Drs. Sarah and Alicia discuss labour. What does labour look like? How can I tell if I am in labour, what are labour symptoms. They also discuss pain managment …
hey guys welcome back I'm dr. Sarah and
this is dr. Alicia and this is our third
video in our series of labor and
delivery talks so Alicia and I are both
family doctors that do maternity care
here in Victoria British Columbia and
we're putting together a series of
videos that can help you learn about how
to manage labor and delivery give this
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we've got great content coming out
regularly you can also check out our
website at www.shefoundhealth.ca for more
great info make sure you read the
medical disclaimers below in the show
notes all other videos that we're making
in this series will be posted in our
show notes as well and if you're
interested we're putting together an
online prenatal course as well so stay
tuned for information on that great so
let's dive in this episode we are going
to talk about active labor so what is
active labor you might ask well it's
when you're having regular strong
painful contractions that are changing
your cervix so oftentimes these
contractions will happen every three to
five minutes the lasts for about a
minute and they'll be happening for more
than an hour and they're painful enough
that you're like you're feeling them
this isn't like yeah this is painful you
got to stop you got to breathe through
you can't talk to anybody
during these contractions and then
in terms of the definition we call three
to four centimeters dilated as when
you're starting transitioning from that
early labor or prodromal labor into the
active labor labor stage so at this
point once you've started into active
labor we can predict a bit better how
the average woman will progress at this
point early labor we can't so much that
comes and goes and it's different for
everyone so you know like Alicia said we
generally say that for a woman who has
not dilated her cervix before we define
active labor is when they hit that sort
of three to four centimeter mark and
after that we can we can estimate that a
woman is going to dilate about a
centimeter per hour or so from four centimeters just fully dilated which is 10
centimeters and we know this will take
about on average six to ten hours
some women dilate more quickly and
others more slowly it depends on your
pelvic shape the strength of your
contractions and the baby's position so
again this is an average right so take
that information with a grain of salt
so we often get a lot of questions about
what kind of pain management should I
use in labor and to be totally honest
you can't predict how you're gonna cope
with labor and what its gonna feel like
to you and frankly from one day to the
next it could feel very different
depending on what your mood is
how stressed you are so we can have a
discussion around what options are for
pain management for you in labor if you
choose any at all but go in open-minded
and don't have a very specific plan of
what you want because you might be
surprised mm-hmm so there's a few
different options we have non-medical
and medical so our natural pain
management options can include things
like using the exercise ball walking
around being in a warm shower or bath
but we don't want you in a bath if
you've broken your waters and other
options include hypno birthing and you
can certainly take some courses online
and a TENS machine TENS machine is a
transcutaneous electrical nerve
stimulation unit so essentially it's
electrical pulses stimulating your nerve
which can help with pain relief mm-hmm
so those are most of our sort of natural
and non-medical pain management options
and then we have a whole host of
medication options that are available to
you the first one women typically start
with is called nitrous oxide you may
also hear this referred to as n2 NOx or
laughing gas so what it is is it's an
inhalation anesthetic which can take the
edge off during your contractions your
nurse will give it to you when you feel
like it's something you want to try and
you either have a piece that goes over
your nose and mouth
or just a mouth breathing device
that you use during contractions so
you start to breathe in at the start of
a contraction and breathe and use it
until your contractions subsides. This can
work really well for a lot of women and
in some women they find it exceptionally
helpful if they've been coping quite
well without any pain medication through
that transition phase so that's sort of
when you're when you're almost fully
dilated from eight to ten centimeters
which can be really intense for women.
The next group of medications we talk
about has two separate medications in it
and it's our opioid class of medications
so the medications are one morphine and
two fentanyl. Morphine is a medication
that we would give you a shot in your
bum with some gravol because it can make
you a little bit nauseous and this can
last for up to four hours sometimes up
to six hours in certain women. We use
this to take the edge off the
contractions and to help you relax a
little bit more during that can in
between contractions . We want to be
careful about the timing of this so if
we think we're you're gonna deliver your
baby within the next four hours we would
try to avoid this medication just
because it can cause some decreased
respirations in your baby which are
easily managed through stimulation and a
medication that we can give your baby if
we need to so if we you're getting close
to to delivery time we would choose the
second option which is fentanyl this is
given through the intravenous and it's a
little bit of a quicker onset and lasts
for about 45 minutes or so so it's great
for that last little bit of labor if you
need something a little bit more than
the nitrous oxide so after opioids next
comes epidural I am an epidural girl I
will just let you guys know I had to
have one with each of my deliveries and
they were amazing so what an epidural is
it's when an anesthesiologist which is
basically a pain pain medicine
specialist they're called in and they
place by needle and then catheter tube
that goes into your spinal column and
they introduce their
medications that causes freezing and
numbness and it it basically affects you
from sort of the nipple line down so
it's localized anesthetic and
does not pass through to your baby and
what it does is it takes away pain but
it doesn't take away pressure so a lot
of women can still feel the pressure of
a contraction but the intensity in that
that pain that's associated with each
and every contraction is is lessened and
sometimes gone completely so technology
has changed a lot and with epidurals we
we we talk about walking epidurals and
we we often say that that's something
that is provided but you know to be
honest most women are pretty much
restricted to bed after an epidural I
would say it's pretty rare that we see
people with an epidural up and walking
around and if people are walking it's
generally just to the bathroom and back
mhm we're not talking walking the wards
the other thing about epidurals is we
need to generally monitor your baby a
little bit more closely with an epidural
so oftentimes you'll have monitors on
during that epidural. epidurals are also great if you
have to go to a cesarean section because it makes it a little bit more quick to get
to that process done we can just put
some more medication in and and freeze
you up a little bit better for that and
there's also a few sort of pre-existing
medical or pregnancy conditions where we
often recommend what we call an early
epidural so perhaps placing an epidural
even before the the contractions or the
fatigue and exhaustion has gotten to a
point where you really want one and
those are in cases like twin or
multiple pregnancies if a woman
is obese and carries a significant
amount of extra weight and tissue that
can cause some complications during
the delivery and for women who have
other medical complications of pregnancy
like high blood pressure or other
underlying conditions like a heart
problem and also sometimes if your labor
is progressing really slowly an epidural
can really be helpful it can give you a
chance to rest and really relax that
pelvic floor which often times allows
that baby to move down and into a good
position often times people ask is when
is it too early to get an epidural or
when is it too late to get an epidural
so when is it too early as if you're not
into that active
phase so generally speaking we we
suggest not getting it unless we're
giving you medication to get your
contractions going prior to about 4
centimeters of dilatation and when is it
too late well if we think your baby's
gonna be out in the next 10 minutes
because it actually takes about 15
minutes for that epidural to kick in so
in people who are actually progressing
very quickly who want an epidural
sometimes we don't get it in time or if
your baby is about to come out then we
often wouldn't know we wouldn't get it
for you but I've given epidurals or
gotten epidural for women who have been
pushing for an hour already
yeah I'd say it's pretty rare for it to
be too late to get an epidural because I
think that's a common fear among a lot
of women yeah so don't worry I had that
fear my birth plan was always
contractions Hospital epidural worked
for me three times yeah great well
that's our topic for today so hopefully
you found it interesting we'll link to
all the other videos that we've made in
this series below don't forget to hit
subscribe and check out our website at
www.shefoundhealth.ca have a great day
thanks guys

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