathing becomes impaired. There is also a domino effect that plays into it as well - once you have one intervention, you are more at risk for more and more. For example, a woman who has an epidural is FOUR times as likely to have to have a caesarean section. Sometimes it relaxes the pelvis so much that you cannot push out your baby, so the use of Vacuum and forceps are significantly increased. This means you also have to have an episiotomy (where they cut the skin from your vagina to your rectum) in order to get the forceps into your vagina. Sometimes there are complications from episiotomies, as you can well imagine, such as bowel incontinence and urinary incontinence. Note: According to Childbirth practices researcher Katherine Hartmann, MD, PhD, close to 1 million unnecessary episiotomies are performed in the U.S. each year. She says episiotomies are probably medically warranted in fewer than 10% of cases. Currently 1 in 3 American women get episiotomies. Hartmann is director of the Center for Women's Health Research at the University of North Carolina in Chapel Hill. The biggest risk of epidural is death - if the anaesthesiologist injects the wrong dose, or makes a mistake, you're in trouble. You can also be paralysed (in very rare cases, permanently) due to nerve damage. Let me repeat, MOST epidurals are safe, but these are some of the risks you need to be aware of. The evidence of epidural risks is well documented, but it is not readily available. No one wants you to know. OK, here is my last rant on the topic (I promise!): Don't you think it is easier for the doctor to be able to "control" their patient if they are lying still and quiet in the bed, paralysed and unable to move around? Ask your doctor what percentage of their patients receive an epidural. Can you go one step further and ask them how much money they make if they give an epidural? Or of it makes their job easier if their patient has an epidural? I think that would be very interesting! If he or she has an alarming rate of epidurals, I would seriously consider changing doctors. If you are still thinking, "I don't care what anybody says, there is no way I am going to go through that pain like some freaky natural childbirth nut", I am here to say that I thought exactly the same way when I was pregnant - at first. But once I did some reading, I thought, wait a second, maybe I could at least try to do child birth labor naturally. In my birth plan I wrote that I wanted to try to do it naturally, but if I ask for an epidural, give me one. (Where we live, midwives can order epidurals.) I also want to say that I do believe that in some cases, epidurals are a really good idea. For example, if you have been laboring a very long time and you need to rest a few hours so that you can gather your energy to push the baby out. I was present at my friend's birth as her support person, and she was not making any progress after about 10 hours. We tried all sorts of positions and everything, but finally her doctor suggested an epidural and I agreed. She was able to rest, and calm down, and then it wore off and she was able to push out her baby without any problems. It was beautiful. (Note: she did not experience any of the above complications.) Please educate yourself by reading some of the books I recommend about child birth labor. You will feel much better about yourself knowing that you did your research and made the right decision for you. Finally, please take a GOOD childbirth education class and read as much as you can so that you are prepared and educated. It's your body and your baby! Fetal monitoring What Causes Labor To Begin? How Do I Know When Labor Will Begin? How Do You Know When Labor is Starting? When does labour begin? What is fetal monitoring? Define the types of fetal monitoring What are the different kinds of monitoring? What are the benefits and risks? Why is fetal monitoring during labor important? When is monitoring done? How Does the Fetal Heart Rate Monitor Work? What About the Old-fashioned Way of Monitoring? Is Fetal Monitoring Beneficial? Is There Any Value in Electronic Fetal Monitoring? What is fetal monitoring? Fetal (FEE-tal) monitoring is a way for your doctor to check the health of your unborn baby. It is used during labor and delivery. Sometimes it may be done at an earlier point in the pregnancy. Monitoring cannot stop a problem from taking place. But it may warn your doctor of possible problems. There are different types of fetal monitoring. Each method has its own benefits. Define the types of fetal monitoring What are the different kinds of monitoring? Fetal Heart Rate Most mothers-to-be and their support people find it comforting to be able to see or hear the baby�s heart beat. The heart beat can be monitored in 2 ways: � outside the body: An elastic belt and a receiver, called an ultrasound transducer, is placed on your belly. The receiver finds the baby�s heart beat. The belt may need to be adjusted as you or the baby move. � inside the body: A tiny device, called a spiral, is placed on the baby�s head or but- tocks. Wires are attached to your upper leg. This monitor moves with you and your baby. It normally does not need to be ad- justed. It is used only after your water has broken and your cervix is dilated. Uterine Activity Your contractions can be monitored during labor. Knowing when your contractions are taking place can help you to better use your breathing exercises. Contractions can be monitored in 2 ways: � outside the body: A small pressure-sensi- tive device, called a toco, is placed on your belly. It