The last weeks of pregnancy may feel like a time of waiting … and waiting. This is especially true if your baby is overdue. As you anticipate the start of labor, it may seem as if time is standing still.
WHILE YOU WAIT
So what do you do while you wait for that little one to arrive? Get ready. Here’s a to-do list.
Review your birth plan Labor is work and not really a time to be making decisions. Discuss with your care provider beforehand his or her preferences and usual practices. For example, when would medication be used to accelerate labor? Is your care provider comfortable with birthing positions other than the traditional one of lying on your back? Under what circumstances would a cut to enlarge the vaginal opening (episiotomy) be performed?
In addition, find out when you should notify your care provider once you’re in labor. Should you go directly to the hospital, call ahead to the hospital or call the care provider’s office first? Are there any other steps your care provider wants you to take?
And remember, not everything may go according to plan. Most women giving birth for the first time don’t have an accurate perception of what it will be like, and they may think that they’re going to be better at coping with the labor process than they actually are. In addition, problems may occur that no one expected. Control what you can — but be ready to let go of what you can’t control.
COMMON QUESTIONS
When discussing labor and childbirth with your care provider, don’t be embarrassed by any question. For example, you may be wondering:
What if I have to go to the bathroom during labor? Some women will be able to get up and urinate every few hours. Your care provider will probably encourage you to do so because a full bladder may slow down the baby’s descent. However, it may be difficult to sense a full bladder when you’re having contractions, especially if you’ve had an epidural. Or you may not want to move, out of fear that doing so will worsen the contractions. Your care team may provide you with a bedpan or empty your bladder with a catheter. Occasionally, a small amount of stool is expelled during birth. This is perfectly normal and nothing to worry about.
Will my pubic hair be shaved? Not likely. Shaving a pregnant woman’s pubic hair used to be standard practice, to clean the site for delivery. Now shaving is rarely, if ever, done. You don’t need to shave at home beforehand.
Will I have to bare myself in front of a lot of strangers? During labor, the team caring for you will perform periodic vaginal exams to check how you’re progressing. A pediatrician also may be present to examine the baby after birth. Who else you have in the labor room or birthing room is largely up to you. Medical professionals who help deliver babies see births almost every day, so they’re used to the messy but awesome experience of birth. At some university hospitals, medical students may observe a labor and delivery, if it is OK with the laboring mother. Remember that medical students are also professionals and may be able to lend a hand or extra support, so consider their presence an advantage.
What if I make loud noises during labor? Labor is a physical act that requires your participation. You may make straining or grunting noises during the workout of labor. Birth is rarely silent; it takes too much physical and emotional effort to expect silence. It’s perfectly normal to make noise during labor and delivery. Medical professionals who help deliver babies won’t be shocked in the least.
Does labor hurt my baby? During the most difficult phases of labor and delivery, your baby is squeezed and pushed down the narrow vaginal canal. Your baby must also corkscrew through the bony passageway of the mother’s pelvis. However, it’s unlikely that this hurts the baby. During intense labor, the baby’s heartbeat slows down intermittently in response to the stress of the journey. This is expected and not serious.
Preregister at the hospital Ask about preregistering at the hospital or birthing center where you plan to deliver. Filling out the necessary paperwork and sorting out insurance matters ahead of time can save you extra work when the big day finally arrives. Face it; it’s no fun to be doing paperwork between contractions.
Pack your bag Because your due date isn’t a given, it’s a good idea to have your bag packed and ready for the hospital ahead of time. Here are some items you may want to have on hand:
A watch or a phone app that counts seconds, for timing contractions
Socks or slippers — labor rooms are often kept cool
Glasses — you may have to remove your contact lenses
Lip balm for dry lips
A camera or video camera
Pajamas or a nightgown that opens in front to allow for easy breast-feeding
A robe
A nursing bra or, if you plan to bottle-feed, a supportive bra
Underwear
Toiletries, cosmetics and a hair dryer
Loose clothing for going home — probably a midpregnancy outfit
A baby outfit, including a hat
A baby blanket
If you don’t want to put everything into your bag yet — your cosmetics, for example — make a list so that you can gather items easily when you prepare to leave. Normally, you don’t have to rush — you might even have time to shower beforehand — but it’s best to be organized. In addition, have a car seat on hand for baby’s ride home.
Try to relax Most women greet the end of their pregnancies with a mixture of anticipation and nervousness. But try not to worry. Women’s bodies are made to accommodate labor and delivery. Labor, as the name implies, is work; that’s true. But you can help make the experience go as smoothly as possible by trying to relax.
