Crib Notes Preparing for Labor and Birth

7/29/2019 Crib Notes Preparing for Labor and Birth

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Chapter 1: Whats Labor Like?

Chapter 2: Stages of Labor

Chapter 3: Signs of Labor

Chapter 4: Birth Stories

Chapter 5: Banishing Labor Myths

Section I: Understanding Labor

1

Most common questions:

- What will labor be like?

- Will it be the worst pain Ive ever felt?

- Can I really do this?

No way to predict how itll be for you

Labor is different for every woman

Meeting your baby at the end makes it all worthwhile


2

What are the main types of

labor?

Labor and birth can happen in

three basic ways: Vaginal birth with pain medication

C-section (always involves pain

medication)

Vaginal birth without pain medication

Chapter 1: Whats Labor Like? Med-Speak

epidural = pain reliefprocedure that blocks pain in

your lower body

cesarean section (c-section)= surgical procedure used todeliver a baby through the

abdomen

3

How long does labor last?

A 2006 survey of U.S. women

showed: Never given birth before

- Median length of labor: 11 hours

Given birth before

- Median length of labor: 6 hours


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Where do women give birth?


5

What type of caregiver do women choose?


6

How many women use pain medication?


7

What do contractions feel like?

How some women have described them:

Strong menstrual cramps

A charley horse

Pressure, tightness, achy throbbing

Gas pains

Backache that wraps around to abdomen


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Stage 1: From early contractions until its time to push

Stage 2: Pushing and delivery

Stage 3: Delivering the placenta


9

What happens to my body

during labor?

Your body does two main things:

Pushes your baby down and out withcontractions of the uterus

Opens the cervix to give your baby away out


Med-Speak

dilation= opening

effacement= thinning

10

First stage of labor

Lasts from early contractions until its time to push

Longest stage (average of 10 to 14 hours for first-time moms)

Three parts: Early labor

Active labor

Transition

Contractions get longer, stronger, and more frequent

Your cervix opens all the way up


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First stage: Early labor

Contractions get longer, stronger, and

closer together

Might be painful or just slightly

uncomfortable

Eventually contractions last 40 to 60 secondseach and come every 5 minutes

Early labor may take 6 to 12 hours

Once your cervix is 4 cm dilated (the size of a Ritz cracker),you move into active labor


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First stage: Active labor

Youll stop being able to talk through contractions

After an hour or two, call your doctoror midwife

Active labor lasts 4 to 8 hours, on average

Medication and natural pain management can help

Epidurals are typically given at this stage

Once your cervix is 8 cm dilated (a little larger than a soda can),

you enter transition


The 5-1-1 Rule

To help you rememberwhen its time to call yourcaregiver, use the 5-1-1

rule. That stands forcontractions coming

about 5 minutes apart,

lasting about 1 minuteeach, and patterned this

way for about 1 hour.

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First stage: Transition

Usually the most painful part of labor

Cervix opens from about 8 cm to 10 cm

(about the size of a bagel)

Very strong contractions that last a minute ormore

If you have an epidural, you should be numb

If you dont, you may feel shaky, nauseated

Transition can take minutes or hours


14

Second stage: Pushing

Begins when youre fully dilated

Contractions do a lot of the work for you

Can last from a few minutes to several hours

Bear down with your abdominal muscles

You might be coached to push during each contraction

You might wait until you feel a spontaneous urge to push

Epidural can reduce the urge to push

Different positions can help


15

Second stage: Crowning & birth

Your babys head will become visible and push against

your perineum

May feel the ring of fire

Crowning is when the widest part of your babys head becomesvisible

Most painful part is over

Baby is turned sideways and slips all the way out


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Third stage: Delivery of placenta

Uterus contracts again, causing placenta to detach

Gently push to deliver placenta

Can take 5 to 10 minutes and usually doesnt hurt

Youre done with labor!


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What happens to my baby after delivery?

