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White-Wilson Medical Center -- The Center for Women's Health

Labor and Delivery

Labor

You cannot predict when labor will start. Still, there are some things you can do ahead of time to be ready. For instance:

  • Pack your bag for the hospital. Leave jewelry and other valuables at home.

  • Plan your hospital route. Know how long it will take to get there. Consider distance, means of transportation, time of year, time of day, who will take you, and if you need a babysitter.

  • Ask whether to call your doctor first or go to the hospital first when you go into labor. Get a car safety seat to bring your baby home.

True Labor Versus False Labor

In the last weeks of pregnancy, your uterus might start to cramp. These cramps may become uncomfortable or even painful as you get closer to your due date. These irregular cramps are called Braxton–Hicks contractions, or false labor. Many women have them.

One good way to tell true labor from false labor is to time the contractions. Time how long each lasts and how long it is from the start of one to the start of the next. It is hard to time labor pains if they are weak. Keep a record for an hour. Ask your doctor when you should call him or her.

Usually, you do not need to go to the hospital as soon as your contractions begin. While you wait at home, rest if you can. Some women may find it more comfortable to walk around or to take a shower or a warm bath. Discuss eating during labor with your doctor. You may be told not to eat or drink anything once labor has begun.

Are You Really In Labor?

Hint

False Labor

True Labor

Timing of contractions

Contractions often are irregular; they do not get closer together as time goes on.

Contractions come at regular intervals and get closer together. They last 30–90 seconds.

Change with movement

Contractions may stop when you walk, rest, or change.

Contractions keep coming no matter what you do.

Strength of contractions

Contractions often are weak, and they tend to stay that way; or strong contractions are followed by weaker ones.

Contractions steadily get stronger.

Pain on contractions

Pain usually is felt only in the front.

Pain usually starts in teh back and moves to the front.

It IsTime to Go to the Hospital If . . .

  • Your amniotic sac ruptures (your "water breaks"), even if you are not having any contractions. Write down the time it happens.

  • You are bleeding from the vagina, more than spotting.

  • The contractions come 5 minutes apart or closer.

  • You have constant, severe pain. Call your doctor right away.

  • If you are less than 37 weeks pregnant and having regular uterine contractions, you may be in preterm labor. Call your doctor right away.

Stages of Labor

Cervix Closed

First Stage
This stage is usually the longest. It begins when the cervix starts to open and ends when it is completely open (fully dilated). Blood-tinged mucus is passed from the vagina (“show”). Near the end of this stage, contractions become longer and stronger.

 

Cervix Open

Second Stage
Once your cervix is fully dilated, the baby needs help to move
down the vagina. You will be asked to push the baby out by bearing down during each contraction, until the baby is born. This is a lot of work. The second stage may last up to 3 hours or longer, especially during a first birth. It ends with the birth of the baby.

 

PlacentaThird Stage
After the baby is born, the uterus will continue to contract and the placenta will be delivered. These contractions are closer together than the contractions that push out the baby. Third StageThey usually cause less pain. This last stage may last from just a few minutes to 15–20 minutes.


 

 


What Happens During Labor

Knowing what happens in labor makes it easier for you to relax and do your part. On average, labor lasts about 12–14 hours for a first birth. In later births, labor may be shorter.

Labor is divided into three stages. During each stage, certain changes take place in your body. Labor begins when the uterus contracts and the cervix starts to open. The uterus tightens and relaxes at regular intervals, causing the abdomen to feel hard, then soft. These are contractions. They make the cervix thin out (efface) and open as wide as it can (dilate). Early labor is often felt as a low backache that moves around to the front. As labor continues, the contractions come closer together, last longer, and are usually felt in the lower abdomen.

Contractions help the baby come through the vagina. Throughout labor, the baby moves deeper into the pelvis and farther down in the vagina. The baby’s head and body move and turn for the easiest fit through your pelvis.


Monitoring During Labor

The heart rate of the fetus usually is monitored during labor to help alert your doctor to warning signs. The doctor and nurse can listen to the fetal heartbeat at certain intervals, often after a contraction. The heartbeat can be heard with a type of stethoscope or an ultrasound device.

