Labour & Delivery

At SAH, all labour inductions begin in the Women and Children’s Health Department – 1A. Whether you are staying overnight or starting an outpatient procedure, you will begin with the same check-in process.

An induction of labour is a procedure used to start labour if it has not begun on its own. It may involve different steps, and in most cases, cervical ripening is the first step. The goal is to increase your chance of having a vaginal birth.

There are many reasons why you may need to be induced. One of the most common reasons is that your pregnancy is 1 week past your due date. Some other reasons may include:

• Your baby is not growing as expected, or their movements have slowed down
• Your water has broken before labour started
• You have an infection
• You have a medical condition like high blood pressure, diabetes, kidney disease or heart problems
• There is a problem with your placenta

If an induction is recommended, your healthcare provider will discuss a personalized plan for your labour and delivery with you.

Initial Assessment (Triage)

Upon arrival, you will be brought into a triage bed for an assessment. During this time your healthcare provider will:

• Perform Fetal Monitoring: The nurse will use two belts on your abdomen to monitor your baby’s heart rate and track any natural contractions.
• Obtain Vital Signs: The nurse will check your blood pressure, pulse, and temperature.
• Vaginal Exam: A nurse, midwife or obstetrician will perform a vaginal exam to determine the best induction method for you.

Starting the Induction

Based on your assessment, your provider will decide on the best method for you:

• If you are staying (Inpatient): You will be moved to your assigned room to begin medication (such as Misoprostol) or active induction.
• If you are going home (Outpatient): If a Foley catheter or specific ripening agent is used and you meet the safety criteria, you may be discharged with instructions to return the following day or if labor begins.

Cervical Ripening

Cervical ripening is often the first part of an induction. The goal is to soften, thin, and open the cervix to increase your chances of a successful vaginal birth. At Sault Area Hospital, ripening can be done as an inpatient or an outpatient, depending on the method used and your medical history.  

Mechanical Method: Foley/Balloon Catheter

A healthcare provider inserts a small, thin tube (catheter) through the cervix. A small balloon at the tip is filled with water.

• How it works: The weight and pressure of the balloon manually help the cervix dilate (open).
• What to expect: It can be uncomfortable when inserted, and you may feel some cramping. The catheter stays in place for up to 24 hours.  
• Location: Often done as an outpatient. If your cervix opens enough, the balloon may fall out on its own. If it does, you can dispose of it in the garbage and call the unit to let them know.  

Hormonal Methods: Prostaglandins

Prostaglandins are medications that act like the hormones your body naturally produces to prepare for labor.  

Misoprostol (Oral Pill)

• • How it works: You take a small pill every 2–4 hours (up to 6 doses).
  • Location: This method is inpatient only. You must stay in the hospital for monitoring between doses.

Cervidil (Vaginal Insert)

• • How it works: A small insert, similar to a tiny tampon, is placed in the vagina. It has a string for easy removal. It can stay in for up to 24 hours.  
  • Location: This may be done as an outpatient or inpatient depending on your provider’s recommendation.

Prostaglandin Gel

• • How it works: A gel is applied directly to the cervix or vagina.
  • Location: This can be done as an outpatient or inpatient.

Making an Informed Decision

Your healthcare provider will discuss which method is best for you based on:

• Your past surgical history (such as a previous C-section).
• The current health of you and your baby.
• The location of your placenta.

Potential Side Effects

It is normal to experience some of the following during the ripening process:

• Backache or cramping.
• Mild stomach upset or diarrhea.
• Increased vaginal discharge.

When your cervix has been prepared (ripened), you will be admitted to a labour room to begin the active phase of induction. Because these methods can cause more intense labour patterns, you and your baby will be closely monitored by the nursing team

This is a common way to progress induction.

• The Procedure: The healthcare provider (an obstetrician or midwife) uses a small, sterile hook (called an Amnihook) to make a tiny tear in the amniotic sac during a vaginal exam.
• What to Expect: You will feel a warm gush of fluid. This does not hurt the baby, but it can make contractions stronger because the baby’s head can now press against the cervix.
• Inpatient Requirement:  Once your water is broken, you must remain in the hospital to monitor for infection and to track the baby’s response.

