Please answer my delivery qus!! Abt to be first time mum.

[LoriRae]

Originally Posted by Cricket

However, you are always bound by hospital policies in hospital - there may be time limits on labour, time limits on pushing, !

Sorry if this is a silly question- I am honestly really clueless when it comes to all this stuff.. but are you serious? Do they really put time limits on length of labour, and pushing, even if everything is going fine?

I continue to be gobmacked by all the new things I learn on BB...

[Cricket]

Yep, I've read several birth stories and heard stories from friends where they were told "We'll let this continue for X number of hours, and then we'll have to section" when they and their babies were fine. Labour was just not moving as quickly as the ob or whoever thought it should. In fact, I believe that is my own mother's birth story - she doesn't really know what happened - she was OK, I was OK, but they did a c-section because it was taking too long, apparently. This was in 1980, and then there was pretty much no such thing as a VBAC. Thankfully, there have been a lot of changes since then! But there are still some hospitals reluctant to change their policies. Pushing may be limited as well - 1 hour or 2 hours, or whatever.

As I said, things are changing - not all hospitals are like this! But most do have some sort of guidelines or policies spelling out what is and what is not allowed during labour. I think they almost have to for insurance, or something. Maybe someone in the field can offer some definite information and clarification.

[paradise lost]

My friend had a section 2.5 years ago because the hospital limit was 2 hours pushing. The nurse had topped up her epidural 3 minutes before she was fully dilated because she "couldn't possibly be ready to push yet!" (they didn't check first). Her daughter's head was VISIBLE in the vagina when they decided to section and the baby is scarred for life from injuries caused by the forceps needed to prise her already moulded head back up out of the pelvic inlet. She was dx failure to progress and CPD (baby's head too big to fit). Nearly a month ago she had her 900gms heavier son via HBAC without any trouble. It took her nearly 3 hours to push him out, but they were both completely fine throughout.

Not all hospitals are like this, and even within hospitals, not all Obs subscribe to the time limits. I could cry at the number of birth stories i read with a woman being diagnosed failure to progress because "After 13 hours of labour i still wasn't dilated" - for a first time mother the first stage (so 4cm to 10cm dilation) can take 24 hours and still be completely NORMAL. For some reason what was once recognised to be a normal labour is a too-long one. By definition, if the average labour is x hours, most will NOT be that length. We are all familiar with the idea that only a small %age of babies come on their due date, which is derived from the average length of a gestation, but so many women are sectioned or cut because their labour wasn't "normal" enough. We are now in a situation where the book which was supposed to provide a general rule of thumb for inexperienced or busy practitioners has become a set of hoops to hop through, and the "failure" of a given cervix or or uterus or vagina to obey the rules set out by the book can carry heavy penalties not for the doctor but for the woman and the baby.

As for what is "normal"... Most hospitals will want to accelerate (by artificially breaking the waters or giving IV sintocin) a labour which is not progressing at at least 1cm every 2 hours after 24 hours, providing they have room in delivery for the mum (if they're full they may send you home repeatedly for up to 3 days provided your membranes are intact). Most hospitals will give antibiotics by IV once 18-24 hours have passed since the mebranes ruptured. Most hospitals forbid you to eat once you are 4cm dilated - this can mean you face a long long hungry labour getting weaker with every hour. There have been several studies on this and all have found that women self-regulate food during labour and it causes no difference in maternal or foetal outcomes to let them choose to eat if they wish. They starve you "in case" you need a general anaesthetic for surgery, which is far more likely to happen if you're exhausted from not eating. Most hospitals also have set rules about certain situations and outcomes for the baby.

