Giving birth: Procedures during labor

Your health care provider may suggest certain procedures during your labor. It is important that you understand the choices you have to make.

To help you and your partner or labor companion make a decision, use the questions at left. If there is something you don't understand, ask to have it explained again. If you want to talk with your partner or labor companion, ask for a few minutes alone.

Fetal monitoring

Our health care provider can assess your baby's well-being by checking your baby's heart rate. This can be done by:

Doptone

This is a hand-held ultrasound monitor like the one your health care provider has used during your pregnancy. Your nurse may use a doptone to check your baby's heart rate from time-to-time.

External electronic fetal monitor

This device constantly monitors and records both your baby's heart rate and your contractions. An ultrasound device records your baby's heart rate. A pressure-sensitive device records when a contraction occurs. Both are held in place on your abdomen by a band or belt. An external monitor may be used for a period of time when you are admitted to the hospital. After that, the monitoring may be constant or on-and-off during labor.

Internal electronic fetal monitoring

Sometimes it is necessary to use a different way to monitor your contractions and your baby's heart rate. This may be done if it is difficult to pick up your baby's heart rate or if more accurate information is needed about how your baby is reacting to contractions.

A small, coiled wire electrode is inserted through your cervix and placed on your baby's scalp to record the heartbeat. A small tube may be placed inside your uterus to measure the strength of your contractions. If your bag of waters hasn't already broken, your health care provider will make a small tear in the amniotic sac.

IV (intravenous infusion of fluids or medicines)

To give fluids, induce labor or give medicines, a small tube may be placed in a vein in your arm or hand. A needle guides the placement of this tube and is then removed. When the IV is in place, you can use your arm and hand.

Inducing labor

Generally it is best to let your labor begin on its own. However, your health care provider may induce (start) labor for your health or the health of the baby. Reasons to start labor or to speed up a slow labor by using induction methods include:

• Your amniotic sac, or bag of waters, ruptured on its own but labor has not started.
• You have been in labor for some time and are tired. Yet, your contractions are not actively dilating your cervix.
• You are or your baby is ill and your baby needs to be born.
• You have a history of short labors. By inducing labor you'll be sure to give birth in the safety of the hospital.

There are several ways to get the uterus to start contracting:

Cervical ripening

Before your baby can be born, your cervix needs to soften so it will open and let your baby pass through. The process of softening is called "ripening." Cervical ripening can shorten the time it takes to induce labor. It may also cause labor to start on its own. There are two ways to do this:

• Stripping the membranes is a procedure that can be done during an office visit. Your health care provider uses his or her finger to separate the amniotic sac (membranes) from the inner wall of the uterus around the cervix.
• Your health care provider can place medicine in your vagina to ripen your cervix. When this is done, you must lie in bed while your baby is monitored. Then, depending on how your cervix responds or the medicine used, you may be able to go home until it is time for your scheduled induction.

Artificial rupture of the membranes

Sometimes breaking the bag of waters, or amniotic sac, will begin or speed up labor. This procedure is called an amniotomy. The amniotic sac is broken with a plastic hook during a vaginal exam. You won't feel pain when the bag of waters is broken — just a warm gush of fluid.

After your water breaks, you'll be monitored for at least 20 to 30 minutes every hour. If your baby's heart rate is fine and your blood pressure is normal, you may shower or walk to try and start contractions. If contractions do not start within a set amount of time, you will be given the medicine PitocinŽ. Your health care provider will decide how long to wait for contractions to start on their own.

An amniotomy is also done to allow the use of an internal fetal monitor or to check the color of the amniotic fluid.

Pitocin (oxytocin)

Pitocin is a medicine that stimulates uterine contractions. It is given through the IV in your hand or arm to induce labor or improve its progress. It may also be given to reduce bleeding after birth.

To induce labor, a nurse will increase your Pitocin rate about every 15 to 30 minutes until you are in active labor. You will probably have to stay in or near your bed or chair because you and your baby need to be monitored. Your IV will stay in place during your whole labor. It is usually removed at the end of the recovery period, one to two hours after your baby's birth.

Contractions may quickly become intense when Pitocin is used. You may have to change your breathing and use more comfort measures. Your husband or labor companion can help you relax with touch techniques like stroking and using massage between contractions. Even if you find it hard to relax during the contractions, focus on getting relaxed between them.

Related Links

Medicines used during labor and birth

Managing labor pain: Many options, your choice

If your labor is induced

First published: 10/04/2002
Last updated: 11/16/2009

Reviewed by: Allina Patient Education experts