AM I IN LABOR?
What is labor?
Labor is the work that your body does to birth your baby. Your uterus (the womb) contracts. Your cervix (the mouth of the uterus) opens. You will push your baby out into the world.
What do contractions (labor pains) feel like?
When they first start, contractions usually feel like cramps during your period. Sometimes you feel pain in your back. Most often, contractions feel like muscles pulling painfully in your lower belly. At first, the contractions will probably be 15to 20 minutes apart. They will not feel too painful. As labor goes on, the contractions get stronger, closer together, and more painful.
How do I time the contractions?
Time your contractions by counting the number of minutes from the start of one contraction to the start of the next contraction.
What should I do when the contractions start?
If it is night and you can sleep, sleep. If it happens during the day, here are some things you can do to take care of yourself at home:
● Walk. If the pains you are having are real labor, walking will make the contractions come faster and harder. If the contractions are not going to continue and be real labor, walking will make the contractions slow down.
● Take a shower or bath. This will help you relax.
● Eat. Labor is a big event. It takes a lot of energy.
● Drink water. Not drinking enough water can cause false labor (contractions that hurt but do not open your cervix). If this is true labor, drinking water will help you have strength to get through your labor.
● Take a nap. Get all the rest you can.
● Get a massage. If your labor is in your back, a strong massage on your lower back may feel very good. Getting a foot massage is always good.
● Don’t panic. You can do this. Your body was made for this. You are strong!
When should I go to the hospital or call my health care provider?
● Your contractions have been 5 minutes apart or less for at least 1 hour.
● If several contractions are so painful you cannot walk or talk during one.
● Your bag of waters breaks. (You may have a big gush of water or just water that runs down your legs when you walk.)
Are there other reasons to call my health care provider?
Yes, you should call your health care provider or go to the hospital if you start to bleed like you are having a period—blood that soaks your underwear or runs down your legs, if you have sudden severe pain, if your baby has not moved for several hours, or if you are leaking green fluid. The rule is as follows: If you are very concerned about something, call.
LABOR? WHAT DO I DO NOW?
First . . . If your baby is due more than 3 weeks from today and you are having back pain or stomach cramps, or there is fluid leaking from your vagina, or your baby has not moved for several hours, or you have other troubling symptoms, call your health care provider now!
Or . . . If you are overdue, be sure to see your health care provider at least once a week and talk with her about a plan for your care.
Showing posts with label labor. Show all posts
Showing posts with label labor. Show all posts
Sunday, December 27, 2009
Thursday, October 15, 2009
J's Birth
J was sent over from the office to the hospital for a NST (non-stress test) and to check the fluid around the baby as she was 41.2 weeks pregnant. The plan was for her to come in the next morning to have her water broke as a means of getting labor started. Her cervix was 4cms in the office that day with the baby's head quite low in the pelvis. Diane had called me to let me know she was coming. Diane would be on call the next day.
J had previously had epidurals with her other children. From what she told me, it sounded like she would get to transition then was offered an epidural, where her response was yes. Then she would deliver 30 minutes later. Her previous children were all caught by doctors. She very much wanted to do this natural.
When J arrived and was put on the monitor in triage, I was a little concerned. I didn't like how the baby's heart rate looked so opted to just keep her for the night. Well, I may have jumped the gun because once she came back to L&D, and was on the monitor, the baby looked fantastic. She was also contracting about every five minutes but feeling just a bit crampy with them. I asked her what she wanted to do...stay and break water tonight, stay and do nothing tonight, or go back home. Her and her husband had already made arrangements for their other children (a set of twins and a singleton) and they lived a fair ways away. She decided to stay.
We discussed breaking her water versus not, and she decided to have me check her first. Her husband wasn't there yet but would be in about an hour. She asked if breaking her water would cause her to deliver before he returned. I told "oh no, you won't go that fast!".
Famous last words.
She was 4-5/100/0 when I checked her so she opted to have her membranes ruptured. We even waited until after the nurses' shift change (maybe 20 minutes) before we did it. Once her water was broke, I asked her to walk a bit. She was also looking forward to getting in the tub and trying the birth ball. I went to do some paperwork and saw her walking a bit in the hallway. In hindsight, she looked a bit out of sorts, but at the time I didn't think too much of it.
