Top 5 Childbirth Questions

As answered by Leslie Menghi-Parzygnat, RN & CCE

1. What can I do to help me have a “natural” vaginal birth (natural means no medication or epidural) and what should I bring to help me have a natural birth?

I would say the most important thing to do would be to frequently practice which ever birthing technique you chose to use early on in your pregnancy until you are ready to give birth. Whether it is Lamaze, Bradley or Mongan- the more often you use a technique the better response you are bound to have. In my opinion, the most important things to bring into your birthing room is a well prepared positive mindset, good support people, and whatever tools you plan to use that you have practiced with (such as relaxation techniques, a focal point, massage tools/oils/lotion, breathing, music, aromatherapy, hypnotherapy, guided imagery, hot/cold packs, birth ball, etc). And hopefully you have dedicated enough practice time with these tools to ensure they will be effective.

2. When can I have an epidural?

You can actually have an epidural at any time during your labor, but the standard response is: you should be in active labor and between 4 -7 centimeters. The reason for this is because the doctor wants to make sure you are really in labor with an established contraction pattern. Having an epidural “too early” (1-3 cm) can slow your labor, which may mean the drug Pitocin may have to be used to re-establish a contraction pattern. If you get an epidural “too late” (8-10 cm) you may not get the effect you were looking for and may not be able to feel the contractions well enough push effectively. In my experience, most women who choose to get an epidural are happy with the pain management results. Please speak to someone in the anesthesia department or attend a Childbirth Education class to learn about the benefits and risks of epidurals so you can make an informed decision. Also check with your doctor to see what their guidelines are.

3. Do I have to have an episiotomy?

I always say that you have the right to say ‘No’ to anything you may not want, but you need to make sure you are not putting you or your baby at risk. I also encourage you to speak in advance to your Obstetrician about their use of episiotomies. Episiotomies are not as common as they used to be and most doctors allow the perineum to stretch on its own during the birth process. You can practice perineal massage to help prepare this area of tissue for birth, but there is always a risk you may still tear the perineum even if you have done perineal massage. There are 2 types of incisions- a midline and a mediolateral. The midline is an incision that starts at the vaginal opening and goes toward the anus. There is a very small risk with this one is that is may extend into the anal sphincter. The mediolateral incision starts at the vaginal opening and goes at an angle toward the buttocks. Women find this one to be a bit more uncomfortable during recovery. I find that a slow, controlled emergence of the baby’s head will help give you the best chance at an intact perineum, but again it is up to you to have the self control during the pushing phase to do this.

4. What does a Labor Support professional do?

Labor Support professionals are somewhat like a Doula. They provide the same emotional support and encouragement to the laboring woman and her Coach (whomever the laboring mom chooses), but the difference is that a Labor Support person is usually a medically trained person, such as a Registered Nurses who has Labor & Delivery experience- where as a Doula is trained in a class and then attends several births to get her certification. There is usually a “Hawthorne Effect” for the laboring woman- which means a person does better when a trained person is present. Most will offer a prenatal meeting and see if you are a good match and if you decide to use her, then a contract is signed. Some charge for this first meeting, some do not. Most provide telephone support and are available to answer questions during your pregnancy until you go in to labor. When you go in to labor they stay with you until you give birth. Most will stay after you deliver and help with the first breastfeeding. Some take photographs, some help with cord blood banking. Depending on the Labor Support person/doula, the services will vary, but most provide emotional support, encouragement, labor positions, breathing techniques, birth ball use, aromatherapy, hot/cold use, massage, distractions, hydrotherapy, Coach relief, Coach encouragement to help the coach be involved to what ever extent is comfortable. I encourage you to meet with several before deciding on one.

5. How do I know when to go to the hospital if I think I am in labor?

First of all, each healthcare provider will give you the parameters of when they want you to call them or go to the hospital/birth center/etc. Most will agree to a 5-1-1 rule. This is where you are having a contraction every five minutes, the contractions are lasting one minute and this pattern has lasted for at least one hour. True labor will not go away or lessen with activity. The contractions will only get closer together and stronger. You will have to be patient enough to allow yourself the time to establish this pattern. I recommend calling your Coach to give them a heads-up that you may be in labor . Call them every 30 minutes about your pattern. Once it is getting to the 5-1-1 then they should come be with you. At that point call the Obstetrician, who will tell you to come in for a “labor check” to see if you are really in labor. If you wait like the 5-1-1 rule suggests, the contractions may go away. The body does this to warm up for the real labor day! This 5-1-1 rule is the pattern of a woman in the active phase of labor and it usually lasts several hours in most first time moms. There is still no need to rush to the facility.

The only exception is if you think you have broken your bag of waters (spontaneous rupture of membranes), call your doctor. Most doctors want to be notified immediately and will ask that you go to the hospital for evaluation. Your responsibility is to remember the acronym COAT- Color / Odor / Amount / Time. The color can be clear, yellow, light brown, or even green. It should not be foul smelling. Membranes can either break in a big gush or it can leak out in a trickle. The doctor will want to know what time of day your bag of waters broke. Most doctors like you to deliver the baby within 12-18 hours of the bag of waters’ rupture as the risk of infection increases once this protective membrane is no longer intact. Call your doctor BEFORE going to the hospital since this gives them the chance to speak to you about what is going on. The doctor then calls the hospital and lets them know to expect you. The doctor then gives the nurse orders as to what he wants done once you arrive. This lets the hospital get ready for you, you when arrive they should have a nurse assigned to you, a room ready for you.

These are general guideline and for more information- please consult your doctor, as he or she will be the best authority for your pregnancy.

Provided by Leslie Menghi-Parzygnat RN & CCE, Labor-of-Love Childbirth Education & Labor Support , Royal Palm Beach, FL