Baby is dried and handed to you

Skin contact helps him stay warm and is good for bonding

May want to breastfeed

Umbilical cord is clamped, then cut


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What happens to me after delivery?

Youll probably be emotional or in a bit of shock

You may be shaky or have chills

Uterus becomes firm

Any tear or incision is stitched up

Epidural removed

After-birth pains may continue


19

Your body starts preparing for labor up to

a month before your baby is born

In labor: contractions are getting longer,

stronger, and closer together

Know the key signs of labor


Fast Fact

Only 1 in 20 womendeliver on their due date.Youre more likely to go

into laborwithin a weekor two before or after.

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Signs that labors coming

Your baby drops

You feel more Braxton Hicks contractions

Your cervix starts to ripen

You pass your mucus plug

Your water breaks call your doctor or midwife!


Med-Speak

ripen = soften, thin, and open

21

When to call your doctor or

midwife

You spend an hour feeling

regular, painful contractions

that last about a minute each

and come every five minutes

If you think you might be in

labor and have concerns

about whether you need care

yet


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Call your caregiver immediately if

Your water has broken, especially if

the liquid is discolored

Your baby seems less active

You have heavy vaginal bleeding,

severe abdominal pain, or fever

You have contractions or signs of

labor before 37 weeks

You have severe headaches, changes in

your vision, unusual swelling, or tendernessin your upper abdomen

Trust your instincts


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Jackie: Stalled labor leads to a c-section

Purvi: Giving birth before the baby shower

Colleen: An epidural offers major relief

Melylah: Drug-free birth and a surprise daughter

Leslie: Induced labor and a long recovery

Breanna: Hoping to avoid an epidural

Scott: A dad's view of a c-section

Shino: A big baby and a painful tear

Kelly: Speedy birth in the family car

Chapter 4: Birth Stories

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Myth #1: Labor pain

Myth: It will be the worst pain Ive ever felt.

Fact: Maybe or maybe not. Be prepared for

anything.


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Myth #2: Coping with pain

Myth: Medication is the only way to ease

labor pain.

Fact: Medication is the easiest way to dramatically

reduce pain, but natural techniques help too.


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Myth #3: Pain medication

Myth: Theres no downside to using pain drugs.

Fact: Pain drugs are safe, but they can have sideeffects for you, your labor, and your baby.


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Myth #4: Laboring in bed

Myth: The best way to labor is lying in bed.

Fact: Laboring in bed isnt your only option. Stayingupright and moving around can help labor along. In

some cases, youll need to stay in bed.


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Myth #5: Eating and drinking

Myth: I shouldnt eat or drink during labor.

Fact: Drinking clear liquids is fine. Eating in early

labor is okay, but talk to your caregiver about eating

in active labor.


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Myth #6: Baths

Myth: I shouldnt soak in a tub after my water breaks.

Fact: Its safe to soak in a tub during the first stage of

labor. Make sure you dont overheat or slip.


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Myth #7: Doctors and nurses

Myth: My primary caregiver will coach me through labor.

Fact: Some caregivers will, some wont. Its wise tohave your own support person: a loved one, midwife,

or doula.


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Chapter 6:Where to Labor and With Whom

Chapter 7:Pain Management

Chapter 8:Medical Interventions

Chapter 9:AfterYour NewbornArrives

Section II: Key Decisions to Make

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Where can I deliver my baby?

Hospital

Birth center

Home

Chapter 6: Where to Labor and With Whom

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At the hospital

Equipped to handle everything

Most options for pain management, including epidurals

Less personalized care

More routine interventions

Ask about the things that are important to you


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At a birth center

An option for low-risk pregnancies

Can move freely

Minimal interventions

No epidural

Personal attention and support for drug-free birth if you want one

Doctor and hospital available in case of complications


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At home

An option for low-risk pregnancies

Safe with a skilled caregiver

Need backup plan for getting to hospital

No pain medication

Greatest control over your experience


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Who will help me?

