Labor is divided into three stages. The first stage begins with the onset of contractions and ends when the cervix is fully dilated (to 10 centimeters). The second stage involves delivery of the baby, and the third stage entails delivery of the placenta and membranes, or “afterbirth.” Although the length of labor varies considerably, women experiencing their first full-term childbirth usually have the longest labors. About half will exceed 12 hours, and 2 in 10 will last longer than 24 hours. After the first baby, labor is usually shorter. Three-quarters of women deliver within 12 hours, and only one in 50 labor for more than 24 hours.
The first and longest stage of labor has three distinct phases: the early, or latent, phase; the active phase; and the transition. During the early phase of labor, contractions are often widely spaced—perhaps 10 minutes or more apart—and feel like a tightening or pulling in your back or groin. They can vary considerably in frequency and intensity. At this point you may feel excited, sociable and talkative, or you may be a bit nervous. Most women remain at home during this phase, during which the cervix dilates from 0 to 4 centimeters, and later arrive at the birth center in active labor.
The Active Phase
As you progress from the early to the active phase, your attention focuses completely on labor. Your contractions occur about 3 minutes apart, last about 45 to 60 seconds, and become more centered in your abdomen. They also become stronger and more rhythmic, peaking and receding like waves.
Your determination may waver during this phase of labor. Extra reassurance from your partner and birth attendant can help you stay focused. Breathing exercises and other relaxation techniques also become more important as your cervix dilates to 8 centimeters—nearly wide enough to allow for your baby's birth.
During the active phase, you may begin to long for relief from the pain and tension of labor. Though medication is an obvious solution for your discomfort, you must consider the safety of the baby. Many drugs cross the placenta and affect the baby, making its heartbeat and breathing more sluggish throughout the remainder of labor and after delivery. For this reason, many doctors recommend concentrating on one contraction at a time and relying on your partner, rather than medication, to help maintain your focus.
If your pain is so intense that it actually impedes your progress, however, medication may help you to relax so that contractions can remain steady and vigorous. Two basic kinds of pain medication—analgesics and anesthetics—are used during childbirth.
Analgesics will relieve most of the pain. Drugs used include Demerol, Sublimaze, Nubain, Stadol, morphine, and fentanyl injected into a muscle or vein. These medications are not designed to provide a pain-free labor, but, in appropriate dosages, they can make you more comfortable.
Potential side effects of these drugs include nausea, vomiting and an abnormally fast heartbeat. They present some additional risk to the baby, but if handled properly pose no significant threat. Large doses, however, can interrupt your labor pattern, and if this happens, additional medications such as oxytocin (Pitocin, Syntocinon) may be needed to reestablish strong contractions.
Regional anesthetics completely eliminate the pain. The most common types used during labor include:
Paracervical block. Medication is injected into your cervix, usually during the first stage of labor, to provide you with pain relief from contractions and dilation without interfering with the urge or ability to push. This drug may not work properly in up to one-third of women, and it must be repeated every hour to maintain numbness. It is no longer used frequently.
Pudendal block. The anesthetic is injected through the vaginal wall during the second stage of labor to relieve pain in the perineum (the area between the vagina and the rectum). It may be used in an otherwise unmedicated childbirth. The medication does not interfere with the urge or ability to push and generally masks the effects and repair of an episiotomy—the incision made to enlarge the vaginal opening.
Spinal or saddle block. A single injection of regional anesthetic is made into your spinal canal, numbing the complete lower abdominal and perineal area. This type of anesthetic is rarely used during labor but may be suggested if a forceps or cesarean delivery is required. Administration of a spinal block completely removes the urge to push and may lower your blood pressure. In rare cases, it causes a severe headache when it wears off.
Epidural or caudal block. A needle holding a thin, flexible tube is threaded into the space between your spinal cord and your vertebrae. When the needle is removed, the anesthetic can flow continuously through the tube. Like a spinal block, this procedure provides full pain relief in the perineal area. Dosages can easily be changed or discontinued. Most physicians consider the epidural block to be the optimal method of pain relief for uncomplicated labor or non-emergency cesarean births because it allows a woman to remain fully alert. Nevertheless, the anesthetic requires up to 20 minutes to take full effect and may leave a painful “hot spot”. In addition, it may diminish uterine contractions, bringing on the need for oxytocin. The risk of a forceps delivery is also increased.
DECIDING WHERE TO DELIVER
Today, women have more options about how and where to deliver their babies than ever before. A hospital remains the choice of many, since it provides the security of extensive medical technology in the event of a complication for the mother or child. Many hospitals offer single rooms that allow you and your partner the privacy to participate more fully in childbirth and care of the newborn. Be sure the staff understands and respects the role your partner wants to play in the birth of your baby well before you check in.
Some medical centers now have separate birthing centers in place of their old labor and delivery wards. These centers are more homelike than the maternity section of the hospital, though a woman still has access to medical help, should it become necessary. Home delivery is another alternative advocated by some women who want childbirth to be as natural as possible, but because emergencies, though rare, can be catastrophic when they do occur, most physicians advise against this. Many obstetrical practices now include one or more midwives. Midwifery is one of the world's oldest and most respected professions. Some midwives only work in medical centers, while others also offer assistance with home deliveries. In one study, women who were assisted by midwives in hospital birth centers reported significantly higher satisfaction than those under the care of physicians in traditional hospital settings. There were no differences in Apgar scores in either group, despite the fact that the midwife-assisted mothers were not monitored electronically, and the rate of cesarean deliveries in both groups was similar. The study concluded that women should be offered choices in obstetrical care, including the selection of a birth attendant.
Women who receive competent and compassionate care throughout labor and delivery are much more likely to remain calm and self-controlled during childbirth and experience the greatest satisfaction. Because of the complications that can arise, a hospital birthing center, combining a warm environment for routine deliveries with access to intensive medical care if necessary, appears to offer women, their babies, and their partners with the best of both worlds.
0 comments:
Post a Comment