Labor and Delivery
Labor can often start several weeks prior to your due date. For some women, prior to real labor, you might experience several days of frequent and short uterine contractions. This early labor is called prodromal labor. These contractions are not strong enough to put you into real labor but they can be exhausting. Prodromal labor is very common with your first baby. Your health care provider will sometimes offer you pain medication or sleeping pills to allow you to get some rest in the hope that you will wake up stronger allowing your body to get into a good labor pattern. Sometimes, your provider will suggest that you go to the hospital to get stronger pain medications to help break the prodromal pattern. Morphine like pills or injections are often given for that purpose. Eventually, you will get into a good labor pattern and the contractions will start to become regular and strong. They will last longer and come on more frequently. There are three stage of labor, the first, second and third stage. The first stage of labor is defined by strong uterine contractions with the cervix dilating from 0 cm to 10 cm. The second stage of labor is the "pushing stage" where you will push your baby down the birth canal until he or she is born. The third stage of labor is the time between the delivery of your baby and the delivery of the placenta. The first stage starts when your contractions are starting to get long, regular and frequent. Your cervix is not dilating much at this time but your cervix is shortening (also called "effacing") well and the baby dropping lower into your pelvis. The first part of the first stage is called the "latent phase" of labor. It can last anywhere from a few hours to over 10 hours. The cervix will often be 4 to 5 cm dilated at the end of this latent phase. At the end of the latent phase, your will notice a chance in the quality of the contractions, they will become consistently stronger and more frequent. Often they will come on every 2-4 minutes. You will notice a difference in your breathing, becoming now very deep, and the contractions are now very strong. Your are now entering the "active phase" of labor. It is a good idea to come to the hospital by the time the active labor has started. A good rule of thumb is to come in to the hospital when the contractions are every 5 minutes and they last a full minute each. If you are unsure if it is time to come in, you can call the hospital or your health care provider. When you come to the hospital, your nurse will check your blood pressure, monitor your baby by doing a NST and do a gentle cervical exam on you to determine your dilation. If you are in a good labor pattern and starting to dilate, you will be asked to stay.This is a good time for you or your partner to present your birth plan if you have one or to verbalize your labor and delivery preferences to your nurse. You will often be given an intravenous line (IV) for hydration purposes. Antibiotics might be given if you were found to have Group B streptococcus (GBS) bacteria in your body. Your nurse will continue to monitor your baby and your contractions with the fetal monitor by your bed and the contraction meter (tocometer). Some hospitals, depending on your specific situation, will perform this monitoring periodically ("intermittent monitoring"), others will expect you to keep the monitors on you for the duration of labor ("continuous monitoring"). At the end of the active phase, usually when you are about 8 to 9 cm dilated, labor becomes the most intense. Contractions are now every 2 to 3 minutes and it seems as if you have little time between them. They often last up to a minute and a half now. The contractions are very intense and you might be getting a lot of pressure on your pubic bone, tail bone and rectum. Some vaginal bleeding is often noted at this time. Some women start getting an urge to push. Your nurse will often encourage you to wait to push until you are fully dilated otherwise the cervix might swell preventing further dilation. When you are fully dilated to 10 cm, the second stage begins. It is now time to push your baby down the birth canal. The pushing is most effective when you push with your contractions. Your spouse, nurse, birthing coach or provider will often help with synchronizing your contractions and your pushing efforts.As you are pushing, the top of your baby's head will soon become visible. This is followed by the "crowning" stage which is when the widest part of your baby's head is at the vaginal opening. During crowning, the vaginal opening is stretched resulting in a strong feeling of burning and tingling. Very shortly thereafter, the head will be delivered. At that point, you health care provider will make sure there is no cord around your baby_s neck and the nose and mouth will be suctioned. You will be asked to push some more to deliver the rest of your baby and your baby will then then often put on your abdomen and the umbilical cord cut. If you partner would like to cut the cord, be sure to tell you health care provider in advance and put it in your "birth plan". Often the nurse in the room will soon take your baby from your abdomen and bring it to a baby warmer located in the room in order to keep it warm. A towel will be used to dry up the amniotic fluid from your baby's skin. Eye ointment and a Vitamin K shot is often given. Your baby will then usually be weighed. Your baby will then be wrapped up in a towel, and it will be given a hat to keep the head warm before being brought back to you. While your baby is being dried and weighed. The third stage of labor is taking place. It starts after the birth of your baby and ends with the delivery of your placenta. The placenta if often called the "after birth". During this time, the uterine contractions will continue but will usually be much milder, shorter and less frequent. After 5-30 minutes, a gush of blood will come out signifying that your placenta is starting to separate from the wall of your uterus. Your provider will then often pull the placental cord a little while rubbing the abdomen over your uterus in order to help the placenta to separate fully so that it can be delivered. After your placenta has come out, you might experience some more bleeding. Your provider or nurse will then often massage the abdomen over your uterus rather vigorously in order to help it contract well since this will diminish the bleeding. A medication called Oxytocin (Pitocin©) will often be given in order to help the uterus contract so that the bleeding decreases. It is now over and you are a mother-congratulations!!