Labor and Delivery
So, this is it. Your big day is here! In your “go” bag you’ve packed everything you need for yourself and your new baby, including your registration forms, toiletries, robe, breastfeeding bra and breast cream. When you first suspect you have gone into labor, please call your care provider before you leave home to let him or her know how your labor is progressing. When you arrive at the hospital, you should come directly to the Admitting Department desk on the far-right side of the front lobby. Follow these same instructions if you arrive for a scheduled C-section.
When you arrive, register and are settled into one of our 12 well-appointed, attractive birthing rooms, you will meet our specially trained obstetrical nurses who will be with you and your labor coach every step of the way. Each of our secure labor and delivery rooms has a private bathroom, complete with a shower and hairdryer, television, CD player and comfortable seating area. You will stay here to labor, deliver and bond with your new baby during the initial period of recovery, up to ninety minutes after the delivery. You and your baby will then be transported down the hall to our Maternal Child Unit. If your baby requires specialized care, he or she may be admitted to our NICU which is located on the same floor.
What to Expect at the Hospital
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At Johns Hopkins Howard County Medical Center, we want moms to know why Cesarean sections are performed, be aware of the risks associated with them and learn about important things to do to prevent a C-section. We encourage moms to have a conversation with their obstetrician to determine the right choice.
For Scheduled and Emergency C-sections
If you are scheduled for a C-section, or if you should unexpectedly need one due to a pregnancy complication, the Birthing Center staff is committed to providing you with a safe and healthy delivery.
If your C-section is scheduled, you may be asked to come to the hospital the day prior to your delivery for laboratory blood work and to check in with one of our Labor and Delivery nurses for pre-op assessment and instructions. If you do not come in the day before surgery you will receive a phone call from a Labor & Delivery staff member to verify the date and time of arrival. To help prevent infection, you will be given a scrub kit to use in the shower both the day before and the morning of your C-section. When you arrive the day of surgery, you will be admitted to a pre-operative waiting area where your family member will be allowed to wait with you. Learn about C-section anesthesia.PLEASE NOTE: We do our best to honor the times assigned; however, many events in obstetrics cannot be planned. Your baby will be delivered as soon as possible and your nurse will keep you informed.
The Birthing Center has two state-of-the-art, fully equipped operating rooms and a pediatrician is present at all C-sections. Your labor coach or significant other is allowed to be with you at all times.
In the unlikely event that your child requires specialized care after birth, he or she will be taken immediately to the NICU and attended by our Johns Hopkins pediatric intensive care team.
Women who have undergone a C-section recover in the hospital up to 96 hours. We allow early discharge if you have excellent support in your home. -
Howard County Anesthesia Associates, PA will work closely with your obstetrician to help you through the birthing process by offering pain relief to make the labor and delivery of your baby as safe and comfortable as possible.
We want you to make informed decisions about the care you will receive during the delivery of your baby, including the kind of anesthesia you choose. The following information about the state-of-the-art pain relief techniques we routinely use here at Johns Hopkins Howard County Medical Center will help you decide how you want to manage your labor pain.
The benefits of epidural and spinal anesthesia over systemic narcotics
There are two basic approaches for using medication to manage labor pain. One method uses systemic narcotics, such as Nubain®, which acts throughout your “system” or body by traveling through the bloodstream to the brain to “numb” the pain. The other methods – epidurals and spinals – are called regional anesthesia because the medication is administered into a specific region of the body to numb pain.
Systemic medications produce drowsiness and sedation in addition to pain relief while the epidural or spinal medication acts only locally, so you will be comfortable, alert and able to fully participate in the birthing process. Epidurals and spinals also require a smaller dose of medication to relieve the pain, resulting in less medication being transferred to your baby than with use of systemic narcotics.
Having an epidural catheter in place also provides “insurance” against the need for general anesthesia in the event of an emergency Cesarean section. Your anesthesiologist will simply administer a stronger local anesthetic through your epidural catheter.
Epidural versus spinal or combined spinal-epidural techniques
Both epidural and spinal anesthesia involve blocking the transmission of pain signals close to their point of origin and each technique has its particular advantages and disadvantages. One advantage of the epidural is that medication can be administered continuously through an epidural catheter (a thin plastic tube inserted into the space next to the spinal cord), providing pain relief throughout labor and delivery or after surgery should a cesarean be necessary.
Spinal and combined spinal/epidural techniques have their own distinct advantages. Because spinals involve injecting a numbing medication directly into the spinal fluid, they take effect more quickly than epidurals and produce a more pronounced pain relief.
The type of pain relief technique you will receive will be tailored to suit your needs. -
Q: Am I required to have an epidural?
A: No. An epidural is one option for pain relief during labor, but is usually done at your request and with your consent.
Q: What other methods of pain relief are available?
A: For some women, massage and breathing techniques may be adequate, and narcotic drugs are also available, although they might not provide as effective pain relief as an epidural. Your doctor may also inject a local anesthetic to the birth canal at the time of delivery.
Q: Are there patients who cannot have an epidural?
