*For Informational and Educational Purposes Only* 

How do I know if I’m in labor?

There are three things that might happen that might indicate that you’re going into labor. 

1.  First would be if you rupture your membranes.  This is normally a fairly dramatic event.  Many patients feel like they’re emptying their bladders continuously without control.  If you feel you may have ruptured your membranes, even if you have no contractions, you should call the office number. 

2.  Secondly, if you have vaginal bleeding, you should call the office.  Sometimes when the cervix begins to dilate, it develops tiny tears that bleed called “bloody show”.  Sometimes, however, you may pass a glob of mucus that is blood tinged or greenish called the mucus plug.  This plug may pass weeks before actual labor begins and is not a reliable indicator of true labor.  Bloody show is more liquid than mucus. 

3.  The third event that may indicate labor is the onset of painful uterine contractions.   Many patients, particularly patients who have had babies before, will develop uterine contractions as early as the second trimester called Braxton-Hicks contractions.  These contractions do not result in dilation or effacement (thinning out) of the cervix.  Real labor contractions are painful in both your abdomen and back, they are regular to the point that you can almost set your watch by them and they get more intense and closer together.  Braxton-Hicks contractions in contradistinction may be uncomfortable in the lower abdomen but don’t hurt in your back and are very irregular.  To time your contractions, you should measure the time interval from the start of one contraction to the start of another—not from the finish of one contraction to the start of another.  When the interval is 5-7 minutes apart and painful, you should call the office number. 

Please don’t go to the Birth Center without calling first, since we may be able to evaluate you in the office without generating a hospital charge for you.  If it is after hours or on a weekend, your call will be handled by our answering system and the doctor on call will call you right back, usually within 15 minutes.

Who do I call if I think I’m in labor?

Always call the office number (919-788-4444).  If the office is open, our phone triage staff will evaluate your symptoms to see if you should come to office or make other recommendations while consulting with one of our doctors.  If the office is closed, the answering system will pick up the call and page the on-call doctor with your message.  He or she will call you back within minutes to assess your symptoms and make recommendations.

What are my options for pain control in labor?

There are two types of pain associated with labor—the pain of labor, which is concentrated in your lower abdomen and back, and the pain of delivery, which is concentrated on your bottom.  There are three options for control of labor pains.  The first of these is breathing techniques or Lamaze techniques.  With this option, you don’t need an IV and the baby doesn’t get any medicine.  You breath rhythmically with your contractions to help you deal with the pain but it doesn’t really get rid of the pain.  Also, this technique doesn’t provide pain relief for your bottom at delivery, so the doctor may inject numbing medicine into the perineum or along the pudendal nerve to provide numbing similar to what the dentist does for fillings.  The second option that you may choose for control of labor pain is IV medication.  We typically use IV StadolÒ, a rapid onset, short duration, synthetic narcotic.  The nice thing about this technique is that you get stuck with a needle once to insert your IV and you can get multiple doses of the medicine through that IV as you need.  It does take the edge off the labor pains better than breathing alone but still doesn’t totally take the pain away.  It doesn’t provide good pain relief for the pain of delivery, so we may inject numbing medicine if needed.  Also the IV medicine crosses the placenta and gets to the baby.  As long as enough time has elapsed since your last dose of medicine, the medicine will come back across the placenta and be metabolized by you.  If, however, you deliver soon after receiving a dose of medicine, the baby may still have some of the medicine on board when the cord is clamped and may seem sleepy.  We can reverse these effects in the baby, by giving the baby a shot of medicine called NarcanÒ but we are usually cautious about giving the IV medicine if we suspect delivery soon.  The third alternative for pain control is an epidural.  With an epidural, you are given a bolus of IV fluids, the skin on your lower back is numbed and a needle inserted into the epidural space in your spine.  A small catheter is then inserted through the needle and the needle removed.  Numbing medicine is then injected through the catheter to numb the nerves from your navel to your knees.  This takes care of the pain of both labor and delivery and does so without the baby getting an appreciable amount of medicine.  The down side to this technique is that you have to have a needle inserted into your back.  Some folks don’t like this idea.  The risk of an epidural involves a 1% chance of a headache the next day.  The risk of a serious complication is very rare—about 1 in 100,000.  As far as choices for pain control in labor, you are the boss and you can change your mind.  It’s perfectly logical to go into labor planning to try breathing techniques first and then IV medicine if needed and then an epidural if that doesn’t work.

When can I get my epidural and when is it too late?

It takes about 20 minutes to get an epidural in place and functioning.  There is no dilation number beyond which an epidural is too late.  More importantly is the rapidity of your labor.  A patient that goes from 4 centimeters dilation to 8 centimeters dilation in 20 minutes may not derive much benefit from her epidural if it is placed at 8 centimeters.  On the other hand, a patient who has been 8 centimeters for 2 hours may get plenty of benefit.  As to the earliest that an epidural may be inserted, it is best to be in good labor and 3 or more centimeters dilated.  However, the patient who is less dilated and in severe pain may be best served by getting her epidural earlier, so she can conserve her energy for later.

Can I eat while I’m in labor?