Many women experience a spurt of energy in the last weeks of pregnancy, a behavior often referred to as nesting. You may find yourself cleaning like mad and anxious to start any projects that you’ve put off. Even though the thought of coming home to a clean house may be tempting, don’t wear yourself out.
Focus on savoring this time you have before your baby arrives. Treat yourself to a nice dinner or fun outing. Indulge in a favorite hobby. Read a good book. Cuddle with your partner. Staying busy but relaxed will help time move along.
HOW YOUR BODY PREPARES
As you’re making final preparations for your baby’s arrival, your body is preparing for labor and delivery, as well. As labor approaches, your body undergoes certain changes that signal that your baby likely will be born soon.
Labor signals Some of the changes to watch for include:
Lightening As you approach your due date, you may feel that the baby has settled deeper into your pelvis. This natural step is called lightening. Lightening may be noticeable to you. The profile of your abdomen may change — your belly may seem lower and tilt more forward. You may find that it’s easier to breathe with less pressure on your diaphragm.
In exchange, you’ll likely feel increased pressure on your bladder from the weight and position of the baby as it drops down into your pelvis. You may feel twinges of pain as the baby bumps up against your pelvic floor. And your center of gravity may feel lower, throwing you off balance slightly.
Don’t worry if you don’t feel or notice baby dropping. Some women don’t experience these changes. This is especially true of women who are already carrying their babies low. And unlike with your first pregnancy, lightening generally occurs much later in subsequent pregnancies. The baby may drop into position just hours before the onset of labor or even during labor itself.
Braxton Hicks contractions Throughout your second and third trimesters of pregnancy, you may experience occasional, usually painless contractions — a sensation that your uterus is tightening and relaxing. They’re especially noticeable when you place your hand on your abdomen. These false labor pains are called Braxton Hicks contractions, and they’re your body’s way of warming up for labor. Your uterus is exercising its muscle mass to build strength for the big job ahead. As you approach your due date, these contractions typically become stronger and may even become painful at times.
Bloody show During pregnancy, the opening to your uterus (cervix) is blocked by a thick plug of mucus. This plug forms a barrier between your cervix and vagina so that bacteria can’t enter your uterus and cause an infection. A few weeks, days or hours before labor begins, this plug may discharge and you may have what’s called bloody show. You may notice a small amount of blood-tinged, brownish mucus leaking from your vagina. Some women don’t notice the loss of this plug. Bloody show may be a sign that things could happen soon, although labor could still be a week or more away.
PRESENTATION, POSITION AND STATION
As the end of your pregnancy nears, your care provider may talk to you, in medical terms, about the presentation, position and station of your baby.
Presentation refers to the part of the fetus entering the pelvis, for example, the baby’s head or feet. Throughout your pregnancy, your baby floats in your uterus and changes position somewhat freely. But, usually between the 32nd and 36th weeks of pregnancy, the baby rotates to — ideally — a headfirst position, settling into place for labor and delivery. Sometimes, though, babies may descend feet-first (breech presentation) or lie sideways (transverse lie) within the uterus.
Position refers to the relationship of the presenting part of the fetus to the mother’s pelvis. Is baby facing up or down or to the left or right. The left occiput anterior position is generally the preferred position for delivery.
Station refers to how far your baby’s head has moved into the pelvic cavity as it prepares for childbirth. Station is measured in centimeters, with each station being 1 centimeter. A baby high up in the pelvic cavity is said to be at a −5 station. A baby at 0 station is midway through the pelvis. Once actual labor begins, the baby’s head continues through the pelvis to +1, +2 and +3 stations. At the +5 station, the baby’s head crowns, emerging from the vagina and completing its passage through the pelvic cavity. For most women experiencing their first labor, the baby will already be at 0 station at the onset of labor. For women who are having their third or fourth babies, this may not happen until labor has progressed for several hours.
Signs you’re in labor It’s one of the most common questions care providers hear from expectant mothers: “How will I know when I’m in labor?” You may have heard other mothers say that “you’ll just know,” but you don’t find that very comforting. Subtle signs often announce the start of labor, but it is the onset of labor pains that let’s you know labor has begun — you’ll feel them!
Thinning and softening of the cervix One sign that labor is starting is that your cervix begins to thin (efface) and soften (ripen) in preparation for delivery. As labor progresses, the cervix eventually will go from an inch or more in thickness to paper thinness. Effacement is measured in percentages. If your care provider says, “You’re about 50 percent effaced,” it means that your cervix is half its original thickness. When your cervix is 100 percent effaced, it’s completely thinned out and ready for delivery.
Dilation of the cervix Your care provider may also tell you that your cervix is beginning to open (dilate). Dilation is measured in centimeters, with the cervix opening from 0 to 10 centimeters (4 inches) during the course of labor. Thinning, softening and dilation of the cervix often precede other signs of labor. They can also occur days, even weeks, before actual contractions begin. With a first pregnancy, effacement usually begins before dilation. With subsequent pregnancies, the opposite is often true.
