it takes nine months to grow a full-term baby, labor and delivery occurs in a
matter of days or even hours. However, it’s the process of labor and delivery
that tends to occupy the minds of expectant parents the most. Read on if you have
questions and concerns around the signs and length of labor, and how to manage
Signs of Labor
started or is coming soon if you experience symptoms such as:
pressure in the uterus
change of energy levels
bloody mucus discharge
labor has most likely arrived when contractions become regular and are
Braxton Hicks Contractions
women experience irregular contractions sometime after 20 weeks of pregnancy.
Known as Braxton Hicks contractions, they’re typically painless. At most, they’re
uncomfortable and are irregular.
Hicks contractions can sometimes be triggered by an increase in either mother
or baby’s activity, or a full bladder. No one fully understands the role
Braxton Hicks contractions play in pregnancy. They may promote blood flow, help
maintain uterine health during the pregnancy, or prepare the uterus for
Hicks contractions don’t cause the cervix to dilate. Painful or regular
contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of
contractions that should lead you to call your doctor.
First Stage of Labor
and delivery are divided into three stages. The first stage of labor incorporates the
onset of labor through the complete dilation of the cervix. This stage is
further subdivided into three stages.
This is normally the longest and least intense
phase of labor. Early labor is also called the latent phase of labor. This
period includes the thinning of the cervix and dilation of the cervix to 3-4
cm. It can occur over several days, weeks, or just a few short hours.
Contractions vary during this phase and can range
from mild to strong, occurring at regular or irregular intervals. Other
symptoms during this phase can include backache, cramps, and a bloody mucus
discharge. Most women will be ready to go to the hospital at the end of early
labor. However, many women will arrive at the hospital or birthing center when
they are still in early labor.
The second phase of labor occurs as the cervix
dilates from 3-4 cm to fully dilated (10 cm). Contractions become stronger and
other symptoms may include backache and blood.
This is the most intense phase of labor with a
sharp increase in contractions. They become strong and occur about two to three
minutes apart, and average 60 to 90 seconds. The last 3 cm of dilation usually
occur in a very short period of time.
Second Stage of Labor
During the second stage, the cervix is fully
dilated. Some women may feel the urge to push right away or soon after they’re
fully dilated. The baby may still be high up in the pelvis for other women. It may take some time for the
baby to descend with the contractions so that it’s low enough for the mother to
Women who don’t have an epidural typically have an
overwhelming urge to push, or they have significant rectal pressure when the
baby is low enough in the pelvis. Women with an epidural may still have an urge
to push and they may feel rectal pressure, although typically not as intensely.
Burning or stinging in the vagina as the
baby’s head crowns is also common.
It’s important to try to stay relaxed and rest
between contractions. This is when your labor coach or doula can be very
Third Stage of Labor
Delivery of the Placenta
The placenta will be delivered after the baby has
been born. Mild contractions will help separate the placenta from the uterine
wall and move it down towards the vagina. Stitching to mend a tear or surgical
cut (episiotomy) will occur after the placenta is delivered.
medicine can provide a variety of options to manage pain and complications that
can occur during labor and delivery. Some of the medications available include
medications are used frequently for pain relief during
labor. Use is limited to the early stages because they tend to cause excessive
maternal, fetal, and neonatal sedation.
are generally given to women in labor by intramuscular injection or through an
intravenous line. Some centers offer patient-controlled administration. That
means you can choose when to receive the drug.
Some of the most common narcotics include:
analgesic medications are sometimes used during labor. Nitrous oxide,
often called laughing gas, is most commonly used. It can provide adequate
pain relief for some women when used intermittently, particularly in the early
stages of labor.
most common method of pain relief during labor and delivery is the epidural
blockade. It’s used to provide anesthesia during labor and delivery and during
a cesarean section (C-section).
relief results from injecting an anesthetic drug into the epidural space,
located just outside the lining the covers the spinal cord. The drug blocks the
transmission of pain sensations through the nerves that pass through that
portion of the epidural space before connecting with the spinal cord.
use of combined spinal-epidurals or a walking epidural has gained popularity in
recent years. This involves passing a very small pencil-point needle through
the epidural needle prior to placement of the epidural anesthetic. The smaller
needle is advanced into the space near the spinal cord and a small dose of
either a narcotic or local anesthetic is injected into the space. This affects
only sensory function, which enables the patient to walk and move about during
labor. This technique is normally used during the early stages of labor.
