- Labor, Delivery and Recovery
Labor, Delivery and Recovery
Labor, Delivery and Recovery
We support the experience you want during labor and delivery by working as a team. Every mother and family's needs and expectations are different, and our staff makes sure your personal needs are top priority. Part of what makes Reston Hospital Center special is our private maternity suites; this means labor, delivery and recovery all occur in the same room.
The Family Center features 14 LDR (Labor, Delivery and Recovery) suites that offer the comforts of home, along with sophisticated medical technology. Each suite is beautifully designed, featuring warm, traditional decor-mahogany wood furnishings and classic upholstery and window treatments. Each has a private bath, as well as sleeping accommodations for the baby's father or another significant other.
A registered nurse trained in labor and delivery and fetal monitor interpretation will care for you. Anesthesiologists are available 24 hours a day. They will work with you and your obstetrician to determine the most appropriate comfort measures for your particular labor and delivery experience.
When you arrive at The Family Center:
- A nurse will examine you, take your blood pressure and possibly a urine sample, and consult with your physician to determine whether you will be admitted. You may need to stay in The Family Center reception for some time to determine the intensity of your labor.
- To check your baby's heart rate, a fetal monitor will be applied. The nurse will give you an expandable belt for use with the fetal monitor that you will need to put around your stomach under your hospital gown.
- Do not be disappointed if you are not admitted on your first visit. It is very common for women to experience symptoms of labor but not be ready to deliver.
- If you are admitted and would like to request a private postpartum room, please do so at this time. Private rooms cannot be reserved prior to admission.
- The nurse will review Reston Hospital Center's Infant Security Policy with you and your partner.
When you are admitted:
- You will be taken to one of our private labor-delivery-recovery (LDR) rooms, where you will stay during your baby's delivery and your immediate recovery.
- Your partner or another support person should store suitcases and other items away in the closets to provide ample room for the delivery team.
- Until delivery becomes imminent, you may listen to music, watch TV or take a shower to ease your contractions. We encourage you to remain as comfortable as possible while also following your doctor's recommendations.
- Everything necessary for the birth of your baby is located in your LDR room. The bed is also adjustable to aid you in delivery.
Information on the Labor and Delivery Process:
- Amniotic Fluid: What to Do When your Water Breaks
- Fetal Monitoring
- Assisted Delivery
- Cesarean Birth
- Labor: Contractions
- Labor: Stages of Labor
Amniotic Fluid: What to do When your Water Breaks
Why is the Amniotic Fluid/Bag of Water Important?
Amniotic fluid is a clear odorless liquid, which surrounds and protects the baby in the uterus and provides a protective barrier from the outside environment. Once the bag of water breaks, bacteria has a way of entering the uterus through the vagina and could cause an infection in either the baby, mother or both. Therefore, you should not douche, take baths (showers are OK), or have intercourse after the bag of water breaks.
How Will I Know the My Water Breaks?
The bag of water could break spontaneously with either a gush of fluid or a continuous, uncontrollable trickle of fluid from the vagina, or your physician may break the bag of waters using an amniohook.
It is sometimes difficult to determine, even for physicians and labor nurses, if the fluid you are leaking is amniotic fluid or urine. If you are unsure, follow these steps:
- Empty your bladder.
- As more fluid leaks, collect some on a sanitary pad.
- If it has a yellow color, it is probably urine. Amniotic fluid is usually colorless and odorless.
- Do a Kegel exercise by holding the pelvic floor muscle tight and see if the fluid stops leaking. If the fluid stops, it is probably urine.
If there is any question that your water may have broken, contact your physician.
What Do I Do If My Water Breaks?
Note the color of the fluid and the time when the water broke and call your physician or midwife. If the fluid is clear and your are having only mild contractions or none at all, your physician may have you stay home for awhile.
If the amniotic fluid is green, brownish-yellow, or anything other than clear in color, notify your physician and come to the hospital as soon as possible.
Although most physicians prefer babies to be delivered 24 hours (or less) after the rupture of membranes to prevent infection, some physicians allow women to labor longer. Check with your physician regarding the timeframe they follow with ruptured membranes and how they monitor for infection.
There is no such thing as a "dry birth." Approximately one third of the liquid is replaced every hour.
Fetal monitoring is by and large done electronically in birthing facilities. Electronic Fetal Monitors are used to detect and trace the fetal heart rate and uterine contractions. These are usually monitored at the same time, however, each one can be obtained separately. In terms of electronic fetal monitoring, it is either external or internal.
