Introduction to Labor, Vaginal and Cesarean Delivery

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Introduction to Labor, Vaginal and Cesarean
Delivery
Cheyenne County Hospital Candi Douthit, BSN OB
Manager
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Understanding Labor and Delivery

• Every labor is different
• Despite modern medicine, we cant predict what
  will happen
• Being prepared with knowledge, helps you and your
  spouse be calmer and less stressed
• You are never alone
• You have every right to ask for things to be the
  way you want them to be

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Types of Delivery

• Vaginal Delivery most natural, baby descends
  through the vaginal canal for birth
• Cesarean Section major abdominal surgery, cut in
  the abdomen which baby is delivered through
• Instrumented delivery use of vacuum or forceps
• There are indications for all types.

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Types of Delivery

• Despite the type of delivery you are planning, it
  is important to know about all of them
• Best plan is to keep in mind that our most
  important goal is a healthy mom and a healthy
  baby.

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Symptoms your body is Preparing for Labor

• Backache persistent dull ache
• Cramps mild to moderate discomfort
• PMS symptoms crabby, irritable
• Nesting Urge
• Frequent, soft bowel movements
• Flu-like symptoms
• Baby drops

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Impending Signs of Delivery

• Mucous plug
• May be thick mucous, blood tinged or not
• It is normal after a vaginal exam to have
  brownish/red discharge d/t the trauma of the exam
• Water breaks
• 80 of time you will go into labor after
• Note the color, any odor, amount
• Go the hospital

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Contractions

• Braxton Hicks irregular or regular, may come and
  go, short while or several hours
• False Labor doesnt mean they dont hurt and
  doesnt mean they arent doing anything to
  prepare for delivery

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Contractions

• Contractions of Active Labor
• Progressive, get stronger and stronger, closer
  together
• Felt in the back, abdomen, or both. May start in
  the back and radiate forward
• Usually increase with activity
• Dont go away with rest or fluids

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Other signs you are in Active Labor

• Dilation of the cervix with vaginal exam
• Labor check-2 exams, one hr apart
• The contractions just dont stop

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When to go to the hospital

• Contractions are 3-5min apart and dont go away
  with rest/fluids
• Water breaks
• If youre having contractions, and/or your water
  breaks and you are scheduled for a c-section
• http//www.youtube.com/watch?v2EnRV31mjZY

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Induction of Labor

• Means we artificially start the labor process
• Done for medical and personal reasons
• Only after 39wks, unless medically indicated
• Associated with increased pain, interventions and
  cesarean delivery (forces your body to do what it
  may not be ready to do)

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What to bring to the Hospital

• Insurance card and preadmission packet
• Your glasses, even if you wear contacts
  normallymay want to take them out. (Dont
  forget contact case and solution)
• Toiletries-things you might want during your stay
• Comfortable lounging clothes
• Slippers and a robe
• Light reading
• Massage oils, lotions, favorite music, favorite
  pillow, movies, whatever you need to relax
• Massage tools, aromatherapy

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What to bring to the Hospital

• For your husband/support person
• Change for the vending machine
• Snacks, snacks, snacks-fridge in the room
• Toiletries-no smelly breath!
• Clothes, something for you to sleep in
• Something to read, DVD player, computer
• Camera, video camera, extra batteries

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What to bring to the Hospital

• After you have the baby
• Clean lounging clothes (we have disposable
  underwear and pads for you)
• Snacks!
• Nursing Bra (we have lanolin and all of the
  things needed to get your breastfeeding off to a
  good start)
• Phone numbers
• Going home outfit

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What to bring to the Hospital

• For Baby
• Onesies
• Going home outfit
• Blanket, if you want
• We supply everything you really need

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What to expect at the hospital

• Fetal heart monitoring
• Vital signs
• IV
• Vaginal exams-determine your progress
• Done by RN or provider
• Effacement, station, dilation, pg 34-35
• Not done on a schedule, just when needed

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Vaginal Delivery

• Vaginal Exam cont.
• Effacement 0-100
• Dilation 0-10
• Station location of babys head in relation to
  spines of the pelvis, -4 to 4
• http//www.babycenter.com/stages-of-labor

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What to Expect During Labor

• Progression of contractions
• Progression of pain
• To move
• Verbalize your needs
• to your support team

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Labor

• Labor is the transition point, going from
  individual to mother, from couple to family.
  Hence with the transition you have many changes
• Physical-labor changes, pain
• Emotional-fear, stress, anxiety
• Intellectual-can I be a mom, will the baby be ok
• Loss of control-we dont like to be vulnerable or
  out of control, creates fear

