Birth may be a matter of a moment.

But it is a unique one. –Frederick Leboyer–

LABOUR AND DELIVERY

To my patients, as you approach your due date, you will have some questions about labour and delivery. If you have attended prenatal classes or been on a hospital tour, the information in this handout about contacting us and when to come to the hospital will supersede anything that you have been told in your prenatal classes.

Knowledge Base

When can I expect to go into labour?

Your due date is only a rough guide as to when you are expected to have your baby. The majority of patients tend to go beyond their due date. This is quite normal. You are only overdue if you have gone ten days or more beyond the due date. There might be some discrepancy between your dates from your last menstrual period and your due date based on the early ultrasound. We usually choose the date based on the early ultrasound as being more accurate. So if you reach and go beyond your due date, do not panic. This is quite normal. There is really nothing that you can do to put yourself into labour. Brisk walking, exercising and all the other old wives’ tales will cause an increase in the Braxton Hicks’ contractions but they will not necessarily cause your labour to start.

What happens if I have some bleeding?

It is very common from 36 weeks to have some spotting and staining. This is quite normal and no need for concern. You might find some spotting and staining after exercise or after going to the washroom. You do not need to worry and continue as normal.

If you have bright red fresh bleeding on your pad that is bigger than the size of a tooney, you should contact me. Preferably, come straight to the hospital so we can examine you and see where the bleeding is coming from.

When labour starts, it is common to have bleeding which can also be mixed with mucous. This is called the show. This bleeding is quite normal and there is no need to be concerned. If the blood has soaked your pad come to the hospital so you can be examined.

What do I do if my waters break?

Contrary to popular belief, your waters will probably not break before you go into labour. Approximately 10% of women break their waters before they go into labour. It is common to have an increase in the vaginal discharge as you get to your due date. When you stand up in the morning after having been lying down for most of the night or stand up after having been seated, you might notice a small trickle of discharge. This is usually a one off thing and does not continue. If you do break your waters, it is usually quite obvious. Signs to watch for are a soaking gush of clear fluid, which will usually soak your underwear, clothes and the bedclothes if you are in bed. The amount of fluid leaked is usually more than the discharge that you are used to seeing up to this point. You may also have what is called a hind water leak. In this case the amount of fluid leaked is not as dramatic but it tends to be an ongoing leak, which usually ends up soaking your pad every hour or so, much more than you usually see with your normal discharge. The water is usually clear or may have a pinkish tinge. It may have a peculiar odour.

If you think your waters have broken and you do not have group B strep. and are not in labour you can wait at home for up to 6 hours to see if you go into labour on your own. Make sure that the water is clear and the baby is moving at regular intervals. If you are at all concerned about yourself or the baby please come to the hospital. There is no need to rush in. I advise that you have something to eat and even have a shower before coming to the hospital. Once you are admitted to hospital we will monitor the baby and confirm that your waters have broken. If the water is clear and everything else is normal, we will send you home until the following morning. Hopefully, you will go into spontaneous labour during this time. However, by the following morning, if you have not gone into labour, the hospital will call you and bring you back so that an induction of labour can be started.

If the hospital has not contacted you by noon of the next day, call me or you can call the hospital at 604–875–2165 and ask to speak to the charge nurse about your induction.

If you think that your waters have broken and you have group B strep. come to the hospital. You have time to have a shower and to eat something before hand, as once you are admitted you will probably not be allowed home. If you are not in labour we will start you on some intravenous antibiotics and give you some medication to help get you into labour. This process is call an induction of labour ( see my note on induction of labour).

How do I know when I am in labour?

First, if you think you are in labour, you are not. When labour starts, you might notice some vaginal bleeding and a mucusy vaginal discharge. It is very common to have menstrual-like cramps in the third trimester. When labour starts, the labour pains are very different to these menstrual cramps. Labour pains typically get stronger, last longer and become more intense over a period of time. They can be felt anywhere over the uterus and also in your back. It is also common to have some diarrhea before labour starts.

