Preparing for Baby

How long does labor last?

 

How long does labor last?

This is a common question I get when my patients walk onto the unit. My usually response, not getting into details, is “It really depends on your body. Everyone is different. No labor is the same. Labor generally lasts from 12-30+ hours.” The 30+ hours usually scares people, but hey, where would I be if I lied to you? I say 30+ because hey, sometimes it happens. I will sum up each labor stage and explain what goes on in each stage.

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Please read the disclaimer

The first stage is the onset of true labor until the cervix is 10cm. The first stage is the longest of them all and is broken down into three categories.

  • Early Labor: From onset of labor till 3cm dilated
  • Active Labor: continues from 3cm until the cervix is 7cm
  • Transition Phase: Continues from 7cm to 10cm.

What does cervical dilation look like? Check out this nifty visual guide here. 

Let’s talk more about Early Labor.

  • It can last 8-12 hours
  • During this time your cervix is working towards effacing and dilating to 3cm
  • Contractions are usually mild and somewhat irregular, but as labor progress they will become more frequent and stronger
  • Contractions can feel like lower back pain, menstrual cramps, or pressure/tightening in the pelvic area.
  • Contractions usually last around 30-45 seconds and are every 5-30 minutes. This gives you plenty of time to rest
  • You water may or may not break. Pay attention to the color. We want to know if it is clear or meconium stained. Meconium stained means your baby had their first poop in utero. If you are overdue, this is fairly common. Sometimes meconium can indicate stress, but this isn’t always true. Just let your provider know time and color if it breaks at home.

What can I do in Early Labor?

Hold up don’t pick up the phone and ring your doc or midwife yet (I know the excitement or nerves are building now, I know it is easier said than done, but really try and relax). Take a deep breath and relax. Enjoy the comfort of your own home before you rush to the hospital.

Conserve your energy, you are going to need it once labor really starts to kick in. Stay hydrated and fuel up. It will be one heck of a roller coaster ride, but so worth it at the end.

Try and rest. You won’t be getting much of it once you kick in. If you can’t sleep try and play a game or watch a movie to keep your mind busy.

If your water breaks or you are really starting to work through contractions, or they are closer together give your doc or midwife a shout.

*please note if you are higher risk, your water breaks, you become dizzy, have a headache you can’t shake, seeing floaters, have pain under your right breast, have increased swelling of your feet, hands, or face,  or you are bleeding bright red call your doc/midwife right away!*

Let’s chat about active labor

This is when things really start to pick up. This is the time you’d give your doc or midwife a ring!

  • It can last from 3-5 hours.
  • During this stage your cervix will dilate from 4cm to 7cm
  • Contractions will be closer together about 3-5 minutes apart and lasting 45-60 seconds.
  • Contractions are going to feel much stronger and longer

What can I do in Active Labor?

This stage is all about pain management and positions. Move, move, move. Try side lying, standing, rocking, hands and knees, or even the shower. If you hospital has a tub even try that.

Back rubs and even pressure on your lower back may help some. Just know going in what you want and communicate it to everyone. Not everyone likes back rubs or being touched.

Even though hard, try and stay hydrated and eat a little bit here and there. I found that fruit, popsicles, or even honey sticks helped keep me/my patients well fueled. Of course as things really progress you may not want to eat and you may become nauseous and vomit.

If you want an epidural, you may even want it during this time. What is an Epidural and the process of getting one? 

The transition phase: things really start to get intense.

This is the phase many women say “I can’t do it,” but honey let me tell you, YOU CAN DO IT! You’re stronger than you think you are, trust me.

This is the hardest phase, but also the shortest (that may help some).

At this point you may get the labor shakes, chills, become nauseous and vomit.

  • This phase can last from 30 minutes to two hours
  • The cervix will finish dilating to 10cm
  • Contractions are much stronger and last 60-90 seconds and come every two minutes

What can I do during this phase?

As mentioned above try different positions. You may not even want to move, but sometimes moving helps. You can use the shower or bath. During this phase you may not want to eat, drink, or even talk. Just prepare your significant other, you may appear angry, but know it is a normal part of transition.

Breath through your contractions and keep telling yourself, “One at a time,” or “One closer to meeting my baby.” It may give you some relief.