Electronic fetal monitoring uses electronic equipment to measure the fetus’s heart rate and uterine contractions. This monitoring can be done with instruments attached to the woman’s abdomen (external). It also can be done by having a small device attached to the scalp of the fetus (internal). Sometimes both types of devices are used.


Pain Relief

For most women, having a baby involves some pain. There are several ways to help you deal with the pain.

Relaxation techniques give some women very good control of the discomfort of labor. These techniques include breathing in certain patterns and imagining you are elsewhere. They are often taught in prenatal classes. Your labor nurse also may be able to teach you.

Analgesics are drugs that ease pain. They can be injected into the muscle or vein. These may make you more comfortable and allow you to rest between contractions.

Anesthetics are drugs that remove pain. Local anesthesia numbs a small area. Regional anesthesia (spinal anesthesia or epidural anesthesia) takes away painful feeling in the uterus and pelvic area. You may still feel the baby move through the birth canal. This type of pain relief allows you to be awake and take part in the birth of your baby without feeling as much pain.


Delivery

The hospital is the safest place to give birth to your baby. Ask to tour the hospital in advance so that you know what to expect. That way, once you are in labor and arrive at the hospital, you will know where to go.


Preterm Labor

The following signs may suggest preterm labor:

  • Vaginal discharge
  • Change in type of discharge (watery, mucous, or bloody)
  • Increase in amount of discharge
  • Pelvic or lower abdominal pressure
  • Low, dull backache
  • Abdominal cramps, with or without diarrhea
  • Regular contractions or uterine tightening

Vaginal Delivery

Most women give birth to their babies through the vagina. When your baby’s head appears at the opening of the vagina, the tissue of the vagina becomes very thin and tightly stretched. Sometimes it is not possible for the baby’s head to fit through without tearing the woman’s skin and muscles. Your doctor may make a small cut in the vaginal opening while it is numbed with an anesthetic. This is called an episiotomy.

Sometimes the doctor needs to help delivery along. In these cases, forceps or vacuum cups can be used.


Cesarean Delivery

In some cases, a cesarean birth may be needed. Cesarean birth is delivery of the baby through a cut made in the woman’s abdomen and uterus.

Sometimes the decision to have a cesarean birth can be made before labor begins. Other times a cesarean birth may be needed during labor. The baby may be too large for vaginal delivery. Sometimes, opening of the cervix may be slow or incomplete. The fetus’s heart rate may decrease or slow for a long time. Cesarean birth also may be needed because of a problem for the woman, such as heavy bleeding.

Some women who have had a cesarean birth can have a vaginal birth in a later pregnancy. This is called vaginal birth after cesarean delivery (VBAC). It is not the right choice for all women and there are some risks. Talk to your doctor to find out if VBAC is an option for you.


Postpartum

After delivery your temperature, pulse, breathing, and blood pressure will be checked often. During this time, you can begin getting to know your new baby.

Unless you or your baby has a medical problem, you will be able to hold the baby. If you had planned to breastfeed, you may be able to start now.

Most women spend about 1–2 days in the hospital after a vaginal birth. If you had a cesarean birth, or if problems occur, you will likely stay longer.

Check with your hospital about who is allowed to visit. You may choose not to have visitors for a while. This gives you more time to rest and to learn about your baby.

Help may be available to teach you some of the beginning skills of being a parent, such as feeding, bathing, and changing the baby’s diaper. This can help you to feel more comfortable in the way you handle your newborn.

Before you go home, your baby may begin to get vaccines. They protect against diseases like rubella and hepatitis. Ask your baby’s doctor what shots your baby should receive and when.


Your Changing Body

While you were pregnant, your body worked round-the-clock for 40 weeks to help your baby grow. Now that your baby is here, there is more work to be done as your body recovers from pregnancy, labor, and delivery. It will take time for things to get back to normal.

Lochia

Once your baby is born, your body sheds the blood and tissue that lined your uterus. This vaginal discharge is called lochia.

For the first few days after delivery, lochia is heavy and bright red. It may have a few small clots. Use sanitary pads instead of tampons.