Obstetrician

Family physician

Midwife

Doula (labor coach)


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Doctor

Most U.S. births are attended by a doctor: an obstetrician

or family physician

High-risk pregnancies usually require an obstetrician

Doctors most available type of caregiver in hospital

Covered by health insurance

May be busy, not with you until youre pushing


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Midwife

More personal and holistic approach

Can spend more time with you

Focus on providing emotional support

Good coach if you want to avoid pain medication

Different types of midwives: Most common is certified nurse-midwife,

or CNM (can deliver babies in any setting)

If your pregnancy is low risk, just as likely to have an excellent

outcome with a midwife as a doctor


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Doula

Serves as a labor coach

Provides personalized, one-on-one attention and support

Costs extra

Can be main coach or work with your partner

Helps before labor

Can assist in hospital, at birth center, or at home

Doulas shown to improve labor experience


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Family and friends

Continuous support can help you feel more

satisfied with your birth experience

Think about whether a loved one can be

there for you

If you dont have support, ask about

volunteers at hospital

Consider who you dontwant in the room


Fast FactAmong women who had supportduring labor, 82% got supportfrom their partnerand 38% got

support from another lovedone. (Some women got support

from more than one person.)

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Chapter 7: Pain Management

How your body can help you

Expert FAQ

NameCredential

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Pain isnt constant

Contractions are intermittent

Take them one at a time

The most intense contractions

last 60 to 90 seconds

Relax between each one


Pain comes in waves

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Little things can help

Create an environment that helps you through labor

Think about the details youd like to set the stage

Setting things up to your taste can help you feel more

in control and positive


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Feel-good hormones

High levels reduce pain

Boost your levels by staying calm

and confident

Stress hormone Hi gh levels slow labor, increase

pain R educe your levels by avoiding

fear and panic, having a support

person close by

endorphins

adrenaline


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Natural methods

Can help any woman

Four basic techniques


Smart Tip

If youre planning an unmedicatedbirth, your nurses will ask you about

your pain levels throughout labor notbecause theyre nudging you to take

pain medicine, but because its arequirement of hospital accreditationand has to be documented.

If youd rather not be asked to report

on your pain levels, you can requestthat your nurse ask instead, How areyou coping with your contractions?

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Breathing

Many breathing techniques can help

One type: slow, deep breaths Can calm and relax you

May help distract you You can do them alone or with your partner

Sends more oxygen to your baby and uterus

Another type: patterned breathing Your caregiver can help you try it

Helps to distract you


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Movement

You may feel the urge to move

Eases discomfort

Can get your baby in a good position

Movements and positions to try: Walk, stand, sway, lean, kneel, rock, lie on your side, straddle

Some can be tried in or near bed

Certain positions can also help when pushing

Your support person can suggest options during labor, or youmight intuitively find what works for you

Practice during pregnancy


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Massage

Physical touch can comfort

Strong, sustained pressure against lower back

(low back squeeze) or hips (double hip squeeze)

can lessen pain

Massage on your face or head can help with

all-over relaxation


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Water

Water can help (hydrotherapy)

Shower or tub

Can work like a massage, ease pressure, relax muscles

Stay hydrated

Water shouldnt be too hot

Tub is safe in first stage of labor, even after your water breaks


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Alternative techniques

These include:

Visualization

Self-hypnosis

Acupuncture


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Limits on natural pain relief

With an epidural or certain interventions, you may not

be free to move around or get in the water

Will help you cope with pain, but wont eliminate it


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Pain medication

Most U.S. women opt for pain medication

Usually need to decide during first stage of labor

whether you want drugs

Some medications dull pain, others block it Four main options


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Systemic medication

Dulls your pain

Affects your whole body

Usually delivered through IV or injection

Doesnt require an anesthesiologist

Many birth centers can offer it

Commonly used in U.S.: Demerol (meperidine), Stadol (butorphanol),Nubain (nalbuphine), Sublimaze (fentanyl)

