What To Expect During Childbirth
What To Expect During Childbirth
Jay Goldberg (Obstetrician/Gynecologist, Cedars-Sinai Medical Center) gives expert video advice on: What can I do to ease my pain during childbirth?; What should I do if I feel contractions but I am not near my doctor or hospital?; How long will it take me to give birth to my baby? and more...
What is a "natural childbirth"?
A natural childbirth most often is referred to when a patient is wanting to do an anesthesia-free delivery. Natural meaning that you don't have any pain relief, with either IV medications, oral medications, or an epidural. So natural childbirth, by definition, is usally no pain relief.
What happens during a normal vaginal childbirth in the hospital?
In a normal vaginal delivery, with an epidural, the paitent will present to labor and delivery when she believes she is in labor and she will be dilated, and admitted to a room. When she has sufficent discomfort that she wants pain relief, an anesthesiologist will administer an epidural. During labor, the epidural will allow for some rastence and relief, and she will be allowed to continue to contract. If her contractions remain regular, on her own volition, she will be examined periodically until she achieves ten centimeters dilated, and at that point in her childbirth she will start to push. If her contractions are not adequate, sometimes we have to supplement the childbirth with some additional medications to increase the frequency of contractions. This medication is pitocin, and this medication is given so we can expedite delivery, whether there's a medical reason to expedite it or for a timing factor to expedite it. When you get to complete dilatation, you begin to push. With an epidural, the average pushing time in a first-time mom is anywhere from one and a half to three hours. In a second or beyond pregnancy, pushing time with an epidural is more likely an hour, sometimes even less, but that's the average. Some women can push for ten minutes, and some women might have to push for more than three hours during childbirth. Your doctor will use their judgment, based on the baby's safety, as to how long they'll allow you to push.
How much pain will I feel during childbirth?
Pain in childbirth is very hard to define. Pain in general is very hard to define. Different people have different pain thresholds. You can have a patient who claims to be the strongest person and have the highest threshold and she presents to labour and delivery begging for an epidural and she's only one centimetre, and a patient who asks for an epidural when she's halfway through her pregnancy because doesn't want to experience any pain and she shows up to the hospital and she's eight centimetres dilated. So a lot of factors come into play with respect to pain. It's very hard to define what pain you experience. It is true to say that most people are surprised at how uncomfortable it is because it's a pain that you can't localize. If you have a muscle cramp you massage your muscle. If you slam your finger in the door you shake it off and eventually the pain goes away. But with a uterine contraction -- and it's often compare to a kidney stone, if anyone experienced a kidney stone -- it's a pain that somewhere inside you that any position you put yourself in, it is hard to find a comfortable position during childbirth.
What are the risks of using pain medications during childbirth?
Pain medications can be used during your labour experience. If you were to get an IV medication then there are a bunch of different IV medications that can be utilised; stadol, fentanyl, morphine, or demerol. Those medications go into the vein and travel through your circulatory system so it will go to all parts of your body giving you a general sense of relief; not overwhelming, but not complete either. Some of these pain medications act immediately and last short term; some take a little longer to act, but act for longer. These medications do get through the placenta and into the baby as well. So, if the pain medication is administered several hours before you're going to deliver, it will be flushed out of you and the baby by the time you deliver. If it's administered and you deliver shortly thereafter then most often your physician will call a paediatrician or a paediatric nurse to come and evaluate the baby because the baby will still have that medicine on board and may appear a little bit sleepy. Epidural or spinal anaesthesia is another medication that is used while in labour and those medications that are administered by a catheter in the spine usually don't have any effect on the baby. They may slow your labour down, but they should not increase the risk of C-section. Several studies I've read say that C-section rates do not increase by epidural administration. I often tell my patients, "If you could be in labour for two hours and have a lot of pain, or three hours and no pain, then sometimes an epidural is the way to go."
What should I do if I feel contractions but I am not near my doctor or hospital?
If you start to experience contractions and you're on vacation or far away from the hospital, or you're remote from your personal physician, it's probably best to be evaluated, to see a local obstetrician or go to a local emergency room. And they can evaluate you as to whether or not these contractions are true labour. If you're very far from your due date, then they'll probably evaluate you and you may need hydration or you may need treatment for an infection that has caused the contractions. But if you're close to your due date and experience contractions, I may ask you why you're travelling because we usually encourage you not to travel about six weeks before your due date.
How long will it take me to give birth to my baby?
Labor can be a short experience or a long experience. Many factors come into play here: the position of the baby, the size of the pelvis, the size of the baby, the frequency of contractions, the intensity of contractions. The date, meaning that if you are 35 weeks and it's a smaller baby, as opposed to 42 weeks and it's a big baby. These factors all come into play, with respect to the length of time of your labor experience.I touched on this earlier, but first time pregnancies take a little bit longer, because the tissues haven't been stretched out by prior pregnancies. Second pregnancies and beyond tend to be more quick. But all these other factors come into play, and just because your first labor took eight hours doesn't mean your second one's going to be less than eight hours. If the baby's bigger, if the contractions are weaker, if your contractions are less close together or less frequent, all these things come into play that your labor may take longer the second time around.