Procedures during labor

Your health care provider may suggest certain procedures during your labor. It is important that you understand the choices you have to make.

To help you and your partner or labor companion make a decision, use the questions listed below. If there is something you don't understand, ask to have it explained again. If you want to talk with your partner or labor companion, ask for a few minutes alone.

Fetal monitoring

Your health care provider can assess your baby's well-being by checking your baby's heart rate. This can be done by:

• Doptone
  This is a hand-held ultrasound monitor like the one your health care provider has used during your pregnancy. Your nurse may use a doptone to check your baby's heart rate from time-to-time.
• External electronic monitor
  This device constantly monitors and records both your baby's heart rate and your contractions. An ultrasound device records your baby's heart rate. A pressure-sensitive device records when a contraction occurs. Both are held in place on your abdomen by a band or belt. It does not
  record how strong the contractions are. An external monitor may be used for a period of time when you are admitted to the hospital. After that, the monitoring may be constant or on-and-off during labor.
• Internal electronic monitoring
  Sometimes it is necessary to use a different way to monitor your contractions and your baby's heart rate. This may be done if it is difficult to pick up your baby's heart rate or if more accurate information is needed about how your baby is reacting to contractions.
  • Baby's heartbeat: A small, coiled wire electrode is inserted through your cervix and placed on your baby's scalp to record the heartbeat.
  • Your contractions: A small tube may be placed inside your uterus to measure the strength of your contractions. If your bag of waters hasn't already broken, your health care provider will make small tear in the amniotic sac. Learn more information about artificial rupture of membranes.
• IV (intravenous infusion of fluids or medicines)
  To give fluids, induce labor or give medicines, a small tube may be placed in a vein in your arm or hand. A needle guides the placement of this tube and is then removed. When the IV is in place, you can use your arm and hand.

Inducing labor

Generally it is best to let your labor begin on its own. However, your health care provider may induce (start) labor for your health or the health of the baby.

Reasons to start labor or to speed up a slow labor by using induction methods include:

• Your amniotic sac, or bag of waters, ruptured on its own but labor has not started.
• Your pregnancy is 41 weeks gestation or longer.
• There is a medical need for your baby to be delivered.

There are several ways to get the uterus to start contracting:

Cervical ripening

Before your baby can be born, your cervix needs to soften so it will open and let your baby pass through. The process is called "ripening" of the cervix. It may shorten the time it takes to induce labor or cause labor to start on its own.

• Your health care provider may determine that you need one of the following medicines or devices to help your cervix soften or ripen. Sometimes a medicine and device are used together in the hospital. You will not receive these medicines if you are having too many contractions.
  • Cytotec^®: This small tablet is given by mouth or placed near your cervix to soften it. You and your baby will be monitored after receiving this medicine. Occasionally, labor may start after receiving Cytotec^®.
  • Cervidil^®: This medicine is a small tablet inside of a soft cloth mesh tape. The tablet is placed near your cervix to soften it. You need to have constant electronic fetal monitoring while receiving this medicine.
  • Ripening balloon: Your health care provider inserts a small inflatable balloon just inside the cervix and then inflates the balloon. Some catheters have two balloons. They are placed on either side, or both sides, of the cervix. The balloon helps the cervix to soften.
  • Osmotic dilator: Your health care provider inserts a small, synthetic device into your cervix to help it soften before inducing labor. The dilator slowly absorbs fluid and gently expands over many hours to cause your cervix to start to open.

Artificial rupture of the membranes

Sometimes breaking the bag of waters, or amniotic sac, will begin or speed up labor. This procedure is called an amniotomy. The amniotic sac is broken with a plastic hook during a vaginal exam. You won't feel pain when the bag of waters is broken — just a warm gush of fluid.

After your water breaks, you'll be monitored at least every hour. Your health care provider will let you know how active you can be. If contractions do not start within a set amount of time, you may be given the medicine oxytocin. Your health care provider will talk with you about how long to wait for contractions to start on their own.

Oxytocin (Pitocin^®)

Oxytocin is a medicine that stimulates uterine contractions. It is given through the IV in your hand or arm to induce labor or improve its progress. It may also be given to reduce bleeding after birth.

To induce labor, a nurse will increase your oxytocin rate at regular intervals to reach the level needed to start your labor. You and your baby will be closely monitored while you receive oxytocin. It may be more difficult or not possible for you to walk around or be as mobile because of these things. Your IV will stay in place during your whole labor. It is usually removed after the recovery period when your health care team determines you no longer need it.

Contractions may quickly become intense when oxytocin is used. You may have to change your breathing and use more comfort measures. Your partner or labor companion can help you relax with touch techniques like stroking and using massage between contractions. Even if you find it hard to relax during the contractions, focus on being relaxed between them.