The real low down on labourLabor is a journey fraught with uncertainties. Whilst most women undergo an uneventful delivery, do remember to expect the unexpected, since no birth ever goes exactly according to plan.

False Alarm
Being first time moms, you may get anxious over the slightest pains or contractions. What you are experiencing is possibly early labor. The contractions are typically irregular, mild and may be associated with bleeding (or show). The bleeding is caused by dislodgement of the cervical mucus plug.

Despite your anxiety and eagerness to receive your baby, if you are at this early stage of labor, don’t be surprised if the midwives/ doctors send you back home and only return if contractions increase in intensity and frequency. Early labor can take a few days before you get into active stage of labor. After all, it is more comfortable to be in the comfort of your digs than to be confined to the hospital bed waiting for things to happen.

Where Is My Doctor?
Many mothers-to-be always wonder whether their obstetricians will be with them throughout their labor process. In most circumstances, you will probably only see your doctor a couple of times during your laboring process. It is more likely that a midwife handles your delivery most of the time, and your doctor will be called only when you are ready for showtime. A team of midwives will monitor you and your baby during your labor and alert the doctors when intervention is needed.

Seeing Different Faces
As your labor may take more than 12 hours, do not be surprised that different faces will come greeting you in your laboring room. An anesthetist may administer epidural for you if you want a pain-free labor process. If your doctor is not available during your showtime, another obstetrician will likely take over his/her duties to deliver your baby. A neonatologist may be called upon to standby during your delivery if a difficult birth is anticipated.

Clearing Your Poo
Some doctors routinely administer a fleet enema to clear your rectum of faeces before your labor. This may avoid an awkward situation later when your baby pushes onto your rectum during descent and cause a horrible stench in the labor room.

Injections
It is almost quite a routine to have an intravenous cannula inserted when you are admitted to the labor ward. This would serve as a channel for administration of fluids to prevent dehydration, oxytocin to augment your labor and speed up the contractions. Antibiotics may also be given should you require them. Post delivery, uterotonics (agents used to induce strong contractions in the womb) can be given through the cannule to reduce bleeding and expedite placental separation.

Epidural
Epidural involves a small injection at your back and passing a tiny catheter into the epidural space. The injection numbs your lower half of the body, thus providing pain relief. Before the anaesthetist gives you the epidural injection, about a litre of fluid will be administered through the intravenous cannula. That is because epidural can dramatically reduce your blood pressure and thus diminish blood flow to your baby, bringing about a drop in your baby’s heart rate. As you will not be able to move around freely when the epidural is in place, a urinary catheter is often inserted to provide passive drainage to your urine.

Vaginal Checks And Fetal Monitoring
The midwife will perform regular checks on your cervical dilatation (dilation) to monitor your labor progress. If progress is slow, an augmentation drip may be commenced to speed up your contractions. Your baby’s heart rate is constantly monitored via electrodes placed on your abdomen. Sometimes, it may not be possible to obtain a decent fetal heartbeat tracing and your obstetrician may insert a scalp electrode ( a tiny wire screwed into the scalp of your baby) to obtain a direct fetal heartbeat trace. This will be removed from your baby’s scalp after birth.

When Is My Baby Coming Out?
When your cervix is fully dilated to 10 centimeters, you will be asked to give repeated strong pushes during contractions. This requires a lot of hard work and coordinated efforts. Listen to your obstetrician / midwife for directions. This is probably the journey that is fraught with most dangers, as emergencies can arise during this period. Depending on your preference, an episiotomy may be performed to help with your delivery. However, if you have requested in your birth plan that you do not wish to have an episiotomy, expect vaginal tears and lacerations.

I Am Pushing My Hardest! Why Is My Baby Not Coming Out?!
You can expect to be pushing for up to 2 hours if this is your first child. Most mothers become exhausted after an hour of pushing and require intervention. Your baby may not be coming out due to several reasons: His/ her position may not be the right one (occiptoposterior or occiptotransverse positions). At this point in time, your doctor will advise you on the options. Will it be an emergency caesarean section or an instrumental delivery?

This is a decision that you need to make in consultation with your obstetrician. Be mindful of the possible complications when your doctor decides to pull out your baby forcefully with a forceps or vacuum. These complications can range from mild and self limiting ones to severe and devastating ones with long term sequelae. If an emergency caesarean section is what you opt for, the team of people managing you will spring into action and get things moving real fast here.

A consent will be taken from you, your pubes may be shaved and you will be pushed into the operating room within half an hour or so. Do expect some drama actions during the process.

Baby is out!
Immediately after your baby is out from his/her comfort zone in your womb, your baby will be placed on your tummy, covered in blood and liquor, and the cord cut. The placenta will then be delivered and the vaginal lacerations / tears repaired. The midwife will then transfer your baby to the cot and perform suction to clear secretions out of their airways to allow better breathing. Babies are also prone to hypothermia and the warmer will keep your baby extremely comfortable in the cot.

Baby’s Turn To Get Busy
Almost immediately after your baby is born, a shot of vitamin K will be given to help blood clot. Your baby’s head shape may appear elongated. But that’s because he/she had to squeeze through a tight birth canal. This will subside over the next one or two days. You may carry your baby and start breastfeeding as soon as now.

A Heave Of Relief
Finally, the ordeal is over, and you are ready to enjoy your parenting from this day onwards. All the pain and hard work now seem insignificant to you.

This article was first published in The New Age Parents online magazine Dec / Jan 2013 issue.

Dr Ben ChoeyBy Dr Ben Choey
Specialist in Obstetrics and Gynaecology
A gynaecologic surgeon who has been committed to women’s health for more than 10 years, Dr Choey obtained his Master of Medicine (O&G) and became a member of the Royal College of Obstetricians and Gynaecologists (United Kingdom) in 2007. He was also appointed Clinical Tutor in Yong Loo Lin School of Medicine and Duke-NUS Graduate Medical School

 

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