Do your homework and choose the right delivery hospital. Prepare to happily welcome the arrival of a new life. How to choose a suitable delivery hospital? Should the focus be on the convenience of production or on hospital equipment? Professional obstetricians and gynecologists will answer the key points and needs of choosing a hospital for different types of pregnant women, and also answer your questions about childbirth!
Meimei, who is 30 weeks pregnant, originally had her prenatal check-up at an obstetrics and gynecology clinic near her home. However, because she was pregnant with twins, she wanted to transfer her to a large hospital due to equipment considerations... Part 1 》How to choose a hospital for delivery?
High-risk pregnancy, common reasons for referral. Regarding the common reasons for referral during pregnancy, Chen Xingyou, an attending physician at the Department of Obstetrics and Gynecology, Zhongxiao Campus, Taipei United Hospital, said: "Some pregnant mothers originally choose the nearest obstetrics and gynecology department. The institute conducted a prenatal check-up, but it was found that the blood pressure tended to increase at about 32 or 33 weeks. Pregnancy toxemia or gestational diabetes was suspected, so the patient was referred to a large hospital. This is the most common referral factor. ”
Gestational hypertension, gestational diabetes, and placenta previa. Lai Zongxuan, director of the Reproductive Medicine Center of Cathay Hospital, further explained that pregnant mothers are often referred by nearby practicing doctors or small and medium-sized hospitals. Some cases are still in the early stages of pregnancy, and the clinic finds that the fetus has no heartbeat and is immediately sent to a large hospital for confirmation; there are also cases where medical practitioners suspect that the pregnant woman has a high-risk pregnancy, such as gestational hypertension or gestational diabetes, placenta previa, or prepartum hemorrhage.
4 major types of pregnant women, choose the hospital carefully
Director Lai also said that he recently treated a patient who had a premature birth at 26 weeks of pregnancy and failed tocoteolysis with previa previa. A pregnant mother with placenta underwent caesarean section. Fortunately, the situation was not serious. The operation went smoothly and did not cause major bleeding. Such a complicated situation is not suitable for general clinics because it may require a large amount of blood transfusion during the operation. He also encountered a pregnant woman with severe placenta previa. The placental blood vessels grew into the bladder, causing massive bleeding during the operation. Later, a urologist was asked to remove 1/4 of the bladder tissue to stop the massive bleeding. He recalled: "At that time, the blood transfusions were up to 1/4. 50,000 C.C., the patient was admitted to the intensive care unit for treatment and observation for two weeks before being transferred to the general ward. It was really thrilling. ”
Type 1 medical diseases include cardiovascular disease and heart disease before pregnancy, such as stenosis. Cardiac disease; chronic medical diseases, such as: chronic diabetes, chronic hypertension, chronic asthma, or a history of allergies and asthma, hyperthyroidism, chronic diabetes, etc. Director Lai Zongxuan pointed out: "It is not recommended to have prenatal check-ups or delivery in general clinics." Kidney disease Taking kidney disease as an example, the most commonly encountered condition is kidney stones. If stones are discovered before pregnancy, it is best to deal with them as soon as possible; if they are discovered after pregnancy, it depends on the situation. The main reason is that stones can easily cause infection and hematuria, and may cause kidney inflammation. In severe cases, they can easily lead to sepsis. Therefore, you should go to a large hospital for diagnosis and treatment. . In addition, Director Lai Zongxuan pointed out: "For example, some kidney failure patients who undergo hemodialysis have a higher chance of miscarriage if they become pregnant." The main reason is that pregnant women must undergo hemodialysis regularly, which can easily wash away hormones or nutrients and cause early miscarriage. Condition. High blood pressure Furthermore, Dr. Chen Xingyou also specifically cited high blood pressure as an example. Because he is worried that pregnant women’s blood pressure will rise during pregnancy, which may lead to blood vessel rupture and stroke in severe cases, so sometimes they need to cooperate with physicians for diagnosis and treatment. In addition, if pregnant women have kidney or liver problems, it is best to go to the hospital for prenatal check-ups and delivery. Most clinics only have obstetrics and gynecology departments, and it is difficult to deal with related complications. Congenital cardiovascular disease, asthma Director Lai said that if you have congenital cardiovascular disease, heart disease, etc., you should first receive an obstetrics and gynecologist or cardiologist to evaluate whether the cardiovascular system can bear pregnancy before pregnancy. He explained: "After pregnancy, the cardiovascular system will increase the load of a baby. In the second and final stages, the body fluids will increase by 50%, and the heart load will increase by 50%." You may feel tired just walking; in the later stages, in severe cases, it may cause The mother's heart failed and her life was in danger.
