From Conception to Delivery: Childbirth

Deciding you want a baby and is usually the first and probably most important step in your birth plan. A birth plan is a plan or set of guidelines you create that highlights what you want in your pregnancy and how you want everything to play out. Although being financially stable and emotionally prepared are very important achievements to wait for, it is important to keep the ticking biological clock at the forefront of your plans.

Dr. Eva Littman, an infertility specialist at Red Rock Fertility Centers, recommends that a woman become pregnant between the ages of 24 and 34, which is what she calls “the grand reproductive age.” Before becoming pregnant it is also recommended that a woman consult with her gynecologist to ensure that she is healthy enough to reproduce and take whatever steps are necessary to be well enough to carry out a full and healthy pregnancy. Sometimes a woman may have a pre-existing condition that could complicate her pregnancy. If that is the case, planning ahead is vital to a successful pregnancy, and a gynecologist can help.

If a woman who wishes to become pregnant is using contraceptives of any kind, Dr. Littman suggests waiting until after the first regular menstrual period after discontinuing their use before trying to conceive. Once a woman suspects she is pregnant and has positive results with an at-home test kit, it is time to schedule an appointment with the gynecologist who can confirm the pregnancy. Usually a gynecologist can also provide obstetric services but if that is not the case your gynecologist should be able to refer you to a good obstetrician. Once working with the obstetrician they can tell you how far along your pregnancy is and you can begin to schedule regular appointments and have proper prenatal care.

The doctor should prescribe vitamins with high levels of folic acid and should give you a list of guidelines to follow according to your health and the baby’s. A popular misconception is that the expectant mother should be sedentary most of the time to avoid harming the baby, but that is actually contrary to what you should do, according to obstetrician/gynecologist Dr. Edmond Pack from Sunrise Children’s Hospital.

“All evidence about exercising shows people who exercise and are fit do better with birth and recovery, so maintaining fitness while you’re pregnant is very important,” said Dr. Pack.

Dr. Pack recommends that a woman talk to her doctor about any exercise she is doing and to make sure she doesn’t overexert herself. He suggests pregnant women keep their heart rate below 130 and usually advises his active patients to wear a heart monitor when working out.

When you become pregnant your stages are measured in weeks — from the first to the final 40 weeks of pregnancy, a lot of changes are going to occur in your body. The first trimester is the early stage, from conception to 12 weeks gestation; this is the period where the morning sickness usually happens. Although not a lot is noticeable on the outside, the most dramatic changes and developments occur during the first trimester. Before eight weeks the developing baby is called an embryo.

The second stage is called the second trimester which goes from the 13th week to the 28th week. This may be when there are first signs of a bun in the oven and swelling occurs, it is also when the quickening occurs (the dark line forming from the navel down to the middle of the abdomen). This is also when the ultrasound can be performed to find out the sex of the baby. The third trimester spans from weeks 28 through the birth of the baby. The belly keeps growing, often to a state of discomfort for many women who can’t find a comfortable sleeping position. It is a good time to start birthing classes and working out the details of the delivery and the baby.

Dr. Pack recommends that a couple do as much research as possible and read plenty of books about being pregnant to keep abreast of all the changes and recommendations.

While doing research, it is also a good opportunity to bring out the birth plan again.

Typical issues to consider when creating a birth plan are your wishes during a normal labor and delivery, such as whether you want to use something to numb the pain, what birthing positions you want to use and the sort of environment you want to have your baby in. You should also consider the options in the case of an emergency, who will be with you in delivery to assist and where you want to deliver. Penni Jackson, a childbirth educator at Centennial Hills Hospital suggests creating a birth plan but also advises against depending too much on the birth plan.

“I always tell my moms to keep an open mind because even though they may have an idea of how things will turn out, because we are dealing with two patients sometimes we have to intervene when one little patient is not on that plan,” said Jackson. Doing research and talking to your doctor should help you make certain decisions in your birth plan. One of the most important decisions you are going to make will also be choosing where you will deliver your baby. Most expectant mothers choose to deliver their babies in a hospital but about 7 percent, according to KidsHealth.org, opt for birthing at home with a doula or midwife who is trained to deliver home births. Hospitals, however, are more common and often recommended because they have all the resources in hand in case something goes wrong with the baby. According to Lisa Holtzclaw, director of labor and delivery at Sunrise Children’s Hospital, sometimes the hospital you choose is directly affiliated with your doctor. Sometimes that doctor cannot practice in that hospital or the insurance is not accepted at certain hospitals, which is why it is a good idea to check these things out ahead of time.

“Convenience is not the whole reason to choose a hospital. It’s great to have a hospital close but you want to have safety precautions and make sure they have the most advanced levels of care,” said Holtzclaw.

