Our Labor and Delivery Practices

You probably have many questions related to our usual management of labor and delivery. We have put together this list of how we manage normal labor and birth based on our non interventionist philosophy. While these are standard practices for all of our providers, many factors could change the management of your particular situation. Please take into consideration that these are ideals and complications may change how we approach your specific care.

When to call for possible labor:

1. When your contractions become regular, uncomfortable, last 60 seconds, and are 3 to 5 minutes apart for at least an hour, please call our office. We will want to speak directly with you rather than your partner. We will then call the hospital and meet you there. While you work through early (latent phase) labor, you may try sleeping if you can or may get into a warm bath. These both help to determine if your labor is active and help you cope with the contractions
2. If your water breaks, please call and we will discuss your specific situation. In general, if you are Group B Streptococcus negative and the water is clear, you can wait up to 18 hours at home for active labor to start. Only 10% of women have their water break prior to labor and 70% of these women will labor spontaneously during this time. If labor (regular contractions causing cervical change) does not begin during those 18 hours, then pitocin will be required to start labor and reduce the risk of infection to mom and baby.

When you arrive in labor:

1. The nursing staff will monitor the baby for 30 minutes while they are asking you questions about your health history and how your labor is progressing. We like to evaluate you by checking your cervix and assessing your contraction pattern ourselves to determine if you are in active labor and ready to stay in the hospital.
2. A saline lock (base of an IV) will be started and your blood will be drawn.
3. If you and your baby are doing well and tolerating the labor, we will encourage you to be out of bed (walking, showering, sitting on birthball, standing…) and will intermittently monitor your baby for 5 minutes out of every 30 minutes. You are encouraged to bring a labor ball, music, essential oils/aromatherapy, dark colored night gown or whatever will make you more comfortable during your labor.
4. We want you to drink liberally because you will not have IV hydration. You may bring whatever drinks you would enjoy during your labor. You should drink both water and drinks with sugar to provide energy for your uterus to work well. Many women prefer not to eat during labor because they are either not hungry or are nauseated. If you are hungry during early labor, we encourage you to eat foods that are easily digested (toast, crackers, jello, etc).
5. We will likely not check your cervix again until you or your baby show us signs of labor progression. We try to avoid exams after your water is broken due to infection risk.
6. A nurse will assist you during labor and we will be in to check on you intermittently (about every 2 hours). We will always be available when you need us.
7. When you are ready to push, you will be free to try multiple positions to find what works best for you. We are very flexible on position for birth whether squatting, hands-knees, side-lying. We request that you not deliver on the floor but on the bed so that we can best help support your perineum and your baby’s birth. There are squat bars available if you would like to squat for your birth. We will usually be with you the entire time you are pushing.
8. We can use warm compresses and olive oil to assist the stretching of your tissue to help decrease tearing. We prefer not to cut episiotomies but to allow time for your perineum to stretch. Rarely episiotomies are necessary in emergency situations.

When you give birth:

1. There will be a nurse present to take care of you as well as a nurse to care for your baby. You may have as many support people with you as you wish, but we encourage you to include only those who are supportive of your birth preferences and will offer your encouragement (not stress). If you want to have a younger child in the room for your labor and birth, we request that you have a specified support person for the child so they can leave the room together if the child finds the birth too intense.
2. Your baby will be placed on your abdomen and vigorously dried off and encouraged to cry to clear the lungs. We prefer to leave the umbilical cord attached until it stops pulsating. This usually occurs between 1 and 3 minutes of life. If you are collecting your baby’s stem cells for banking, we need to cut the cord within 1 minute after birth to obtain an adequate sample of cord blood. The benefits of delayed cord clamping are equivalent at 1 and 3 minutes of life.
3. Your baby will be assessed while resting on your chest or abdomen unless intervention is needed to help your baby make the transition to breathing for himself.
4. We frequently give pitocin through the IV after the placenta passes to help contract your uterus and decrease blood loss. We assess your individual situation to determine if pitocin would be beneficial. Minimizing blood loss is important for your recovery from childbirth and initiation of breastfeeding.

After your birth:

1. You and your baby will remain in your labor room for about 1-2 hours for recovery and evaluation. The nurse will check your vital signs and bleeding frequently. The baby will be quickly weighed in the room prior to breastfeeding; the nurse will help you to breastfeed thereafter when your baby begins to root.
2. When you are ready to go to your postpartum room, the standard practice is for your partner and baby to go to the nursery for a bath and full physical exam. You may accompany your partner and baby to the nursery and can give the baby his first bath or delay the bath if you choose. Most women settle in their postpartum room and entrust their partner with these responsibilities. The vitamin K injection and erythromycin eye ointment are hospital and state mandated respectively, and must be given in the first 2 hours of life; they can be declined if you are strongly opposed. You can opt to give the Hepatitis B vaccine at this time as well, but this is easily declined or deferred until a later date. Because the placenta is an organ, Texas law requires the hospital to properly dispose of your placenta. If you want to keep your placenta, you must get a court order before you come to the hospital in labor. Please see our website for a detailed description of how this is accomplished.
3. The standard hospital stay is 2 days not including your day of delivery. If you want to leave earlier than 36 hours, you should make arrangements with your pediatrician in advance as it is the baby’s discharge that generally causes the delay.
4. Following an uncomplicated vaginal birth, we will see you in the office 6 weeks after your birth.