Interventions During Your Labour and Delivery

Time to talk about the main event... the birth of your baby! This is a continuation of the last post on vaginal birth in the hospital. I'll discuss different interventions you might encounter, like what happens during pushing, and the delivery. Once you decide to deliver at a hospital, you most likely will have some of these interventions. This post will help you be prepared for what lies ahead. This blog is representative of my experiences during vaginal birth as a labour and delivery nurse.  I have come to realize that every single birth is unique and different. There is no blog post that can cover all the different variations.  Just like there are billions of different women out there, there are billions of different births.

Interventions - Epidural

Epidurals can be great even though they are not for everyone!

It is an extremely personal choice whether or not to get one. I am not going to go into the pros and cons, but rather cover the basic information of what to expect if you do decide to get an epidural.

If you ask for an epidural, you might have to wait before you get it.  Even if there is an anesthetist (the doctor that administers the epidural) dedicated to the labour and delivery floor, he or she might be busy.

Sometimes the anesthetist even works on other units of the hospital. Therefore, it's good to be prepared to be able to cope with the pain of contractions, because, even if you have decided to get an epidural, you might have to wait.

There are a lot of unknowns in birth! Especially in a hospital setting where lots of things are going on. Get support from your nurse or partner while you wait for the epidural!

When Should You Get the Epidural?

A lot of women ask this question and especially want to know when it's too late to get an epidural. The answer depends on your hospital. Some women want to feel labour for a bit before getting an epidural. They want to walk around first and the epidural can restrict you to the bed. Other women want an epidural right away and prefer not to feel any pain.

Some unit policies allow putting in an epidural anytime. Other hospitals have more strict policies, and might only allow you to get an epidural once you are in active labour and won't put one in after you've reached a certain stage in your labour.

Find out from your health care provider what the policies are at your hospital so you can plan ahead!

Does The Epidural Hurt?

Pain is a subjective thing. Depending on where you are in your labour and how you usually respond to pain, it can be different for every woman. When you get the epidural, you get two needles. The first poke is for local anesthesia so that you're numb before you get the actual epidural needle. Women usually describe it as a bee sting. The second needle feels mostly like pressure while the doctor tries to find the epidural space in your back. That's where the medication that will numb you goes. Women feel the epidural more if they are not in active labour. If they are in a lot of pain due to contractions, they usually will barely feel the epidural go in.

How Does Labour Feel After The Epidural?

If the epidural works well you will feel pain relief, but it does not usually take away pressure. In some cases, the epidural doesn't work well and you might still feel pain. Every woman has a different experience. Sometimes, if the epidural does not work at all, it might need to be reinserted.

Most often you will have to stay in bed, and you might need a urinary catheter because you will not feel the urge to pee. Once it's time to push, you most likely will feel pressure in your bum. This differs among women as well. Some feel lots and lots of pressure, others feel barely any!

It is debated whether epidurals delay birth, or whether they make it more difficult to have a successful vaginal delivery. 

Most women are able to get some sleep, and that can be very helpful because pushing is extremely hard work.

Oxytocin Used to Speed up Your Labour

This medication is used to speed up labour. It mimics the hormone oxytocin that you naturally produce in labour.

If the doctor orders this, the nurse will administer it through your IV (intravenous line) and start at a low dose.

Every woman needs a different amount to get into active labour, so it is increased slowly as the nurse pays close attention to the duration, frequency and quality of your contractions.

Oxytocin will make your labour stronger, and your contractions will be more painful and close together.

This will open your cervix faster. Oxytocin is routinely used on the labour and delivery floor, and it is also administered to you after the delivery to contract your uterus and prevent bleeding.

If you are having an induction you will have this medication for sure! Read all about inductions right here on Babytalk! Everything You Ever Wanted to Know About Inductions

All About Episiotomies

If your baby needs to come out fast, sometimes the doctor will need to cut the perineal tissue between your vagina and bum to make room for the baby's head. That is an episiotomy! This might happen if there is an issue with baby's heart rate, or if you've been pushing for a long time and the baby needs to come out quickly. Luckily, this intervention most often used only when necessary. If you don't have an epidural the doctor will use freezing in the area before cutting. Healing can take longer than with a regular tear and the stitches will dissolve naturally.

Pushing Your Baby Out!

You will start to push once fully dilated (ten centimetres) and the baby is low enough.  The level your baby is at is called station, and it's dependant on the position of the baby's head in your pelvis. If the baby is low, it will be at a plus station (+1, +2, +3, with +3 being the lowest) if the baby is high, it will be at a minus station (-1,-2,-3, with -3 being the highest). Typically, the lower the head, the more pressure you will feel. I said typically because again, every woman is different! Some feel pressure their whole labour!

Pushing is different for every woman. Some feel a strong urge to push and their bodies do it automatically. Others don't feel any urge at all and need coaching the whole way through.

If you do feel the urge, it will feel like you need to have a bowel movement. As gross as that sounds, it's the best way to describe it!

Coached Pushing and Positions

In a hospital setting, the nurses usually use coached pushing.

This means you will be asked to take a deep breath, hold your breath like you are going underwater, and push for three repetitions each contraction with a breath in between.

When you push, you are going to be asked to "push into your bum, like you're having a bowel movement." Although not the most appealing, it works for most women. That way you are able to focus your efforts into the right region of your body to bring the baby down and out!

It depends on the hospital and delivering doctor what position you will be pushing, but most obstetricians tend to want to catch the baby in the lithotomy position.

That is, on your back with your feet bent at the knees, and legs spread open. I say most because every doctor is different.

If you feel more comfortable pushing in another position, don't hesitate to voice that. You know your body best and unless you say something, it is harder to help you reach your goals. For example, you can push on all fours or lying on either of your sides.

It really depends on what is most comfortable to you, and what the delivering provider is comfortable with.

The Birth of Your Baby

Once the baby is very close to delivery the doctor will be called in to catch the baby. The doctor is most often not present for pushing, your nurse will be your primary support during that time.

If your doctor or nurse thinks the baby will need more support after delivery, another baby team might come to your aid.

Some hospitals have a dedicated baby nurse to take care of the baby right after delivery.

If the baby needs help transitioning, they might need to take him or her to the baby warmer.

Most places will allow you to do skin-to-skin right after delivery if the baby is transitioning well, so let your nurse know beforehand if that is your plan.

Read about the evidence for skin-to-sin right here on Babytalk! Skin-to-Skin: The One Place Your Baby Wants to be After Birth

The baby might be covered in blood and vernix (the white stuff that protects the baby's skin), but it's all good, your baby is here! You might need some stitches down below, and the doctor will stitch you up while you enjoy the first few moments with your newborn.

It truly is a magical time, so wait as long as you can before you invite more people in to see your newborn baby.