During the last weeks of pregnancy, new changes
will signal the approaching birth. For example, you may feel that
the baby is lower in your abdomen, and people may tell you that it
looks as though your baby has "dropped." This is called
"lightening" and it means that the baby's head has
settled down into the bony part of your pelvis. Sometimes this
happens quickly and you find it suddenly easier to breathe.
Sometimes "lightening" does not occur until after labor
Contractions of the uterus late in pregnancy
are normal. They are called "false labor" because they
do not open the cervix as does true labor. There are some signs to
help you distinguish between false labor and the real thing:
The contractions of false labor are usually
The contractions of false labor often go
away when you walk around in real labor, they'll feel
The contractions in real labor get stronger
and closer together with time.
You may notice some tightening in your lower
abdomen or even occasional contractions of the uterus late in
pregnancy. These contractions will go away when you walk around or
practice your breathing techniques. If they do not go away,
contact your doctor.
Signs of Labor
The beginning of labor is a very individual
thing. Some women don't even realize they are in the first stage
of labor, mistaking it for gas, heartburn, backache, or
There are three signs that labor has begun.
They do not necessarily occur in any particular order and they may
occur in a different order with each pregnancy. They are:
Contractions occur because your uterus is
tightening and relaxing to help open the cervix and push the baby
out through your birth canal. During the early part of labor this
may feel like menstrual cramps. Some women feel only abdominal
contractions or only a backache. Contractions of true labor occur
regularly. They usually start about 15 to 20 minutes apart and
last 30 to 45 seconds. As your labor proceeds, the contractions
become more frequent and last about 60 seconds. If you walk around
or lie down they will not go away as they did in false labor.
As your baby pushes against the cervix or neck
of the uterus, the cervix opens and a pink colored
"show" or plug of mucus comes loose. Also, there is
generally a small amount of blood.
A flow of water from your vagina indicates the
breaking of the membrane or "bag of waters" that
surrounded the baby during pregnancy. There is no pain; it just
feels like a flow of warm water. You can lose about a quart of
water, but the amount depends on where the sac breaks. You may
continue to lose fluid as your body continues making it. Sometimes
the "bag of waters" breaks at the beginning of labor and
sometimes it happens late in the first stage of labor.
Call your doctor immediately when your membrane
or "bag of waters" breaks or when your contractions are
regular and 15 minutes apart. For the first child the doctor will
probably tell you to come to the hospital when they are 5 minutes
apart. Don't worry that you may not make it; the first stage of
labor is about 8-12 hours long for a first baby. Generally
speaking, if you have had at least one baby your labor will be
shorter than with the first.
At the Hospital
When you arrive at the hospital you usually go
to the admitting office. If there is time, you will be asked for
certain information for your records. If not, the person who
brings you to the hospital may give any information needed. You
are then taken to a maternity admissions room or labor room where
you put on a hospital gown.
As the baby comes down the birth canal, you
will feel as if you have to move your bowels. This is just the
pressure of the baby and nothing else.
The Support Person
Most hospitals permit you to have someone with
you during the labor and some will also allow that person to
accompany you into the delivery room. It is usually the baby's
father, but it may be your mother, an older sister, or your
childbirth education teacher. Be sure to check the hospital's
policy and your doctor's policy about this arrangement since some
only allow people who have attended childbirth classes.
A Note to the Father
Throughout the childbirth classes you and your
partner have been studying the birth process, learning breathing
exercises and the ways you can make her more comfortable during
delivery. Nothing, however, can fully prepare you for
participating in your first labor and delivery.
Remember, this is a very special time for both
of you. Even if you have not attended childbirth classes you may
want to be present at the birth of your child.
Do not be surprised at your partner's behavior
or at anything she says. Help her through the labor and delivery
and don't give up. She needs your support and caring. Remember,
this is also your chance to be present at your child's first
Stages of Labor
Labor means work. During this time, you have to
work to help the baby move from your uterus into the world. It may
be some of the hardest work you will ever do. Your cervix, which
is made up of firm tissue shaped like a small doughnut with a tiny
hole in the center, has been closed throughout the pregnancy. Now
it must stretch wide enough for the baby to pass through. The
uterus tightens or contracts and forces the opening wider, little
by little, over a period of several hours. Contractions feel
different to different women. Some describe them like a wave that
builds to a peak and then recedes.
Labor is divided into stages. During the first
stage of labor your cervix will dilate (opening to the fullest),
so that the baby can pass through. The second stage of labor
begins when you push the baby out of the uterus into the birth
canal and ends when the baby is born. The third stage is when the
placenta (afterbirth) is expelled. The whole process of labor
lasts about 12-14 hours for a first baby and about 7 hours for
During the first stage of labor, you will be
examined regularly to see how fast your cervix is opening
(dilating). This is done by a vaginal examination. The doctor
measures the cervical opening in centimeters. When the cervix is
open to its fullest, 9 to 10 centimeters, the opening is large
enough for the baby to pass through.
Cervix fully dilated
A nurse or nurse midwife will probably be with
you most of the time you are in labor. The father of the baby or
other support person may be allowed to stay with you, if you want,
and if hospital rules permit.
To make sure the baby is in good condition
during labor, the doctor or nurse will check the baby's heartbeat,
either by listening with a stethoscope or by electronic fetal
monitoring through wires taped to your abdomen.
When the cervix has opened wide enough the
baby's head will begin to pass through. If the bag of waters has
not already broken, it will at this time, causing a gush of fluid
from the vagina.
In the second stage of labor, the baby is
pushed through the open cervix, through the birth canal (vagina),
and is born. This stage is much shorter than the first, about 1
1/2 hours for first babies, and 30 minutes or less with later
children. Contractions during this part of labor are about 2 to 3
minutes apart and last about a minute.