External Fetal Monitoring
External fetal monitoring means that the baby's heartbeat is detected by placing a small round ultrasound (high-speed sound waves) disc with ultrasound gel on your abdomen and held in place by a lightweight stretchable band or belt. Uterine contractions are recorded from a pressure-sensitive device that is placed on your abdomen and also held by a lightweight stretchable band or belt. External monitoring of contractions in this manner only tells how often your contractions are occurring and how long each is lasting, but not their actual strength.
When you first arrive at the hospital or birthing center, part of the initial assessment of you and the baby is 20-30 minutes of externally monitoring your uterine contraction pattern and the baby's heart rate in response to them. Usually, if the initial fetal heart rate and contraction pattern show that both mom and baby are doing well, the monitor is removed and used intermittently. If there are no indications for continuous fetal monitoring, it is OK to ask the nurse to remove the monitor to allow you to walk.
Internal Fetal Monitoring
If your physician or labor nurse feels the need to observe the baby's heartbeat more closely, internal monitoring may be used. A small electrode is attached to the baby's scalp to directly monitor the baby's heartbeat. This is possible only after the bag of water has/or is broken. Internal fetal heart rate monitoring may be more comfortable since one of the pieces placed around the mother's abdomen will be removed, which allows more freedom of movement.
Depending on your labor progress, it may also become necessary for your provider and labor nurse(s)to know the actual strength of your contractions. This is done internally by performing a vaginal exam and placing a thin, catheter-shaped monitoring device inside the uterus.
Fetal monitoring is a valuable tool for measuring fetal well being and assessing labor progress. Due to the sensitivity of the monitor, it may indicate a contraction is diminishing even before you notice the pain subsiding. This information can be a very useful energy saving tool and source of encouragement for you and your partner. Continuous electronic fetal monitoring does limit your mobility regarding walking around, however, if you are able, sitting up in a chair or on the side of the bed with your legs supported are options to staying confined to lying in the bed.
Occasionally your pushing efforts may need assistance. This may occur in situations such as:
- There is a sudden change in the fetal heart rate or maternal condition that require immediate delivery. (In this situation, the baby is often low enough in the birth canal to accommodate immediate vaginal delivery rather than cesarean delivery.)
- The baby is turned and in a difficult position for delivery, such a posterior position.
- There is ineffective pushing due to numbness from anesthesia.
- The mother is exhausted and unable to continue to push effectively.
When delivery is assisted with either forceps or vacuum extraction, some form of anesthesia is administered before the forceps or vacuum is applied. Assisted deliveries should be discussed with your physician.
Suction is applied to the baby's head to help turn his head and/or assist with delivery. The baby may have a bruise on the area in which the suction cup was attached. This bruise will gradually fade.
Forceps are instruments that are placed on the baby's head to turn the baby and/or assist the mother with delivery. Forceps are most commonly used when the baby is in the lower portion of the vaginal outlet (low forceps delivery). Only on rare occasions would forceps be applied in a higher position. If forceps marks (small reddened areas on the baby's cheeks) appear, they tend to fade quickly.
Having a cesarean birth, or cesarean section, means your baby is delivered through incisions in the abdominal wall and uterus instead of being delivered vaginally. Some cesarean sections are planned because it is known prior to labor that a vaginal delivery is not recommended for the safety of the mother and/or baby. Many however are not planned and occur because of events in labor that indicate a vaginal delivery is not possible or may jeopardize the safety of the mother and/or baby. Because many cesarean births are not planned, it is important to discuss this with your healthcare provider or childbirth educator to become familiar with the procedures involved in a cesarean birth at your hospital. Even though a cesarean section is major abdominal surgery, advance preparation can make it a satisfying birth experience for the entire family.
Indications for Cesarean Birth
Although there are several reasons that a cesarean birth is indicated, the ones listed below are the most common:
- Cephalopelvic Disproportion (CPD) Occurs when the baby's head will not fit through the pelvis. This diagnosis may also be used to indicate a labor that fails to progress, (a prolonged labor, an extended period of time since rupture of membranes or weak, ineffective contractions.)
- Fetal Distress The baby is not receiving enough oxygen. It may be indicated by an abnormal fetal tracing, or a drop in the fetal heart rate when your healthcare provider or labor nurse listens to the rate during or after a contraction.
- Abnormal Position of the Baby Instead of the baby's head presenting first in the pelvis with his/her chin tucked inward, the presenting part of the baby may be his/her head extended outward, the shoulder, bottom (breech) or leg(s).