Oxytocin Infusion

Oxytocin (often called Pitocin) is a medication that mimics the hormone your body naturally produces to cause contractions. At SAH, if you are receiving Oxytocin, you will be admitted as an inpatient for the duration of your induction.

• Administration: It is given through an IV (intravenous) line using a computerized pump.
• The “Slow Start”: Your nurse will start the medication at a very low dose and increase it slightly (usually every 30 minutes). This allows your body to adjust gradually and safely.
• The Goal: To achieve a “labour pattern” where contractions occur every 2 to 3 minutes and last about 60 seconds.

Constant Electronic Fetal Monitoring (EFM)

Because Oxytocin can make contractions very efficient, we need to ensure the baby is tolerating labour well. Continuous monitoring is required for all patients receiving Oxytocin.

• Two elastic belts are placed around your abdomen. One monitors the baby’s heart rate, and the other measures the frequency and duration of your contractions.
• Being on a monitor doesn’t mean you are stuck in bed. You are encouraged to use a birthing ball, sit in a chair, or stand by the bedside to stay comfortable.

Labour, delivery and immediate recovery all happen in one of our birthing rooms. After delivery, you will stay in the labour room for a couple hours so that you and your baby can be closely monitored. Once you are both stable, you will be transferred to one of our post-partum rooms with your baby. 

Your body will slowly heal over the next few weeks, but it is important to rest as much as you can, and follow the care instructions provided to you upon discharge. 

Some things you may experience following a vaginal delivery:

Vaginal bleeding and cramping

• After a vaginal delivery, you can expect to have bleeding similar to a moderate-heavy period for the first few days. The discharge will be dark red in appearance, and should not contain clots larger than a golf ball. 
• This discharge will turn pink within a week, and then white or yellow after about 10 days. This can last up to 6 weeks, until your uterus has healed.
  Only sanitary pads should be used during this time, and changed often to promote healing, prevent infection, and to easily be able to monitor your bleeding. 
• Cramping is normal for the first few days after giving birth, as this is how your uterus shrinks down to its normal size. You may notice more cramping while breastfeeding – this is normal. You may take acetaminophen (Tylenol) and ibuprofen (Advil) for pain relief. You will be given a Self-Medication Kit during your hospital stay. Please read and follow the instructions provided with the kit. Too much of one medication can be harmful to your body. 

Reasons to return to the Emergency Department:

• You have bright red bleeding that continues after resting
• You soak through a perineal pad in one hour or less
• You have passed a clot the size of a golf ball or larger (after the first 24-48h)

Episiotomy or Perineal Tear

If you had a perineal tear or episiotomy (cut) during your delivery the nurse will be checking the stitches while you are in the hospital.

The stitches that were used to repair the episiotomy (cut) or tear will dissolve on their own, usually within 2 weeks. Occasionally you may notice a piece of suture (string) as it falls out or is partially dissolved. That is normal. If you are having episiotomy discomfort, be sure to take the pain medication that your doctor has prescribed. 

Call your doctor if…

• you have discharge with a foul odour
• the perineal area becomes hot, swollen and reddened
• the episiotomy or tear site is becoming more painful instead of feeling better
• you have a fever over 38^oC or 100.4^oF

Peri-Care

A plastic squirt bottle will be provided to use whenever you go to the bathroom.  Using warm water from the tap: direct the stream of water over your perineal (bottom area) so that it sprays from the front-to-back.  This should be soothing for your bottom, as well as cleansing.  Using toilet paper, pat dry from front to back.  Change the pad every time you use the toilet. Do not use tampons until after you see your doctor at your 6-week postpartum check-up.  Continue with peri-care, until your bleeding stops. Be sure to wash your hands before leaving the bathroom

Often it is difficult to empty your bladder completely because of swelling, bruising and discomfort.

