About Your Care during Labour and Birth

Childbirthordeliveryorlabourisanaturalevent.Mostmothersandbabiesgothrough
labourandbirthwithoutseriousproblems.Certainsituationsmayariseattheendofyour
pregnancyorinlabourthatcanaffectthecareforyouoryourbaby.Thisformincludes
informationonsomecommonpracticesyoumightexperienceduringyourdeliveryand
laterinthehospital.Italsohighlightsaboutafewsituationsaffectingthemotherand
baby.Uponreadingtheformifyouhaveanydoubtsorqueriesyoumustaskthedoctors
availableandresolvethemattheearliest.

Labour
1)Anursealongwiththegynaecologistondutywilltakecareofyou.ThePrimary
consultantunderwhomyouareregisteredwillbeinformedfromtimetotimeandhis/
herguidancewillbetakenfromtimetotime.
2)Youmay/maynothaveabloodtestduringlabourtomeasureyourbloodcount,orfor
otherpurposes.
3)Whenyouarriveatthehospitalinlabour,initially,anursewillputafoetalmonitoron
yourabdomentocheckthebabysheartbeat.Iftheheartbeatisreassuring,themonitor
mayberemoved.Thebabysheartbeatwillthenbecheckedfromtimetotimeduring
labour.
4)Youmayhaveanintravenousline(IV)duringlabourtosupplyIVfluidsand/orprovide
certaintypesofpainreliefmedicationsorantibioticstopreventinfectiontothemother
andthebaby.
5)Therearemanyformsofpainreliefavailableforlaboursuchaswalking,useofthe
bathtuborshower,breathinganddeeprelaxationtechniques,andmassage.Ifyoufeelyou
needadditionalpainrelief,yourdoctorormidwifecanofferyouotherchoicesthataresafe
foryouandyourbaby.Theseinclude:
Medications: Youcanbegivenamedicationasashotor throughanIVline.You
mightgetalittledrowsy.Allergicreactionsareinfrequent,butcanhappen.
Entonox: A gas mixture of nitrous oxide and oxygen to be inhaled, that can
temporarilyreducethepain.
Epidural:Anepiduralisthemostcommonformofpainreliefforlabourandbirth.
Thisprocedurewilltakeabout2030 minutes.AnAnaesthetistwillplaceathin
flexibletubeinyourbackwithpainreliefmedications.Thiswilldiminishmostofthe
labour pain. You can avail this modality of pain relief only when your cervix is
sufficientlydilated.Epiduralanaesthesiadoesnotguaranteevaginalbirth,infactit
 mayprolongtheprocessofbirthing.But,itwillsurelyreducethepainandhelpyou
copeupbetterwithlabour.Alsoaseparateconsentformneedstobesignedfor
Epiduralanalgesia.
6)Ifyourlabourslowsdown,yourdoctorormidwifemightgiveyoucertainmedications
suchasoxytocinthroughanIVtomakeyourcontractionsstrongerandclosertogether
7)Sometimes,beforeawomanstartslabouronherown,herhealthorthehealthofher
babymakesitnecessaryforlabourtobeinduced.Ababythatisoverdue,ababywhich
hasnotgrownwell,infection,highbloodpressure,diabetes,orruptureofthebagofwater
arefewcommonreasonsforInductionoflabour.Yourdoctorcanhelpgetlabourstarted
invariousways.
Inductionhascertainrisksincludingcreatingcontractionsthataretoostrongortoo
frequent,whichcanstressthebaby.Inalmostallsituations,thisriskismanageableand
thecontractionscanbedecreased.