Breaking of water At some point during labor, the bag of water (amniotic sac) housing your baby begins to leak or it breaks, and the fluid that has cushioned your baby flows out of your vagina in a trickle or a gush.
You may fear that your water will break and your labor start while you’re out in public. In reality, few women experience a dramatic breaking of water, and if they do, it usually happens at home.
Most often, a woman’s water breaks while she’s in active labor and already at the hospital. In fact, your care provider may even break your water for you during labor to help move things along or allow more careful monitoring of the baby.
Contractions At the beginning of labor, the uterus begins to squeeze (contract). These contractions are what move your baby down the birth canal. Labor pains (contractions) often begin with cramping or discomfort in your lower back and abdomen that doesn’t stop when you change position. Over time, the contractions become stronger and more regular. To distinguish between false and true labor, consider:
Frequency of your contractions. Using a watch or clock, time your contractions — from the beginning of one to the beginning of the next. True labor will develop into a regular pattern, with your contractions becoming closer together. In false labor, contractions remain irregular.
Length of your contractions. Measure the duration of each contraction by timing when it begins and when it stops. True contractions last about 30 to 45 seconds at the onset and get progressively longer — up to 75 seconds — and stronger. False labor contractions vary in length and intensity.
CAN YOU KICK-START LABOR?
Most pregnant women have heard of at least one folk remedy for starting labor. Perhaps you’ve gotten advice on things you can do to help get labor going, such as:
Frequent walking
Having sex
Exercising
Using a laxative
Stimulating your nipples
Eating spicy foods
Driving on a bumpy road
Fasting
Being frightened
Consuming castor oil
Drinking herbal tea
Keep in mind that most folk remedies aren’t based in science and simply don’t work. Some are even ill-advised. For example, fasting really isn’t good for you or the baby. A few folk remedies have some basis in science. Nipple stimulation, for example, may cause uterine contractions, similar to what happens when a baby breast-feeds right after birth. It’s also biologically plausible that sex might trigger contractions because semen contains substances similar to those used in labor-inducing medications. But that doesn’t mean that your care provider will advise that you try either of these methods. Generally, the best advice is to be patient and let nature takes its course.
WHAT DOES LABOR FEEL LIKE?
Except for perhaps menstrual cramps, labor pain (contractions) may be unlike anything you’ve experienced. That’s because you’re not accustomed to feeling your uterine muscles contracting.
A contraction usually begins high in the uterus — close to your diaphragm — and radiates down the abdomen and into the lower back. You may feel the pain in your lower abdomen, lower back, hips or upper thighs. This sensation has been described as an aching feeling, pressure, fullness, cramping and backache.
For some women, labor pains seem like very strong menstrual cramps. For others, they take on a whole different feeling.
IT’S TIME! — OR IS IT?
Once you’ve started having regular contractions, the next question is: Is it time to leave for the hospital or birthing center, or call your care provider?
Your care provider probably will give you instructions about whom to call and at what point. For example, you may be told to call your care provider when it becomes difficult for you to walk or talk through the contractions. Many women are told to go to the hospital or birthing center after an hour of contractions that come five minutes apart. You may need to leave sooner if your labor seems to be progressing rapidly or your water breaks.
As your due date approaches, keep your car’s gas tank full. You might even make a practice run to the hospital or birthing center if you’re not sure how long it will take you. If you have other children, make arrangements for a friend or family member to come to the house in case you have to leave in the middle of the night.
A false alarm? It’s possible you might leave for the hospital or birthing center with regular contractions that are five minutes apart, and after you arrive, they simply stop. You may even be sent home if your contractions aren’t to the stage called active labor and your cervix isn’t dilating. If this happens, don’t feel embarrassed and try not to feel frustrated. Think of it instead as a good practice run.
Sometimes, telling real labor from false labor can be tricky. When in doubt, call your care provider or go to the hospital. If your water breaks, most care providers want you to come to the hospital. If there are concerns about your health, your care provider may also instruct you to go to the hospital or birthing center sooner rather than later.
If you are sent home, it likely won’t be long before true labor sets in and you’re back at the hospital — this time to stay.
WHAT’S THAT FOR?
If you’ve never been hospitalized, you may find medical surroundings slightly intimidating. But if you understand what’s going on around you, you can better relax. Here’s a list of equipment and supplies often found in a typical delivery room and what each item is used for during the birthing process.
