Terminology

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Word(s) of the day: Stages of labor

Wednesday, July 15th, 2009

When I heard about the term “labor” for childbirth, I assumed it meant pushing the baby out.  As in,  when someone says “how long were you in labor?”.  I did not realize that there are actually three stages of labor and did not learn the specifics of that until I took my childbirth class when pregnant with my first baby.

It is important to learn the lingo of childbirth since your doctor, the hospital and other experienced women will be using terms like first stage, second stage and third stage labor.  There are also very unique characteristics of each stage of labor and becoming familiar with them will help you understand more about your own birth.

Every woman’s labor is unique and the signs of each stage vary from woman to woman.  Typically, labor can on average last 12-24 hours for a first pregancy, and shorter with subsequent deliveries.

First stage: Contractions & Dilation

First stage labor is from the start of true labor to the completion of the dilation of the cervix.  It is the longest of the three stages of labor.  It can be broken down into three stages of it’s own: early labor, active labor and transition.

Early Labor

  • cervix gradually effaces and cervix dilates
  • mild to moderate contractions
  •  30-60 seconds long
  •  5-20 minutes apart
  • may have bloody show (mucous plug, spotting or discharge), runny nose, several bowel movements, need to urinate frequently
  • pressure or crampy feeling

The contractions at this time do no space out from changing activity.  It generally feels better to walk (helps to open the inlet of the pelvis) around.  Rest when you can.   Mom may be talkative, anxious and smiling.  It may be helpful to take a shower or bath, listen to relaxing music, have a gentle massage, try slow, deep breathing, change positions, drink water, juice or other clear liquids, eat light, healthy snacks or apply ice packs or heat to your lower back

 Active Labor

  • 5-8cm dilation
  • stronger contractions
  • 60 seconds long
  • 5 minutes apart or less
  • may be sweating, uncomfortable, feel increased pressure and fullness in pelvis, have backache
  • bag of waters may break

The contractions are intense and close.  It is hard work and takes concentration to stay relaxed.  It may feel better to still walk or you may feel the need to lie down.  Sitting on the toilet often brings comfort.  Also, changing positions, rocking in a rocking chair, rolling on a birthing ball, taking a warm shower or bath, placing a cool, damp cloth on your forehead are natural pain relieving methods.  Make sure to relax between contractions as well.

Transition

  • contractions may double peak, become irregular or stop completely for a while
  • you may experience intense emotions including confusion, panic, disbelief and fear

Transition can be the hardest part of labor but it doesn’t last long.  1/3 of women experience difficult transition, 1/3 have a mild transition and 1/3 have no transition at all.  It is commonly during this time when a woman will say “I give up” or “I can’t take it anymore” or even request pain medication but it only takes an average of 10-30 minutes to get through this time and then you will be pushing when the pain is relieved totally by pushing.

Second Stage: Pushing

  • begins when cervix is fully dilated to 10 cm and mother has urge to push
  • expulsive contractions
  • usually space out more
  • may get a “second wind”
  • a lot of pressure in your bottom area
  • burning sensation as baby’s head crowns
  • may experience a tear to the perineum

This stage continues until your baby passes through the birth canal, vagina, and is born. It may last two hours or longer.  Still try to rest between contractions and save your strength for pushing the baby out during the contractions. Your support person can help you find the most comfortable position, continue to offer encouragement, and help you focus on your breathing.

Third Stage: Placenta delivery

The last stage of labor begins after the baby is born and ends when the placenta separates from the wall of the uterus and is passed through the vagina.  You are probably holding your baby and enjoying those first precious moments of bonding but a lot is still going on in your body.  Uterine contractions will help expel the placenta (breastfeeding helps with this), usually within 20 minutes of the delivery of the baby. You may have some bleeding, chills or exhaustion.  If you had some tears or an episiotomy, your physician will do the repair.