As time goes on, the flow gets lighter in volume and color. A week or so after birth, lochia often is pink or brown. By 2 weeks postpartum, lochia often is light brown or yellow. After that, it slowly goes away.

Return of Menstrual Periods

If you are not breastfeeding, your period may return about 6–8 weeks after giving birth. It could start even sooner.

If you are breastfeeding, your periods may not start again for months. Some nursing mothers do not have a period until their babies are fully weaned.

After birth, your ovaries may release an egg before you have your first period. This means you can get pregnant before you even know you are fertile again, even if you are breastfeeding. If you do not want another baby right way, start using birth control as soon as you resume having sex. Talk with your doctor about which method is best for you.

Your Abdomen

Right after delivery, your uterus is hard and round and can be felt behind your navel. You may still look like you are pregnant. During pregnancy, the abdominal muscles stretched out little by little. So give your body time to go back to normal. Exercise will help. Ask your doctor when it is safe to start exercising.

You also may have backaches after delivery. Your stretched abdominal muscles do not help your back muscles support your weight. To prevent a sore back, practice good posture, support your back when you breastfeed, and try not to lift anything heavier than your baby for a while.

Easing Discomforts

After your baby’s birth your body will feel sore but most aches will not last long. Following are some ways to relieve postpartum aches and pains.

Afterbirth Pains

Your uterus contracts and then relaxes as it shrinks back to its normal size. These cramps are sometimes called afterbirth pains. If you have given birth before or you are breastfeeding, they may be more painful. They will go away in just a few days. In the meantime, take an over-the-counter pain reliever.

Painful Perineum

The perineum, the area between your vagina and rectum, stretches during delivery. You may have had an episiotomy or your perineum may have torn. Any of these causes may make this area feel sore and look swollen and bruised.

To ease discomfort and speed healing:

  • Apply cold packs or chilled witch-hazel pads to the area.

  • Take sitz baths. Soaking in a few inches of warm water will bring relief.

  • Use a water bottle you can squeeze to soothe the area with a stream of warm water after you urinate.
  • Always wipe from front to back after you use the toilet. This will help prevent a healing episiotomy or tear from getting infected with germs from your rectum.

Hemorrhoids and Varicose Veins

If you had varicose veins in your vulva or hemorrhoids during pregnancy, they may get worse after delivery. These sore, swollen veins also can show up for the first time now because of the intense straining you did during labor.

For relief, try medicated sprays or ointments, sitz baths, and cold witch hazel compresses. If hemorrhoids make bowel movements painful, be sure to eat a diet rich in fiber and drink plenty of fluids. A stool softener also may help. Ask your doctor before taking one. Although constipation is common after giving birth, try not to strain when you have a bowel movement. This can worsen hemorrhoids. In time, they will get smaller or go away.

Urinary Problems

In the first days after delivery, you may feel the urge to urinate but cannot pass any urine. You also may feel pain and burning after you urinate. This usually goes away within days of delivery.

To lessen swelling or pain, try a warm sitz bath. To help trigger the flow of urine, spray warm water over your genitals with a squeeze bottle. Running the tap while you are in the bathroom also may help. Be sure to drink plenty of fluids. If you still cannot pass urine regularly, contact your doctor.

Some women may have problems with leaking urine after delivery. With time, the tone of your pelvic muscles will return and the problem will go away in most cases. Kegel exercises also will help tighten these muscles (see box). If urinary problems persist, let your doctor know. There are treatments he or she can offer.

Swollen Breasts

Your breasts fill with milk about 2–4 days after delivery. When this happens, they may feel very full, hard, and tender. The best relief for this engorgement is breastfeeding. If you are not breastfeeding, avoid rubbing your breasts. Wearing a good-fitting support bra or sports bra may help ease the pain. Severe engorgement should not last more than about 36 hours. If you develop fever and redness, call your doctor. You could have an infection.

Cesarean Incision

If you had a cesarean birth, your doctor will tell you how to take care of your incision after delivery. It will take a few weeks to heal. You should check your incision for numbness, soreness, and pain. If you have fever or heavy bleeding, or the pain gets worse, call you doctor and follow his or her advice. These may be signs of infection.


