MUM KNOWS II. - GETTING READY FOR A CHILDBIRTH

Dear Mothers to be,

Your due date is approaching and you’ve come to our hospital hoping that this long-anticipated moment will be one of the most special experiences of your life.

The following text should provide you with information about what you can expect, what medical examination you will be subjected to, what is going to happen in the delivery room, how will your newborn baby be examined and other useful information. Further down you will also find a list of things that you and your baby are going to need in the hospital and a list of necessary documents.

LAST WEEKS OF YOUR PREGNANCY

Up to now you have been in the care of your gynecologist, who issued your pregnancy card and recorded there the results of all the medical examinations that you completed during your pregnancy.

Here is a short overview of the routine prenatal examinations you were supposed to complete

• Gynecological examination, in most of the cases including culture samples from vagina and urine.
• Cervical examination – PAP test (or smear) for cervical cancer (in case you did not have results of this examination not older than a year).
• External measurement of the pelvis – the aim of this examination is to find out if there are not any irregularities in the shape and size of the pelvis and eventually confirm possible disparity between the size of the pelvic birth canal and the size of the baby.
• Breasts examination serves as a screening method for breast cancer. The gynecologist can also provide information about what to do in case of flat or inverted nipples (inverted nipples can be corrected for breastfeeding by wearing breast shells for 8 weeks before the childbirth).
• Blood tests for blood typing and screening of antibodies against a substance found in red blood cells, so called Rh factor. The original result of this examination must be enclosed in your pregnancy card, so that this data is immediately available for us in case you need a blood transfusion.

If a mother has a negative Rh factor, we watch the Rh antibodies closely. If her child is Rh positive after the father, Rh negative mother could create antibodies against the child’s red blood cells which can break them down. The breakdown of the baby’s red blood cells can result in severe anemia and building up of bilirubin in blood.

• Tests for infections as syphilis, HIV, and basic biochemical examination including urine sample testing.
• All pregnant women are subjected to ultrasound and biochemical screening to discover possible developmental abnormalities in the fetus as soon as possible.

Ultrasound

The 1st ultrasound is performed between weeks 11 to 14 to make sure that any possible developmental abnormalities are detected as soon as possible. Ultrasound scanning is used to measure the size of the fetus and to verify the expected day of delivery and to see if there is more than one fetus.

The 2nd ultrasound scanning is performed between weeks 18 to 23.

The 3rd ultrasound scanning is performed between weeks 30 to 32 of your pregnancy.

Biochemical Screening

This screening is performed between weeks 16 to 17 of your pregnancy. We measure the levels of three hormones in your blood. If the test is positive it can identify a fetus which might be at risk for genetic defects.

WHAT TO PACK FOR THE HOSPITAL

Please pack your hospital bag approximately 3 weeks prior to your due date.

For delivery:

• Bathrobe
• Washable slippers (eventually slippers for the shower)
• Toiletries, toilet paper, two towels
• Lip balm
• Something to read, a notebook, a pen
• Find a pediatrician and take his/her contact details to the hospital (name, address)

For the stay in maternity ward:

• 2 nursing bras
• Breast pads for the nursing bras (or sterile cloth diapers), eventually cream for the nipples
• Net underwear or disposable underwear – you can buy them in pharmacies
• Sanitary pads
• Diapers and wet wipes for your baby

Documents:

• Your ID card and health insurance card
• If you are married: marriage certificate
• If you are not married: your birth certificate and confirmation of the fatherhood from the registry in your local municipality
• If you have been divorced for less than 300 days: a copy of your divorce decree and the confirmation of fatherhood from the registry (if you don’t have it, you will need birth certificate)
• If you have been a widow for less than 300 days: death certificate and marriage certificate
• If you have been a widow for more than 300 days: death certificate, official agreement about fatherhood (if you don’t have it, you will need your birth certificate)

Foreigners must have all these documents translated to Czech and notarized.

Also:

• Fill in the form ◦◦ about childbirth (signed also by the father of your child, according to Czech legislation if a man doesn’t officially pronounce that he is the father of the child he will not be written in the birth certificate and the child automatically gets her/his mother’s family name.)
• Fill in part of a form called „Hlášení o narození“ (Report of childbirth). This report will be used as a record in the registry.
• We would also like to inform mothers, that according to Czech legislation if you have a baby girl, the family name gets a suffix “–ová”. It is possible to record the name of a baby girl without this suffix in the registry but it can only be done on request of both parents and if the child is a) a foreigner, b) a Czech citizen with permanent residence abroad, c) a citizen whose parent is a foreigner, d) a citizen with a foreign nationality.

