Having Your Baby

Delivery in the Hospital

Having Your Baby

If you are not sure if something is worth getting checked out, call the birthing suite. In the Oshawa Hospital, the number is 905-576-8711 X 3232. A nurse will walk you through a few questions and then recommend what she thinks is appropriate. If she tells you to come for assessment, I recommend that you do not eat or drink until you are told you can do so. Some women may feel sick while they are in labour, and those who are in for surgery are asked to fast for at least 6-8 hours before surgery.
 
 
What to bring to the hospital
Normal Labour
IOL-Induction of Labour
Labour
Episiotomy
Vacuum and Forceps
Cesarean Section (Please also read VBAC)
VBAC (Vaginal Birth After Cesarean Section)
Vaginal Breech Delivery
Circumcision
 


What to bring to the hospital when you are in labour

Your health card
Private insurance if applicable
Copy of your birth plan
Picture of object you find comforting
Watch
Massage oil or lotion
Hot water bottle
Cold packs
Lip balm
Camera, with charge batteries, and enough storage
Extra pillow
Personal stuff: hairbrush, shampoo, soap, toothbrush and paste, deodorant, sanitary pads (absorbent one), night gown, nursing bras (if breast feeding), inexpensive underwear and socks, slippers, something top wear on the way home (items that fit when you were 5 or 6 months pregnant) (Top)
 

Normal Labour

Labour usually starts on its own. This occurs most commonly between 37 and 42 weeks, and usually close to your due date. As we noted earlier, labour should be natural, with the minimal interventions. Below we will cover some of these interventions, and the main reasons why they may be offered to you.

On your visit to the hospital

A nurse will review your history so far, and then attach you to a fetal monitor. This is a machine that measures your baby’s heart and records it on paper. The machine will also measure your contractions and sometimes, your baby’s movements. This is very similar to the NST or Non Stress Test, if you have had that done before.

The value of this test is to confirm that your baby is doing well, and to help confirm you are in labour. There are other benefits as well that will be discussed with you in more details if needed.

If your pregnancy and labour is considered a high risk one, you may be advised to keep this monitor at all times during your labour. Women who chose to have a natural labour may ask not to have this monitor attached to them all the time. The nurse will still check on the baby’s heartbeats intermittently to monitor the baby over the course of labour. (Top)

IOL-Induction of Labour

Sometimes there will be a reason why you need to deliver before you are in labour on your own. Examples include high blood pressure, diabetes with pregnancy, or if you are about 10 days past your due date or so. On other occasions, if the baby is not growing as expected, or is not moving well and failed its testing (NST), you may need an “Induction of Labour”.

When you go for an induction of labour, you will first be seen by one of the nurses. She will go through your medical history with you, and review why your labour is being induced. She will then put you on the ‘monitor’ where they will check that your baby is doing ok. Then one of the obstetrics team will come in and review your history again.

Induction of labour is usually done by a medication called ‘Prostaglandin’. This comes in 2 forms, either as a gel or in tape form. The tape has the advantage of being easily removable if needed. If you have a tape (called Cervidil) you will be monitored for one hour, and then checked for progress 12 hours later. A second tape may be needed 24 hours from the first one if you are not in labour by then.
 
Some recent studies have shown that 'balloons' are very successful in inducing labour, being faster and less tiring than medications. This is basically a catheter with a balloon at its tip. Your doctor will pass it through your cervix and fill it with water. The procedure is similar to an pelvic exam. Is may be uncomfortable but is not really painful. You are then observed for a while to make sure you and baby are fine. The "balloon" can be used even if you had a C Section before The other medications cannot be used if you had a C Section. 

If you get the gel, you will be monitored for one hour as usual, but you will be checked 6 hours later. You may then be given a second dose of gel. The maximum is 3 doses of gel 6 hours apart. If you are not in labour 6 hours after the 3 gel, the obstetrician will review the reason why you needed to be induced, and will discuss possible management options with you.

Sometimes induction of labour is done by ‘breaking your waters’ or ARM (artificial rupture of the membranes). This is only possible of your cervix is open 2-3 cm, and thinned out. ARM is more possible in women who have had at least one or two vaginal deliveries in the past.

The success rate depends on many things, including why you needed to be induced, how far along the pregnancy are you, how open (dilated) is your cervix and how thinned out it is.

You may choose not to have an induction of labour. The course of action will largely depend on how far along you are in the pregnancy as well as why your offered an induction of labour in the first place. Each situation is different. Make sure you understand why you were offered the induction in the first place.

Possible complications from Induction of Labour (IOL)

* Increased risk of operative delivery and Caesarean section (C/S) especially in first time mothers. Note that it can difficult to point to the true reason for operative delivery (i.e., whether it is from the IOL itself, or due to whatever led to the IOL in the first place).

* Failure to achieve labor. If the reason for inducing labour is not an urgent one, you may be given a rest period of 24 hours or so before trying again.

* Uterine Hyperstimulation with fetal ‘distress’. Sometimes the uterus responds to the medication by contracting for a long period of time and does not relax. The blood and oxygen flow to the baby may be reduced, and baby’s heart may start showing some changes. Your health care team will then take a series of steps to decrease the effects of this complication. Rarely a C Section may be needed.

