Labor and Delivery
As her due date approaches, an expectant mother often looks for signs that her labor is starting. It is important for a woman to be aware of the changes that her body is going through as it prepares for labor, and what to expect when the labor process begins. If a woman suspects that she is in labor, she should contact her doctor or midwife immediately.
Signs of Labor
As labor approaches, some women may experience a burst of energy, and the impulse to clean or get the home ready for the baby. This urge is commonly referred to as "nesting," although not all women experience it. As the body begins to prepare itself for labor, the fetus may "drop" (move into the lower part of the pelvis), and the cervix begin to thin and soften. Vaginal discharge that is clear or slightly bloody may begin a few days before labor begins. Additional signs of labor include the following:
- Lower-back pain, or cramping that does not subside
- Cervical dilation
- Uteterine contractions at regular intervals
- Rupture of membrane (water breaks)
It may help to time the contractions to determine whether they are true contractions, or Braxton Hicks (false) contractions. True contractions last about 30 to 90 seconds, and become more frequent and intense. If this is your first pregnancy, go to the hospital when your contractions are five minutes apart for one hour. If this is a subsequent pregnancy, call when your contractions are 7-10 minutes apart for one hour. Do not call the doctor during the night if you think you are in labor or if your bag of water has broken, this cannot be diagnosed over the telephone; instead just go to Labor and Delivery to be evaluated.
Stages of Labor and Delivery
The process of labor and delivery occurs in three stages, beginning with the onset of labor. Depending on her preference or birth plan, a woman may choose to experience the first phase of labor at home and, only as it progresses to active labor, go to a hospital or medical facility. In a hospital setting, the heart rate and vital statistics of both mother and fetus are monitored during the labor process. The health and safety of the mother and fetus should always be the first consideration when planning for labor and delivery.
The first stage of labor occurs in two phases: early labor and active labor. Early labor begins when the baby has moved down into the birth canal, and the cervix begins to dilate. Mild contractions occur, and a brown or red discharge indicates that the mucus plug has been shed from the cervical opening. This phase can last from 6 to 12 hours, but can occur more rapidly in women who have given birth before. Contractions become more frequent and much more intense during active labor as the cervix continues to dilate. An epidural may be administered for pain. The membranes around the amniotic sac may rupture. Active labor can last up to 8 hours.
The second stage of labor occurs when the cervix has fully dilated, and the mother is ready to push the baby out of the birth canal. When the top of the baby's head fully appears (crowns), the doctor or midwife advises the mother to push, and helps deliver the baby. If necessary, the doctor makes a small incision to enlarge the vaginal opening (episiotomy) and help the baby fit through the birth canal. After the baby is delivered, the umbilical cord is cut.
The third stage of labor is the delivery of the placenta (afterbirth). This stage lasts from 5 to 30 minutes. After the baby is delivered, contractions continue and the mother may experience chills or shakiness. Usually, the woman will push one more time, expelling the placenta from the uterus. If an episiotomy was performed, it is stitched at this time. Labor is over once the placenta has been delivered.
Pain medication is a personal choice during labor. Many women find relief from the use of medication, and are better able to relax. Other women choose to experience labor and delivery without pain medication, and use natural pain-relief methods such as a taking a warm shower or bath, playing music, getting massages, or having the assistance of doula. Childbirth is a different experience for each woman, and the methods used to relieve pain will vary based on the health and safety of the mother and fetus, and what the doctor recommends.
Complications of Labor and Delivery
In most cases, the labor and delivery process occurs without any complications. In some cases, however, a Cesarean section (C-section) is necessary when unexpected problems arise during labor or delivery. During a C-section, which is performed in a hospital operating room, a doctor surgically removes the baby through the mother's abdomen. A C-section may be necessary in the following instances:
- The fetus is in a breech position
- The fetus shows signs of distress (low or elevated heart rate)
- There are problems with the umbilical cord
- There are placenta problems
- The mother has high blood pressure
- There are multiple fetuses
A C-section may also be necessary if the mother has underlying health problems, or an HIV or herpes infection. Because of the possibility that a C-section may be necessary, a woman with a high-risk pregnancy is advised to go to a hospital when she is in labor.