Birthing bed A birthing bed (delivery bed) is usually a twin bed that’s high off the ground. Delivery beds are designed to be practical. The bed can be raised or lowered, and the end of the bed can be removed to facilitate delivery. The bed may have a bar that you can hold on to while you push. Most delivery beds have stirrups that can be pulled out. Sometimes the stirrups are helpful during delivery, or you may need them if you require stitches after the birth.
Fetal monitor This piece of equipment records your contractions and your baby’s heart rate. In external fetal monitoring, two wide belts are placed around your abdomen. The one high on your uterus measures and records the frequency of your contractions. The other belt, usually secured across your lower abdomen, records the baby’s heart rate. The two belts are connected to a monitor that displays and prints out both tracings at the same time so that their interactions can be observed. Fetal monitoring indicates how baby is doing. Specific patterns suggest that labor may be negatively affecting your baby and intervention may be needed.
Blood pressure monitor This device measures your blood pressure throughout your labor and delivery. A cuff goes around your arm just above the elbow and is attached to a measuring instrument.
Other items Your room may also have extra comforts, such as a rocking chair or a birthing chair, stool or ball. You can request extra pillows, blankets and towels. Some rooms have a tub or shower for your use during labor. At some point, a bassinet may be brought into the room for baby to be placed in once he or she is born.
STAGES OF LABOR AND CHILDBIRTH
Labor is a sequence of events, or a process, that takes place over the span of an hour to as long as 24 hours or more. How long your labor will last depends on many factors. As a rule, labor is usually longer with first babies. That’s because the openings of the uterus (cervix) and birth canal (vagina) of first-time mothers are less flexible, and therefore it takes longer for labor and birth. For women giving birth for the first time, labor usually lasts between 12 and 24 hours, with an average of 14 hours. For women who have given birth before, labor usually lasts between four and eight hours, with an average of six hours.
How long labor lasts and how it progresses differs from woman to woman and from birth to birth. However, even though every labor is unique, the sequence of events that takes place remains roughly the same. Labor is formally divided into three natural stages. Stage 1 occurs when the uterus, on its own, opens the cervix to allow descent of the baby. Stage 2 is pushing and delivery — the birth of your baby. Stage 3 is delivery of the placenta (afterbirth).
Stage 1 The first stage of labor is the longest of the stages and is, itself, divided into three phases — early labor, active labor and transition.
Early labor Early labor is the phase when your cervix dilates from 0 centimeters (cm) to a little over 3 cm. This period is usually the least intense phase of labor. Early labor begins with the start of contractions, which vary tremendously from woman to woman. These contractions cause the cervix to thin and pull up around the baby’s head. Repeated contractions eventually stretch the cervix to a full 10 cm, an opening large enough for the baby’s head to pass through.
DILATION OF THE CERVIX
In general, contractions during early labor last from 30 to 60 seconds. They may be irregular or regular, ranging between five and 20 minutes apart. They’re usually mild to moderately strong. You may also experience a backache, upset stomach and, possibly, diarrhea. Some women report a sensation of warmth in the abdomen as labor begins.
Early labor can last for hours, so you may need to be patient. Your cervix needs to soften before it can dilate. Labor doesn’t always begin when your contractions start. You may have irregular, painful contractions for hours or even several days before your cervix dilates, especially if this is your first baby.
How you may feel. With the onset of your first real contractions, you may be giddy with excitement. At the same time, though, you may be scared about the unknown. Try to remain relaxed.
What you can do. Until your contractions pick up in frequency and intensity, do household chores, watch television or a movie, or make phone calls. You may want to relax in a chair or get up and move around. Walking is a great activity because it may help relieve your discomfort. You may also find it helpful to take a shower or listen to relaxing music. It’s OK to drink water or have a light snack.
If you’re experiencing low backache, try ice packs or heat, or switch between hot and cold. Use a tennis ball or rolling pin to apply pressure to the lower back.
The timing and intensity of your contractions will help you know when it’s time to go to the hospital or birthing center or to call your care provider.
At the hospital or birthing center. You will likely be taken to your room, often a labor room, where admission procedures are completed. After you’ve changed into a hospital gown or your own nightgown, you’ll probably be examined to determine how dilated your cervix is. You may be connected to a fetal monitor to time your contractions and check your baby’s heart rate. Your vital signs — your pulse, blood pressure and temperature — may be taken at regular intervals throughout your labor and delivery.
You may have an intravenous (IV) line placed into a vein, usually on the back of your hand or arm. The line is attached to a plastic tube leading to a bag of fluid that drips into your body. The bag hangs on a movable stand, which you can wheel with you when you take a walk or go into the bathroom. The fluid you receive through the IV helps to keep you hydrated. Medications also can be administered through your IV, if needed.
