Labor and Delivery

Signs of Labor• Contractionsoryourabdomentightensandthen

relaxes.

• Youfeelcontractionsatregularintervalsandlasting30-70seconds.

• Contractionskeepcomingnomatterwhatyouaredoing.

• Inlabor,contractionswillgetstronger,lastlongerandbeclosertogether.

• Ifyouthinkyouarehavingcontractionsandyouarenearyourduedate:

• Continuetodrinkfluids.• Trytogetsomerest.• Trysomeofthecomfortmeasures.

Call your healthcare provider or clinic at the Center for Women’s Medicine if you have any of the following:• Vaginalbleeding.

• Waterbreaks,notethetime,colorandamountoffluid.

• Contractionsthatbecomeregularandstronger,andareabout5minutesapart.

• Feelingthebabynotmoveasmuchasithasbeen.

• Ifanythinghappensthatyouarenotsureof,oryouhavequestions.

Comfort Measures in LaborFinddistractionsinearlylabor.Herearesomesuggestions:

• Takeawalk.

• Listentomusic.

• Dolighthousework.

• Trytovisualizeapleasantmemory.

• Focusoncountingyourbreaths,recitingaverse,chanting,movingrhythmicallytomusicoryourownrhythm.

• Focusontouch,strokingormassagebyyourpartner.

• Changepositionatleastevery30minutes.

• Keepyourbladderempty.

• Siponfluids,waterorjuices.

• Takeawarmshowerorbath.

Is This Really Labor?

There are several options for delivery• Vaginaldeliverywithspontaneouslabor(labor

thatstartsnaturally)orinducedlabor

• Cesareandelivery

• VaginalbirthafterCesareandeliveryorVBAC

Menu — Click on Topic• Is This Really Labor?

• Birth Plan

• Upon Arrival to the Labor and Delivery Unit

• Your Stay While You are in Labor

• Induction of Labor

• Cesarean Delivery

• Vaginal Birth After Cesarean (VBAC)

• Skin-to-Skin Contact

• Father’s /Partner’s Role in Labor

If you think you are in labor… Call your healthcare provider or the clinic at

the Center for Women’s Medicine.

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Birth Plan

Getting to know you!Inorderforustoensurethatyourbirthexperienceispositiveandcomplieswithyourwishes,pleasecompletethissectionofthehandoutwithinformationregardingyouandyourpartner(ifapplicable).Pleaseusethissectiontoshareinformationaboutanypreviouslaborexperiencesorifyouhaveanyspecialneeds.

Support PeopleWeencourageyoutohaveasupportpersonwithyouatalltimesduringlabor.Ifyouchosetoalsohaveadoulapresentwithyouduringlabor,letyourhealthcareteamknowwhenyouareadmitted.Yoursupportperson/doulamaywalkwithyouinthehallways.Wedoaskthatthehallnotbeusedasagatheringplacetoensurethesafetyandprivacyofbothyouandotherpatients.Ifyouhaveotherchildren,theymaybeinthelaborroomwithyouonlyiftheyhaveanotheradulttosupervisethem.

Tell us your concerns Pleasetelluswhatyouaremostconcernedabout,suchasthefollowing:

• Epiduralornoepidural? •Fetalmonitoring• IVtherapy •Havingyourfamilywithyouinthelaborroom?Pleaseletusknowyourconcernssothatwemaybemindfulofyourwishesduringlabor.

Labor PreferencesAtmosphere:Youmayhavespecialpreferencesforyourlabor,suchassoftlighting,relaxingmusicorpeaceandquiet.Wehavedoneourbesttomakeourlaborroomsascomfortableaspossible.Youmayalsobringitemswithyoufromhomethatwillpersonalizetheatmosphereforyou.Theseitemsmayinclude:

• familyphotos •iPod• focalpoints •massagelotion• pillows •anyitemyoufeelwillbenefityouinlaborPosition Changes:Positionalchangesaswellasmovementareencouragedtohelpfacilitatelabor.Youcantrythefollowing:

• walking •usingarockingchair•takingashower •usingabirthingball• pelvicrocking •anypositionorcombinationofpositionsthatgivesyoucomfortOccasionally,yourhealthcareprovider,midwifeornursemayaskyoutogetintoacertainpositionforthebenefitofthebaby.

