Going into hospital in labor can be a frightening experience, especially when one remembers what some of our more ancient hospitals look like in the middle of the night! The important thing to remember is that everyone in the hospital wants the mother-to-be to have an easy labor and a successful delivery of a healthy baby. Everything is, therefore, done with this in mind.
Sometimes you will not understand why certain steps are being taken. If so, however busy the midwife or doctor may be, they should always spare the time to explain what is happening. There may not be time for lengthy or involved explanations and discussions, but simple answers can always be given. If this is not the case, then keep on asking until it is.
When you report to the admission desk it will be very helpful if you have a card showing your hospital number. This will enable the admissions’ clerk to find your hospital notes quickly. Next you will be taken, probably on a trolley or in a wheelchair, from the admission desk to the obstetric department where you will be seen by a midwife. She will enquire about your contractions, whether or not you have had a show of blood and whether or not the membranes have ruptured (waters broken). She will also take your temperature and blood pressure, feel your tummy and listen to the fetal heart.
Most hospitals no longer shave off all pubic hair, but many do a mini-shave to remove the hair around the vaginal opening. (This helps the doctor or midwife to see this area of skin more clearly in labor, especially at the time of the baby’s birth). Likewise, the bad old days of large soapy water enemas are fortunately gone. Instead, a small enema or a suppository is given on admission to enable you to go to the lavatory and empty the bowel normally. (A full bowel may temporarily hold up progress during labor and may then empty itself just before or at the time of birth). In hospital, cleanliness remains next to godliness, so unless you have had aimmediately before coming into hospital you will probably be asked to have one on admission. If your membranes have ruptured, you will be asked to take a shower instead.
As soon as the admission procedures are complete, the midwife or doctor will carry out a vaginal examination to see how labor is progressing. For this, one or two of the examiner’s fingers will be lubricated with antiseptic cream and will be gently inserted into the vagina. By this means, the degree of dilatation of the cervix and the amount of descent of the fetal head through the pelvis will be determined. Nowadays, dilatation of the cervix is measured in centimetres although some older doctors and midwives still use the traditional ‘fingers breadth’. The dilatation of the cervix will be described in terms of one to ten centimetres dilated, or one to five fingers breadth dilated. Every time you are examined, ask the midwife or doctor how far dilated you are. It is good to know that one is making progress.
The descent of the baby’s head is usually described in relation to the two bony points (ischial spines) in your pelvis. In early labor, the top of the baby’s head will be above the level of the spines ; later on it will descend to the same level and, later still, shortly before delivery, will be below their levels. In many hospitals, nowadays, the progress in labor will be marked on a partograph. If you ask, you can see your own partograph and get a good idea of how things are progressing.
In normal labor a vaginal examination will be needed every two or three hours to assess the progress. One will also be done when the membranes rupture or when it is thought that you are fully dilated, which is ten centimetres or five fingers breadth – enough to allow the fetal head to come through.
AFTER THE ADMISSION PROCEDURES
In most hospitals you go from the admission room to a first-stage labor ward. You stay here until ready for delivery when you go to a delivery room where the actual birth will take place. In some hospitals you go straight to a room which serves for both first-stage labor and delivery. In either place you will sit up or lie in bed, whichever is the most comfortable, and will have a midwife with you or will be able to call one by means of a call bell.
At this stage of labor the presence of your husband or birth partner may be very comforting. He can be with you constantly, whereas your midwife will have to come and go depending upon how busy the labor ward is at the time. If your husband cannot be present, if you have both decided that you prefer him not to be there, or if the midwife has to go out, do not worry: she will be within easy reach.
Togetherness certainly helps in labor, but whether or not other members of the family should be around at this time is debatable. Most hospitals find it hard to cope with family parties in the labor ward and most mothers-to-be prefer to be alone or with their husbands in this situation. During the first stage of labor you can get up and walk about if you wish. You will probably not be offered anything to eat since there is a tendency to vomit later in labor and an empty stomach helps to avoid this. There is no objection to the drinking of fluids, such as water, fruit juice, tea or coffee, in reasonable amounts, but, here again, you may not be allowed to do so if there is any suggestion that you may require an anaesthetic at a later stage.