Judith Trimble, BSN discusses what to expect when you go into labor, the different stages, and when you should head to the hospital.
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Prepared Childbirth, Part 1: Once Labor Starts
Featured Speaker:
Judith Trimble, BSN, RNC-OB, C-EFM
Judith Trimble BSN, RNC-OB, C-EFM is a Perinatal Educator RN for BayCare. Judy has been a labor and delivery nurse for over 35 years and was a Certified Childbirth Educator for 20 years. She has worked for BayCare at Mease Countryside Hospital Labor and Delivery for over 12 years. Judy received her ADN from State University of New York at Upstate Medical Center School of Nursing in Syracuse, NY and her BSN from St. Petersburg College. She is a member of Lamaze International, International Childbirth Education Association (ICEA), Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN). Transcription:
Introduction: Here's another edition of the BayCare Health System’s podcast series BayCare HealthChat with Melanie Cole.
Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole. And today we're discussing prepared childbirth, part one. What can you expect once labor starts? Joining me is Judy Trimble. She's a Perinatal Educator at BayCare. Judy, it's a pleasure to have you join us. What an exciting time for new parents. But a lot of times they're not quite sure whether they're in labor. We've heard about Braxton Hicks. You get all of these pains and things and feelings while you're pregnant. It can be a little confusing. How does someone know they're in labor? What are some of those signs?
Judy Trimble: What's kind of interesting is no one knows exactly what causes labor to start. It is a change of hormones. So in the final weeks of pregnancy, your body begins to release more prostaglandin, which softens your cervix, settles your baby in your pelvis. And then you start having some signs that are possible signs. You can be tired, have a restless backache, frequent soft bowel movements, mild to moderate abdominal cramping and sort of a nesting time, which a lot of women say they have where they want to get their house all ready. Then you move into, as it gets a little closer to your due date, pre labor or false labor, you were talking about Braxton Hicks contractions, they are irregular. They start and stop. The pattern changes if you change your position, if you drink some water and they go away, it's a Braxton Hicks. What happens is there isn't any cervical change, but it isn't a waste of time. It's actually getting your body ready for labor.
Then you move into some more positive signs. Positive signs would be contractions that are regular. When you time a contraction, you time it from the beginning of one to the beginning of the next. And I usually recommend that you write the time down because it would be hard to remember, was it six minutes ago or 10 minutes ago? And then I was talking to some pregnant women who said there's actually an app on their phone so that they hit the app when their contraction starts and that's the way they can time their contraction accurately. What's going to happen is in real labor, your contractions will become more regular. They'll become longer. They can go from 35 seconds to 60, and earlier labor from 60 to 90 seconds, in later labor there'll be more frequent. And when your cervix is checked, there'll be changes on your cervical exam.
Host: Well, that was a great description for people that have not gone through it before. So when is it that somebody goes to the hospital when they've started timing their contractions and boy, do I remember how that felt? And it can be a scary time, but such an exciting thing to have happen. When do they go to the hospital? Do they wait until their water breaks? What if their water breaks? Tell us a little bit about what to do next?
Judy Trimble: What your doctor or midwife will want you to do is call if your water does break; however, your water breaks on its own only about 15% of the time. So it probably won't be one of the signs you're looking for. What you're basically looking for is a rule they call the 411 or 511 rule. When your contractions are intense enough, you require a focus and pattern breathing. If they're four to five minutes apart, one minute long, for about one hour. So that would be the 411 or the 511. When you do call your doctor, they're going to want to know how long the contractions last, how many minutes apart, how long they've been like this, if there's any fluid leaking or any bleeding or bloody show.
Host: So then what? We toddle off to the hospital, somebody drives us. And in this time we're allowed to have somebody with us. Right?
Judy Trimble: Right.
Host: So then what happens? Tell us about the stages of labor. And if you want to go into some of the protocol now and what pregnant ladies can expect, that would be great.