According to Holtzclaw, Sunrise Children’s Hospital has the highest level baby care with a level three care unit and the staff is prepared for any emergency situation with the baby. Once the mom has made a decision as to where she wants to have her baby, Holtzclaw suggests that she take a tour of the hospital. She recommends that the tour is taken in the seventh or eighth month to be prepared when the ninth month rolls around.

Holtzclaw says that at Sunrise Children’s Hospital they allow the expectant mother to register ahead of time so that she is not dealing with any of the insurance processing and paperwork during the labor and delivery. You also want to know the rules of the hospital for example at Sunrise Children’s Hospital there is no limit to how many family members and friends can be in the room during labor unless there is a safety reason to reduce the numbers.

At Centennial Hills Hospital one of the perks is that they don’t have any visiting hour restrictions, meaning someone can visit any time of day or night.

“Probably from the beginning we really wanted to be that premier place to give birth. Our customer service is unique; we have a pledge for excellence. We do bedside reports every hour to make sure the mom has everything she needs,” said Tony Boyd, the director of women’s services at Centennial. Part of their unique experience is the massage that is provided to the mothers by actual massage therapists as part of making their stay comfortable. However, customer service and excellent care is just part of what makes Centennial so special, according to Boyd, as the hospital also boasts a level two birth center which allows them to take care of high – risk moms.

Most hospitals also have a birthing class that parents can attend. These classes are important for both parents to attend to learn about preparedness for the day and ask all questions they may have about labor. Jackson, the childbirth educator at Centennial, recommends that parents take the class no earlier than their seventh month to ensure that all the information is fresh in their minds when they deliver. The class also tells you how to prepare a care package for the day and what items to have prepared and ready.

“The class is very important, especially if they are first time parents because it helps them cope with true labor pain and helps them learn measures they can take. We also help involve the dad or coach in the preparation because sometimes they feel like a fish out of water because they feel there is nothing they can do,” said Jackson.

When that day comes, the expectant mother usually knows. However, if labor is in the beginning stages the doctor will tell you during the prenatal visit if the baby has dropped. According to the Office of Women’s Health, this process is called “lightening.” However, more obvious signs are also important to keep in mind such as contractions that become stronger at regular and increasingly shorter intervals, lower back pain that doesn’t go away, the water breaks or if there is a bloody mucus discharge. Sometimes there are also signs of false labor called Braxton Hicks contractions. These can occur several weeks before the actual labor day. The key to knowing if these are real is to time them. If they are not in a regular pattern, it might just be false labor. Sometimes these can go away if a woman engages in activity such as walking; however, it is still a good idea to call your doctor.

Labor occurs in three stages, the first stage is the longest stage and usually last about 12 to 19 hours. This stage of labor can usually be spent at home relaxing with family or with a walk or whatever is written in the birth plan. At this stage you time your contractions and your doctor will let you know when it’s a good time to head to the hospital. At the hospital the doctor will monitor the progress of your labor by checking your cervix. The more time passes the more painful and close together your contractions get, the cervix is fully dilated when it reaches 10 centimeters and that is also when the second stage begins. The second stage involves the pushing and delivery of the baby. This is where you can go back to your birthing plan and decide if you want help to manage the labor pains. Opioids are narcotics given through a tube inserted in the vein and make the pain a bit more bearable. The most popular is the epidural, which involves placing a tube into the lower back where small doses of medicine are given to help numb the pain. The birth plan might not involve any pain medications, but those choices can change when there is actual pain and can be done so usually even if close to delivery.

Typically a woman will have a vaginal birth, but about 30 percent of women will have a cesarean section, according to the CDC. A cesarean section is an alternative that is used only if there are complications such as a breech baby, twins or there are problems with the cord. This is usually not the woman’s choice but an emergency precaution. If you are having a vaginal birth the second stage involves the pushing which usually takes 20 minutes to two hours and this is a great way for your coach to help keep you focused. When the top of the baby’s head appears (called crowning), the doctor will let you know when to begin pushing and deliver. Sometimes a doctor is required to make a small cut called an episiotomy to enlarge the opening; however, many women do not need it.

The third stage involves delivering the placenta, which is called afterbirth. Contractions begin five to 30 minutes after birth and lasts anywhere from five to thirty minutes.

If it’s in the birth plan, the designated coach will cut the baby’s cord and the loving can begin! The doctors will clean the baby off and test it and wrap it in a blanket before handing him/her over. With so much rush and emotion a baby name might not be immediately chosen, but according to Holtzclaw, the parents can come back later to have the name placed on the birth certificate.

Usually the mother and baby are released the next day if there are no complications and mom will probably feel sore and exhausted, Dr. Pack said.

Because all labors and deliveries are different, Dr. Pack says recovery is also different for everyone. C-sections can take a little longer to recover from because it is actual surgery but Dr. Pack said if you listen to your body you will be fine. Six weeks is a good time for most recoveries, he said.

However to be more exact, “complete recovery is over in about 18 years,” said Dr. Pack.