DIRECTIONS:Readthisdocumentthoroughly!PrintoutandcompleteeachsectionoftheBirthPlanhandoutfoundattheendofthistab.Pleasereviewtheinformationprovidedbelow,asitwillassistyouwhileyoufilloutyourhandout.

Pleasespeaktoyourhealthcareproviderormidwifetodiscussanyriskfactorsinyourpregnancythatcouldaffectyourbirthoptions.Ifyouhaveanyquestionsaboutyourbaby’scare,pleaseconsultwithyourbaby’shealthcareprovider.YouareencouragedtobringcopiesofyourBirthPlanwithyoutothehospital.

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Relaxation and Comfort Techniques: Itisveryimportantforyoutobeascomfortableaspossibleduringlabor.Somerelaxationmethodsmayinclude:

• massage

• useofcounterpressure

• imagery

• breathingtechniques

• heatandcoldapplications

• anyotherrelaxationtechniqueyouhavefoundthatworksbestforyou

Labor Support:Werealizethatthesupportyoureceiveduringlaborwillhavealottodowithyourconfidencetogivebirth.Pleaseletusknowifthereisanythingwecansayordothatwillhelpyou.

Education:Pleaseindicatealloftheclassesyouhavetakentoprepareforbirthandparenting,eventhosetakenorcompletedoutsideofthehospital.

NOTE: Certaindecisionssuchasepiduralanesthesiamaylimittheaboveoptions.Pleasediscussthiswithyourhealthcareprovider.

Medical Interventions During Labor and BirthIfyouhavespecialrequests,pleasetalkthemoverwithyourhealthcareproviderormidwifeduringyourclinicorofficeappointmentsbeforelaborbegins.Decisionsmayneedtobemaderegardingmedicalinterventions.Pleaseindicatewhetherornotyouwouldliketobeinvolvedinthedecisionmakingprocess.Youmayprefertoleavethedecisiontoyourhealthcareproviderormidwifeshouldaninterventionbecomenecessary.

Fetal Monitoring: Afetalmonitorisonewaytodetermineyourbaby’sheartratethroughoutlabor.Yourhealthcareproviderwillusuallywantyoutobemonitoredconstantlyonceyouareinactivelabor.Ifyouareadmittedtothehospitalwhenyouareinearlylabor,yourhealthcareprovidermaymonitoryourbaby’sheartrateatscheduledintervals.Havingafetalmonitorappliedtypicallydoesnotrestrictyourmovements,yourabilitytowalk,changepositionsorsitinachaircomfortably.Weofferintermittentmonitoringforlowriskmomsinlabor.Talkwithyourhealthcareproviderormidwifetoseeifthisisanoptionforyou.Weencourageyoutodiscussanyconcernsyoumayhaveregardingfetalmonitoringwithyourhealthcareproviderormidwifebeforeyoucometothehospitalorwithyournurseonceyouarriveatthehospital.

Eating and Drinking/Intravenous (IV) Fluids: Youcaneatlightfoodsathomewhileinearlylabor.OnceyouareintheLaborandDeliveryUnit,eatingwillbelimitedtoicechipsandsnowconesduringlabor.MostmothersreceiveIV’sforfluidreplacementinlabor.Theyarealsousedforadministrationofmedications,forIVpainmedication,inpreparationforanepiduralandforCesareanbirths.Ifyouchoosetoreceivepainmedicationoranepiduralduringyourlabor,youmaywanttowaituntilyourlaborbecomesactivesoyouhavetheoptiontowalkaround,ratherthanrequestingituponadmission.YourIVmayalsobediscontinuedfromtheIVfluidbagand“cappedoff”,ifyouarenotbeinginduced,receivinganepiduraland/ordehydrated,sothatyoumaybemoremobile.