Judy Trimble: So, when you arrive at the hospital, you usually go to a triage area where they determine if you're in labor and then you go through an admission process. Usually they have you change into a hospital gown. The nurse does a medical, an OB history. She asks you lots of questions. Has you sign consent forms, draws labs and starts an IV. You are usually able to drink clear fluids during that process, but no food until after you deliver. So once you're in the hospital throughout labor, the nurse will check you regularly - your blood pressure, temperature, pulse, fluid intake, urine output, activity, and emotional state. She or the physician or midwife will do a vaginal exam intermittently as needed to find out where you are in your labor. For the baby, one thing that will always happen when you get there is they'll put an electronic fetal monitor on. One part of the monitor records the baby's heart rate. Another part will pick up your contractions that you're having. The monitor can be intermittent, or they can leave it on continuously, depending on what's going on with you at that stage of labor.
Host: Then what happens? Can you have somebody with you? And what do you expect as far as pain relief, whether you want that or not, how are all those decisions made.
Judy Trimble: At this time, we're doing this interview, you're allowed to have one support person with you in labor. They will be the one that you have the whole time that you're there. They can come and go. They prefer that they stay as much as they can, but at the moment you're only allowed one support person. Labor is painful. It's purposeful, anticipated, it's intermittent. And you do have some options for pain relief. Generally what your nurse will ask you is what your pain number is on a scale of one to 10. How well you're coping with labor. We usually say one is you're feeling totally normal. And 10 is imagine, you know, having some severe leg cut off or something like that without anesthesia. And so then we try to be a little realistic about where the pain falls in between that one and 10.
You have basically two choices for pain relief. You have analgesics and anesthetics. The analgesics are usually systemic like an opioid. It's usually given IV or as a shot. It reduces awareness of pain and is calming. You don't lose consciousness. There are some side effects, but that's one of your options. The second option would be an anesthetic, which is either regional or general. The regional is the epidural, which is generally about 68 to 70% of women will get an epidural. According to the American Congress of OB and GYN, epidural is the most effective way for reducing pain. You stay alert it can be given anytime up to a half an hour before you deliver. You would be in bed. You can't move, but you are relieved of pain. It works until you deliver, and then we shut it off after you deliver.
Host: Well, I certainly remember all of this. So, what about Caesarean? What are the most common reasons for a primary Caesarean section that's not preplanned? And while you're telling us about that, kind of give your best advice for once labor starts for couples. And what you want them to know about timing the contractions, and really why not to worry and not to panic.
Judy Trimble: So here are some reasons, common reasons for a primary caesarean section that wouldn't be planned. One is failure to progress. There are certain stages of labor. Each one usually lasts a certain amount of time. The first stage of labor, early labor lasts six to 12 hours. Active labor, once you get to six centimeters, lasts about four to eight hours for first time moms. Transition is the last part of the first stage of labor that lasts one to two hours. And you could push anywhere from two to three hours. And as long as you're progressing, it's considered normal. What happens with a Cesarean section is failure to progress. You fall out of those parameters. The doctor gives you time. It isn’t an emergency, but it's obvious that you're failing to progress. That's the most common reason. Concerns about a fetal heart rate would be the second reason. When the monitors on the doctor and nurses see something that's concerning to them and they feel like a Cesarean section would be the best way to go. Another reason would be breech or unfavorable position, baby is not head down. However, the good news is only about 3% of babies are not head down. So that would be a different reason. Multiple gestation, which would be twins, triplets. And the last reason would be suspected macrosomia, which is just really a fancy way of saying the baby's probably too big to fit.
Host: So then wrap it up for us with your best advice for new parents to be and what they can expect at BayCare when they go into labor and just give them your best advice, wrap it up for us.
Judy Trimble: When you're preparing to have a baby, you almost need the wisdom of the ages and the latest research. It's always a good idea to have read about your options. It's a good idea to know as many approaches as possible to labor, understand how to relax and use breathing techniques, get complete information about what's available to you, risks and benefits, knowing that the regular nursing care that you're going to get from your labor nurse is going to be excellent. They're very much hands on. They take a lot of time with you. My goal as a labor and delivery nurse is I want you to look back on your labor and delivery with a good memory, something that you're not going to say, I never want to do that again, but with just a sense of accomplishment of what you've done through your pregnancy and through your delivery. And know that pregnancy and birth are perfectly designed. They're safer than ever before. Not just because of medical techniques that we use, but because women are healthier, we have better hygiene. We have better techniques. We have antibiotics. We have a lot of things in place to give you a safe and satisfying childbirth.
