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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
Ok, I’m back, the storms have passed for the moment and I’m picking up where I would have left off. So, here we go.
Recovery for a C – Section typically goes like this. After the completion of your surgery in the OR, you’ll be moved to the recovery room. You shouldn’t be able to move the lower half of your body yet, so we will move you ourselves.
In recovery the nurse closely monitors vital signs, oxygen saturation of the blood and EKG status. Usually recovery is 1-2 hrs. depending on your hospital. The nurse also checks your uterus, your bandage and your vaginal bleeding frequently. After the recovery room we move you to your postpartum room. You can probably move your legs good enough to help us get you to your bed, as your spinal has wore off. You will be on bedrest for about 6-12 hrs. after surgery, then the nurse gently helps you to sit at your bedside, then stand and take a few steps to the bathroom. You’ll be started on pain Meds as soon as you start to feel discomfort.
You’ll keep your catheter in your bladder until you can walk to the bathroom without problems. You’ll keep your IV longer, in most hospitals it’s kept in until 24 hrs. after surgery, but if you have no nausea and are up walking and drinking fluids, the nurses may saline lock your IV, or cap it off for ease of movement.
You’ll be on liquids only, jello popsicles juice and water and broth until your intestines fully wake up, and we know that is happening when you are able to pass gas. After that, you may have solid foods.
For a vaginal birth, most insurances cover up to 2 days after before discharge. For a C – Section usually it’s 3 days after, some cover 4 days, check with your insurance carrier to be sure when you need to be discharged.
Thats about it, in my next entry I’m going to cover new baby information that I’m sure all you new mothers and fathers, will find valuable. As always, I hope you found this information handy and feel free to input any response you feel adequate.
God bless always,
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 everyone,
My last entry was about covering the options you have regarding epidurals and whether or not it’s a good choice for you, if you haven’t had the chance to read it and or submit a comment, please feel free. Today, I am going to write about inducing labor.
Induction of labor or artificially starting the process.
Why would you induce labor ? Usually for medical reasons of some sort, either with mom or with the baby and or the placenta.
Mom may have medical issues, problems with blood pressure being too high, or if she has any underlying medical disorders, such as heart problems or lung problems.
There also may be baby growth issues, the baby may be growing ahead of schedule and getting to be too big or on the other side of the coin, maybe not growing sufficiently because of placenta issues not functioning 100 %.
The most common reason other than those is post dates, that being the baby is 1 week or more overdue.
There are 2 types of induction. Which one is used depends on your dilation and cervical effacement, ( or thinning ). If your cervix is very little dilated and not soft, and if your having no or irregular contractions, the doctor’s will probably try a cervical ripening agent, prostoglandin, to help get the cervix ready. It’s administered in the form of a vaginal suppository placed behind your cervix during an exam.
If your cervix is more dilated and softened, the doctors will progress right to Intravenous Oxytocin called Pitocin to help. The Pitocin works with the contraction you are already having to make them closer and stronger and will help make your labor progress. It can also be used to help a labor that has been going but has slowed, to get it going again.
Thats pretty much it with inductions and how they work and why you may need one. As always I would like to encourage you to submit your experiences with our other readers and thank you for visiting.
God bless,
Meredith – RNC
Hi everybody,
It’s been a few days since my last entry. I’ve had to work and taught my birthing class yesterday so i’ve been a little busy. But, today I’m going to write about your options regarding whether or not you should get an epidural.
There are 3 options in the medicine realm.
- Natural childbirth – no medicine no drugs. Hey, believe or not, many women still take this route, not me, but many do.
- Narcotic shot via IV or subcutaneous injection to “take the edge off” – it will not fully take the pain away.
- Epidural Analgesia – an injection into your epidural space surrounding your spinal cord, and placement of a catheter (very small) to give you continuous medicine for pain.
Natural childbirth – This is really difficult but obiously possible. Even now as I have stated, with all of our medical advancements, women still occassionally choose to go natural. Excellent focusing skills and relaxation are needed, along with mental strength. But it’s still doable. Just last week I had a lady with her 3rd child and she did it naturally. It was a very good labor and a relatively easy birth, but it was also her third child. : )
Shot of Narcotic, either through your IV or injected subcutaneously. Many drugs can be used at my institution, we use either Stadol ( in the Demerol family ) or Nubain ( in the morphine family ). Onset is short if IV, usually 1-3 mins., up to 5-10 mins. for a shot in the arm. These drugs last for approx. 2-3 hours before wearing away. The only problem with these meds is the timing. They cannot be given if you are dilated to 8cm or more, as birth may occur before drug is out of mom and baby’s system.