is held in place with an elastic belt. The device keeps a record of how long your contractions are and how often they take place. It does not measure the strength of the contractions. � inside the body: A small, soft tube is placed inside the uterus beside the baby. The tube measures how long your contrac- tions are and how often they take place. It also shows how strong the contractions are. Internal monitoring of either your baby or your contractions can only be done after your water has broken. Telemetry Some hospitals may have a monitoring unit that can move with you. This unit will keep track of your baby�s heart rate and your con- tractions. It allows you to walk around freely. This method is good for the early stages of labor. For more information For more information about fetal monitoring, talk to your doctor. * Fetoscope: This is a special type of stethoscope used for listening to a baby. There are many types of fetoscopes available, and a regular stethoscope works as well. This can usually be used after about 18 weeks. * Doppler: This is a handheld ultrasound device that transmits the sounds of the baby's heart rate either through a speaker or into ear pieces that are attached. This can generally pick up heart tones after 12 weeks gestation. * Electronic Fetal Monitoring: This is an ultrasound device used during labor and birth, or during certain testing (non-stress test, contraction stress test, etc.) to record the baby's heart rate, and sometimes mother's contractions. It can be used intermittently or continuously. * Internal Fetal Monitoring: It is an internal monitoring with an electrode attached to the baby's head to record heart tones, and a pressure catheter to record contractions. This is also used during labor and birth, however, it is not used intermittently. * Telemetry Monitoring: It is a lot like the regular Electronic Fetal Monitoring, however, one can maintain mobility. What are the benefits and risks? * Fetoscope: This method is non-invasive, simple to use, and has a live person on the other end (This can prevent some of the errors that are mechanical.). This gives mother the mobility to deal with her labor, shower, etc.. It does require that the person using it be trained, although it is a standard procedure taught in every medical and nursing type institution. In the case of high risk, induced, or with certain medications, it cannot provide the round the clock monitoring that may be necessary. * Doppler: This method is also used intermittently, requires little training to use, has a live person on the other end, and allows mother to maintain her mobility. It may also be easier to use during a contraction. This device does use ultrasound and does not provide the continuous monitoring needed for high risk labors. * Electronic Fetal Monitoring: This method provides beat to beat view of the baby's heart tones, in relationship to mother's contractions. This may be used either continuously or intermittently. This is a benefit for the high risk mother, but of questionable benefit to the low risk mother. This method does use ultrasound; leaves room for mechanical error, which may cause incorrect interpretation, unnecessary interventions etc.; loss of maternal mobility (when in use), which may slow labor; and may switch attention from the mother to the machine. * Internal Monitoring: This is more accurate than the electronic monitoring, does not use ultrasound, and can provide continuous monitoring for the high risk mother. This method requires that your water be broken (An amniotomy will be performed if you water is still intact.), and that you be 2-3 centimeters dilated. Amniotomy adds risks of its own. However, the risks and benefits of each procedure must be weighed. This type of monitoring is almost exclusively used in high-risk situations or when more accurate types of monitoring may prevent other unnecessary interventions. This type of monitoring also has been associated with fetal injury (from the electrode), infection for mother or baby, etc. * Telemetry Monitoring: This is the "newest" type of monitoring available. It uses radio waves, connected to a transmitter on your thigh, to transmit the baby's heart tones to the nurses station. You maintain your mobility, and have constant monitoring, but again, continuous monitoring for the low risk mother is very questionable in benefit. Which is right for me? We have talked about the different type of monitoring available. There is no one right way for every woman. Depending on your choices of labor management, your monitoring will be tailored (If you talk to your care provider before hand, many have standards that you wish to avoid.) to your situation. If you are high risk, are induced, or choose epidural anesthesia you will be more likely to have continuous monitoring Think about your labor choices and how you plan to cope with labor. Study the different types of monitoring and talk to your care provider. Be aware of what is going on with the standards of monitoring in your community. Problems with Standard Practices of Fetal Monitoring The problems with standard fetal monitoring is that we tend to want to use continuos fetal monitoring on everyone. However, today we know that in most cases, routine continuous fetal monitoring of every woman does not improve fetal or maternal outcomes, it only tends to increase the cesarean rates. We have found that using a fetoscope or doppler is just as effective in predicting fetal well-being. Why is fetal monitoring during labor important? Fetal monitoring can help make the birth of your