* Risk of uterine rupture may be increased in certain situations.

* Umbilical cord prolapse with artificial rupture of membranes (ARM). When your waters are broken, and if the baby’s head is not fitting well in the pelvis, the umbilical cord may fall through the cervix. Although your health care team will always take extra precautions to prevent this from happening, it is still possible. If this occurs, an immediate C Section is needed.

* Increased risk of infection in the uterus

* If there was a mistake in calculations, we may end up delivering a baby before its due time. (Top)
 

Labour

At the time when the baby is coming out, tears are common, and these usually need a few stitches. If you have had an epidural, this is usually enough for you not to feel any pain with the stitches. If you have no epidural, or if you still feel some pain down below, you will get some local freezing. Rarely, if you have more tears than usual, or if the obstetrician needs to examine the lower uterus and the cervix, they may take you to the main OR and put you to sleep before they do their ‘exploration’ and stitching.
 

Episiotomy

Better known as the ‘cut’. This used to be more common in the past. Today, it is not part of the routine labour process. It is rarely used, but is still seen as a valuable option if your labour has not been progressing as usual. Basically this is cut that is done by the obstetrician. It helps the baby deliver, especially if the mother’s muscles were keeping the baby in, or if there is a need for a vacuum or forceps delivery. It is also helpful in preventing a big tear, for example, when the baby is looking sunny side up (or OP).

No one will go ahead with it without first explaining to you why it is needed, and before making sure you are frozen enough.

If you choose not to have it done, still, you need to review with your obstetrician why he or she recommended it, and what alternate plans they will offer for your delivery at this point.

If you were offered an episiotomy, you are likely to have tears. Both will need to be stitched. Stitches usually dissolve on their own. (Top)
 

Operative Delivery

Vacuum and Forceps

In some cases, your obstetrician will offer an operative delivery; either vacuum or forceps. He or she will explain why this is needed.

The vacuum is a small cup that attaches to baby’s head. We then create suction. With contractions, and with the mother pushing, the obstetrician will pull on the vacuum cup, helping baby’s head out.

The obstetrics forceps are a pair of metal blades that may come in different shapes. Depending on why we need them, the obstetrician will use the appropriate type. When applied to the baby’s head, they form a metal cage that helps pull baby’s head through.

A common reason for an operative delivery is that the baby’s heart is acting in a way that makes immediate delivery the safest option. Other reasons may include an exhausted mother who has been pushing for a long time with no real progress. Sometimes, if baby’s face is not looking the right way, forceps may be use to ‘rotate’ baby’s head and then help it deliver.

Like everything we do, there are possible risks relating to such interventions.

Risks might include injury to the vagina or cervix of the mother, or wounds of the scalp of the baby. Rarely, there may be some wounds relating to the bones of the baby’s head.

Usually the baby after delivery may have a ‘cone-head’; this usually only lasts 2-3 days as it mostly swelling from being squished through delivery. The baby may be at more risk of jaundice after delivery.

On rare occasions, there may be brain hemorrhage associated with their use, or with forceps, skull bone fractures.

In general, they are regarded as safe procedures, though. Their benefits usually are regarded to outweigh their possible complications. Long-term follow-up of children delivered by vacuum or forceps did not reveal any differences in learning abilities and other brain functions when compared to children who delivered with no assistance.

One of the things your obstetrician will talk to you about is, what happens if a trial of vacuum or forceps was tried out and they are still not able to deliver your baby. Chances are, you will be offered a Cesarean Section.


A Cesarean Section is the other option for delivery, if you do not want to try any of these options. You need to know that a Cesarean Section done after a trial of vacuum or forceps may be more difficult, and may be associated with more complications than if it was done as the primary mode of delivery.

The decision to go straight to a Cesarean Section or to try one of vacuum or forceps will depend on many things. Your obstetrician will go with you through your situation and the need for delivery. He or she will also talk to you in more detail about the likelihood of success and safety of the vaginal route vs. the C Section.

At the end, you have a say into what you want done. There is no real wrong or right answer. If you are offered options, this means that they are all possible decisions. You choose what makes you feel more comfortable. If the decision is not in your best interest (yourself and your baby) the obstetrician will clarify this for you. (Top)
 

Cesarean Section (Please also read VBAC)

This is a surgery in which a baby is delivered through a cut in the abdomen. Reasons for this are many. Examples include a baby’s heart reading indicating that baby cannot tolerate labour any more, or if the mother has been pushing for a long time and labour looks obstructed, etc. The list of reasons is a long one, and you will be given a clear explanation of why a C Section is suggested or needed in your particular condition.

If the reason why you need it is not a permanent one, you will likely be able to try to deliver vaginally in your following pregnancy (call VBAC or Vaginal Birth After Cesarean). The success rate of a vaginal birth after C Section is classically quoted at 75%.

Complications of C Section, like all other surgeries, may include side effects of the anesthetic used, or the procedure itself. These are outlined below.

With an epidural or spinal, there is the risk of it failing, in which case you may then be put to sleep. Other complications include a headache after surgery, infection at the site of the needle or feeling sick. The anesthetist will talk to you in more details about possible side effects and risks.

