What to expect when you're expecting (151 page)

If you have any questions—about hospital or birthing center policy, about your condition, about your practitioner’s plans—that haven’t been answered before, now is the time for you or your coach to ask them. Your coach can also take this opportunity to hand a copy of your birth plan, if you have one, to the birth attendants.

Take your blood pressure.

Monitor your baby with a Doppler or fetal monitor.

Time and monitor the strength of your contractions.

Evaluate the quantity and quality of bloody discharge.

Get an IV going if you’re going to want an epidural.

Possibly try to augment your labor if it’s progressing very slowly by the use of Pitocin or by artificially rupturing the membranes (if they are still intact).

Periodically examine you internally to check how labor is progressing and how dilated and effaced your cervix is.

Administer pain relief if you choose to have some.

They’ll also be able to answer any questions you might have (don’t be shy about asking or having your coach ask) and provide additional support as you go through labor.

Are Things Slowing Down?

There’s probably nothing you want more than to keep things moving along when it comes to labor. And making good progress during labor—which happens most of the time—requires three main components: strong uterine contractions that effectively dilate the cervix, a baby that is in position for an easy exit, and a pelvis that is sufficiently roomy to permit the passage of the baby. But, in some cases, labor doesn’t progress by the book, because the cervix takes its time dilating, the baby takes longer than expected to descend through the pelvis, or pushing isn’t getting you (or your baby) anywhere.

Sometimes, contractions slow down after an epidural kicks in, too. But keep in mind that expectations for the progress of labor are different for those who have an epidural (first and second stage may take longer, and that’s typically nothing to worry about).

To get a stalled labor back up and running, there are a number of steps your practitioner (and you) can take:

If you’re in early labor and your cervix just isn’t dilating or effacing, your practitioner may suggest some activity (such as walking) or just the opposite (sleep and rest, possibly aided by relaxation techniques). This will also help rule out false labor (the contractions of false labor usually subside with activity or a nap).

If you’re still not dilating or effacing as quickly as expected, your practitioner may try to rev things up by administering Pitocin (oxytocin), prostaglandin E, or another labor stimulator. He or she might even suggest a labor booster that you can take into your own hands (or your coach’s): nipple stimulation.

If you’re already in the active phase of labor, but your cervix is dilating very slowly (less than 1 to 1.2 cm of dilation per hour in women having their first babies, and 1.5 cm per hour in those who’ve had previous deliveries), or if your baby isn’t moving down the birth canal at a rate of more than 1 cm per hour in women having their first babies, or 2 cm per hour in others, your practitioner may rupture your membranes and/or continue administering oxytocin.

If you end up pushing more than two hours (if you’re a first-time mother who hasn’t had an epidural) or three hours (if you have had an epidural), your practitioner will reassess your baby’s position, see how you’re feeling, perhaps attempt to birth your baby using vacuum extraction or (less likely) forceps, or decide to do a cesarean delivery.