Epidural Analgesia – is becoming more and more popular. There are some requirements for an epidural. You MUST have an IV running, the Anesthesiologist won’t do the procedure unless you’ve had 1 Liter of fluids or more. You also MUST have results of a CBC ( Complete Blood Count ) to check your hemoglobin and platelet levels. Also, you MUST be dilated to 4 cm ( a few docs say 3cm ) before you can get it. You will have to sign a consent form for the procedure and your nurse will help get you into the proper sitting position, sitting up with your back curled, lower back pushed out. You MUST hold still during the procedure for safety. Placement takes approx. 5-10 mins., you’ll feel a “bee sting” of local to numb the area that they will be working in. Then, you’ll feel some touching and pressure, but nothing sharp. After placement, the anesthesia staff will secure the catheter to your back with a good amount of tape. Then after returning to your back, your blood pressure will be monitored frequently for a short time. The epidural takes about 10-20 minutes to fully work. Contractions will progressively become less strong, with a 70% decrease in pain as the goal.
After the epidural is placed the nurses will empty moms bladder about every 2 hours. Moms legs will be numb and unable to get her to the bathroom, your bladder will be numb also. : )
There are PROS and CONS of course: Pros – decreases pain, significantly. Increases relaxation of muscles.
Cons – It can slow labor, pain relief may be spotty or sketchy at times, mom may be unable to push if she can’t feel much, and she has to remain in bed and cannot get up.
Thats about it, at least for today. As always, I hope this entry will be of some help to you and please feel free to chime in with your experiences and thoughts.
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
Hello,
I hope you all had a nice fathers day weekend.
Well my last entry consisted of timing contractions and whether or not you should come into the hospital, today I am going to cover when you SHOULD go to the hospital for labor OR otherwise. OB after 14 weeks, and to the ER earlier.
NON-LABOR REASONS: FALLS- Anytime you fall and injure yourself even if you didn’t fall onto your abdomen.
INJURY: If you get hit/kicked or punched in the abdomen ACCIDENTAL OR OTHERWISE. This is very important. For falls or injury you’ll get monitors for a few hours and blood tests to determine if the placenta had any injury at all.
DECREASE IN FETAL MOVEMENTS: If the baby is not moving, and hasn’t moved at all for one full hour, even little movements, usually we will monitor you and try to get the baby to move.
CHANGE IN YOUR VAGINA DISCHARGE: If watery, muccousy or bloody you’ll get monitered and get a speculum exam to check for bleeding, water breaking or possible vaginal infection.
FLU OR OTHER GI UPSET: Throwing up and not keeping anything down, possibly with diarrhea, you’ll get monitored and possibly an IV for hydration.
PRETERM CONTRACTIONS: Prior to 36 weeks, more than 6 contractions in 1 hour, and they may be painless. You’ll get monitored and depending on how many contractions possibly an IV and Meds to stop the contractions.
BURNING WITH URINATION: Probably a urinary tract infection, you’ll get monitored, ( I say that a lot huh, : ) ) a urinalysis and antibiotics if an infection is found.
EPIGASTRIC PAIN: Pain in your upper abdomen ( not over your uterus ) on the right side commonly. Some times seen with visual changes.
VISUAL CHANGES: Seeing spots, sparkles in your vision, and
SUDDEN WEIGHT GAIN: A gain of 2-3 lbs. or more in 1 week can be accompanied by an increase in swelling of the feet and hands, these last 3 can be signs of preeclampsia, commonly called toxemia, a dangerous syndrome combined with elevated blood pressures and abnormal lab values. You’ll be monitored depending on the severity of the preeclampsia and you may get an IV for fluids and or Medicine.
LABOR: If you are past 37 weeks and you think your water broke and you’ve had contractions 5 min. apart or closer for at least 1 hour ( 2 is better ) and are having ” bloody show ” , mucousy blood tinged discharge, you may be in labor, get to the hospital immediately.
I will be covering more here in the next few days, I hope this information helps you, and as always, if you have any questions or comments please feel free to chime in. Talk to yaw soon.
God bless,
Meredith – RNC
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