Arrival to the Labor Unit
Upon admission to the labor unit, you will be asked to read and sign several consent forms:
- Admission and treatment
- Vaginal and/or Cesarean delivery (although most women are expected to deliver vaginally, sometimes the medical conditions of the mother or baby require a Cesarean delivery)
- Blood transfusion (in the unlikely event that it becomes necessary)
- HIV testing (as required by Texas law)
- HIPAA- Health Insurance Portability and Accountability Act
Notifications of the Baby’s Doctor
You will be expected to name your baby’s doctor so the staff can notify the doctor after the baby is born. If your chosen doctor does not admit babies to the hospital where you deliver, a doctor will be assigned to your baby during your baby’s stay and you will follow up with your chosen doctor after discharge.
Nursing care and procedures to expect:
- Your nurse will ask questions about your pregnancy and check the vital signs of you and your baby
- You will be asked to sign consent form for admission, treatment and both a vaginal or surgical (Cesarean section) delivery
- Your blood will be drawn and you will be asked for a urine sample for routine lab tests.
- An IV (intravenous fluid line) may be started.
- You may be allowed to walk in the halls and shower (as long as you and baby are progressing without problems)
- Your contractions will be monitored ( either intermittently or continuously by electronic monitor) to make sure you are progressing without problems
- Your cervix will be checked periodically by the nurse or doctor
- Your vital signs, and your baby’s heart rate will be monitored (intermittently or continuously as needed)
- Your contractions may get longer and stronger as the time for delivery nears.
- Labor is a natural process that can be painful. The maternity staff believes that managing your pain is an important part of your care. To help us manage your pain, we will ask questions and have you rate your pain on a scale from zero (no pain) to 10 (the worst pain you have had). Breathing and relaxation techniques, massage, showers, rocking and frequent position changes are some of the choices you have for coping with labor pain. You may also choose an epidural, or medicine in your IV to help with the pain.
If you choose an epidural for vaginal delivery, you will first receive a bag of IV fluid and will need to have your bladder emptied periodically by catheter.
The length of each person’s labor is very individual to that person’s history and unique circumstances. An average length of labor to expect is 12 to 24 hours.
- When your cervix is fully dilated (10 centimeters), you will be asked to begin pushing with each contraction. Pushing may last as short a time period as 5 minutes or as long as 3 hours.
- Your chosen “significant other” will be allowed to stay with you during labor and delivery or Cesarean section. (Exceptions are when an epidural or spinal anesthesia is being inserted, during delivery with general anesthesia, or at the discretion of hospital staff when unexpected circumstances arise. Your significant other will be asked to wait outside during these times.)
Choosing Anesthesia at Childbirth*
When the time comes for you to enter the hospital to deliver your baby, you will be faced with some choices concerning whether or not to have anesthesia, and if so, what type of anesthesia. You will need to make rational decisions with your obstetrician and anesthesiologist. If you desire or need anesthesia while having your baby at a Seton hospital, it will most likely be administered by a physician from Capitol Anesthesiology Association. If you have a question and would like to talk to a nurse in the anesthesia department, you can call 324-1153.
The choice of anesthesia is based on your needs and wishes, the needs of your obstetrician, and the judgment of your anesthesiologist. Our main concern is the safety of you and your baby. The most common types of obstetrical anesthesia delivered by Capitol Anesthesiology are epidural and general anesthesia.
Epidural anesthesia is the most frequently used form of obstetrical anesthesia because it can be used during labor, and then extended for vaginal delivery or Cesarean surgery. A medication is placed in the epidural space by an injection. The epidural space is an area on your back between the tough ligament that connects the vertebra and the lining of the spinal canal, the dura. Epidural anesthesia may be used for relief of labor discomfort or as the complete anesthetic for a Cesarean section.
To receive epidural anesthesia, you will be asked to roll into a tight ball and to arch your back outward. The more effective you are in this maneuver, the easier it is for us to administer the anesthesia. A local anesthetic, or numbing medicine, will be injected into the area where the epidural is to be placed. A larger needle will then be used to access the epidural space. There may be some discomfort during this part of the procedure, but it is generally mild. Once the needle is in place, a small plastic tube or catheter is threaded through the needle and into the epidural space. The needle is then removed and you will receive medicine through the small tube.
If the epidural is for management of pain during labor, we will inject the medication into the epidural space once the labor is progressing well. Your blood pressure and the progress of your labor will be monitored closely while the anesthetic is administered. Generally, the epidural takes 10 to 15 minutes to take full effect.
If the epidural anesthesia is for a Cesarean section, you will receive oxygen as part of the routine care. During the Cesarean section we will continue to monitor your vital signs closely. During surgery you will be aware of the movement of your body and the pressure on your abdomen as the baby is delivered, but you should be comfortable during the Cesarean surgery.
If you, your obstetrician and your anesthesiologist concur, your epidural pain relief may be extended to the postoperative period by injecting morphine into the epidural space. This highly purified morphine will be administered through the catheter just before it is removed after surgery.