As for asthma, if it can be properly controlled during pregnancy, there won’t be much of a problem. Asthma medications are FDA Category B safe medications and can be used during pregnancy without any obvious risk of teratogenesis. Hepatitis B As for liver diseases, the most common one is hepatitis B. If the condition is stable, it can be delivered in the clinic. However, Dr. Chen Xingyou reminds: "If the mother is a hepatitis B carrier, the baby must receive immune globulin after birth." Autoimmune problems In addition, pregnant women with autoimmune problems, such as lupus erythematosus, etc., for them Pregnancy is a risk. If the disease breaks out, it may lead to the death of the mother in severe cases. Therefore, her immune status must be monitored at all times and she must cooperate with a specialist in rheumatology and immunity for consultation. Director Lai Zongxuan pointed out that thyroid dysfunction also needs to be properly controlled with medication. In addition, cancer diseases such as cervical cancer, if it is known before pregnancy, it is best to deal with it first, because hormonal changes during pregnancy accelerate the growth of tumors.
Type 2 Weight and age factors: too heavy - gt; gestational diabetes; too underweight - gt; premature birth. For elderly mothers who are overweight or too thin and are over 34 years old, Dr. Chen Xingyou said: "Not necessarily Give birth in a large hospital, and if there are no problems during the prenatal check-up, you can give birth in a clinic."
However, Dr. Chen reminded that pregnant women who are overweight or underweight should be careful during pregnancy. If you are overweight, you are worried about gestational diabetes; if you are underweight, the fetus is more likely to be born prematurely, or the pregnant woman may be malnourished, causing the fetus to be underweight. If the baby is born with a low birth weight, it will be more difficult to handle it in a clinic that does not have a pediatrician. However, during the prenatal check-up, ultrasounds are taken to monitor the weight of the mother and baby, so the prenatal check-up process goes smoothly and it is not necessary to go to the hospital.
If the mother is really overweight or too old, Director Lai Zongxuan recommends giving birth in a large hospital. If the baby is born with any condition, the pediatrician can provide immediate support, while avoiding the transfer journey and delaying the golden opportunity for treatment.
Type 3 has had surgery
Although there is no medical disease, there is some surgical history. Director Lai Zongxuan explained, for example: before pregnancy, uterine fibroids were surgically removed. Wounds may cause uterine contraction during delivery, causing uterine rupture and internal bleeding, putting the mother and fetus at risk. He suggested: "Pregnant mothers who have had uterine operations before, it is safer to go to a large hospital to give birth."
For example, those who have had uterine fibroids removed, or those who have undergone uterine debulking surgery due to adenomyosis ( For pregnant women who have had adenomyosis removed, Dr. Chen Xingyou explained: "The chance of uterine rupture during pregnancy and childbirth is greater than that without surgery. It is recommended to go to a large hospital."
If you have had chocolate cysts, ovaries removed, etc. For the operation, Director Lai analyzed: "The risk of childbirth is not that great. I am just worried that early pregnancy may cause early miscarriage due to insufficient luteal function, but general clinics should be able to handle it."
Be careful if you have had a caesarean section or induced abortion. Placenta accreta
In addition, Dr. Chen Xingyou said that pregnant women who have had a history of caesarean section or induced abortion should pay attention to the problem of placenta accreta, which is sometimes discovered during ultrasound examination during prenatal check-ups. Regardless of caesarean section or natural delivery, placenta accreta may cause severe bleeding during delivery, and general clinics are not able to handle this problem.