Can make you sleepy, dizzy

Can reach your baby

May have to stay in bed at first

Unlike epidural, doesnt make other medical interventions more likely lateror interfere with ability to push

Many women start with systemic drugs then use an epidural later

1 in 5 women who use drugs during labor use systemic narcotics


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Epidural

Most common form of pain relief

during labor

Delivers continuous pain medicationthroughout labor

Blocks pain in lower body

How it works: numb your back, insert

tiny tube, deliver medication through

tube

Can take about 15 to 40 minutes to

feel full relief


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Epidural

Pros

Effective, long-lasting relief

Can help you rest

Stay alert

Dose can be adjusted Little medicine reaches baby

Cons

Lose sensation and strength in legs

May need to stay in bed

Will need IV and monitoring Can make pushing stage longer, make pushing more difficult,

lead to assisted delivery

May feel spotty pain relief, itchiness

Rarely, leads to bad headache


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Spinal block


Takes effect within a few minutes

Lasts only a few hours

Only tiny amount of medication

reaches baby Easier to administer than epidural

Good option if youre short on time

Recommended if youre having a

planned c-section

Will need IV and continuousmonitoring

Cant get out of bed

Can make pushing more di fficult

and lead to other interventions


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Combined spinal/epidural


Swift relief of a spinal

Long-lasting relief of an epidural

Has drawbacks of both spinals

and epidurals

Not done at all hospitals;

check with yours


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What pain medication is right for me?

Best person to help you is your caregiver

Ask what your options are

Talk through the pros and cons

Get personalized advice


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Fetal monitoring

What it is:

Tracks your babys heart rate

Most hospitals do continuous monitoring

Transducers strapped to your belly with wide, stretchy bands

Internal monitor used for more accurate reading

Intermittent monitoring uses transducers on belly or handheld device

Intermittent monitoring done at birth centers and some hospitals

Chapter 8: Medical Interventions

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Fetal monitoring

What to know about it:

Wires limit your movement

Wireless or waterproof monitors may be available

Transducers can be bothersome

Reduces seizures but not mortality or long-term problems

Continuous monitoring required with epidural, induction, complications

Continuous monitoring can create false alarms

Intermittent monitoring can be just as effective


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Inducing labor

What it is:

Your caregiver uses medication or other techniques

to kick-start your labor

Getting more and more common

More than 1 in 5 U.S. women induced

You might be induced if:

Youve gone 1 to 2 weeks past your due date Its been 12 to 24 hours since your water broke

You have preeclampsia

Your placenta isnt working properly You have low amniotic fluid Your babys health or yours is at risk


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Inducing labor

How it works:

Several ways to do it Ripen cervix with medication or other technique

Contractions may start on their own

If not, start contractions with Pitocin (synthetic form ofoxytocin)

Induction methods include: Medication inserted into your vagina

Small, water-filled balloon against cervix

Stripping or sweeping the membranes Breaking your amniotic sac (bag of waters)

Pitocin

Many women experience more than one of these


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Inducing labor


Youll need continuous fetal monitoring

Some induction methods can make contractionscome on too strong and fast

Rarely, can cause more serious complications

Induction recommended only when necessary

If induction doesnt work in timely manner, youllneed a c-section


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C-section

What it is:

Surgical procedure; baby deliveredthrough abdomen rather than vagina

Quickest way to deliver when vaginal birth isnt

progressing well Can be a planned procedure 1 in 3 U.S. babies delivered by c-section

Major abdominal surgery Usually awake, with anesthesia

Procedure: Small incision, usually horizontal

Cut through skin, uterus, amniotic sac Remove baby and placenta


Fast Fact

What are your chances of ending upwith a c-section? Not too high

unless your doctor tells you duringpregnancy that you'll need one.

Less than 2 out of 10 women whogo into labor planning to delivervaginally end up with a c-section,

according to Yale Universityresearchers.