 

The period after the cervix is 10cm to the delivery of baby

What happens during this stage?

  • This stage can last anywhere from 15 minutes to 2+ hours
  • Contractions may slow or stay consistent at 2 minutes, everyone’s body is different. They last about 45-90 seconds and come every 2-5 minutes.
  • At this point you will have an urge to push, lots of rectal pressure. Make sure to tell your nurse/provider once you feel this! We all get pretty excited
  • Okay – let’s talk poop. You are going to do it, get over it. Really. It isn’t a big deal, in fact it is pretty natural. After all you are using the same muscles.
  • At this stage your baby will crown, you will feel a burning sensation. This is known as the “ring of fire”. While you crown you may hear your provider say small pushes, or grunt your baby out. This is so you don’t tear  too much

How should I push? What should I expect?

There are many different positions you can deliver in. Hands and knees, side lying, on your back (not all the way flat), and you can even using a birthing stool. As mentioned there are many positions, you don’t have to be confined to one spot! Of course if you have an epidural, you may not be able to get into some positions.

Only push when you have a contraction or feel the urge. Use the same muscles as you would during a bowel movement. Just remember you will poop, it is inevitable. Don’t worry about it, it isn’t like the provider or nurse will announce it! We are pretty discrete, you may not even notice.

Rest as much as you can in between. You’re going to need all the energy

If you want ask you provider or nurse for a mirror to watch your progress. It may give you a little extra umpf!

Oh! I want to mention, don’t be discouraged if you see baby’s head move back in. Baby rocks back and forth, this is so they can get under that bone. Eventually he/she will crown, just keep pushing.

 

Third stage of labor

The delivery of the placenta. It lasts about 5-30 minutes. During this time the provider may be expecting your perineum to see if you tore, while waiting for the placenta.

Remember no bones for this one! Phew!

Your provider will massage your uterus. This may be uncomfortable, or painful, you did just push a baby out of it. And like any muscle after a long workout, it will be sore and tired.

After the delivery of the placenta you will be monitored for a few hours to make sure you don’t bleed. This means extra fundal checks (yay!) and frequent vitals. The upside? You get to snuggle your cute little bundle of squish!

Questions or comments? Feel free to comment/ask away below or email mamaelyfant@gmail.com

 

Preparing for Baby

What You Really Need in Your Hospital Bag

What you really need in your hospital bag, the inside scoop from a labor and delivery nurse.
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I know that you may have seen many of these posts, but what makes this different is that I am a Labor and Delivery nurse and mother! I have seen many people come in with tons of bags (they never touched half of them) to people who brought in very little (and ended up heading home for essentials). What you need in your bag really depends on how long you will be there.

Now, if you are going in for an induction you may be there for a while. If it is a first time induction than you know you will be there for a while. I am not saying you are going to be there forever, but enough to need a little extra in your bag. You’ll also need an extra outfit if you’re going for a c-section. You don’t need to pack your whole house. I promise you won’t use half of it. Bear with me.

Free checklist download at the end! 

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When should I pack?

Well, in my opinion start getting things together by week 37. It doesn’t mean to pack the entire thing. I’d have the bag ready at week 39. You never know when labor will strike. Some moms are just too excited (hey I was one of them) and packed as early as week 35! I couldn’t contain my excitement and I get it. Just be prepared to be tweaking and adding as the weeks go on.What you really need in your hospital bag. The inside scoop from a labor and delivery nurse

It really isn’t a big deal when you get ready, just be prepared. Nothing like running around the house in a panic trying to get a bag together while preparing to expel a human from your body!

Okay, so tell me, what do I need?

The average hospital stay for a vaginal birth is usually two days (this is after the delivery, this doesn’t include how long you are in labor). The average stay for a c-section is three-four days, depending on your recovery and hospital policy.

Labor for first time moms (sometimes second, third, etc moms too) can last 12-30 hours, depending on your body. So in reality you have no idea exactly how long you will really be there, but this doesn’t mean to pack the whole house. While in labor you won’t want to be wearing much of anything anyways! Hospitals have fancy mesh undies that make you feel like a total super model. Or you can buy some awesome granny panties and rock them. We will get back to this later.