Host: Thank you so much, Judy. It's great information and such an exciting time for couples at this time. To learn more about BayCare's maternity services, please visit our website at BayCareMaternity.org for more information, and to get connected with one of our providers. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.
Introduction: Here's another edition of the BayCare Health System’s podcast series BayCare HealthChat with Melanie Cole.
Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole. And today we're discussing prepared childbirth, part one. What can you expect once labor starts? Joining me is Judy Trimble. She's a Perinatal Educator at BayCare. Judy, it's a pleasure to have you join us. What an exciting time for new parents. But a lot of times they're not quite sure whether they're in labor. We've heard about Braxton Hicks. You get all of these pains and things and feelings while you're pregnant. It can be a little confusing. How does someone know they're in labor? What are some of those signs?
Judy Trimble: What's kind of interesting is no one knows exactly what causes labor to start. It is a change of hormones. So in the final weeks of pregnancy, your body begins to release more prostaglandin, which softens your cervix, settles your baby in your pelvis. And then you start having some signs that are possible signs. You can be tired, have a restless backache, frequent soft bowel movements, mild to moderate abdominal cramping and sort of a nesting time, which a lot of women say they have where they want to get their house all ready. Then you move into, as it gets a little closer to your due date, pre labor or false labor, you were talking about Braxton Hicks contractions, they are irregular. They start and stop. The pattern changes if you change your position, if you drink some water and they go away, it's a Braxton Hicks. What happens is there isn't any cervical change, but it isn't a waste of time. It's actually getting your body ready for labor.
Then you move into some more positive signs. Positive signs would be contractions that are regular. When you time a contraction, you time it from the beginning of one to the beginning of the next. And I usually recommend that you write the time down because it would be hard to remember, was it six minutes ago or 10 minutes ago? And then I was talking to some pregnant women who said there's actually an app on their phone so that they hit the app when their contraction starts and that's the way they can time their contraction accurately. What's going to happen is in real labor, your contractions will become more regular. They'll become longer. They can go from 35 seconds to 60, and earlier labor from 60 to 90 seconds, in later labor there'll be more frequent. And when your cervix is checked, there'll be changes on your cervical exam.
Host: Well, that was a great description for people that have not gone through it before. So when is it that somebody goes to the hospital when they've started timing their contractions and boy, do I remember how that felt? And it can be a scary time, but such an exciting thing to have happen. When do they go to the hospital? Do they wait until their water breaks? What if their water breaks? Tell us a little bit about what to do next?
Judy Trimble: What your doctor or midwife will want you to do is call if your water does break; however, your water breaks on its own only about 15% of the time. So it probably won't be one of the signs you're looking for. What you're basically looking for is a rule they call the 411 or 511 rule. When your contractions are intense enough, you require a focus and pattern breathing. If they're four to five minutes apart, one minute long, for about one hour. So that would be the 411 or the 511. When you do call your doctor, they're going to want to know how long the contractions last, how many minutes apart, how long they've been like this, if there's any fluid leaking or any bleeding or bloody show.
Host: So then what? We toddle off to the hospital, somebody drives us. And in this time we're allowed to have somebody with us. Right?
Judy Trimble: Right.
Host: So then what happens? Tell us about the stages of labor. And if you want to go into some of the protocol now and what pregnant ladies can expect, that would be great.
Judy Trimble: So, when you arrive at the hospital, you usually go to a triage area where they determine if you're in labor and then you go through an admission process. Usually they have you change into a hospital gown. The nurse does a medical, an OB history. She asks you lots of questions. Has you sign consent forms, draws labs and starts an IV. You are usually able to drink clear fluids during that process, but no food until after you deliver. So once you're in the hospital throughout labor, the nurse will check you regularly - your blood pressure, temperature, pulse, fluid intake, urine output, activity, and emotional state. She or the physician or midwife will do a vaginal exam intermittently as needed to find out where you are in your labor. For the baby, one thing that will always happen when you get there is they'll put an electronic fetal monitor on. One part of the monitor records the baby's heart rate. Another part will pick up your contractions that you're having. The monitor can be intermittent, or they can leave it on continuously, depending on what's going on with you at that stage of labor.