Early labour or false labour is the time period that it takes for the labour pains to become painful, regular and strong enough so as to dilate your cervix. This process can last from a few hours to a few days. During this time you will feel these pains become more intense and uncomfortable. However, in early labour you will still be able to walk and talk during a contraction. They may also be irregular in their frequency and intensity.

You are in real labour only when your contractions are so painful that you cannot walk or talk when you have a contraction. They should also be 3 to 5 minutes apart and last about one minute long.

My advice is to stay at home until the contractions are every 3 to 5 minutes apart. You count from the start of 1 contraction to the start of the next contraction. The contractions should last about 45 seconds to 1 minute in duration. However, the most important criteria to take note of are that the contractions should be painful enough that you cannot walk or talk during one.

Once the labour pains are 3 to 5 minutes apart, lasting 45 seconds to a minute, and you cannot walk or talk during the contraction, you are now in active labour and you can now come to the hospital.

Who do I call before I come to the hospital?

You do not need to call the hospital or me. Once you have been admitted to the hospital, the nurses will call me or one of my colleagues. It is usually the doctor on call who will be paged and informed that you have been admitted.

Where do I go to when I arrive at the hospital?

You may park in front of the Admitting area. If there are no parking spaces available, you may park in the doctors’ parking spaces for a short time while you check in. If you are too uncomfortable to walk into the hospital, stop the car in front of the door and get your partner to go inside and ask one of the nurses for help. When you check in, leave your bags in the car.

What will happen to me after I have checked in at BC Women’s Hospital?

After you have registered at the Admitting desk, you will be taken to the Assessment Room where you and your baby will be checked. If it is very busy, there might be a bit of a wait before you have a nurse and a bed available for you. Your prenatal records will be at the hospital so the nurses should have all the information about you and your pregnancy.

Once in the bed, the nurse will check your baby’s heartbeat and also perform an internal examination to check your cervix.

If your cervix is 3 cm or more dilated, you will be admitted to a birthing room. Once again, there may be a delay at this point until there is a bed and a nurse available to take you through into the birthing rooms.

Once you are settled in the room, get the bags from the car. If you are parked in short-term parking in front of the Admitting area, move the car to the long-term parking spaces. Bring the bags into the labour room before you move the car, as there may be quite a walk back to the room.

What happens if my cervix is not 3 cm. dilated?

If your cervix is not 3 cm dilated or if your contractions are not frequent or intense enough, you are not in active labour and therefore you will not be admitted to a labour room at this point. You will probably want to go home to a more comfortable and familiar environment and wait there until the contractions are more frequent and intense before returning to the hospital. Before you go home, you can request something for pain. Morphine is usually offered to you at this time so you can go home and have a rest before returning to the hospital.

What can I do while I am at home to make myself more comfortable?

It is important to keep drinking and if you feel like it, you can continue to eat. Eat whatever you have an appetite for but don’t eat large quantities. Find a position that is most comfortable for you. Most women find that standing and leaning forward during a contraction is the most comfortable position for them. However, it is quite acceptable to sit, lie or stand.

Having a warm shower or lying in a warm bath is also quite comforting. Do not have a bath if your waters have broken but you may shower. Your partner can also massage your lower back using the hands or a small ball. Applying a warm heating pack to your lower back is also quite comforting.

Wait at home as long as you can. When you feel that your contractions are very painful, regular and frequent, come back to the hospital. You do not need to call us; just get going. Once you arrive the admitting process will be repeated.

Do I need to book a private room?

You will labour and have your baby in a private room. Once you have had your baby you will be moved to a postpartum ward. Most of these rooms are private. When you check into the hospital, you will asked you if you want to secure a private room. This will cost you approximately $150 a day. Extended medical plans cover this and there will be no charge to you. Included in the package are a parking pass and a coupon for baby photos from the hospital baby photographers.

