As a private practice obstetric provider, my passion for educating, informing and supporting first-time moms and moms who have given birth twice or more remains a key component of my life’s work and mission in the field of medicine. The transition from the first birth to giving birth more than once is fraught with peril. I am often surprised how long this transition can sometimes take.
Unlike shift workers like hospitalists and nurses, a private practice health-care provider doesn’t have shifts. A typical weekend “on call” means the health-care provider is on call for two to three days 24/7. Recently, during a busy “on call” weekend (and in the wee hours of two successive mornings), several first-time moms, who were certain they were ready to give birth, came in for evaluation. It turned out in each case, they were early in labor (based on total cervical dilation and contraction intensity) to be admitted. The early-morning arrival of these women, and the unlikely coincidence of this happening twice on successive nights, lead me to realize that there is still an overwhelming need to better inform and educate women — first-time moms in particular — about the stages of labor and when to come to their hospital or birthing center-of-choice.
TIMING VS. INTENSITY
For certain, during the 12 to 15 prenatal visits a mom usually has during pregnancy, information is usually shared about the start of contractions as well as labor and delivery. For example, they are reminded that the intensity of contractions is a much better guide to active labor than the timing of contractions. The truth, however, is that the actual utilization of all the information received is often not the focus as the mom as she gets closer (with both excitement and apprehension) to giving birth and meeting her baby for the first time. In addition, without a real frame of reference for the “intensity” of normal labor, the sensitive nature of the hormones of birth can entice her go to the hospital too soon and forget she should be experiencing strong, active contractions first.
It is the generally believed that the first-time mom should go to the hospital when contractions of the same intensity are at 3-1-1 — when contractions are three minutes apart, each lasts for one minute and this has been going on for one hour. Some medical professionals say first-time moms should to go the hospital when contractions are at 4-1-1, when contractions of the same intensity are four minutes apart. Others use 5-1-1 as their test in deciding when to go to the hospital. 5-1-1, when contractions of the same intensity are five minutes apart.
ARRIVING TOO SOON
Many first-time moms come to the hospital having pain and irregular contractions but without a definite 5-1-1, 4-1-1, or 3-1-1 pattern, resulting in still not having enough cervical change to be in active labor. Depending on mom’s resilience and anxiety level, she will probably be sent home with pain medicines such as morphine or Ambien to help her sleep and “labor on” in the safety of her own home. This plan may be considered old-fashioned by some health-care practitioners, but I believe we still need to give all low-risk first-time moms more time in labor, and be adequately championing a “keep calm and labor on” attitude in both the early phase of labor (allowing mom-to-be to stay home longer) and the active phase of labor.
Some colleagues suggest admitting a mom who is having pain and irregular contractions but does not having enough cervical change to be in active labor is the better option. I respectfully disagree. The more hours moms are at the hospital prior to their baby’s birth, the higher the risk of unnecessary intervention. She doesn’t need what I call “meddlesome obstetrics” — things like an early epidural, or inducing and ripening the cervix. What mom needs is effective communication and balanced patient-centered teamwork to keep her calm and labor on. Further, she needs to learn how to recognize active labor so she does not go to the hospital until she has strong, active contractions. Research shows that many C-sections are unnecessary, the outcome of not giving low-risk first-time moms more time in the early and active phase of labor.
USING A DOULA
First-time moms are often encouraged to consider having a doula in labor and delivery with them. A doula is a labor support person (and usually a mom herself) who will labor with mom at home, before the transition to a hospital or birth center is made. In a nutshell, doulas are well-trained childbirth coaches who provide continuous physical, emotional and informational support and assistance to mom before, during and just after birth. Doulas do not deliver babies—they speak up for mom in delivery room when necessary, help during labor with back rubs, nourishment and best pain relief positions. They give mom’s partner ideas on how to best support and encourage her and keep her calm, and may even prevent an unnecessary cesarean delivery.
I remain concerned that the United States’ cesarean rate has increased so much over the years that a C-section — which should only be a life-saving intervention — is now a procedure performed as a matter of course during one in three U.S. births. Today, as health-care providers are focused on improving, supporting and fostering vaginal birth in first pregnancy, practitioners should make every effort to shorten the dysfunctional labor in women, and educate first-time moms more effectively through childbirth classes and learning materials on labor and delivery, particularly on contractions. The goal is to gently, safely and wisely usher mom into the birth process.
This article originally was published by the Marin Independent Journal.
