Labour wards, nurses and you

Do you wonder what happens in hospital? Isabel Shan and Rachel Lewis have the insider info about the maternity unit.

 

Pregnancy-Labour-wards-nurses-doctors-and-you

What happens on arrival

Your first stop is the hospital admissions desk, where you’ll be directed to the maternity unit. A midwife or nurse will be there to take you to a delivery suite ¾ an area of the labour ward where your condition will be assessed. You’ll see different on-duty midwives or nurses attending to you throughout this time, since no one can predict how long your labour will last, says Dr Christopher Chong, an obstetrician and gynaecologist at Gleneagles Hospital.

Your initial assessment

You will be asked if you’ve had a “show” (a plug of mucus, often tinged with blood, a sign that labour has begun), whether your waters have broken and if so, what colour the fluid was, whether contractions have started and their frequency. The midwife will want to know how many weeks pregnant you are and whether you’ve had any problems in your pregnancy. She’ll also need to see your patient card.

          Next, she will check your blood pressure, temperature, pulse and urine. An external examination of your stomach will reveal the baby’s position. The midwife will also do an internal or vaginal examination — the only way to find out how many centimetres you have dilated. The midwife will start a record of your labour and takes note of everything, so that when she goes off duty, the succeeding midwife or nurse will be able to assess your progress quickly. You’ll also be asked to change into a hospital gown.

          At some stage, the midwife or nurse will probably ask if you have any birth plan or special labour preferences. Do alert her if you prefer to use or avoid certain pain-relief options.

          Women in early labour may choose to go home to wait for things to start moving along. If your labour is progressing or you prefer not to go home, you will probably be sent to the maternity ward or a special waiting area. If you’re in established labour (dilated 3cm or more), you’ll be taken to the delivery room, where you’ll remain until your baby is born.

When your labour starts

Throughout your labour, the midwife will regularly check your pulse, temperature, blood pressure, urine, cervix and the baby’s position and heart rate. If everything is going to plan, you’ll be left on your own for your labour to progress. But many deliveries include some form of medical intervention.

Induction

Your labour may be artificially started if you show signs of pre-eclampsia (high blood pressure and high levels of protein in the urine) or you’re more than 10 days overdue. Labour is triggered with a drip containing syntocinon, an artificial form of the labour hormone, oxytocin. The drugs can create stronger and faster contractions than those in a “normal” labour, so you may require pain relief. If you are induced, the baby’s heart rate will be monitored using a CTG (cardiotocograph) machine.

Augmentation

Once you’re in established labour, if your cervix is not dilating by at least half a centimetre an hour or your contractions have slowed or stopped, the midwife or nurse may call your doctor to discuss augmentation (speeding things up). Your waters will be broken with a hook unless this has already taken place. If this doesn’t work, you may get a syntocinon drip and the CTG machine will monitor your baby’s heartbeat.

Pain relief

Options include entonox (gas and air), pethidine (an opium derivative injected into the muscle) and an epidural (a local anaesthetic in your spine ¾ this takes about 15 to 20 minutes to organise).

Forceps and ventouse

If your labour has not progressed adequately, and you’re too exhausted to continue, or your baby is in distress (indicated by its heart rate), your gynae may decide on an assisted delivery. Your doctor will check your baby’s position and its progression along the birth canal before deciding which instrument - forceps or ventouse - is safest to use. A ventouse is a vacuum device with a suction cup attached to your baby’s head to grip him as well as help guide him out when you push. Forceps are surgical “tongs” ¾ positioned at either side of the baby’s head ¾ that allow him to be turned or pulled out quickly. There are different types, depending on what’s required.

          Unlike a ventouse delivery, forceps often require an episiotomy (a cut to the skin behind the vagina), as they tend to be used if the baby is further up the birth canal. Both procedures will leave slight marks on your baby, but these will disappear within a few weeks.

After the birth

Your baby will get a brisk rubdown, cleaned, and tagged with an identification band. The doctor and nurses will weigh, measure and check your baby, and then give him to you to hold. Aw… You’ll also be checked to see if you need stitches down there. Your gynae will offer you a jab with a drug called syntometrine to speed up delivery of the placenta.

          The midwife or nurse may show you how to start breastfeeding and care for your baby. Although the aftercare may be less attentive in busier hospitals, don’t be afraid to ask for help on anything. It’s best to initiate breastfeeding in the first two hours post-delivery, when baby’s rooting and sucking reflexes are good; they tend to become sleepy after that.

          You will be taken to the postnatal ward. If you did not have a Caesarean section, get something to eat. Expect your gynae to visit you during the day of your delivery, or the next as he needs to make sure you’re recovering well.

          You’ll usually stay in the hospital for one or two days for a regular delivery. But you’ll stay three to five days if you’ve had a Caesarean. Before you are discharged, you and your baby will get checked over. Your baby’s reflexes and hearing will be tested, and you’ll get advice on how to care for your wounds or stitches. Once all the forms have been filled and the boxes ticked, you’ll be totally responsible for that tiny person. Now, that’s when the fun really starts!

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