There it is. Your first real contraction. Your instincts tell you it's go time. You rush out the door heading to the hospital. You're ready for this. You know what to expect … you think. But what if your doctor needs assistance with the delivery. What then? "Today I see patients desiring less intervention and a more natural birthing process," says John H. Wilters, M.D., department chair of TriStar Centennial Women’s Hospital OBGYN. All the norm now? Babies moving in with Mom and getting skin to skin right after delivery no matter if Baby arrives vaginally or via C-section. Also, waiting for labor rather than being induced at 39 weeks and using a labor coach. Everyone wants healthy babies and healthy moms. While everyone hopes for a typical delivery, Wilters says each woman and baby is unique and vitals change because of that. Sometimes delivery tools are necessary.
MONITORING BABY
"Monitoring your baby’s heart during labor and measuring the intensity and frequency of contractions is standard of care in the United States," says Wilters. It's monitored with an external monitor that rests on your belly. However, Wilters says there are some instances when an obstetrician (or midwife) can't determine the baby’s heart rate pattern (how well the baby is doing in labor) with this device and may discuss with you their desire to place a very thin electrode (fetal scalp electrode) on the baby’s scalp while in utero. In addition to the external monitor, Centennial also has the Novii monitor, an external wireless monitor that helps to monitor the infant of women who desire more mobility during labor. These monitors improve the ability to monitor women who have a higher Body Mass Index (BMI). The hospital also has a variety of labor balls and peanut balls to aid laboring moms with positioning.
WHILE IN LABOR
When your doctor needs to get a fuller view of your cervix, he may use a speculum — like the ones used to perform gynecological exams — although these are rarely used during labor. If your physician decides your cervix isn't changing (the cervix is long and closed, not dilated), he may use a cervical ripening agent such as Cervidil, Oxytocin (pitocin) or Cytotec — which usually helps to dilate the cervix and jump start labor. Once your cervix is dilated, the decision to break your water may be made. An amniotic hook (amni hook) is used for this, and Wilters says breaking the water stimulates labor. Another item that may be used is a catheter. "Babies usually are hanging out in a uterus with lots of water surrounding them," says Wilters. "This is normal and needed during labor as the fluid helps to protect the umbilical cord during contractions." However, Wilters says that when there's minimal or no fluid in the uterus, a contraction can lead to a drop in the fetal heart rate resulting in fetal distress. Doctors insert a small flexible catheter into the uterine cavity to infuse sterile saline. "This technique usually relieves the cord compression and allows labor to continue," he says. The catheter also measures the intensity and frequency of your contractions which isn't possible with an external device.
VACUUM, FORCEPS?
Baby's birth is imminent, but you've been pushing for three hours with no success. Exhaustion takes over, and your doctor determines you will need help. Wilters says this is when you're obstetrician (OB) may — or may not — discuss using a vacuum extractor or forceps. "The vacuum extractor is a flexible plastic cup that fits on the baby’s head," says Wilters. "When you push, the OB uses the extractor to assist in getting the baby to come out. A discussion of the risks and benefits of a vacuum extractor with your OB prior to labor is a good idea." Forceps are another tool Wilters says may be necessary. These large instruments with broad pincers encircle the baby's head and assist with delivery. "Forceps are not used as much as they were years ago," says Wilters. Of course, you will see scissors for cutting the umbilical chord and possibly for an episiotomy. Your OB performs an incision in the numbed (with xylocaine) perineum. Wilters says an episiotomy gives a little more room for the baby to come out and helps to prevent large, irregular lacerations to the perineum. "The episiotomy is easier to repair and heals better than a repair with multiple jagged lacerations," adds Wilters. Of course, discuss an episiotomy with your OB prior to delivery, too. "The better informed you are in this journey to delivery, the more productive your conversations with your OB will be," Wilters says. "Prenatal classes are good ways to gain knowledge — knowledge and understanding will decrease your stress level and that of your spouse," Wilters adds.