Most women experience good continued pain relief for 8 to 12 hours after surgery. Although some women experience itching of the skin, most feel that it is a minor discomfort in light of the pain relief they gain from the epidural morphine. The management of this service will result in an additional charge.
Side Effects of Epidural Anesthesia
In general, epidural anesthesia for labor does not make you totally numb, and occasionally some discomfort continues. Infrequently you may feel a “hot spot,” a small spot of discomfort. We can try a number of things to relieve a hot spot. sometimes replacing the epidural catheter is necessary. Occasionally, however, these hot spots cannot be helped.Your blood pressure may fall after administration of the anesthetic agent; occasionally some nausea and vomiting may occur. In many instances patients get “the shakes” after receiving an epidural. These are somewhat distracting but rarely uncomfortable.
During labor we will supply additional medication through the catheter as you need it. Occasionally labor progresses very fast after the epidural medication is administered. There may not be enough time for you to get adequate pain relief before the baby is born. If labor proceeds rapidly after the epidural is placed, the obstetrician may need to supplement your anesthesia by infiltration of local anesthetic in order to do an episiotomy or to use forceps.
Risks of Epidural Anesthesia
Although epidural anesthesia is a widely accepted form of obstetrical anesthesia, it is not without possible complications. These are uncommon and in general are easily treated. With epidural anesthesia there is a possibility of residual backache and/or spinal headache. Also, rarely a seizure can occur from too rapid absorption of local anesthetic into the bloodstream. On rare occasions a numbness or tingling in one leg may persist after the anesthetic wears off. Levels of anesthesia which are high can occur and may require some assistance in breathing until the anesthetic dissipates. Another problem which can arise is an incomplete or unsuccessful block. In this case, some other form of anesthetic may be required.
The successful management of these potential problems requires the anesthesiologist to remain available in the hospital for the full course of the anesthetic. The anesthesiologist will confer with the obstetrician concerning the anesthetic to be administered for each individual patient.
General anesthesia will put you “to sleep.” It is used for Cesarean sections or occasionally for other obstetrical procedures. First, you will be prepared for surgery. When the surgical team is ready, you will be put to sleep by an injection into your vein through the IV. We use a small amount of anesthesia during the beginning of a Cesarean section to minimize the amount of drug that the baby receives.
Side Effects of General Anesthesia
Usually the side effects of general anesthesia are minor and mild. Nausea and vomiting can occur and occasionally require treatment with anti-nausea medications. Some patients experience a sore throat after general anesthesia, but this is usually mild.
Risks of General Anesthesia
Risks of general anesthesia for Cesarean sections are similar to those of general anesthesia for other surgeries. Additionally, in pregnant patients it takes longer for the body’s normal mechanisms to empty the stomach. Therefore, there is greater risk of vomiting and aspirating gastric contents into the lungs when anesthesia is induced. Because the baby is exposed to the anesthetic agents that are injected into your body to put you to sleep, we use the smallest possible amounts of these drugs. As a result, women occasionally hear loud noises or have vivid dreams during the early part of anesthesia.
Effects of Anesthesia on Newborns
A normal uncomplicated epidural anesthesia has virtually no effect on the newborn infant. As mentioned, general anesthetics have varying effects on the newborn depending on the duration of exposure. Exposure is usually minimal and the anesthetics do not cause developmental or congenital problems when exposed during delivery.
For more information, visit www.capanes.com.
*Information provided by Capitol Anesthesiology Association.
Cesarean delivery is delivery of your baby through an incision or surgical opening in your abdomen. Cesarean section may be needed due to certain conditions of the mother or baby. If you need to have a Cesarean delivery your doctor or clinic provider will explain the reason.
If you are scheduled for a Cesarean section:
- Plan to arrive at least 2 hours before your scheduled start time.
- You will need to consult with an anesthesiologist to discuss options for anesthesia (preferably before your scheduled date).
- Follow your doctor’s specific instruction for eat and drinking before surgery. Most doctors specify no food for at least 8 hours before surgery.
For all Cesarean deliveries:
- Your abdomen will be washed and shaved.
- A catheter will be inserted to keep you bladder empty
- You will receive an epidural, spinal or general anesthesia. ( Your partner will be asked to wait outside the delivery room if a general anesthesia is used.)
- You will be in the surgical area for delivery for about 1 hour. (The baby is usually delivered in the first 5 to 15 minutes, and the rest of the time is spent closing your uterus and abdomen.)
The type of incision you receive will depend on the reason for the Cesarean, the position of the baby, position of the placenta, and your doctor’s preference. You will most likely receive a “bikini cut” (low, horizontal line across your lower abdomen) unless it is an emergency delivery and a “classic incision” (vertical line between your umbilicus and lower abdomen) may be faster.
Labor Induction and Augmentation
A labor induction is a procedure that artificially starts labor. Labor may be induced by giving a medication (intravenously or vaginally), or by physical stimulation (stripping or artificial rupture of your membranes by a doctor). Sometimes a pre-induction treatment is required. Your doctor or clinic provider will explain procedures and reasons for induction.