Well first you need a duffel bag. I found that I really liked this bag. If you’re looking for something else this is also a good purchase.

The Vera Bradley bag has enough room for 2-3 baby outfits, 3 outfits for yourself, 3 outfits for your significant other, and some other essentials. That is of course if you pack it the right way. We will get to that.

Okay, really, what do I need?

What you really need in your hospital bag, the inside scoop from a labor and delivery nurse.
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Baby cloths and a blanket – Now skin to skin is a biggie in baby friendly hospitals. Most of the time you’ll want your baby skin to skin. This helps your baby get to know your smell and if you are breastfeeding helps promote bonding. So when it comes to baby outfits you don’t need a ton. I promise.

Bring an outfit for pictures, some hospitals have a professional photographer, or any accessories you think will look cute. Now about baby size, I’d go with 0-3 months. Rather be safe than sorry. Make sure to bring an outfit for the baby to go home in. Two outfits will be enough.

One blanket should be plenty. I know it is so hard to chose ONE. You get about a million of them as gifts!

Cloths for you – Pack something comfortable, no jeans. Really you’ll thank me. You will still have a bit of a baby belly so those jeans that fit pre-pregnancy may be snug and uncomfortable. Go for yoga pants that can stretch. I would’t pack your favorite pj’s either. Things get messy. I am not saying it is a blood bath, but you’ll be bleeding (almost like a heavy period) for a few days. You don’t want a huge blood stain on those favorite yoga pants or pjs. You can buy some inexpensive yoga pants or pj’s at Walmart or Target.

Breastfeeding! Don’t forget your bras. I’d bring 2 and one nursing tank or night time bra. Bravado! is a definite go to bra. They are soft and comfortable. Medela is a good brand as well.

For easy access during breastfeeding bring a zip up hoodie. No need to fuss. The less fuss the more bonding with your little one. Not a big fan of hoodies? Try a soft comfortable robe. This way you are covered and you can stroll about the unit.

Socks & Underwear – Don’t forget essentials like socks or underwear. Let’s stop on socks for a second (I love socks, fuzzy ones especially). I got these fun and spunky labor socks. Not only do they have grips on them my nurses got a kick out of them.

Back to underwear… Now I mentioned before most hospitals have mesh underwear. They are great, because they are huge like granny panties and you can throw them out. No need to worry about ruining your favorite leopard print underwear and more space left in the bag. You’ll only need a real pair of underwear for the ride home (unless you don’t mind the mesh). If you are not too keen on that buy some cheap underwear you don’t mind throwing out.

Flip Flops – Don’t forget to add a pair of  flip flops for the shower. They clean the bathrooms, but still…

Pads –  Hospitals supply pads, so less to pack and more room for other essentials. If you are not interested in using their pads, bring your own, but make sure they are super absorbent like these.

Significant other’s items – Don’t forget about your significant other. Make sure they have 2-3 outfits with underwear and socks included. They’ll thank you.

Pillows – The pillows at the hospital are usually super flat. I mean we are talking pancakes. Something I wish I brought for myself was my own pillow. I’d bring your own pillow, but make sure to bring a pillow case you don’t mind ruining.

Your boppy if you are breastfeeding. The nurses will teach you how to use it if you are uncertain.

Car Seat – You need to be able to take your little one home. Of course you can’t fit this in your bag. 😛

Snacks! Let me tell you some hospitals don’t have room service at 1am. After delivery you are HUNGRY. Like, you could eat a horse hungry. So having a few snacks stashed away is a must. You just worked hard, so good fats, carbohydrates, and yes sugar will help you get some energy back. We all know your energy stores from here on out will be sapped. Make sure to eat something before getting up for the first time. We don’t need you getting woozy and passing out.

Don’t forget your cell phone charger. I don’t know how many times a significant other wanders out to the nurses station asking for a charger.

A camera (and batteries for that camera), ipad chargers or any other chargers you may need. Music is also a good thing to add. It helps with a relaxing (and fun) environment.

Being induced? If you are going in for an induction prepare to bring some entertainment. This can include a book, card games, an ipad, or anything that can keep your preoccupied. You may need an extra outfit. In this case some patients found it helpful to pack an extra bag of cloths and leave it in the car in case they needed it.

