Labor & Birth General Information

Many changes happen in your body before labor begins.

You may have some of these signs before you go into labor:

• A small amount of light pink or brownish mucus from your vagina
• Your baby moves down into your pelvis
• You may feel less pressure on your stomach and more pressure on your bladder
• Diarrhea
• Cramps or mild contractions. These feel like when you get your period
• Lower back pain
• Your bag of water may break. You might have a gush or a trickle of fluid from your vagina (You can be in labor without breaking your water)

When should I call my provider?

Call your clinic during office hours. After office hours, call 617.414.2000 or the number your provider gives you if:

• Your bag of water breaks. Call even if you do not have contractions.
• You have regular, painful contractions.
• You have bleeding from your vagina.
• Your baby is not moving as much as before.

What to do about early labor:

• During the night, stay in bed and rest as much as you can.
• During the day, go for a walk or talk to friends.
• Drink plenty of water and eat meals and snacks at regular times.
• For pain relief, try a warm bath or shower massage or a hot water bottle.
• Ask for help from your partner, Birth Sister, or other support person.
• Call your provider before you come to the hospital.
• Leave valuables like jewelry at home.

Directions to Women & Infants Center

If you arrive at BMC between the hours of 5AM and 9PM, enter through the Menino Pavilion, 840 Harrison Ave. If you arrive after 9PM and before 5AM, you’ll need to enter through the Emergency Room entrance on Shapiro Drive (off of Albany St.).

Take the Yawkey building elevators to the fourth floor, the Women and Infants Center and check in at the front desk to be registered.

Once you’re at the hospital

You’ll be taken to triage to see if it is time to be admitted (stay on labor and delivery). Sometimes when labor has just started it may be too early to stay at the hospital. If you and your baby are healthy you may be sent home to wait for labor to progress.

Is it really labor?

You may have contractions that do not open your cervix. Your provider may ask you to drink water and walk for 1 or 2 hours. Your contractions may stop or get stronger. The provider will check your cervix again and decide if you should stay or go home.

• Once it is determined that your baby is ready to be born, you will move to a private birthing room.
• During labor, you will have a primary nurse and a midwife or doctor in charge of taking care of you and your baby. You may also be seen by resident doctors in obstetrics, family medicine, or emergency medicine during your labor. Anesthesiologists are available if you want an epidural during labor. Medical students, student midwives, or physician assistant students, may help you in labor, together with your midwife or doctor.

We will:

• Check the baby’s heart rate
• Check your cervix to see how dilated you are
• Have blood taken for some tests
• You may have an IV placed (not everyone requires an IV in labor)
• Discuss your pain control options
• Talk to you about the risks of labor and birth and ask you to sign a consent form to care

Early Labor 

(5 to 24 hours) Rest, eat, and drink lightly. Breathe slowly through contractions and relax.

Cervix opens 
0 to 4 centimeters.

Active Labor

(3 to 6 hours) Change your position. This may be taking a shower, sitting in a chair or rocking on your hands and knees.

Cervix opens 
4 to 8 centimeters.

Transition 

(10 to 60 minutes) This is a very intense part of labor but does not last very long. You may need extra support during this part of labor.

Cervix opens 
8 to 10 centimeters.

Pushing and Birth 

(5 minutes to 3 hours) Push in a comfortable position. Blow or pant when your baby’s head is crowning. This helps to prevent tears to your vagina.

Your baby moves out of your uterus, through your vagina and out of your body. 

Birth of the Placenta 

(5 to 30 minutes) Contractions feel very mild. Your vagina may feel sore. 

You may be shaky and cold. Your placenta moves out of your uterus, through your vagina and out of your body. 

We offer you many options to provide comfort during your labor and birth. These options include various medications or natural methods (without medication).

Childbirth Education

Taking a childbirth education class can help you prepare for labor. Even if you plan to use medication when you are in labor it is good to know some natural ways to deal with labor pain that you can use at home when labor starts. Find out more and sign up for a childbirth education class.

Each woman deals with her labor pain in her own way. Understanding how your body works and feeling relaxed, loved, and supported will help you to deal with labor. Natural labor techniques that you can do include:

• Breathe through your contractions
• Use warm packs or ice packs where it hurts
• Walk if you can
• Change your position when it is hard to cope
• Use a birth ball
• Choose a support person who can help you through the contractions. You may have up to three people in the delivery room to support you.
• Hydrotherapy/Tub
  • Hydrotherapy is using warm water to help relieve pain. You can use the shower or one of the labor tubs to help with labor pain. Medical studies show no problems with tub use during labor. Some women find it to be very soothing during labor and it can help you use less pain medication during labor.

Some women choose pain medication to deal with labor pain. There are three types of medications: nitrous oxide, narcotic medication, and anesthesia medication.

Nitrous Oxide “Gas and Air”

This is a medication that is inhaled through a mask. It only works while you are inhaling and the effects go away when you stop breathing in the mask.

Pros:

• May take away some of the pain
• May make you feel more relaxed
• You may still feel pain but you don’t mind it as much

Cons:

• May not take all of the pain away
• Sometimes women feel dizzy or nauseous

Narcotics

This is medication given through your IV or by shot.