Pain Relief Options
are many options for women seeking a nonmedical pain relief for labor and
delivery. They focus on reducing the perception of pain without the use of
medication. Some of these include:
electrical nerve stimulation (TENS)
Induction of Labor
can be artificially induced in several ways. The method chosen will depend on
several factors, including:
- how ready your cervix is for labor
- whether this is your first baby
- how far along you are in the pregnancy
- if your membranes have ruptured
- the reason for the induction
reasons your doctor may recommend induction are:
- when a pregnancy has gone into week 42
- if the mother’s water breaks and labor doesn’t
begin shortly thereafter
- if there are complications with the mother
of labor is usually not recommended when a woman has had a previous C-section
or if the baby is breech (bottom down).
hormone medication called prostaglndin, a medication called misoprostol, or a
device may be used to soften and open the cervix if it’s long and hasn’t softened
or started to dilate.
the membranes may induce labor for some women. This is a procedure in which
your doctor checks your cervix. They will manually insert a finger between the
membranes of the amniotic sac and the wall of the uterus. Natural
prostaglandins are released by separating or stripping the lower part of the
membranes from the uterine wall. This may soften the cervix and cause
contractions. Stripping the membranes can only be accomplished if the cervix
has dilated enough to allow your doctor to insert their finger and perform the
like oxytocin or misoprostol can be used to induce labor. Oxytocin is given
intravenously. Misoprostol is a tablet placed in the vagina.
regularly monitors your baby’s position during prenatal visits. Most babies
turn into a head-down position between the week 32 and week 36. Some don’t
turn at all, and others turn into a feet- or bottom-first position. Most doctors
will try to turn a breech fetus into a head-down position using external
cephalic version (ECV).
an ECV, a doctor will try to gently shift the fetus by applying their hands to the mother’s abdomen, using an
ultrasound as guidance. The baby will be monitored during the procedure. ECVs
are often successful and can reduce the likelihood for a C-section delivery.
national average of births by C-section has gone up dramatically over the last
few decades. According to the Centers for Disease Control and Prevention, about 33 percent of mothers in the United
States give birth by this method. A C-section is often the safest and quickest
delivery option in difficult deliveries or when complications occur.
C-section is considered a major surgery. The baby is delivered through an
incision in the abdominal wall and uterus rather than the vagina. The mother
will be given an anesthetic before surgery to numb the area from the abdomen to
below the waist. The incision is almost always horizontal, along the lower
portion of the abdominal wall. In some situations, the incision may be vertical
from the midline to below the belly button.
incision in the uterus is also horizontal, except in certain complicated cases.
A vertical incision in the uterus is called a classical C-section. This leaves
the uterine muscle less able to tolerate contractions in a future pregnancy.
mouth and nose will be
suctioned after delivery so that they can take their first breath, and the
placenta will be delivered.
women won’t know if they’ll have a C-section until labor begins. C-sections may
be scheduled in advance if there are complications with mother or baby. Other
reasons a C-section may be necessary include:
previous C-section with a classical, vertical incision
fetal illness or birth defect
mother has diabetes and the baby is estimated to weigh more than
infection in the mother and high viral load
or transverse fetal position
Vaginal Birth After
once thought that if you’ve had a C-section, you’ll always need to get one to
deliver future babies. Today, repeat C-sections are not always necessary. Vaginal
birth after C-section (VBAC) can be a safe option for many.
who have had a low-transverse uterine incision (horizontal) from a C-section
will have a good chance at delivering a baby vaginally. Women who have had a
classic vertical incision should not be allowed to attempt a VBAC. A vertical
incision increases the risk of a uterine rupture during a vaginal birth.
important to discuss your previous pregnancies and medical history with your
doctor, so they can assess whether VBAC is an option for you.
are times towards the end of the pushing stage where a woman may need a little
extra help in delivering her baby. A vacuum extractor or forceps may be used to
assist in delivery.
episiotomy is a downward cut at the base of the vagina and perineal muscle to increase
the opening for the baby to come out. It was once believed that every woman
needed an episiotomy to deliver a baby. Episiotomies are now typically only performed
if the baby is distressed and needs help getting out fast. They are also done if
the baby’s head delivers but the shoulders get stuck
episiotomy may also be performed if a woman has been pushing for a very long
time and can’t push the baby past the very lower part of the vaginal opening.
Episiotomies are generally avoided if possible, but the skin and sometimes
muscles may tear instead. Skin tears are less painful and heal faster than an