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Word of the day: Episiotomy

Friday, May 29th, 2009

Per Mosby’s Medical Dictionary, an episiotomy is a surgical procedure in which an incision is made in a woman’s perineum to enlarge her vaginal opening for delivery.  This is usually done in the last stages of delivery to prevent tearing.  It has been debated medically whether allowing a tear to happen naturally or to perform an episiotomy is the better scenario.  It used to be thought that a tear is harder to mend and harder to heal but it is recognized now that a natural tear heals just as well as a surgical incision (more TMI: I have a good testimony to that.  I had a 3rd degree tear on the last push due to my son’s shoulder dystocia, but at many checkups I had nurses comment – “oh your stitches look great” or even better, “your bum looks great!”).

In the world of natural childbirth, an episiotomy can be performed without using drugs to numb the area.  What?!?!  Cut me open with scissors on purpose and without dulling the pain first?  Yes.  Again, a wonder of our Creator and how birthing works, you can have what is called a pressure episiotomy and it will not hurt.  If properly applied by your medical professional, all you will feel is perhaps a release of pressure.  To ensure this works correctly, your medical professional should wait until the baby’s head is crowning and cut only during a contraction when the stretched perineum is without circulation and sensation is naturally reduced.

Prior to baby’s arrival, there are some things you can do to avoid a tear or episiotomy.  Having good nutrition means healthier skin.  Squatting improves elasticity to the perineum.  Kegels helps tone and tighten the pelvic muscles with helps baby to put chin on chest, encouraging the smaller part of the head to come first.  Avoid soap which is drying.  Lotion and massage can help.  Talk to your doctor to explain your wish to avoid this all to common procedure (35% of mothers with a vaginal birth experienced an episiotomy according to the Listening to Mothers survey conducted by Childbirth Connection).

Additionally, during labor and delivery there are things you can do to avoid a tear or episiotomy.  Your birth supporters can apply warm compresses to your perineum and use massage to encourage stretching naturally.  Keep your elbows up and out and knees back when pushing.  Push with self-control, be patient with your pushing and ease your baby out.

The advantages to an episiotomy are: a faster birth (but baby and mommy need that time), it prevents tearing towards the clitoris (ouch, very rare) and it allows for more room (for what, to get both of doc’s arms in there?).  The disadvantages are: generally unnecessary (typical to a lot of medical procedures these days), can cut through muscles (ouch to that), more blood loss (and it could be scary to see your newborn come out with your blood on it’s head), creates too fast of a birth (not allowing for baby and mommy to do their thang), more pain in recovery (it’s not fun to carry a blow-up, donut pillow around in case you do feel like sitting) and swelling (which makes healing harder).

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Vocabulary quiz: “Hoo-hoo”, “vah-j-j” and other terms your mama didn’t know you heard on the school bus

Friday, May 22nd, 2009

(…and sometimes I had to explain those terms to my mom.)

Let’s see what we all know and don’t know about pregnancy and childbirth terminology*.  Hint: just like those high school assessment tests and college placement exams, the rumor is true: when in doubt, choose “C”.

1) Vagina

a) Topic of a Broadway show

b) Technical term for hoo-hoo, vah-j-j, down there, etc.

c) Birth canal

2) Perineum

a) Per 1000 years

b) A place you would have to be crazy to want to get pierced

c) The skin and tissues between the vagina and the anus

3) Urethra

a) A female Motown singer

b) Word that we have so many other words to use instead of it

c) Tube which carries urine from bladder to exterior of body

4) Kegel

a) A brand of sausage

b) Not to be mistakenly pronounced for kee-gal

c) Name for the pelvic floor muscle that runs from the symphysis pubis in front to the coccyx in back which supports the abdominal organs and uterus; also name of exercises to strengthen it

5) Braxton-Hicks contraction

a) A legal binder between Toni and Taylor

b) The shortened form of Braxtonheimer and Hicksenschmidt

c) Normal intermittent painless uterine contractions

6) Engagement

a) The ceremony you hope your daughter goes through before getting knocked up

b) The ceremony you hope you son goes through before he says oops

c) The entrance of the presenting part of the baby into the pelvis prior to birth

7) Bloody show

a) English man’s term for a performance

b) The warning/rating for the Texas Chainsaw Massacre films

c) Passage of blood tinged mucous or mucous plug prior to onset of labor as the cervix begins to dilate

