When you arrive at the labor and delivery area, you will be assigned to an appropriate birthing suite. After answering several of the nurse’s questions, you will be asked to change into a hospital gown.
The nurse will then monitor your pulse and blood pressure and the baby’s heart beat. The nurse will also record the frequency and duration of your contractions and check the cervix for effacement and dilation. The nurse will then notify the on-call physician or nurse midwife of your presence in the delivery area and ask for further directions.
Enemas are not routine since many women experience frequent bowel movements, which are associated with the onset of labor. If you have not had a bowel movement within the eight hours before coming to the hospital, you will be offered a Fleets enema since a full rectum may be uncomfortable for you and may slow your progress in labor.
Electronic fetal heart rate monitoring is usually performed to ensure that your baby is doing well during the stresses of labor. If a baby is experiencing some distress during labor, the electronic monitors make us aware of developing problems at a much earlier stage than the monitoring provided by a stethoscope.
The prevailing opinion is that monitoring is in the best interest of your baby. If early distress is detected, appropriate measures can be instituted to avert more serious problems. Many women find that it is helpful for them to know when a contraction is beginning, and they also like the assurance of seeing the baby’s heart rate at all times.
There are two types of monitoring: external and internal.
With external monitoring, two belts are placed around the abdomen. One belt contains a device that detects the uterine contractions; the other belt detects the fetal heart rate by means of a Doppler ultrasound, similar to the one used in our office.
If you are in early labor, an initial 15- to 20-minute monitoring strip will be obtained to assure that the baby is doing well. Intermittent monitoring for 15–20 minutes out of each hour will typically be performed until you are in the active phases of labor.
One objection raised to external monitoring is that it restricts the ability of the laboring mother to move about. This is easily overcome by the intermittent monitoring of early labor, when you wish to be up and walking. The monitor can be easily disconnected if you need to go to the restroom.
As you enter the more active phases of labor, it is common to begin monitoring continuously and to switch to internal monitoring. With internal monitoring, a small clip is attached to the baby’s scalp to detect the baby’s heart rate. Internal monitoring provides a more accurate reading of the baby’s heart rate and allows the laboring woman to move about more freely than she can with external monitoring.
Many people are concerned that the electrode on the baby’s scalp may be painful; however, the discomfort is probably minimal compared to the sensations the baby experiences with contractions. An infrequent complication of internal monitoring is that an infection may occur where the electrode is applied to the baby’s scalp. This is easily treated if it does occur.
We strongly believe that the minor inconveniences and risks posed by both forms of monitoring are offset many times over by the increased safety they provide your baby during the birthing process.
Another safety measure that we believe is necessary is a buffalo cap. The buffalo cap is a small, plastic tubing that is inserted into the vein in the forearm and capped off with a small amount of medication called heparin, which prevents a blood clot from forming in the tube. Although obstetrical emergencies occur infrequently, when they do occur, they may arise suddenly. The buffalo cap provides a means of responding to these emergencies effectively and quickly. Medications or blood can be given through the intravenous catheters. In the event of prolonged labor, a solution of water and dextrose can also be administered through the buffalo cap to provide energy and to prevent dehydration.