Contractions may start and stop regularly, but then stop for an extended period. If this happens, your care provider may suggest that you take a nap or go for a walk to try and get things moving again. If labor doesn’t start again, your care provider may break your water, if the membranes haven’t already ruptured.
FACTORS THAT SPEED OR SLOW LABOR
Many factors can affect how your labor will progress. They include:
Size of your baby’s head Because the bones of the skull aren’t yet fused together, your baby’s head molds itself to the shape and size of your pelvis as it moves through the birth canal (vagina). If the head moves through at an awkward angle, it can affect the length of your labor.
Position of your baby Babies aren’t always so accommodating — their heads may not be in the most ideal position, and sometimes they’re breech with their buttocks or feet coming first. They may even be sideways in the uterus. See Chapter 28.
Ability of your cervix to thin and open In most labors, the cervix opens as expected, but the speed of that dilation may vary considerably.
Medication Certain medications for pain relief can both help and hinder labor. Some care providers believe that if medications relieve pain early on, they can leave you rested and better equipped for the work of getting baby out. Some medications may interfere with your ability to push, undoing some of their usefulness.
Shape and roominess of your pelvis Your pelvis must be roomy enough for your baby’s head to pass through. Fortunately, babies are generally well-matched to the size of their mothers. Women who have smaller frames, for example, tend to have smaller babies. In rare instances, the size of the pelvis can be a problem and slow labor.
Your ability to push Because you use your abdominal muscles to help push the baby out, the better shape you’re in physically, the more you can assist. If you’ve had a long labor and you’re tired, your pushing may be less effective.
Your physical state If you go into labor healthy and well-rested, you’ll have more strength to work through your contractions. If you’re ill or tired, or the early phase of your labor is particularly long, you may already be exhausted when it comes time to push.
Your outlook If you have a positive outlook and you’re actively involved in your labor and delivery, you’ll cope better and the process may progress more quickly.
Support from staff and your labor coach They can enhance the coping skills necessary for labor and delivery. An atmosphere of caring support gives you peace of mind and helps you remain calm.
Active labor During this phase, your cervix dilates from 3 or 4 cm to nearly 7 cm. Your contractions will become stronger and progressively longer. They may last 45 seconds to a minute or longer. They may be three to four minutes apart, or perhaps even two to three minutes apart. There’s less rest between contractions.
The good news is that your contractions are accomplishing more in less time. Your baby is on the move down through your pelvis as your cervix continues to open. The average woman in her first labor generally dilates at least 1 cm an hour once she reaches 4 cm. If you’ve had a baby before, progression is often faster. Active labor lasts, on average, between three and eight hours.
Throughout active labor, you’ll have occasional pelvic exams to see how your cervix is changing. Your vital signs will likely be checked on a regular basis. If your amniotic sac hasn’t broken already, it may break as your cervix dilates further. Or your care provider may break the water for you.
How you may feel. During active labor, your contractions become more painful, and you may feel increasing pressure in your back. You may be unable to talk through your contractions now. Between contractions you may still be able to talk, watch television or listen to music, at least during the early part of active labor. You may feel excited and encouraged that things are starting to happen.
As your labor advances, your excitement may give way to seriousness as your labor progresses and the pain intensifies. Your smile may fade as you become inwardly focused. You may feel tired and restless. Some women report feeling sensitive and irritable. You may reach a point that you no longer want to talk much. You may even need to have the room quiet and the lights dimmed so that you’re completely free to concentrate on the job at hand.
During active labor, you may need greater help from your labor coach, seeking encouragement as your contractions peak and wane. Or you may react in the opposite manner. You may resist being touched or coached, in an attempt to stay focused and in control.
BACK LABOR
Some women experience back labor — intense back pain, especially during active labor and transition. Often, back labor occurs when the baby is in an awkward position as it enters the birth canal. The baby’s head may be pressing against the mother’s tailbone (sacrum). But that isn’t always the cause. Some women simply feel more tension in their backs than do others.
To relieve back labor:
Have your labor coach apply counterpressure to your lower back. Have him or her massage the area or use hands or knuckles to apply direct pressure.
Apply counterpressure by placing a tennis ball or rolling pin — if you brought either with you — under your tailbone.
Have your labor coach apply heat or cold, whichever feels better to you, to your lower back.
Change to a more comfortable position.
If possible, take a shower and direct the warm water spray on your lower back.
Ask for pain medication if you wish to try to relieve the pain.
What you can do. Use your breathing and relaxation techniques. If you haven’t practiced or learned natural childbirth techniques, your health care team will know some tricks that can help you get through tough times. Give them a try. However, no single strategy works for everyone, so if what is suggested doesn’t work for you, ask for another idea.