A few minutes later she went back in the room and the nurse came and asked me if she could have something to eat as she was feeling light-headed. I went in to check on her and she was sitting on the edge of the bed. She told me this was what she didn't like about labor last time either...I suggested some protein as well as carbs. I told her I would be right back to check on her. I went to another patient's room to check in on her. While I was in there the nurse came and stuck her head in the door to tell me that J was asking for an epidural.
I was like "what???" She was doing fine when I had just been in there. So I tell the nurse not to do anything, I'm coming to check on her first. When I get to the room, she's still sitting on the edge of the bed. She tells me I can't do this. Then she grunts and bears down.
I'm thinking "what the heck?" I told J, let me check you before we make any decisions, you haven't tried the tub yet, and it sound slike you are getting close. She was spontaneously bearing down with each contraction. I checked her and she was 9 and a half cms! I said no epidural. She wanted to get in the tub so she squatted in the tub. I sat at her side holding her hand. I started worrying that her husband wasn't going to make it. I don't think she was in the tub more than 10 minutes when she started pushing again. She told me that the baby was coming. I checked and she was certainly correct - she was completely dilated and the baby was at a +2 station. I asked her if she could get out and maybe squat by the bed for delivery (we aren't supposed to do waterbirth although if she hadn't been able to get out, oh well). She was able to move over by a chair in the room. My thought was that she could lean on the chair and I would catch the baby from behind. Not quite how it worked out.
She squatted while I sat on the floor. She had one arm around my shoulders with her other hand on my leg for support. The nurse stood near by, not really sure what to do. She wanted to listen to the baby's heartbeat but I said not to worry about it, we could listen when the baby came out. I could not see what was going on as my head was crushed against J's chest. It was kinda funny :) I kept talking her through her contractions. She would talk completely normally in between contractions, asking what to do. I had one hand at her vagina, where I could feel the head crowning. She slowly and gently pushed the head out. It was such a thrill to not be able to see what I was doing but feel the head being born into my hand. We had a little trouble with the shoulders but nothing that wasn't remedied by me getting both hands involved. She gracefully pushed out the rest of her baby. I brought the baby up to her arms and the nurse threw a blanket over them. The baby was doing absolutely fine as was momma. We helped her move to the bed where she could rest while latching the baby on to the breast. Her husband walked in literally five minutes after the birth.
She pushed out her placenta just as gracefully. She had just a small perineal tear requiring no stitches.
Congrats J on a beautiful birth!
J had previously had epidurals with her other children. From what she told me, it sounded like she would get to transition then was offered an epidural, where her response was yes. Then she would deliver 30 minutes later. Her previous children were all caught by doctors. She very much wanted to do this natural.
When J arrived and was put on the monitor in triage, I was a little concerned. I didn't like how the baby's heart rate looked so opted to just keep her for the night. Well, I may have jumped the gun because once she came back to L&D, and was on the monitor, the baby looked fantastic. She was also contracting about every five minutes but feeling just a bit crampy with them. I asked her what she wanted to do...stay and break water tonight, stay and do nothing tonight, or go back home. Her and her husband had already made arrangements for their other children (a set of twins and a singleton) and they lived a fair ways away. She decided to stay.
We discussed breaking her water versus not, and she decided to have me check her first. Her husband wasn't there yet but would be in about an hour. She asked if breaking her water would cause her to deliver before he returned. I told "oh no, you won't go that fast!".
Famous last words.
She was 4-5/100/0 when I checked her so she opted to have her membranes ruptured. We even waited until after the nurses' shift change (maybe 20 minutes) before we did it. Once her water was broke, I asked her to walk a bit. She was also looking forward to getting in the tub and trying the birth ball. I went to do some paperwork and saw her walking a bit in the hallway. In hindsight, she looked a bit out of sorts, but at the time I didn't think too much of it.
A few minutes later she went back in the room and the nurse came and asked me if she could have something to eat as she was feeling light-headed. I went in to check on her and she was sitting on the edge of the bed. She told me this was what she didn't like about labor last time either...I suggested some protein as well as carbs. I told her I would be right back to check on her. I went to another patient's room to check in on her. While I was in there the nurse came and stuck her head in the door to tell me that J was asking for an epidural.
I was like "what???" She was doing fine when I had just been in there. So I tell the nurse not to do anything, I'm coming to check on her first. When I get to the room, she's still sitting on the edge of the bed. She tells me I can't do this. Then she grunts and bears down.