When DD was born she had passed meconium before birth (probably because they told me to fight the pushing reflex for the entire second stage!) and was a bit clogged up and shocked when she finally shot out (i was never worried, i KNEW she was ok, but her apgars were 9 at 1 minute, 7 at 5 and 10 at 10). She had her nose and throat suctioned and was put on my naked chest with an oxygen tube flowing under her nose and a bunch of warm towels and blankets wrapped around us both. She was BFing within 40 minutes. I was told if she'd been born in hospital she'd have gone to SCBU for the night, had 2-hourly glucose blood tests, not been allowed to BF and not been allowed out of her incubator until she could maintain her own body heat. As a sensitive first-time mother holding her 2-hour old baby when i was told this, i can tell you how my heart pounded and my grip tightened - they would take my baby from me!? When she NEEDED me?!

The most important thing is the ask about all this. "What is your policy on xxx" and "What will happen if i don't consent to that?" are the questions to ask. Don't be defensive, smile, be interested but firm. LISTEN when they tell you their reasons (and don't accept "It's hospital policy" - ask how the policy came about and if necessary point out that their basis is now out of date). TALK about what you want and decide what you will compromise on and what not.

If you are feeling uncomfortable with the care offered it is FINE to go look for different care elsewhere - often when pregnant women argue we are made to feel like naughty girls questioning our caring parents, and not grown women making some of the most important decisions of our lives. Don't be bullied. Hold on to the fact that caring for YOU is THEIR job, it's your baby and your body, they should be able to reassure you and be honest about the care they can give. Resist the pressure to shut up, be a good girl and let them get on with their job, get the answers you need.

Bx

[kitten76]

I totally agree with hoobley,Our bodies are all different and as long as there is no fetal distress natural labour should be allowed to proceed naturally.There should be no set time (within reason ,a week seems a bit long ) to give birth especially if your low risk. I stayed on my feet to let gravity help the job along and only lay down to push.
Also if I was told I couldnt eat or drink during labour I would have gone off the deep end. Labour is exactly that and you need sustanance to get you through, both emotional and nutritional.

You just need to ask lots of questions like hoobley said. This is possibly the most important day of you lives and you want it to be a pleasant and happy experience.
Good luck sweets

[Evie76]

Hospital birth here and it was all good.

Everyone was just standing back watching the show (down the end I couldn't see). They may as well had cups of coffee or been standing at a bar having a chat after work.

[Lady Zaidie]

I will tell you my very funny story about time limits on pushing.

At my hospital, you're allowed to push for two hours. I had been pushing for three when the midwives asked if they could fudge my notes; it was 1.30 and I'd been pushing for almost 3 hours I think, only they'd told the Obs to come in at 2, so could they please put I started to push at 12? That was fine with me. Baby was well and truly on the way out at this point, the head had cleared the cervix at any rate.

The Obs was "helping" another patient at the time so didn't show up until 2.30: the midwives were livid that he wasn't there at the appointed time! Because clearly that second after two hours was so important that they can't even fudge times to make their paperwork OK, 2 hours is the limit and that's it.

I still find that quite hilarious.

BTW, I was at 2cm dilated from ?midday until ?2am (I think from about 7am but no-one checked and was 4cm by 4am); this was fine and normal. Almost 24 hours of a "stalled" labour with mild contractions.

[paradise lost]

Ryn did they call that "labour" though? I know my midwives didn't count how fast i was dilating (or stay in my house - they could have missed the birth due to that!) until i was 4+, which never was because i was 2-3 and then crowning at the two VE's. I think in hospital they would have counted it because my waters had gone though...? It's so funny, before i had DD i had this very clear idea in my head of how labour works and how each stage would be, and since having DD i don't have a scooby do WHEN labour actually "started" for me - i was contracting for 18+ hours, waters gone for 16, painfully contracting for 6, really breathtakingly so for 3, avoiding the pushing urge for 2, yet when i lay down for the VE to "see if i was in labour yet" (midwife's words) she was born!

Bx

[Lady Zaidie]

Nah, the hospital... actually, I don't think I had a labour. Just the pushing. Cos I wasn't in labour at all according to what they were telling me. Maybe from 4am onwards. Even though the old monitor was showing regular, labourific contractions.

For me, labour started because there was a definate "this is a labour contraction" moment; for everyone else... who cares?