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Súhlasím

Labor/Delivery/Childbirth

When does labor begin?

The expected date of labor is calculated on the basis of your last menstrual period, as referred by you. Labor of a mature baby may begin between 37 and 42 weeks of pregnancy. The due date is further revised during the first trimester by ultrasound scan of the fetal size, when the fetus can be measured. If the difference between the due dates estimated by the last menstrual period and by the fetal size exceeds one week, the date calculated by fetal size will prevail. Further ultrasound scans of the size are not used to correct the date of labor.

 

When labor must be induced and how?

Prior to the completion of 41 weeks of pregnancy, it is our duty, quite naturally, to provide for enhanced care for the mother and her yet unborn baby.  The reasons for induction include the risk factors and pathological pregnancy caused by gestational diabetes, mother’s high blood pressure, preeclampsia, sings of risks to fetus (the fetus has stopped to grow, suspected fetal distress shown on CTG monitors, blood flow disorders), etc. In such cases the expectant mother is admitted to hospital for monitoring the baby’s conditions by means of the baby’s heartbeats recording and for possible uterine contractions (by cardiotocography) which may help in detecting a possible oxygen supply insufficiency. In addition, blood flow in fetal vessels and the conditions of health of the mother are also monitored. Thus, every effort is made to assist and ensure a natural childbirth by inducing the normal labor activity. 

Readiness of your labor routes and uterus depends on cervical conditions: cervical position, dilation, softness, and effacement (thinning and ripening). Also important is information concerning the position of the baby, how far the baby’s head or bottom has descended into the pelvis.

 

The only possibility to find out about the baby’s position is by means of vaginal examination. This is very important because only when uterine cervix is sufficiently ripe, and the labor routes are ready for the delivery, we can succeed in inducing the contractions, and thus also the birth-giving. Induced labor may be opted according to the actual conditions of the labor routes. When non-ripe, pre-induction by mechanical or pharmacological means may be chosen. Mechanically, gel sticks are administered vaginally at night for better cervical response.  Pharmacological method rests in the application of prostaglandine tablets in the vagina for the night. With the help of the prostaglandine tablet in the cervix, labor is induced through induced contractions, and the delivery process continues further in a natural manner.

What is giving birth in this sanatorium like?

Delivery/labor consists of three stages. The first stage is the opening (ACTIVE PHASE) lasting  10-12 hours in women giving birth to their first baby , 6-8 hours in women who have already given birth. The contractions cause opening of the birth canal as the passage for the baby. During the second stage, the expulsion stage, the mother actively pushes to get the baby out. This may last 20 minutes, on average, but sometimes it may take a full hour. The third stage is the delivery of placenta. You may find greater details below.

 

How labor proceeds in this sanatorium?

During all stages of your labor we will keep you informed about what we are planning to do. Our delivery plan is based on scientific knowledge, and follows the procedures recommended by prominent professional associations (in the Czech Republic, Germany or the USA and UK). Hopefully, it will be suitable also for you. We are ready to discuss also your individual requests. Not all of then may be medically reasonable, therefore any request may be granted subject to approval by our doctors. In unclear or unreasonable cases consultations are offered to pregnant women to prevent any adverse risks to health of the mother and her child. Hopefully you will understand this approach, as responsibility for good health of the mother and her child is our main concern.  Only one close person is allowed to be present in the delivery room (due to space limits). We expect such person to respect our customary procedures (described above) without any interference with the delivery processes. In case of any disturbance or improper conduct, we reserve the right to oust the wrongdoer.

 

What happens during the first stage of delivery?

With your consent, cleansing enema will be performed upon admission.  During the first stage you don’t have to lie down in bed, be active instead: moving around the room or the corridor, sitting on a fitness ball, and taking a shower are recommended. You may move around also while infusion is being administered.  During labor/delivery eating is restricted for any unexpected surgery intervention (in general anesthesia), however, it is extremely important to take liquids continuously during the whole labor process. You may drink tea with little sugar or mineral water.  You may also have glucose candies which are quickly absorbed (without any residue).

During the first stage fetal heart rate is monitored. In case of any irregularity, cardiotocography of the baby’s heartbeats and uterus contractions frequency must be continuously watched. Only in this manner insufficient supply of oxygen can be discovered early.  

For the delivery to progress, uterine contractions must be sufficiently intense. On average, the length of effacement and dilation of cervix takes up to 12 hours after the onset of regular sufficiently strong uterine contractions. The labor progress is evaluated by vaginal examination made by the physician/obstetrician, taking into account cervical dilation and descent of the head or breech into the pelvis. Vaginal examination is made every two-three hours.  Even though you have contracted an obstetrician of your choice, occasionally another obstetrician may examine you (on admission, doctors’ ward round or in case of any pathological condition). Should the cervical dilation remain unchanged after three hours, labor progress fails, and intravenous infusion containing Oxytocin (the hormone assisting uterine contractions also in spontaneous labor) will be administered. Oxytocin, not given as a routine, is used only upon medical indication that will be clarified and explained to you. A vaginal examination may be conducted also by a midwife authorized by the physician, upon your consent, of course. Similarly, intravenous cannula is not routinely used.