- Prolapsed Cord When the umbilical cord is in the vagina ahead of the baby. This most commonly occurs after the membranes rupture and the baby is in a breech position or his/her head is not well engaged in the pelvis. This is an emergency and an immediate cesarean section is necessary to prevent the presenting part from compressing the cord and cutting off the oxygen supply to the baby.
- Abruptio Placentae The placenta partially or completely separates from the uterine wall before the baby is born. This is an emergency and an immediate cesarean section is necessary to prevent the mother from hemorrhaging, which can cause the baby to lose all or part of his/her oxygen supply.
- Placenta Previa A condition in which the placenta partially or completely covers the cervix. The degree of severity determines whether or not a cesarean section is indicated. If the cervix is completely covered, a cesarean is mandatory since the placenta would deliver first in a vaginal delivery and the baby would lose his/her oxygen supply.
Labor contractions are the periodic tightening and relaxing of the uterine muscle, the largest muscle in a woman's body. Something triggers the pituitary gland to release a hormone called oxytocin that stimulates the uterine tightening. It is difficult to predict when true labor contractions will begin.
Contractions are often described as a cramping or tightening sensation that starts in the back and moves around to the front in a wave-like manner. Others say the contraction feels like pressure in the back. During a contraction, the abdomen becomes hard to the touch. In the childbirth process, the work of labor is done through a series of contractions. These contractions cause the upper part of the uterus (fundus) to tighten and thicken while the cervix and lower portion of the uterus stretch and relax, helping the baby pass from inside the uterus and into the birth canal for delivery.How Are Contractions Timed?
Contractions are intermittent, with a valuable rest period for you, your baby, and your uterus following each one. When timing contractions, start counting from the beginning of one contraction to the beginning of the next.
The easiest way to time contractions is to write down on paper the time each contraction starts and its duration (the amount of time each contraction lasts), or count the seconds the actual contraction lasts, as shown in the example below.
Writing down the time and length of the contraction is extremely helpful for describing your contraction pattern to your physician, midwife and hospital labor and delivery nurses.
What Contractions Feel Like
Many mothers describe contractions that occur in early labor as similar to menstrual cramps, or as severe gas pains, which may be confused with flu symptoms or intestinal disorders.
Imagine your contractions as looking like a wave. Each contraction will gradually gain in intensity until it peaks, then slowly subside and go away. As your body does the work of labor, it is likely that time between contractions will become shorter.
As the strength of each contraction increases, the peaks will become sooner and last longer. There should be some regularity or pattern when timed. Persistent contractions that have no rhythm, but are 5-7 minutes apart or less, should be reported to your physician.
Think of each contraction as something positive that is bringing you closer to the birth of your baby. Visualize what the contractions are accomplishing, the thinning and opening of the cervix, and the pushing of the baby downward. Try to work with your body rather then against it by staying as relaxed as possible.
A typical labor for a first time mother is 8 to 14 hours, and is usually shorter for subsequent births.
Labor: Stages of Labor
The four stages of the childbirth process are based on changes in the uterus and cervix as labor progresses. The beginning and end of each stage are described below:
First Stage of Labor
- Begins at the onset of labor and ends when the cervix is 100 percent effaced and completely dilated to 10 centimeters.
- Average length ranges for a first-time mother is from 10 to 14 hours and shorter for subsequent births.
Second Stage of Labor
- Begins when the cervix is completely effaced and dilated and ends with the birth of the baby.
- Average length for a first time mother ranges from 1 to 4 hours and shorter for subsequent births.
Third Stage of Labor
- Begins with the birth of the baby and ends with the delivery of the placenta.
- Average length for all vaginal deliveries ranges from 5 to 15 minutes.
Fourth Stage of Labor
- Begins with delivery of the placenta and ends 1 to 2 hours after delivery.
How Will I Know If I'm Making Progress?
The progress of labor and the baby's position is determined by an internal vaginal exam. These exams usually are not done frequently and may or may not be done during a contraction. Internal vaginal exams assess:
- Cervical effacement (thinning measured as 0 to 100 percent)
- Cervical dilation (opening measured as 0 to 10 centimeters)
- Presentation (part of the baby to be born first, i.e. head, buttocks, feet, etc.)
- Position of the baby's presenting part (anterior: facing your back, or posterior: facing your front)
- Station (distance of the presenting part from above or below the mid pelvis in "plus" or "minus" numbers)
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