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Labor and Delivery

During the last weeks of pregnancy, new changes will signal the approaching birth. For example, you may feel that the baby is lower in your abdomen, and people may tell you that it looks as though your baby has "dropped." This is called "lightening" and it means that the baby's head has settled down into the bony part of your pelvis. Sometimes this happens quickly and you find it suddenly easier to breathe. Sometimes "lightening" does not occur until after labor begins.

False Labor

Contractions of the uterus late in pregnancy are normal. They are called "false labor" because they do not open the cervix as does true labor. There are some signs to help you distinguish between false labor and the real thing:

• The contractions of false labor are usually not regular.
• The contractions of false labor often go away when you walk around in real labor, they'll feel stronger.
• The contractions in real labor get stronger and closer together with time.

You may notice some tightening in your lower abdomen or even occasional contractions of the uterus late in pregnancy. These contractions will go away when you walk around or practice your breathing techniques. If they do not go away, contact your doctor.

Signs of Labor

The beginning of labor is a very individual thing. Some women don't even realize they are in the first stage of labor, mistaking it for gas, heartburn, backache, or indigestion.

There are three signs that labor has begun. They do not necessarily occur in any particular order and they may occur in a different order with each pregnancy. They are:

• Regular contractions, which usually begin in your lower back and then travel to the front of your abdomen.

Contractions occur because your uterus is tightening and relaxing to help open the cervix and push the baby out through your birth canal. During the early part of labor this may feel like menstrual cramps. Some women feel only abdominal contractions or only a backache. Contractions of true labor occur regularly. They usually start about 15 to 20 minutes apart and last 30 to 45 seconds. As your labor proceeds, the contractions become more frequent and last about 60 seconds. If you walk around or lie down they will not go away as they did in false labor.

• A pink "show" or plug of mucus

As your baby pushes against the cervix or neck of the uterus, the cervix opens and a pink colored "show" or plug of mucus comes loose. Also, there is generally a small amount of blood.

• A gush or trickle of water from your vagina

A flow of water from your vagina indicates the breaking of the membrane or "bag of waters" that surrounded the baby during pregnancy. There is no pain; it just feels like a flow of warm water. You can lose about a quart of water, but the amount depends on where the sac breaks. You may continue to lose fluid as your body continues making it. Sometimes the "bag of waters" breaks at the beginning of labor and sometimes it happens late in the first stage of labor.

Call your doctor immediately when your membrane or "bag of waters" breaks or when your contractions are regular and 15 minutes apart. For the first child the doctor will probably tell you to come to the hospital when they are 5 minutes apart. Don't worry that you may not make it; the first stage of labor is about 8-12 hours long for a first baby. Generally speaking, if you have had at least one baby your labor will be shorter than with the first.

At the Hospital

When you arrive at the hospital you usually go to the admitting office. If there is time, you will be asked for certain information for your records. If not, the person who brings you to the hospital may give any information needed. You are then taken to a maternity admissions room or labor room where you put on a hospital gown.

As the baby comes down the birth canal, you will feel as if you have to move your bowels. This is just the pressure of the baby and nothing else.

The Support Person

Most hospitals permit you to have someone with you during the labor and some will also allow that person to accompany you into the delivery room. It is usually the baby's father, but it may be your mother, an older sister, or your childbirth education teacher. Be sure to check the hospital's policy and your doctor's policy about this arrangement since some only allow people who have attended childbirth classes.

A Note to the Father

Throughout the childbirth classes you and your partner have been studying the birth process, learning breathing exercises and the ways you can make her more comfortable during delivery. Nothing, however, can fully prepare you for participating in your first labor and delivery.

Remember, this is a very special time for both of you. Even if you have not attended childbirth classes you may want to be present at the birth of your child.

Do not be surprised at your partner's behavior or at anything she says. Help her through the labor and delivery and don't give up. She needs your support and caring. Remember, this is also your chance to be present at your child's first breath.

Stages of Labor

Labor means work. During this time, you have to work to help the baby move from your uterus into the world. It may be some of the hardest work you will ever do. Your cervix, which is made up of firm tissue shaped like a small doughnut with a tiny hole in the center, has been closed throughout the pregnancy. Now it must stretch wide enough for the baby to pass through. The uterus tightens or contracts and forces the opening wider, little by little, over a period of several hours. Contractions feel different to different women. Some describe them like a wave that builds to a peak and then recedes.

Labor is divided into stages. During the first stage of labor your cervix will dilate (opening to the fullest), so that the baby can pass through. The second stage of labor begins when you push the baby out of the uterus into the birth canal and ends when the baby is born. The third stage is when the placenta (afterbirth) is expelled. The whole process of labor lasts about 12-14 hours for a first baby and about 7 hours for subsequent babies.

During the first stage of labor, you will be examined regularly to see how fast your cervix is opening (dilating). This is done by a vaginal examination. The doctor measures the cervical opening in centimeters. When the cervix is open to its fullest, 9 to 10 centimeters, the opening is large enough for the baby to pass through.

A nurse or nursemidwife will probably be with you most of the time you are in labor. The father of the baby or other support person may be allowed to stay with you, if you want, and if hospital rules permit.

To make sure the baby is in good condition during labor, the doctor or nurse will check the baby's heartbeat, either by listening with a stethoscope or by electronic fetal monitoring through wires taped to your abdomen.

When the cervix has opened wide enough the baby's head will begin to pass through. If the bag of waters has not already broken, it will at this time, causing a gush of fluid from the vagina.

In the second stage of labor, the baby is pushed through the open cervix, through the birth canal (vagina), and is born. This stage is much shorter than the first, about 1 1/2 hours for first babies, and 30 minutes or less with later children. Contractions during this part of labor are about 2 to 3 minutes apart and last about a minute.

