Labor and birth

  Managing labor and birth!

Soon, you’ll experience the amazing process of childbirth! Find out the signs of labor and learn about your options for giving birth.

Prepare for Labor and Birth

Once you reach the third trimester, you should talk to your doctor or midwife about labor and delivery. Learn your options for pain relief. Find out how to reach her if you go into labor. And ask her at what point in labor should you call.

Before you reach the last few weeks of pregnancy, you and your partner should visit the hospital or birthing center. Make sure you know how to get there, where to park and where to check-in. Find out if you can pre-register so that your insurance information is already in the computer when you arrive.

Signs of Labor

Many women, especially with their first babies, think they are in labor when they’re not. This is called false labor. So don’t feel embarrassed if you go to the hospital thinking you’re in labor, only to be sent home!

If you think labor has begun, you should call your doctor or midwife. They can decide if it’s time to go to the hospital or if you should be seen at the office first. Learn the signs of labor so you will know when the time has come.

Call your doctor if you experience any of the following :

* Contractions that come at regular and increasingly shorter intervals. Contractions should also become stronger over time.
* You have lower back pain that doesn’t go away. You might also feel premenstrual and crampy.
* Your water breaks (can be a large gush or a continuous trickle).
* You have a bloody (brownish or red-tinged) mucous discharge. This is probably the mucous plug that blocks the cervix. Losing your mucous plug usually means your cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start right away or may still be days away.

Choosing Where to Deliver

Many women carefully choose the kind of environment in which to deliver her baby. You will need to contact your health insurance to find out what options are available. Not all companies will cover care given at a birth center and fewer will cover planned homebirths. In general, women can choose to deliver at a hospital, birth center or at home. Nowadays, most hospitals and birth centers offer birthing classes like Lamaze and breastfeeding support.

Hospital

Women with health problems, pregnancy complications or those who are at risk for problems during labor and delivery should give birth in a hospital. Hospitals offer the most advanced medical equipment and highly trained doctors for pregnant women and their babies. In a hospital, doctors can do a cesarean section if you or your baby is in danger during labor. Women can get epidurals or many other pain relief options.

Only certain doctors and midwives have admitting privileges at each hospital. So before you choose your doctor or midwife learn about their affiliated hospital. When choosing a hospital you might consider:

* Is it close to your home?
* Is an anesthesiologist at the hospital 24-hours a day?
* Do you like the feel of the labor and delivery rooms?
* Are private rooms available?
* How many support people can you invite into the room with you?
* Does it have a neonatal intensive care unit (NICU) in case of serious problems with the baby?
* Can the baby stay in the room with you?
* Does it have an on-site birth center?

More and more hospitals are adding on-site birth centers. At these hospitals you can choose to deliver your baby in the comfortable, intimate setting of a birth center. If something goes wrong, you and your baby have the added security of already being in a hospital.
Birth Centers

Healthy women who are at low-risk for problems during pregnancy, labor and delivery may choose to deliver at a birth or birthing center. Birth centers give women a "homey" environment in which to labor and give birth. They try to make labor and delivery a special, warm, family-focused process. Usually certified nurse-midwives, not obstetricians, deliver babies at birth centers.

Birth centers do not do any "routine" medical procedures. So, you will not automatically be hooked up to an IV. Likewise, you won’t have an electronic fetal monitor around your belly the whole time. Instead, the midwife or nurse will check in on your baby from time to time with a handheld machine. Once the baby is born, all examinations and care will occur in your room. By doing away with most high-tech equipment and routine procedures, labor and birth remain a natural and personal process.

Women can not receive epidurals at a birth center although some pain medicines may be available. If a cesarean section becomes necessary, women must be moved to a hospital for the procedure. Basic emergency care can be done on babies with problems while they are moved to a hospital.

Many birthing centers have showers or tubs in their rooms for laboring women. They also tend to have comforts of home like large beds and rocking chairs. In general, birth centers allow more people in the delivery room than do hospitals.

Birth centers can be inside of hospitals, affiliated with a hospital or completely independent, separate facilities. If you are interested in delivering at a birth center, make sure it is accredited by the Commission for the Accreditation of Birth Centers. Accredited birth centers must have affiliated doctors at a nearby hospital in case of problems with the mom or baby.
Homebirth

Healthy pregnant women with no risk factors for complications during pregnancy, labor or delivery can consider a planned homebirth. Some certified nurse midwives and physicians will deliver babies at home. If you are considering this choice you should ask your insurance company about their policy on homebirths. Some health insurance companies cover the cost of care for home births and others don’t.

Homebirths are common in many countries in Europe. But in the United States, planned homebirths are still a controversial issue. The American College of Obstetricians and Gynecologists (ACOG) is against homebirths. ACOG states that hospitals are the safest place to deliver a baby. In case of an emergency, says ACOG, a hospital’s equipment and highly trained physicians can provide the best care for a woman and her baby.

If you are considering a homebirth, you need to weigh the pros and cons. The main advantage is that you will be able to experience labor and delivery in the privacy and comfort of your own home. Since there will be no routine medical procedures, you will have control of your experience.

The main disadvantage of a homebirth is that in case of a problem, you and the baby will not have immediate hospital/medical care. It will have to wait until you are transferred to the hospital. Plus, women who deliver at home have no options for pain relief.

To ensure your safety and that of your baby, you must have a highly trained and experienced midwife along with a fail-safe back-up plan. You will need fast, reliable transportation to a hospital. If you live far away from a hospital, homebirth may not be the best choice. Your midwife must be experienced and have the necessary skills and supplies to start emergency care for you and your baby if need be. Your midwife should also have access to a physician 24 hours a day.

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