• Enema: an enema is available if necessary or if you request it, but it is not required
• Shave or “prep”: you will not have to be shaved or “prepped” unless a caesarean section is performed
• Eating in labor: you’re allowed to have ice chips, hard candy, or popsicles
• IV: an IV is necessary for administering antibiotics, pain medication, an epidural, or fluids for hydration. Keeping moms hydrated is better for the baby. An IV provides a way to give medicine to help stop your bleeding once the baby is born.
• Bedpans or urinary catheters: bed pans are only necessary if you are restricted to bed. Urinary catheters are sometimes necessary with an epidural or if the baby’s head is low. A full bladder will prevent the baby’s head from descending into the pelvis.
• Activity: during the early or “latent” phase of labor, it may be helpful to be up and moving around. You may take walks with your labor coach, sit in a chair, relax, sleep if you can, or take a warm shower. As labor progresses, walking or sitting may help the baby descend into the pelvis.  The nurse will help you by making suggestions about walking or activity. If medication is needed to help your labor progress, if you have an epidural, or if continuous monitoring of your baby is required then you will need to remain in the bed.
• Monitoring: the baby’s heart rate and your contractions will need to be monitored during labor. It may be done periodically during early labor if all seems well. In most cases the baby will need to be monitored continuously during active labor. This may be done by external belts or internal devices placed through the dilated cervix. The doctor or nurse will explain which is best in your case.
• Labor management: the doctor or nurse will be checking your cervix periodically to evaluate your progress. At some point the doctor may break your water. This is not a painful procedure because the membrane around the baby does not have nerves.  The doctor may recommend a medication called pitocin, a naturally occurring hormone in pregnant women, to be given by IV to strengthen the contractions.  These methods can sometimes help prevent a prolonged labor or a Caesarean section.
• Pain relief: your nurse and labor coach will help you with measures such as positioning and relaxation techniques to relieve discomfort. Pain medication can be given through the IV in small doses to help you relax. An epidural is often a great choice. An epidural does NOT slow the progress of labor.

• Pushing: positions for pushing include lying down, squatting, or kneeling. Squatting and kneeling may be difficult if you have an epidural for pain relief. Your nurse will help you find the best position for you. She and your labor coach will help you push. This sometimes takes one to three hours.  The doctor will evaluate pushing periodically to determine progress.
• Episiotomy: an episiotomy is not routine, but may be done to prevent excessive tearing of the vaginal area or to assist in a difficult delivery. A local anesthetic may be needed to numb the vaginal area if the patient does not have an epidural.
• Forceps or vacuum: forceps or vacuum are used only if absolutely necessary for the health and safety of both you and your baby. The doctor will discuss these measures if it becomes necessary.

• Breast feeding: if there are no complications, you may hold and nurse the baby soon after delivery. It is best to try to nurse the baby within the first hour because they are usually very alert at that time.
• Postpartum care: under most circumstances with a vaginal delivery you will deliver your baby in the same room you came to when you were admitted to the hospital. You will also remain in this same room for the remainder of your hospital stay. If you have a C-section you may be transferred to a different room on the same floor
• Nursery or “rooming in”: most new moms will keep the child in the room with them during the majority of their stay. The nursery is utilized if mom needs a break or if the baby needs special attention.

There are several optional tests available to all pregnant women. While there are no prenatal therapies or cures for fetal abnormalities, parents can use early diagnosis to prepare for the birth of the baby. Screening tests are noninvasive and can determine if there is a high or low risk for certain abnormalities. Diagnostic tests are invasive and can determine if a certain abnormality is present or not. Testing is not perfect and is only available for certain abnormalities. Fetal abnormality testing is not required but is an option that may be chosen by the patient in consultation with her care providers. These tests are not for the purpose of deciding whether or not to keep the pregnancy but to provide information that may guide you and your doctor in following the pregnancy as it progresses.

• Cystic Fibrosis Carrier Status: Cystic Fibrosis is an inherited genetic disease that is characterized by severe respiratory and digestive problems. The test for cystic fibrosis is a Maternal Blood Test that evaluates whether the mother is a carrier of the disease. If this test is positive we then screen the father’s blood for the gene mutation. If both are positive, the parents may opt to have an amniocentesis to determine if the baby has cystic fibrosis. Of course your pediatrician can proceed with testing after delivery if needed.
• First Trimester Screening + Second Trimester AFP: This screening pairs an Ultrasound to evaluate specific measurements of the baby with Maternal Blood Tests done at the same time. This determines if the baby is at high or low risk for specific chromosomal abnormalities. This screen can detect 90% of Down’s Syndrome cases and 97% of Trisomy 13 or 18. This test has a 5% False Positive Rate. If this screening shows that the risk of abnormalities is high, you may opt to have an invasive test to confirm the diagnosis. Patients may also opt to have blood drawn again in the second trimester to screen for spina bifida. This screen can detect 98% of open neural tube defects. There is a 6% False Positive Rate. If this screening test shows that the risk is high, you may opt to have an invasive test to confirm the diagnosis.
• Second Trimester Screening: This Maternal Blood Test that determines if the baby is at high or low risk for specific chromosomal abnormalities or open neural tube defects/spina bifida. This screen can detect 80% of Down’s Syndrome cases, 70% of Trisomy 13 or 18, and 98% of spina bifida. There is a 6 % False Positive Rate. If this screening test shows that the risk is high, you may opt to have an amniocentesis (drawing amniotic fluid from around the baby) to confirm the diagnosis.

• Chorionic Villus Sampling: This diagnostic test is an ultrasound guided needle aspiration of cells from the placenta, and it can detect 99% of chromosomal defects as well as some other inherited disorders.  The risk of complications, including fetal injury and miscarriage, is approximately 1/100. This test is only performed by the doctors at the Perinatal Center or UT High Risk Obstetrics.
• Amniocentesis: This diagnostic test is an ultrasound-guided needle aspiration of fluid from around the fetus, and it can detect 99% of chromosomal defects and open neural tube defects as well as some other inherited disorders. The risk of complications-including infection, bleeding, fetal injury, rupture of membranes, and miscarriage-is approximately 1/300.

This is a consultation between a patient and an expert in the field of inheritable diseases. The visit involves evaluation of the patient’s family history and discussion of testing options available. This service is widely available; however, it is commonly utilized in patients who are at high risk for fetal abnormalities.