Going to the Hospital or Birth Center

birth center
Sometime during early or active labor, you will decide to go to your place of delivery. Whether or not this is your first baby, the distance to the hospital or birth center, your previous labor history, and your caregiver’s opinion are factors to consider. Learning to recognize the signs of the various labor phases will allow you to judge your progress and thus avoid arriving too early.

When you go to the hospital or birth center, leave all your valuables at home. Take your suitcase, but leave it in the car. do not forget your Lamaze bag. At a hospital, you generally go to the admission office during the day and to the emergency room entrance at night. In many hospitals, you go directly to the labor and delivery unit.

When you arrive at the labor and delivery unit, your partner may be directed to a waiting room. This allows the nurse to speak privately with you. If you wish to remain together, inform the nurse. Not all facilities separate couples upon admission.

When you arrive in the birthing room, you will be asked questions about your medical history, your allergies to medications, and your present labor symptoms. You will also be asked if you plan to breastfeed or bottle feed. If a contraction starts during the questioning, stop talking and go into your breathing pattern. The nurse will wait. Finally, you will be given a vaginal exam to determine cervical dilation and effacement, and station of the presenting part.

After your labor has been verified and you have been admitted, you may be asked to undergo certain procedures depending on your caregiver, desires, and labor progress. Do not consider any of these procedures routine. Depending on your circumstances, they may or may not be necessary.

If delivering in a hospital, you will be placed on an electronic fetal monitor to determine the regularity and duration of the contractions. The nurse will also observe the baby’s heart rate to assess fetal well-being in response to the contractions. (For a further discussion of this, see “Electronic Fetal Monitor“.) If delivering in a birth center, the nurse-midwife will assess your baby’s heart rate by using a doptone and will observe your contractions for strength and frequency. Your blood pressure, temperature, pulse, and respiration will be taken. You will be asked to provide a urine sample, your blood will be drawn, and a vaginal culture may be done to detect the presence of group B strep.

If you are still in early labor, you may be instructed to walk around for a while to increase the strength of the contractions. Your physician may order an enema to cleanse the lower bowel. This is usually a soapsuds enema, which is made with about 1 quart of water and a soap solution. In addition to emptying the bowel, the enema also increases the strength and frequency of the contractions. This procedure will not be done if you are in advanced labor. Many doctors feel that an enema is unnecessary, especially if you have had a good bowel movement within the previous 24 hours. Occasionally, a woman may request an enema if she has been constipated or if she feels that she will not be able to effectively relax her bottom during the pushing stage for fear of soiling the bed. In this case, a small disposable will suffice.

Many facilities provide tubs or showers for laboring women. After the stress of the trip to the hospital or birth center and the admission procedures, relaxing in water can be soothing and can lower your blood pressure. The warm water provides buoyancy and reduces external stimuli, which allows you to relax both physically and mentally. Your relaxed body is better able to produce endorphins, the natural pain relievers. The more comfortable a woman is, the less likely she is to produce stress-related hormones, which can raise her blood pressure or slow the labor. There has been no increase in complications, such as infection, associated with laboring in water, even if the membranes have ruptured.

Most caregivers no longer prep laboring women (shave their pubic hair), since studies have shown that there is no increase in infection and the mother is spared the itching and discomfort associated with the regrowth of hair. If the hair is long, it may be trimmed with scissors. Some doctors do a mini prep (shave the area between the vaginal outlet and the rectum, which is where the episiotomy would be done). This is usually done prior to the actual delivery.

An IV may be started if indicated. To allow for increased mobility, some physicians place a saline lock or heparin lock in the vein. The procedure is the same as for starting an IV, but the bag of fluid is not connected and the line is flushed with either saline or heparin solution to keep the vein open. (For a discussion of this, see “Intravenous Fluids“.)

The Labor Partner’s role as a Support Person

labor partner roleMany women have more than one support person for labor and birth. If you and another person are serving as labor partners, you can work together at times, while allowing each other a break occasionally. Your job is to provide comfort, support, and encouragement to the laboring woman and to remind her of her breathing and relaxation techniques and other comfort measures. If the other labor partner is a trained professional, she can supply the knowledge and technical expertise, while you provide the emotional support.

If you are separated from the mother-to-be during admission, you will be reunited with her within 30 to 45 minutes. When you are finally reunited with your partner, you may find her tense and losing control without your assistance. Immediately start encouraging her to relax and help her with her breathing techniques. Some couples do not want to be separated at all during labor so that the labor partner can assist the woman in remaining relaxed and cooperative from the start and can help her avoid the panic some women feel when they are left alone. Make your request during the admission procedure.

A few physicians still ask the labor partner to leave during exams and other procedures. Discuss this with your caregiver in advance.

For a summary of the labor partner’s role during labor, birth, delivery of the placenta, and bonding and recovery, see Table 6.2