Host: Then what happens? Can you have somebody with you? And what do you expect as far as pain relief, whether you want that or not, how are all those decisions made.
Judy Trimble: At this time, we're doing this interview, you're allowed to have one support person with you in labor. They will be the one that you have the whole time that you're there. They can come and go. They prefer that they stay as much as they can, but at the moment you're only allowed one support person. Labor is painful. It's purposeful, anticipated, it's intermittent. And you do have some options for pain relief. Generally what your nurse will ask you is what your pain number is on a scale of one to 10. How well you're coping with labor. We usually say one is you're feeling totally normal. And 10 is imagine, you know, having some severe leg cut off or something like that without anesthesia. And so then we try to be a little realistic about where the pain falls in between that one and 10.
You have basically two choices for pain relief. You have analgesics and anesthetics. The analgesics are usually systemic like an opioid. It's usually given IV or as a shot. It reduces awareness of pain and is calming. You don't lose consciousness. There are some side effects, but that's one of your options. The second option would be an anesthetic, which is either regional or general. The regional is the epidural, which is generally about 68 to 70% of women will get an epidural. According to the American Congress of OB and GYN, epidural is the most effective way for reducing pain. You stay alert it can be given anytime up to a half an hour before you deliver. You would be in bed. You can't move, but you are relieved of pain. It works until you deliver, and then we shut it off after you deliver.
Host: Well, I certainly remember all of this. So, what about Caesarean? What are the most common reasons for a primary Caesarean section that's not preplanned? And while you're telling us about that, kind of give your best advice for once labor starts for couples. And what you want them to know about timing the contractions, and really why not to worry and not to panic.
Judy Trimble: So here are some reasons, common reasons for a primary caesarean section that wouldn't be planned. One is failure to progress. There are certain stages of labor. Each one usually lasts a certain amount of time. The first stage of labor, early labor lasts six to 12 hours. Active labor, once you get to six centimeters, lasts about four to eight hours for first time moms. Transition is the last part of the first stage of labor that lasts one to two hours. And you could push anywhere from two to three hours. And as long as you're progressing, it's considered normal. What happens with a Cesarean section is failure to progress. You fall out of those parameters. The doctor gives you time. It isn’t an emergency, but it's obvious that you're failing to progress. That's the most common reason. Concerns about a fetal heart rate would be the second reason. When the monitors on the doctor and nurses see something that's concerning to them and they feel like a Cesarean section would be the best way to go. Another reason would be breech or unfavorable position, baby is not head down. However, the good news is only about 3% of babies are not head down. So that would be a different reason. Multiple gestation, which would be twins, triplets. And the last reason would be suspected macrosomia, which is just really a fancy way of saying the baby's probably too big to fit.
Host: So then wrap it up for us with your best advice for new parents to be and what they can expect at BayCare when they go into labor and just give them your best advice, wrap it up for us.
Judy Trimble: When you're preparing to have a baby, you almost need the wisdom of the ages and the latest research. It's always a good idea to have read about your options. It's a good idea to know as many approaches as possible to labor, understand how to relax and use breathing techniques, get complete information about what's available to you, risks and benefits, knowing that the regular nursing care that you're going to get from your labor nurse is going to be excellent. They're very much hands on. They take a lot of time with you. My goal as a labor and delivery nurse is I want you to look back on your labor and delivery with a good memory, something that you're not going to say, I never want to do that again, but with just a sense of accomplishment of what you've done through your pregnancy and through your delivery. And know that pregnancy and birth are perfectly designed. They're safer than ever before. Not just because of medical techniques that we use, but because women are healthier, we have better hygiene. We have better techniques. We have antibiotics. We have a lot of things in place to give you a safe and satisfying childbirth.
Host: Thank you so much, Judy. It's great information and such an exciting time for couples at this time. To learn more about BayCare's maternity services, please visit our website at BayCareMaternity.org for more information, and to get connected with one of our providers. That concludes this episode of BayCare HealthChat. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. I'm Melanie Cole.