VIDEO TRANSCRIPT: THIS TRANSCRIPT WAS GENERATED USING AN AUTOMATED SERVICE SO WE APOLOGIZE FOR ANY TYPOS AND SPELLING ERRORS.

Part 1: Labor series

Shieva Ghofrany: [00:00:00] Hi team. Hi tribe. Okay. We're gonna do a three part series today, tomorrow, and what's today, Wednesday, Friday, about birth, because I thought this is always good review, and especially because we're getting ready for our launch next week for Tribe called V. So we're gonna talk today about. What can happen?

Just quick things about going into labor. We've talked about it before, but it's always a good review and what can transpire during, during labor because patients keep coming in saying, well, like what do you think? Am I gonna have a C-section or not? And the answer is, we don't know. If it's obvious that your baby is breach, I know you're gonna have a C-section short of that.

or you've had a repeat cesarean section scheduled. Short of that, I don't know if you're gonna have a C-section or not until you go into labor. Right now the C-section rate across the country hovers anywhere between, I'm gonna give you a broad range, like 30 to 40% based on the doctor that pro the circumstances, the risk population that she operates in, things like that.

So what can happen towards the end of the pregnancy? , you probably have been told by your doctors, my patients get told by [00:01:00] me every week after 36 or 37 weeks, I start reiterating the same thing. If you think your water breaks meaning a big gush of fluid, even if you're not sure, is it pee? Is it discharge?

Is it semen that sat in there and liquified? I know that sounds gross, but that happens. Is it one of those things? I don't know, but I have a gush coming. Call your doctor if your water breaks. Your Dr. May or may not tell you to go right to the hospital or to go to the office or to stay home for a couple hours.

That's something you should discuss with your doctor. There's no right answer. I feel more comfortable when someone's water breaks, having them go to the hospital, not immediately, but you know, within a couple hours, one hour or so, just because the cushion around the baby is now kind of coming out. The fluid is coming out and I like to make sure the baby.

Is being monitored. That is not necessarily the right answer. There are certainly doctors who feel very comfortable letting you stay at home longer, especially if you're feeling the baby move and you're not bleeding heavily. And again, that is not wrong. So talk to your doctor. So again, one is what if your water broke or you think your water broke?

And sometimes it's not obvious to [00:02:00] you or to us. We do certain tests to try to figure it out. Sometimes we're do an ultrasound to see how much fluid is. Often it's very obvious. Occasionally it's not. You guys will discuss it together and try to figure it out together. Second is if you're bleeding heavily, what I differentiate is if you're having like mucusy blood or like little bits of just brownish stuff and you're feeling the baby move, I'm not worried.

But if you're bleeding like a period, yes, it could be bloody show, but I wouldn't just assume that Cuz bloody show really implies you're in labor actively and your cervix is changing. So I would tell you to go to the hospital after you've called your. Meaning it could be your mucus plug, but that would just be stringy little bits and brown and reddish.

If it's bleeding, like a period you should call your doctor. It's rare that it means something concerning, but occasionally it can be signs or symptoms that your placenta is misbehaving. Third is if you're not feeling the baby move. Now, what do I mean by not feeling the baby move? Well, clearly if you're not feeling the baby at all for a couple hours, you should call your doctor because when you're towards the end of the pregnancy, that baby should be moving to prove to [00:03:00] us that the baby is okay.

If the baby's not moving well, probably things are fine, but we can't say that for sure, so we have to look and make sure. So what I say, not moving. What I tell patients is, Do not compare your baby to any other baby but your own baby. Meaning if last week your baby has moved this many times in the day, then compare your baby to that.

Yes, it's true. Babies will slow down a little bit towards the end of the pregnancy a little bit because they're getting bigger. Their space is getting smaller. Their fluid might be getting lower. But they should not have a dramatic change. Dramatic decrease is not what you want, and you wanna make sure that the baby is still moving enough every day, that you feel confident that the baby's doing well in there, because that's our only way of telling what's going on in between your visits.