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Induction and Augmentation of Labor: Theseproceduresartificiallybeginlabororhelpittoprogressbyworkingwithyourbody’sownoxytocin.Yourhealthcareproviderormidwifewilldiscusstheseoptionswithyou.

Vaginal Exams: Adoctor,nurseormidwifemaydoavaginalexamtoseehowyourlaborisprogressing.Avaginalexammaybedonewhenyouarriveatthehospitalandmightberepeatedperiodicallytoevaluateyourprogress.

Pain ManagementPleaseletusknowyourpreferencesforpainmanagement.Therearemanysolutionstopainmanagement,besidesmedication.Youmayplanonusingsomealternativecomfortmeasuressuchas:

• relaxation •breathing

• massage •movement

• shower •thebirthingball

Pleaseletourstaffknowhowwecanhelpyou.Ifyouareplanningonusingadoula,besureherroleisclearlydefinedandsheknowsyourexpectationsforlabor.

Second Stage of Labor and BirthHaveyouthoughtaboutwhatpositionsyouwouldliketotryforlaborandwhenyoustarttopush?Weencourageyoutoshareanyofthepositionsthatyouwouldliketotrywithuswhenyouareadmitted.

Herearesomeothersituationsyoumaywanttoclarifywithyourhealthcareteam:

• Wouldyouliketousethebirthingballinlaborandthesquattingbarwhenyoupush?

• Afterthebabyisborn,doyouoryourpartnerwanttocutthecord?

• Doyouwanttoidentifythesexofthebabyyourself?

• Wouldyoulikeyourbabyplacedskin-to-skinwithyoudirectlyafterbirth?

• Areyouareplanningonbreastfeeding?Itisrecommendedthatyoubeginbreastfeedingduringthefirsthourafterbirth.

• Doyouhaveanyquestionsorconcernsaboutthatfirstfeeding?

• Doyouwantfamilyandfriendstobewithyoudirectlyafterthebirthorwouldyouprefersomepersonaltimealoneasanewfamily?

Phone Calls:Inordertoprotectyourprivacy,weareunabletogiveinformationtoinquiringfamilyandfriends,sopleaseletyourfriendsandfamilyknowourpolicybeforehand.

Recording the Birth:Youarewelcometouseyourcameraforstillphotographsduringthefirststageoflabor.Videotapingispermittedduringthefirststageofthelaborprocessaswell,however,videotapingisexcludedduringthesecondandthirdstagesoflabor(pushinganddelivery),duringaCesareanbirthandduringimmediatetransitionofthenewborndeliveredvaginally.Thehealthcareproviders,pediatricians,certifiednursemidwivesandnurseswantyouandyourbaby’ssafetytobetheirprimaryconcern.Videotapingduringtheabovementionedtimesmayposeadistractiontopatientcare,potentiallyimpactingthesafetyofmotherandnewborn.

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Cesarean BirthDuringtheoperation,aurinarycatheterisrequiredtokeepyourbladderemptyduringsurgery.FormostCesareanbirths,spinalanesthesiaisusedduringthesurgery.Afteryourbabyisborn,othermedicationsmaybegiven.Thesemedicationsmayaffectyouralertnessintherecoveryroomwithyourbaby.Postpartum,yourpainmayberelievedbymedicationsgiventhroughyourIVorwiththeuseofaPCA(patient-controlledanalgesia)pump.

YoursupportpersoniswelcometoattendaCesareanbirth.She/hedoesnothavetowatchtheoperation,butcansitbesideyourheadduringandafterthesurgeryandmayholdthebabyafterthebabyhasbeenstabilized.Pleasenotethatthisisasterileprocedureandtheymaynotcutthecord.

HerearesomethingstoconsiderifyouarehavingaCesareanbirth:

• DoyoudesiretohaveyoursupportpersonwithyouduringaCesareanbirth?

• DoesyoursupportpersondesiretobepresentduringaCesareanbirth?

• Doyouhaveanalternatesupportpersoninmindincaseyourprimarysupportpersoncannotbepresent?

• Doyouwanttobreastfeedaftertheprocedure?