I'm thinking "what the heck?" I told J, let me check you before we make any decisions, you haven't tried the tub yet, and it sound slike you are getting close. She was spontaneously bearing down with each contraction. I checked her and she was 9 and a half cms! I said no epidural. She wanted to get in the tub so she squatted in the tub. I sat at her side holding her hand. I started worrying that her husband wasn't going to make it. I don't think she was in the tub more than 10 minutes when she started pushing again. She told me that the baby was coming. I checked and she was certainly correct - she was completely dilated and the baby was at a +2 station. I asked her if she could get out and maybe squat by the bed for delivery (we aren't supposed to do waterbirth although if she hadn't been able to get out, oh well). She was able to move over by a chair in the room. My thought was that she could lean on the chair and I would catch the baby from behind. Not quite how it worked out.
She squatted while I sat on the floor. She had one arm around my shoulders with her other hand on my leg for support. The nurse stood near by, not really sure what to do. She wanted to listen to the baby's heartbeat but I said not to worry about it, we could listen when the baby came out. I could not see what was going on as my head was crushed against J's chest. It was kinda funny :) I kept talking her through her contractions. She would talk completely normally in between contractions, asking what to do. I had one hand at her vagina, where I could feel the head crowning. She slowly and gently pushed the head out. It was such a thrill to not be able to see what I was doing but feel the head being born into my hand. We had a little trouble with the shoulders but nothing that wasn't remedied by me getting both hands involved. She gracefully pushed out the rest of her baby. I brought the baby up to her arms and the nurse threw a blanket over them. The baby was doing absolutely fine as was momma. We helped her move to the bed where she could rest while latching the baby on to the breast. Her husband walked in literally five minutes after the birth.
She pushed out her placenta just as gracefully. She had just a small perineal tear requiring no stitches.
Congrats J on a beautiful birth!
Sunday, August 23, 2009
A Day in the Life of a Midwife
Typically we do 24 hours of call at a time or a whole weekend, however there are occasional 12 hour call shifts also. I was on call for 12 hours recently...and it was very busy!
0700 Call starts - I'm in bed.
0745 The first page of the day from Labor & Delivery (L&D). Someone's water has broken - which is ok because she's supposed to be having a baby anyway.
0747 Get up and help the husband get the kids off to school. Avoid the whole raised-by-wolves-look by actually brushing the girls' hair.
0815 Think about getting dressed.
0816 Lay back down.
0820 Get up, get dressed in my fashionable hospital scrubs. Go play on computer (blogs, email, etc).
0840 Page from L&D, patient #1 is ready to deliver
0933 Patient #1 delivers
0950 Start making rounds on the two other laboring patients and charting on everyone
1100 Head to postpartum to see postpartum patients and chart on everyone
1145 Grab some lunch in the doctor's lounge and head over to the office
1200 Pull into parking lot of office when L&D pages, patient #3 that just came in at 8cms and feeling pushy.
1201 Bang head against steering wheel
1202 Head back to hospital with lunch in hand
1215 Arrive at patient #3's room to find her smiling and contracting every 6-7 minutes.
1216 Contemplate stepping outside of room to bang head against the wall but opt not to as I have a headache already
1216 Discuss labor support, etc with patient #3. She doesn't feel like getting out of bed at this point.
1220 Call office and tell them I will try to be there by 2pm
1240 Patient #2 is complete and starting to push, I proceed to spend most of the next hour and a half working with her, while running next door to check on patient #3, who is planning natural childbirth
1300 Call office to tell them I will try to be there by 3pm
1400 Call office to tell them I ain't coming.
1438 Patient #2 delivers.
1500 Patient #3 is hurting and just generally not having a good time. She's still the same exam
1515 I get her in the tub and I sit on the toilet. With a chux over it which turns it into a chair. I realize how bad that sounded.
1530 the tub works its magic.
1545 Patient #3 delivers
Meanwhile patient #4 is gradually getting into labor, which was the goal.
1605 Admit patient #5 for labor
1609 Sit down and try to catch up on charts, without mixing up deliveries and patients
1630 The doc wants to know if I will take over his patient as he is going off call and a doc from another practice will be covering (if the patient is ok with this). The patient (#6) has met me before and is fine with me taking over. She has also been stuck at 8cms.
