A Guide to Labor

• Early Labor
• Active Labor
• Birth

Early Labor

In the early stages of labor when your cervix is thinning out (effacing) and opening up (dilating), from 1 to 5 centimeters, we encourage you to be out of bed as much as possible. Walking during early labor is encouraged unless continuous monitoring is required for you or your baby. While you are in early labor you may have sips of clear liquids (apple juice, water, 7-up, ice chips or a popsicle). In some cases, your doctor/nurse midwife may prefer that you have nothing to eat or drink. He/she will explain to you why this is necessary and your nurse will make you as comfortable as possible.

Taking childbirth classes is an excellent way to prepare for labor and delivery. They help relieve some of the anxiety and fear your may have about labor and delivery by telling you what to expect and providing ways to cope with pain. They also give your partner suggestions on how to make you more comfortable during labor.

Partner's Notes for Early Labor

• Encourage your partner to be up and out of bed as much as possible. Walk with her in the room or the hall. Ask her nurse about alternate positions, such as sitting in a recliner or putting the bed into an upright position.
• Suggest activities to help the time pass, such as a game of cards, reading aloud, watching a TV program together, or listening to music.
• As contractions become stronger your partner may want to begin special breathing techniques you have learned in your childbirth classes. If you did not attend childbirth classes or need some suggestions, the nurse will be happy to help you.
• A back rub or foot massage is often appreciated during this stage of labor.

Active Labor

During the active phase of labor (from 4-8 centimeters), contractions usually become closer together and stronger in intensity. A variety of strategies, i.e., paced breathing, position changes, relaxation techniques, and distraction techniques, may be used to cope with the increasingly intense contractions. Ask your nurse to assist you if you choose to use some of these coping strategies.

Taking childbirth preparation classes is an excellent way to prepare for labor and delivery. The classes help relieve some of the anxiety and fear you may have about labor and delivery by telling you what to expect and providing ways to cope with pain. They also give your partner suggestions on how to make you more comfortable during labor.

You may desire some type of pain medication or anesthesia during your labor. (Pain Control)

Two kinds of pain relief available: You may be given pain medication which is given into a vein or a muscle. These medications usually last about 1 to 2 hours. They take the sharpness from your contractions, making them easier for you to cope with.

Epidural anesthesia:

To receive epidural anesthesia, an epidural catheter is first placed in your back while you sit on the edge of the bed or while you are lying on your side in bed. This is done by an anesthesiologist when your cervix is about 3-5 centimeters dilated. The anesthesiologist locates the epidural space in your back and numbs your skin in that area. He/she then inserts a needle into the epidural space. When he/she is sure the needle is in the right space, a very small catheter is threaded through the needle into the epidural space and the needle is removed. The catheter is then securely taped to your back. Once the epidural catheter is in place, medication can be injected into the catheter throughout your labor and birth. After the epidural catheter has been injected, you may not feel your contractions at all or if you do, they will be much less strong and easier to cope with.

The University of Iowa Hospitals and Clinics has an anesthesiologist in the Labor and Delivery area 24 hours a day, seven days a week. After you are admitted, he/she will come to your room to talk with you about your options for pain relief and the risks involved with various types of pain relief. He/she will examine you and take a brief medical history, and answer your questions. Your doctor/midwife also will be available to discuss pain relief with you and answer any questions you may have.

Partner's Notes for Active Labor

• Breathing and relaxation techniques are very important during the active stage of labor. Breathe with your partner through difficult contractions, if that helps her. Remind her to relax and breathe normally between contractions.
• If a fetal monitor is being used, ask the nurse to show you how to read it. Let your partner know when her contraction is at its peak and starting to go away. This will help her realize the contraction is going to end and she can begin to relax.
• Meet your partner's requests as much as possible. Give her a back rub if she wants it. Provide ice chips or sips of water between contractions. Use a cool damp washcloth to help cool her face and body.
• Take a break yourself to get some fresh air or something to eat. The nurse will be happy to assist your partner while you take a break.
• If your partner receives pain medication and is able to rest or sleep, then you should try and rest too. Extra pillows and blankets are available for your comfort.

Cesarean Section

If you need to have a cesarean birth, you will have epidural, spinal, or general anesthesia. When general anesthesia is given you are put to sleep by the anesthesiologist and do not wake up until your baby is delivered and the surgery is over. If you have epidural or spinal anesthesia, you can be awake during your surgery and you can see your baby right after he/she is born Spinal anesthesia is similar to epidural anesthesia but no catheter is inserted after the needle is placed in your back. The needle is placed, medication is injected through the needle and then the needle is removed. Enough medication is given to keep you numb during your surgery and the numbness will wear off within a few hours after surgery. With epidural or spinal anesthesia you will not be able to see your surgery being done or feel any pain, but you may feel some pressure when the baby is born.

If you have epidural or spinal anesthesia, a medication called Morphine can be given through your epidural catheter or through the spinal needle before it is removed. This medication will give you pain relief for up to 24 hours after your cesarean section. This method of pain relief has advantages and disadvantages, which will be explained by your anesthesiologist. If you do not have Morphine or if you have general anesthesia for your surgery, your doctor will order pain medication for you after surgery to keep you comfortable.

Several members of the health care team will be present for your cesarean section. There will be at least two to three obstetricians to perform your surgery, two nurses to assist them and an anesthesiologist. There will also be a pediatric team present to care for your baby. Your husband, partner or support person can usually be present during your surgery to lend support and share in the birth of your child.

Partner's Notes for Cesarean Section

• If you choose to be with your partner during the cesarean section, your nurse will bring you scrub pants, a scrub shirt, a hat, a mask and shoe covers. You will be asked to wait in your partner's room until the anesthesiologist is ready for you to come to the operating room.
• Remember that a cesarean section is abdominal surgery. The surgical area will be draped with sterile drapes. Please do not touch them. The nurse will give you a stool to sit on.
• You can sit right next to your partner during surgery. If she had epidural or spinal anesthesia she will be awake and you can talk to her and offer support. If your partner had general anesthesia you will be asked to leave the operating room after the baby is born.
• If the baby is doing well, you will be able to hold him/her in the operating room. Hold the baby close to your partner if she is awake so she can see and touch the baby.
• If you begin to feel dizzy or sick to your stomach during the delivery, let someone know right away. The nurse may have you sit on the floor or take you out of the room for some fresh air or a drink of water.