Birth Plan
Many patients ask, “Do I need a birth plan?” or “What should my birth plan include?” Deciding to write a birth plan is up to you. Some people like to put their preferences and their labor experience in writing. Should you decide to develop a Birth Plan, please bring it to our office during one of your prenatal visits for review by a physician.
Many different web sites offer different templates of birth plans, which often have out of date or simply inaccurate information. We want you to have the best experience possible with your labor, with the goal being a healthy mother and a healthy baby after delivery. However, unforeseen circumstances may arise that will not allow for all scenarios (discussed below) and for all requests to be met. The information discussed below, we hope, will better explain what to expect during the laboring process.
Early Labor
We generally will evaluate your labor after you have been having intense contractions every 5 minutes for at least 1-2 hours or if you think your water has broken. We will also assess you and your baby if you have vaginal bleeding or decreased fetal movement (less than 4 movements in 1 hour). If one of the doctors deems you in labor, or with broken membranes, you’ll be admitted to the hospital. Other circumstances may also require you be admitted to the hospital.
During this early stage of labor, if you and your baby appear well, you will be able to walk around, change positions, use a birth ball, sit in a rocking chair and basically do whatever makes you comfortable. You may also drink fluids, listen to music and watch TV. It is also possible that during early labor no significant cervical change may occur and we may offer to augment your labor with artificial rupture of membranes or Pitocin. Pitocin is identical to oxytocin, which is the hormone that your body produces to start labor.
After your admission to the hospital, blood will be drawn for lab evaluation and the baby will be monitored for some time. An IV is usually started with active labor or labor induction. This does not necessarily mean you will be attached to a bag of fluid, but IV access is needed in case of emergency. We do not routinely give enemas or shave the pubic area at admission.
Active Labor
During active labor, we routinely do vaginal exams only as needed, to evaluate progress, usually every few hours for a first labor and more frequently if labor is progressing quickly. Once you are in active labor, your contractions will be much stronger and your cervix will likely change in dilation. At this point, you may request IV pain medication, epidural anesthesia or continue with natural labor. We do not favor one method over the other. We also do not require a certain dilation in order for an epidural to be placed. Also, there is no certain “window” of time of dilation under which an epidural must be placed. If you do have an epidural, you will have to remain in the labor bed as your ability to move will be limited.
Delivery
At this point, you will have reached complete dilation and will begin pushing. Often women push while reclining with knees up and slightly out to the side. You may, however, push in any way that is most comfortable.
During the actual delivery, women deliver while reclining. We do not routinely use episiotomies but it might reduce tearing when used appropriately. This decision is usually made just as the baby’s head is crowning. Once the baby has been delivered, you or your partner may cut the cord. After holding the baby for a few minutes, the baby will be evaluated, warmed and weighed by the nurses. Also, the baby will be warmed and bathed in your presence in the delivery room. You will be able to breastfeed very soon after delivery.
Inductions
There are certain circumstances that exist when we recommend that we induce your labor. Some examples include: post-dates pregnancy, preeclampsia, low amniotic fluid, diabetes, and twins.
Inductions are carried out at the Rex Hospital Birth Center. There are several different methods for induction of labor. The method that we choose depends on your cervical dilation and effacement. If you cervix is not very dilated or effaced (thin) then we will probably have you come to the hospital the night before your induction to undergo “cervical ripening.” You would then stay overnight and continue the induction in the morning. There are several methods that we may use with the ultimate goal to dilate and efface the cervix overnight under more restful conditions. We will explain those methods at that time.
If you don’t require “cervical ripening” then your induction will most likely start in the morning or early afternoon. A nurse from Rex Labor and Delivery will call you between 5-7 am that morning and will tell you what time to arrive at the Birth Center. Please have your bags ready and childcare arranged so that you can arrive quickly after being called to the hospital. Once at the hospital, you will be taken to a labor room and be admitted. One of our doctors will then see you and get the induction started. The usual method of induction involves giving you Pitocin medicine through an IV, breaking your water, or both. After this we usually need to increase the Pitocin dosage until your contractions become strong and you progress into early labor. At that point, your labor will be the same as if you had come in for spontaneous labor as discussed previously.
Post Partum
You will move to a different room post partum and the baby will be able to “room in” with you assuming that the baby is several hours stable. You may, of course, send the baby to the nursery when you need some rest. Also, a lactation nurse will come to help you if you need help breastfeeding. Circumcision of your newborn baby boy, if desired, is usually done the following day. Typically, women go home one to two days after a vaginal delivery or three to four days after Cesarean section.