1635 Bang head against the wall
1636 Utilize the magic peanut with patient #6
1645 Sit and catch up on charts
1700 Re-check patient #4 to determine the next course of action. She's definitely in labor now so onward and forward
1715 Sit down and do nothing for a few minutes.
1745 Re-check patient #6 - complete and ready to go!
1800 Call Lylaine to give report as she comes on call for the weekend
1815 Patient #6 delivers
1840 Check on patient #5, who is doing well and making progress.
1855 Leave the hospital
1900 Off call
Tiffany
0700 Call starts - I'm in bed.
0745 The first page of the day from Labor & Delivery (L&D). Someone's water has broken - which is ok because she's supposed to be having a baby anyway.
0747 Get up and help the husband get the kids off to school. Avoid the whole raised-by-wolves-look by actually brushing the girls' hair.
0815 Think about getting dressed.
0816 Lay back down.
0820 Get up, get dressed in my fashionable hospital scrubs. Go play on computer (blogs, email, etc).
0840 Page from L&D, patient #1 is ready to deliver
0933 Patient #1 delivers
0950 Start making rounds on the two other laboring patients and charting on everyone
1100 Head to postpartum to see postpartum patients and chart on everyone
1145 Grab some lunch in the doctor's lounge and head over to the office
1200 Pull into parking lot of office when L&D pages, patient #3 that just came in at 8cms and feeling pushy.
1201 Bang head against steering wheel
1202 Head back to hospital with lunch in hand
1215 Arrive at patient #3's room to find her smiling and contracting every 6-7 minutes.
1216 Contemplate stepping outside of room to bang head against the wall but opt not to as I have a headache already
1216 Discuss labor support, etc with patient #3. She doesn't feel like getting out of bed at this point.
1220 Call office and tell them I will try to be there by 2pm
1240 Patient #2 is complete and starting to push, I proceed to spend most of the next hour and a half working with her, while running next door to check on patient #3, who is planning natural childbirth
1300 Call office to tell them I will try to be there by 3pm
1400 Call office to tell them I ain't coming.
1438 Patient #2 delivers.
1500 Patient #3 is hurting and just generally not having a good time. She's still the same exam
1515 I get her in the tub and I sit on the toilet. With a chux over it which turns it into a chair. I realize how bad that sounded.
1530 the tub works its magic.
1545 Patient #3 delivers
Meanwhile patient #4 is gradually getting into labor, which was the goal.
1605 Admit patient #5 for labor
1609 Sit down and try to catch up on charts, without mixing up deliveries and patients
1630 The doc wants to know if I will take over his patient as he is going off call and a doc from another practice will be covering (if the patient is ok with this). The patient (#6) has met me before and is fine with me taking over. She has also been stuck at 8cms.
1635 Bang head against the wall
1636 Utilize the magic peanut with patient #6
1645 Sit and catch up on charts
1700 Re-check patient #4 to determine the next course of action. She's definitely in labor now so onward and forward
1715 Sit down and do nothing for a few minutes.
1745 Re-check patient #6 - complete and ready to go!
1800 Call Lylaine to give report as she comes on call for the weekend
1815 Patient #6 delivers
1840 Check on patient #5, who is doing well and making progress.
1855 Leave the hospital
1900 Off call
Tiffany
Saturday, August 15, 2009
Doula speaks on breastfeeding and labor similiarities, communication
This is a guest post by Katie Dibenedetto, who is a doula I have gotten to work with firsthand. Please enjoy ~ Tiffany
On Tuesday night D called, my new postpartum client. She was worried about her milk supply and is supplementing with formula on the recommendation of the hospital nurses. I sort of gently reminded her that breastfeeding is supply and demand and in order to increase her supply she needs to nurse, nurse, nurse! And also relax! Because so often I see women and they're so tense. They're fretful about the positioning or the baby not latching right away or the baby not nursing for very long and you can see the beads of sweat forming on their brows. But if you can relax and let go and let it flow....you probably will! Same with labor - if you're all tense and tight and holding your breath and clenching....that completely goes against what your body is trying to do - open up.
