Special Tips for First Time Mothers

Special Tips for First Time Mothers

Of the joys and challenges you face in life, none is more extraordinary than having your first baby. From the moment you find out that you are pregnant to the day you give birth, you will experience many changes and learn new ways to take care of yourself and your growing baby.

Mother and baby experts from our hospitals and physician groups in our network have shared their knowledge and expertise to provide you with the best possible care. Working together, we established care recommendations based on the experiences of more than 152,000 first-time mothers across our network. This scientific evidence identified best practices for promoting a healthy pregnancy and safe delivery. As a part of this effort, we have compiled the following information about childbirth and created these Special Delivery Considerations for First-Time Mothers to recognize and support this magnificent time in your life.

    Early Labor
    Induction
    Comfort and Pain Management
    Episiotomy
    Pushing
    Recovery
    Breastfeeding
    Baby

Early Labor

Special note!Because you have never experienced labor before, you may find it difficult to know if you are in labor. Before heading to the hospital, call your physician or midwife to discuss your labor symptoms.
More than one hospital trip
It is common for first time mothers to make more than one trip to the hospital. If you are in early labor and sent home, the following activities may be helpful:
    walking
    showering
    resting
    drinking fluids
    renting a video
    listening to music, etc.

Prodromal Labor
Some first-time mothers experience a prolonged period of early labor with minimal to no change in their cervical dilation. This condition is called "Prodromal Labor". If this occurs, it is especially important to
    alternate rest and activity
    to keep hydrated
    maintain your physical energy with light, high energy food
Partners and families can be very helpful in keeping the mother distracted with activities and in keeping up her spirits. Periodic contact with your healthcare provider is also helpful.

Active Labor
Literature shows, and we have found, admitting a first time mother to the hospital when she is in active labor has a better outcome than admitting a first time mother to the hospital when she is in early labor. Admitting a first time mother during active labor helps her labor progress with minimal interventions and she has a higher occurrence of having a vaginal delivery. In active labor, the contractions are less than 5 minutes apart, lasting 45-60 seconds and the cervix is dilated 3 centimeters or more.

Induction

Although inducing labor may be needed for certain medical problems or prolonged pregnancies, induction for a first-time mother carries additional risk. Induction of labor for a first-time mother, (especially with a cervix that is nearly closed), doubles or triples the length of labor and possibility of a cesarean birth. However, in subsequent pregnancies, the chances for a cesarean delivery after induction are lower. Inductions are not done prior to 39 weeks gestation unless there is a medical reason.

Comfort and Pain Management
Pain is a natural part of labor and every woman is unique in the level of pain she can tolerate. Women also have varying success with the kind of activities or interventions that can help decrease their labor pain and increase their comfort. Outlined below are the three types of activities and interventions: comfort measures, medication, and regional anesthesia.

    Comfort measures — There are several good approaches to pain relief that are effective throughout labor that everyone should try. Any of the following approaches with which you feel comfortable can be used during your labor:
        Walking
        Water therapy (e.g. shower or tub)
        Sitting or leaning on a birthing ball or rocking chair
        Keeping a restful environment in your labor room (quiet, low lighting, soothing music). Carefully select support people for a calm environment
        Using various positions (all fours, sitting on toilet, kneeling, squatting, pelvic rock) and supporting with pillows if necessary
        Massage/back rubs by support person
        Effleurage (light massage of abdomen)
        Having your partner or a support person rub a tennis ball over your lower back
        Applying warm or cold compresses
        Using relaxation/breathing techniques
        Prayers or religious ceremonies
        Guided meditation using calming imagery
    Utilizing several comfort techniques is an excellent way to involve first-time partners in supporting and working with you in the childbirth process.


    Medication — For some women, as labor progresses and contractions become stronger or they get too tired to cope, comfort measures no longer provide enough relief. Pain medications are commonly used at that point, and your physician or midwife will explain the benefits of each type and will help you select the appropriate medication that is safe for you and your baby. You may want to discuss medications in advance of labor with your doctor or midwife.

    Medication may not totally eliminate labor pain, but can help ease it so you can better rest and cope with the discomfort. Continue to use comfort measures that help you relax as much as possible between contractions. Except in early labor, the most commonly used medications are short acting, minimizing the effect on the baby. For some women, no other medications are necessary to help cope with labor pains.


    Regional Anesthesia (Epidural, Spinal or Intrathecal Medication) — If you reach a point in active labor that comfort measures and/or medication are no longer giving you adequate pain relief, your physician or midwife may order regional anesthesia to provide stronger pain relief. The anesthesiologist inserts a needle in your lower back to administer regional anesthesia. The goal of regional anesthesia, especially after your cervix is completely dilated, is to reach a balance between easing your feeling of pain and still feeling the urge to bear down to actively participate in delivering your baby. The various methods of regional anesthesia are discussed later in the section on medications. Talk to your physician or midwife in advance of labor about regional anesthesia, and tour the hospital in order to find out what types of regional anesthesia are available.

Pushing

Also known as the second stage of labor, pushing starts sometime after the cervix is completely dilated (10 centimeters).

The importance of waiting
It is important to wait for the natural urge to bear down before starting active pushing. You are often encouraged to push by "holding your breath and push as hard and as long as you can." Research has suggested that a woman's spontaneous urge to push occurs three-to-five times during a contraction while the woman is exhaling and bearing down.

Pushing with an epidural
If you use an epidural, you may be encouraged to rest until you have the sensation to push. Women who receive epidural anesthesia for labor may have difficulty pushing, especially if the strength of the anesthetic numbs the sensation to bear down. The practice of delayed pushing (waiting for the baby to passively come through birth canal) is an alternative to routine pushing at 10 centimeters in women using epidurals.