WHEN TO GO TO THE HOSPITAL

Your water breaks

Take a sanitary pad and after it gets soaked check the color of the water. If it is pink, slowly get ready and check in the hospital within two hours. If the water is different color (yellow, brown, green or bright red), go to the hospital immediately.

You are bleeding

If you are bleeding and the blood is bright red, go to the hospital immediately.

Your contractions are regular

If your contractions are regular, the period between them is getting shorter and they get more and more intense, go to the hospital when they are 4-5 minutes apart. If you feel a strong pressure on your rectum, go to the hospital even if the intervals are longer.

In case of doubts about the baby’s movements

If you can feel a change in the baby’s movements – they are too intense or painful, or they are too gentle or you don’t feel them at all, go to the hospital, where your child will be checked on electronic fetal heart monitor.

You have enough time to go to the hospital if:

• You have contractions which cause discomfort but they don’t occur at regular intervals and they are not getting stronger. You can try a bath in warm water, if the pain gets weaker during your bath and the contractions occur at longer intervals, it is probably fake contractions (also called Braxton Hicks contractions). These contractions only prepare the body for the childbirth. They can occur 1-2 months before the delivery and don’t last longer than 1-2 hours. If they become regular and last longer than 2 hours, you should go to the hospital.
• The mucus plug came out. The plug comes out at once and this is not followed by any leakage. It can be pink, watery or thick mucus. It falls out approximately 24 hours before giving birth.

You should have a companion when you head to the hospital, ideally someone who will be able to interpret for you. You can have a company even during giving birth – it is usually necessary to arrange this in advance and pay for the company according to the policy of the hospital that you chose to give birth in.

In case of any complications (heavy bleeding with bright blood, strong contractions with pressure on the rectum, strong contractions in short and regular intervals, don’t be afraid to call emergency – dial 112.

CHECKING INTO THE HOSPITAL

During checking in you will fill in a form called “porodopis“ where all the important facts which can influence the birth giving are recorded. Some data from your pregnancy card will be recorded there as well. If you are not going to be accompanied by a person, who speaks Czech, you should write down in advance all serious illnesses that occurred in your family. Also, if you have any special requirements for the time when you will be giving birth, please put them on a list in Czech and hand them over when checking in.

The caregiver will take your temperature, pulse, blood pressure and a sample of your urine. You will receive a routine gynecological examination. Also, the electronic fetal heart monitor will be used to get an electronic record of your baby’s heartbeat.

GETTING READY FOR THE CHILDBIRTH

After checking in you will be taken to the delivery room. Here the nurse-midwife will give you enema to clean the rectum and colon. This procedure will prevent soiling during the second stage of active labor when you will be “pushing“. It is also necessary to shave your perineum (the tissue between vagina and rectum) because of eventual episiotomy.

THE STAGES OF DELIVERY

STAGE 1 (DILATION)

The first stage is the actual beginning of the active childbirth. Regular contractions open up your cervix. The first stage is over when your cervix is fully dilated and effaced (the cervix becomes incorporated in the lower segment of the uterus) so that the obstetrician cannot feel it. The first stage takes about 10-12 hours if you are having your first baby, in other cases it lasts shorter time - approximately 6-8 hours.

If your water did not break up to now, your obstetrician will rupture the bag of waters so that the water goes away.

You will be checked by an obstetrician or nurse midwife approximately every hour during the first stage of labor. This is necessary for seeing the progress of childbirth. Your temperature and heart pressure will be taken, too.

The activity of your child will also be monitored. This will enable us to see if your baby is not experiencing any distress and to decide if the childbirth should be quickly ended by caesarean section.

Relaxation position and movement during the Stage 1

Movement is crucial during the 1st stage. Walk slowly, you can lean against the wall during contractions and breathe through them. In many hospitals, there’s is usually equipment for relaxation available: a gym ball, on which you can rock, a mattress, where you can kneel, somewhere even hayracks. If you have to lie down (e.g. because your baby’s heart rate has to be monitored), position yourself on your side or stay half sitting. Most of the hospitals are equipped with modern hospital beds, which can be positioned for your comfort.

Taking a Shower or Bath

Comfortably warm water can bring you a relief from the pain. In all hospitals shower is available, in some hospitals they may have a massage bathtub. Take a shower or bath anytime you feel it could help you.

Breathing during the first stage of childbirth it is quite specific. So called abdominal breathing is most suitable during contractions. Inhale deeply through your nose so that not only your chest, but also your belly raise and exhale deeply through your mouth. Breathing in through your nose will prevent your mouth to get too dry. The abdominal breathing is very important during the first stage of childbirth. It brings oxygen to your body and it gives your baby oxygen during the contraction. This type of breathing also has a calming antistress effect.