If you do not have extended medical coverage do nothing, as there is a good chance that you will get a private room.

How do I get one of the new birthing suites?

The single room maternity care unit (SRMC) is a unit on the second floor of the hospital where you deliver your baby and stay in the same room until you are discharged. These rooms are a little more spacious and are a little more modern. They have a shower and a tub in the room. The rooms are allocated on a first come, first serve basis. When you are admitted, feel free to ask the nurse if there are any beds available on the SRMC unit. Before being admitted to the unit, you have to fulfill the criteria for admission to this unit. You have to have a low-risk pregnancy. There is no extra charge for these rooms.

If you do not have extended medical coverage do nothing, as there is a good chance that you will get a private room.

When will I meet the doctor?

You will usually meet myself or one of my colleagues only once you have been admitted to the labour room. Depending on how busy the unit is and what we are doing, we would sometimes be able to see you in the Assessment area. However, in most cases, we will see you once you are admitted to the labour unit. You may ask the nurse to page us if we have not been in to see you after you have been admitted.

How many people can I have with me in the labour room?

You can have as many people as you wish accompanying you in the labour room.

Pain control – What can I have and when can I ask for it?

For information on pain control see visit our Pain Control in labour section.

When is too late to get an epidural?

It usually takes 30 minutes from getting the epidural until it makes you comfortable. If you are fully dilated or progressing rapidly you may not have time to get an epidural, as you will probably have the baby before you get comfortable. However, in your first labour, as the progress is usually a little slower, you may be able to get the epidural at any stage in labour, even if you are fully dilated.

How will my baby and I be monitored in labour?

There will be a nurse with you at all times during your labour. She is there to support you and make sure that both you and your baby are safe. You will have your blood pressure and temperature checked on a regular basis. The doctors from my call group and the residents will check your cervix approximately every 3 hours. The nurse will listen to your baby’s heartbeat every 15 minutes during labour. The aim is to keep your labour as natural as possible and for you to be as free and unattached to monitors as possible. In labour, should the nurse hear an abnormality in the baby’s heart rate or if you need to be given oxytocin, we then monitor the baby’s heart rate continuously. This is done by putting a small monitor on your belly. The monitor is attached with a soft strap that goes around your belly. When we monitor the baby’s heartbeat, it is quite common and normal for the baby’s heartbeat to drop for a short period from time to time. When this happens, the doctors are often called. Do not panic if you see us coming into the room. We are simply there to monitor the heart rate, which usually picks up and goes back to being normal. The nurse may also change your position and make you lie on your side to help get more blood and oxygen to your baby. We may also get you to put on oxygen mask for a few minutes.

If we are concerned about the baby’s heart rate in labour we may want to monitor the baby even more closely. We do this by putting a “clip” on the baby’s scalp. This does not hurt the baby. We may also do a test on the baby in labour to see if the baby is getting enough oxygen. This involves making a tiny prick on the baby’s scalp so we can get a drop of the baby’s blood. We then check the amount of acid in the baby’s blood to help tell us if the baby is doing well. If the labour is stressing the baby we may need to get the baby delivered sooner and this may mean having a casearen section.

We expect you to dilate at about 1 cm hour. Only once you are fully dilated—that is, 10 cm—can you start to push.

How long will my labour last?

This is very difficult to predict but the average first labour last approximately 10 to 14 hours. Your cervix will dilate at approximately 1 centimetre per hour and as the cervix has to get to 10 centimetre s before you can start to push this stage of labour can take between 6 and 12 hours. The pushing stage usually takes between 1 to 3 hours.

Who is going to deliver my baby?