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C-section


Riskier than vaginal delivery

Higher risk of:

Infection

Excessive bleeding

Blood clots

More severe postpartum pain

Longer hospital stay and recovery

Partner can be with you


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C-section


Planned c-section:

If you shouldnt labor or deliver vaginally

Previous uterine surgery

Twins or multiples

Placenta previa

Baby is breech or transverse

Baby is ill or has abnormality

Unplanned c-section:

When problems arise during labor

Labor stalls

Babys heart rate worrisome

Umbilical cord slips

Placenta separates

Herpes outbreak

Y

ou or your baby is in distress


Fast Fact

Some moms choose to have a c-sectionwithout any medical reason. These

controversialelective c-sections getattention, but they aren't too common

Yale University researchers estimate thatthey're less than 2% of all c-sections and

less than 0.5% of all births.

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Episiotomy

What it is:

Surgical cut in the perineumto enlarge the vaginal opening

Helpful if: Your baby needs to be born quickly.

Your doctor or midwife needs moreroom to pull your baby out.

Youll be numbed before the procedureand before you get stitched up

Becoming less common


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Episiotomy


Was thought to help reduce risk of tearing orincontinence

May actually cause problems

Can make recovery longer and more painful

Most experts say episiotomies should be done only

when necessary, not routinely

Best protection against episiotomies is a caregiverwho

tries to avoid them


Fast Fact

About 35% of women whogive birth vaginally get an

episiotomy but studiesshow that only about 7%

truly need one.

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Assisted delivery

What it is:

Happens when your baby is almost out

Caregiver uses a vacuum or forceps tohelp pull your baby out

Happens in about 1 in 20 U.S. births

Done because baby needs quick

delivery or mom cant keep pushing

Vacuum: Flexible, curved cup stuck to

babys head

Forceps: Curved surgical tongs grasp

babys head


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Assisted delivery


Can leave bruising or blisters on your babys head

You might need an episiotomy

Higher risk of tearing

If it doesnt work, youll need a c-section


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How can I avoid unnecessary interventions?

Interventions carry some risk and lead to more interventions

To avoid unnecessary interventions:- Choose a caregiver you trust and whose views ring true to you

- Have a dedicated advocate- Practice natural pain management techniques

-Ask questions

Consider asking:- For a clear explanation of what your caregiver wants to do- Why its necessary-About the risks and benefits- Whether it could lead to further interventions

- If there are alternatives- If it can wait


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Newborn screening tests

States require various screening tests

1 in 1,000 babies has something amiss

Catching conditions early allows treatment

before lasting harm is done

Tests cause little discomfort

Chapter 9: After Your Newborn Arrives

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Newborn treatments

Antibiotics in eyes

Vitamin K injection

Hepatitis B vaccine


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Feeding your baby

Think about whether you want to breastfeed

Recommended by many experts

If you cant or dont want to breastfeed, your baby

will drink formula

Pros and cons to every approach

Decide whats right for you and your family


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Reasons to breastfeed

Strongly recommended by experts

Provides all vitamins and nutrients

Helps protect babies from disease

Can be good for you, too

Much cheaper than formula


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What if I have trouble breastfeeding?

Almost three quarters of U.S. moms plan tobreastfeed

Some women and babies have trouble

Many sources of help

Can use a breast pump and a bottle

Worth trying right after birth

Youll be producing colostrum

Breastfeeding doesnt have to be all or nothing


Med Speak

lactation consultant =breastfeeding specialist

colostrum= first milk,

with powerful immuneproperties

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Reasons to formula feed

Formula is specially prepared to meet babies needs

Can ask pediatrician for help choosing one

Reasons to formula-feed include: Poor sucking reflex

Excessive pain during breastfeeding

Returning to work

Baby not getting enough milk

Being away for a long time

Medication that shouldnt be passed through your breast milk

Desire to involve other loved ones


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Rooming in

Having your baby stay with you instead of in the nursery

Nice way to bond and get to know your baby s signals

Can have your baby with you as much as possible

or just when youre awake

You might want your baby in the nursery so you can rest


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Cord blood banking

Saving your babys cord blood to later treat disease

Cord blood is different than regular blood:

a rich source of stem cells

Can treat dozens of diseases

Collecting cord blood doesnt cause any pain

or discomfort


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Cord blood banking

Private banking: Pay for your own familys use

Public banking: Donate to a public bank

Private banking:- Expensive

- Many families dont end up needing the

cord blood

- When baby has a condition, cord blood likely

to be affected (and useless)

