What to Expect in a Normal Delivery

During labor; the "three P's"

Labor Is Truly Labor-Intensive
Once all the paperwork is done, you'll be admitted to a labor and delivery room, which is usually a private room in most hospitals (although there are exceptions).

An IV (intravenous) line will be placed in one of your arms. This IV line serves multiple purposes:

  • Fluids and medications can be administered to the patient while she is in labor.
  • Blood transfusions, if needed, can be administered quickly through the IV.
  • Pain medications can be administered through the IV, and an anesthesiologist will want to make sure that you have a working IV in case you have an emergency c-section.
The baby will be placed on an external fetal monitor where the baby's heart rate and the mother's contraction pattern will be evaluated. The mother will also have her blood pressure checked regularly throughout labor. The mother's heart rate can also be monitored with a pulse oximeter, which measures the maternal heart rate, in addition to how well she is oxygenating.

During this time, the doctors and nursing staff will be monitoring the progression or lack of progression of the labor. The doctor will probably check your cervix every two hours, as needed, to determine whether or not you are making progress with cervical dilation, effacement, and station.

The Nurse's Role during Labor
The nurse who is handling your case quickly becomes your best friend in crime, so to speak, because he/she is probably going to be the person whom you see the majority of the time. Usually, the nurse has one-on-one care of a patient, or at most, she might be taking care of two patients at the same time.

The nurse will be your most visible health care provider during the laboring stage. She (or he) attends to your every need, monitors your condition constantly, answers questions, takes care of unwanted visitors, coordinates with the doctor, administers medicines as necessary, listens to your fears, and generally serves as your point man/woman for any problems during your labor. She will check your vital signs, help you go to the bathroom, maintain close observation of the baby's heart rate, and do the necessary charting. She will maintain your IVs. The nurse is there to look out for your best interests. She's also making sure that your spouse and other family members are comfortable as well; but her primary care rests with you, her patient.

Treat this person like gold – they are certifiable saints.

The Doctor's Role during Labor
If you have an outside doctor (meaning he doesn't work at the hospital), he will be notified the moment you arrive and he may ask a nurse to do the initial evaluation. He will immediately make plans to be there for the delivery, but he might not be there for the duration of the labor. Instead, he may ask the nurse to do the cervical check if you're not close to delivery, and then he might ask the nurse to give him a call once the patient reaches 8-10 centimeters. That way, he can complete his schedule with his patients in his office or finish surgery if he's in the middle of surgery. However, if there is a problem, he will drop everything to get there immediately. If the doctor's schedule is free, he will probably go into the hospital to monitor your progress once you're admitted.

When the doctor arrives at the hospital, he will be meeting with you to evaluate your progress and answer any questions. He'll continue to be in touch with your nurse and give orders to the nurse about procedures that need to be given. Even though your doctor may not be in the room as much as your nurse (he may have other patients in the hospital that he's responsible for), he will be accessible and usually waits in the boardroom, which is a place where electronic monitors are centralized. He will be monitoring your heart rate, your contractions, and your baby's heart rate from that remote location within the hospital. If everything is going smoothly with your labor, you will see the doctor every two hours until you are about to deliver. However, if there are any concerns or any problems arise, then the doctor will be coming in more frequently.

Pain Medications during Labor
Labor hurts – no ifs, ands, or buts about it. Once you are in active labor, the pain can be quite significant. But not all women experience the same reaction or level of discomfort with their contractions. If you request pain relief (and don't hesitate to do so if you need it), your doctor will review several options for you, including IV pain medications or regional anesthesia, which can include an epidural or an intrathecal (slightly different location than an epidural). The doctor will determine which one of these regional anesthetics will work best for you. This is not a choice made by the patient. Usually, the doctor will make the choice in consultation with an anesthesiologist.

The IV pain meds are given by the attending physician or nurse. An anesthesiologist usually administers epidurals or regional anesthesia, although your obstetrician may also administer anesthesia, depending on the hospital.

If Your Labor Slows Down, or The Three P's
Occasionally, the mother's labor pattern may slow down or stall altogether. This could be due to several reasons. First, the contraction pattern may have stopped for an unknown reason also known as a dysfunctional labor pattern. Second, the mother may have an infection of the uterus. Third, the mother may not have a pelvis that is the optimal size for a vaginal delivery. In this case, even if the baby is a normal size, it might get hung up on the bony structures within the birth canal. Doctors will check you carefully if your labor slows or stops to try to determine what is going on (or not).

Typically, doctors check for the three "P's" when trying to determine why labor has slowed or stopped. The first P refers to power – that is, the frequency, strength, and duration of the contractions. The next P refers to the pelvis. Doctors check to see if the pelvis is large enough for the baby to traverse through it or if there are any obstructions preventing the baby from going through. The third P refers to the passenger (or the baby). Is the baby's size or the way the baby is orienting itself in the pelvis the problem? For example, the head could be down, but turned in an improper way.

In truth, it's usually varying combinations of the three P's that contribute to protracted or slow labor. The doctor will make the determination as to why the labor has slowed and how best to correct the situation.

excerpted from:

Reproduced from Absolute Beginner's Guide to Pregnancy, by John Adams and Marta Justak, by permission of Pearson Education. Copyright © 2005 by Que Publishing. Please visit Amazon to order your own copy.

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