As the baby moves, little by little, through
the birth canal, it puts pressure on the rectum and causes an urge
to "bear down" as though having a bowel movement. The
doctors and nurses may ask you to use special breathing techniques
while bearing down. Pushing usually relieves some discomfort and
shortens labor. However, it is important not to start this pushing
until the doctor says to do so.
You will now be moved from the labor room to
the delivery or birthing room (In some hospitals the labor and
delivery rooms are the same room). Here you will be placed on the
delivery table, with support for your feet and legs. Drapes will
then be placed over your legs and abdomen. A large mirror may be
overhead, and can be turned so that you can watch your baby being
born. Once the scalp is visible, pushing with the next few
contractions will bring the baby into the world.
In the third stage of labor, the placenta and
membranes pass out the vaginal opening. This generally happens
within 5 to 30 minutes after the baby is born.
Medications for Pain and Anesthesia
During labor your contractions may cause you
much discomfort. You may request medicines to help relieve the
pain. The doctor will select the most appropriate medicines taking
into account how you and your baby are doing.
Analgesics are medicines that relieve pain.
They are sometimes administered by injection to help relieve the
pain associated with contractions.
Anesthetics are medicines that completely
deaden feeling in part or all of your body. General anesthesia,
which puts the patient to sleep, is rarely used today because it
can cause breathing problems for the baby. In addition, general
anesthesia can make you nauseated and cause you to vomit when you
Regional anesthesia is used most commonly
today. This method of anesthesia deadens pain in limited areas of
your body but allows you to remain awake to help your baby come
into the world. With regional anesthesia, you and your baby are
generally not as subject to the bad effects associated with
general anesthesia. You should discuss any risks with your doctor.
Your physical condition, that of the baby, your progress in labor,
and your desire to participate in the delivery will help you and
your doctor decide which, if any, anesthetic you are going to use.
There are a number of different techniques used
to administer the anesthetic. Each has advantages and limitations.
For example, while the anesthetic may relieve pain, it may also
weaken the contractions and thus slow labor. Also, some anesthetic
may reach the baby. Ask your doctor to explain the various
methods. They include the following:
Spinal anesthesia involves a single injection
directly into the spinal fluid in the lower back to block the pain
carrying nerves. A "saddle block" is a spinal injection
that is given in the back to anesthetize a smaller area.
Epidural anesthesia consists of injections of
small amounts of anesthetics near the spinal nerves several times
Caudal anesthesia consists of one or more
injections near the tailbone.
Pudendal and paracervical blocks consist of
injections through the walls of the vagina and near the cervix,
An episiotomies is a small cut made between
your vagina and anus to allow more room for the baby to be
delivered. Making this cut prevents possible tearing of your
tissue and is done only when necessary. A few stitches are used to
close it. These stitches are absorbed during the postpartum period
and do not need to be removed. Before labor ask your doctor or
nurse midwife about their policies for making an episiotomies.
There are techniques that can be used to help avoid this
Instruments Used in Delivery
Forceps are used in the delivery of your baby
only if the doctor feels that pressure on the baby's head must be
relieved and if the birth of the baby is not progressing. The
baby's welfare is always foremost and forceps are never used in
ways that could be harmful to the baby.
Natural or prepared childbirth classes are
designed to help you understand pregnancy, labor, delivery, and
birth, and to have your baby with little or no anesthesia, pain
relieving medicines, episiotomies, or instruments. Both the mother
and a support person, generally the father, are taught about
breathing and muscle relaxation methods. During labor the support
person keeps the mother comfortable, helps with techniques for
breathing and relaxation during contractions, and provides
reassurance and encouragement. Some women who use a prepared
childbirth method need no anesthetics or pain relievers at the
time of delivery. However, taking these classes does not mean you
cannot have pain relievers or anesthetic if you and your doctor
should decide you want and need them. If you are interested in
prepared childbirth, discuss it with your doctor or nurse midwife.
The doctor and delivery room staff must participate if this method
is to be effective.
Your doctor can help you find a class or
teacher to instruct you in prepared childbirth techniques. Also,
there are a number of books on the subject. Even if prepared
childbirth is not for you, you can still benefit from regular
A cesarean delivery or C Section is an
operation in which the baby is delivered through an incision in
your abdomen rather than through the vagina. Even though a
cesarean delivery is considered major surgery, the risk is
The cesarean delivery is performed only when
the risks of vaginal delivery outweigh the benefits. The cesarean
is used when vaginal delivery would threaten the life or safety of
the mother or infant, when a previous child has been delivered by
cesarean, or in the presence of certain diseases and conditions.
Most babies enter the birth canal head first.
Rarely, a baby may enter the birth canal in another position. A
breech baby is one whose feet or buttocks enter the birth canal
first. This usually makes labor longer and more difficult for the
baby, so you are most likely to have a cesarean section if your
baby is in a breech position. Your doctor will let you know if
your baby is in a breech position and will tell you what to
Immediately after birth, your baby is held with
the head lowered to assist in the drainage of amniotic fluid,
mucus, and blood. A small bulb syringe may be used to suction the
mouth and nose. The cord is then clamped, the baby is dried, and
warmth is insured with blankets, heat lamps, or a heated bassinet.
Oftentimes the baby is placed on your chest immediately after
birth to establish skin-to-skin contact.
Drops to prevent infection will be put into the
baby's eyes and identification bands will be placed on you and the
baby before leaving the delivery room. The baby's hand and foot
prints may also be taken.
The Recovery Room
Before going to your own room, you may be taken
to a recovery room for an hour or two. Here you will be watched
closely and checked frequently for any excessive bleeding or
unusual change in blood pressure. The baby's father may be allowed
in the recovery room with you. If there is no recovery room, you
may stay in the delivery room for an hour or so.