Public banking:

- Not available at all hospitals


Fast Facts

About 5 percent of familiesbank cord blood

80 percent of collected cordblood is banked privately; 20

percent publicly Researchers estimate thatanywhere from 1 in 2,500 to 1 in

200,000 families end up usingtheir privately stored cord blood

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Circumcision

Surgical removal of the foreskin at the end of the penis

Practice is controversial

AAP says parents should decide


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Circumcision

Potential benefits Slightly lower risk of UTIs, cancer of the

penis, and HIV May help prevent infection

Religious beliefs, cultural reasons, personalpreference

Potential risks Complications like bleeding, infection,

injury, improper healing

May reduce sexual pleasure

If youre planning to breastfeed andcircumcise, consider delayingcircumcision until breastfeeding isgoing well


Fast Fact

U.S. circumcision rates

Northeast: 64%

Midwest: 78% South: 55%

West: 34%Across all regions: 56%

These percentages reflect thenumber of baby boys circumcised

in a hospital. Some boys arecircumcised in doctor's offices andother nonhospital settings, so the

actual numbers are higher thanwhat you see here.

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Chapter 10:YourTo-Do List

Section III: Things to Do Before Youre Due

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Consider your options

Chapter 10: Your To-Do List

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Create a birth plan

Helps you focus your

thoughts about

what you want

Spells out your preferencesso everyones

on the same page

No guarantee things will go

according to plan!


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Create a birth plan

Review your options

Think about your goals

Ask your partner for input

Plan for the unexpected

Write it down

Review and revise, then finalize


Fast FactIn a BabyCenter poll, 42% ofmoms say labor and birth didn't

go at all as they planned butonly 12% were really

disappointedby the experience.

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Review insurance coverage

Understand whats covered and whatisnt

Find out how and when to add your

baby to your planAsk about coverage for your babys stay

in the nursery


Smart Tip

If you plan ahead, you can get agreat tax break on the money you'll

spend on medical care for yourselfand your baby. Healthcare flexible

spending accounts allow you to setaside money ahead of time, tax-free,

for certain medical expenses.

Be careful to put aside only what

you're sure you'll spend, because ifyou don't use the money by the endof the year, you lose it. Talk to your

tax professional or human resourcesrepresentative for details.

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Arrange maternity leave

Find out what youre eligible for

Fill out all the paperwork you can

Understand your options in case of complications


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Take a tour

On your tour, youll:

Find out where to park, enter,

and check in

See the rooms

Visit the nursery

Ask questions


Smart Tip

You may be able to preregisterat the hospital when youre

visiting. (Who wants to fill outpaperwork while having

contractions?)

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Photo courtesy of: Scripps Memorial Hospital, La Jolla

Take a tour

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Plan your trip

Map most direct route to hospital or birth center,

as well as alternates just in case

Have plenty of gas in the tank


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Install car seat

You cant drive your baby home without one


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Pack your bag

Make sure to include: Drivers license or ID

Insurance card

Hospital paperwork

Birth plan, if you have one

Cell phone and charger

Glasses

Toiletries

Camera

Nursing bra

Comfortable clothing for trip home


93

Line up help

Ask for help with food and housekeeping

Many women ask for this as a baby shower gift

Try to spread out the help over the first few months


94


Practice natural pain management

If you practice, more likely to come easily

Practice with your partner

Can ease pregnancy discomfort

95


Enjoy some quality time

96

Documents

Crib Notes Preparing for Labor and Birth