Stephen J. Schueler, M.D.

Pregnancy Treatment

Regular prenatal care should start in the first trimester. Women who begin prenatal care before the 10th week of pregnancy are more likely to have a normal delivery and a healthy baby.

General treatment for pregnancy include:

Pregnancy 1) Childbirth Options

There are a number of different options available for delivery of your baby. If you take a childbirth education class, you may complete a birthing plan. The birthing plan will address some of the options available to you.

There are several options for the location of delivery. Possible choices include the hospital, home, or a birthing center. Certified nurse midwives usually staff birthing centers. Nurse midwives also perform home deliveries. Midwives work closely with doctors, so that the doctor can provide care when problems arise during the pregnancy or delivery.

Most physicians prefer to deliver babies at the hospital. This is because the hospital provides the tools and technology needed to manage complications. All high-risk pregnancies or deliveries are performed at the hospital.

Pregnancy 2) Pain Control

Options for pain control during delivery include:

  • Epidural anesthesia:
    • Medications is injected into the lower spinal column. This makes you completely numb from the groin, down, but does not affect the delivery.
  • General anesthesia:
    • You are completely asleep for the delivery; this is more common for Cesarean sections.
  • Natural childbirth:
    • No pain medications are given. Instead, alternate methods are used to control pain. These may include distraction, massage, visual imagery techniques, meditation, and controlled breathing.
  • Pain medication by injection:
    • Medication administered as an injection into muscle, or into a vein through an intravenous line (IV).
  • Paracervical block:
    • Injection of anesthetic medication into the cervix, in order to reduce the pain associated with cervical dilation.
  • Pudendal block:
    • Injection of anesthetic that numbs the nerves between the vagina and the rectum.

Pregnancy 3) Labor Process

Preparation for Delivery
In the past, preparing for delivery meant an enema and shaving the pubic region. Today, this is not necessary. If an episiotomy is required, preparation may include shaving the skin between the vagina and anus. This makes it easier for the doctor to perform the episiotomy and repair the opening after the baby has been delivered.

Getting Ready to Deliver
The obstetrics department in your hospital has a floor dedicated to monitoring women who are in labor. Your vital signs, such as blood pressure, breathing, pulse, and temperature, will be measured. The nurse and doctor may also ask you questions about your medical history. You may require an intravenous line, in order to provide medications into a vein.

The timing and strength of your contractions may be monitored electronically. During the early stage of labor, the nurses may want you to walk. This can help to make your contractions become stronger. Fetal monitoring is also performed at this time. This will allow the staff to monitor the infant's heart rate during your contractions.

You will have a series of sterile vaginal exams, which are used to determine how much your cervix is dilated and to determine the position of the baby. The lower the baby lies in the pelvis, the closer you are to delivering.

Pregnancy 4) Fetal Monitoring

Types of fetal monitoring include:

  • External continuous electronic monitoring:
    • Two belts are placed around the mother's abdomen. Attached to the belts are two small transducers. One of these transducers will measure and record the fetal heartbeat. The second transducer records the contractions of the uterus.
  • Internal continuous electronic monitoring:
    • This is used when more accurate readings are required. To perform internal monitoring, the amniotic sac, or bag of water, is broken. Internal fetal monitoring involves the placement of special electrodes on the baby's scalp, which will allow the doctor to monitor the baby's heart rate. The placement of these electrodes is a routine procedure: they do not hurt the baby. A long, soft catheter, filled with sterile water, is inserted into the uterus. This catheter is attached to a transducer that records contractions of the uterus and connects to the monitor. Internal monitoring can be very useful since the powerful contractions of the uterus can place stress on the baby. Internal fetal monitoring provides the doctor with a way to detect trouble quickly, so that he or she can intervene quickly.
  • Fetal pulse oximetry:
    • This device measures fetal oxygen levels during labor and delivery. A small sensor is attached to the fetus. The sensor uses red light and infrared light to measure oxygen levels in fetal bloodstream, and then displays this information on a monitor. Combining fetal pulse oximetry with fetal heart rate monitoring help doctors detect when the fetus is in distress.

Pregnancy 5) Induced Labor

In some cases, medications may be used to stimulate labor: this therapy is called induced labor. Inducing labor may be beneficial when labor does not begin as it should, or when labor does not progress rapidly enough.

Reasons for inducing labor include:

  • Membranes have ruptured, but uterine contractions are very weak.
  • Pregnancy has progressed more than two weeks beyond the due date.
  • The mother has health condition that limits her ability to tolerate prolonged labor.

Labor can be induced using a hormone, called oxytocin. This is a natural female hormone normally produced in the pituitary gland. Oxytocin stimulates the uterus to contract. During induction, oxytocin is administered directly into a vein. Other medications, such as prostaglandin E, may be placed into the vagina, in order to stimulate the cervix to dilate.

Inducing labor requires fetal monitoring. If labor causes fetal distress, or if induction is not successful, then a cesarean section may be necessary.

Pregnancy 6) Episiotomy

Episiotomy
An episiotomy is an incision that is made between the bottom edge of the vagina and the anus. The procedure is performed before the baby is delivered. The episiotomy allows more room for the baby's head as it passes through the birth canal. It also prevents tearing of the vaginal wall as it stretches during delivery.

The decision to perform an episiotomy is based on the size of the infant's head and the risk for a vaginal tear. A vaginal tear can be serious, and may extend into the rectum. The episiotomy is performed after numbing medicine is injected into the lower part of the vagina. The incision is then repaired with stitches after the delivery. Women who have delivered vaginally in the past are less likely to require episiotomy.

Pregnancy 7) Forceps

A forcep is a tool used to assist in the delivery of a baby that is in an awkward position. The forceps look like a large pair of spoons or tongs. They may be used to move an infant through the birth canal quickly. Forceps may be used when the fetus is in distress. In most cases, doctors prefer to perform an early cesarean section, instead of using forceps, to deliver the baby.

Pregnancy 8) Cesarean Section

Most babies are delivered through the vagina. In some cases, however, a cesarean section, or c-section, must be performed.

During a cesarian section, the baby is removed from the uterus through an incision in the mother's abdomen and in the wall of the uterus. A cesarean delivery requires general anesthesia or spinal anesthesia. The procedure may be performed on an elective basis, or as an emergency.

Your doctor may recommend a c-section for one of the following:

  • The mother has preeclampsia.
  • Placenta previa
  • Placental abruption
  • Blood flow is poor through the placenta.
  • The fetus is 2 weeks overdue.
  • The head of the infant is too large to pass through the pelvis.
  • The umbilical cord has passed through the cervix and into the vaginal canal.
  • The cervix is dilating too slowly.
  • The fetus is in distress.
  • The mother has open sores on the vagina caused by genital herpes.

Pregnancy Specialist

Physicians from the following specialties evaluate and treat pregnant women:

Continue to Pregnancy Home Care

Last Updated: Sep 28, 2010 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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