Regarding previous caesarean sections, Director Lai further explained: "If you have had more than three caesarean sections, this is your fourth pregnancy. It is best to go to a large hospital for delivery." Due to too many caesarean sections, the seam wall of the uterus has been damaged. It will become thinner and may crack at the end of pregnancy, which may easily lead to uterine rupture.
Type 4 multiple pregnancy In addition, multiple pregnancy is like twins and triplets. Dr. Chen Xingyou analyzed: "If the pregnancy is healthy, it can be delivered in a general clinic. But be careful. The uterus is like a house. If more than two people live in a single room, it will become more crowded, which may increase the chance of premature birth."
Which hospital should you choose? Convenience, equipment, and medical team When choosing the hospital’s key points, Director Lai Zongxuan pointed out: “First of all, the main ones are convenient transportation and close to home.
Second, understand whether the hospital's equipment meets the needs of this fetal production. Based on the above situation, it is obvious that more medical care manpower and equipment are needed. He also cited previous uterine surgeries as an example. Since there is a high chance of intra-abdominal adhesions, the complexity of the surgery will increase. Consideration must be given to improving equipment and manpower of the medical team.
Situations such as placenta previa, placental dissection, macrosomia, or pregnancy-induced hypertension require not only the nursing manpower of the obstetrics and gynecology department, but also the pediatric and anesthesiology departments for consultation; even Neonatologist or pediatric ICU.
When considering choosing a hospital, Dr. Chen Xingyou pointed out: "Most people will focus on convenience. But if you have the above problems, it is recommended to choose a hospital with complete equipment and covering various departments such as internal medicine, pediatrics, etc.
Timing of changing prenatal check-up centers: caesarean section → 33 weeks; natural delivery → 35 weeks
Since many obstetrics and gynecology clinics now only have prenatal check-ups but no delivery, Dr. Chen Xingyou recommends that you should switch to delivery at 32 weeks of pregnancy The hospital uses several prenatal check-ups to familiarize the doctor with the condition of the pregnant woman. Director Lai Zongxuan added that the patient should be referred for a caesarean section earlier, around 33 weeks.
What kind of prenatal check-up documents should be brought during the prenatal check-up? Dr. Chen said, such as the blood test, urine test and other reports for the first prenatal check-up, high-level ultrasound, or Down syndrome test report. In addition, there are also reports for pregnant mothers. Diabetes screening and even hepatitis B reports are recommended to be brought to the delivery hospital.
Director Lai Zongxuan explained that in principle, pregnant mothers have regular prenatal check-ups, and the doctor will record them in the mother's handbook, and pregnant women will take them with them. When the mother's handbook is referred to other hospitals, doctors can usually understand the situation after asking about the prenatal examination. Unless there are special examinations, such as the initial "early Down syndrome screening" or "fetal nuchal translucency" examination, it is recommended that pregnant women take part in the examination. Take it with you. In addition, you can also ask the doctor to write a referral form and briefly describe the mother's medical history to help understand the key points of the referral. Part 2 Questions about expecting labor
Q1 What are the signs of a pregnant mother going to the hospital expecting to give birth?
1 Labor pain Ans: Generally speaking, natural birth is divided into "primiparous women" and "multiparous women". A primipara is the first child. Director Lai Zongxuan analyzed that there are three standard symptoms when preparing to seek medical treatment for childbirth: labor pain, water rupture, and redness, all of which are applicable to primiparas and multiparous women.
However, the timing is slightly different. For first-time mothers, if contractions occur regularly every 3 to 5 minutes during labor and last for more than an hour, they should come to the hospital. As for multiparous women, if they contract more than 3 times regularly at intervals of 5 to 10 minutes, it is recommended to seek medical treatment as soon as possible.
2 Redness: The cervix will slowly open when giving birth. Dr. Chen Xingyou explained that at this time, there will be some mucus mixed with some blood, which is called "redness". Most people will have uterine contractions first and then start to have redness. For first-time mothers, they can go to the hospital for examination first, but the delivery time may not have come yet.
