Concerns About Labor Progress and Pain Management for Third Pregnancy

Q: Concerns About Labor Progress and Pain Management for Third Pregnancy

Hello： 1. If you have undergone continuous fetal heart rate monitoring for several sessions, each lasting 30 minutes, and there are no abnormalities, it indicates that the fetal condition is generally good, so please do not worry too much. 2. Generally speakin

Could you please provide more details about the issues related to labor and delivery?

Hello Dr.
Lu,
I would like to ask you a few questions.
I am currently expecting my third child, with the due date on the 15th.

1.
On the 12th, I started experiencing contractions every 10 minutes, but after a 30-minute monitoring in the delivery room, they said I wasn't dilated and sent me home.

2.
On the 14th, I had more pain and increased yellow discharge, so I went back for another 30-minute monitoring.
They said my contractions were irregular and that I was 2 cm dilated, then sent me home again.

3.
On the 16th, the contractions were every 4-5 minutes, lasting about 50 seconds.
I returned to the delivery room for another 30-minute monitoring, but they said the contractions were still irregular and I was 3 cm dilated, so I was sent home again.

4.
The pain is quite intense; can I receive an epidural? When is the right time to get it? (I received it for both of my previous births.)
5.
I would like to ask the doctor about my progress: from the 12th to the 14th, I dilated from 0 to 2 cm, and from the 14th to the 16th, I only dilated 1 cm in 2 days, totaling 3 cm in 4 days.
Is this too slow for a third baby? The monitoring showed irregular contractions, but at home, the pain is consistent in the evenings.
However, when I go to the hospital in the morning, the contractions seem irregular again (I hesitate to go back for fear of being sent home again).
This is my third baby, and the doctor estimates the weight to be 3400 grams, and I am already past my due date.
I am concerned about potential issues with post-term pregnancy (such as oligohydramnios, meconium, or the baby being too large to deliver...).
Should I go to the hospital for more detailed examinations? My first baby weighed 4196 grams, and my second was induced early due to sciatic nerve pain, weighing 3250 grams.
Both previous inductions took over 20 hours, and the contractions were not ideal.
Could there be an issue with my uterus? Should I undergo further examinations? Or do I need to go to another larger hospital for evaluation?
Given that my third baby is already estimated at 3400 grams and past the due date, I am very worried.
Please advise me on what I should do.

Concerned mother, thank you.

Zhen, 30~39 year old female. Ask Date: 2010/11/16

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello:
1.
If you have undergone continuous fetal heart rate monitoring for several sessions, each lasting 30 minutes, and there are no abnormalities, it indicates that the fetal condition is generally good, so please do not worry too much.

2.
Generally speaking, the risk to the fetus significantly increases only after being overdue by one to two weeks.
You have not exceeded that yet.

3.
You have a record of delivering your first baby weighing 4196 grams, so with the current weight of 3400 grams, you should still be able to have a natural delivery.

4.
Some pregnant women may experience a longer period of false labor, which can be uncomfortable.
As long as fetal movements are normal and fetal heart rate monitoring is also normal, there is no need to worry.
When the time comes, the cervix will naturally dilate, leading to true labor and natural delivery.

5.
If you still feel uneasy, you can always visit the outpatient clinic to discuss and evaluate your concerns with a physician.
I encourage you to express your worries and expectations openly.
Generally, physicians will do their best to accommodate your needs as long as it does not compromise medical safety.

Wishing you health and safety,
Dr.
Lu Li-Cheng, Director of the Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2010/11/16

More Info

Dear Concerned Mother,
Thank you for reaching out with your questions regarding your third pregnancy and the concerns you have about labor progress and pain management. It’s completely understandable to feel anxious, especially given your previous experiences. Let’s address your concerns one by one.

1. Labor Progress: It’s not uncommon for labor to progress slowly, especially in subsequent pregnancies. The cervix can take time to dilate, and every pregnancy is unique. The fact that you are experiencing contractions is a positive sign, but the irregularity can be frustrating. It’s important to remember that labor can be unpredictable, and dilation can sometimes happen quickly once it begins to progress.

2. Pain Management: You mentioned that you have experienced significant pain during contractions. Epidural anesthesia (commonly referred to as "pain relief" or "epidural") is typically offered once you are in active labor, which is generally defined as being 4-6 cm dilated and having regular contractions. Since you have previously had epidurals during your first two births, you can certainly discuss this option with your healthcare provider. They can assess your pain levels and the progress of your labor to determine the best time for administration.

3. Concerns About Slow Dilation: It’s natural to worry about the pace of your labor, especially after having two previous births. However, slow dilation does not necessarily indicate a problem with your uterus or labor. Factors such as the position of the baby, the strength of contractions, and your body’s response to labor can all influence how quickly you dilate. If you feel that your contractions are regular and painful at home, it may be worth returning to the hospital for further evaluation, especially since you are past your due date.

4. Monitoring for Complications: Given your history of larger babies and prolonged labor, it’s wise to keep a close eye on your situation. Concerns such as oligohydramnios (low amniotic fluid), meconium-stained amniotic fluid, or fetal macrosomia (large baby) are valid, especially as you approach your due date. If you are feeling anxious about these possibilities, discussing them with your healthcare provider can help. They may recommend additional monitoring or tests, such as an ultrasound, to assess the baby’s size and the amount of amniotic fluid.

5. When to Seek Further Evaluation: If you are experiencing increased pain, changes in fetal movement, or any other concerning symptoms, do not hesitate to return to the hospital. Trust your instincts; if something feels off, it’s always better to get checked out.
6. Emotional Support: It’s also important to take care of your mental health during this time. Pregnancy and labor can be stressful, and having a support system in place can make a significant difference. Consider discussing your feelings with your partner, friends, or a counselor who can provide reassurance and support.

In summary, while it’s normal to have concerns about labor progress and pain management, it’s essential to communicate openly with your healthcare provider. They can provide personalized advice based on your medical history and current situation. Remember, you are not alone in this journey, and many mothers share similar experiences. Trust your body and instincts, and don’t hesitate to seek help when you need it.

Wishing you a safe and smooth delivery,
Doctor Q&A Teams

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