Some women find that as the pain intensifies, rocking in a rocking chair, rolling on a birthing ball, or taking a warm shower or bath helps them relax between contractions (see images of labor positions at the end of this chapter). Changing your position may also help your baby descend. Some women find walking helpful. If walking feels comfortable, continue with it, stopping to breathe through contractions. Vary your activities because no single approach is likely to work throughout labor. If these measures aren’t effective, don’t be afraid to request pain medication.
Try to concentrate on relaxing between your contractions. Doing so will help you stay energized through each stage of labor and delivery. Your labor won’t last forever, and the only way through labor and delivery, really, is to go through it with as much determination and concentration as possible.
You may feel slightly nauseated during active labor. But most times, you’re discouraged from eating or drinking as labor progresses. To keep your mouth and throat from becoming dry, suck on ice chips or hard candy. Apply lip balm to your lips to keep them moist.
Transition The last phase of the first stage of labor is called transition. It’s the shortest but most difficult phase. During transitional labor, your cervix opens the remaining three centimeters (cm), dilating from seven to 10 cm.
During transition, your contractions increase in strength and frequency with little break between. It may seem like there is time for only a hurried breath before the next one arrives. Your contractions reach peak intensity almost immediately, and they now last 60 to 90 seconds. In fact, it may feel as if your contractions never completely disappear.
Transition is a demanding time, and you’ll likely feel a lot of pressure in your lower back and rectum. In addition, you may feel nauseated and vomit. One minute you may feel hot and sweaty, the next, cold and chilled. Your legs may begin to shake or cramp, which is fairly common.
The closer you get to your baby’s birth, your pain medication options become more limited, but you still have a few choices available. Trust your care provider to help you make decisions about pain medication.
How you may feel. Transition can go quickly. You may suddenly be past it and ready to push. During this phase of labor, don’t worry if you feel exhausted and somewhat overwhelmed. That’s normal. Try to stay focused as best you can. Until it’s safe to push, relax those muscles that you have control over, and save your energy.
What you can do. During transition, concentrate on getting through each contraction. If it helps, focus on getting through just the first half of each contraction. After a contraction peaks, the second half gets easier. If your contractions are being monitored, your partner can watch their progress, letting you know when they’ve peaked so that you know when the hardest part is over.
During transition, you may not want things like a radio or television distracting you. Don’t think about the next contraction. Just take each one as it arrives.
If you feel the urge to push, try to hold back until you’ve been told you’re fully dilated. This will help prevent your cervix from tearing or swelling, which can delay delivery. It can be hard to resist this sensation when your body is telling you to bear down. To fight the urge to push, instead pant or blow.
Stage 2: The birth of your baby Once your cervix is fully dilated and you are instructed to, you can push. It isn’t unusual, especially with first-time mothers, to have to push for an hour or two before the top of your baby’s head appears (crowns) at the opening of your vagina. It may still take another few minutes and few pushes to deliver the baby.
After you push the baby’s head out, you’ll probably be instructed to stop pushing for a moment while your care provider makes sure that the baby’s umbilical cord is free.
You may find it difficult to stop pushing when told to, but try. It may help to pant instead of pushing. Slowing down gives your vaginal area time to stretch rather than tear. To stay motivated, you may be able to put your hand down and feel the baby’s head or see it in a mirror. You’re very close now! When you’re told to, push again and your baby will be born!
HOW BABY COMES OUT
The human pelvis has a complex shape, making your baby negotiate several maneuvers during labor and delivery. Your pelvis is widest from side to side at the top (inlet) and from front to back at the bottom (outlet). The baby’s head is widest from front to back, and the shoulders are widest from side to side. As a result, your baby must twist and turn on the way through the birth canal.
Because almost every mother’s pelvis is widest side to side at the entrance, most babies enter the pelvis looking left or right (illustration 1). The exit from the pelvis is widest from front to back, so babies almost always turn faceup or facedown (illustration 2). These maneuvers occur as a result of forces of labor and the resistance provided by the birth canal.
In addition to making these turning maneuvers, the baby is simultaneously descending farther down the vagina. Finally, the top of your baby’s head appears (crowns), stretching your vaginal opening (illustration 3). When the vulva has stretched enough, the baby’s head will emerge — usually by extending the head, lifting its chin off the chest and thus emerging from under your pubic bone. The baby usually emerges facedown but will turn to one side very quickly as the shoulders turn to take the same route (illustration 4).
Next, the shoulders are born one at a time, and with a great slippery rush, the rest of the body is delivered — and now you can hold your new baby.