Having had the pleasure of getting to know you and looking after you in your pregnancy I would really like to be with you during your labour and deliver your baby. However, as you can imagine it is impossible to work all day and night 7 days a week. Having babies can also be a very long and sometimes stressful process. For you and your baby’s safety the hospital authorities have limited the number of hours that doctors are able to work in a shift. We are allowed to work only a 12-hour shift and then we have to have a rest. This applies to all doctors who deliver babies at B.C. Women’s Hospital. As much as I would like to be with you and deliver your baby, this may be impossible. What this means for you is that there may be a number of physicians and nurses looking after you during your labour. Rest assured that if I am not present you will be looked after by one of my specialist colleagues. Our way of managing your labour is the same, and your safety and comfort are of the utmost importance. Our way of managing your labour is the same and your safety and comfort are of the utmost importance.

If I do not see you in labour I will still get to see you in the hospital before you go home. I am usually at the hospital every weekday to see my patients. These visits are usually early in the morning before work or after work in the afternoon.

How will I know if I need a Cesarean section?

Unfortunately, in most cases there is no way of predicting this prior to your labour. Factors during your labour, such as the health of your baby, your health and the progress of labour, will determine whether you need a cesarean section or another procedure to help you deliver your baby.

We can make this decision only during the process of labour. If a cesarean section or any other procedure is required, we will first explain to you what our concerns are, what procedure we recommend and the options that are available to you. We will also explain the risks of the procedure to you and your baby. If the situation allows you will be given some time to discuss these options with your partner and to ask us questions.

What happens to my baby after it is born?

B.C. Women’s Hospital has a baby-friendly policy. The plan is to keep the baby with you at all times. As soon as the baby is delivered and as long as there are no complications, the baby is put directly on your skin. We try to wait 1 or 2 minutes before cutting the cord. We encourage skin-to-skin contact as soon as possible. There will be a pediatrician present in the room at the birth but if all goes well, the baby goes to the mom first and the pediatrician sees the baby some time after the birth.

Your partner is more than welcome to cut the cord if they so wish. The baby usually stays with you and you can start to breastfeed almost immediately. Only if there are any concerns about the baby’s condition at birth will the baby will be taken from you and examined by the pediatrician. A pediatrician sees the baby within the first 30 minutes after the birth. A pediatrician sees the baby within the first thirty minutes after the birth. This examination only takes a few minutes. After this examination, the baby is returned to you for feeding and cuddling.

How long will I stay in hospital?

The typical stay after an uncomplicated labour is usually 2 nights after the delivery. This is only a suggested length of stay. If all is well with you and your baby, you can leave a little sooner, although I usually do not recommend this. There is usually a lot to learn during your short stay in hospital. If necessary, your stay in hospital can be longer.

Once I go home who do I call if I have a question or a problem?

If you have a non-urgent question, feel free to call my office at 604–874-6848 during office hours and I will return your call at the end of that working day.

If there is an urgent situation requiring immediate assistance, phone 604–875–3070. This will get you the nurse in the Assessment Room who may be able to help you. If you wish to speak to a doctor, please phone 604–875–2161 and ask for the Level I doctor on call.

What happens after I go home?

After you go home the community nurses will usually contact you the following day and they will usually come and see you within 48 hours after coming home. Your baby should see your family doctor within 5 days of discharge from the hospital.

You should call me if you have any problems with your recovery. I would like to see you 6 weeks after your delivery. Please call the office to set up an appointment when you get home from the hospital.

We are expecting a son in a few months. Should I have him circumcised?

This is one of the more controversial topics in pediatrics today. The American Academy of Pediatrics, in their most recent Circumcision Policy Statement, concluded that “data are not sufficient to recommend routine neonatal circumcision” and that “parents should determine what is in the best interest of the child.” More detailed and specific information is available in my website: circumcision

PAIN CONTROL IN labour

If you are in early labour and you are not being admitted to the hospital, if you wish we can give you some morphine and gravol as an injection to help you cope with the contractions and help you get some sleep when you go home. These medications are safe to use in early labour. They help take the edge off the pain so that when you go home, you are able to rest while you are waiting for your labour to become more established.

