Duchess Kate in Labor: What to Expect with Birth of a First Child

CBSNews.com
July 22, 2013, 1:07 PM
Duchess Kate in Labor: What to Expect with Birth of a First Child
By RYAN JASLOW / CBS NEWS

Featuring: Dr. Jill Rabin, chief of ambulatory care, obstetrics and gynecology at LIJ Medical Center

 

The Duchess of Cambridge, the former Kate Middleton, is in the early stages of labor in a London hospital.

She was brought by car to St. Mary's Hospital with her husband Prince William earlier this morning, according to Kensington Palace.

The child will be the first for the couple, who married in 2011.

Early labor can take up to 24 hours for a woman having her first child, Dr. Jill Rabin, chief of ambulatory care, obstetrics and gynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., explained to CBSNews.com. During that time a woman's cervix, the lower end of her uterus (womb) located at the top of the vagina, dilates from 0 to 4 centimeters.

Medical personnel continue to monitor the cervix as it dilates further at a rate of 1 to 2 centimeters every one or two hours.

Following that stage is active labor, when the cervix dilates from 4 to 8 centimeters.
By the time the cervix reaches 8 centimeters, it goes into what's called transition labor. A mother can experience a lot of pain and could receive an epidural or some other type of pain reliever, according to Rabin.

The pushing stage of the labor can last between three and four hours. The baby gets delivered, and the umbilical cord -- which connects from the mother's placenta to the baby to deliver oxygen and nutrients -- gets clamped.

The final stage of the birth is when the placenta is pushed out, which could take anywhere from 5 to 10 minutes or up to 30 after birth.

Throughout the process, doctors watch the blood pressure and heart rate of a mother and baby to make sure they are both stable. They'll take blood pressure readings, monitor oxygen in the blood with a pulse oximeter or look for signs of unusual swelling of the face or hands and feet, proteins or sugars in the urine, or nausea, vomiting and pain. These may all be signs of pre-eclampsia, Rabin explained.

The condition may lead to seizures, caused by the spasms of blood vessels that damage the vessels' lining. Left untreated, pre-eclampsia can lead to serious, potentially fatal complications for a mother and her baby, according to the Mayo Clinic. Magnesium sulfate medications may be given to prevent seizures, but the only cure for pre-eclampsia is having the baby, said Rabin.
"I'm sure she's being watched very carefully," said Rabin, who has no direct knowledge of the Duchess' care. "Naturally anything can happen because labor is a dynamic process."

If the labor does not progress smoothly, doctors may turn to a Cesarian, or C-section, surgery to remove the baby.

Some speculation has arisen about whether the Duchess, who some expected to give birth last week, is overdue. Rabin explained an expected delivery date is an estimate, and a physician would not induce labor for up to two weeks after the due date passed (42 weeks, known as post-term). That's because the placenta is only designed to last a certain amount of time, and can fail to adequately provide oxygen and food to the baby.

"That's why we want them out before 42 weeks," she said.

In the United States, the medical birth team often consists of labor nurses, an obstetrician (OG/GYN), and could also include a midwife, who offers care to the mother during pregnancy, birth and in the weeks after called the postpartum period, said Rebekah Ruppe, assistant director of the Nurse Midwifery Program at Columbia University School of Nursing in New York City.

She told CBSNews.com a midwife takes a comprehensive, holistic approach to not only ensure the health and well-being of the child, but to make sure there is holding back the mother during the labor process.

"We do pay a lot of attention to her own emotional and physical needs, in addressing those we hope to keep a labor progressing normally," said Ruppe. "We do take that role to heart and we do really practice with that in mind."

A midwife may help a woman in labor get massages, cold wash cloths, sips of fluids, or whatever else she may need, Cindy Cover, director of midwife services as the Cleveland Clinic told CBSNews.com. Though protocols are different in the U.S. compared with medical care in the U.K., Cover explained midwives may work in 12 or 24 hour shifts and wait by the mom's side throughout.

"Midwife means 'with woman,'" said Cover, who herself just got off a 24-hour shift.

Immediately following the birth, she points out it's essential for a new mother to bond with the baby. Typically, the newborn would be placed on the mother's abdomen, skin to skin, where her or she can look at the mother and hear the parents, whose voices should already sound familiar from the child's time in the womb. The baby is most alert within an hour or two after birth, and Cover sees this as an essential time for bonding. She points out during this time, the medical team still monitors the baby's vital signs.

"It's the best of both worlds, added Cover. "The midwives doing the tender loving care, and the obstetrician is standing by in case there are any complications."

Rabin agreed the collaborative team approach is generally what works best in childbirth, since many preparations are made and the staffers communicate throughout the entire birth.
But even after birth, there's much more to do. Pediatricians monitor the baby's health or any changes early on his or her life, and in the event of a complication, is available to step in minutes after birth.

A midwife's job continues for up to six weeks after birth, Ruppe said. They help with feeding, provide emotional support, and she pointed out in the U.K., a midwife typically makes home visits during the early weeks following childbirth to make sure a mom is adjusting well.
 

 

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