Immediately after birth At birth, your baby is still connected to the placenta by the umbilical cord. Often the parents can assist with the clamping and cutting of the cord. If you’d like to assist, make your wishes known, and you’ll be shown what to do. There’s usually no particular urgency to cut the umbilical cord. Two clamps are placed on the cord, and then a scissors is used to snip painlessly between the clamps. If the umbilical cord has looped snugly around the baby’s neck, the cord may be clamped and cut before the shoulders are delivered.
Immediately after birth, your baby may be placed in your arms or on your abdomen. Occasionally, the baby may be passed to a nurse or pediatrician for evaluation and attention.
Eventually, your baby is weighed and examined. He or she is dried off and then wrapped in blankets to keep him or her warm. Apgar scores are taken and recorded at one- and five-minute intervals. An identification band is placed on your baby so that there’s no mix-up in the nursery. This is just the first of many safeguards to ensure no mistake in identification is made.
In most cases, you’ll be able to hold and breast-feed your baby right after birth. But if your baby shows any signs that help is needed, such as trouble breathing, he or she may need to be evaluated more thoroughly in the nursery.
Stage 3: Delivery of the placenta After your baby is born, a lot is happening. You and your partner are celebrating the excitement of the birth. You’re likely both decompressing, relieved that labor and childbirth are finally over. Meanwhile, a care provider in the background is examining your baby as he or she takes the first breaths and you hear those wonderful first cries.
The third, and final, stage of labor and childbirth is delivery of the placenta. The placenta is the organ inside the uterus attached to the baby by the umbilical cord. It’s the organ that has nourished your baby throughout your pregnancy.
For most couples, the placenta — also called the afterbirth — is of little significance. For the medical personnel attending the birth, delivering the placenta and ensuring that the mother doesn’t bleed excessively are important.
What’s happening. After your baby is born, you’ll continue to have contractions, but they’re mild. These contractions are necessary for several reasons — one of which is to help you deliver the placenta.
Usually about five to 10 minutes after the birth, the placenta separates from the wall of the uterus. Your final contractions push the placenta out from the uterus and down into the vagina. You may be asked to push one more time to deliver the placenta, which usually comes out with a small gush of blood. Sometimes it may take up to 30 minutes for the placenta to detach and be expelled.
Your care provider may massage your lower abdomen after you have delivered your baby. This is to encourage your uterus to contract, to help expel the placenta.
After delivery of your placenta, you may be given a medication such as oxytocin by injection or by intravenous (IV) drip to encourage uterine contractions. Uterine contractions after birth are important. Sometimes additional medications are needed to help firm your uterus.
How you may feel. You shouldn’t feel much pain while your uterus contracts to push out the placenta. The hardest part may be simply being patient as you wait for the delivery of the placenta. The deep massages of your abdomen by your care provider may hurt.
What you can do. You can help expel the placenta by pushing when directed. As you push, your care provider may pull gently on the leftover umbilical cord attached to the placenta. In most instances, delivery of the placenta is a routine part of childbirth, but complications can arise if your placenta doesn’t spontaneously detach from the uterine wall (retained placenta). In this situation, the care provider must reach inside the uterus and remove the placenta by hand.
Once the placenta is out, your care provider examines it to make sure it’s normal and intact. If it’s not intact, he or she must remove any remaining fragments inside the uterus. Rarely, surgery is needed to remove placental fragments. Remnants that aren’t removed could cause bleeding and infection.
After delivery, your care provider disposes of the placenta. Most women never see it, but if you’re interested you can ask to. It’s usually round and red, about 6 to 8 inches in diameter and about 20 ounces in weight.
In multiple pregnancies, there may be more than one placenta to deliver. Or there may be one placenta with more than one cord coming from it.
At last. For most parents, all of the preparation, pain and effort that went into bringing a newborn into the world are quickly forgotten as they hold their newborn child. This is one of the most significant moments in your life. You are now a parent, and a new human being has taken his or her place in your family. It truly is an absolute miracle. Savor this moment, cherish it and embrace the joy that nothing else in life can quite match.
IF YOU’RE THE LABOR COACH
You may be the father-to-be, a partner, parent, sibling, or friend. Whatever your other roles, your job as labor coach is to support the mother-to-be both physically and emotionally during her labor and delivery. Here are some ways that you can help.
During early labor Through the first phase of childbirth:
Time her contractions Measure the time from the beginning of one contraction to the next. Keep a record. When contractions are coming five minutes apart and have been that way for an hour, it’s usually time to call your care provider or go to the hospital.
Keep her calm Once contractions begin, you both may feel some initial butterflies. After all, it’s the big moment you’ve been anticipating for the past 10 months. But during labor and delivery, your goal is to keep the expectant mother relaxed. That means staying as calm as possible yourself. Take some deep breaths together. Between contractions, practice the relaxation techniques you learned in childbirth class. For example, suggest that she let her muscles go limp or that she concentrate on relaxing her jaw and hands. Gently massage her back, feet or shoulders.
