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Every hospital admits patients
differently. Registering with the hospital is done separately from the
doctor . . . most of the time. But almost all hospitals want you to pre-admit long before
your due date. When you pre-register to your hospital it is similar to
making hotel reservations. Every time you are admitted you may be asked fill out
papers. When you do go into labor, you may forego the admitting
procedure and only concentrate on getting settled.
Conditions of admission
Most hospitals will want you to
understand the way they conduct business. The hospital has a
form for this and may ask you to read and sign it. If you have
insurance you may need to contact your carrier and tell them
when your baby is due and possibly need to call them when you
arrive at the hospital in labor.
Durable power of attorney for
health care
When thinking about birth, you might not
have thought about what would happen if you were unable to make your own
health care decisions. Rarely do I have a patient who has given any
thought to what would happen if they couldn’t make health care
decisions for themselves. But a question you may be asked on admission
is "Do you have a durable power of attorney for health care?"
My patient gives me an alarming look and commonly reply "no,
should I?" And I usually reply back "don’t feel bad, no one
else has one either." But in reality I can’t recommend a better
time to touch on such an important issue, that concerns your life. Your
hospital has information all about this and can direct you through the
process.
Living-will
A Living will is not the same as durable
power of attorney. It doesn’t make your wishes known about life
support. I am not an attorney, but I encourage you to seek
advice on these most important things. You can start with your hospital
where you are planning to have your baby. They may have information on
where to go to have all these things done.
Touring
the birth room
The birth
unit may offer tours or you can call the hospital and arrange
a tour. This is good to plan when pre-registering. Each
medical center has different atmospheres and room
arrangements.
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LDRP's are a labor, delivery, recovery, and post
partum suite. Single room maternity care is where you
are admitted to a birth room, labor, give birth and stay
until you go home. |
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LDRs
are a labor, delivery, and recovery suite. You and your baby
will be moved to another room for your mother/baby care. |
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Labor
& Delivery Rooms are a traditional birth suite. You will
labor in one room then be moved by bed or stretch into a
delivery room and then after the baby is born be moved to
another room for your recovery.
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Touring the birth unit may give you a
sense of ease and comfort on knowing where to go when you arrive at the
hospital in labor and an opportunity to ask the nurses questions about
your stay. If you are unable to tour the birth unit, you can call the
hospital and ask where to go when you’re in labor. Important questions
to ask;
- Where do we park?
- What floor are the birth rooms
on?
- Do we go to the Emergency Department
or go directly to the birth unit?
- Do I have to notify my doctor before
coming to the hospital?
One thing nice about calling the hospital
is that the nurses are there 24 hours a day, seven days a week. And you
can call
any time.
During pregnancy, women experience many
changes and a variety of discomforts. Every pregnancy is different;
discomforts felt during one pregnancy may not occur in another. Many of
your aches are thought to be the result of hormonal changes. As
pregnancy advances, pains are undeniably accentuated by physical changes
associated with the growing uterus.
Uterus—this almost solid organ
increases in size and becomes a large, thin-walled, muscular sac that is
500 times its original size and can hold one or more babies, amniotic
fluid, and placenta. The enlarged uterus blood supply increases rapidly,
and by the middle of pregnancy a woman has 30 to 60 percent more blood
volume than before pregnancy. It is normal in late pregnancy to have
swollen hands and feet at the end of the day. This normal swelling goes
away with rest. During labor the top of the uterus contracts causing a
thrusting action to push the baby out.
Vagina—because of pregnancy changes
the vaginal wall becomes more elastic and increases secretions that
cause more vaginal discharge. This increases your chances for vaginal
infections. Because of this, vaginal infections are common and sometimes
difficult to treat.
Breast—the breasts become firm,
tender, and enlarged. The nipple and areola (air-e-o-la) darken and
develop pimple-like bumps called Montgomery’s tubercles. The nipple
secretes an antibacterial substance that keeps the nipple clean for the
baby. The first milk called colostrum appears around the 16th
week of pregnancy and can sometimes be squeezed from the nipple late in
pregnancy.