Pros:

• May take away some of the pain
• Makes you feel more relaxed and sleepy
• Can help you to sleep in between contractions

Cons:

• May not take all of the pain away
• Can make your baby sleepy and have a harder time breathing if you get the medicine too close to giving birth
• Can cause an allergic reaction in some women. This is rare.

Anesthesia

This is a medication given by an anesthesiologist (a doctor specially trained to give anesthesia medicine) to numb labor pain. During labor or a C-section, anesthesia can be given three (3) different ways:

1) Epidural: This is when the anesthesiologist places a small catheter or tube in your back. Pain medication goes through the tube to numb your labor pain. You can get more pain medication through the tube as you need it during your labor. It takes about 20 minutes for the pain to stop. An epidural is the most common way to give anesthesia pain medication.

2) Spinal anesthesia: The anesthesiologist gives you a shot of pain medication in your back. Spinal anesthesia numbs labor pain in a short amount of time and is more often used for a cesarean section.

Pros:

• Epidural and spinal anesthesia help to numb most of your labor pain
• Less pain makes you feel more relaxed

Cons:

• Epidural and spinal anesthesia may make your legs very numb and heavy
• These can slow the pace of your contractions and make pushing time longer
• These may cause a headache that can last several days

3) General anesthesia: In some cases, the anesthesiologist will have to give you medicine to make you go to sleep during surgery. You will have a tube down your throat to help you breathe while you are asleep. General anesthesia is not used very often.

Welcome baby! Enjoy this special time after your baby is born. Your baby is awake and alert for the first hour after birth and then usually falls into a deep sleep. This is a great time to breastfeed your baby for the first time and hold the baby skin-to-skin. Your provider, nurse, or birth sister can help your baby breastfeed for the first time. Expect to stay in your labor room for 1 to 2 hours after birth.

Immediate Skin-to-Skin Holding

If it is safe, your baby will be placed on your bare chest immediately after birth. Keeping the baby there for at least an hour and as much as possible after birth will help with:

• Bonding.
• Breastfeeding.
• Keeping your baby warm and calm.

Your baby’s exam and medications can be done while he or she is on your chest. Your baby will be weighed after this first important hour.

If your baby needs to be helped by a pediatrician right after birth, he or she will be given back to you as soon as possible for skin-to-skin holding.

You and your baby will both go to your shared room down the hall, in the Mother-Baby Unit. Staff will provide you and your family with the best care possible during this very special time. Here, you’ll learn about your new baby and how to care for him/her, and yourself.

Rooming In

Your baby stays in your room with you all the time. This is known as rooming in. All the exams and tests will be done on your baby in your room. Rooming in helps your baby cry less and causes your baby less stress. It also helps with breastfeeding because you get to know your baby’s feeding cues.

Skilled Mother-Baby Unit nurses will work with you to complete all of the necessary steps to prepare you and your baby for a safe transition home.

Exams and tests for your baby

We are able to care for your baby in your room and do exams and tests for your baby there. These include:

• Hepatitis B Immunization: This is the first of three injections to prevent the Hepatitis B infection.
• State newborn metabolic screen and bilirubin screen: These screening tests require blood samples, which are taken from your baby’s heel. Blood will be taken for both these tests at the same time.
• Hearing test: This test is simple and painless, and takes only a few minutes.
• Heart screen: This is done to make sure your baby’s heart is healthy.
• First bath: This will not occur until your baby is 12-24 hours old. We delay the bath to help your baby stay warm and to make sure the blood sugar stays in the normal range.
• Removing the umbilical cord clamp: We will remove your baby’s umbilical cord clamp 24 hours after they are born. Please let us know if you want us to save the clamp for you. Circumcision: We wait until the baby is at least 12-24 hours old, has peed at least once, and is showing signs that he isn’t having any trouble eating. This procedure is done in an exam room in the Mother-Baby Unit, on the same floor where you are staying.
• Pictures: Smile! BMC has photographers that come to your room if you would like pictures of your new baby. You can take family photos or photos of just your baby. Every mother will receive one free 8×10 photo and can order more photos if desired.

For the Mother

• You might be due for some vaccinations, like Flu or MMR (Measles, Mumps, and Rubella). We will review your records and share with you what we recommend. o Your nurse will fill out the Women, Infants, and Children (WIC) Food and Nutrition program form, if this is needed.
• If you are breastfeeding, we will provide you with information about breastfeeding support groups like Baby Café. More about BMC’s Baby Café is located at www.bmc.org/obstetrics/breastfeeding.
• If you are formula feeding, we will give you information about how to safely prepare infant formula.

When you and your baby are ready to leave BMC, your nurse will remove the security (HUGS) band from your baby.

• Car Seat: BMC requires all newborns to have a rear-facing car seat prior to going home, even if his/her parents do not own a car. Most car seats can clip into a stroller that is easy to use for walks and taking public transportation. We want to be sure you know how to safely place your baby in the car seat and that you have enough time to practice and ask questions.
• Birth Certificate: Our birth certificate specialists will come to your room to ensure you sign the paperwork.
• Newborn Appointment: Please choose a provider for your baby. We will make your baby’s first primary care appointment for when they are 3 to 5 days old.

Ride Home: Please start planning your ride home. Our goal is for you and your baby to leave by 11:00 AM.