Pregnancy Essentials: Labor & Delivery

Written by Dr. Daniel Niku, February 2020.  Daniel Niku, MD, MS is a dedicated OBGYN in Beverly Hills, CA. Dr. Niku works as a health care partner and patient advocate, providing integrative care that supports every aspect of women’s health through all phases of their lives. Read Pregnancy Essentials Part 1-5 here.

Ready for the final PUSH? The finish line is here, but the last intense step will require some LABOR of love.

It is OK to feel overwhelmed, anxious, nervous, and excited. So many thoughts for you and your team! I trust that my experiences as an OBGYN, and drawing from the thoughts and concerns shared by my patient’s during their labor experiences, will help alleviate any additional concerns you have.

So let us start with some recaps:

• Remember, full term is 40 weeks, not the classic 9 months as commonly advertised. Knowing your due date and how many weeks you are is key.
• Having your “go” bag, knowing the hospital route, and having your team aware and readily available to you should make the labor and delivery process easier.
• Having a birthing plan is a great idea! This is a document that informs your delivery team your wishes and plans before, during and after labor. After all, this is your experience!
• However, remember to trust your physicians, the hospital team and residents if those plans need to be changed.
• We want to make this process as easy and safe for you as possible.
• WhatToExpect.com has some additional info!
• Remember your labor precautions.

So now you are at the hospital.

You will be examined by the hospital team, not always by your doctor. Some physicians may not even come to the hospital until you are ready to deliver. But be rest assured, your doctor should be up to date with your plan and progress.

When you are seen, a few things can happen to determine if you are in labor:

“Remember: Labor means having adequate contractions every 3-5 minutes with cervical change”. A history will be taken by the team and your charts will be reviewed. You can always carry a copy of your labs, just ask your doctor! A vaginal exam is done to see if you are making cervical change. You may hear them say three numbers: Dilation – how much your cervix has opened Effacement – how much the cervix has thinned Station – how far down the baby’s head has come down

So this may sound like this: “She is 4 cm dilated, 100% effaced, -1 station”

This means, you are 4 cm open, your cervix has completely thinned out, and the baby’s head is a little behind your pelvic opening.

• You are also placed on the fetal monitor to listen to the baby’s heart beat and to determine if you are having contractions (see below).
• Blood work and an IV may be placed in case you are in labor.

If you are in labor, here are some things to know:

Labor is divided into two parts:

• Early labor (0-6 cm) – can last between 6-21 hours
• Active Labor (6-10 cm) – can last 6-8 hours
• On average, the total time in labor for a first-time pregnancy can be 8-14 hours from the time you are having regular contractions to the time you are fully dilated.
• What will you see in the labor room?
  An IV will be placed by one of the nursing staff. Blood is collected and fluids will be given for hydrated. Labor is an intense work out and many muscles will be used.
• Will be placed on the fetal monitor. It has two straps, each one measuring the fetal heart beat and your contractions.

• This is the fetal strip monitor. It looks at the baby’s heart beat (the top part) and the contractions (the bottom).

• There are times wherein a normal labor process the patient can undergo intermittent monitoring, meaning you can be off the fetal monitor for a short period of time to allow the patient an opportunity to walk.
• Some practitioners are ok with their patients eating. But this also depends on the situation. Always ask what your doctor’s policy and the hospital’s policy is on eating.
• Some family members are allowed to visit up until the time you are ready to have the baby. Make sure they are just as supportive as the couple below:

What interventions are possible on labor and delivery?

You may be checked every few hours to see if you are making cervical change.

• If you aren’t adequately dilated, you may need something to help your labor, like Oxytocin.
• Some doctors elect to break your water as well (artificial rupture of membranes) to help augment the labor process.
• If the contractions are not strong enough, a monitor may be placed inside the uterus to help monitor those contractions. This is safe for you and is not harmful to the baby.

What about epidurals? Is it for me?

Epidurals is a method to administer analgesia (or pain relief) to patients in labor. It is the MOST popular method of pain relief. The medication that is given is a combo of local anesthetic such as lidocaine, mixed with low dose opioid or narcotic. The medication is effective and can last a long time, but it can also run out, so you can always get a re-dose of the medication.

Now! Some women will say they want to have a “natural” birth without pain medications, which I am all for! But if you are in pain and desire relief, then you dictate those terms, and NO ONE ELSE!

Again communication is key! Express your concerns to your doctor, team and hospital providers.

The American Pregnancy Association has more great information!

Delivery! Here we go! The Final Stage!

• Remember! 10 cm is the magic number!
• Your contractions can be intense, even with an epidural. They can occur every 1-2 minutes
  • Remember, contractions are tightening of the uterine muscles. It feels like doing an intense ab workout every 3-5 minutes.
• Your ability to push with contractions will guide the baby through the birth canal
  • Your team of doctors, nurses and family members will be there to encourage you
  • The best way I have gotten my patients to deliver is to tell them that the “Pushing” feeling is as if they are having a bowel movement when constipated. It will take some time and practice. But it is pretty incredible how quickly your body adapts and the instincts of “having a baby” kick in.
  • In total, it may take up to 3 hours of pushing
• An episiotomy (aka the cut made at the vagina before delivery) is not commonly practiced. It is only performed as needed.
• When your baby is delivered, be prepared for immediate skin-to-skin contact!
• Don’t forget about the placenta too! That still needs to be delivery.

A final point:

I was trained in a program that advocated for vaginal deliveries, even after a patient had a previous cesarean section (but no more than 1 previous c-section). Like myself, most OBGYNs want to avoid c-sections unless it is necessary. A c/section is a surgery! I want to advocate for vaginal deliveries, and there are many benefits.

Benefits of vaginal delivery for…

Maternal
Better recovery time compared to c-section
Decreased risk of blood loss
Decreased risk of infection
Allows for early skin to skin contact and early Breast feeding

Neonatal
Contractions allow the lungs of the baby to be stimulated
Decreased hospital stay

Lastly: Many aspects of labor and delivery are not covered here or covered in depth, including what to expect in certain emergencies. I have chosen to leave these out in order to focus more intently on the general interventions of the average pregnancy. Please feel free to contact me with specific questions. I am always here as a resource.

– Dr. Daniel Niku