Once you are admitted to the labour ward, the options of pain control are as follows:

Positional Change and Massage

With the aid of your nurse, find a position that is most comfortable for you to labour in. Most women like standing and leaning forward during a contraction. We have large air-filled balls, which you can sit on or lean on to help make you feel more comfortable. A lower back massage, especially during a contraction, may help you cope with labour.

Take a Shower or a Bath

There are showers available in most of the labouring rooms. Only some rooms have a bathtub. A lot of women find that warm water on their lower back helps alleviate the pain of labour. Your partner can get into the shower with you if they want. Make sure they pack their swimsuit.

Nitrous Oxide Gas or Laughing Gas

This pain control option involves putting a mask over your nose and mouth during a contraction and sucking in the gas. A lot of women find the mask makes them feel claustrophobic and the gas makes them nauseous. The gas also can make you dizzy. If you like the gas and it is helping you cope with the labour pains you can continue to use the gas for as long as you want. If you do not like the gas stop using it and consider the epidural.

Epidural

This is the most effective form of pain control in labour. Most of my patients who have had an epidural in labour say that they just loved it. The aim is to make you comfortable in labour so that you can get some rest and not be too exhausted when it comes time to push. It also helps make your labour a more relaxed and enjoyable experience. You can get an epidural only once you are admitted to a labour room. You will need to have an IV started before getting the epidural. The nurse usually does this. The anesthesiologists administer your epidural. This involves inserting a small tube in your lower back. You will be given a local anesthetic over the area before getting the epidural so you will not feel pain when it is inserted. The thought of having a needle and a tube inserted into the lower back can be very frightening, but most women hardly notice the epidural going in. The epidural is inserted in between contractions.

At Women’s Hospital, we use what is called the “walking epidural.” This epidural should allow you to be mobile and change position in labour. It may even be possible for you to walk with the epidural in place. This may help improve the efficiency of your labour. It is common to feel some pressure in the pelvis during a contraction but if the epidural works correctly you should not feel any pain.

We can keep the epidural working no matter how long your labour lasts. If you start to feel pain during labour, we have ways of boosting the medication in order to make you comfortable again. An epidural will typically slow your labour down and so it is quite common for us to start a medication called oxytocin to help get you back into labour after you have the epidural. Oxytocin is safe for use in labour.

The epidural may have some side effects. It may make you itchy and it is also common for it to cause you to shake just as if you were cold. It may also make you nauseated. If you are nauseated or itchy we have medications to help with these side effects. Epidurals can cause some lower back pain after the labour and this may last for a few weeks but will eventually go away. The risk of developing any long-term back injury or spinal cord injury is extremely rare.

Once your cervix is fully dilated and it is time to start pushing, there is no point in pushing if you are completely frozen from the epidural. You will not be able to push effectively and you will be wasting your energy. What we usually do at this point is to turn the epidural down. The aim is for you to feel pressure but no pain. This will allow you to push more effectively while still allowing you to be comfortable. Do not start to push until you feel pressure in your pelvis. This pressure should feel like you need to go to the washroom.

The epidural is safe for your baby. The medication administered does not go into your blood and therefore does not cross over to the baby or your breast milk. It will not affect your breast milk production or your ability to breastfeed.

There might be a bit of a wait getting the epidural depending on how many anesthesiologists are working and how busy the unit is. The epidurals are usually administered on a first come first serve basis, so if you feel you would like to have one, ask for it early.

Once you have an epidural in place you will probably not have any sensation to empty your bladder. We often have to put a little tube into your bladder called a catheter to help you empty your bladder. This does not hurt.

If you feel the situation is urgent and cannot wait for a phone call then come directly to BC Women’s Hospital and we will be happy to see you there.

When Is Too Late To Get An Epidural?

It usually takes 30 minutes from getting the epidural until it makes you comfortable. If you are fully dilated or progressing rapidly you may not have time to get an epidural, as you will probably have the baby before you get comfortable. However in your first labour, as the progress is usually a little slower you may be able to get the epidural at any stage in labour, even if you are fully dilated.