Labor and delivery do's and don'ts

Pregnancy Myths Disspelled
By Dr. Laurie Green

  • Eating spicy foods will make you go into labor and sex during pregnancy induces labor.
    No food or activity will induce labor. The detailed mechanism by which labor begins remains a mystery. There is probably a fetal contribution, and a maternal hormone shift, but the actual steps have not been clearly elucidated. It is truly fascinating that labor usually begins within days of the due date, even though the term is around 270 days!

  • Methods of delivery are hereditary.
    That depends. Pelvic size and shape may run in families, and a generous pelvic size makes labor faster and easier. Some women report that their mothers had very fast labors. That may bode well, but women 20-40 years ago were often younger when having their first child compared to today. Having a first baby under the age of 30 probably means a more efficient uterus muscle and therefore fewer contractions for birth. Also, women today consume more calories during pregnancy--and probably more processed foods--than was the case a few decades ago. This can yield larger (and therefore slower to deliver) babies.

  • Your water doesn't necessarily have to break for you to go into labor. If it does break, you need to deliver in 24 hours.
    90% of women begin labor with contractions, and only around 10% start with the water breaking. IF a woman carries Group B streptococcus, a bacteria for which patients are cultured at the start of month 9, she must come to the hospital immediately if the water breaks. It is probably true that other types of infections increase in frequency after 24 hours, leading some physicians to prefer birth within 24 hours, but there is no hard and fast rules. Women also need to be aware of exhaustion. When the bag breaks, adrenaline surges, and the mom is at the point of no return. The average first labor is 12 hours from 5 minute apart contractions to delivery, and the last 2 of these 12 hours are when the mother must muster force to push. That can be very difficult on hour 24!

  • Episiotomies are always needed during delivery.
    At least 5 years ago, the American College of Obstetrics and Gynecology recommended that episiotomies cease to be routine with delivery. This was based on the theory that if a cut is made, it is more likely to extend than if a spontaneous tear occurs. In essence, the episiotomy was the equivalent of cutting through selvage: the cloth tears. In most areas of obstetrics, nothing is black and white. While the era of 'one size episiotomy for all' is over, to say that episiotomies should never be performed is also too inflexible. It is better to have a small, targeted episiotomy than to tear into the clitoris, where a large and active group of blood vessels is located. Likewise, it is better to have a small cut in the hymen (the inside ring) than to have this ring tear off, as active bleeding can occur. And it is better to have a small cut than to develop a huge abrasion of the vaginal floor from the head rubbing back and forth repeatedly, or a jagged bottle glass tear. That said, no physicians perform episiotomies as a matter of course today, and almost all will explain why a small one might be preferable to tearing and ask the patient's permission first.

  • The white stuff that's on your baby after delivery is great for your skin.
    The white creamy material is called vernix. The vernix is felt to protect the baby's skin, given that the baby is fully immersed in water (amniotic fluid) in utero. It is thick and feels like expensive face creams to the touch, but no one has bottled it or used it on adult skin. It can be massaged into the baby's skin and is a good emollient.

  • A woman can be pregnant with twins and not know it until delivery.
    In the old days when ultrasound was not precise, yes! I recall delivering a patient as a resident in Kaiser, Honolulu, around 1980. I had been told that the patient had fibroid tumors, making her look very large. After I delivered her baby, I reached into the vagina to feel the placenta and it kicked me. Baby #2 was born 10 minutes later. Today, episodes like that are exceedingly rare. Experienced obstetricians doing 'leopold maneuvers' in which the baby's body is felt, and sonograms which are quite accurate and done at least once in most pregnancies today, should effectively rule out twins. It is far more difficult to discern numbers of babies when a mother carries more than 5 fetuses, hence Octomom's surpise baby #8.

  • You get a burst of energy right before you're going to go into labor.
    Generally, no. Most women are sleeping erratically prior to delivery, and some have pre-labor cramps. Other than the actual start of regular contractions, nature offers few forewarnings.

  • Epidurals are unsafe.
    When administered in hospitals by board certified anesthesiologists, epidurals are quite safe. Epidural anesthesia involves the placement of a small tube, or catheter, into the lower back in a space outside the spinal fluid. A local anesthetic (plus or minus a narcotic) similar to dental anesthesia is continuously administered through the catheter, bathing the nerves and providing pain relief. Epidural techniques have evolved considerably in the past few decades. In the 1980's, the anesthesiologists would administer a large dose of medication into the catheter every 1-2 hours. This would result in strong anesthesia, which would gradually wear off. The idea that epidurals slow labor arose from that era, since immediately after the large dose was administered, labor would often stop. In the past several years, the medication had been administered via a low dose, continuous infusion, thanks to sophisticated pumps. Recently, the baseline dose has been lowered further, and patients are given a button to press so they can decide how much medication they desire. This patient controlled epidural is known as a 'walking epidural'. For safety reasons, women are not allowed to get up and walk with this epidural in place, but they can move their legs or perform a Kegel, and they could probably get up and walk out in an emergency evacuation! These lower dose epidurals do not slow labor, and sometimes actually speed it up by relaxing tight pelvic floor muscles that impeded descent of the baby's head. There are risks associated with epidural anesthesia, including allergic reactions to the medication, drops in blood pressure leading to fetal or maternal reactions, spinal fluid leaks leading to headache, spinal rather than epidural administration leading to breathing difficulties, and in less than 1 in 10,000 cases, nerve damage. When addressed immediately (medications to raise blood pressure, blood patches to cure spinal fluid leak, etc) these complications can be treated. In the hands of competent, experienced anesthesiologists, complications are rare.
How friends & family can help new moms
  • When should friends stop by?
    When a new baby arrives, friends and family are excited and eager to share their enthusiasm and love with the new parents. However, friends and family must remember that new parents are usually exhausted, especially when a first baby arrives. The average first labor itself lasts 12 hours, and the lead-in to labor can add another 6 hours, so new parents are almost guaranteed to have lost at least one night's sleep by the time the birth occurs. In most hospitals, the new family recovers in their labor room for 3 hours, and is then moved to a post-partum room where they have to settle in. For both new mother and father, labor is a physically intense and sometimes stressful event. By the time the new parents settle into their postpartum bed, they need sleep! New grandparents can be quite helpful. It's sometimes a good idea to let the new dad go home to get rest while a grandparent stays at the hospital with the mom. Some couples have addressed the visitor dilemma by sending an email along with pictures of the new baby, telling family and friends if and when to visit. Many new parents are aching for sleep but too shy to ask visitors to leave!

  • What do couples really need?
    More than anything, new parents need help with the errands of life. I recommend that family members come in tandem, ie, string out grandparents over as long a time as possible rather than having the entire family descend for a week after the birth and then disappear. Most new parents can't fathom the amount of laundry, diaper pail emptying, and cleaning involved with a newborn, and most are awake for at least 30-45 minutes every 2-3 hours around the clock while the baby feeds. Highly productive adults find it difficult to shower daily, much less go to the market or run errands. Some of this is a consequence of fatigue, which dampens organizational skills and clear thinking. If family cannot come to help, friends should take turns bringing food with the expectation that it will be left on the doorstep, that is, don't expect new parents to socialize! A family calendar on a shared website is one way for friends to 'sign up' for errand running, food delivery, etc.
Dr. Laurie Green is an OB-GYN at the Pacific Women's OB/GYN Medical Group in San Francisco.

Pacific Women's OB/GYN Medical Group
3838 California Street, Suite 316
San Francisco, CA 94118
(415) 379-9600
FAX (415) 379-9823
Dr. Green's bio