If the redness is only a little bit, director Lai Zongxuan said that there is no need to seek medical treatment so quickly. If the amount is like the second day of menstruation, it may be that the cervix is ??dilating quickly, and you should go to the hospital as soon as possible. Especially for multiparous women, who give birth very quickly, it is recommended to come to the hospital for examination whenever you notice redness, no matter how much or how little, so as not to miss the opportunity to give birth.
Dr. Chen Xingyou also reminded that if the amount of bleeding during labor is as heavy as on the second day of menstruation, in addition to the rapid dilation of the cervix, it may also be due to early separation of the placenta or placenta previa, which is prone to heavy bleeding during contraction. It is recommended to seek medical treatment immediately. He also cited early placental separation as an example. Since the connection between the baby and the mother is the placenta and the umbilical cord, if the placenta is separated early, it means losing the blood and oxygen supplied by the mother to the baby, affecting the baby's breathing and heartbeat, as if being strangled. Neck, there will be immediate life danger.
3 Water Breaking When water breaks, Director Lai Zongxuan explains, transparent water-like liquid flows out from the vagina. No matter how much you rest, it will still flow and you can't hold it back. Because there is a worry that water rupture will cause infection, or the umbilical cord will fall from the water rupture point to the vagina, causing umbilical cord prolapse or emergency. Therefore, once the water breaks, whether it is a first-time or multiparous woman, she should come to the hospital as soon as possible.
4. Feeling of falling and urge to defecate. However, not every pregnant mother will have obvious symptoms such as labor pains, water rupture, and redness. Director Lai explained that some pregnant mothers just feel backache or a feeling of having a bowel movement in their lower body, which may actually be a sign of labor. Especially if you still feel a sinking sensation and severe backache even when you are resting, you may wish to come to the hospital for examination. He has also encountered pregnant women who only had backache and the feeling of having a bowel movement, and then gave birth urgently.
Dr. Chen reminds multiparous women to be cautious once contractions occur. In principle, if the baby is about the same size and age, the second delivery may take half as long as the first. For example, it took 2 hours for the first baby to be born, and maybe less than an hour for the second baby. Therefore, as long as a multiparous woman has a little labor pain, it is recommended to come to the hospital for examination.
Expectant mothers who are hospitalized one day early for a caesarean section and are expected to have a caesarean section, Dr. Chen Xingyou said, it is best to go to the hospital the day before and undergo some examinations, such as blood draws, urine tests, electrocardiograms, and fetal heart sounds. Monitoring, etc., to understand the mother's condition before caesarean section.
Caesarean section is usually scheduled at 38 to 39 weeks, 1 to 2 weeks before the expected date of delivery. Director Lai analyzed that he did not want to wait for the mother to have labor pains before performing a caesarean section, so as not to increase the risk of childbirth.
Q2 How many centimeters should the cervix be dilated before entering the delivery room? Ans: Dr. Chen Xingyou explained that generally speaking, you can go to the hospital to wait for delivery when the cervix is ??dilated to 4 centimeters, and for multiparous women, it is about 3 centimeters, but it still depends on the situation.
When the cervix is ??dilated to 3 to 4 centimeters, Director Lai Zongxuan added, which means the cervix is ??dilated by two fingers, then the progress of labor will accelerate and enter the active stage of labor. The five fingers are fully opened. On average, it takes about 1 to 2 hours for first-time mothers to open from two fingers to five fingers, and about 1/2 to 1 hour for multiparous women. If the fetus's head is larger or the mother's pelvis is smaller, the progress It will become slower and more difficult to deliver.
Q3 What are the preparation procedures for childbirth? Ans: In the process of expecting a pregnant woman to give birth, Dr. Chen Xingyou pointed out: "Whether it is a natural birth or a caesarean section, blood tests and urine tests are required, and a fetal monitor is installed to control the frequency of uterine contractions and the heartbeat of the fetus."
1. Blood test: Director Lai Zongxuan explained in more detail that the purpose of drawing blood is to detect anemia and coagulation insufficiency. For example, some pregnant women are malnourished and can know that hemoglobin is severely deficient through blood drawing. They are worried that the blood flow of childbirth bleeding will not be coagulated, and doctors are asked to prepare blood before operating.
