Labor and Delivery
When her due date approaches, an expectant mother may look for signs that labor may be starting. Certain signs may suggest that labor may be starting soon. 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 as the labor process begins. If a woman suspects that she is indeed 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 house 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 baby may "drop" or move into the lower part of the pelvis. The cervix may 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:
- Lower back pain or cramping that does not subside
- Cervix begins to open or dilate
- Uterus begins to contract at regular intervals
- Rupture of membranes (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.
Stages of Labor and Delivery
The process of labor and delivery occurs in three stages beginning with the onset of labor. Depending on their preference or birth plan, some women may choose to experience the first phase of labor at home and as it progresses to active labor, they may choose to go to a hospital or medical facility. In a hospital setting, the heart rate and vital statistics of both mother and unborn baby are monitored during the labor process. The health and safety of the mother and unborn baby should always be considered first 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 may indicate that the mucus plug has been shed from the cervical opening. This phase may last from 6 to 12 hours but may occur more rapidly in women who have given birth before. Contractions become more frequent and much more intense during active labor and the cervix continues to dilate. An epidural may be administered for pain. The membranes around the amniotic sac may rupture (water breaks). Active labor may 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 and deliver the baby. When the top of the baby's head fully appears (crowns), the doctor or midwife will advise the mother to push and will help deliver the baby. If necessary, the doctor may make a small incision to the enlarge the vaginal opening (episiotomy) to 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 afterbirth (placenta). This stage may last from 5 to 30 minutes. After the baby is delivered, contractions will continue and the mother may experience chills or shakiness. Usually, the woman will push one more time and the placenta is expelled 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 and many women find they are able to relax more and find relief from the use of medication. Other women may choose to experience labor and delivery without pain medication and use natural methods of pain relief such as a warm shower or bath, music, massage, or the assistance of doula. Childbirth can be a different experience for each woman and the methods used to relieve pain can vary based on the health and safety of the mother and child, as well as the recommendations from her doctor.
Complications of Labor and Delivery
In most cases, the labor and delivery process will occur without any complications. In some cases however, a cesarean section (c-section) may be necessary when unexpected problems arise during labor or delivery. During a c-section, a doctor surgically removes the baby through the mother's abdomen. It takes place in the operating room of a hospital. A c-section may be necessary when:
- The baby is in a breech position
- The baby 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 any underlying health problems such as a heart condition, or an HIV or herpes infection. Because of the possibility that a c-section may be necessary, most women with high risk pregnancies are advised to go to a hospital when they are in labor.