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Attending Saint Barnabas Ob/Gynecologist
with practices in West Orange and Mr. Arlington
For most women, pregnancy brings significant excitement
about parenthood and the new addition to the family. It is
the labor process; however, that raises the most concerns
and questions. Sometimes the process can be anxiety provoking,
especially for first time moms who are not quite sure of what
to expect. The following are common questions of expectant
mothers regarding pregnancy and the birthing process.
Q.
A. It is difficult to explain to a new mom how contractions
feel. Most people, including ob/gyns, tell their patients, "you’ll
know when you are in labor," and although true, this
simple explanation does little to allay a new mom’s
anxiety. I tell my patients that contractions feel like menstrual
cramps that increase in intensity, along with tightening
of the abdomen. For moms who have never experienced menstrual
cramps, I tell them that they will feel recurrent pelvic
and abdominal pains along with abdominal tightening.
Q.
A. Always call your doctor if there is decreased or absent
fetal movement, vaginal bleeding other than mild spotting,
and/or rupture of membranes. If contractions are the only
symptom of labor, the general rule is to call when contractions
are occurring every five minutes for at least one hour. This
minimizes the chance of being sent home for false labor.
For moms who have had at least one child, the general rule
is to call when the contractions are occurring every seven
to ten minutes because labor can be much faster.
Q.
A. Rupture of the membranes is not always obvious. Sometimes
women experience a large gush of fluid, at which point it
is pretty clear that the membranes have ruptured. Other times
there may be a small trickle instead. Generally speaking
once membranes break the leakage of fluid tends to be constant
because amniotic fluid is continuously being produced. If
the membranes rupture at night, one way to differentiate
it from urine is by the smell. Urine has a strong ammonia
smell that is not characteristic of amniotic fluid. When
in doubt, always check with your obstetrician. Once your
water breaks, call your doctor and head to the hospital,
particularly if you are GBS positive and antibiotics have
to be administered.
Q.
A. The mucous plug is a gelatinous substance released from
the cervix, which may be blood-tinged at times. The mucous
plug can be dislodged in the presence of cervical dilation
and effacement, but in the absence of contractions it usually
does not mean much.
Q.
A. For most women the answer is yes. This is a common concern
for women who have a longer commute to the hospital. The
truth is that for most first time moms there is ample time
because the labor process is usually longer. For women who
have had at least one child, call your doctor sooner rather
than later if the contractions are consistent, or as soon
as your water breaks.
Q.
A. Labor is a clinical diagnosis defined by persistent contractions
and cervical dilation. Once in the hospital, labor can be
confirmed by digital examinations along with monitoring of
contractions. Even if the contractions are regularly occurring,
if there is no cervical change, chances are you will be sent
home.
Q.
A. Typically, an IV is started to ensure venous access in
case of an emergency. The baby’s heart rate is monitored
via an external Doppler, and the contractions are also monitored
externally. The rest of the labor management depends on each
individual’s situation. Some women whose membranes
haven’t spontaneously ruptured may need to have their
membranes artificially ruptured, while others may need augmentation
with Pitocin, which is used to stimulate contractions.
Q.
A. GBS stands for Group Beta Strep, which is a bacteria that
lives in the genital tracts of approximately 10-30 percent
of women. All pregnant women are tested in the last weeks
of pregnancy. If positive, the recommendation is treatment
with antibiotics during labor to prevent transmission to
the neonate. Although the bacteria are harmless to adult
women, it can have serious consequences if transmitted to
an infant, thus the recommendation to test all pregnant women
and treat accordingly.
Q.
A. Fetal movement is a sign of fetal well being. A sharp decrease
is fetal movement may be indicative of fetal compromise.
Likewise, the fetus may be in a sleep cycle. When in doubt,
you should check fetal kickcounts. A simple way to do this
is to lie on your left side and note the time, count ten
fetal movements and then look at the time again. If the movements
occurred within the hour the movement is adequate, if not
call your obstetrician.
Q.
A. Perinatal morbidity and mortality increase significantly
after 41 completed weeks of gestation. For this reason, your
obstetrician will schedule an induction sometime between the
41st and 42nd week. The method of induction varies depending
on whether there is already some cervical dilation along with
other favorable factors. If there is a "favorable" cervix,
Pitocin and artificial rupture of membranes are used to induce
labor. If the cervix is not favorable, it has to be ripened
with medications know as prostaglandins.
Q.
A. One of the anesthesiology textbooks classifies labor pain
as the 3rd worse type of pain. The first is traumatic amputation,
the second is terminal cancer pain, and the third is labor
pain. Having said this, no one really knows what your experience
will be like because everyone has a different degree of pain
tolerance. One thing is for sure, epidurals are a safe and
effective method of pain relief if you do decide to get one.
Obviously there may be special concerns that should be discussed
with your physician. If you are in doubt, don’t hesitate
to call.
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