What to Expect in a Normal Delivery

Helping the baby along

Internal Monitors on the Baby
For most patients, external monitors are adequate; however, if the baby's heart rate becomes worrisome or if it's difficult to tell how well a patient is contracting, internal monitors may be recommended. A fetal scalp electrode is placed on the baby's head to measure the baby's heart rate and any abnormalities. There might also be an IUPC (intrauterine pressure catheter) inserted that is not attached to the baby, but is a flexible probe inserted between the baby and the uterine wall through the vagina. This device detects the strength of the contractions and offers a more accurate interpretation of labor. The IUPC also serves as a means to increase the amount of fluid surrounding the baby, called an amnio infusion. This occurs when saline or water is transfused into the space around the baby and provides additional cushioning for the umbilical cord in times of stress. When the patient gets internal monitors, the external monitors are removed. There is a slightly increased chance of infection, which is why these monitors aren't routinely placed on all patients.

Using Pitocin to Speed Up Labor
If your labor has slowed or stopped and the doctor has made the assessment of the three P's and it is still possible to deliver vaginally, then the doctor might administer pitocin through an IV. Pitocin is a medicine that stimulates the uterus to contract. It mimics the body's own natural hormone called oxytocin, which is supposed to do the same thing – that is, speed up labor. Pitocin is generally a safe medicine; however, there are some precautions that need to be taken – for example, its dosage needs to be carefully regulated.

In rare circumstances, the uterus may become overstimulated, in which case the uterus contracts so frequently that the baby receives less oxygen. This may lead to a decrease in the baby's heart rate as the uterus doesn't have any downtime from the contractions. When the uterus is contracting, oxygen is at its worst for the baby. During the relaxation phase between contractions, the baby's optimal oxygen status is usually restored.

If, by some chance, the contractions become too frequent, the doctors will recommend turning down or turning off the pitocin temporarily in order to give the baby a break and a chance to recover sufficiently. In extreme circumstances, when this does not work, the doctor may recommend that the patient receive a different medication to relax the uterus and counteract the effects of pitocin temporarily.

One other potential complication from pitocin is that the uterus could rupture, due to hyperstimulation (overstimulation) or extreme contraction strength generated by the drug. For these reasons, the drug is carefully monitored at all times.

Repositioning the Baby
If the doctor determines that your lack of progress is due to the baby's position or malpresentation, then the doctor may attempt to reposition the baby's head during a vaginal exam, if at all possible. To do this, the doctor will gently feel the landmarks on the baby's skull to imagine which way the baby's head is pointed. Then he will attempt to turn the baby and correct any malpresentation that exists.

Many times, labor will resume in a normal fashion after repositioning without any further intervention, and the mother will eventually reach maximal dilation of 10 centimeters. When the mother is maximally dilated and effacement is 100%, then she is ready to push.

Pushing and Delivery
Usually, the patient's nurse or doctor will have coached her ahead of time so that she knows what to expect when they ask her to push. Pushing is timed to coincide with each contraction for maximum effect. When the uterus is contracting, this is the best time for the mother to exert her pushing efforts in order to deliver the baby. A contraction lasts approximately one minute. She will be asked to push three times during each contraction, with each effort lasting approximately 10 seconds.

In-between contractions, the patient is asked to rest and not push, but to take slow deep breaths of oxygen in order to give the baby as much oxygen as possible. Remember, this is one of the most stressful times for the baby. Not only is the uterus contracting, but most of the amniotic fluid has leaked out so there is less cushioning to counteract the pressure that is being generated by the contracting uterus. Also, the space is tighter for the baby as it works its way down the birth canal.

In the early stages of pushing, the doctor or nurse may be examining you simultaneously with your pushing. For the doctor, this is a good opportunity to see how effective the patient is able to push.

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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