Labor & Postpartum Care

When You Are In Labor


Call us if you experience:

  • 5-1-1 Contractions. Call when you are having contractions five minutes apart, lasting one minute each, for one hour.
  • Ruptured membranes with clear fluid and no labor pains, if your vaginal culture for Group B strep at 36 weeks was positive. If your membranes rupture during the day, call us. If your membranes rupture after 5:30 p.m. and your Group B strep culture was negative, you can wait for signs of labor. If you are not in active labor by 7:00 a.m., please call our office.
  • Ruptured membranes with green amniotic fluid. This may be meconium (fetal stool) which occasionally signifies fetal distress. You will be instructed to come to the hospital when fluid is this color.
  • Heavy bleeding and/or unremitting, severe pain.

How to reach us:

  • During office hours, please call us at (415) 666-1250, and choose option 2.
  • After or before office hours, please dial (415) 666-1250 and press 0. Our nurse triage service will make an assessment and give you instructions. An on call physician is available 24 hours a day and the nurses can reach us if necessary.
  • If instructed by a physician, call the CPMC hospital triage desk at (415) 600-2100.

Labor pains are typically uniform in their intensity and predictably rhythmic in their timing.

In general, when at term, there is NO need to call if:

  • You are cramping or having erratic contractions, even if some are strong.
  • You note a slight bloody discharge, pass your mucous plug or see blood-tinged mucous in the absence of regular labor pains.

Pain Relief During Labor


You may want to start thinking about whether you would like pain relief during labor and delivery. You don’t have to decide now, but it’s a good idea to know your options. Even if you do make a decision now, you may change your mind once you’re in labor.

Each woman’s labor is unique. The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby, the strength of contractions, and how you handle pain.

Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications.

There are two types of pain-relieving drugs — analgesics and anesthetics. Analgesics lessen the pain, while anesthetics block all pain and sensation. Some forms of analgesics used in labor are: morphine, fentanyl, and nitrous oxide. Different analgesics are able to be used during different stages of labor:

  • Morphine: Sometimes used in early labor and is given through an intramuscular injection. It helps dull the pain for about 4 hours. It can cause nausea and is given with an anti-nausea medication, phenergan to alleviate this possible side effect. Before and with this medication the baby’s heart rate is monitored.
  • Fentanyl: Sometimes used in early labor or active labor, but not given close to delivery and is given through an IV. It helps dull the pain for about 30 to 60 minutes. Before and with this medication the baby’s heart rate is monitored.
  • Nitrous Oxide (laughing gas): Can be used during any stage of labor during the peak of a contraction. The mother holds a face mask and breathes in needed amount. Again, this dulls the pain but doesn’t fully eliminate the pain.

Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. General anesthesia usually is not used for vaginal births. Other forms, such as regional anesthesia, remove all feeling of pain from parts of the body while you stay conscious. Several forms of regional anesthesia are used during childbirth:

  • Epidural Block: Epidural blocks cause loss of some feeling in the lower part of a woman’s body, yet she remains awake and alert. An epidural block may be given soon after contractions start or later as labor progresses. It is given through a thin tube inserted in the lower back.
  • Spinal Block: A spinal block — like an epidural block — is done with an injection in the lower back. It provides good relief from pain and starts working fast, but it lasts only an hour or two. It usually is used for cesarean delivery and only rarely in late labor or for a vaginal delivery.
  • Combined Epidural-Spinal Block: A combined spinal–epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor.

There are advantages and disadvantages for each form of analgesia and anesthesia. An anesthesiologist will work with your health care team to help you choose the best method.

Children in the Delivery Room


Some families invite their older children into the delivery room to witness their sibling’s birth. Only you can know if this is right for you or your child. If you would like to make your baby’s birth a family affair, let us know so we can guide you ahead of time.

If your other children are going to be in the room, each needs to have his or her own adult support person. Even if your child isn’t with you during delivery, he or she can meet the new brother or sister shortly after birth.

Postpartum Instructions


Follow-up Appointment
When discharged from the hospital, please call to schedule a post-partum appointment at six weeks after a vaginal delivery or two weeks after a cesarean section.

Bleeding and Cramping
Bleeding and cramping should gradually decrease after delivery and may not completely disappear for four to six weeks. You may occasionally pass some clots or have heavy bleeding. Unless you are soaking a pad every hour for four hours, there is no need to worry. If you develop worsening abdominal pain, please call us.

Breastfeeding
Fevers are common as breast milk comes in. Occasionally, a duct or gland may get clogged and form a lactocoele. Continue breastfeeding and eventually the lactocoele will resolve and the fever will abate. If fevers over 101.5 persist and are accompanied by skin redness, this may be a sign of mastitis. Please call us.

For other breastfeeding problems and/or concerns, newborn connections outpatient lactation clinic at CPMC is able to see mothers and newborns with an appointment. Call them at (415) 346-2229. They have two locations now; CPMC Van Ness and CPMC Mission Bernal.

CPMC Van Ness Hours: 10am to 5pm Monday-Friday, 10am to 2pm Saturday

CPMC Mission Bernal Hours: 10am to 5pm Monday-Friday *closed for lunch 1-2pm

Newborn Connections

Stitches
Stitches from repair of an episiotomy will dissolve by your follow-up appointment. Sitz baths can help promote healing, reduce swelling & inflammation, and can relieve pain. Fill either a commercial sitz bath or your bathtub up with warm water and soak 2-4 times a day for about 10 minutes each time.