Using ice packs on your perineal area helps to relieve swelling and bruising for the first 24 hours. After that, heat can be soothing and keeping the area clean will promote healing. This can be done in various ways:

• frequent peri-care
• a portable sitz bath (available on our unit at a charge, ask your nurse for details) which sits on the toilet and provides a continuous flow of water to the affected perineal area, cleaning and increasing the flow of blood to it.
• a spray from the shower head
• a warm bath at home in a clean tub (avoid oils or Epson salts in the water)

Call your OB/Midwife or present to the hospital if: 

• You have discharge with a foul odour  
• The perineal area becomes hot, swollen and reddened  
• The episiotomy or tear site is becoming more painful instead of feeling better  
• You have a fever over 38℃ or 100.4℉

Constipation and Hemorrhoids

• Hemorrhoids are swollen veins around the rectum. A sitz bath, ice packs or “Tucks” medicated cooling pads can help reduce discomfort. 
• To relieve burning or itch, you can use a cream or suppository that your doctor has ordered. Your nurse will gladly help you decide what works best for you.  
• Avoid sitting or standing for long periods. 
• Keep bowel movements soft by eating a high fibre diet and drinking lots of fluids (6-8 glasses per day). Your nurse will offer you a laxative or suppository ordered by your doctor if you need it. Hemorrhoids usually disappear a few weeks after birth, if you just developed them during your pregnancy.  

If you are having a planned c-section, you will be contacted by the SAH Admitting Department to book a pre-operative phone consult with a maternity nurse. This will be scheduled within a month of your scheduled delivery date. If your obstetrician also ordered an anaesthesia consult, this will also be booked through the Admitting Department and this visit will require you to come to the hospital to meet with the anaesthesiologist. 

A Caesarean birth may be planned or decided during labour due to complications that may have put you or your baby at risk. Regardless of the reason for your Caesarean birth, you may be sleepy and/or uncomfortable for the first 24 hours after surgery. Your baby will stay in your room and you must make arrangements to have your partner or support person stay for the first 24 hours after the birth to help with the baby’s care.

You may experience many emotions such as disappointment, anger or guilt because you were unable to deliver vaginally. These feelings are normal. It is important for you to share these feelings with your nurse, partner or support person.

During the first 12-24 hours after your surgery, you will have an intravenous, which will remain in until you are able to drink enough fluids.

You will also have a catheter in place to keep your bladder empty for the first 12-24 hours.

In most cases, a small dressing will cover your incision. Usually, by the second day after your surgery, you will have been able to shower, and your dressing will be permanently removed.

As each doctor has his/her own preference, your incision could be closed with staples or one long continuous stitch, with or without a knot. If you have a long continuous stitch with a knot, the knot will be clipped before you leave the hospital. Removal of your staples or a long continuous stitch may be done before discharge or at a later date. You may also have steri-strips (small paper-like Band-Aids) across your incision. As you shower/bathe they may loosen and curl, which is acceptable. Remove them after the first week if they have not fallen off.

After your surgery, it is important that you do deep breathing and coughing exercises to help clear mucous from your lungs. Placing a pillow across your incision will help decrease any discomfort caused by coughing.

You will need to be helped out of bed within 6 hours of your surgery. On the first day, you will walk around your room and to the bathroom. The sooner you start moving, the sooner you will feel better. Frequent position changes (at least every hour) while in bed helps to prevent stiffness and help the “gas” to start moving. Move your feet, ankles and legs often. This will help to maintain circulation.

Some tips to help gas discomfort…

• Avoid ice and carbonated drinks (leave the beverage opened for a while to let it go flat)
• Walk as soon and as much as you are able without becoming overly tired
• Drink warm fluids
• Avoid using straws as this increases gas discomfort
• Lie on your left side when you are in bed
• A laxative or suppository may be necessary to get the gas moving.

To care for your incision…

• Shower daily – this will keep the incision clean
• Normal healing – the incision appears clean, with the edges of the incision close together. It is normal for the skin around the incision to feel numb. The scar will fade as it heals.
• Tip: To stop your underwear from rubbing against the incision, place a mini-pad on the inside of your panties along the elastic.

Call the doctor if you experience…

• Increased redness, tenderness or swelling along the incision line.
• Bleeding or other discharge from the incision
• Separation of the incision
• Fever (over 38^oC or 100.4^oF)