And then last is when you think you're in active labor, which with your first baby is not easy because active labor can take a long time to get to. So from zero to about six centimeters is what we call that latent phase. And in a perfect world, you would stay at home. if you're feeling the baby move and you're not bleeding heavily and things like that.

But in the real world, it's hard to know. [00:04:00] So what I describe is if your belly feels rock hard, tight, and painful, start timing it. If it's like every two to five, five to eight, nine to 10, six to eight, oh, it was every five for a couple minutes, then it stopped. That's probably still just early labor or what we call prodromal labor sometimes, which is this labor process that can precede good labor and it can be really annoying and really painful and really frustrating for the patients, but it can happen.

So in other words, if you're having frequent painful, but irregular contractions, I personally would try to encourage you to stay at home again, assuming you're feeling the baby moving, you're not bleeding. But if you start having rock hard pain every five minutes for at least an hour, some people will say five 11.

Then it warrants at least a thought of, Ooh, this might be happening. Now, in a perfect world, I try to encourage my patients to stay home until it's every three to five minutes and yet, can't even look at your partner anymore. I say, because when it's that intense, every three to five minutes for at least an.[00:05:00]

With the baby moving with you, not bleeding heavily. Assuming your water hasn't broken, then you're probably really in active labor and you're more likely to walk into the hospital further dilated. Now, again, with first time moms, this is hard because inevitably you're confused and it's, you don't know.

Did How much blood did she say is okay? Do I feel the baby move? I don't know. Is that water? Was it mucus? What was it? So inevitably, You end up having a couple of phone calls and I think that that's appropriate because you just don't know what's kind of going on necessarily. Um, now that's first time.

Second time or anything. After the first baby, I would not stay home till the rock hard pain every five minutes because it can go super fast. Now you get to the hospital right now in Covid Times at our hospital, everyone gets tested on admission. and the partner is allowed to stay in the room during it.

And if you are continuing in labor and staying at the hospital, then your partner can stay with you whether or not you have covid, assuming you are asymptomatic. If you are asymptomatic Covid patient, your partner's not allowed to stay with you at our hospital. Ask your doctor what their, um, what they know as far as what their policies and procedures are, and that might change over the next couple weeks [00:06:00] or months, obviously, depending on what's happening with Covid, which right now, Definitely on the rise.

We have more and more patients at our hospital. Not pregnant necessarily, but it's going up in our area. So you get to the hospital, the nurses will put you on the monitor. They'll have you put on one of those really fancy little gowns. They'll start an iv assuming you're staying. When I say start an iv, meaning they'll put in the little plastic tube.

They won't necessarily hang the fluids unless you're either showing signs of dehydration. Or you need it or want it. Some women don't want it, and if you don't, that's okay to tell them that and they'll help assess if you really need to have I IV fluid running. But once you're there in labor, most hospitals will ask you to have actually IV line because they wanna have access.

Remember, the whole purpose of you being at the hospital is, God forbid, something happens where you need us. I love, and I joke that I love those deliveries where the truth is you didn't really need our services and we were just there for fun and to clean everything up. But the truth is that we never know who's gonna need us.

You could be a very young, healthy second or third time mom and still need medical attention as opposed to being able to just [00:07:00] deliver anywhere. And so that's why you're there. And there's certain safety mechanisms like the iv, so they'll put in the, I. , they'll put the baby on the monitor. You'll have two monitors on your belly.

One is gonna monitor your contractions. It's just monitoring the change in shape of the uterus. It's a little round thing that sits on your belly sometimes with a strap around it. Sometimes it's got cords with it because it depends on if it's a wireless system or not. We have both in our hospital so that you can sometimes walk around and be monitored pre covid times during covid.

