PREGNANCY AND CHILDBIRTH

FREQUENTLY ASKED QUESTIONS

I think I am in labour, what should I do?

Please be aware of the fact that you will be admitted to hospital for delivery once you are in the active phase of your labour. This means that contractions are getting more and more intense and closer together, and that cervical dilation continues at a steady pace past 4 centimeters of dilation. If you observe signs of active labour, please report to your labour ward where you are booked to deliver. No need to break land speed records. 

If you are assessed in-hospital as not being in active labour, do not be discouraged as this is part of a completely normal process. Also be aware that early labour can be a long process which can be a different experience for every woman. The body prepares for labour and birth with early contractions. These may not be the same as previous Braxton-Hicks contractions you have experienced, and may genuinely feel like labour. However, in early labour contractions start up and then slow down and stop after several hours. Take the time to rest when this happens so you can have adequate energy for the active labour stage. In active labour, contractions increase in intensity to the point that rest is not possible and you will definitely know that labour is in progress. 

Sometimes active labour can progress very quickly, and that is why it is important for you to be aware of your body’s signals and go to hospital for an assessment as soon as you believe that your contractions are intensifying and getting closer together with no sign of being irregular or slowing down. It’s always best to come to hospital and have the progress of your labour assessed by an experienced medical professional. 

How do I know if I am in labour?

You will experience regular lower abdominal or back pain increasing over time in frequency and intensity. Your water may break, releasing amniotic fluid.  A mucous show is a poor sign of labour as some ladies lose theirs a week before labour. Please be aware that labour occurs in several stages and is not the same as what we see in the movies. Weeks before active labour, while your body is preparing to give birth, you may experience Braxton-Hicks contractions which are practice contractions that are not painful, Prodromal labour which is early labour that may feel very real but then slows down or stops, and then finally active labour which is when your contractions do not slow down or stop and your cervix continues dilating from 4cm to 10cm when you are ready to deliver your baby. 

I think my water has broken. What should I do? 

Sometimes the water breaks when contractions have not yet started. It is important to come in to hospital and be assessed at this stage in order to prevent infection from occurring which can be dangerous to mother and baby. You may be given antibiotics and labour will be expected to start within 24 hours. If no change occurs within 24 hours, please consult with Dr. de Gouveia regarding safe delivery options.  Sometimes there may be sufficient amniotic fluid to allow you to wait past the initial 24 hours; however, these factors must be discussed with your doctor in order to ensure your safety and that of your baby’s. 

What will happen upon my arrival to the hospital?

You will be greeted by the labour ward sister on duty.  She will take a history and examine you.  This will include taking your pulse, blood pressure and temperature and performing a urine check.  She will check your baby by performing a cardiotocograph (a measurement of baby’s heart and the frequency of your contractions) for 20 minutes.  She will be obliged to perform an internal examination to check for cervix dilatation.  She will then relay all this information to Dr. de Gouveia.  If you are not in active labour, normally more than 4cm dilated you may be given the option to go home and come for reassessment in 4 hours.  If you are in active labour, you will be admitted.  Remember to give your birth plan to the sister at this point.  The sister will monitor your labour with hourly checks of blood pressure.  She will examine you internally every two hours to chart on the partogram (a chart of how fast labour is going).  When you are near delivery she will call Dr. de Gouveia to come in. Dr. de Gouveia may also arrive earlier during the progress of your labour if there are any concerns or if you arrange to have her monitor your progress directly due to any risk factors that may be present. 

What should I bring with me

Please pack a bag for baby, including the following: 

Clothing for baby, including at least one extra set of clothing. Nappies. Receiving blankets and warm blankets if needed. Surgical spirits and dressing for baby’s umbilical cord. Formula, sterile water and bottles if  you will be bottle-feeding. A cover or scarf for breastfeeding if needed. 

Please ensure to bring an appropriate car seat to safely bring your newborn home. 

A bag with essentials for yourself, including the following: 

Linen savers for the car ride to the hospital if your water has broken. At least two comfortable gowns to wear in the hospital. A change of clothing to wear after delivery, including a shirt or top that is convenient for breastfeeding. Maternity pads and 2-3 hospital panties or comfortable panties of your choosing. Personal care items such as a comb, toothbrush and toothpaste, your own comfortable pillow and extra blanket if you choose. Please be aware that depending on your delivery, you may need to stay in hospital for an extra day or longer. It is always best to pack extra items you may need such as books to read. Other essentials include your medical aid ID and the main member’s ID, your personal identification, charger for phones, camera to take photos, your printed birth plan, and snacks and drinks for you and your partner. 

