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Hello everyone,
I haven’t had a chance to add an entry in the last few days, July is a very, very busy month in my family. My husbands birthday was on the 9th, my sons birthday is today and we have a few others. Not to mention the holiday weekend and work, so I slowed down a little bit, but despite today being my sons 6th bday, Im going to add a quick entry here. As always, I hope you all find it useful and informative and if you have anything to add, please feel free.
INFANT PROCEDURES FROM BIRTH TO DISCHARGE :
When babies are born, they have many things done to them. Once born and dried off, they usually get weighed and measured – length, head and chest circumfrence and indentification bands are placed on mom, dad and baby that all match with moms personal information.
In lots of hospitals, footprinting is also done. In my hospital the prints go on a “keepsake” certificate, which also contains the date/time, and name typed in, but is not any type of legal document.
The pediatrician will usually do an initial physical exam sometime in the first few hours with the nurse assessing vital signs hourly for the first 4 hours.
Sometimes in the first few hours of life, the infant gets a sponge bath and shampoo under a radiant warmer to prevent heat loss. This is usually done in the mothers room so the family can observe. The only exception is when mom has a c – section, which means the baby has its bath and shampoo in the nursery.
After the bath, the infant may receive 2 injections. Vitamin K is first, it helps boost the babys clotting factors, as babies are born with a deficiency. Important for boys and girls, but even more so for boys as they may get circumcised and we don’t want much bleeding to occur. The second is hepatitis B – our hospital offers to give the first of the 3 at birth which is one less shot in the next months of Dr. visits. Hepatitis B injections ( set of 3 ) are now required for children attending public schools, so it just helps get them done faster.
Some other procedures that may differ at other hospitals are as follows. We offer a free hearing screening test to all infants. The test is very simple. While the infant is sleeping, small sticky electrodes are placed on the forehead and the nape of the neck, ear cups are placed on the ears and are connected to a computer. The computer gives small sounds, and the electrodes pick up when the brain responds. This type of test is called AABR, or Automated Auditory Brainstem Response.
We also have a screening program for Jaundice, or yellow discoloration of the skin. At 24 hours, all babies get tested using a non-invasive light sensor test on the skin of the breastbone to detect levels of Jaundice. If below a certain level, baby is deemed ok, and no further treatment is needed. If babies are above that certain level, a blood test is drawn ( from a heel stick ) to correlate the blood level with the skin level. If elevated the pediatrician may order phototherapy, or treatment of Jaundice with low dose ultraviolet lights. I’ll cover more on Jaundice in another post.
Babies at our hospital usually get a 24 hour health screening blood test, once again from a heel stick. This is a screening test which tests for rare but serious disorders, such as Phenylketonuria, Maple Syrup Urine disease, Sickle Cell Anemia and Hypothyroidism. If these disorders are detected they can be treated with a special diet or medication.
Thats it for todays post, I hope this offered you some information you may have been looking for and would like to encourage your participation. Have a great day !
God bless always,
Meredith – RNC
Hello again,
It’s been a few days since my last post, I hope everyone had a safe and enjoyable holiday weekend. In this post I’m going to cover new babies and what you should expect. As always, I hope that you find this post useful and feel free to comment and share your experiences any time possible.
New babies:
Neonates/infants/newborns, take your pick, they all have interesting characteristics. Some of these are present regardless of birth method, others are specific to the way they were delivered.
ALL babies are born and come out with a bluish-purple discoloration, this is NORMAL until they get breathing properly. ALL babies also have vernix caseosa, or a white cream-cheese like substance on their bodies when they are born. Babies born at or before 37 weeks have more, babies at 40 weeks or more generally have less.
All babies also have acrocyanosis or a bluish discoloration of their hands and feet after their trunk turns pink. This discoloration may last for a few hrs. after birth, then normalizes.
For babies born vaginally, it is common to see molding – commonly called “conehead” , especially with first babies. It is caused by the overriding of the non-fixed skeletal bones to fit into the pelvic opening during birth. Usually it goes away within a few days.
Vaginally birthed babies also can have a swollen face and swollen eyes due to the pressure of being pushed through the birth canal, this also subsides in a day or two.
Babies born via planned C – Section usually don’t have molding, not being pushed through the pelvis and usually don’t have swollen faces either.
Some of the other “normal – abnormals” are swollen genitalia on boys and girls, swollen scrotum and swollen labia.
“Erythema toxicum” or normal newborn rash, looks like little red areas about 1cm or less with white centers. There can be quite a few or very little. They are more common on the trunk and back, but anywhere is ok. Baby isn’t allergic to anything, though it looks like a breakout.