With the surgery itself, you get a scar on your tummy. This is usually side ways, and usually low enough to be at your bikini line so it does not show. You also get a scar on the uterus. This means that you need to deliver in hospital with your following pregnancies. You may try VBAC or elect a repeat C Section. If you have more than one scar on your uterus, your safest option is repeat C Section because the risk of your scar giving way, or bursting, becomes quite high.

Other risks include possible skin infection. This is more likely if you had your waters broken, or if you have been in labour for a long time before your section. You will be given an antibiotic to prevent infection.

There is also the risk of injuring your internal organs like the bladder, bowel or ureter. This risk is present with any operation on your abdomen or pelvis, and the surgeons try their best to prevent this from happening. If it does occur, a repair is usually done at the time of surgery. Sometimes, general surgeons or urologists may be consulted.

As with all major surgeries, there is the risk of having a blood clot in your leg and or lung. This risk is somewhat increased with pregnancy, and is higher with a vaginal birth or a C Section. This is why you are encouraged to walk out of your bed the first day after your surgery.

In general, people who are overweight are at a higher risk of surgical complications occurring than those who weigh less. (Top)
 
Vaginal Birth After Cesarean Section VBAC

If you had a Cesarean delivery, you can still have a vaginal delivery. Some of the factors that may affect this decision include why you had the previous C Section, the type of scar in your uterus (not on the skin), how motivated are you to try a vaginal birth, etc. Now there are risks to everything we do in life. There are many risks associated even with a vaginal birth, but since it is a ‘natural’ process, we usually do not discuss them in too much detail. Again, there are risks related to surgery, and a C Section carries some of the risks of both a vaginal delivery and a surgical procedure.

With a vaginal delivery after C Section (VBAC), you have the same risks of a vaginal delivery, plus one more. This is the risk of your scar giving way, or opening up. This is not common (0.2% of cases) in well selected patients. You should not try this if you had a scar in your upper part of the uterus (called a classic C Section, or a T scar, or in association with removing fibroids-myomectomy). If you had any of those, you are at a higher risk of your scar opening up. The same is true of you had more than once scar, or more than one C Sections in the past.

There is more risk for bleeding, blood transfusion, the need for surgery, may be hysterectomy, and even may be losing the baby or the mother. Again, these risks are low. You carry a success rate of between 50 and 75%. That is 2-3 of every 4 who try a VBAC will end up having a vaginal delivery. If labour does not progress smoothly, or if the baby’s heart rate starts showing concerning patterns, a C Section will be the safer way out.

During VBAC you are monitored closely, and you will probably have continuous monitoring to your baby’s heart rate patterns. You will have an IV in, and we do recommend you have an epidural in place.

You cannot be induced by protagalndins if you had a previous C Section (these are the Gel or the Tape options). You cant still have Pit, the IV medication that makes your contractions stronger. If you need to be induced, a catheter (Foley’s Balloon Catheter) may be used to open your cervix a little bit. This will allow us to break your waters, and start Pit. If it does not work, we might need to evaluate why we need to induce labour at that point, and what are the options available. (Top)
 
 
Vaginal Breech Delivery

Following a large and famous trial (Term Breech Trial) that looked into vaginal breech delivery, the recommendation came out that all breech babies need to be delivered by a C Section. The results pointed out to how much safer a C Section is for babies. There was evidence of increased complications for mothers, though.

Recently, the trend is gradually shifting towards allowing selected cases to proceed with a vaginal delivery. The baby should be of average size, be term, and the head is not extended (not looking upwards-by ultrasound). If ultrasound say the baby came as footling breech, you will need to have a C Section. Some obstetricians are not comfortable offering you a vaginal delivery if the breech was your first baby.

Since not all obstetricians are comfortable delivering breech vaginally, we cannot guarantee that you will have a breech delivery. (Top)
Circumcision
A world old tradition, many parents have questions about Circumcision. Some cultures, like in the Moslem and Jewish population will do it for religious reasons, while other cultures will do it for aesthetic and hyegenic reasons. What it is, basically, is taking off the extra piece of skin off the penis (called prepuce). It can be done at any age, but typically is done within the first days after birth.
Benefits of circumcision include easier cleaning, less infections and apparently has some protective against some infections, like HIV.
If you have a family history of bleeding disorders, especially Hemophylia on the mothers side, you need to discuss this with your doctor and ask if the baby is still OK going ahead with it or not.
There is this point of view that promotes not performing an aesthetic procedure on a baby that did not chose to have it done and did not have a say in the whole story. This can be a very long discussion.
Circumcision is not covered by OHIP. You will have to pay the hospital (by credit card-only) and the physician (cash only) on the day of the procedure. The last I asked, the total was less than CAD 500. Dr Gibson, one of the Urologist, is the physician performing this procedure. He visits the hospital nearly every day.
If you want to circumcise your newborn boy in the hospital (recommended time, better than later) tell your nurse, and she will help you arrange it.
Again, we are talking about the Oshawa Hospital.
 
 
 
 
 
 
 
 
 
 
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© 2016 by Dr Abdel Hadi

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