You walk around in your room, um, and then the other monitor. Looks at the baby's heart rate. This is an important thing for you guys to know that during labor we're always looking at the baby's heart rate. And even if no one's in the room with you, the nurses and the residents and the doctors are sitting at the central monitoring looking at that heart rate and kind of obsessing over it, and that heart rate is not a sign.

Of the actual baby's heartbeat and what's going on with the baby's heart, as much as the baby's heartbeat, as a reflection of what's happening to the baby with regard to the oxygen status. Okay, so when the baby is inside getting squeezed with contractions, the baby's placenta and [00:08:00] umbilical cord can also get squeezed, and that means that the baby can often tolerate it, but sometimes because of either the placenta not necessarily working as well.

As it should, or the position of the cord, if it's either wrapped around the neck, which is 25 to 30 at least percent of the time, if not more, or it can be like pinched against a shoulder. Sometimes that cord decreases the amount of oxygen, and then the baby can show signs of that by showing us heart rate changes, some of which are more concerning than others.

But a very common thing is for the nurses and maybe the doctors to come running into your room, flipping in all different kinds of positions. We used to use oxygen. We don't necessarily use that anymore. We turn down the Pitocin. If you're on Pitocin for labor, for contractions, if your contractions have slowed down or they've stopped, and that's all in an effort to make sure that the baby's.

Has returned to what we feel is comfortable. The baby's heart rate will often during labor, decelerate meaning drop down, and as long as it comes back up and comes back up with a certain pattern that we feel comfortable with, we know the baby's okay. There are [00:09:00] times where we're not sure and we have to make some adjustments or do certain things to check and make sure that the baby is still thriving inside and getting the oxygen that the baby needs.

If it seems like the baby. That would be a reason for a C-section. So why would you have a C-section when you're in labor? Either because the baby's showing us signs that she just doesn't wanna be inside anymore. And I think you need to trust your doctor on that one. Unfortunately, I know it's hard, but if the doctor is saying, we're worried and we can't prove everything's okay, it's not just cuz she's covering her butt, it's because she cares about you and the baby.

So that might be one reason. The second reason might be, As you're progressing in labor, your cervix might stop dilating. Why would it do that? Well, there's a couple of things that we call the peas, the power, the passenger, the pelvis. The power is the level of your contractions, whether they're on your own or with Pitocin.

Sometimes we can't get your contractions strong enough. The passenger is the baby. What position is that baby in? You've heard me talk a lot about when the baby is sunny side up where the head is tilted. It makes it hard for the baby to come out in the easiest way cuz the diameter of. Is bigger and the pelvis, what shape is your pelvis?

Sometimes your pelvis is a different shape. If you guys wanna Google it, [00:10:00] you'll see we as women have four different pelvic shapes, and the optimal pelvic shape is not what we all have. And so sometimes our pelvic shape dictates the position of the baby, and that position can then dictate the power, meaning the contractions, and that can change labor.

It could make it harder for you to get to fully dilated or even hard for the baby to come out after you've pushed. So you might end up having a C-section because your cervix hasn't dilated enough, or because the baby's heart rate has dropped, or because you've gotten to fully dilated and push and then you need a C-section cuz the baby hasn't come out.

That is the toughest one. emotionally, cuz you've gotten that far. And rec cooperatively, that's the toughest one. And it's the toughest one for the doctor to do. So in an effort to try to decrease that, we have certain ways of trying to predict, but it doesn't always work. I had a patient recently who I would've sworn I thought would've had a C-section, and guess what?

She got to fully dilated. It took a long time. She pushed and she did great. But for every patient like that, we have patients where they push and they don't end up delivering vaginally. So again, please go into this with your plan being, I would like to come. To have a baby. I would like the baby to be happy and healthy.

I would like me to be happy and [00:11:00] healthy. Let's try vaginally If it doesn't work, thank you for doing the C-section. That would be ideal. Okay. So that's what happens during labor. I'm gonna do another one tomorrow about what happens, like right when the baby comes out. Um, and then we'll talk about what to do when you go home.

Okay? Okay. Bye.