Do's and Don'ts

Labor - Moving Right Along

Intravenous (IV) fluids may be given to you to prevent dehydration and are used to hydrate you prior to an epidural. IV access is important should a medical emergency arise, therefore, an intravenous catheter (a small tube) may be placed in your arm at some point after your admission.

In addition, some medications used to advance labor such as pitocin (oxytocin) and pain reducers (Stadol¨ and Nubain¨) are given intravenously. Be sure to talk with your clinician or the staff about any concerns with IVs.

Jot down any questions you have about having IVs:
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Use of Labor Stimulants

There are several ways to stimulate labor. Position changes and nipple stimulation are natural ways to progress labor. The following are common ways used to stimulate labor:

• Rupture Your Membranes - commonly referred to as your "water breaking", your membranes may rupture naturally (before or during labor) or artificially (amniotomy). Your clinician may rupture your membranes to help start or speed up (augment) labor or for internal monitoring. Whether it happens naturally or artificially, rupturing membranes is painless. The sensation is a warm, wet, leaking feeling as though a water balloon just broke inside you!
• Pitocin- this is a synthetic form of oxytocin, the hormone that causes contractions. It is given through an IV and may induce your labor or increase the strength and frequency of your contractions. If your labor slows down or does not progress (sometimes this happens after an edpidural), your clinician may recommend the use of Pitocin.
• Cervidil and Misoprostol (cytotec) are medications used to soften your cervix. These medications are administered directly into the cervix through the vagina.

Jot down any questions you have about labor stimulants:
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Controlling Your Pain

You may choose to labor naturally, have pain medications only when you request them, or plan to use anesthesia-based pain control. Your health care providers will support you with your decisions and recognize that your choices may change as you go through labor!

During labor there are several types of anesthesia available to you:

• An epidural is medicine given through a small catheter (tube) placed in your lower back that reaches a specific space near your spine. It relieves pain by numbing you from the waist down. The amount of medication given to you can be adjusted throughout your labor. To adminster an epidural safely, it is administered with continuous fluids passing through the IV. If you're considering an epidural, ask your clinician about the best time for your epidural to be started as it can slow labor when given too early. An epidural will decrease your urge to push, but will not prevent you from pushing. An epidural can safely be given with labor stimulants like pitocin. Some hospitals administer epidurals which permit you to walk and move more freely in your room. This type of epidural is called a "walking" epidural. Ask your clinician if this option is available to you.
• A paracervical block is a short acting (about one hour) local anesthetic injected by your physician into the cervix that may help alleviate pain during active/transitional labor. Paracervical block may cause changes in your baby's heart rate, so you will be monitored closely.
• A pudendal block is a short acting (about one hour) local anesthetic injected into the pudendal nerve (between your vagina and rectum) to help numb the vagina, rectum and area between them. It is given just before delivery by your physician. A pudendal block should not cause changes in your baby's heart rate.

It's important to know that a normal response to epidural or block anesthesia is not feeling the urge to urinate. If you are unable to urinate on your own, you may need to be catheterized (a tube placed into your bladder to drain urine).

Be sure to let your clinician and hospital staff know your plans for controlling pain. If you have further questions regarding these options, please consult your clinician(s).

As I think about it today, I'd like the following plan for pain control:
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Monitoring Your Baby

Fetal monitoring allows your health care providers to observe the baby's heart rate for signs of well being and stress during labor and contractions.

There are two types of monitoring generally used during labor:

• External monitoring is performed using disc-shaped ultrasound monitors placed on your abdomen and secured by belts. It can be used for short periods of time or continuously.
  Some hospitals have monitoring units which allow you to walk or be out of bed. This type of monitoring is called telemetry monitoring. Ask your clinician if your hospital has telemetry monitoring.
• Internal monitoring is done by an electrode that is attached to the baby's scalp. If they haven't already, your membranes will rupture during application. A second electrode may be placed inside the uterus to measure the strength of contractions. This type of monitoring is usually continuous.
  Internal monitoring provides more accurate monitoring of the fetal heart rates and uterine activity. It may also be used to monitor women who have had a previous cesarean-section or to evaluate why labor is not progressing as expected. It may be used when a baby is difficult to monitor externally or shows signs of distress.

Each hospital has a policy on fetal monitoring. Be sure to ask your clinician about the standards for monitoring at your hospital.
I have these questions about monitoring:
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