We talked about how, if she is going to continue supplementing, then for each supplement she needs to pump. Your boobs don't know the baby is getting formula so how will they ever know to make enough milk? I mean obviously I don't want her to be supplementing with formula to begin with - this is another "intervention", "risk", whatever you want to call it of birthing in a hospital with a typical OB and an uneducated nursing staff versus either birthing at home with a midwife or birthing in a hospital or birth center with a supportive team that you love and trust. Hospital staff are all too often completely ignorant about breastfeeding. So they of course encouraged her at the hospital to supplement with formula because she had a 9 pound baby and couldn't possibly make enough milk to satisfy such a big boy's appetite. First of all - way to set a mom up mentally! And second of all - what a great evolutionary design! Let's make women's bodies inadequate so that they don't produce enough milk for their babies. I understand, yes, sometimes there are issues with supply. But in most cases our bodies are perfectly designed to feed our babies a more than satisfactory amount. I just wish people would try more things instead of going straight to formula. But it's just like with birth - I wish people would try more things before going straight to a cesarean. But then you have the ultimate issue - going straight to formula is way easier (for the doctor, nurse, hospital staff, etc. not for the mother obviously) than sitting with a woman for an hour and helping her to relax, reassuring her, helping her find the right position, etc. And going straight to a cesarean is way easier (again for the doctor, hospital, etc.) than having her labor longer and staying with her and helping her walk or change positions or helping her to open up about anything emotionally that she may be holding on to.
Now this is often the hardest part for me about being a doula - to be able to communicate effectively with my moms in a way that is educational and informative, but doesn't make them feel like they have done or are doing anything wrong. And I always try to take an attitude of 'you know, let's acknowledge what we maybe could have done differently and let's deal with any emotions regarding that (I'm not a big fan of denial), but let's move on and focus on what we can do now'. I think this is actually harder for me because I generally just blurt out whatever I am thinking at any given time. Trust me, my husband has spent the better part of our three year marriage trying to teach me "tact". And boy, can I rant and rave with the best of them. It's just another way that being a doula has made me a better person. These communication skills I've learned serve me in all aspects of my life. Anyway, I encouraged D on the phone and she seemed to feel better just talking it out. We set up a time for me to come over the next day."
To be continued...
On Tuesday night D called, my new postpartum client. She was worried about her milk supply and is supplementing with formula on the recommendation of the hospital nurses. I sort of gently reminded her that breastfeeding is supply and demand and in order to increase her supply she needs to nurse, nurse, nurse! And also relax! Because so often I see women and they're so tense. They're fretful about the positioning or the baby not latching right away or the baby not nursing for very long and you can see the beads of sweat forming on their brows. But if you can relax and let go and let it flow....you probably will! Same with labor - if you're all tense and tight and holding your breath and clenching....that completely goes against what your body is trying to do - open up.
We talked about how, if she is going to continue supplementing, then for each supplement she needs to pump. Your boobs don't know the baby is getting formula so how will they ever know to make enough milk? I mean obviously I don't want her to be supplementing with formula to begin with - this is another "intervention", "risk", whatever you want to call it of birthing in a hospital with a typical OB and an uneducated nursing staff versus either birthing at home with a midwife or birthing in a hospital or birth center with a supportive team that you love and trust. Hospital staff are all too often completely ignorant about breastfeeding. So they of course encouraged her at the hospital to supplement with formula because she had a 9 pound baby and couldn't possibly make enough milk to satisfy such a big boy's appetite. First of all - way to set a mom up mentally! And second of all - what a great evolutionary design! Let's make women's bodies inadequate so that they don't produce enough milk for their babies. I understand, yes, sometimes there are issues with supply. But in most cases our bodies are perfectly designed to feed our babies a more than satisfactory amount. I just wish people would try more things instead of going straight to formula. But it's just like with birth - I wish people would try more things before going straight to a cesarean. But then you have the ultimate issue - going straight to formula is way easier (for the doctor, nurse, hospital staff, etc. not for the mother obviously) than sitting with a woman for an hour and helping her to relax, reassuring her, helping her find the right position, etc. And going straight to a cesarean is way easier (again for the doctor, hospital, etc.) than having her labor longer and staying with her and helping her walk or change positions or helping her to open up about anything emotionally that she may be holding on to.
