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Labour and Delivery

Back to the Obstetrical Care Program

Where to go


Your labour and delivery will occur at Mount Sinai Hospital, which is located at 600 University Avenue:

 MCC_Image_FamilyHealthClinic_PN_Resources_MSHMap.jpg

Then, go up to the 15th floor, triage area:

Once admitted, you will have a private room during the labour and delivery. You will be assigned a nurse. On the labour floor at Mount Sinai Hospital, nurses are only assigned one patient, so you will have attentive care.

Premature labour


If labour begins early, before 37 weeks, it is called premature (or pre-term) labour. Call your caregiver if you begin premature labour.

It is important to know the signs and symptoms of premature labour. The signs are often different from those a woman experiences later in pregnancy. They include:

  • Bad cramps or stomach pains that don't go away
  • Bleeding, trickling or gushing of fluid from the vagina
  • Increase in the amount of vaginal discharge
  • Fever, chills, severe dizziness, vomiting or a bad headache
  • Contractions that are significantly stronger and more regular than Braxton-Hicks contractions
  • A significant change in your baby's movements

If you are experiencing any of the above symptoms, call your care provider who will help you decide what to do next:

Daytime Prenatal Nurse 
Phone: 416 603 5800 ext. 2335

Urgent Contact Information 24 hours per day

Mount Sinai Hospital "locating" Operator 
Phone:  416 586 4800 ext.  5133 
Ask to speak with the family medicine resident on call for obstetrics, they should call you back within 10-15 minutes.

Labour and Delivery Floor Triage Nurse at Mt. Sinai Hospital
Phone: 416 586 4800 ext. 3210

If you have not been seen yet for your first prenatal visit with our program, please contact your own family doctor, or, 911 if an emergency.

Labour


You may have worked out a plan with your care provider to stay at home during early labour, and have agreed on the stage at which you should come to the hospital. It is often more comfortable to spend the early stages of labour at home. Trust your instincts. If anything seems unusual, contact your care provider.

The two main signs of labour are contractions and pinkish mucus, which is discharged from your vagina. It should not contain obvious blood or clots. Timing your contractions can help you determine when labour has been established.

Other signs of approaching labour may include:

  • Contractions that weaken or vary in strength over time - contractions that weaken or stop altogether when you move around - contractions that are irregular and never settle into a pattern - loose stools - crampiness - your water breaking
  • Established labour may begin with contractions that: - get steadily stronger - make your uterus grow harder - continue to get stronger even when you move around - become quite regular and predictable over a period of about 30 minutes - are between 30 and 70 seconds long

In general, once the contractions start coming every four to five minutes, last 45 to 60 seconds, and are painful, you should get ready to come to hospital. If labour is not painful, try to sleep or relax, or continue with your regular activities. Once labour is well established, you can move it along by staying upright and active.

What happens when/if your water breaks?


Your "water" is the term many people use to describe the amniotic fluid surrounding the baby. The amniotic fluid and baby are both sitting in a "bag" called the amniotic membrane. This bag has protected your baby throughout the pregnancy.

When your water "breaks", it usually means that the bag has broken. Many women describe a gush of fluid from their vagina. Other women feel a steady trickling.

If you are not sure if your water has broken, you should come to the hospital. 
If your water has broken, and you are not having contractions:

  • The liquid is clear, your GBS is negativeThe baby is head-down and moving normally - You do not have to come to the hospital right away. However, please call the resident on call to let them know that your water has broken, and they will discuss a plan with you. All patients need to be assessed within 12 hours of their water breaking, even if they are not in labour.​
  • The liquid is clear, your GBS is positive. The baby is head-down and moving normally - Come to the hospital within 4 hours or call us
  • The liquid is green or yellow-green, the baby is breech or not moving as well or if you are having a bleeding like a period or heavier - Come to the hospital right away. It is not an emergency but we want to ensure your baby has a safe delivery

Again, the numbers to call us are:

Mount Sinai Hospital "locating" Operator 
Phone: 416 586 4800 ext. 5133 
Ask to speak with the family medicine resident on call for obstetrics, they should call you back within 10-15 minutes.

Labour and Delivery Floor Triage Nurse at Mt. Sinai Hospital
Phone: 416 586 4800 ext. 3210

Coping with pain


Everyone experiences labour differently, but one thing is constant – there is always pain during labour. There are many ways to cope with labour pain, including relaxation, vocalization, positioning, breathing techniques, massage and pain medication.