What will happen during labour?

You will be encouraged to move around and be upright for most of the time.  You may bounce, dance, walk stairs.  You must eat and drink.  You will not have an IV drip unless medically indicated and no catheter.  You will be examined every two hours so if you wander please come back for those examinations!

You may deliver in any position which is most comfortable to you.  Your pain relief is individualized to your needs but we do have a wide range of options.  An epidural can be given whenever your pain experience is too intense. 

Your baby will be placed immediately skin to skin and you should not need to be separated from your baby unless intense resuscitation is needed.  Dr. de Gouveia delays the cord clamping so baby gets extra blood.   Once the cord is cut, the placenta is delivered actively by pulling gently.  Dr. de Gouveia will then examine you for tears which may need to be sutured.  You may breastfeed and bond with baby while this happens.  

What happens after delivery?

You will remain in the labour ward for an hour after delivery to be observed for bleeding.  Once you are stable you will be transferred to the post-natal room where you will be staying for a minimum of six hours and perhaps a day or two.  Depending on your birth you may go home quite quickly.

Can my partner or husband attend the birth? 

Your life partner or husband, and/or a doula, friend or family member for support can be with you during your labour and birth. Having your own birth partner at the hospital with you to support you is encouraged. Please pack a change of clothes and snacks/drinks for your birth partner. 

VBAC

Vaginal Birth After Cesarean

The medical practice of Dr. Elizabeth de Gouveia supports the informed choice of women and their families who seek to attempt a Vaginal Birth After Cesarean (VBAC). VBAC birth is an option for women who have preferably had one Cesarean section with a low-transverse uterine scar.

The following factors decrease risk for VBAC complications:

  • Only one previous Cesarean section
  • A low-transverse uterine scar (as opposed to a scar from a vertical Cesarean incision)
  • Active labour that begins within the full term of pregnancy (38 to 40 weeks) and not before or after the term.
  • Regular appointments at our clinic to ensure that the pregnancy is progressing in a healthy manner and that both mother and baby are healthy.
  • That the patient take the time to conduct the relevant research regarding VBAC risk factors and is therefore properly informed about the risks of uterine rupture and aware of issues that may arise. Monitoring of fetal heart rate during labour is essential, as well as for the labour to progress at an appropriate rate once active labour is established.

CESAREAN SECTION

Dr. Elizabeth de Gouveia is skilled at delivering babies by Cesarean section and strives to provide patients with an informed experience that allows patients to participate in the decision making process. 

Options for anesthesia include: 

  • Local anesthesia utilising a combined epidural and spinal block. This allows the patient to be awake during the operation and interact with baby after delivery. The baby can be given to the mother for skin-to-skin contact after delivery and breastfeeding if the mother so chooses.
  • General anesthesia during which the mother is asleep during the delivery. The baby will be well cared for by hospital staff and given to the mother for skin-to-skin contact and breastfeeding once the mother is awake and able to care for the baby.

In the case of emergency Cesarean section, or Cesarean section that becomes necessary due to complications that occur during an attempted VBAC, you can expect the following: 

  • Should you or Dr. de Gouveia become aware of risk factors that may lead to an emergency Cesarean section, Dr. de Gouveia will exercise extra care in monitoring the progress of your pregnancy and labour to ensure a prompt and timely emergency response.
  • In the case of VBAC, you may choose to:

1. Schedule an elective Cesarean section rather than attempting an in-hospital VBAC in the case that your labour does not progress, that there are concerns about the baby’s heart rate, your pregnancy continues past your due date, or you for any reason choose to not go ahead with an attempted VBAC.

2. Request Dr. de Gouveia’s presence at your labour in-hospital for an extended period of time (as opposed to being called in when you are close to delivery) to monitor your progress and consult with you regarding when would be the appropriate time to prepare for a Cesarean section. This type of open communication and planning is beneficial to you and your baby as it may prevent the need to wait for the operating theatre to be prepared and assistant medical staff to arrive. Please refer to the extensive research which relates fast response times to VBAC emergencies (such as uterine rupture) to improved outcomes for both mother and baby. It is important that you are aware of all of the factors involved in a successful VBAC and that an emergency Cesarean section is properly prepared for as a safety measure to ensure the best possible outcome for you and your baby. 

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