Admitted

Welcome to the real deal! OK, you are officially admitted in labor. So what happens once you are admitted? The RN will call your OB and get admit orders. We have what we call "standing orders." Most of the time the doctor will say, "Usual orders, AROM (Artificial rupture of membranes- Breaking your water.), they will say you can have an early epidural, or they will say, IV pain medications prior to epidural, or even epidural when she is 3-4 centimeters. They will also give orders for Oxytocin. Odds are if you aren't three or four centimeters in active labor, your labor will be augmented with oxytocin (Pitocin). If you are trying to avoid Pitocin, then you probably should have been a little more active before you arrived. But, either way, you will wind up with a baby in your arms!

At this point the nurse will call the doctor and got admission orders. Oh, and a huge favor for your nurse and yourself,  please put your cell phone away or turn off the ringer for the time being. It makes it so much easier for everyone if you are getting through the initial questions and admission without taking phone calls or text messages. It is really quicker and easier for everyone if you can alleviate those interruptions. Also, unless you came in and your are 8-10 cm, your family, and friends will still have plenty of time to get to the hospital for your delivery. Odds are you will be there from 6 to 24 hours before your baby is born, especially your first baby.

Most of the time you will now get your IV started. The nurse has to draw some labs with your IV start. There is important information in the lab results. If you are planning (or not planning, you might change your mind later when the pain gets worse) to get an epidural, your labs give the anesthesiologist information that he/she needs to feel comfortable placing your epidural. Most of the time you can't really refuse an IV. Almost 100% of the time, the MD will insist on the IV or at least a saline lock. I personally see no reason to avoid an IV. Most pregnant woman come in a little dehydrated already.  In an emergency situation the time that it takes to start that IV could make a difference.

OK, now your labor RN will put in your IV. Here's where EVERYONE, 90% at least, tell me that they "hate needles." I really don't know anyone that "loves needles." We use a pretty good size needle to start your IV. It is usually an 18 gauge needle. It looks big, it is big. I try to use lidocaine to numb the IV area prior to inserting the IV. But, that is a needle too, and it does sting. Although, having experienced an IV start in my own arm both with and without lidocaine, I do prefer the lidocaine. It takes a minute to set everything up for your IV. Your husband can hold your hand. Please try to just go to your happy place in your mind while we are starting your IV. There is no real reason to get lightheaded, or pass out. I think most of the people feel faint at this point, get themselves so worked up and anxious that they wind up making it a horrible experience for themselves and their nurse. If you are collecting cord blood from your babies cord we will draw the maternal labs that the kit requires at this time, along with the hospital labs from the IV site.

Congratulations your IV is started! Some people tell me that the IV was worse than the epidural. Now at this point you will have to answer a large amount of questions. Some of these questions are quite personal in nature. You really shouldn't have visitors in the room while the nurse asks you these questions. For example, if you have a history of genital herpes, will you state "yes" to that question in front of your mother-in-law? If you had a therapeutic abortion, will you want your parents or grandparents to know? Most likely you don't want them to know these things. Make sense? So if your family, and friends are rushing to the hospital to be there for the baby's birth, they really shouldn't show up until you have been admitted for about an hour or so.

Now your IV is in, you are oriented to the room, the call light, and you are officially going to have your baby. What happens from here on will be a pretty tiring process. Having visitors in your room from admission to delivery adds to the exhaustion. I feel so badly for the husbands that can't lay down on the dad's bed, because the mother, friends, sister, uncle, and cousins have taken over the room. The best advice I can give  you, is to have your visitors stay  home until you are close to pushing. Rule of thumb, once you are 4 cm dilated, you will go about a centimeter an hour, then you will "labor down" for an hour or two, and then you will push. For a first baby it isn't unusual to push for 1 to 3 hours.

Just a final note while I am thinking of it, there are many doctors that care if you are going to increase your chance of a cesarean section, and to be brutally honest, there are many doctors that would rather do a cesarean section. That is the truth of the matter. It is important to ask your doctor what their c-section rate is. In my opinion, that does tell you something.

Until next time!!

Kathy RN, L&D.