You will need to determine what is right for you. You might want to learn different coping techniques while you are pregnant so you will have many strategies to draw from during labour. Prenatal classes teach a variety of relaxation techniques. You can learn about some of these in the following pages. Once you have learned a relaxation technique that works, use it whenever you need it.

During labour you will feel more comfortable with a method that you have used often and trust. There is nothing magical about relaxation techniques. You may already be using them in your everyday life. Which ways of relieving stress have worked for you before? Think back to an especially stressful time in your life. What worked? What didn't? Does it work best for you to be quiet or to scream and curse? How might you be able to modify your own proven strategies to work for you during pregnancy and labour?

Some of you may have been skimming through these paragraphs looking for the information on drugs! Many women want to use epidurals and other pain medications; others want to avoid this alternative. Think about this option before labour begins and use the information below to learn and to create your own pain control strategy. Even if medications will be a major part of your strategy, these other techniques can help you cope during the birth:

  • Relaxation
  • Massage
  • Breathing techniques
  • Positions
  • Medication
  • Shower/bath
  • Music

Epidural


Labour is painful, but how you control that pain is a personal choice. Most women at Mount Sinai choose an epidural. There are other options if you can't have an epidural, or don't want one (see above).

We will also support you if you choose to have a natural delivery. Please keep an open mind either way, as we may make suggestions if we think the safety of your delivery is at stake. There are always doctors who specialize in epidurals (anesthesiologists) on-call. You can expect that it will take at least 30 minutes between when you request the epidural and when you experience pain relief.

Episiotomy


An episiotomy is a cut made in the perineum (the skin and muscle between the vagina and anus). It is used to enlarge the vaginal opening and make the birth of the baby easier if the perineum is not stretching. Local anesthetic can be used and the cut will be stitched up after the birth. It should heal within 4-6 weeks.

Episiotomies used to be performed routinely; however, several studies showed that with normal births, women who did not have episiotomies generally fared better than women who had one. Therefore, most women will not need or get an episiotomy. However, there are some circumstances when an episiotomy may help to prevent a larger tear from happening.

Electronic Fetal Monitoring


This is a machine used to record the baby's heartbeat and the frequency of the mother's contractions during labour. Electrodes that record the baby's heartbeat can be put on the mother's belly with a belt (external monitoring) or can be placed onto the baby's scalp, through the mother's vagina (internal monitoring).

Electronic fetal monitoring is not used routinely but it may be used to check the baby's health during the birth. When internal monitoring is done, your water must be broken if this has not already occurred naturally. The monitor will be attached to your baby's head with a scalp clip. This is a safe technique with very few risks.

Forceps and Vacuum


These instruments are designed to guide the baby out of the vagina, when a woman needs help to push her baby out completely. These methods may be used if: you are exhausted - the position or size of the baby makes the birth difficult or if there is fetal distress.

Both procedures will be discussed with you in detail at the time of delivery if they are necessary for your baby to be born safely.

Induction of Labour (artificial starting of labour)


There are many reasons why you may need to be induced, such as:

  • Going past your due date
  • Concerns about baby's health
  • Concerns about mother's health

The most common ways of inducing labour are:

  • Artificial rupture of membranes (ARM)
  • Oxytocin
  • Prostaglandin gel

Augmentation of Labour (artificial speeding up of labour)


A very long labour increases the risks of childbirth for you and your baby. Therefore, augmentation of labour is done when your labour is progressing more slowly than usual.

ure of membranes

In the hopes of starting or speeding up labour, your caregiver may break the bag of amniotic fluid surrounding the baby. This may be done with a long thin plastic hook called an amnihook.

Prostaglandin Gel


Prostaglandin gel is a hormone. Prostaglandin gel can be used when the cervix is less than three centimeters dilated. It is applied to the back of the vagina where it softens and "ripens" the cervix, to help it dilate. At Mount Sinai Hospital, this is usually done on an outpatient basis.

Oxytocin


Oxytocin can cause or increase the strength of your contractions, and usually makes the birth proceed more rapidly. It is given through an intravenous line after the woman is in the birth room. Once you are receiving oxytocin, your baby's heart beat will be monitored continuously.

Cesarean Section


A cesarean section is a surgical procedure used to deliver a baby. Your partner is allowed to stay with you and your baby during the surgery.