Now this is often the hardest part for me about being a doula - to be able to communicate effectively with my moms in a way that is educational and informative, but doesn't make them feel like they have done or are doing anything wrong. And I always try to take an attitude of 'you know, let's acknowledge what we maybe could have done differently and let's deal with any emotions regarding that (I'm not a big fan of denial), but let's move on and focus on what we can do now'. I think this is actually harder for me because I generally just blurt out whatever I am thinking at any given time. Trust me, my husband has spent the better part of our three year marriage trying to teach me "tact". And boy, can I rant and rave with the best of them. It's just another way that being a doula has made me a better person. These communication skills I've learned serve me in all aspects of my life. Anyway, I encouraged D on the phone and she seemed to feel better just talking it out. We set up a time for me to come over the next day."
To be continued...
Wednesday, July 22, 2009
ROM+2hrs=birth
I had a woman by the name of E come in for her postpartum visit recently and we were re-visiting her birth story. She graciously has allowed me to share her birth story here!
E had her first child a little premature at 36 weeks. This pregnancy was hanging on a bit more! She had been experiencing lots of bouts of contractions since about 35 weeks with some cervical change. She came into the hospital triage at 38 weeks contracting very regularly at every 2-2 and half minutes. She was 4/90/-1 (the first number is how many centimeters dilated with the ultimate goal being 10cms/the second number is effacement which is how thin the cervix is and ultimate goal being 100%/the third number is where the baby's head is in relation to certain landmarks in mom's pelvis - +3 is crowning). She walked for a bit with no change in her cervical exam...just these persistent contractions that were causing her some discomfort but not really changing anything.
I know that E was ready to be done with the pregnancy and offered her the option of AROM (artificial rupture of membranes). I explained the risks (infection, fetal distress, need for pitocin) and benefits (onset of labor!) to her as well as letting her know she had the option of therapuetic rest (little trick where morphine is given to someone in prodromal labor - will allow the woman to rest and she will either wake in full-blown labor or it will knock the prodromal stuff out) or just going home.
She and her husband discussed the choices and opted for the AROM. Her first baby had come very quickly after ROM but she was 8cms at the time. She had natural childbirth with her child and planned to do the same with this one. Once she was settled in her room, the plan was to break her water and then send her out walking, then into the tub. The ROM worked very well as E became increasingly uncomfy while walking so we moved her to the tub. She was coping very well with her contractions and working hard. She had not been in the tub long when she felt she needed to push.
She moved to the bed and I checked her cervix - she was 10/100/+1. She pushed beautifully, very well controlled and delivered her baby over an intact perineum (bottom).
I looked at the clock...total time elapsed from ROM at 4 cms to birth was 1 hour and 51 minutes. WOW!
Tiffany
E had her first child a little premature at 36 weeks. This pregnancy was hanging on a bit more! She had been experiencing lots of bouts of contractions since about 35 weeks with some cervical change. She came into the hospital triage at 38 weeks contracting very regularly at every 2-2 and half minutes. She was 4/90/-1 (the first number is how many centimeters dilated with the ultimate goal being 10cms/the second number is effacement which is how thin the cervix is and ultimate goal being 100%/the third number is where the baby's head is in relation to certain landmarks in mom's pelvis - +3 is crowning). She walked for a bit with no change in her cervical exam...just these persistent contractions that were causing her some discomfort but not really changing anything.
I know that E was ready to be done with the pregnancy and offered her the option of AROM (artificial rupture of membranes). I explained the risks (infection, fetal distress, need for pitocin) and benefits (onset of labor!) to her as well as letting her know she had the option of therapuetic rest (little trick where morphine is given to someone in prodromal labor - will allow the woman to rest and she will either wake in full-blown labor or it will knock the prodromal stuff out) or just going home.
She and her husband discussed the choices and opted for the AROM. Her first baby had come very quickly after ROM but she was 8cms at the time. She had natural childbirth with her child and planned to do the same with this one. Once she was settled in her room, the plan was to break her water and then send her out walking, then into the tub. The ROM worked very well as E became increasingly uncomfy while walking so we moved her to the tub. She was coping very well with her contractions and working hard. She had not been in the tub long when she felt she needed to push.
She moved to the bed and I checked her cervix - she was 10/100/+1. She pushed beautifully, very well controlled and delivered her baby over an intact perineum (bottom).
I looked at the clock...total time elapsed from ROM at 4 cms to birth was 1 hour and 51 minutes. WOW!
Tiffany
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