Pregnancy Child Birth

Oxytocin Pheromones for Women

Feb 22 2008

Continuous Monitoring

With continuous monitoring, your baby and contractions are monitored almost all the time. However in most cases, there is no reason why you cannot stand, sit, or squat with the monitors in position. Some hospitals have equipment that allows you to walk around as much as you want and to be monitored by radio signal.

Pros And Cons

With continuous electronic fetal monitoring you are more likely to end up having cesarean delivery or a forceps or vacuum delivery. The reason is that your care provider may see changes in your baby’s heart rate that are a cause for concern. Unfortunately, it is impossible to know the cause of many heart rate abnormalities it may be something minor or it may indicate a fall in oxygen levels, which is potentially serious. No one wants to take any risks with your baby, so a cesarean delivery will usually be recommended. If the fetal heart rate changes happen while you are pushing, a forceps or vacuum delivery may be recommended to you. As well as increasing your risk of cesarean, the belts may be uncomfortable during labor. The benefits of electronic fetal monitoring are not completely clear, although experts agree that continuous monitoring reduces the small chance that your baby will have a seizure after birth. Seizures are one symptom of brain injury from low oxygen. Most hospitals have policies requiring a minimum of intermittent fetal monitoring. You can refuse electronic monitoring, but expect your care providers and the hospital staff to be unhappy about this. You may be asked to sign a statement releasing them from liability if your baby dies or develops cerebral palsy.

Scalp Electrode

A scalp electrode is another way to monitor your baby’s heart rate electronically. Instead of listening through your skin and uterus a small wire is placed in your baby’s scalp. The scalp electrode is placed during a vaginal exam and will not feel uncomfortable. It is used if your care provider is concerned about your baby’s heart rate or can not get a good signal using an external monitor.

Disadvantages

The risks to your baby are small. There is a small risk that your baby can get a scalp infection, which can be treated with antibiotics. Your care provider or nurse should discuss the scalp electrode with you before it is placed, and you should understand why it is being done. Once a scalp electrode has been placed you cannot move far from the heart rate monitor, although you should be able to change labor positions.

Intrauterine Catheter

An intrauterine catheter is usually placed to measure the strength of your contractions (the external monitor can only record how often they are). If you are more than 4cm dilated, you should be in active labor this means that your cervix should usually be opening by 1cm more each hour. If labor is not progressing and your contractions are less frequent than every 2-3 minutes, your care provider will probably give you oxytocin (right), and an internal monitor is not necessary. If you are having frequent contractions, but your cervix is not changing, it may be because your contractions are weak. At this point, your care provider may recommend an intrauterine catheter to measure the strength of your contractions to help determine how much oxytocin to give you. A uterine catheter is a thin flexible tube that is usually placed during a vaginal exam it is not particularly painful, and you will probably not notice it after it is inserted. Although the risks of a uterine catheter are low, they should not be used routinely. You should be told when a uterine catheter is being placed and be told why it is being done.

Speeding up Labor

If you are in active labor but your cervix is not continuing to dilate (open) as expected, your care provider may suggest your labor be speeded up (augmented) by one of two ways, breaking the amniotic sac (amniotomy), or oxytocin. The chances of you needing this intervention is higher as you get older, especially if this is your first pregnancy and your uterus hasn’t had previous practice.

Amniotomy

Breaking the bag of waters (amniotomy) is painless and not likely to be harmful to you or your baby. It can shorten the time you are in labor by 1-2 hours. It can also significantly decrease the chance that you will need oxytocin in labor. However, it does not decrease the risk of cesarean delivery. In first time mothers, breaking the waters is probably safest when it is done in active labor (after the cervix has dilated at least 4cm). If you have already had a vaginal delivery, amniotomy is safe during the earlier stages and can even be used to put you in to labor. To release the amniotic fluid, your care provider will do a vaginal exam, during which he or she should be able to feel the bag of water through your cervix. Using a plastic instrument with a hooked end, your provider will make a small hole in the amniotic membrane, allowing the amniotic fluid to leak out.

Oxytocin

Oxytocin is a synthetic form of a natural substance released from your pituitary gland. Oxytocin is usually given during established labor because contractions are too infrequent or too weak for labor to progress effectively. (It is also used to induce labor). Once you are in active labor (when the cervix has dilated to at least 4cm), most care providers like to see that the cervix is dilating by at least 1cm an hour.

Women over 35 are more likely to need oxytocin during labor to keep labor progressing. Once you start receiving oxytocin, you must be hooked up to an IV pole. Some women worry that contractions will be too strong and too painful after oxytocin. One way to look at this is that the weaker contractions aren’t doing you much good. If you have to be in pain, it’s better to have the pain be effective in dilating your cervix. You are more likely to need oxytocin after epidural analgesia, but in this case you won’t reel the stronger contractions. Oxytocin is usually started at a low dose and increased over a period of time. If contractions become too strong or too frequent, the dose can be turned down and the oxytocin quickly clears from your system. Used correctly, oxytocin is safe and can reduce the chance that you will need a cesarean delivery. Oxytocin is also commonly given after you have delivered to decrease vaginal bleeding and keep the uterus firm.

Episiotomy

Episiotomy is a cut that your care provider makes at the vaginal opening to help deliver your baby more quickly. Episiotomy used to be performed routinely, but doctors now understand that it can cause more severe tearing than allowing a tear to occur on its own. However, if your baby is in distress and needs to be delivered quickly, an episiotomy may be necessary.

The cut is either toward your rectum (midline) or toward the back of your thigh (mediolateral). Midline episiotomy more than doubles the chance of a serious tear in to the tissues surrounding your rectum or in to your rectum it self. Mediolateral episiotomy does not increase the risk of rectal tearing, although recovery can be painful. Tearing in to the rectal muscles or in to the rectum doubles your chances of having fecal incontinence (losing control of bowel movements). You may also have problems controlling gas. Both are difficult to correct surgically. Despite active campaigns to educate care providers, episiotomy was still performed in about 33 percent of women in 2000. Given the potential long term risks after episiotomy, it is in your best interest to talk seriously with your care provider early in pregnancy about this important topic. Episiotomies are repaired similarly to regular obstetric tears.

Forceps Delivery

Forceps are metal paddles that are used to guide the baby’s head out from the vagina. In general, forceps are not harmful for your baby, although birth injuries can very rarely occur. However, the use of forceps does have substantial risks for you, increasing your chances of having a significant tear in to the rectal muscles. This then increases your chances of incontinence of gas or stool (losing control of bowel movements). The risk of significant tear after forceps delivery is 30 percent in first time moms. Despite these risks, forceps may be needed if your baby has signs of distress at the end of labor a forceps delivery can get your baby out much more quickly than a cesarean. If forceps delivery is being offered to shorten the pushing stage, or because you are very tired, you may want to consider the risks. You have the option of continuing to push, or you can ask for a cesarean delivery to prevent possible rectal damage.

Tags:anticoagulant, child birth, labor progress, medical interventions, narcotic analgesics, natural childbirth oxytocin