After Your Baby is BornYour Baby’s Healthcare Provider: Haveyouselectedahealthcareproviderforyourbaby?Doesshe/hehaveprivilegesatthehospitalwhereyouaredelivering?Ifnot,pleaseconsultwithyourhealthcareproviderbeforeyouradmissiontothehospitalregardingarecommendationwhileyouareatthehospital.Youwillneedthisinformationwhenyouareadmittedtothehospital.Forimmediatehighriskcareofasicknewbornwehavespeciallytrainedneonatologists(healthcareproviders),nursesandrespiratorytherapistsinourNeonatalIntensiveCareUnitorNICU.

Immediate Newborn Care:Normalnewborncarewilltakeplaceinyourlaborroomfollowingthebirth.Thisincludes:

•weighing •measuring

•checkingtemperature •pulse

•respiration •cordcare

•physicalexam •eyeointment

•vitaminKinjections

Weencouragebreastfeedingmotherstointroducethebabytothebreastduringthefirsthour.

Infant Feeding: Doyouplantobreastfeedorbottlefeedyourbaby?Tofacilitatethebeststartwithbreastfeedingweencourageearlyfeedingandfrequentfeedingsassoonasyourbabyshowshungercuesandbeforeshe/hestartstocry.Typicalfeedingsoccurevery1-3hours.Forthosewhoneedadditionalassistance,lactationconsultationsandeducatorsareavailablethroughoutyourhospitalstay.

Here are some things to consider if you are having a Cesarean birth:

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Getting to know you: ___________________________

______________________________________________

Support people:________________________________

______________________________________________

Tell us your concerns:___ Epiduralornoepidural?___ Fetalmonitoring?___ IVtherapy?___ Havingyourfamilyinlaborroom?___ Useofinterventions?

Labor preferences:

Atmosphere: ___ Familyphotos___ iPod___ Focalpoints___ Massagelotion___ Pillows___ Otheritemsyoufeelmaybebeneficial

Position changes: ___ Walking___ Usingarockingchair___ Takingashower___ Usingabirthingball___ Pelvicrocking___ Other

Relaxation & comfort techniques:___ Massage___ Useofcounterpressure___ Imagery___ Breathingtechniques___ Heat&coldapplications___ Other

Medical interventions during labor & birth:

Pain management: ___ PainMedication___ Relaxation&Breathing___ Massage___ Movement___ Shower___ BirthingBall___ Other

Topics to consider during second stage positions and birth: _____________________________________

______________________________________________

______________________________________________

In the event of a Cesarean birth, will you have a support person present?

___Yes___No

After your baby is born: Mybaby’shealthcareprovideris:

________________________________________ Ihavenotchosenahealthcareproviderformy

baby___ Iplantobreastfeed___ Iplantobottlefeed___ Idoplantohavemysoncircumcised___ IDONOTplantohavemysoncircumcised

Going home:

Specialconcerns/requestsforthecareofyourbaby:

______________________________________________

______________________________________________

Pleasebesuretohaveyourbaby’scarseatinstalledinyourcarpriortodischarge.Nursescannotassistyouininstallation.

Name:___________________________________________________________Myduedateis:___________________

Myhealthcareprovideris: __________________________________________________________________________

ThankyouforsharingyourBirthPlanwithus!Welookforwardtocaringforyouandyourbaby.

Birth Plan Worksheet

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Your Stay While You are in LaborWhileyouareapatientinLabor&Delivery,youwillbecaredforbyaregisterednursespecificallyassignedtoyourcarealongwithyourhealthcareproviderandaresidenthealthcareprovider.

Who will be present when I deliver my baby?Atthetimeofdelivery,aregisterednurse,technicalpartner,yourhealthcareproviderandaresidenthealthcareproviderwilllikelybepresent.Ananesthesiahealthcareproviderornurseandspecialtystaffforyourbaby,healthcareproviders,nursesandarespiratorytherapistfromtheLevelIIINeonatalIntensiveCareUnit(NICU)areavailableifneeded.

