Your due date is set at 40 weeks of gestation. Most women do not deliver on their due date. Sometimes induction of labor has to happen due to various complications with pregnancy or for other reasons that your doctor will discuss with you. Depending on your cervical exam, different methods of induction will be chosen. The most common medications used include prostaglandins (Cervidil or Cytotec) and oxytocin IV (Pitocin). Mechanical dilation of the cervix can also be achieved with placing a balloon and inflating it with water within the cervical canal or laminaria.
Usually if your cervix is "favorable," which means soft, thinned out and dilated, oxytocin is used through the IV to make contractions occur regularly and strongly. If your cervix is not favorable, meaning it is thick and closed, then it needs to be "ripened" with prostaglandins first (E.g., Cervidil). Cervidil is a medication that is placed vaginally by the cervix for 12 hours so that it can ripen it. Sometimes you may need more than one Cervidil. Cytotec is another prostaglandin that we can use for ripening and for induction of labor with a favorable cervix as well. Breaking your water (amniotomy) when it is safe can also speed up the process and cause more contractions. All of the above happens in the hospital while you are being monitored for contractions and your baby's heart beat is also closely watched.
Your care on Labor and Delivery unit begins with admitting you to a private room. If you have a birth plan, please let the nurses know and review it. Most patients agree to IV fluids during labor; after all, it is a very labor-intensive workout and you need to be hydrated! If you'd rather not have IV fluids, you would still need IV access in case of emergency.
Those in favor of natural childbirth may be interested in attending various classes where pain control techniques are described (massage, breathing, meditation). Having a designated birth coach is usually helpful as well.
If you would like some pain control, but not an epidural, then options would include IV pain medications and/or pudendal block.
IV medications can be given until you are 8 cm (out of 10cm) dilated. After this point, no further IV medications can be given in order to avoid delivering a very "sleepy" baby.
Pudendal block is an injection performed by your OB doctor when you are ready to push. It helps with pain at your perineum, but does not help contraction pains.
Epidural anesthesia is safe and available to you when you are in active labor. You can talk to the anesthesiology provider in more detail about it when you are admitted. Epidurals are probably the most effective pain relief method available. While pain is relieved, you may still feel some pressure sensation.
It is our standard of care to monitor your baby and contractions during labor and induction of labor. We typically use external monitors to do so. If your membranes are ruptured and/or your doctor needs a more accurate assessment, internal monitors may be placed. Your blood pressure, pulse and temperature will also be monitored.
After a routine, uncomplicated vaginal delivery, you can stay for two days. After a cesarean delivery, you have three to four days. Please make sure that you have a car seat available upon discharge!
Labor prior to 37 weeks of gestation is considered preterm. True preterm labor means that preterm contractions are accompanied by cervical dilation. This condition is common; about 12 percent of pregnancies in the United States are preterm. If you start having persistent contractions, especially if they become more and more painful, your doctor will need to monitor you for preterm labor. Usually this involves observation in the hospital, monitoring of your baby and contractions, ruling out various infections that could contribute to this, and deciding on whether there is a high risk of preterm delivery.
In many cases, depending on gestational age, a cervical length measurement is obtained to see if your cervix is starting to shorten, which happens with contractions. Also, there is a test called fetal fibronectin that can be used to predict the likelihood that preterm contractions are not going to lead to true labor. It is very reassuring when it comes back negative; it means that you are not likely to have a preterm delivery in the next two weeks.
If your doctor deems it necessary, you may need to be given a tocolytic agent (a medication that can help slow down or stop contractions). Steroid injections are also given between 24 and 34 weeks in order to help with baby's lungs and brain if preterm delivery actually occurs.
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