Also babies – boys and girls – can have swollen breast tissue, from hormonal involvement, and that goes away in a few days also.
Peeling skin is common with babies that are overdue, just keep them moisturized and it will eventually correct itself.
Lanugo – or fuzzy body hair, is common but usually sheds itself naturally with bathing. This is common on the back, shoulders and sideburn areas on both boys and girls, even occasionally on foreheads.
Milia or skin pores on the face with vernix in them are normal. They look like little whiteheads. They need no medicine or removal as they will absorb on their own without anything being done.
Cross-eyed appearance is present sometimes due to immature ocular muscles. As babies grow, the muscles strengthen, which usually corrects this problem.
In my next entry, I will cover some infant procedures from birth to discharge. I hope this entry has helped you in some way and as always appreciate your comments and feedback.
God bless,
Meredith – RNC
Hello,
In my last entry I covered a typical C – Section and what you should expect. This time around I am going to cover how a typical recovery for a vaginal delivery goes. As always, if you have any questions, I will do my best to answer them and if you would like to add anything to it, feel free, as always, we all appreciate your input.
After the baby and placenta have been delivered and any repairs of episiotomy or lacerations have been completed by the doctor, then recovery starts. For the first hour or so your nurse will be checking your vital signs, your bleeding, your perineum and checking your uterus every 15 minutes. She does the uterine check by rubbing your lower abdomen to massage the uterus. This keeps your uterus contracted, which decreases your bleeding.
You’ll keep your IV until you get up to walk to the bathroom for the first time. If you had an epidural we have to wait for the numbness to wear off before walking. Also, the nurse will be sure you can urinate without a problem before removing your IV. Your nurse will also show you how to cleanse your perineum properly to avoid infection, and a topical spray Med is usually available for perineal discomfort.
You’ll be able to eat solid foods again after recovery, if no nausea. For the first day vaginal bleeding is usually a little heavy, but begins to decrease 8-12 hours after delivery.
We are experiencing some serious storms right now, so I’m going to close off this post and finish with recovery for a C – Section in just a bit. As always, I hope this helps.
God bless,
Meredith – RNC
Hello again,
Today I wanted to continue on with C – Sections and the standard routine for them.
The following may occur if you have a planned C – Section. The doctors usually schedule you at 38-39 weeks, before you’d go into labor. On the day of your surgery, you’d have had nothing to eat since midnight the night before. You would arrive about 2 hours prior to surgery time. As you arrive to the hospital, the nurse will start fetal monitoring. The next thing they do is make sure surgical and anesthetic consents are signed. Sometimes people sign them at the doctors office prior to surgery.
The nurse then starts your IV and gets your labs drawn, CBC or Complete Blood Count, and type/cross, which are standard for most hospitals. You then get a clipper shave fo the lower abdomen down to the pubic bone, and the nurse inserts a catheter into your bladder. Sometimes doctors can let you wait until your spinal has been placed before the catheter, to make it a painless procedure. You’ll have to discuss this with your doctor beforehand.
Then you’ll go to the OR, and sit up for your spinal anesthetic. The anesthesiologist injects with a combination of numbing meds with longer acting narcotics. Then the nurse will help you lay down quickly so the spinal works properly. You are then draped with a sterile drape, have a blood pressure cuff and EKG leach attatched and an electrocautery grounding pad attatched.
Then the surgery begins. The doctors usually do a low transverse or ” Bikini Cut ” incision on skin and uterus. Just a few minutes after they the start, the baby is born, followed by manual removal of the placenta. The longest part of the surgery is after the birth, as the surgeon has to repair each layer as they close up your incisions, skin, fat, fascia, muscle ( which is separated not cut ) and the uterus. Usually doctors use dissolveable below the skin sutures to close the skin with steri strips. After surgery you are in recovery for 1-2 hrs., then to your postpartum room.
My next entry will cover the recovery and differences for vaginal versus C – Section delivery. As always, thanks for taking part in this discussion and offering your experiences.
God bless,
Meredith – RNC
Hello again,
I left an entry earlier, which was a post from a frequent reader. I hope that many of you will find this post useful, as I know that was the authors hope as well. This next entry is going to cover the 3rd category of C – Sections, which generally is not something you would like.
Moms do not have ANY control over any of these happening or not.
These cases are true emergencies with the babys or possibly the mothers life at risk. One cause can be fetal distress, such as the babys heartrate drops and doesn’t recover with moms positon changes, ( such as to her side ) and mother getting a high flow of oxygen by mask, along with IV fluids.