Going in for a c-section? The stay tends to be an extra day or two, so pack accordingly. Also, abdominal binders. The hospital has them. My patients always tell me they are amazing. They compress a bit helping alleviate some strain on your incision. I only mention these, because I have seen some patients bring their own.

 

Toiletries

  • Toothpaste & Toothbrush (the ones at the hospital are not the greatest, but if you forget them they should have some)
  • Deodorant
  • Hair brush
  • Chapstick (lips get super dry during labor, this is useful!)
  • Hair elastics
  • Pads (most hospitals have them, but feel free to bring your own of course!)
  • Nursing Pads (now, the first few days while you are in the hospital you produce colostrum and won’t leak much. Leaking really happens when your milk comes in. They are not an essential, but you can bring them if you want)
  • Underwear you don’t mind chucking or one pair for going home. Use the ones at the hospital
  • Glasses and Case
  • Contacts and Case
  • Contact solution
  • Shampoo
  • Body wash

Phew…that seemed like a lot. Can I really fit it in the bag? Why yes, yes you can. I roll my clothes and stack them as high as they can go in the bag and start again next to the column. This way I have more room. It is like tetris, but you can pack a whole lot in a bag with a bit of thinking outside the box. But I can’t say it enough you don’t need to go terribly overboard. Remember you need to bring these things back with you.



Don’t stress too much about the bag, really. Just pack what you need. Hope this helped. If you have any comments or questions feel free to ask away. 🙂

Preparing for Baby

Epidural 101, What is an Epidural?

Epidural 101, what is an epidural?
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Read the disclaimer.

Epidural 101, what is the process of an Epidural? Read here.

Epidural anesthesia is the most popular method of pain relief in labor.

What is Epidural Anesthesia?

Epidural anesthesia is regional anesthesia that blocks nerves in a specific area of the body. The goal of an epidural is to provide pain relief, not anesthesia. Epidurals help relieve about 80-85% of your pain. What do I mean by this? We want you to have pain relief (analgesia instead of anesthesia), not be a limp noodle. Anesthesia leads to a total lack of feeling. Analgesia is the inability to feel pain.

Wait you said only 80-85% of my pain will be gone? What gives?

As mentioned in Epidural 101, what is the process of an Epidural, we want you to have some sensation. This aids in pushing. A total block won’t let you know when you need to push. That feeling like you have to take the biggest poop of your life, we want you to have it.

What nerves do epidurals block?

Epidurals block nerves in the lower spinal segments. This in turn leads to decreased sensation in the lower half.

Where does the Epidural go?

Epidural 101, what is an epidural?
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A catheter will be placed in your epidural space. The epidural space is the space between your dura mater (a membrane) and the vertebral wall. This wall contains fat and blood vessels. The space is just outside the dural sac. The dural sac is filled with cerebrospinal fluid and  surrounds nerve roots.

Types of Epidurals

1. Regular Epidural

The most common epidural used during Labor and Delivery. A catheter is left in place in your back. A medication such as fentanyl or morphine will be administered via a pump continuously. Narcotics are usually used over anesthetics. Ask you doctor which ones your hospital uses, as it varies. You will have a button you can push for extra relief if needed. You won’t be able to get out of bed. Food and drink may be prohibited. Talk to your doctor about your hospital’s policies.

2. Intrathecal, combined Spinal-Epidural, or “walking epidural”

Instead of the medication going in your epidural space, the medication is delivered into the intrathecal space. You may get an initial dose of narcotic, anesthetics, or a combination of both. This pain relief only lasts 4-8 hours, but a catheter is usually left in place. If you want an epidural later this is an option. This “walking epidural” allows you more freedom to move in bed and help with position changes. This doesn’t mean you will be walking.

As you can see there are differences between them. In regards to pain management in the regular epidural gives you pain relief until delivery with no interruption. As the intrathecal the pain medication can wear off, as it isn’t being infused continuously.

Have any questions or comments? Feel free to comment below or e-mail me at mamaelyfant@gmail.com

Preparing for Baby

Epidural 101, What is the Process of Getting One?