LehighValleyHospitalisateachinghospital.Theresidentphysiciansworkcloselywithyourhealthcareprovider.Youmayhavemedicalstudentsandnursingstudentaskingtoparticipateinyourcare.

Can I eat while I am in labor?Wedonotfeedyouwhileyouareinlabor.Icechipsandsnowconesareavailableformouthcomfort.Coffee,juiceandsodaareavailableforyourpartner.

Can I bring my birth plan/wishes?Besuretodiscussanybirthplansorspecialwishesyoumayhavewithyourhealthcareproviderpriortoyourdelivery.Abirthplanandaworksheettocompletearelocatedinthistab.

The baby’s footprintsBringyourbabybookforthedelivery.Welovetoputfootprintsinthebooks!

• PerinatalCarearea(Triage)iswhereyouwillbeevaluatedtodeterminewhetherornotyouareinlabor.Afteryouareevaluatedanditisdeterminedthatyouareinlabor,youwillbeassignedtoaprivatebirthingroom.

• Onceyouhavebeentransportedtoyourroom,youwillmostlikelyhaveintravenousfluids(IV)insertedintooneofyourarmsandafetalmonitorappliedtomonitorthebaby’sheartrateandyourcontractions.

• LehighValleyHospitalisateachinghospital.Themembersofyourcareteamareyourhealthcareprovider,nursingstaff,midwives,residents,medicalandnursingstudents.

• Anesthesiologists,neonatologists(healthcareproviderswhospecializeinnewborncare),maternalfetalmedicineperinatologists(physicianswhospecializeintakingcareofhighriskmaternalissues)areavailable24hoursadayifyouoryourbabyshouldneedthemforcare.

Upon Arrival to the Labor and Delivery Unit

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Help your labor progressChangeyourpositionatleasteveryhour.Keepyourbladderemptybyurinatingeveryhour.Walk,sitinarockingchairorusethebirthingball.Duringcontractions,leanonyourpartneroroverthebed,rockinarockingchairorinbed,swaywiththebirthingballorswaywhileleaningoverthebed.Youcanalso“slowdance”withyourpartnerduringcontractions.

What are the visiting guidelines while I’m in labor?Foryourcomfort,respectforyourprivacyandinfantsafety,visitinginLabor&Deliverysupportsfamilypresence.Yourfamilywillbepermittedbasedonyourneedsandsafety.

Can my partner cut the cord after delivery?Yourpartnermaycutthecordafteravaginaldelivery.Ifthereisanemergencywithyourbaby,thehealthcareprovidermayquicklycutthecordandhandthebabytotheawaitinginfantsupportteam.

Duetoariskofinfection,yourpartnercannotcutthecordduringaCesareandelivery.

Can we take pictures of the delivery?Noaudio-video/stillphotography/cellphonecameraswillbepermittedduringpatientcare,duringdelivery,stabilizationofmother,infantorduringanyprocedure.

Photographymustnotinterferewithpatientcare.

Nophotographyofanyhealthcareproviderispermittedwithoutfirstobtainingwrittenconsentfromthatprovider.

Failuretocomplywiththeserulesmayresultinremovalfromtheclinicalunit,aswellasfromthehospitalsetting.

TheOBproviders,pediatricians,certifiednursemidwivesandnurseswantyouandyourbaby’ssafetytobetheirprimaryconcern.

Who will notify my baby’s healthcare provider about our birth?ThestaffontheMotherBabyUnitwillnotifyyourbaby’shealthcareproviderwhenyourbabyisborn.Yourbabywillbeexaminedbyhis/herhealthcareproviderwithin24hours.

Can my baby stay with me after birth?YourbabywillstaywithyouinLabor&Deliveryafteravaginaldeliverysothatyoucanspendtimetogether.IfyouhadaCesareandelivery,youwillseeyourbabyrightafterbirththenthebabywillgotothenurseryforobservationuntilyoursurgeryiscompleted.Yourpartnercangowiththebabytothenurseryandtakepictures.Whenyouaresettledintherecoveryroom,thebabywillspendtimewithyouintherecoveryroom.