If a labor induction is planned for you:
- You and your doctor or clinic provider will schedule a start time with the hospital.
- You generally are not allowed to have anything to eat or drink after midnight the evening before your scheduled induction.
- You should notify your doctor or clinic provider of any changes in your health as soon as possible before your scheduled induction.
- Labor augmentation is use of medication (Pitocin) to improve the progress of your labor. Your doctor may recommend augmentation to increase the strength and frequency of your contractions if your labor is progressing slowly.
As soon as the baby’s head is delivered, baby’s nose will be suctioned. As soon as your baby’s body is fully delivered and appears healthy, your baby will be laid at your breast or dried and wrapped in blankets for warmth. Baby’s footprints will be imprinted onto paper, and matching identification bands will be placed on mother, baby and mother’s choice of significant other. You will be encouraged to cuddle and feed your baby as soon as possible after delivery.
(Within the first 2 hours after delivery)
- Your nurse will continue to check your condition after delivery.
- Your abdomen will be massaged periodically to minimize bleeding and to make sure your uterus stays firm.
- If you delivered vaginally, an ice pack may be applied to your vaginal area to minimize swelling.
- Your IV will stay in place for about 1 to 2 hours for a vaginal delivery and usually up to 24 hours for a Cesarean section (until your vital signs and bleeding are stable).
- Your significant other will be allowed to stay with you during the recovery time, or go to the nursery with the baby if necessary.
- Your baby will be weighed, measured and bathed.
- Your baby will be given a vitamin K shot to aid in blood clotting, and an antibiotic eye ointment to prevent eye infection.
- You will be encouraged to breastfeed your baby as soon as possible after delivery. (Babies are generally the most alert and ready to feed in the first 1 to 2 hours after birth.) Your nurse will assist you with positioning and feeding.
- Be sure to wait for a nurse or nurse assistant to help you out of bed the first time or two. You will be encouraged to walk in your room as soon as your condition allows (1 to 2 hours after vaginal delivery and 8 to 12 hours after Cesarean section). Your nurse will let you know when your condition allows you to get out of bed without nurse assistance.
- Postpone visitors until after the immediate recovery so that the nurse may monitor you and your baby closely.
(2 hours or more after delivery)
Once you are past the immediate recovery period of 1 to 2 hours, your condition may not require such frequent monitoring by the nurses. You will be transferred to the Mother/Baby Unit for the rest of your hospital stay. You will be allowed more privacy and time to rest and recover with you new baby and family. The staff is readily available when called to assist you and teach you all you need to know about mother and baby care. This is the time to learn all you can about what you need to know to care for yourself and baby at home. Take advantage of all the available reading materials, television programming and one-on-one instruction from the staff.
Routine Mother Care
- Your nurse will periodically monitor your recovery. Your uterus will be checked for firmness, and your vital signs will be monitored.
- An ice pack may be used in the first 12 to 2 hours to minimize swelling and discomfort in your vaginal area.
- Pain medication is available at your request for any discomforts. Please don’t hesitate to ask for pain medication by pushing your nurse call button.
- All new mothers should rinse with warm water each time they go to the bathroom for up to 6 weeks after delivery. This rinses away germs and vaginal discharge. A plastic squeeze bottle is provided for this purpose.
- A sitz bath (warm water soak) and TUCKS (witch hazel pads) are available to sooth and cleanse your episiotomy stitches and hemorrhoids.
- If you had a Cesarean section, bandage changes will be necessary after showering. If your incision was closed with staples, the staples may be removed by your nurse or doctor before you go home, or in the doctor’s office at your first visit.
- Expect to stay in the hospital 24 to 48 hours after the baby is born by vaginal delivery, and 3 to 4 days by Cesarean section.
You will be asked to sign additional consent forms after the birth of your baby:
- Hepatitis B vaccine for your baby
- Circumcision (if you plan this choice for your baby boy)
It is a good idea to discuss circumcision and vaccinations with your baby’s doctor or clinical provider during your pregnancy. If you make the decision before you enter the hospital, you will feel less pressured for time to make your decision before you go home.
Routine Baby Care
You will enjoy more opportunities to learn basic baby care before you go home while you room in with your baby. The nursing staff is available to provide hands-on assistance. You will be given written instruction to take home as a reference. Take advantage of every opportunity to learn while there are staff members available to answer questions. Your baby’s crib will be stocked with all the basic diapering and daily care supplies you need. Clean blankets and T-shirts are provided for your baby while in the hospital, but are not to be taken home.
- The baby’s nurse will be monitoring baby’s health and vital signs periodically
- Your baby will receive a blood test call “Newborn Metabolic Screening,” which is required by law
- Circumcision, if chosen for your baby boy, is usually done on the day you go home
- A newborn hearing screening will be offered for your baby as required by Texas Law. There is a fee for the screen that is generally covered by insurance.
- The first Hepatitis B vaccine may be given before your baby goes home (depending on the preference of your baby’s doctor).