Epidural 101, what is the processing of getting one? The inside scoop from a labor and delivery nurse
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Planning on getting an epidural? What does the process entail? Well, get the inside scoop from a Labor and Delivery nurse.

Read the disclaimer.

What is an Epidural? Read here.

Okay so let me start off with this. Epidurals don’t take away ALL the pain, only about 80-85% of the pain. Now you must be thinking, “Then why spend all that money if I am still going to be in pain?” 

Ok so here is the thing. The pain is different. It isn’t the same pain as contractions  (if that makes sense). You should feel pressure and some mild cramping. We don’t want you to be a limp noodle. Why? We want you to be able to push and feel when it is time to push. We also would like a little help when we need to turn you. Our backs will thank you! But I promise, it will give you relief.

So what happens after I request an epidural? 

The nurse will tell your provider, who in turn calls the anesthesiologist. Time between asking and getting the epidural is very dependent on the hospital. Usually it shouldn’t take more than an hour.

If you don’t have an IV, you’ll be getting one now.

Before the anesthesiologist comes, your nurse should be giving you a bolus of fluid.

Once the anesthesiologist arrives what happens? 

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A consent should be signed, they’ll go over the risks.

Your nurse will be hooking you up to everything. The fetal heart rate monitor should be on you at all times (if it hasn’t already been), along with the toco (measures contractions), a pulse oximeter, and a blood pressure cuff will be applied.

Make sure to listen to your anesthesiologist and nurse carefully as they will give you instructions on positioning for the epidural (usually a sitting position).

Now, I am not going to sugar coat things. Trying to stay still is hard during contractions. Just be as still as you can be.

Once you are in position they’ll clean your back off. Then they will tell you to push your back out. Sounds odd, but hug a pillow, tuck your chin into your chest, and curl around your baby.

Before the catheter goes into your back they will numb the area. This is the worst part about the whole thing. You may not even notice, as contractions are a lot worse than the little bee sting.

Once numbed up they will feel around to place the needle, it will go into your epidural space.

Then the anesthesiologist will thread a catheter into the epidural space. You may feel a “zing”, a very odd sensation that goes down one of your legs. If you feel this make sure to tell them. This just means it hit a nerve and the anesthesiologist will make an adjustment.

Next is a test dose to make certain that it is in the right spot. They will tell you to let them know if you have any strange symptoms like ringing in your ears or a metallic taste in your mouth.

Once confirmed the needle is removed. The anesthesiologist will tape the heck out of your back. You’ll get a free wax later, but all this tape is needed. This is to make sure the catheter doesn’t move.

Give the medication a few contractions to kick in, about twenty minutes. It isn’t instant (don’t we wish)!

Your nurse will then place a Foley catheter. You won’t be able to get up to pee anymore. Plus a full bladder can inhibit a baby from descending.

About baby descending. When this happens, baby blocks some of the medication from getting to certain nerves. This is a good thing. This means that baby is close to coming. Embrace it. It won’t be awful (not pain free), but we WANT you to feel this pressure. Again, as mentioned before we don’t want all your pain gone. A good epidural gives you some sensation. A bad epidural numbs you to the point where you have NO pressure feeling. Not cool.

What can go wrong? 

Not that you know the steps, I will go over what can possibly go wrong. Rather you be informed and educated before you go in.

The catheter can migrate or in some cases pull out

Epidural 101, what is the process of getting an epidural? The inside scoop from a labor and delivery nurse
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The Anesthesiologist may miss the first try. Sometimes this could be due to how your positioned or the doctor’s skill.

Some people have a “window”. This just means there is an area where the nerves are bundled and the medication can’t get to that area.

Anatomy can play a huge role. Some people’s anatomy is different. One person may get no relief while one may get good pain control

Once your epidural is in communicate with your nurse. If you are still feeling pain after it is placed, speak up. It won’t be INSTANT pain relief. It should start to decrease after a handful of contractions, about twenty minutes.

When you feel that pressure tell your nurse. I am not exaggerating when I say this, but we want to KNOW EVERYTHING. 

Do you have any questions regarding the process? Or other questions related to the epidural? Feel free to comment below or e-mail me at mamaelyfant@gmail.com