TheremaybetimeswhenthebabywillneedtogototheNeonatalIntensiveCareUnitforcloserobservationandspecialtycare.WewilltakeyoutotheNICUassoonaspossibleafterdeliverytosee,touchandbondwithyourbaby.

Do I stay in the labor room after I have my baby?Afterthebirthofyourbaby,youmayhaveuptoatwohourrecoverytimeinLabor&Delivery.YouwillbetransferredtotheMotherBabyUnitafteryourrecoverytime.

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What is induction of labor?Stimulatinglaborbeforeyourlaborbeginsnaturally.

When is your baby considered full term or ready for delivery?Yourbabymaycome2weeksbeforeorafteryourduedate.Overdueorpostdatesare2weeksafteryourduedate.

Why should I have my labor induced?Whenthebenefitofdeliveryforyourbabyisgreaterthantheriskofcontinuingyourpregnancy.

What are the different types of inductions?Inductionmaybenecessarywhenthereissomereasontoendthepregnancysuchas:

• Youarepastyourduedate.

• Yourwaterbreaks.

• Yourmedicalconditionworsens:

• Diabetes• Highbloodpressure• Babyisnotgrowingproperly(IntrauterineGrowth

Restriction).• Thereisnotenoughamnioticfluidaroundthebaby.• Thereisaninfection.

• Electiveinductions:

• Yourlastlaboronlytookacoupleofhours.• Youliveagreatdistancefromthehospital.• Youhaveavalidfamilyproblemsuchasyour

husband/partnerisabouttobedeployed.

Who will decide if induction is right for me and my baby?• Youwilldiscussyouroptionswithyourhealthcare

providerormidwife.

• Thehealthcareproviderormidwifeshouldexplainthereasonsforinduction,therisks,theprocedureandalternativestoinduction.

• Theofficewillscheduleyourinduction.

• Inductionsmaybepostponedorreschedulediftheneedarises.

How long will my induction take?• Timefrominductionoflabortodeliveryofinfantis

unpredictable.

• Generally,inductionsmaytakealongtime,18to24hours,ormore.

Are there risks to induction of labor?Yes,anymedicineorprocedurehasrisks:

• Sideeffectsfromthemedicationsusedfortheinduction.

• Riskswhenthehealthcareproviderormidwifebreaksyourwater.

• Inductionmayleadtoepisiotomies,vacuum,forcepsorCesareandeliverytohelpthebabydeliver.

• Inductionoflabor,comparedtonaturallabor,hasariskofoperativedelivery:vacuum,forcepsorCesareandelivery.

• Babymaynottoleratealonglabor.• Withprolongeduseofpitocin,thereisariskof

increasedvaginalbleeding,uterinemusclefatigueorexcesswaterretention.

What are the risks of induction of labor after I have my baby?• Dependsonthelengthoflabor.

• Infectionsmayberelatedtolonglabor.

• Uterinemusclemaynotcontractafterdeliverywhichmayresultinincreasedbleedingthatmayleadtoanemia.

Induction of labor is not without risks for you or your baby. Discuss the need for induction, risks and procedures with your healthcare provider or midwife. Ask questions and discuss the issue thoroughly until you understand.

Induction of Labor

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Cesarean Delivery or C-Section

Cesarean delivery• Babyisdeliveredthroughthemother’sbelly.

• Theincisioniseitherfromsidetoside(transverse)orupanddown(classical).

• Thecutonyourskinmaybedifferentthanthecutonyouruterus.

• Askyourhealthcareproviderwhattypeofcutismadeonyouruterus.

Ifthecutonyouruterusissidetosideortransverse,youmaybeabletodeliveryvaginallywithyournextdelivery.

• Cesareandeliveryisamajorsurgerysoyouwillbeinthehospitalfor3daysafteryourdelivery.

• BreastfeedingafterCesareandeliveryisnormal.

