Labor and Delivery

How to prepare for your labour?
When should you report to the hospital?

If you have any of the following you should get ready for your admission at the hospital:
• you have gone into premature labour or had a threatened miscarriage during your current pregnancy.
• you have a low-lying placenta (placenta praevia) after you are 26 weeks pregnant.
• you have cervical weakness (also called cervical incompetence).
• you are pregnant with three or more babies.
• you have serious heart or lung disease.
• you have persistent vaginal bleeding.
• you have very high blood pressure

What should you keep packed and ready in the last month of your pregnancy?

You should probably pack and keep a bag ready to take with you when you go into labour. The bag should contain the following:
• Comfortable clothes [including undergarments] for you to wear after your delivery
• 2 packs of large sanitary pads
• Some clothes for your baby, including diapers, clothes and most important some form of cap to cover your babies head
• Some reading material
• A compact music system if you want your own music during and after your delivery
• Your mobile phone so that you could be in touch from your bedside
• You personal toiletries such as towels, napkins, soap, shampoo, toothbrush, toothpaste, makeup etc
• Bras that are designed for nursing
• Toiletries for your baby such as soap, oil, powder etc

Blood donor

You must try to locate a friend/relative who has the same blood group as you and see that they are contactable at the time that you may go into labour. If blood is required blood banks do not always have stocks of all groups and this may become life saving. This is particularly important if you have a Rh negative or otherwise rare blood group.

Transport to the hospital

Make sure that some form of transport is available for you to get to the hospital. If a car is unavailable keep a list of four or five taxi company telephone numbers readily available.

Enema and shaving

When you go into labour and are admitted at the hospital you will probably receive an enema as well as have your private parts shaved [you could in fact do the shaving at home before you are admitted if that is more comfortable for you].

Admission test

You may have an ‘admission test’ which is a short NST [electronic fetal heart monitoring] done at the time of admission which will tell your doctor if your baby is receiving enough oxygen. It is a type of screening test to pick up any potential problems early. If this test is okay then your baby will probably be alright for a few hours of labour. If this test shows a problem then your baby is receiving less oxygen already and may not be able to tolerate labour and may need to be delivered by caesarian section

The stages of labour

Your labour is divided into 3 stages:
• The first stage-is from the onset of labour contractions till the cervix is fully dilated which about 10 cm dilatation of the cervix is. The cervix is the ‘mouth’ of the uterus which is closed during pregnancy and has to dilate [open] to about 10cm for the baby to come out. This is further divided into a ‘latent’ phase which is from onset of contractions till about 3cm dilatation and an ‘active’ phase which is from 3cm to full dilatation of 10cm.
• The second stage-is from full dilatation of the cervix till complete delivery of the baby
• The third stage-is the delivery of the placenta [afterbirth]

How does a normal labour progress?

• The latent phase till 3cm dilatation may be of very variable duration and is not very important in deciding the outcome of your labour. However once you cross 3cm dilation with active contractions your cervix should dilate at the rate of at least 1.2cm/hour for primigravid patients [1st delivery] and 1.5cm/hour for multigravid patients [2nd and more deliveries]. This progress is charted on a graph called a partogram and if you do not dilate at the required rates some intervention needs to be taken. If the dilatation is tardy and the contractions are of poor strength then labour needs to be augmented with drugs [Pitocin/Syntocinon/Prostaglandins] to improve the contractions. If the dilatation is slow in spite of good contractions then your doctor will seriously consider an operative delivery such as a caesarian section. During this first stage of labour you need not ‘push’ or bear down. You need only to take deep breaths during the contractions.
• It is when you enter active labour that you may elect to take an epidural for what is frequently known as a painless labour.
• When you are fully dilated [10cm] you have entered the second stage of labour which may last upto 2 hours for a primi or 1 hour for a multi. This is when you should with every contraction take a deep breath and ‘push’ as hard as you can. If your second stage is long or you or your baby are exhausted at this time your doctor may decide to apply a forceps or a vacuum to assist in the actual delivery of the baby.
• An episiotomy may be given just before the head is delivered. This is an angular cut near the vagina to help to increase the space available for the head to come out. This is almost always given for 1st deliveries and sometimes for subsequent deliveries too. It also reduce the chances of severe tears to the vagina and rectum.
• After your baby has been delivered your doctor will cut the umbilical cord and hand over the baby to the nurse or paediatrician for cleaning and suction of the mouth and the nose. Within about 10-30 minutes you will expel the placenta and that would be the end of your delivery

After your delivery

If an episiotomy has been given it will be stitched usually with dissolvable stitching material and you will be cleaned up. Some drugs are usually given to prevent excessive bleeding and you will probably be kept in the labour room for about an hour to observe for bleeding. You will be handed your baby as soon as the paediatrician has finished and you may start to nurse the baby as soon as it is comfortable for you.

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