Skin—the skin is sensitive to
pregnancy changes. Dark areas may appear across the forehead or over the
cheekbones called—chloasma (pregnancy mask). A dark line down the
center of the abdomen from the navel to the pubis is called linea nigra.
Placenta—this soft, circular organ
resembles a jelly-fish. It filters unwanted substances, but it
cannot keep out such things as recreational drugs and certain viruses.
The placenta is remarkable; by providing nutrients from mom through the
umbilical cord, it allows oxygen and carbon dioxide exchanges. The
placenta secretes hormones that help maintain the pregnancy. These
hormone changes also cause morning sickness. We are just-victim to our
hormones!
Umbilical
cord—this connects the baby’s
navel and the placenta. The cord contains two arteries that carry waste
from baby to mother and one vein that carries nutrients from mom to baby
thought the placenta. The average umbilical cord length is two feet.
Some are longer or shorter. The blood from the cord can also be stored
for future use in life threatening diseases.
Amniotic
sac—also known as the bag of
water. This fluid surrounds the fetus in the mother’s uterus. The
amniotic sac contains up to 1 quart of fluid that is clear and odorless.
When the water breaks, it leaks out through the vagina and may continue
leaking fluid until the baby is born.
Cervix—this is the lower portion or
neck of the uterus. It secretes an abundance of mucous that forms a seal
from the vagina to the uterus. This seal, called the mucous plug,
prevent germs from entering the uterus. During labor, the cervix thins
(effacement) and opens (dilation) to allow the baby to pass into the
vagina. This is where you experience most of your labor pain. In the
last week of pregnancy when the cervix is preparing for birth and is
effacing, you may see an increase of mucus and even some bloody show.
- Dilation refers to the measurement of the
opening cervix from 1-10 centimeters
- Effacement refers to the measurement of
the thinning of cervix in percent from 1-100% or completely effaced.
Pelvis—this bony structure is part of
your hips. The female pelvis is special as it cradles the uterus during
pregnancy.
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The ligaments are the braces that support
the uterus to the pelvis. From about the 20th week of
gestation until birth the ligaments are being stretched by the growing
uterus. If you do not use good posture, you may experience sharp pains
caused by the pulling and stretching of these ligaments. The pain can be
strong enough for you to think something terrible is wrong. To assure
good posture, think of the pelvis as the baby’s cradle, avoid
waddling, which causes the uterus to act as a sling pulling the tender
ligaments! If you have already experienced pain it is not too late for
you to correct it. By doing the pelvic curl exercise and using good
posture, you should get relieve within a week. Pelvic discomfort my
increase as the baby drops (lightening) in the last month and falls
closer to the pelvic midline (0 station). |
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Station refers to the level of the baby’s
head in the pelvis. The narrowest part of the pelvis is the pelvic
outlet, this is called 0 station. Each centimeter above 0 station is
referred to as minus (-1, -2 etc.), and each centimeter below 0 station
is referred to as plus (+1, +2 etc.), +5 is the baby’s head crowning
on the perineum, which is visible on the outside. |
Pregnancy lasts 40 weeks or nine months.
Despite numerous research studies, no one knows what or who (hormones,
mother or baby) initiates labor. Your due date, expected date of
confinement (EDC) is based on the first day of your last menstrual
period (LMP). To calculate this yourself, simply start with the first
day of your last period, go back three months and add seven days. So if
your period started March 18th, your due date would be
December 25th. Ultrasound is another way of determining the
due date if done in the early weeks of pregnancy. Most babies are born
within two weeks of the due date; any time from 38 to 42 weeks is
considered a term pregnancy. Calculating the pregnancy is important
because babies born too early; premature, and babies born too late, post
dates, may require special care. But basically all babies are born with
normal growth and development and are fine.
There are many things that may make you
aware that labor is near.
