Labor & Delivery

Baby Position
The Epidural
Birth
Episiotomy

Baby Position

Lightening or dropping
If this is your first pregnancy you can expect lightening to occurr during the last few weeks of pregnancy. If this is not your first baby, lightening probably won't ocurr until labor begins.

lightening or dropping is the process in which your baby naturally positions itself for delivery. The baby's body becomes inverted and the head descends into the pelvis usully just behind the pubic bone. The baby's body along with the curve of your abdomen shifts down and forward. As a result, pressure is taken off the mother's diaphragm making it easier for her to breath and to digest. This gives the mother a lightened feeling. Thus the name "lightening."Although pressure is relieved from the upper regions of the mothers abdomen, increased pressure is applied within the pelvis. This can cause a more frequent need to urinate, and aches and twinges of pain within the pelvic region.

The Epidural

A tube inserted into the spine to administer pain relieving drugs.

The procedure

The mother lies on her side and curls into a ball to increase space between the vetebrae.
A local anesthetic is used to numb the area.
An epidural needle is inserted between two vetebrae.
A catheter (a thin flexile plastic tube) is inserted through the needle.
Once the catheter is in place, the needle is removed
The doctor then uses a computerized pump to control the flow of pain control drugs through the catheter.

It takes about 30 to 40 minutes from the time the doctor begins the process of placing the epidural to the time the drugs start working effectively.

Benefits of the epidural

It provides the most pain relief to the mother while greatly limiting drug exposure to the baby.
It relieves pain while retaining the mother's muscular control.
It usually allows the mother to rest during the first stage of labor, so she can save her energy for when it's more prominently needed (during the second stage of labor and the birth).
If the mother needs a Caesarean section or a forceps delivery anesthesia can be administered through the epidural.
If the mother experiences a vaginal tear or if the doctor needs to perform an episiotomy (an incision to widen the birth opening) Pain control drugs can be administered for an additional 24 to 48 hours through the epidural.

Side effects

Non continuous pain relief.
Over 95% of women who receive epidurals are satisfierd with their epidural experience. However, some experience a less than consistent control of pain. Their pain comes and goes during the delivery. This ocurrs less frequently now with the use of computerized pumps. However, scar tissue, an abnormal spinal curvature, or a misplacement of the needle can result in the reduced effectiveness of the epidural.
Spinal headaches
Nausea
Fever
Muscle weakness
Decreased respiration
Low blood pressure
Increasing the length of labor (usually no more than an hour). Since the epidural relieves the pain, this is not a major concern.

Birth

Umbilical cord
Once the baby has been delivered, Two clamps are placed on the umbillical cord, and it is painlessly cut with a scissors about 1 to 1.5 inches from the base. If you or your partner would like to cut the cord, usually you may. A metal pin or pastic clamp is applied and left on the remaining cord. The remaining cord will fall off your baby within 12 to 15 days after birth.

Episiotomy

An incision made to enlarge the vaginal opening.

A local anesthetic is injected
The doctor enlarges the vaginal opening by making an incision through the muscle and skin lying between the vagina and the anus.

Reasons for having an episiotomy

To reduce the pressure on a baby that is premature or abnormally fragile.

A jagged tear in the tissue surrounding the vagina is more difficult to repair than a straight incision. The following situations increase the risk of tearing, so an episiomy is often used to prevent tearing in these situations...

To deliver a baby that is too large for the opening, such as one with broad shoulders.
To deliver a breech baby, a baby that comes out feet first.
A foceps delivery
A vacuum extraction
If the mother cannot wait long enough for the opening to dilate before giving birth. If a woman decides not to take an epidural, the doctor may need to speed up the delivery, requiring an episiotomy to avoid tearing. Without an epidural, the mother may not be able to endure the pain long enough for complete dilation to ocur, and may become desperate to end the delivery quickly. Without pain relief the mother may also be unable to relax and to conserve her energy for the final stages of delivery. If she becomes exhausted the doctor may need to finish the delivery early requiring an episiotomy. So as you can see, you may be able to avoid an episiotomy by taking an epidural. This will allow you to relax and to endure a longer period of labor, during which your opening would have ample time to dilate.

Side effects

An episiotomy is an incision through skin and muscle. It will be uncomfortable following the procedure.
If the incision is not repaired properly, it can lead to rectal problems.
Surgical procedures do damage tissue, cause scarring, can lead to complications, and thus, according to many, should be used as a last resort.