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Labor

• Average 12-16hrs for first baby
• Is difficult and painful, even with drugs
• Your body instinctively knows what to do
• Your body gives you time between contractions to
  rest and prepare for the next one

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Stages of Labor

• Stage One-onset of labor to 10cm dilation
• Early Phase Avg 8hrs
• Active Phase Avg 4-5hrs
• Transition Phase 30 min to 2hrs
• Stage Two-10cm to birth of baby, 1 contraction to
  2hrs
• -laboring down, pushing, delivery
• Stage 3-delivery of the newborn to delivery of
  the placenta, 5-30min

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Stage One of Labor

• 1. Early Phase
• Start of labor to 3cm
• Feel very social, excited, anticipatory
• Conserve energy
• Longest phase, one you are most comfortable in
• 2. Active Phase
• 3-7cm dilation
• Contractions are stronger and more intense,
  regular
• Need to concentrate on the work at hand, no
  longer social
• Relaxation techniques helpful here

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Stage One of Labor

• 3. Transition
• 7-10cm dilation
• Hardest but shortest stage
• Contractions are very intense and feel they come
  one after the other
• Pressure in the perineum as the baby comes down

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Labor Stage Two

• May feel the urger to bare down
• Push when the physician tells you to do so
• Prior to this you have been cooperating with your
  body, now you will actively work with your body
  to deliver the baby
• With each contraction you will bare down and move
  the baby through the birth canal

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Labor Stage Three

• Birth of the baby
• Focus on the baby
• Several more labor-like contractions will come
  then delivery of the placenta (physician will
  massage your belly to facilitate this)
• Breastfeed or just watch and touch your baby

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Live Natural Birth

• http//www.babycenter.com/2_live-birth-natural_365
  6508.bc

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Instrumented Delivery

• Vacuum
• Episiotomy-dont do unless necessary
• Forceps
• Complications occur in labor and delivery. Cant
  always be predicted, just have to react when they
  occur. We will tell you what is going on
  throughout if this occurs.
• http//www.babycenter.com/2_vacuum-and-forceps-dur
  ing-birth_3656512.bc

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Cesarean Section Birth

• Indications prior c-section, infant
  complications, mother complications
• Know that any delivery can go to a cesarean
  section at any time.again, our goal is a healthy
  mom and a healthy baby
• If mom or baby has complications, this will
  happen very quickly, goal is delivery within 30
  min.

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What to expect for a scheduled c-section?

• Arrive early in the morning
• To sign consents, talk to the CRNA, complete
  paperwork (nurses do this online)
• Labs drawn day before or morning of
• IV, catheter, tight-fitting hose
• Fetal monitor
• Support person will put on scrubs

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Risks of Cesarean Delivery

• Mother
• Longer hospital stay
• Increased blood loss
• Infection
• Injury to bowel, bladder, ureter
• Blood clots
• Anesthesia complications
• Pain
• Admission to the ICU
• Hysterectomy

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Risks of Cesarean Delivery

• Baby
• Not squeezed, so increased breathing
  complications
• Less immediate contact with mom
• Longer till breastfeeding is initiated
• Scalpel injury
• Fetal death

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Risks of Cesarean DeliveryRisks for future
pregnancy and birth

• Repeat cesarean is likely
• Placental accreta
• Pre-term labor and lower birthweight baby
• Placental abruption

• Placenta previa
• Ectopic pregnancy
• Increased risk of uterine rupture

http//www.babycenter.com/2_live-birth-c-section-s
urgery_3656510.bc
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• Role of the Support Person in Labor and Delivery

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Support Person Job Description

• You are the second most important person in the
  room
• You know mom best, can best read her, and will
  know what she needs throughout delivery, she will
  hear you better than the rest of us
• Together, this is your birth experience, not your
  wifes and the health care staff. Take an active
  role in the labor process.

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Support Person Job Description

• 1. Emotional supporter
• 2. Provider of reassurance
• 3. Reminder of class content
• 4. Time officiate
• 5. Sharer of what makes her feel best
• 6. Hand holder, brow mopper
• 7. Family liaison
• 8. Photographer, baby and mom assistant
• 9. Breastfeeding helper
• 10. Bouncer

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Support Person Job Description

• Your job if so very important, post delivery, mom
  needs a lot
• Hormonal shifts, mom needs support
• Need to stay overnights to help with baby and
  learn how to be a dad!
• See support person handout as well!

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Questions???