Why do some women need a Cesarean delivery?Cesareandeliveriesmaybeplannedforseveralreasons:

• Breechpresentationwiththebaby’sbuttocksorfeetcomingfirst

• Morethanonebaby• Placentaisoverthecervix• Activevaginalinfectionsuchasherpes

MostCesareandeliveriesareunplanned.• Babydoesnotfitthroughthemother’spelvis.• Babydoesnottoleratelabor.• Laborfailstoopenthemother’scervix.• Mother’sworseningmedicalcondition.

• Diabetes• Highbloodpressure• Othermedicalproblem

Babyhasspecialneeds.

What are the risks of having a Cesarean delivery?• Infection

• Bleeding

• Injurytonearbyorgans

• Reactiontoanesthesia

If you are admitted for a scheduled Cesarean delivery:• Donoteatordrinkaftermidnight.

• Arrive1½hoursbeforeyourscheduledCesareandeliverytime.

• WhileyouarebeingpreparedforaCesareandelivery,visitorsmaybelimitedpriortogoingintheoperatingroomwithyou.

What is the procedure after delivery?• Atthetimeofdelivery,yourhealthcareproviderwill

handyourbabytothestafffordrying,warmingandtocheckthebaby’sbreathingandheartrate.Youmayheartheinfantcrybutsomebabiesarequiet.

• Yoursupportpersonmaybecalledtothecribwhenthebabyisstabilized.Thesupportpersonmaytakepicturesofthebabyinthecrib.Videotapingisnotallowedintheoperatingroom.Yourbabywillbebroughtovertoyouforavisit.Yourbabyandsupportpersonwillgotothenurserytogether.

• Followingthesurgery,yournursewillbepressingdownonyouruterustokeepitfirm.Thismaybeuncomfortablebutitwillhelpdecreaseyourbleedingfollowingthesurgery.

• Youwillstayintherecoveryroomforaboutanhour.

• Ifthebabyisstable,thebabywillcometotherecoveryroomforbondingandbreastfeeding.

We try to maintain our schedule as much as possible. If an emergency arises with another mother or her unborn baby, please be patient as we continue to provide care for our families.

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Vaginal Birth After Cesarean (VBAC)

What is a VBAC?• YouhadaCesareandeliveryforapriorbirthandyouwanttohaveavaginaldeliveryforthebirthofthischild.

Are there risks to having a VBAC?• TherearerisktothemomandherbabyiftheuterinescarfromthepreviousCesareandeliveryopensorruptures

duringlaboranddelivery.

What are the advantages of VBAC?• Cesareandeliveryisamajorsurgery.Vaginaldeliveryisnot.

• Lessriskforinfection,bleedingandothercomplications.

• Youwillhaveashorterrecoverytime.

Talk to your healthcare provider to see if a VBAC is right for you.• Whatisthepositionofyourbaby?Yourbabymustbeheaddown.

• WhydidyouneedaCesareandeliverywithyourlastbaby?

• DoyouhavehealthproblemsthatwouldpreventVBAC?

• DoyouhavepregnancyissuesthatrequireCesareandelivery?

• Twinsortriplets• Lowlyingplacentaorplacentaoverthecervix• BabyinBreechposition

Call your healthcare provider or the clinic at the Center for Women’s Medicine when your labor begins.

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Skin-to-Skin Contact for You and Your Baby

What is “Skin-to-Skin”?Skin-to-skinmeansyourbabyisplacedbelly-down,directlyonyourchest,rightafterthebabyisborn.Yourhealthcareproviderdriesoffthebaby,putsonahat,coversthebabywithawarmblanket,andgetsthebabysettledonyourchest.Thefirsthoursofsnugglingskin-to-skinletyouandyourbabygettoknoweachother.Theyalsohaveimportanthealthbenefits.Ifthebabyneedstomeetthepediatriciansfirst,orifyoudeliverbyCesareandelivery,youcanunwrapthebabyandcuddleshortlyafterbirth.Newbornscraveskin-to-skincontact,butit’ssometimesoverwhelmingfornewmoms.It’soktostartslowlyasyougettoknowyourbaby.