VaginalBirth
1)Labour contractions slowly open the cervix. When the cervix is completely dilated,
alongwiththemother'shelp,thebabyispushed throughthebirthcanal(vagina).
Usually,thebabysheadcomesoutfirst,thentheshoulders,followedbytherestofthe
body.
2)Somemothersneedsomehelpgettingthebabydeliveredthroughthebirthcanal.A
doctormayapplyaspecialVacuumcuporForcepstothebabysheadtohelpthemother
pushthebabyout.Largestudieshaveshownthatthevacuumcupandforcepsaresafe.
Itiscommontoseeswellingorbruisingontheheadofthebabywhichtakesfewdaysto
subsidenaturally.
3)Inapproximatelyonepercentofbirths,theshouldersdonotcomeouteasilywhichis
aconditioncalledShoulderDystocia.Ifthishappens,yourdoctorwilltrytohelpfree
thebabysshoulders.ShoulderDystociamaycauseabrokencollarboneorarmforthe
babyornervedamagetothebabysarm.Mostoften,theseproblemshealquickly,but
insomeinstances,thedamageanddisabilityispermanent.Shoulderdystociamay
causeperinealtearsaroundthevaginalopeningoradditionalbleedingtothemother
duringdelivery.Itisnotalwayspossibletopredictthiscondition/complicationbutit
iscommoninfoetuseshavinghighbirthweight.
4)Inordertofacilitatethedeliveryprocessdoctorsmayneedtomakethevaginalopening
biggerbymakingacut.ThiscutiscalledasEpisiotomy.
5)Mostwomenwithperinealtearsoranepisiotomywillneedstitches,whichdissolveover
afewweeksduringtheprocessofhealing.
6)Infectionandbleedinginsidethewoundoroutsideandimproperhealingofsuturesare
knowncomplicationsthatmayoccurduringvaginaldelivery.Sometimesyoumayneed
tobegivenanaesthesiaforsuturingthesewounds.
7)Normally,theuteruswillexpeltheplacentasoonafterbirth.Butinaboutonepercentof
births,thisdoesnthappenandthedoctormustreachintotheuterusandremovethe
placenta.Ifthishappens,youmayneedanaesthesiasothattheGynaecologistcan
removetheplacenta.
8)Allwomenlosesomebloodduringchildbirth.Thenaturehaspreparedthemothers
bodytocopeupwithcertainamountofbloodloss.However,ifthebloodlossismore
thanaverageorifthepatientisnotabletotoleratethebloodlosswell,thenonemay
requirebloodtransfusionorotherbloodproductstobegiventothemother.
9)Duringtheprocessoflabourasthevaginadistendsduetothebabyshead,themuscles
aroundthebirthcanalmaygetlose.Thismayleadtoloseningofthevagina,leadingto
prolapseofurinarybladderandincontinenceofurinarybladderandbowel.
10)Oxytocin,Prostaglandins,Methylergometrinearefewcommonmedicinesthatcan
helpreducebleedingafterbirth.
11)Whilethebabynegotiatesthroughthebirthcanalitstretchesthemusclesandthe
tissues in the pelvic region. This may cause loosening around vagina and sexual
dysfunction,difficultyincontrollingtheurinationorgasorstoolsifthesphinctersare
injured.
12)Theprocessofvaginalbirthisstressfultothebaby.Mostofthebabiesareableto
copeupwellwiththestress.Sometimesthebabiesshowsignsofdistresssuchasheart
beatsgoingtoofastorslow.Insuchsituationsyourdoctormayneedtotakeimmediate
decisiontodeliverthebaby.Cordprolapseisaveryrarecomplicationinwhichthecord
comesoutbeforetheheadandgetscompressedalmoststoppingthebloodsupplytothe
baby.Insuchcasesimmediatedeliveryiswarranted.
CaesareanSection
1)Duringcaesareanbirth,adoctordeliversthebabythroughanincisioninthemothers
abdomen.
2)Somecaesareansareplanned,whileothersareunexpected.
3)Themostcommonreasonsforcaesareanbirthare:
1)Thecervixdoesntopencompletely.
2)Thebabydoesntmovedownthebirthcanal.
3)Thebabyneedstobedeliveredquicklybecauseofaproblemformotheror
baby.
4)Thebabyisnotinapositionthatallowsforavaginaldelivery.
4)AnaesthesiaisalwaysusedforaCaesareansection.Closeto95percentare
performedusingspinalorepiduraltechnique,sothemotherisawakeduringthe
procedure. About 5% of Caesarean sections are performed using general
anaesthesia.
5)Athintubecalledacatheterwilldrainthebladderduringtheoperation.Itwillusually
remaininplacefor1224hoursafterwards.
6)LikevaginalbirthsomeamountofbloodlossisexpectedinCaesareanbirth.Ifitis
more than average, blood transfusion may be needed. The need for a transfusion is
infrequent(12in1,000).
7)Likevaginalbirth,infectionmayoccurinthewound,hencethedoctorsoftenusesafe
antibioticsduringthebirthtohelppreventthis.
InlessthanonepercentofCaesareansections,theoperationmaycausedamagetothe
bowelorurinarysystem.Mostofthetimetheseproblemswillberecognizedand
correctedduringtheoperation.Inlessthan1%ofCaesareansections,thebabymightbe
injuredduringthebirth.Whenthisdoeshappen,itisusuallyminor.
8)OverallincidenceofcomplicationsismoreinemergencyCsectionsascomparedto
electiveCsection.
AfterBirth
1)Youmayhavecrampsastheuterusreturnstoitsnormalsize.Thiscrampinggets
strongerwitheachbirth.Youmaynoticeitmorewhenbreastfeeding.
2) If your baby is delivered vaginally, you will probably have discomfort around the
vaginalopening.
3)IfyouhaveaCSection,youwillhavepainfromtheOperatedsite.Askyourdoctorfor
painreliefifyouneedit.
4)Vaginalbleedingisnormalafterbirth.Itwilllessenover12weeks.
5)Aboutonepercentofwomenhaveheavybleedingandneedtreatment.Sometimes,this
typeofbleedingcanhappenweeksafterbirth.
6)Mostwomenfeeltiredandweepyafterbirth.Forabouttenpercentofnewmothers,
thesefeelingsdontgoawayorgetworse.Ifthishappens,askyourdoctorormidwifefor
help.
Various factors influence the mother when she goes home from the hospital, which
includemother'shealth,yourbabyshealth,andthesupportonehasathome.

