Labor and Delivery

Signs of Labor – As your due date approaches, you will begin to look for signs that labor is about to start. “Lightening,” is the term used to describe the baby moving to the head-down position. It releases pressure on the mother’s abdomen. Your doctor may do a pelvic exam during a prenatal visit and report changes in your cervix that you cannot feel. These changes suggest that your body is getting ready. Some women go through “nesting.” This is a flurry of energy and the impulse to cook or clean.

Signs of Labor (These signs suggest that labor may begin very soon and you need to contact your doctor or midwife.)
Contractions become stronger at regular and increasingly shorter intervals.
Lower back pain and cramping that does not go away.
Water breaks (can be a large gush or a continuous trickle).

Bloody (brownish or red-tinged) mucus discharge. This is probably the mucus plug that blocks the cervix. This means the cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start soon or may still be days away.

False Labor – Sometimes women think they are in labor when they are not. “Practice” contractions called Braxton Hicks contractions are common in the last weeks of pregnancy. The uterus tightens and might startle you with some that might be painful. With true labor, the contractions will become regular, stronger, and more frequent. Braxton Hicks are not in a regular pattern and will taper off and go away. Many women will mistake Braxton Hicks contractions for real labor contractions. It can be hard to tell so if you are unsure if contractions are true labor, call your doctor.

Stages of Labor for Vaginal Birth – Every woman’s labor progresses differently. However, the three stages of labor feature some milestones that are true for every woman.

First Stage of Labor:

• Begins with the onset of labor and ends when the cervix is fully opened.
• Longest stage of labor, sometimes lasting about 12 to 19 hours.
• Most women can drink and eat during labor which can provide needed energy later. (However, check with your doctor. Some doctors advise laboring women to avoid solid food as a precaution should a cesarean delivery be needed.)
• At the hospital, the mother will be monitored to check the cervix, as well as the baby’s position and station (location in the birth canal).
• Most babies’ heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up towards the mother’s abdomen. The doctor might try to rotate the baby or the baby might turn on its own.
• As you near the end of this stage of labor, the contractions become longer, stronger, and closer together.
• The doctor might use an electronic fetal monitor to be sure the baby’s blood supply is okay. This involves putting two straps around the mother’s abdomen. The straps measure the strength and frequency of contractions and record how the baby’s heartbeat reacts to the contraction.
• The cervix is fully dilated when it reaches 10 centimeters.

Second Stage of Labor:

This stage involves pushing and delivery of the baby. It usually lasts 20 minutes to two hours.
When the baby crowns (head fully appears), the doctor will tell you when to push and deliver the baby.
Sometimes an episiotomy is needed. This is a small cut to enlarge the vaginal opening.
Sometimes, forceps or suction is used to help guide the baby through the birth canal. This is an assisted vaginal delivery.
After the baby is born, the umbilical cord is cut.

Third Stage of Labor:

• The third stage involves delivery of the placenta or afterbirth.
• Contractions, five to 30 minutes after birth, will signal that it’s time to deliver the placenta.
• Labor is over once the placenta is delivered.
• If needed, the doctor will repair the episiotomy and any tears you might have.

Cesarean Birth

Cesarean delivery, also called a c-section, is delivery of a baby by surgery. The baby is taken out through the mother’s abdomen. It is surgery and healing takes longer than with vaginal birth. Most healthy pregnancies result in a vaginal delivery. However, the number of c-sections has risen from 1 in 5 in 1995 to nearly 1 in 3 women today. It is important to get the facts about
c-sections before delivery. The mother should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

Reasons for C-sections – The doctor might recommend a c-section if it appears to be safer for the mother or the baby than a vaginal birth. Some c-sections are planned but most c-sections are done when unexpected problems happen during delivery.

Some studies show that the benefits of having a c-section may outweigh the risks when:

• Carrying more than one baby (twins, triplets, etc.).
• Health problems including HIV infection, herpes infection, and heart disease exist.
• The mother has dangerously high blood pressure.
• There are problems with the shape of the mother’s pelvis.
• There are problems with the placenta.
• There are problems with the umbilical cord.
• There are problems with the position of the baby, such as breech.
• The baby shows signs of distress, such as a slowed heart rate.
• The mother has had a previous c-section.

Resources for Stages of Development and Labor and Delivery

Website – Womenshealth.gov, Office on Women’s Health, U.S. Department of Health and Human Services
“The First 9 Months,” by Vicki L. Dihle, PA-C and Bradley G. Beck, M.D. and Focus on the Family