women s health issues
Labor
Admission to a hospital or birthing center
A woman should go to a hospital or birthing center when one of the following occurs: The membranes rupture. Strong contractions occur 6 minutes apart or less and last 30 seconds or more. If rupture of membranes is suspected or the cervix is dilated more than 1 1/2 inches (4 centimeters), the woman is admitted. If the doctor or midwife is not sure whether labor has started, the woman is usually observed and the fetus is monitored for a hour or so, and if labor is not confirmed by then, she may be sent home. When the woman is admitted, the strength, duration, and frequency of contractions are noted. The woman's weight, blood pressure, heart and breathing rates, and temperature are measured, and samples of urine and blood are taken for analysis. Her abdomen is examined to estimate how big the fetus is, whether the fetus is facing rearward or forward (position), and whether the head, face, buttocks, or shoulder is leading the way out (presentation). Position and presentationof the fetus affect how the fetus passes through the vagina. The most common and safest combination consists of the following: Head first Facing rearward (facing down when the woman lies on her back) Face and body angled toward the right or left Neck bent forward Chin tucked in Arms folded across the chest Head first is called a vertex or cephalic presentation. During the last week or two before delivery, most fetuses turn so that the back of the head presents first. An Fetal Presentation, Position, and Lie (Including Breech Presentation) —such as buttocks first (breech) or shoulder first or the fetus is facing forward—makes delivery considerably more difficult for the woman, fetus, and doctor. Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the position of a fetus is facing rearward (toward the woman’s back) with the face and body angled to one side and the neck flexed, and presentation is head first. Avaginal examinationusing a speculum is done to determine whether the membranes have ruptured. (A speculum is a metal or plastic instrument that spreads the walls of the vagina apart). Then the doctor or midwife examines the vagina and cervix with a hand to determine how dilated (noted in centimeters) and how pulled back (effaced) the cervix is (noted as a percentage or in centimeters). This examination may be omitted if the woman is bleeding or if the membranes have ruptured spontaneously. The color of the amniotic fluid is noted. The fluid should be clear and have no significant odor. If the membranes rupture and the amniotic fluid is green, the discoloration results from the fetus’s first stool (fetal meconium). Anintravenous lineis usually inserted into the woman’s arm during labor in a hospital. This line is used to give the woman fluids to prevent dehydration and, if needed, to give drugs. When fluids are given intravenously, the woman does not have to eat or drink during labor, although she may choose to drink some fluids and eat some light food early in labor. An empty stomach during delivery makes the woman less likely to vomit. Very rarely, vomit is inhaled, usually after general anesthesia. Inhaling vomit can cause inflammation of the lungs, which can be life threatening. Antacids are typically given to women who are having a cesarean delivery to reduce the risk of damage to the lungs if vomit is inhaled. 