BreastfeedingSnugglinggivesyouandyourbabythebeststartforbreastfeeding.Eightdifferentresearchstudieshaveshownthatskin-to-skinbabiesbreastfeedbetter.Theyalsokeepnursinganaverageofsixweekslonger.TheAmericanAcademyofPediatricsrecommendsthatallbreastfeedingbabiesspendtimeskin-to-skinrightafterbirth.Keepingyourbabyskin-to-skininthefirstfewweeksmakesiteasytoknowwhentofeedthebaby,especiallywhenthebabyisalittlesleepy.

A Smooth TransitionYourchestisthebestplaceforyourbabytoadjusttolifeintheoutsideworld.Comparedwithbabieswhoareswaddledorkeptinacrib,skin-to-skinbabiestendtostaywarmerandcalmer,cryless,andhavebetterbloodsugars.

BondingSkin-to-skincuddlingmayaffecthowyourelatewithyourbaby.Researchershavewatchedmothersandinfantsinthefirstfewdaysafterbirth,andtheynoticedthatskin-to-skinmomstouchandcuddletheirbabiesmore.Evenayearlater,skin-to-skinmomssnuggledmorewiththeirbabiesduringavisittotheirpediatrician.

Skin-to-Skin Beyond the Delivery RoomKeepcuddlingskin-to-skinafteryouleavethehospital–yourbabywillstaywarmandcomfortableonyourchest,andthebenefitsforbonding,soothing,andbreast-feedinglikelycontinuewellafterbirth.Skin-to-skincanhelpkeepyourbabyinterestedinnursingifhe’ssleepy.Dadscansnuggle,too.Fathersandmotherswhoholdbabiesskin-to-skinhelpkeepthemcalmandcozy.Multiplestudiesoverthepast30yearshaveshownthebenefitsofskin-to-skincontact.Inallthestudiesdescribedhere,motherswererandomlyassignedtoholdtheirbabiesskin-to-skinorseethemfromadistance.Formoreinformation,seeAndersonGC,GC.Moore,E.Hepworth,J.Bergman,N.Earlyskin-to-skincontactformothersandtheirhealthynewborninfants.[SystematicReview]Cochrane Pregnancy and Childbirth Group Cochrane Database of Systematic Reviews. 2, 2005.

MassachusettsBreastfeedingCoalition/www.massbfc.org| © 2005 MBC and Alison Stuebe

Babies who have skin-to-skin get to:• smellyou

• hearyou

• feelyou

• nursefromyou

• staywarm

• becalmedandlovedbyyou

It’s my birthday, give me a hug!

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Father’s/Partner’s Role in Labor

Take care of yourself• Donotskipmeals• Drinkfluids• Restwhensherests

Try these activities if she is agreeable:• Massage,gentlerhythmicmassage• Counterpressureatthebaseofherspine• Encouragerhythmtomovementssuchasrockingorswaying• Encouragerhythmtobreathing,moaningorchanting• Wipeherfaceandneckwithacooldampcloth• Withasoftgentlevoiceofferwordsofencouragementandpraise

• “Goodjob!”• “Youdidgreatwiththatcontraction!”• “Youcandothis!”

• Speakinasoothinglowrhythmictoneofvoice• Breathwithherduringthecontraction-usingslowdeepbreaths• Letherknowwhenthecontractionisatthemidpointandalmostover.

• Matchyourvoicetoherrhythm.• “Youarehalfwaythroughthiscontraction.”• “It’salmostover.”

• Assisthergettingintomorecomfortablepositionsorpositionstoenhancelabor,evenifthepositionlastonlythroughafewcontractions

• Offericechipstocoolandmoistenherlips• Offerchapstick• Keeproomdimlylit• Keeproomquietwithonlysoothingsounds

• Usemusicshefindsrelaxing• Avoidloudsuddennoises

• Allowonlythevisitorsshewantspresent• Helphermaintainprivacy• Providethecomfortoftouch

• Stroking• Backrubs• Hand-holding

Simkin, P. & Ancheta, R. (2005). The Labor Progress Handbook 2nd ed. Blackwell Publishing

Note: Some women do not like to be touched when they are in pain.

Follow her cues.