Newborn
1)Atoneandfiveminutesafterbirth,thebabywillbeassignedApgarscores.Thescores
measurethebabysheartrate,breathing,colour,muscletone,andvigour.Thesescores
assistyourpaediatricianandthenurserystaffinplanningthecareofyourbaby.
2)About34percentofbabiesarebornwithbirthdefectsoutofwhichmanydonothurt
thebaby(suchasextrafingersortoes).Some,whichmaybeseriousaresomeheart
abnormalities.
3)Approximately710percentofbabiesarebornbeforeterm(lessthan37weeksof
pregnancy),orhaveaproblemthatwillrequiresomeformofspecialcare.
4)ApproximatelysixpercentofallnewbornbabiesrequiretreatmentinaSpecialCare
Nursery(LevelIInursery)andthreepercentrequireadmissiontoaNeonatalIntensive
CareUnit(LevelIIInursery).
5)About1216percentofbabiespassmeconium(thefirstbowelmovement)intothe
amnioticfluidbeforedelivery.Whenthisoccurs,thebabysmouthandairwaywillbe
suctionedatthetimeofdeliverytoremoveasmuchofthemeconiumaspossible.
6)Afteryourbabyisborn,heorshewillbegivenaninjectionofVitaminK.Usingonlya
fewdropsofbloodfromhisorherheel,testswillbedonetoscreenyourbabyforseveral
enzymesresponsibleforvariousmetabolicdiseasesofwhichsomearecommoninthe
Indian population; the results will be sent to your paediatrician. You will also be
encouragedtohaveyourbabyreceivethefirstimmunizationbeforegoinghome.

InfrequentorRareEvents
Thefollowingproblemsoccurinfrequentlyorrarelyduringpregnancy:
1)Afewbabiesareborntooearlytosurvive,orhaveseriousmedicalproblems.About7
10outof1,000babiesdieinlatepregnancy(stillbirth)orsoonafterbirth.
2)About3outofevery1,000mothersdevelopbloodclotsintheirlegsaftergivingbirth,
andrequiretreatment.Thisismorelikelytooccurafteracaesareansectionthanaftera
vaginalbirth.
3)Inabout12outof1,000births,adoctormustremovetheuterus(hysterectomy)to
stopheavy,uncontrolledbleeding.Thismeansthewomancannotbecomepregnantagain.
4)About6outofevery1,000womenreceivebloodtransfusionaftergivingbirth.The
risksassociatedwithbloodtransfusionincludeanallergicreaction,fever,orinfection.The
chance of contracting hepatitis from a transfusion is 1 in 100,000; the chance of
contractingHIVislessthan1in1,000,000.
5)Veryrarely(lessthan1in10,000),mothersdontsurvivechildbirth.Causesmight
include extremely severe bleeding, high blood pressure, blood clots in the lungs, and
problemscausedbyothergravemedicalconditions.

Summary
1)Mostbabiesarebornhealthyandmostmothersgothroughlabourandbirthwithout
seriousproblems.
2)Youshouldrealizethough,thatpregnancyandchildbirthhavesomerisks.Manyofthe
possible problems sound very frightening. Remember, most of these problems are
uncommon,andthemostseriouseventsareinfrequentorrare.
3)Yourhealthcareteamwillwatchcarefullyforsignsofpossibleproblems.Theywilldo
theirbesttoidentifythemearly,explainthem,andofferyoutreatment.
4Yourhealthcareteamlooksforwardtocaringforyouduringlabourandbirth,andto
deliveringahealthybaby.
AuthorizationforObstetricalCare
1)IhavereadAboutYourCareduringLabourandBirth.
2)Iunderstandwhathasbeendiscussedwithme,aswellasthecontentofthisform.
3)IsaythatIhavebeengivenadequateinformationaboutlabourandchildbirthduring
antenatal period through the workshops and lectures and other educational activities
conductedfromtimetotime.
4) I have been given information about need for the above mentioned procedures,
alternatives,benefits,effectsofrefusalandcommoncomplicationsandrisks.
5) I have been given the opportunity to ask questions and have received satisfactory
answers.
6) Iunderstandthatnoguaranteesorpromiseshavebeenmadetomeaboutexpected
results of this pregnancy. Ongoing discussion(s) about my current status and the
recommendedstepswillbeapartofmycare.
7)Iamawarethatotherrisksandcomplicationsmayoccur.
8) I also understand that during the remainder of my pregnancy, or during labour,
unforeseenconditionsmayberevealedthatrequireadditionalprocedures.
9)Iknowthatanaesthesiologists,paediatricians,residentdoctors,nursesandotherstaff
mayhelpmydoctor.
10)Iretaintherighttorefuseanyspecifictreatment.

Iconsenttoobstetricalcareduringmybirthingexperience.Iunderstandthatsomeofthe
proceduresdescribedabovemayoccur.Iretaintherighttorefuseanyspecifictreatment.
Ongoingdiscussion(s)aboutmycurrentstatusandtherecommendedstepswillbeapart
ofmycare.