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Lightening — this is when the baby
drops into the pelvis. You should feel more pelvic pressure, but it may
be easier to breathe. In women who have had other children this may not
occur until the onset of labor. |
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Bloody show – this vaginal discharge
can be seen as pink to a brownish color. This happens when the cervix
begins to efface (thin) enough for the mucus plug to escape. It almost always occur after a pelvic exam. This is not labor and there is
no reason to be worried. |
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Fetal Movement –
after the twenty-fourth week (six months) of pregnancy
your baby should move, kick, wiggle, and being
stretching up to the time of birth. Ten movements an
hour is average . . . if you think you haven't felt the
baby move in the last two hours, lie down on your left
side put your hands on your tummy and count how many
times you feel or see your baby move. If you can't count
ten movements in an hour call your doctor or midwife.
Most babies are more active in the late afternoon and
evening than any other time of day. You are the best
caretaker of your baby and know when your baby is the most
active and when your baby's quiet. Babies’ do not stop moving at
the end of pregnancy! |
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Contractions – the uterine muscle
tightens and relaxes throughout pregnancy; these are called Braxton-Hicks contractions, they are normal and should be expected –
some women say it may feel as if the baby is "balling up" and
others find them quite painful, this is false labor. |
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Rupture of Membranes – the amniotic
fluid that surrounds the baby gushes from the vagina. It happens as
a gush or intermittent trickle, but it may not stop. It can break
before contractions begin or anytime during labor or birth. If you think
your water may have broken, but are not sure, call your doctor or
hospital. Remember that the water
may not stop coming out until your baby is born. |
Coping with labor pain can be difficult
if you do not prepare yourself. Learning conscience relaxation and
breathing techniques may be your first line of defense in coping with
labor. Having someone close to you that can give you support and
encouragement is invaluable; this can be your husband, mother, sister or
friend. This can be a special attachment time for many couples.
The pain from labor can be understood
when the uterus is seen as the large muscle it is. Simply, muscles
become painful from fatigue when worked over a period of time — labor
contractions last for hours. Think of the time you might have run up a
flight of stairs or exercised intensely. Marathon runners are all too
familiar with muscle fatigue. Most of us would stop exercising at the
point of pain. Labor pain is intermittent. It starts when the uterus
contracts, becomes more severe as the contraction reaches a peak, and
disappears when the contraction ends. In a term pregnancy the uterus is
the largest muscle in the body and being an involuntary muscle, it will
not stop contracting until the baby is born. The pain from labor can be
challenging but reasonably dealt with if you prepare yourself
emotionally and physically.
During early labor you may be more
comfortable at home, you can eat and drink what you want, and rest in
your own home. A bath or shower is relaxing and can stimulate your
labor. If you are planning an unmedicated labor, this time at home may ease your labor and reduce anxiety. Have someone stay with you who can
be a labor support person. If your water breaks, be sure to call your
health provider or go to the hospital.
Back labor – If you have it, no one has
to tell you. But, it can be relieved or eliminated. When the back of the
baby’s head "occiput posterior" presses against mothers’
lower back this causes lower back pain. Ideally, the goal is to get the
baby to move so the baby rotates to an "occiput anterior"
position. It is a known fact when the mother changes her position, like
at night when you change your sleeping position, you may notice the baby
will also move
and change position. By doing one or all of these steps for at least 10
contractions may rotate the baby.
- sit on a chair backwards
- sit on the toilet backwards
- get on all fours (hands & knees)
Environment — adjust the room lights
and blinds/shades to decrease the glare. Ultraviolet light can be over
stimulating. Sounds can affect your mood, select quiet soothing music
for relaxing.
Focal Point — during uterine
contractions it is a good thing to focus on something: whether it is a
picture of your older child, a pet or, an object in the room. Some women
like to close their eyes and concentrate that way. Whichever works best
for you, use it. Start as early as possible in your pregnancy with
conscience relaxation and breathing exercises.
Touch — soothing the body through hand
holding or gentle stoking gives support. Some women in the transition
phase of labor may not want to be talked to or be touched between
contractions so they can rest and regain their strength.
Water — warm water is extremely
relaxing and reduces pain. Sitting in a warm bath or standing in a warm
shower is comforting. Also warm compresses to your back and lower
abdomen feels soothing, especially during the second stage of labor
while pushing.
Breathing helps birthing
Slow, even
breathing conserves energy and can be relaxing during labor.