Help distract her Suggest activities — such as watching television or taking a walk — that will help keep both your minds off labor. Humor can be a great distraction, too. Enjoy some laughs, when appropriate.
Ask her what she needs If you’re unsure what to do for your partner, ask her what would make her more comfortable. If she isn’t sure what she needs, do your best to suggest something that you think might make her feel better. But don’t take it personally if she doesn’t take you up on your suggestions or focuses inward during contractions.
Give encouragement Offer her encouragement and praise through each contraction. Remind her that with each contraction, and with each passing hour of labor, she’s getting closer to meeting the baby. What you don’t want to do is criticize her or pretend that the pain doesn’t exist. She needs your empathy and support, even if she’s not complaining.
Take care of yourself, too To keep up your strength, have some refreshments periodically. But respect that your partner may not want you to eat in front of her or to leave her for an extended period to eat. If you feel faint at any time during labor and delivery, sit down, and then tell someone on the health care team.
During active labor As labor progresses to the next stage:
Quiet the room If it’s possible, keep the labor room or birthing room as calm as possible by keeping the doors closed and the lights dimmed. Some women find it relaxing to listen to soft music during labor.
Help her through contractions Learn to recognize the start of your partner’s contractions. If she’s on a fetal monitor, ask someone how to read it. Or place your hand on your partner’s abdomen and feel for the telltale tightening of the uterus. You can then alert your partner when a contraction is beginning. You can also offer encouragement as each contraction peaks and wanes. If it helps her, breathe with her through difficult contractions. Try to make her more comfortable by massaging her abdomen or lower back or by using counterpressure or any other techniques you’ve learned.
Some women prefer not to be touched during labor, so take your cues from your partner. If she’s uncomfortable, suggest a change of position or a walk — if possible — to help labor progress. Offer her water or ice chips if she’s allowed to have them. Mop her brow with a cool, damp cloth if she likes that.
Be an advocate As much as possible, serve as her go-between with the health care team. Don’t be afraid to ask questions about how her labor is progressing or to ask for explanations about any procedures or the need for medications. If your partner requests pain medication, discuss pain relief options with her care providers, openly or in private. Remember: Labor isn’t a test of pain endurance. A woman doesn’t fail at labor if she chooses pain relief medication.
Continue to give encouragement By the time a woman is in active labor, she’s likely feeling quite tired and uncomfortable, and perhaps edgy. As in early labor, be supportive and encouraging by saying things such as: “You did a great job getting through that last contraction,” or “You’re doing great! I’m really proud of you.”
Don’t take things personally Things may be said in labor that aren’t meant. Don’t take it personally if your partner seems irritated with your thoughtful attempts to comfort her or if she doesn’t respond to your questions. Your presence alone is comforting and sometimes is all that’s needed.
During transition During this particularly difficult stage of labor:
Continue to help her through contractions Transition, as the baby progresses down the birth canal, is usually the hardest time for the mother. Now is the time to give her even more encouragement and praise. Remind her to take it one contraction at a time. If it helps her, talk her through each contraction or breathe with her. Some women find they don’t want to have someone coaching them as contractions intensify. Give space, if needed. In fact, holding her hand, making eye contact or simply saying, “I love you,” may convey more than many words.
Put her needs first Throughout labor and delivery, stay conscious of her needs. Offer her water or ice chips, if allowed. Massage her body. Suggest position changes periodically. Keep her informed of how labor is progressing and how well she’s doing. It’s more important for you to take care of her than to record everything on film or call friends and family.
During pushing and delivery When you get to this last phase:
Help guide her pushing and breathing Using cues from the health care team or from what you learned in childbirth classes, guide her breathing while she pushes. You might also support her back or hold one of her legs while she’s pushing.
Stay close by A lot may happen quickly when it comes time for her to push. Or she may have to keep pushing on and off for several hours. Once she gets ready to push, don’t feel that you’re in the way as your partner’s care provider takes charge. Your presence is important, particularly as labor nears completion.
Point out her progress As the baby’s head crowns, if allowed, hold up a mirror so that she can see for herself how she’s progressing. Or tell her how close the baby is to being born!
Cut the cord, if desired If offered the opportunity to cut the cord, don’t panic. You’ll get clear directions from medical staff about what to do. Don’t feel pressured to do this if you’re uncomfortable with the idea.
Celebrate! Once the baby has arrived, enjoy bonding with the new baby. But don’t forget to give your partner some well-earned words of praise, and congratulate yourself, too, for a job well done!