baby as safe as possible. If your doctor decides to use fetal monitoring, do not worry. It does not mean there is a problem, and it will not affect your labor. It is simply one way to let your doctor know how your baby is doing during your labor. When is monitoring done? All mothers are monitored for at least a short time when they are first admitted to the hospital. Most mothers will be monitored throughout active labor. You may be continuously monitored during your labor if: � your labor is induced; for example, using Pitocin � you have diabetes, high blood pressure, or heart disease � you receive epidural (eh-pih-DOOR-ul) anesthesia � you have current, or have had earlier, pregnancy problems � your doctor or midwife orders it (you can discuss this during prenatal visits) How Does the Fetal Heart Rate Monitor Work? The fetal heart rate monitor is simply an electronic box that monitors to measure the fetal heart rate and contractions of the uterus. It counts the fetus' heartbeats and prints them out on a rolling sheet of paper, and displays the rate on a screen. A monitor allows doctors and nurses to distinguish between the "lub" and the "dub" beats of the fetus' heart so that a beat isn't counted twice. A very slow heart rate may fool the monitor into detecting a false heart rate. However, this is extremely rare. Each fetal monitor screen has two channels. The top channel displays the fetal heart rate and the bottom channel displays the uterine contractions. Correlating the changes in the fetus' heart rate with the timing of the uterine contractions is more informative to the doctor or nurse than following the heart rate alone. There are two basic types of monitoring devices: external and internal fetal heart rate monitors. What About the Old-fashioned Way of Monitoring? A stethoscope is just as effective as a fetal heart rate monitor for picking up the more dramatic and important changes in the fetus' heart rate. Today, it is uncommon for women to forego electronic monitoring. However, studies have shown that in healthy mothers with uncomplicated pregnancies, babies who are monitored by listening carefully and often to the fetus' heart rate with a stethoscope have no increase in complications compared to babies monitored by continuous electronic fetal monitoring. For more information on fetal monitoring, go to: * Fetal Monitoring: External & Internal Monitoring. * Risks of Fetal Monitoring. * Fetal Monitoring: Reading Monitoring Tracings. Is Fetal Monitoring Beneficial? Clinical understanding of the value of fetal heart rate monitoring has undergone dramatic changes in recent years. When fetal monitoring was first developed, medical scientists hoped the widespread use of this device would allow doctors and nurses to detect early signs of trouble during labor and delivery, prompting cesarean sections to prevent cerebral palsy. (Cerebral palsy is thought to be sometimes caused by inadequate oxygen to the fetus during pregnancy.) In the 1970s and 1980s, doctors increased the number of cesarean sections based on some of the heart rate patterns described above, confident they would reduce the rate of cerebral palsy. Unfortunately, fetal heart rate monitoring has not lived up to that expectation. In the early-1970s, the rate of cesarean sections in the was about 5%. By the early-1990s, the rate of cesarean sections had risen nationwide to over 20%. Unfortunately, recent surveys from several countries where fetal monitoring has been widely practiced have revealed no decline in the rate of cerebral palsy. Many studies comparing the traditional method of using a stethoscope to the newer method of electronic heart rate monitoring fail to show any reduction in cerebral palsy or any long-term neurological handicap among babies undergoing electronic fetal heart rate monitoring. One study in premature babies actually showed an increase in cerebral palsy among babies who underwent electronic fetal monitoring compared to those managed by a more traditional method. Although this does not mean that fetal monitoring causes cerebral palsy, it is very clear that fetal heart rate monitoring will not prevent cerebral palsy or neurologic injury to a baby. It is now increasingly clear that most babies with traditionally worrisome fetal heart rate patterns tolerate these patterns perfectly well. On the other hand, babies who are developmentally abnormal before labor begins will probably show abnormal heart patterns during labor that may prompt a cesarean section. In most cases, the damage has been done at some point in the uterus before labor, rather than during the few hours of the labor and delivery process. Is There Any Value in Electronic Fetal Monitoring? Although fetal monitoring has not significantly reduced the rate of neurologic impairment in infants, it has almost eliminated fetal death during labor (stillbirth). Current electronic fetal heart rate techniques enable the birthing team to detect when the baby appears not to be tolerating labor well and needs to be delivered. In addition, the electronic monitor can help doctors and nurses detect changes in the baby's heart rate and/or the contraction pattern that suggest other complications that could cause injury or fatality. These include a prolapsed umbilical cord, placental abruption, or a fetal hemorrhage. In many hospitals, the electronic image from a patient's room can be transmitted to a central station where nurses can observe a bank of monitors. Thus, the mother can be assured that her baby is being watched carefully even when the nurse is not in the room. |