When you hold your breath and breath rapid your muscles tense
and become tired. Target and relax each muscle that is tense.
Making noises releases tension — remember, when you move a
heavy object you moan when you exhale. While practicing, tense
individual muscle as your contractions become longer,
stronger, and closer together, your cervix dilates and effaces
more. You may feel that you are losing control of the labor,
and the previous breathing pattern may no longer help. To
retain control accelerate your breathing pattern and continue
to concentrate on your focal point. (Refer to comfort
measures). You may feel a need to breathe faster or more
deeply in an effort to keep up with the labor. This will
eventually cause hyperventilation, to prevent this,
maintaining equal intake and output of air exchange. Modified
and patterned breathing techniques are some good tools to use
when slow breathing technique no longer works for you.
(Practice during the day when you notice a Braxton-Hicks
contraction. Or for short periods (2 –3) minutes several
times a day will be the best preparation for labor). By saying
a short phrase may help you concentrate and keep your focus on
your breathing pattern. Such as: "Relax and let it
go". Breathe in, breathe out". You can create your
own phrase, but practice this out load and repeat 25 times a
day. Participating at a Yoga class may be the easiest way to
learn relaxation and breathing techniques.
The following breathing techniques are
for you to practice with and use during labor. Conditioning yourself
with help prepare you for the journey through labor. When the slow
breathing technique is not helping you relax and concentrate this is the
indication to move onto the modified breathing technique and so on.
Slow Breathing Technique
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contraction begins |
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take a full cleansing breath (breathe
in through your nose and out through your mouth) |
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obtain a focal point, consciously
relax your muscles |
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contraction begins take a full
cleansing breath (breathe in through your nose and out through your
mouth) |
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obtain a focal point, consciously
relax your muscles slowly breathe in through your nose(2 3 4) and
out through your mouth (2 3 4) until the end of the contraction (30
— 60 seconds) |
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when the contraction ends take a
cleansing breath, and relax. |
Modified Breathing Technique
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contraction begins |
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take a full cleansing breath (breathe
in through your nose and out through your mouth) |
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obtain a focal point |
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consciously relax your muscles |
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breathe slowly in through your nose(2
3 4) |
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exhale out through your mouth (2 3 4 )
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accelerate your breathing during the
peak of the contraction (no faster than twice your normal breathing
rate) until the end of the contraction (30 — 60 seconds) |
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when the contraction ends take a
cleansing breath, and relax. |
Patterned Breathing Technique
- contraction begins
- take a full cleansing breath (breathe
in through your nose and out through your mouth)
- obtain a focal point, consciously
relax your muscles
- slowly breathe in and out through your
mouth in a controlled accelerated pattern
- breathe, breathe, breathe, puff
- breathe, breathe, breathe, puff
- breathe, breathe, breathe, puff until
the end of the contraction (about 60 seconds)
- when the contraction ends take a
cleansing breath, and relax
remember concentrate on your focal point
and relax after the contraction — keep in mind that there might be
only one minute between contractions.
Pushing Technique
At this stage of labor the contractions
space further apart, every 3 — 5 minutes. Many women feel relieved by
pushing.
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contraction begins |
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take a full cleansing breath then
inhale and hold that breath for 5 – 10 seconds |
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relax your pelvic floor, and bare
down, bulging the pelvic floor, similar to using the bathroom |
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let your breath out, take another
breath and repeat |
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at the end of the contraction take a
cleansing breath |
Special
circumstances may arise during your pregnancy that may need
special assistance or highly technical equipment to help you
or your baby or both. Birthing and newborn nursery facilities
are established at different levels of care varying from
hospital to hospital. I’ll explain the most sophisticated
first: Level III Nursery’s called Neonatal Intensive Care
Units (NICU); provide all care for special needs babies. Level
II Nursery’s provide care for babies born after the 34th
week of pregnancy
that may not need a breathing tube to sustain life or need
surgery. Lever I Nursery’s are for the well babies that are
born full term with no health problems. Fortunately most
babies are in this category. But, it may be necessary under
certain conditions for a transport
team from a Level III facility to go to a Level I or II
hospital to stabilize and transfer the baby to a NICU. This is
commonly done when babies are born with special needs. Your
doctor caring for you and your baby may explain and give you
advise on the safest and most favorable way to handle your
special circumstances. Below may be some of the circumstances
that may lead to concern.