A: Certain medical conditions such as bleeding disorders, infections at the site of epidural, spine surgery or disease of the nervous system might make an epidural unadvisable. You should discuss any concerns with your anesthesiologist.
Q: Is an epidural painful?
A: A local anesthetic, which stings for a few seconds, is injected under the skin before insertion of the epidural to make you more comfortable. You may experience a feeling of pressure in the back during insertion.
Q: Will the epidural slow my labor?
A: The dose and timing of an epidural are carefully tailored to your needs during labor. In fact, an epidural can improve the descent of your baby by relieving pain and relaxing the pelvic muscles.
There is controversy about whether epidurals and spinals will slow labor. This is not normally an issue during the first stage of labor (from the onset of regular contractions to full dilation of the cervix). However, it is possible that these techniques may prolong the duration of the second stage of labor (from full cervical dilation until delivery of the baby) by a few minutes.
The challenge of obstetric anesthesia is to make you as comfortable as possible without compromising your ability to push out your baby. To prevent this, we may slow or stop the infusion of epidural medication to enable you to regain some sensation of pushing and/or muscle strength. Because the epidural catheter remains in place, we can always administer additional doses if needed. Every woman is unique, and we will customize your pain relief to make you as comfortable as possible during the entire labor and delivery process.Q: When should I have my epidural?
A: Most patients are able to receive an epidural once they are in adequate or active labor. Your provider will help you determine the best time for you, depending on your specific circumstance. An anesthesiologist is available for laboring patients around the clock to provide this service.
Q: How long does it take the epidural to work?
A: Normally, it takes 10 to 15 minutes for the epidural to take full effect. For women who receive the epidural in the active stage of labor, analgesia can take up to 20 minutes.
Q: Will I be numb?
A: The goal of epidural anesthesia is pain relief rather than total numbness, which can lead to decreased ability to push the baby out. Most patients experience numbness or tingling after the initial dose of medication, then gradually less numbness but continued pain relief. Patients are often aware of their contractions, but they should not be painful. As labor progresses, especially close to delivery, you may experience more pressure; this is difficult to alleviate and attempts to do so can lead to ineffective pushing, which can delay delivery.
Q: Will the epidural/spinal last long enough?
A: Yes. Epidural catheters are connected to a continuous infusion of medication that is stopped only after the baby is delivered. Except in rare circumstances, spinal anesthetics greatly exceed the time required for a Cesarean section.
Q: What if the epidural does not work?
A: The anesthesia team will assess the patient's response to the initial dose of medication. If the relief is not satisfactory, the epidural is reassessed. Options include administering additional medication, adjusting the catheter, or replacing the catheter.Q: What if I need a C-Section?
A: Various factors influence the choice of anesthesia for a Caesarean section, but they are usually done under epidural or spinal anesthesia. You are numb from the level of the nipple line down, but will remain awake during the birth of your baby and your partner may be present.
If your baby needs to be delivered quickly due to an emergency situation or if epidural or spinal anesthesia is not adequate, general anesthesia may be necessary.
Q: Will any of these the medication affect my baby?
A: Medications used for labor and delivery are safe and normally do not affect the baby. Spinal and epidurals can cause the mother's blood pressure to decrease in the first few minutes, but your vital signs will be followed more frequently during this period and your anesthesiologist and nurse will closely monitor you and your baby throughout your labor and delivery.
Q: What are the risks and side effects of an epidural (or spinal)?
A: Some women experience a persistent headache. Other complications include incomplete anesthesia, low blood pressure, shivering and nausea. Recent studies have ruled out long-term back pain as a side effect of epidural anesthesia.
Q: What is a bolus?
A: A bolus is the administration of additional medication(s) through an epidural to alleviate pain.
Q: What is a PCEA?
A: PCEA stands for Patient Controlled Epidural Anesthesia and is a method that allows you to administer your own "extra" dose of medication if the pain intensifies. -
The Department of Anesthesiology at Johns Hopkins Howard County Medical Center is pleased to offer consultations to obstetric patients before delivery, to ensure a safe anesthesia plan is in place for your baby’s arrival. Patients who should consider having an anesthesia consultation include:
- Patients with a personal or family history of a severe reaction to any type of anesthesia (particularly those with a personal or family history of malignant hyperthermia).
- Patients with a history of problems with the brain or spinal cord, including but not limited to prior back surgery; severe back pain with associated numbness, weakness or severe pain involving arms or legs; tumor involving the brain or spine; or neuromuscular disease, such as multiple sclerosis or myasthenia gravis.
- Patients with a history of cardiac problems, including but not limited to problems with heart rhythm, decreased heart function or problems with heart valves (murmurs).
- Patients with a history of problems with excessive bleeding, low platelets (a component of blood that helps with blood clotting), an increased tendency to make blood clots (including deep vein thrombosis [DVT] or pulmonary embolism [PE]), or any patient on blood thinning medication (such as Lovenox or heparin).
- Patients with a history of substance use, including those on methadone or Suboxone therapy.
You can request an appointment for obstetric anesthesia consultation by calling 410-730-0099, or online at howardcountyanesthesia.com. If you are unsure as to whether or not you should have a consultation with us, please discuss with your obstetrician first.