Doctors cannot predict this happening, and the cause can be many, such as the babys positioning, uterus having too many too close contractions ( hyper stimulation ) or the umbilical cord pinched off by babys position.
Another cause can be umbilical cord prolapse, in which the umbilical cord precedes the babys head and gets pinched off when the head progresses down. Most often this can happen when moms water breaks and she is not in labor yet, the cord can be carried with the flow of fluid. If your water breaks at home and you feel as though something is in your vagina, PROCEED DIRECTLY to the hospital WITHOUT DELAY. If this happens, baby can survive with rapid delivery.
Yet another cause can be placental abruption ( Abruptio Placentae ) or a separation of the placenta from the uterine wall. When this happens, blood
flows into the space between the two and forms a blood clot. Since blood cannot flow through a clot, bloodflow to the baby is decreased. How much decreased, depends on how large the abruption area is. Trauma to the abdomen such as a fall, auto accident or being hit or kicked can cause this. Some signs are vaginal bleeding, and a rigid board like abdomen over the area, with intense abdominal pain.
Again, if rapid delivery occurs as soon as this is diagnosed, the baby has a chance for survival. Although this doesn’t happen all that often, it does happen so you should know about it and be prepared for it if it does.
As always, I hope you find this entry useful and feel free to comment on it or your experiences.
God bless,
Meredith – RNC
Hello again,
This will be a short and quick post today, and I am going to discuss Non-Emergent C – Sections.
Other than planned C – Sections this is our most common category regarding C – Sections. Usually these C – Sections result from a labor that for whatever reason does not progress to a vaginal delivery.
Commonly it is because babys head does not fit properly into moms pelvis, a condition call CPD, or Cephalo-Pelvic Disproportion. This cannot usually be determined prior to labor, so usually labor starts, but at some point mom stops dilating and doesn’t progress further.
Other causes can be babys head turned at an odd angle, again not fitting into the pelvis. I will cover this and more in my next post, sorry so short, time to get ready for work.
God bless all of you always,
Meredith – RNC
Hello again,
I just arrived home from a long day at work, but didn’t want to go more than a day or so without adding a new post so today I am going to cover what ” Everyone should know about C – Sections.
First of all, something to consider, every single labor has the chance to become a C – Section, and the rate is about 20 % in the United States.
Why are C – Sections done ? For a number of women, certain reasons can make it necessary to schedule a C – Section prior to labor starting. Moms can have placenta previa, a condition in which the placenta affixes itself over the lower uterine segment, either partially or fully blocking the cervix. The baby cannot be delivered vaginally through his or her placenta. Usually the doctors know this is the case as they can track placenta location with ultrasound.
Another reason for a planned surgical delivery is multiple births. At our hospital we only do up to twins, any pregnancies with more than 2 babies have to be delivered at a regional high risk hospital with an NICU – Neonatal Intensive Care Unit.
Some other reasons are, Malpresentations – meaning the baby is not in a position compatible with safe vaginal delivery. The most common malpresentation is breech, or buttocks first. The babys legs can be flexed or extended with their feet up by their head. Another bad position is transverse, baby lying sideways, with neither head nor buttocks as the presenting part. Most of these positions can be determined with ultasound.
Not common, but still seen at times. If mom has a medical or physical condition that her doctor deems unsafe for labor, such as a heart defect in which her doctors don’t want her to become over exerted, or another condition similar to that.
I hope this entry helps and as always your comments are appreciated by all.
God bless,
Meredith – RNC
Hello,
Let me tell you now, this isn’t going to be real exciting. It was actually a pretty quiet day. Although we did have a woman who went from 3cm dilation to 10cm in about an hour, which is odd and rather insane. She was on her fifth child though, and believe it or not, that makes a huge difference. That was about it for the day though, nothing crazy, nothing complicated. I’m tired, talk to you soon.
God bless,
Meredith – RNC
Hello,
I finished up my last entry covering induction of labor and your options and today I’m going to cover delivery aids used to help mothers in their pushing.
There are 2 methods used, forceps and vacuum.
FORCEPS – Forceps are large metal spoon like instruments that can be used to assist mom in her pushing. Only her attending doctor can use them. He/She places one on each side of the fetal head by feeling where the skull bones are, the handles interlock together and while mom pushes the doctor gently helps guide the head out. With PROPER use, side effects are minimal. Usually, some small areas of bruising on the head that go away quickly.