Pre-term or premature birth is the most
common for transferring a baby to a Level III facility. Babies that are
born without the ability to breathe without a breathing tube in place
are more then likely transferred to a hospital for that can give very
sophisticated, high tech care to these special babies.
Pregnancy Induced Hypertension
(PIH)
— is a multi organ disease of pregnancy characterized by
high blood pressure, protein in the urine and swelling in the
face, hands, and feet that is not relieved by rest. Symptoms
are headache, visual disturbance, and epigastric pain. In most
mild to moderate cases of PIH, symptoms are silent. In severe
cases women feel a severe frontal headache unrelieved by
medication, such as: Tylenol. Epigastric pain unrelieved by
heartburn antacids. And/or spots before their eyes not related
to getting up from a lying down position. In cases of severe
PIH the mother can experience a seizure. Keeping medical
appointments is crucial during pregnancy in order to avoid
illnesses and side effects related to disease. There are many
theories of what causes PIH, but no one knows a defiant answer
to what the cause is. It maybe as simple as: eating a diet
high in body building foods (protein), just as hand washing
before eating and after use the bathroom decreases the common
cold and flu.
Bladder
Urinary tract infections and
Pyelonephritis (kidney infection) —
is usually caused by a germ called e-coli that is normal to have in the
rectum, but does not belong in the urinary system. Symptoms may be
frequency in urinating, or pain or burning upon urination. With
Pyelonephritis the symptoms may also cause a pain in the mid-section of
your back and fever. Unfortunately
women are prone to this more than men because the urethra is in close
proximity to the rectum. If this has been happening to you, always wipe
from front to back when using the bathroom. You may also try filling a
small squirt bottle with plain water and rinsing after using the
bathroom. This washes away germs that cause infection and odor.
Fevers
Severe nausea and vomiting —
illness can happen anytime during pregnancy, you need to report it to
your doctor.
Vaginal bleeding
Bleeding
is not normal, and you should notify your doctor. Spotting may
be normal in the last weeks of pregnancy. The spotting is a
bloody mucous discharge. Hemorrhaging is an emergency; you
should go to the closest hospital immediately.
Most
pregnancies go to term and have healthy outcomes resulting in
a new and fabulous family. But if you have a question or
concern during your pregnancy call your doctor/midwife or
their nurse.
You may
ask, "How do I become a labor coach?" It starts
before having your baby. Use the techniques listed below to
support and encourage her during labor. And by doing so you
may be the best coach. Take this list with you to the hospital
and refer to it often. Remember be interested and supportive
of her pregnancy. Rent childbirth videos, help prepare the
baby’s nursery, choose a name together. Give her lots of
TLC; she’s your most intimate friend. ~ Strong, self-reliant
women do become dependent during pregnancy. This is a creation
the two of you made together. Having a child and heir is
nothing short of a miracle. The mother of your child has
honored you with a gift of life you couldn't have done without
her. And she also honors you, as the child will carry your
name for the rest of their life. This is a new right of
passage for the both of you, but at the same time the most
stressful, as you both adjust to parenthood. Remember, she is
at her weakest, emotionally and strongest, physically. Do not
take what she does or says personally during labor! You may be
surprised to find that this is the most emotional day of you
life.
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In labor, be a partner advocate; make
her wishes known to birth attendants |
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Encourage her to rest or nap but don’t
nag her |
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Be aware of the need to use relaxation
and breathing techniques |
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Give her your undivided attention,
(turn off the TV) especially during contractions |
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Hold her hand or stroke her face and
say nothing |
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Re-evaluate coping strategies when she
gets discouraged |
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Help her change positions |
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Assist her to the bathroom |
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Massage her back in a firm but gentle
way |
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The breathing technique needs to begin
at the very start of the contraction, don’t wait until the
contractions under way to begin the breathing technique. |
You can do it, coaching her is a fine
thing!
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