As the baby moves, little by little, through the birth canal, it puts pressure on the rectum and causes an urge to "bear down" as though having a bowel movement. The doctors and nurses may ask you to use special breathing techniques while bearing down. Pushing usually relieves some discomfort and shortens labor. However, it is important not to start this pushing until the doctor says to do so.

You will now be moved from the labor room to the delivery or birthing room (In some hospitals the labor and delivery rooms are the same room). Here you will be placed on the delivery table, with support for your feet and legs. Drapes will then be placed over your legs and abdomen. A large mirror may be overhead, and can be turned so that you can watch your baby being born. Once the scalp is visible, pushing with the next few contractions will bring the baby into the world.

In the third stage of labor, the placenta and membranes pass out the vaginal opening. This generally happens within 5 to 30 minutes after the baby is born.

Medications for Pain and Anesthesia

During labor your contractions may cause you much discomfort. You may request medicines to help relieve the pain. The doctor will select the most appropriate medicines taking into account how you and your baby are doing.

Analgesics are medicines that relieve pain. They are sometimes administered by injection to help relieve the pain associated with contractions.

Anesthetics are medicines that completely deaden feeling in part or all of your body. General anesthesia, which puts the patient to sleep, is rarely used today because it can cause breathing problems for the baby. In addition, general anesthesia can make you nauseated and cause you to vomit when you awaken.

Regional anesthesia is used most commonly today. This method of anesthesia deadens pain in limited areas of your body but allows you to remain awake to help your baby come into the world. With regional anesthesia, you and your baby are generally not as subject to the bad effects associated with general anesthesia. You should discuss any risks with your doctor. Your physical condition, that of the baby, your progress in labor, and your desire to participate in the delivery will help you and your doctor decide which, if any, anesthetic you are going to use.

There are a number of different techniques used to administer the anesthetic. Each has advantages and limitations. For example, while the anesthetic may relieve pain, it may also weaken the contractions and thus slow labor. Also, some anesthetic may reach the baby. Ask your doctor to explain the various methods. They include the following:

Spinal anesthesia involves a single injection directly into the spinal fluid in the lower back to block the pain carrying nerves. A "saddle block" is a spinal injection that is given in the back to anesthetize a smaller area.

Epidural anesthesia consists of injections of small amounts of anesthetics near the spinal nerves several times during labor.

Caudal anesthesia consists of one or more injections near the tailbone.

Pudendal and paracervical blocks consist of injections through the walls of the vagina and near the cervix, respectively.

Episiotomy

An episiotomy is a small cut made between your vagina and anus to allow more room for the baby to be delivered. Making this cut prevents possible tearing of your tissue and is done only when necessary. A few stitches are used to close it. These stitches are absorbed during the postpartum period and do not need to be removed. Before labor ask your doctor or nursemidwife about their policies for making an episiotomy. There are techniques that can be used to help avoid this procedure.

Instruments Used in Delivery

Forceps are used in the delivery of your baby only if the doctor feels that pressure on the baby's head must be relieved and if the birth of the baby is not progressing. The baby's welfare is always foremost and forceps are never used in ways that could be harmful to the baby.

Prepared Childbirth

Natural or prepared childbirth classes are designed to help you understand pregnancy, labor, delivery, and birth, and to have your baby with little or no anesthesia, pain relieving medicines, episiotomy, or instruments. Both the mother and a support person, generally the father, are taught about breathing and muscle relaxation methods. During labor the support person keeps the mother comfortable, helps with techniques for breathing and relaxation during contractions, and provides reassurance and encouragement. Some women who use a prepared childbirth method need no anesthetics or pain relievers at the time of delivery. However, taking these classes does not mean you cannot have pain relievers or anesthetic if you and your doctor should decide you want and need them. If you are interested in prepared childbirth, discuss it with your doctor or nursemidwife. The doctor and delivery room staff must participate if this method is to be effective.

Your doctor can help you find a class or teacher to instruct you in prepared childbirth techniques. Also, there are a number of books on the subject. Even if prepared childbirth is not for you, you can still benefit from regular prenatal classes.

Cesarean Section

A cesarean delivery or CSection is an operation in which the baby is delivered through an incision in your abdomen rather than through the vagina. Even though a cesarean delivery is considered major surgery, the risk is relatively small.

The cesarean delivery is performed only when the risks of vaginal delivery outweigh the benefits. The cesarean is used when vaginal delivery would threaten the life or safety of the mother or infant, when a previous child has been delivered by cesarean, or in the presence of certain diseases and conditions.

Breech Baby

Most babies enter the birth canal head first. Rarely, a baby may enter the birth canal in another position. A breech baby is one whose feet or buttocks enter the birth canal first. This usually makes labor longer and more difficult for the baby, so you are most likely to have a cesarean section if your baby is in a breech position. Your doctor will let you know if your baby is in a breech position and will tell you what to expect.

After Delivery

Immediately after birth, your baby is held with the head lowered to assist in the drainage of amniotic fluid, mucus, and blood. A small bulb syringe may be used to suction the mouth and nose. The cord is then clamped, the baby is dried, and warmth is insured with blankets, heat lamps, or a heated bassinet. Oftentimes the baby is placed on your chest immediately after birth to establish skintoskin contact.

Drops to prevent infection will be put into the baby's eyes and identification bands will be placed on you and the baby before leaving the delivery room. The baby's hand and foot prints may also be taken.

The Recovery Room

Before going to your own room, you may be taken to a recovery room for an hour or two. Here you will be watched closely and checked frequently for any excessive bleeding or unusual change in blood pressure. The baby's father may be allowed in the recovery room with you. If there is no recovery room, you may stay in the delivery room for an hour or so.

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