2 Urine test As for the urine test, check whether there is a urinary tract infection, because pregnant women are prone to bladder inflammation and infection. Once infected, it may even cause inflammation of the amniotic cavity, causing fever during labor.
3 Fetal heart sound monitoring during labor. Due to uterine contractions, the fetus seems to be vibrating every two or three minutes in the uterus, which may compress his heart or umbilical cord, causing the fetal heart sound to drop. Therefore, Fetal heartbeat monitoring will be done throughout the process. It not only monitors the status of fetal heart sounds to understand whether there is deceleration or early deceleration, but also monitors the frequency and intensity of uterine contractions.
4. The reason why hair removal requires preparations such as external surgery and shaving, Director Lai pointed out: "Hair is not sterile, and the hair follicles are prone to bacteria, so infection may occur regardless of caesarean section or natural hair." In addition, pregnancy is affected by hormones, which may lead to hair hyperplasia in the genital area. In order to avoid infection during suturing, people will become accustomed to shaving. However, now the concept has changed, and more emphasis is placed on the concept of humane production. If it does not hinder production and wound suturing, shaving is not necessary.
5 *** During delivery, not only the birth canal will be squeezed, but the rectum will also be squeezed by the fetal head. Sometimes the fetal head will squeeze out the feces in the mother's intestines. Because I am worried that feces will get on the baby and increase the chance of infection, I use a vagina to keep the delivery clean. However, Director Lai Zongxuan said that a compromise approach is being adopted at present, and the procedure will be carried out based on whether the patient is willing.
6 Intravenous drip Generally, when performing intravenous drip injection, the pipeline will be prepared first.
When it is discovered that the fetal heart rate has decelerated, the mother's blood pressure has suddenly dropped, or the uterine contractions are not intensive enough, or intravenous medication must be administered, there is a pipeline available; even if there is sudden massive bleeding, a blood transfusion can be carried out immediately.
Q4 Can I eat or drink during labor? Ans: Naturally produced. In principle, you can eat and drink water, mainly liquid and easy-to-digest food. Director Lai Zongxuan reminded: "However, you must first evaluate the labor process. When the cervix is ??opened and you have to exert force, you should not eat again within the last two hours, so as to avoid the food in the stomach being vomited out or even inhaled into the lungs, causing Aspiration pneumonia. ”
As for the caesarean section, since she was preparing for admission the day before, Dr. Chen Xingyou said that she would fast from 12 o’clock the night before. However, in order to prevent the mother from not eating or her blood sugar drop, Intravenous injection will be given as appropriate.
Q5 There is still no sign of labor after 37 weeks, should I exercise more? Ans: Director Lai Zongxuan pointed out that it can be carried out starting from 36 weeks. The easiest way is to walk or take a walk. You might as well take a walk for an hour after eating a full meal every day to promote uterine contraction, which will make it easier to give birth. If the weather is not good, you can also hold on to the legs of a table, squat on the ground and then stand up, or climb stairs. This is also a good way to exercise.
Dr. Chen Xingyou specially added: "It is recommended to walk on flat ground when walking. There is no need to climb stairs, because climbing stairs puts a greater load on the knees. If you have stomach pain or any discomfort in your body, don't force it. You may as well sit down and rest. Wait until you feel more comfortable before continuing."
Q6 If there is no sign of labor after 41 weeks, can I have a caesarean section? Ans: There are cases of women who are over 41 weeks due to give birth but have no signs of labor. Generally speaking, a pregnancy exceeding 42 weeks is considered an expired pregnancy. The placenta is prone to aging and degeneration, resulting in the fetus not growing large and the amniotic fluid decreasing.
In principle, induction of labor will be recommended after 41 weeks. During the induction, *** suppositories will be given to soften the cervix until a certain level, and intravenous birth drugs will be added.
Dr. Chen Xingyou added that women can still give birth naturally after undergoing labor induction procedures, and caesarean section is not necessarily necessary. The birth-inducing drugs will not affect the baby, but they are worried that the mother will react too strongly to the drugs, causing the uterus to contract too densely and affecting the baby. However, during the delivery process, the baby's heartbeat will be monitored with a fetal monitor, and any situation can be dealt with immediately.