VACUUM – This is becoming a much more popular method and again only the mothers doctor may use this method. It has a suction cup looking plastic piece about 3 1/2-4 cm, that is placed on the fetal head. The doctors assistant has a hand held pressure device to reach a certain vacuum pressure. It is hand held only, not electric or plugged in, at all. And again, with mom pushing her doctor will gently pull to assist the head out. This is to help bring the baby out, not a replacement for pushing, therefore side effects are minimal. When used properly, all you will see is a small suction cup mark on your babies head.
These methods cannot be used just because you don’t feel like pushing anymore. Mom has to bring the baby down a good amount for the doctors to safely use these methods. Usually, they are used if we see by the monitoring that baby is getting tired of being pushed and needs to get out soon.
Commonly an episiotomy is performed to allow for extra room for a quicker delivery, with help.
Thats it for todays entry, I’ll cover more soon, and as always, your input is appreciated and encouraged. Thanks for reading.
God bless,
Meredith – RNC
Hello,
Well, we really still have quite a ways to go when talking about what to expect with your labor and delivery. Generally my classes last about eight or nine hours, so obviously when writing about the subject, its going to be quite substantial. I’ll do my best to get right to the point. So, here we go.
These are the stages of labor and what you might expect with each one.
There are 3 stages of labor:
1. All the cervical dilation from 0-10 cm.
2. Pushing the baby out.
3. Delivery of placenta. ( By far the shortest )
1.) The First Stage, encompasses all of the bodies work – contractions – to get the cervix dilated all the way to 10 cm. For a first baby this can range anywhere from as little as 6-8 hrs. ( Lucky !! ) to as many as 24 or more hours. First babes always take longer, compared to subsequent children. Contractions may start out mild , even “crampy” in nature and be irregular usually 5 min. and anywhere from 6-15 min. apart, and can be that way for a while. If this is true labor, they will gradually get stronger and closer. At first mom may just feel a tightening sensation, and not really any pain, but that will eventually change. Early Phase, 0-3 cm, Contractions, crampy and irregular, possibly not painful yet. Mom may not be sure this is labor yet. For this phase, gentle activity such as walking is a very good idea, also rocking in a rocking chair. If uncomfortable, a warm shower or bath will probably help. Remember to rest at intervals, even if not tired, turn the lights off and just lay down. If hungry, eat lightly, no heavy or greasy foods. Most moms are still at home for this phase.
Active phase – Labor becomes active, contractions continue and get closer and stronger, generally 3-5 min. apart. Mom may not be able to talk through a contraction at this point. Dilation is generally 4-7 cm. Most moms go to the hospital and get admitted as this phase begins, which means, this is the point where fathers are running around like lunatics ! : )
Once you get to the hospital you’ll be in triage at first until they determine that this is the real thing. At which point, you’ll be moved to a labor room, and your nurse will get you on the monitor, start an IV and do some admission paperwork, sorry but this is necessary. If you wish to walk and move about during labor, tell your nurse and she can let your Dr. know that is what you’d like. At this point you’ll only get ice chips for fluids but you’ll have an IV for hydration too. Things should continue to progress, contractions will continue, dilation at an average of 1cm per hour. Once you are dilated to 4 cm, most doctors will let you have an epideral if you want one. ( I’ll go over Epiderals in my next post. )
Transition phase: 8-10 cm dilation, this is the shortest and most intense phase. Almost ready to begin pushing. Contractions are 1 1/2 – 3 min. apart and very strong. Momma may even feel the urge to push before complete dilation, but your Dr. or nurse will check your cervix to make sure its time. Pushing before dilated to 10cm can cause problems such as a tear in the cervix or swelling in the cervix prolonging labor. So have them give you the O.K. to push before you do.
2.) Pushing – ONLY after dilated to 10 cm, and only with contractions at their peak, to get the most out of your push. Your nurse will and can help coach you in your pushing and help as much as she can. Pushing for your first baby can average from 45 min. to 2 + hours. Yes, thats long but its reality. You just keep on pushing until delivery, and you don’t give up. Ever ! Speaking personally here, I pushed for 3 + hours, but my little dude had a REALLY BIG HEAD !! THANK DADDY FOR THAT !!! I lived through it just fine.
3.) Delivery of the placenta – by far the shortest phase. Takes anywhere from a few minutes and up to about 20. Then……..you’re all done !! Time to recuperate. Get some sleep, you probably need it.
Coming up soon, I’ll talk about epiderals and an explanation on why to get it and why you may not want to get it.
Take care, and god bless.
Meredith – RNC
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