At Virginia Beach Obstetrics and Gynecology, we pride ourselves in creating a birth experience for you and your family that is both safe and rewarding. As pregnancy progresses, many patients ask, “Should I create a birth plan?” Rather than having each patient start from scratch we have created this guide to advise you on routine practices at our birthing center at Sentara Princess Anne Hospital, that we hope will help allay some of your fears and concerns. Please review. This will serve as an excellent tool for communication. Should you have specific questions, please speak with one of your providers.
Labor:
It is not standard practice to have an enema or shaving of pubic hair in labor. You are generally free to move around at will and even walk during labor. However, if you have an epidural, have recently received narcotic pain medication, or if continuous fetal monitoring is necessary due to fetal condition or use of pitocin you will be required to remain in the birthing bed for safety reasons. You are allowed to bring your own music to play during labor. The environment is generally kept as quiet as possible and, if you desire, the lights may be kept low. You may wear contact lenses/glasses at all times unless general anesthesia is required. You must have an IV in place during labor for administration of fluids, medication and blood products in the case of emergency. You will require monitoring of the fetus for safety, and continuous monitoring may be necessary. An internal monitor will only be used in cases of fetal need. Sometimes, amniotomy (artificial rupture of the membranes) and/or pitocin are used for augmentation of labor and /or induction of labor. You will be aware of this and involved in this decision-making process.
Anesthesia/Pain Medication:
Pain medications exist and you can ask for them as necessary. You need not commit at the onset of labor to either a medicated labor or a “natural” labor. In early labor, IV pain medications (like Nubain or similar medications) are available. In later active labor and second stage of labor (pushing), epidural anesthesia is preferred. Once you choose to have an epidural, you will not be able to stand or walk due to decrease in the strength of the leg muscles.
Cesarean Delivery:
Should a cesarean delivery be indicated, you will be fully informed and involved in the decision-making process. The surgery occurs in the operating rooms on the birthing center in most cases. Unless general anesthesia is used, the birth partner will be present for the birth. Breastfeeding is an option with cesarean delivery. If the newborn is well, the infant will be able to be seen and touched and held by the parents prior to being moved to the nursery with the birth partner. In the case of cesarean delivery, the birth partner will not be able to cut the umbilical cord as the surgical site is a sterile area.
Episiotomy:
Our practice engages in “selective use of episiotomy”- meaning episiotomy is not routinely performed. We often use perineal massage to assist with stretching of the vaginal opening and minimize the extent of tearing. There are cases where tearing is imminent or rapid delivery of the fetus is absolutely necessary where the doctor may decide to perform an episiotomy. Both episiotomies and spontaneous lacerations (tears) are repaired in the delivery room immediately after birth with suture. If no epidural is present, local anesthetic (numbing medication) can be used to assist with pain control for the repair. Medications will be prescribed postoperatively and the patient will be given instruction on care of the healing area.
Delivery:
Most patients deliver in the lithotomy position (semi-upright lying position with thigh and knees flexed). Alternate positioning is an option if epidural is not present and the patient is able to bear weight. A mirror is available so the patient can view the perineum during pushing if she wishes. The partner and nurses will help support the patient’s legs if necessary. If the newborn is well, he or she may be placed directly on the mother’s abdomen prior to being moved to the infant warmer for full evaluation. Neonatology staff may be asked to be present for the newborn’s evaluation and care if the doctor is concerned regarding the newborn’s well-being at the time of the birth.
Immediately after birth:
The birth partner or patient may cut the cord if he or she desires and the newborn’s condition does not preclude this. If the newborn is well, he or she will be evaluated at the bedside in the presence of the patient and her birth partner. Breastfeeding may occur soon after birth (once delivery of the placenta and repair of any lacerations has been accomplished). You may view the placenta if you desire- just ask the delivering physician to show it to you. When the infant is taken to the normal nursery, the birth partner may accompany the infant and participate in his or her care. Specific preferences regarding nonstandard infant care (administration of medications or immunizations) should be discussed with your chosen pediatricians.
Postpartum:
Private rooms are assigned for all patients except in very unusual circumstances of hospital volume. You may have the baby in the room with you if you desire with the exception of times where the infant will be in the nursery for evaluation and testing. If you prefer, the infant can be kept in the nursery and brought to you upon request.
Breastfeeding:
If you plan to breastfeed, you may start very soon after birth. Nurses and lactation consultants will be available to assist you. If you do not want your infant to be given a pacifier, please notify the pediatric nursing staff at birth.
Circumcision:
Circumcision of male infants is elective. If desired and covered by insurance or patient payment, it is performed the day after birth or the day thereafter by the obstetrician on call. Pain medication is used to assist with pain management for the infant. Parents are not permitted to view the circumcision.
Photo/Video:
It is hospital policy that no videotaping or digital video footage is allowed in the birthing center (labor and delivery suite). Still photographs are permitted at any time with the permission of the patient and the persons being photographed.
Support Persons:
Hospital policy states that 3 support persons (in addition to the patient herself) may be present for the birth on labor and delivery. Additional family and friends may wait in the family room, but are not allowed to wait in the hallways and doorways. Siblings of the newborn may visit during the labor process. If you have children you want to be present for the birth experience itself, we recommend you speak with us in advance so we can help guide you to make the best choice based on their maturity level and level of preparation.
Cord Blood Banking:
Cord blood donation for public use is not an option at our facility. Cord blood banking for personal use is permitted. Should you elect to do so and contract with a private company, please let us know. We will be happy to provide the cord blood collection service. There is a fee for cord blood collection. Be advised that it is your responsibility to bring the materials to the hospital and arrange for transport after collection according to the guidelines provided by the company you choose.
Thank you for allowing us to participate in your obstetrical care. We consider it an honor and a privilege to care for you during your pregnancy and with the birth of your child. Please let us know if you have any questions, or if we can do anything to improve your experience.