There are many things that lead to nausea and possible vomiting while in labor.  Once labor begins, digestion ceases for up to 24 hours.  If you have a full stomach, you will probably throw up at some point in your labor.  The pain associated with labor along with some of the IV medications used to alleviate that pain might also lead to nausea.  Vomiting is no fun anytime and particularly when you are in labor.  Since you are more likely to aspirate the vomit into your lungs while pregnant, leading to life-threatening pneumonia, we prefer that you limit your diet to non-particulate liquids while in labor.  Feel free to bring hard candy to suck while in labor—but no chocolate until after delivery!  Also, it’s probably a bad idea to stop at the Burger Doodle for a happy meal on the way into the hospital for your labor check.

Will I have to have an IV?

If you are planning to “go natural” without pain medicine or an epidural, you don’t have to have an IV.  If you are positive for Group B Strep, you will need IV antibiotics in labor but the IV and be “heparin locked” thereby disconnecting you from the tubing between doses.  If you labor is long, you may need an IV for hydration.  You will need an IV for IV medication or an epidural if you opt for these methods of pain control.

Will the nurse give me an enema or shave my bottom for delivery?

Shaving the perineum of a labor patient is not done today and you will only get an enema if you request one.  Occasionally, we may offer an enema to a patient who has ruptured her membranes but is not laboring, since the enema my help to stimulate the onset of labor without pitocin.

Circumcision

If you would like your son circumcised, our doctors will do this on postpartum day 1 or 2, after the pediatrician has evaluated the baby and placed him on the “circ list”.  Our doctors will discuss the procedure as well as the pros and cons of injectible analgesia with you prior to doing the circumcision.  There are two basic techniques for doing circumcision and each doctor has a preferred method with which he or she is most comfortable.  Both are safe and effective techniques for removing the foreskin.  If the doctor performs the procedure using the PlastibellÔ technique, a plastic ring will be inserted under the foreskin and a suture tied tightly around the ring.  After a few days, the foreskin will fall off with the ring.  If the doctor uses the GomcoÔ technique, the foreskin is removed at the time of the procedure and the head of the penis (the prepuce) wrapped in Vaseline gauze.  Each time you change your son’s diaper, you should rewrap the prepuce with Vaseline gauze or dab a small amount of Vaseline onto the prepuce to keep it from sticking to his diaper.  After several days, the prepuce will be covered with a smooth, dry layer of cells that will not stick to the diaper and you can stop using the Vaseline.

Do you routinely do episiotomies?

An episiotomy is an incision on the perineum (the tissue between the openings of the vagina and rectum) that opens the vagina more to facilitate delivery of the baby.  It is not routine.  There are 2 reasons to perform an episiotomy:  to speed up the pushing stage of labor or to prevent a bad tear in the mother.  If  the doctor feels that an episiotomy is indicated, he or she will discuss this with you at the time of delivery before performing one.

How do I choose a pediatrician?

All of the pediatricians in the area are good.  Our suggestion would be to find an office that is convenient to your home or work since you will be visiting that office a lot!  Kids get sick a lot and they get well quickly, but they do get sick a lot.  If you do not live in Raleigh, and plan to take your child to your pediatrician or family doctor back home, the neonatologists at Rex Healthcare will take care of your child while hospitalized.

How much weight should I gain?

For the average patient who is pregnant, we recommend a weight gain of 25-35 pounds for the pregnancy.  For twins, we recommend 35-45 pounds of weight gain.  If you were underweight before pregnancy, you might gain more and if overweigh, you might gain less.  At a minimum, you should gain at least 16 pounds.  If you gain excess weight during the pregnancy, it doesn’t hurt the baby but may be difficult to lose afterward.  Also, excess weight gain has been associated with big babies, difficult deliveries and the need for cesarean section.

When will I go home following delivery?

Following vaginal delivery, most patients go home on postpartum day 2 or occasionally day 3.   Following cesarean delivery, patients usually go home on postoperative day 3 or 4.  Occasionally, cesarean delivery will require an extra day in the hospital, to day 5.

When will you see me for my postpartum visit?

Don’t worry about scheduling a postpartum appointment.  We will take care of that for you.  After you leave the hospital, we will send you a postcard with your postpartum appointment.  The card will arrive in about 2 weeks and the appointment will be 4-6 weeks following delivery.  If the card arrives, and we chose a bad day for your postpartum appointment, feel free to call to reschedule.

When can I return to work following delivery?

Most patients require 6 weeks disability following delivery.  You may wish to add additional family leave, but your employer will not be required to pay you for that additional time.  If you need disability forms or family leave forms completed, please bring these to the office so that we can fill them out there rather than at the hospital—many times, we need information that is contained in your office chart in order to properly complete the forms.

What kind of activity can I do following delivery?

You may resume most of your usual activities once you feel up to them.  You should avoid driving for one week following delivery and resume driving only if you can press on the brake comfortably and aren’t taking narcotics for pain.  If you tire during an activity, stop to rest.  If you are breastfeeding, you should drink a glass of water or milk each time you feed the baby, otherwise you may get dehydrated and decrease your milk supply.  You should put nothing in the vagina until after your 6 weeks postpartum visit.

*For Informational and Educational Purposes Only*