Contractions may be experienced differently by different women.

• They are rhythmic and recurrent becoming uncomfortable as they continue.
• They are often felt as back pain that radiates around the abdomen. For your first pregnancy, we would like you to call us if your contractions are every 5 minutes for one hour.
• For subsequent pregnancies, please call us if contractions are 7-10 minutes apart. Call us before leaving for the hospital. Again, our numbers are: 495-2068 during office hours, and 495-5711 after hours.

Ruptured membranes, often experienced as a gush of fluid or as a continuous trickle, may precede labor.

• If you think you may have ruptured membranes, please call us at once, even if you are not having contractions. Most women will begin to labor within the next 4-6 hours.
• Please avoid tub baths, tampons, vaginal intercourse or douching if the membranes have ruptured.
• If you are more than 37 weeks gestation and labor does not begin spontaneously, it is our practice to induce labor. We believe that this minimizes the risk of infection associated with prolonged rupture of the membranes.
• When you arrive at the hospital, you will be briefly interviewed at the Obstetrical Admitting Desk in the main lobby. You will be escorted to the Labor and Delivery Area.

In the labor room, you will be admitted by a nurse and a physician. The physician will be the faculty practice member on-call for that day.

• It is our practice to monitor your baby’s heart rate upon arrival in the labor room, and then, at least intermittently, throughout labor.
• If your pregnancy has been complicated by maternal or fetal problems, we will recommend continuous heart rate monitoring.
• This may be done by external means (attaching a fetal monitor to your abdomen with a belt) or by internal means (attaching a tiny clip to the baby’s scalp).

Not every woman requires intravenous (IV) fluids during labor and delivery. There are some medical and obstetrical conditions, however, that do warrant continuous IV fluids. Although they occur less often than do uncomplicated labors, they can arise suddenly and may require quick action. For this reason, we prefer to insert a heparin lock during early labor. The heparin lock, a tiny, flexible tube, is placed in a vein and capped off. It can be connected to fluids if necessary. If left unused, it will not interfere with your activity during labor. We do not require shaving or enemas.

• While in labor, you may drink clear liquids and eat lightly.
• Since the stomach does not empty well during labor, filling it simply increases the likelihood that you will vomit and may aspirate during labor.
• We encourage you to practice the relaxation techniques learned in your childbirth class. You and your partner will be helped by the nurse, as well.
• Pain relieving medications are available in several forms.
• Epidural anesthesia is a popular method of pain relief.  There is also a narcotic agent available by injection, which provides temporary relief.  Please explore these options in your childbirth class and during your next few office visits.

Not every woman requires an episiotomy. If it seems that you will naturally stretch enough to accommodate the birth of your baby without tearing, an episiotomy may not be necessary. If tearing seems inevitable, the OB physician may suggest making a small incision, using local anesthesia.

• Your newborn will be briefly examined in the Delivery Room.
• If your baby is doing well, s/he will be wrapped in a blanket for warmth and handed to you.  You may place the baby on your chest, "skin to skin", if you prefer.
• If a problem is suspected or arises suddenly, a pediatrician will be present in the Delivery Room; otherwise, your baby will be seen by a pediatrician within 24 hours of birth.
• If your pediatrician does not come to this hospital, we will arrange for a local pediatrician to care for your baby until discharge.
• Massachusetts state law requires that the baby’s eyes be treated with Erythromycin in order to prevent gonococcal or chalmydial eye infections.
• When you are ready, you and your baby will be transferred to the postpartum floor approximately one hour postpartum.

If you have a planned or emergency cesarean section, under spinal or epidural anesthesia, your partner may stay with you throughout the surgery. If you require general anesthesia, he/she must have specific approval from the staff involved in order to attend.