During labor: Procedure or practice

Options

Enema

• No enema
• Self-administered or given by nurse
• If constipated at onset of labor
• To start or stimulate labor

Shaving of pubic hair

• No removal of pubic hair
• Clip hair around vagina
• Shave hair around vagina
• Shave for cesarean

Presence of partner /others

• At mother's discretion
• One or more partners present throughout labor andbirth
• Limit on number of support people
• Other children at birth
• At doctor's, nurse's, or anesthesiologist's discretion

Position for labor.

• Freedom to change position and walk around
• Confined to bed in various positions
• Confined to one position in bed

Onset of labor.

• Spontaneous (begins on its own)
• Sel£-induced: nipple stimulation, enema, castor oil, sex, acupressure
• Medical or surgical induction: artificial rupture of membranes, prostaglandin gel, intravenous Pitocin
• Induced with or without tests for fetal maturity and well-being
• Induced for medical reasons or for convenience

Food/fluids

• Eat and drink as desired
• Water,juice
• Popsicles
• Ice chips only
• IV fluids
• Heparin lock in case IV fluids needed
• No liquids

Rupture of membranes

• Spontaneous
• Artificial, before or during early or late labor
• Replace lost fluid via amnioinfusion, if needed

Vaginal exams

• At mother's request
• Only when labor changes
• Occasionally
• Frequently

Monitoring fetal heart rate.

• Auscultation with stethoscope
• Auscultation with Doppler (ultrasound stethoscope)
• Intermittent external electronic fetal monitoring
• Internal electronic fetal monitoring for medical reasons
• Routine continuous electronic monitoring-internal or external
• Fetal scalp stimulation ( or acoustic stimulation) to confirm fetal distress

Pain relief

• Help from partner(s) and nurses or midwife
• Relaxation, breathing, comfort measures
• Tub bath or shower
• Medications, anesthesia only at mother's request
• Medications and/or anesthesia encouraged by medical staff

Enhance or speed labor

• Walk, change position
• Nipple stimulation
• Enema
• Rupture of membranes
• Pitocin

To empty bladder

• Walk to toilet
• Bedside commode
• Bed pan in bed
• Catheterization

For birth: Procedure or practice

Options

Position

• Mother's choice of position
• Caregiver's choice of position
• Lithotomy and stirrups

Expulsion techniques

• Spontaneous bearing-down
• Directed pushing
• Prolonged breath-holding and straining

Speed up birth

• Gravity-enhancing positions
• Prolonged pushing on command
• Episiotomy
• Forceps or vacuum extractor

Bed for birth

• Mother's choice of birth chair, bean bag, tub (water birth), floor, or bed
• Birthing bed
• Labor bed
• Delivery table with or without stirrups

Covering of perineal area

• Undraped, mother may touch baby during birth
• Sterile drapes around vagina

Care of perineum

• Try for intact perineum with massage, support, hot compresses, controlled pushing, and positions to promote perineal stretching
• Anesthesia, before or after episiotomy, and stitches
• Ice packs immediately after birth

After birth: Procedure or practice

Options

Cord cutting

• Clamp and cut after it stops pulsating
• Partner cuts cord
• Clamp and cut immediately

Delivery of placenta

• Spontaneous
• Encouraged with breast stimulation, baby suckling
• Hastened with massage of the fundus and/or medication (Pitocin)
• Manual extraction

Maintaining uterine muscle tone

• Frequent checking for uterine tone
• Fundal massage by mother, as necessary
• Fundal massage by nurse
• Medication-1V or by injection

Contact between modter and partner or loved ones

• Regulated by mother
• Restricted to visiting hours only

Discharge of mother and baby

• When desired
• Early discharge (within 24 hours after birth)
• Standard discharge (1 to 3 days after birth)

Baby care: Procedure or practice

Options

Airway

• Baby coughs and expels own mucus; suctioned if necessary
• Suction with bulb syringe almost immediately
• Deep suctioning with tube down windpipe

Warmth

• Baby skin-to-skin with mother with blanket covering both
• Wrapped in heated blanket
• Placed in bassinet with radiant heater or in electrically warmed bed
• Placed in thermostatically controlled, heated isolette

Immediate care

• Baby held by parents and suckled by mother; in parents' arms for observation
• Kept near parents in bassinet or isolette
• Taken to nursery for observation, weighing, and feeding

Eye care

• None
• Use of nonirritating agent, such as erythromycin or tetracycline
• Use of silver nitrate

Vitamin K

• None
• Oral doses (after birth and a few days later)
• By injection soon after birth

First feedings

• Breastfeeding on demand
• Scheduled breastfeeding
• Supplemental reedings (water, glucose water, formula) to breastfed baby given by parents or nurse
• Supplemental reedings (water, glucose water, formula, breast milk) given by medicine dropper, "finger feeding," or bottle
• Demand reedings with infant formula
• Scheduled formula reedings

Contact between baby and mother/parents

• 24-hour rooming-in
• Daytime rooming-in
• For reedings only, in nursery at other times

Circumcision

• None
• With one or both parents present to comfort baby
• With no anesthesia
• With local anesthesia
• Out-or-hospital circumcision

Unexpected Events

If problems develop either during labor or afterward, you may have to let go of some of your preferred options, because more interventions may be necessary for safety. Thr following are some options that are usually available under such circumstances.

Cesarean birth: Policy

Options

Timing (if cesarean is planned)

• After labor begins
• Scheduled before labor begins

Presence of partner/others

• More than one supportive person present
• Father or partner only
• Partner seated at mother's head
• Partner stands and watches or photographs surgery and birth
• No partner present

Anesthesia

• Regional anesthesia with little or no premedication
• Regional anesthesia with premedication
• Sleep-inducing medication for sedation for the first few hours after birth
• General anesthesia

Participation

• Screen lowered at time baby is delivered
• Anesthesiologist or obstetrician explains events
• No explanation to parents

Contact between baby and mother/parents

• Held by partner soon after birth, where mother can touch and see
• Breastfeeding as soon as possible
• Sent immediately to nursery or intensive care

Discharge of mother and baby

• When desired
• Within four to five days

Premature or sich infant: Policy

Options

Contact between baby and mother /parents

• Parents visit and care for baby as much as possible
• If baby is in another hospital from mother, partner goes with baby
• Baby separated from parents with little or no visiting

Feeding when baby is able to digest food (before this point baby fed intravenously)

• Mother nurses baby
• Mother's expresses milk to be given to baby by bottle, dropper, or tube
• Formula feeding by bottle, dropper, or tube
• Fed by parents or nurse

Contact with support group

• Initiated by parents, nurses, or support group
• No contact

Stillbirth: policy

Options

Onset of labor

• Spontaneous (begins on its own)
• Induction of labor

Sedation

• No sedatives
• Medication that leaves the mother awake and alert
• Sleep-inQucing medications

Conduct of labor and birth

• Participation in decision making and use of labor coping techniques
• Management left to hospital staff

Death of a newborn: Policy

Options

Contact with baby after death

• See and hold baby as often and for as long as desired
• See and hold baby initially after death
• No contact with baby
• Obtain mementos (photograph, lock of hair, foot , prints, naming the baby)

Care of baby after death

• Autopsy
• Spiritual services (baptism, memorial service, funeral)

Mother's recovery

• On postpartum unit
• In room separate from postpartum unit
• Early discharge
• Spiritual and grief counseling
• Contact with parent support group