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What You Should Know About the Big Day

Posted Aug 24 2008 1:49pm
MICHELLE LAMOTHE, MD: Hello, and welcome to our webcast. I’m Dr. Michelle La Mothe. Childbirth – depending on who you ask, it’s either the most wonderful or the most excruciating experience one can have. If you’re facing childbirth for the first time, you probably have lots of questions and concerns – what happens exactly, how long does it take, what are the possible complications?

Well, joining me today are two experts to answer our questions. To my left, Dr. Adrianne Moore, Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, New York Hospital, New York, and her colleague, Dr. Steven Hockstein, Assistant Professor of Obstetrics and Gynecology, Weill Cornell Medical College, New York Hospital, New York. Welcome. Thank you both for joining and talking with me about labor and delivery -- childbirth.

MICHELLE LAMOTHE, MD: ... generally. At what time of a gestation, or the length of time of a pregnancy, does an average woman give birth to an average baby? When can we anticipate that? Dr. Hockstein?

STEVEN HOCKSTEIN, MD: A woman’s due date is 40 weeks after her last menstrual period – 280 days. And that is about the time most women deliver plus or minus a couple of weeks.

MICHELLE LAMOTHE, MD: Okay. So you have a window there of about a couple of weeks. Dr. Moore, what are the signs and stages of labor?

ADRIANNE MOORE, MD: Well, the signs of labor are rhythmic contractions, generally about five minutes apart, and lasting for a full minute.

MICHELLE LAMOTHE, MD: And there are how many different stages to labor?

ADRIANNE MOORE, MD: There are three stages of labor. There’s – in the first stage is – are both early labor and the active phase of labor. In the second stage of labor, which is probably the hardest, the most physically challenging, is the stage in which a woman is pushing after the cervix is completely open. And the third stage of labor is simply the delivery of the placenta.

MICHELLE LAMOTHE, MD: Can you talk a little bit about, Dr. Hockstein, about the beginning of contractions and how the cervix or the neck of the vagina begins to open to allow the baby to pass through?

STEVEN HOCKSTEIN, MD: Well, it’s very common – throughout the latter part of pregnancy a woman has contractions. They come, they go. They are generally mild, and they’re not regular in their pattern.

During this time, the cervix will change. It becomes softer, and it dilates some – a centimeter or two. The woman will go into labor eventually around her due date, at which point the regular, painful, stronger contractions will dilate her cervix. The cervix shortens at the same time as it dilates. And the physician or nurse – when they check a woman – to check the progress during labor, they measure it in centimeters – if a woman is six centimeters dilated, eight centimeters dilated. And they also check how thick it is.

MICHELLE LAMOTHE, MD: And what about the breaking of the water that may or may not happen around this time?

STEVEN HOCKSTEIN, MD: Well, the bag of water is a membrane that surrounds the fetus inside the uterus, and it contains the amniotic fluid. During labor – sometimes prior to the onset of labor, this bag may break on its own, or a patient’s physician may break it. When that happens, prostaglandins are released, and contractions become stronger, they become more regular, and the progress of labor generally picks up.

MICHELLE LAMOTHE, MD: Tell me, again – now, what are prostaglandins?

STEVEN HOCKSTEIN, MD: Prostaglandins are chemical mediators for contractions throughout the body. But they are involved in mediating uterine contractions.

MICHELLE LAMOTHE, MD: So they move the delivery along. They move the labor along.

STEVEN HOCKSTEIN, MD: Yes, they do.

MICHELLE LAMOTHE, MD: Okay. And can you tell me, Dr. Moore, when does a woman know when to go to a hospital? And once she arrives there, how is she going to be treated? What can she expect?

ADRIANNE MOORE, MD: Well, she and her physician will have discussed beforehand how soon she needs to present to labor and delivery. And when she does go to labor and delivery, she’ll be greeted by the nursing staff. And generally she’ll be hooked up to a fetal monitor, which measures the fetal heart rate and also can measure the contractions – may also be monitored. She’ll be given an IV usually, and some blood will be drawn. From that time on then she’s moved to a labor room where she’ll be for the rest of her labor.

MICHELLE LAMOTHE, MD: And how long can she anticipate – on average again – that her labor might take?

ADRIANNE MOORE, MD: Anywhere from 12 to 24 hours.

MICHELLE LAMOTHE, MD: Now, during that period, if a woman is uncomfortable, there are lots of different pain medications. One that we may have heard of before is an epidural. Can you explain to us, Dr. Hockstein, what an epidural is?

STEVEN HOCKSTEIN, MD: Epidural anesthesia is when an anesthesiologist places a smaller catheter – very similar to an IV – a plastic catheter into the small of her back. Medicine is then injected around the spinal cord. This gives the woman excellent pain relief from the waist down, the belly button down. And it can be titrated, meaning that the dosage can be adjusted. If she’s uncomfortable, some more medication can be injected. Throughout the course of the labor, if it wears off some more medicine can be given. And many women choose this while they’re in labor and find it really excellent.

MICHELLE LAMOTHE, MD: Dr. Moore, may I ask you a question about the word “Apgar?” Many of us have heard of Apgar scores. Can you tell me something about that?

ADRIANNE MOORE, MD: The Apgar score is a traditional means of scoring. And it’s a general guage of the well-being of the infant at the time of birth. It has no implications for how well the baby will do thereafter.

MICHELLE LAMOTHE, MD: After a normal labor and delivery, how long does a pregnant stay in the hospital?

STEVEN HOCKSTEIN, MD: For a vaginal delivery, people typically stay in the hospital for two days. So if a woman delivers on Monday, Tuesday is considered Day 1. Wednesday – she will go home. For Caesarian section, women typically stay in the hospital four days if her recovery is uncomplicated.

MICHELLE LAMOTHE, MD: And what happens, Dr. Moore, with a mother and her baby within those two days in the hospital?

ADRIANNE MOORE, MD: In many hospitals, the mother and the baby are allowed to stay in the same room, and the mother learns to care for the baby, especially if she’s a new mother, and learns to bathe the baby and breastfeeding and things like that.

MICHELLE LAMOTHE, MD: So right away she can become involved in her baby’s care. Well, very good. Thank you both for joining us and walking us through labor and delivery. And thank you for joining us. I’m Dr. Michelle La Mothe.

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