LABOUR & DELIVERY

There is excellent information on the City of Toronto Public Health Website on prenatal programs, free online prenatal classes and preparing for labour and parenthood. Dr. Po's patients deliver at Sunnybrook Health Sciences Centre. The information below is pertinent to her patients only. Please ask your doctor if this information applies to you.

Where is the Sunnybrook Birthing Unit?

The Birthing Unit for the Sunnybrook Women and Babies Program is located in the M-Wing on the 5th Floor. Obstetrical Triage is located there. This is where you go if you have any emergent concerns during pregnancy, for a scheduled induction or for a Caesarean Section.

Who will deliver my baby?

There are 20 obstetricians that deliver at Sunnybrook and we take turns covering each other at night and during the day. Sunnybrook is a teaching hospital, so you will also have medical students and resident involved in your care.

Who can I bring with me?

When you are in labour, the hospital requests that you only have TWO support people with you. This is for infection control and to maintain patient privacy. No children are allowed in the Birthing Unit. Please verify with the staff on Birthing Unit as this may change.

Who will provide health care for my baby after I leave the hospital?

When you are in the hospital, a paediatrician will check your baby after the birth. After you are discharged from the hospital, the baby should be checked again in 2 – 5 days. You will need to find a paediatrician or a family doctor who looks after babies BEFORE the end of your pregnancy. You do not need a referral from us. One of the best resources is to ask your neighbours and friends who they take their kids to. You can also go to the CPSO website to find a doctor near you.

Where can I get more Information?

Go to Sunnybrook Women & Babies website for detailed information about having a baby at Sunnybrook. There are guides on what to bring to the hospital, what to expect when you arrive, breastfeeding, and how to register for prenatal classes. You can call (416) 480-5368 to inquire about prenatal classes or hospital tours. Free online prenatal classes are also available on the City of Toronto Public Health website.

WHEN DO I GO TO THE HOSPITAL?

If you are patient of Dr. Po's and you have any of these symptoms below 16 weeks, go to the emergency department. If you are over 16 weeks, please go do the Sunnybrook Obstetrical Triage for assessment.

If you are NOT a patient of Dr. Po's, please ask your obstetrical provider where to go for emergencies. Each doctor and each hospital may have different policies and recommendations.

If you are contracting

Any amount prior to 37 weeks: go to the hospital.
After 37 weeks
- First baby: every 5 minutes for at least 1 hour.
- If you have had at least 1 baby: every 10 minutes for at least 1 hour.
- If your baby is breech or you are planning on having a Caesarean Section: go to the hospital with any contractions.
If you have significant abdominal pain or are worried about the pain, you should go to the hospital.

If you are having bleeding

Any amount prior to 37 weeks: go to the hospital.
After 37 weeks
- If you are having bleeding like a period: go to the hospital.
- A little bit of blood or bloody, mucosy discharge is very common during labour or before labour starts. You do not need to go to the hospital if this occurs.
- If you loose your mucous plug, you do not need to go to the hospital.

If your water has broken

Before 37 weeks: go to the hospital.
After 37 weeks
- If you are GBS POSITIVE, go to triage. Click here to learn more about GBS.
- If you are GBS NEGATIVE, go to triage to confirm you have broken your waters. If everything is stable and you are not in labour, you have the option to go home to see if labour will start within 12 hours of when you broke your waters. If labour still has not started at 12 hours, then you need to return to the hospital to be reassessed and you may need to be induced with IV medications.
- The water should be clear. If it is green or brown, go to the hospital immediately.

If you are not feeling your baby move

You can perform kick counts. Lie down on your left side and you should feel 6 movements in 2 hours. If you do not feel this, go to the hospital. Learn about how to do kick counts here.
You should start feeling baby movements between 18 – 22 weeks but it will not be regular at first. Once the movements become regular, you should feel about 6 movements over the whole day.

If you have a severe headache, changes to your vision, feel unwell, or YOU ARE WORRIED,

Go to the hospital.

TRIAL OF LABOUR AFTER CAESAREAN SECTION (TOLAC)

You might have heard of the "VBAC" (Vaginal Birth After Caesarean Section) before but the actual correct term for a patient who wants to try to labour after a previous C-Section is "TOLAC" (Trial of Labour After Caesarean Section).

If you have had a previous Caesarean section, you might be considering to try to have a vaginal birth. In the right patient, a vaginal birth, compared to a Caesarean section, is associated with a faster recovery time, lower risks of future pregnancy complications and reduced neonatal complications. Overall, up to 75% of patients who try to labour after a previous Caesarean section will have a vaginal birth. The likelihood of a vaginal delivery will depend on several factors including why you had a Caesarean section the first time and if there are any issues in your current pregnancy. Click here to use an online calculator to determine what the likelihood is for you to have a vaginal delivery.

What are the risks of TOLAC?

The most common risk is that the delivery ends up as a Caesarean section. There could be a number of reasons why that is but most commonly, it is because the cervix doesn't fully dilate or there are concerns about baby's heart rate. If a Caesarean section is done during labour, then there is higher risks of bleeding requiring a transfusion and infection.

The most serious risk is a uterine rupture. This is when the scar on your uterus, from your previous Caesarean section, opens up. This is not a common complication - it will happen to 1 in 200 patients who are doing a TOLAC. What does this mean for the labour patient and baby? For the patient, it might mean higher risk of bleeding requiring transfusion and rare cases of hysterectomy if the bleeding cannot be stopped with conservative measures. For the baby, in very rare circumstances, it can mean a brain injury or death (2 to 3 in 10 000 cases of uterine rupture).

What can be done to reduce these risks?

One of the first signs that a uterine rupture is happening is a change in baby's heart rate pattern. We always recommend continuous fetal monitoring during active labour. We also recommend an epidural and insertion of an IV during labour. This way, we can act quickly if we need to do an urgent Caesarean section.

What is the alternative and what are the risks?

Instead of TOLAC, you could choose to have a repeat elective Caesarean section. The benefit is that you have an idea of what to expect based on your previous delivery experience. You might also be able to choose the date of your baby's birth. You would also avoid the risks of TOLAC. The risk of repeat Caesarean sections include the typical surgical risks of infection, bleeding requiring transfusion, injury to the surrounding organs (bowel, bladder, blood vessels, nerves, ureters), clots of the legs and lungs and pain. A rare but unique risk of having multiple Caesarean sections is that in future pregnancies, the placenta could grow in to the old uterine scar. This is called a placenta accreta. If you have a placenta accreta, you might have a preterm delivery, and significant blood loss during your delivery which might lead to transfusions and a hysterectomy.