Kegel Exercises

Kegel exercises are used to strengthen the muscles that surround the openings of the rectum, vagina, and urethra. Just like doing sit-ups to flatten your abdomen, these exercises only work when the right muscles are used, the “squeeze” is held long enough, and enough repetitions are done.

Your doctor or nurse will ask you to squeeze your sphincter muscles as if you were stopping a bowel movement. When you begin the exercise program, place a hand on your abdomen to make sure you do not squeeze those muscles. Also do not squeeze your thighs or buttocks.

Squeeze your pelvic muscles for 10 seconds, 10–20 times in a row. Your doctor will tell you how many times a day to perform the exercises and how long you should keep doing them.


Emotional Changes

Women have many different emotions after childbirth. Having a baby can be an exciting time. For some women, this is a time of stress and, at times, sadness.

The Baby Blues

Nearly 70–80% of new mothers get the baby blues. About 2–3 days after birth, you may begin to feel anxious, sad, and upset. For no clear reason, you may feel angry with the new baby. These feelings are scary, but they fade quickly. The baby blues tend to last from a few hours to a week or so. Most often, they go away without treatment. Until then, do the following to help you:

  • Talk to your partner or a good friend about how you feel.

  • Ask your partner, friends, and family for help.

  • Get out of the house each day, even if it is only for a short while.

  • Join a new mothers’ group and share your feelings with the women you meet there.

Postpartum Depression

For some women, new motherhood brings with it more intense feelings. About 10% of new mothers have postpartum depression. This is marked by feelings of despair, severe anxiety, or hopelessness that get in the way of daily life. It can occur after any birth, not just the first.

Postpartum depression is more likely to occur in women who have had one or more of the following:

  • Mood disorders before pregnancy.

  • Postpartum depression after a previous pregnancy.

  • Recent stress, such as losing a loved one, family illness,
    or moving to a new city.

If you are prone to depression, seek professional help and enlist support from your loved ones before your baby arrives. Treatment and counseling will help relieve postpartum depression. Talk to your doctor right away if you have any of these signs of depression:

  • Baby blues that last for more than 2 weeks.

  • Strong feelings of depression or anger that come 1–2 months after birth.

  • Not finding pleasure in things that used to make you happy.

  • Intense concern and worry about the baby.

  • Lack of interest in or feelings for the baby or your family.

  • Panic attacks, such as being afraid to be left alone with the baby.

  • Thoughts of harming the baby or yourself.

Return to Daily Living

Having a baby will change the way you live your daily life. Your relationship with your partner will be affected. Your old routines may no longer work. If you know this in advance, you will be a lot more relaxed as you start your life with the new baby.

Your partner also is going through a lot of changes right now. The needs and concerns of partners can be overlooked, with the focus on you and the baby. It is important to spend time together as a family.

Going Back to Work

If you work outside of the home, there are many factors to take into account when thinking about going back to work, such as finances and child care. You also will want to decide about going on with breastfeeding when you go back to work.

No matter what you choose to do, try to discuss it with your partner before the baby is born. Be careful to build in some time for yourself. You cannot know how you will feel about work until after your baby is born.

Sex And Family Planning

Your doctor will suggest when you can resume having sex. It likely will be a month or so after delivery. Make sure your partner understands this, too.

When you and your partner are ready to start having sex again, it is vital to start thinking about birth control. Birth control can allow your body to heal before having another baby and allow you to plan your family. Talk with your doctor about which method is best for you and how long to plan between pregnancies.

Your Follow-up Visit

You will have a postpartum visit with your doctor to make sure that your body has recovered from pregnancy and birth and that you are not having any problems. This visit usually is done within 6 weeks of the birth of your baby. If you had a cesarean birth, your doctor may want to see you sooner to check the incision.

Use this time to bring up any questions or concerns you have about the healing process, breastfeeding, birth control, weight loss, sex, or your emotions. To help you remember everything you want to talk about, jot down any questions you have and bring them with you to this visit.


Finally...

You can improve your chances of having a healthy baby by leading a healthy lifestyle during pregnancy and getting proper prenatal care. Learn as much as you can before the birth of your baby. Know your own body and what to expect during pregnancy, labor, and delivery.


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