Q7 What is the timing for pain-relieving delivery? Ans: Mothers often have doubts about the time to administer pain-relieving injections during childbirth. Director Lai Zongxuan analyzed that if the pain-reducing injection is given too early, the labor process may be prolonged; if the injection is given too late, the uterus may have already dilated and is ready for delivery when the medicine is about to take effect. Therefore, generally speaking, when the cervix is ??dilated to about one and a half fingers, the anesthesiologist will be notified to perform pain-reducing delivery.
Pain-reducing delivery will not cause backache. According to Dr. Chen Xingyou’s experience, usually when giving birth to the first child, more pregnant women will use pain-reducing delivery. The main reason is that the waiting time for the first child is longer; As for the second child and above, it depends on the situation. After all, it takes some time for the pain-reducing injection to take effect. If the labor progresses quickly, the baby will be born before it takes effect.
In addition, the older generation believes that pain-reducing childbirth hits the spine, and once the climate changes, it will cause back pain. To this question, Director Lai Zongxuan replied: "This should not be the case." Now. The pain-reducing delivery technology is very good, and the needles used are thin, so long-term backache is rare. Furthermore, even without pain relief injections during childbirth, extreme exertion during delivery, as well as subsequent breastfeeding, holding the baby, etc. may cause back pain, which is not necessarily related to pain relief delivery.
In this regard, Dr. Chen Xingyou also added that pain relief delivery is injected into the epidural space. The needle used now is very thin, so there is no need to worry about lower back pain after the injection, and it will not affect the baby. . However, after pain-relieving delivery, the mother is less likely to feel pain, so she is less able to cooperate with uterine contractions and exert force, which may lead to a longer labor process. There is also a lower chance of using a vacuum suction device to suck out the baby during delivery. big.
Have a happy delivery! Director Lai Zongxuan said that medical science is now advanced, obstetrics and gynecology specialists are well-trained, and there are hospital evaluations. Currently, the standards of Taiwan’s maternal and child hospitals are good. Pregnant women can choose the nearest hospital for prenatal check-ups, and they do not necessarily have to go to big hospitals. However, If there is a high-risk pregnancy or the fetus has many conditions, it will be recommended to choose a large hospital for delivery, which is safer and more reassuring.
Dr. Chen Xingyou also said: "The most important thing is to maintain a relaxed and happy mood." During delivery, even if injections are given to reduce pain, although it has a good relief effect, it is difficult to be completely pain-free, but we still encourage you to be accurate. Mommy can relax, and it is best if her husband can accompany her throughout the whole process. In addition to giving mommy psychological comfort, he can also help her have sex properly, which will make the delivery process smoother.
Interview and writing/Wei Jiewei Consulting/Director of the Reproductive Medicine Center of Cathay Hospital, Lai Zongxuan, and Chen Xingyou, attending physician of the Department of Obstetrics and Gynecology, Zhongxiao Campus, Taipei United Hospital
Lai Zongxuan’s education: National Cheng Kung University Medicine Bachelor of Medicine, Research Physician in the Department of Obstetrics and Gynecology, Johns Hopkins University Hospital, USA Experience: Attending Physician, Department of Obstetrics, Gynecology and Reproductive Medicine Center, Cathay Hospital, Hsinchu, USA, Research Scientist, Cornell University Reproductive Medicine Center, USA Current Current position: Reproductive Medicine, Cathay Hospital, Taipei Center Director, Senior Attending Physician in the Department of Obstetrics and Gynecology, Taipei Cathay Hospital
Chen Xingyou Education: Department of Medicine, Taipei Medical College Experience: Resident physician and chief physician in the Department of Obstetrics and Gynecology, Mackay Hospital, Research Physician in Gynecology, Mackay Hospital, Taipei Director of the Department of Obstetrics and Gynecology, Zhongxiao Campus, Taipei City United Hospital Current position: Attending physician, Department of Obstetrics and Gynecology, Zhongxiao Campus, Taipei City United Hospital