 8) Dilation

a) What they do to your eyes at the ophthalmologist’s office (the ophtha who?)

b) The method of making a call with rotary phones

c) The act of opening the cervix to approximately 10 cm

9) Effacement

a) A meeting in person

b) A confrontation

c) The act of thinning the cervix, usually expressed in percentage

10) Afterbirth

a) The rumored cosmetic of how Dick Clark looks so youthful

b) The period of time directly following pushing your baby out

c) The placenta and membranes expelled after the baby is born

11) Station

a) What you listen to the radio on

b) Where you pump your gas

c) The downward progress of the baby relative to the ischial spines expressed in cm, i.e.: -1, +2, etc.

12) Lochia

a) The payback for 10 months of no menstruation

b) What your doctor didn’t forewarn you about

c) The bloody discharge for several weeks following birth

13) Vaginal exam

a) What a guy tries to do on the first date

b) What a guy tries to do on the second date

c) Entering the vagina with gloved hand to assess the dilation, effacement, descent and position of baby.

14) Crowning

a) The ceremony when a new matriarch is enthroned.

b) The fake tear/ “I cannot believe it”/bobby pin the bling on portion of any beauty pageant.

c) The portion of second stage labor when the baby’s head pushes the tissues forward looking like a crown.

15) Breech

a) A security risk

b) Something misrepresented, not what you thought it was

c) Presentation of baby with buttocks, foot or feet first.

 How to score your quiz:

13-15 correct:  You need to contact me regarding taking a natural childbirth class since I told you all the correct answers were “C” but I can give you a few since some of the others can technically be true statements as well.

9-12 correct:  You need to contact me regarding taking a natural childbirth class AND a reading comprehension class since I told you all the correct answers were “C”.

 5-8 correct:  You need to contact me regarding taking a natural childbirth class AND a reading comprehension class AND perhaps a math class since I told you all the correct answers were “C”.

1-4 correct:  You need to contact me regarding taking a natural childbirth class AND a reading comprehension class AND perhaps a math class AND I will provide the funding for these classes since you must not have a job with such little regard for direction since I told you all the correct answers were “C”.

0 correct:  I give up.  Are you getting anything out of what I’m trying to teach you here?!?!

 

*All definitions taken from my imagination, The Urban Dictionary and The Bradley Method® Student Workbook – you decide which.

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Word of the day: Amniotomy

Tuesday, May 12th, 2009

Per The American Heritage® Medical Dictionary, amniotomy is the “surgical rupture of the fetal membranes to induce or expedite labor”.  In layman’s terms, it is the breaking of the bag of waters.  It may also be done for the insertion of an internal fetal monitor and to check for meconium (the baby’s first stool).

Amniotomy is performed with an amniohook amniohookclosewhich is a long, thin, crochet needle-looking tool that is inserted through the cervix and snags and breaks the amniotic sac.  When the bag of waters is ruptured, the amniotic fluid, which is full of the hormone prostaglandin, comes in contact with the cervix and may or may not produce stronger, more regular contractions.
 
The average time of rupture of the bag of waters in a natural labor with no interventions is 8-9cm dilation and at times, a baby may deliver with the amniotic sac still intact.
 
An amniotomy should only be performed if you are in active labor (4cm or more dilated), the baby is at full term, the head should be engaged and there should be an indication for the procedure.  Once the procedure is done, there really is no turning back.  Most medical care givers will not let a woman with a broken bag of waters go more than 24 hours without delivering the baby, which could lead to a cesarean section if you do not progress.
 
Some potential side-effects, risks and complications are: cord prolapse, cord compression, infection, harder and more intense contractions during labor (the bag of waters equilizes the pressure and acts as a cushion for baby and mother), more tears to the perineum (the bag of waters allows for more gentle stretching), swelling to baby’s head from uneven pressure and as mentioned above, you will on a time clock for delivery.
 
As with any medical procedure, there is a time and place for it.  Interventions have advantages and disadvantages and they may lead to further interventions and complications.  Always consider your options carefully and make informed decisions that are right for your baby, for you and for your birth and try not to make it out of rashness and a desire to have the labor be over with.

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