There may be circumstances, such as having a strong regional anesthetic, or an arrest of labor, where you may not feel the urge to push. In event of such a circumstance, you will be assisted with pushing (see section on assisted delivery).

Other information/tips

    Upright positioning (sitting, squatting, standing) allows gravity to help you push.
    Allowing the baby's head to gradually stretch the tissue at the outlet of the vagina (perineum) will reduce the risk of a significant tear. Lying on your side is associated with fewer significant tears.
    During second stage labor, your uterus pushes the baby down the birth canal (passive descent).
    Perineal massage (gradual stretching of the vaginal and perineal tissues) from 36 weeks on has been associated with fewer perineal tears. Ask your doctor or midwife for information about perineal massage.
    If your obstetrician or midwife is concerned about your or your baby's health, he or she may opt to shorten the second stage of labor by using a vacuum or forceps on the baby's head (performed by the obstetrician).
    The breathing techniques used for pushing vary and depend upon what works best for you.

Recovery

This is a special period of adjustment to life outside of the womb for your baby. Your body is also adjusting to great physical changes. The first hour after birth is a time for you to make these adjustments and, with your partner, enjoy these ""magical moments"" as a new family.

During the approximately 90-minute recovery period, your temperature, pulse, blood pressure, respirations, condition of your uterus and vaginal discharge (lochis) will be checked frequently. Throughout this time period, your baby will become acquainted with you through his/her sense of sight, touch, and smell. He/she will probably self-attach for breastfeeding, as babies are in a very alert state and ready to nurse and bond with their parents at this time.

After the recovery period, you and your baby will be taken to the postpartum room.

Breastfeeding

    It is important to hold your baby skin to skin in the first hour following birth. This closeness will assist with your first breastfeeding experience.
    Your baby is most interested in nursing within the first hour of life. Your baby is eager to meet you and needs the colostrum (initial fluid from your breast) for energy and protection against infection.
    After the first 1 to 2 hours, your baby may become sleepy and less interested in nursing.

Baby

Purchase and learn how to use an approved car seat. California State law requires the use of a federally approved car seat.

Your baby must always be placed in the car seat, beginning with the ride home from the hospital.

Improving neonatal care with neuroscience

Improving neonatal care with neuroscience

Reported from kangaroomothercare.com, 

The incubator was invented 100 years ago, but modern neonatal care only started taking shape about 50 years ago. This care assumed the incubator was the only possible PLACE such care could be given. The care was focused on improving survival, and it was partly based on a belief that as long as the heart and the lungs and the stomach was working, then the brain would be fine, as it develops so much later in the human being. As a result, we now have amazing survival rates, however, these survivors have physical and psychological problems, the more so the lower the gestation. In fact we now know that even late preterm infants perform poorly when they start school, and economically cost more to support (there are more of them!). For the last twenty years these developmental outcomes have not improved.

For the same twenty years there has been an explosion of knowledge in neuroscience, and this explains why these problems are there. The fetal brain development with respect to its anatomy is complete at 20 weeks, and all its basic connections are complete at 28 weeks. Development is now about collecting sensory information about the world, and that fires and wires pathways that adapt or mould the brain to be suited or adjusted to the world. Good sensations provide a platform for higher level development and approach behaviours. Bad sensations fire more lower level defensive or avoidance pathways, and when these are overused, there is “wear and tear” on basic pathways. Future stresses and “knocks in life” later trigger pathway failures that show themselves in the various physiological and behavioural problems we later see.

One of the most basic abilities, and that appears early in development, is to determine whether a sensation (or even constellation of such) is safe, dangerous or life threatening. This is seen in early fetal life, and is fully competent from 28 weeks. All the sensations in the uterus tell the fetus it is SAFE. At birth the baby is highly stressed, and this birthing stress is necessary to activate the systems that make for breathing air and coping with “life outside”. But once outside, the need for being SAFE is primary, and essentially it is only mother’s presence providing familiar sensations that achieve this. The chest of the mother is to the newborn its PLACE of care. Care means the three basic biological needs are met: mother skin-to-skin contact ensures warmth, her breasts provide nutrition, and her arms cover baby for protection. The baby is wired to respond to this place in many different ways, the two we can easily see we call self-attachment and breastfeeding. After feeding, sleep cycling is essential to establish the pathways that were fired.

When mother is absent, the newborn brain feels unsafe, it perceives danger and threat to life, and its basic needs are not provided. The brain kicks in a powerful defence reaction, which first makes a short burst of crying before shutting that down and lowering heart rate and temperature, and then shuts down all activity, reverting to the immobilization defence, similar to that of frogs and reptiles. This looks like sleep! But it is not, and it is maintained by high levels of cortisol, which make the “wear and tear” which is the primary first cause of all subsequent problems preterm infants suffer from. This is not actually sleep, so the pathways are not established. Instead, when stress is prolonged, the cortisol disrupts brain architecture, unless there is “buffering protection of adult support”.

This new understanding of the brain and its development can profoundly improve neonatal care. Mother’s presence is an absolute requirement for OPTIMAL development. This is the underlying scientific rationale for Kangaroo Mother Care, which is defined as continuous or prolonged maternal-infant skin-to-skin contact (supplemented by father or other attachment figure). The definition includes breastfeeding, which must alternate with protecting sleep cycles. And so, mother and father must be central to the care team, not just in theory but physically central as well! Premature infants have brains that are ready, but bodies that are not. They may need technology, but this was not designed with the thought that mother should be the PLACE of care. Ingenious solutions are usually required. Then, even with mother present, the sensations from the environment must not be intrusive or stressful. Bright light and noise are the most common stressors. When by circumstance and necessity parents cannot be present, then the environment must be made as “womblike” as possible.