Amniotomy is artificial rupture of membranes serving to make labor more progressive. With the discharge of the amniotic fluid, the head presses on the lower part of uterus causing the increased discharge of endogenous Oxytocine (originating internally). Amniotomy is usually performed when the cervix is 3-4 centimeters dilated. In case of physiological fetus, if you do not wish to have amniotomy performed we can wait until 8-9 centimeter dilation. When pushing with the amniotic sac retained, there is a risk of premature placental abruption/separation, threatening the life of both the mother and her child.

 

The second stage of labor

Where labor progresses, we will wait until cervical dilation of 10 cm is complete. Then the uterine edges join the vaginal walls to form a birth canal, and the birth routes are ready for the delivery of the baby – the second stage. Mother will help the baby to come to this world by intense pushing similar to that applied in case of hard stools. The more intense pushing, the faster the baby passes through the birth canal and the faster the baby is born. The second stage of labor (pushing) may take between ten minutes and two hours, when the fetal physiological conditions are O.K. 

 

Our adjustable birth beds offer enough comfort during delivery, providing for minimum tiredness. Labor is recommended not to take place out the birth bed. 

During the second stage some women are unable to use sufficient pushing force. Or similarly, if the baby’s life is at risk due to insufficient oxygen supply, it will be necessary to induce the delivery promptly, and the obstetrician, acting in the interests of the baby’s health and life, may intervene with forceps or vacuum extractor. In both cases the obstetrician will manage such interventions, and these tools are safe both for you and your baby.  Should anything happen during the labor process that may threaten your or your child’s health or life, we will be ready to intervene also by cesarean section. However, this method is used only in the last resort, in exceptional cases, and not as a method to alleviate delivery. (For details see the information and informed consent at cesarean section)

 

 

Is it necessary to perform episiotomy (incision on perineum, the area between the vagina and anus)?

Episiotomy is not done routinely. However, it must be done when the child suffers from insufficient oxygen supply during the expulsion stage, or when, in case of large fetus (weighing over 4 000 grams), the labor does not progress because the rigid cervix is a barrier, and as a result, the child may suffer form insufficient oxygen supply. Sometimes episiotomy must be done in breech birth, the bottom down presentation, to speed up the head presentation. Episiotomy is not painful, it is done at the peak of contractions, and after delivery the woman does not know at all whether it has been performed or not. In case of epidural analgesia, the women have no feelings of any pain at all.

There is no difference between healing of spontaneous tears and episiotomy cuts.

Episiotomy is used not to accelerate the delivery but to prevent more extensive lacerations, post-labor pelvic relaxation of the endopelvic fascia. It is not performed arbitrarily but only in cases of imminent large rupture of the perineum. Deliveries without any injuries are exceptional.  Before suture of episiotomy or lacerations of the birth canal or vulva, your anesthesiologist will apply a further dose of anesthetics in the epidural catheter. If it is ineffective, anesthetics may be administered locally in the region which is being treated. Even petty surgical interventions are painful after the anesthetics subside.

 

  

The third stage of labor process

In our sanatorium, the third stage of labor is actively managed in accordance with the recommendation of the Gynecological Association and the World Health Organization, i.e. Oxytocine will be administered in one dose of intravenous infusion after childbirth. This will shorten the period of placental delivery, thus reducing the need of blood transfusion.  Oxytocine is a synthetic medication identical with Oxytocine produced in your body.  Its plasma terminal half-time is very short (five minutes) and will not affect the subsequent production of natural Oxytocine.

 

Is it possible to wait until the umbilical cord stops pulsating?

After delivery, we wait until the umbilical cord stops pulsating (about 1- 3 minutes, provided the health conditions so permit). Then it is clamped and cut off. If Father wishes to do so, he must make such request in advance.  Delayed clumping beyond this time is not considered reasonable or beneficial for the child’s health. Delaying clamping is not recommended with parental Rh factor incompatibility (Rh negative mother and Rh positive father).

 

Are there any additional payments (for epidural analgesia, father’s presence at labor, cesarean section, longer stay in hospital in case of complications, etc.)?
Apart from the above standard fee quoted in the price list, you will not pay anything else, and the standard fee is the same for spontaneous childbirth or caesarean section, epidural analgesia or father’s presence at childbirth. The standard fee is not limited to the number of days in hospital, i.e. if your baby’s health or your conditions after childbirth require longer stay in hospital you will not pay more, except for the suite.  

 

My birth plan – will it be accepted?
We are ready to discuss your individual plans of childbirth. It will be accepted subject to the approval by the group of doctors consisting of the OB/GYN Medical Director, OB/GYN Head Doctor, the Head of Neonatal Ward and Head of Neonatal and Intensive Medicine. Not all of such requirements are medically reasonable, and therefore in unclear or unreasonable cases we will consult with you the possible risks to life and health for you and your child and how to avoid them. Thus, the birth plan that has not been approved in advance cannot be accepted. We hope you will understand this approach in which responsibility for the health of the mother and the child prevails.     

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