Pressure Points

If you are experiencing pain in the lower back these pressure points might help you. To massage these points, you need a partner. He or she can apply a strong pressure on a spot in your lower back - your partner can make circular movements approx. 5 cm on the left and right side of your spine (with the direction away from the spine) and move down to the small of your back.

STAGE 2 OF CHILDBIRTH (EXPULSION)

The second stage begins when the cervix is fully dilated and it ends when the baby is born. It usually lasts 20-30 minutes.

This stage can start with a strong urge to push as during bowel movement. It is necessary to suppress the urge in the beginning and breathe through the pain. You can start panting as a dog – fast frequent breathing in and out. Try not to scream, you would lose part of the strength that you are going to need through the final push.

Once the obstetrician or nurse midwife make sure, that the head of your baby is in the right position, you will be told to push. You will hear the doctor or nurse midwife say: „TLAČTE!!“ (t-lach-te) (push)

From now on, if you feel pain coming, take a deep breath, close your eyes and mouth, put your chin on your chest and push as when you are having a bowel movement when constipated. Relax between the contractions, breathe and try to regain strength for another contraction and pushing. Again, try not to scream, use all your strength to push your baby out.

At the end the doctor can do episiotomy. This procedure is done when there is a danger of vaginal, perineal or even anal injury. Episiotomy heals better than natural tears and it will make the passage easier for your child. The doctor performs episiotomy during a contraction, when the skin is very stretched so you probably won’t even notice it happen.

STAGE 3 OF CHILDBIRTH

This stage starts with the birth of the baby and ends when the placenta is delivered. A few minutes after the birth of your baby you will be asked to push for the last time and you will deliver the placenta with amniotic sac. The obstetrician will check the placenta carefully to make sure there is nothing left in the uterus.

COMPLICATIONS DURING AND AFTER THE CHILDBIRTH

Caesarean Section

Caesarean section is a surgical childbirth. It is only performed when there is a health risk for the fetus, the mother or both. It is either planned – (the reasons can differ, serious health problems of the mother, the position of the fetus, fetus that is too big etc.) or it is performed during child birth – emergency caesarean section (the baby doesn’t have enough oxygen, the health condition of the mother is getting complicated, the birth giving doesn’t progress etc.).

Caesarean section is performed either in general anesthesia or regional anesthesia (the anesthesia is applied in the spinal canal; the mother is fully conscious but does not feel the pain). A horizontal incision is made in the lower part of your abdomen, so the scar can be easily hidden even in summer in a swimsuit.

The mother spends 1-2 days in the emergency unit after the surgery. The nurses bring the baby to the emergency unit for nursing. Then the mother is transferred to the maternity unit, where she can hold her baby if she feels good an there are no further complications.

Forceps Delivery

Forceps is a medical tool designed in a way to be harmless for both the mother and the baby. The obstetrician usually decides to use them when the mother can’t push the baby out, the head of the baby proceeded in the mother’s pelvis and it is not possible to perform caesarean section and the child is in danger because of lack of oxygen. Forceps delivery can only be performed by experienced obstetrician and it is not a reason to worry.

Manual Extraction of Placenta

If the placenta fails to deliver in 30 minutes after the childbirth, or in case heavy ongoing bleeding occurs, the obstetrician performs manual extraction. This procedure is done in regional or general anesthesia and it is not a reason to worry.

FINAL EXAMINATION OF THE MOTHER

As soon as the placenta is delivered, the obstetrician checks your genitals thoroughly and stitches tears or episiotomy. This is performed under local anesthesia. You will spend two hours in the delivery room and then you will be transferred to the maternity unit.

EXAMINATION OF THE NEWBORN BABY

First, the obstetrician clamps the baby’s umbilical cord and hands the baby to the nurse or nurse midwife.

The nurse will put the baby on a heated bed, where the baby will be dried, the rest of the amniotic fluid will be removed from his/her mouth and nose if necessary and the nurse will attend the umbilical cord. The umbilical cord will be tied with a sterile rubber, so that it does not bleed and shortened to approximately 2cm. Then the nurse applies eye drops in the newborn’s eyes to prevent bacterial infection that could be contracted from the mother’s body.

The baby is immediately marked in three ways – he or she gets a wrist band with a number (you will get the same number) and an identity band on a second hand. The third way of marking differs in different hospitals – usually the baby wrap is marked, in some hospitals the names of the babies are written on the skin of their leg with gentian violet or a marker.

When the baby is marked and examined, he/she is measured and weighed. His/her state of health is examined by a nurse and a doctor.

Then the nurse will bring the baby to you and help to latch the baby to your breast. Early nursing is very important both for you and your baby. It triggers the release of hormone called oxytocin, which helps the uterus to contract and it eliminates the postpartum hemorrhage. It also plays important part in the initiation of successful breastfeeding.