Labor and Delivery

Childbirth Class Childbirth classes are a very important part of preparing for labor. A good class will teach you what all of your childbirth options are and how to navigate the system, as opposed to tell you what hospital policy is and what the standard is for your area. There are many organizations that certify childbirth educators, like Lamaze, Bradley and ICEA. Be sure to use a certified educator for your classes. Signs of Labor Some women experience very distinct signs of labor, while others do not. No one knows what causes labor to start or when it will start, but several hormonal and physical changes may indicate the beginning of labor. These changes include: Lightening, Passing of the mucus plug, Contractions, Water breaking, Effacement and dilation of the cervix. The process of your baby settling or lowering into your pelvis just before labor is called lightening. Lightening can occur a few weeks or a few hours before labor. Because the uterus rests on the bladder more after lightening, you may feel the need to urinate more frequently. The mucus plug accumulates at the cervix during pregnancy. When the cervix begins to open wider, the mucus is discharged into the vagina and may be clear, pink, or slightly bloody. Labor may begin soon after the mucus plug is discharged or one to two weeks later. During contractions, the abdomen becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft. The way a contraction feels is different for each woman and may feel different from one pregnancy to the next. But, labor contractions usually cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Contractions move in a wave-like motion from the top of the uterus to the bottom. Some women describe contractions as strong menstrual cramps. Unlike false labor contractions or Braxton Hicks contractions -- true labor contractions do not stop when you change your position or relax. Although the contractions may be uncomfortable, you will be able to relax in between contractions. Before "true" labor begins, you may have "false" labor pains, also known as Braxton Hicks contractions. These irregular uterine contractions are perfectly normal and may start to occur in your second trimester, although more commonly in your third trimester of pregnancy. They are your body's way of getting ready for the "real thing. Braxton Hicks contractions can be described as a tightening in the abdomen that comes and goes. These contractions do not get closer together, do not increase with walking, do not increase in how long they last and do not feel stronger over time as they do when you are in true labor.

How Do I Know When I Am in True Labor?

To figure out if the contractions you are feeling are the real thing, ask yourself the following questions.

Delivering

It's time! You'll deliver your baby during the second stage of labor.

How long it lasts: It can take from a few minutes up to several hours or more to push your baby into the world. It often takes longer for first-time moms and women who've had an epidural.

What you can do: Push! You may be encouraged to push with each contraction to speed the process. Or you might take it more slowly, letting nature do the work until you feel the urge to push.

Many women choose to push while lying in a birthing bed. Squatting or sitting works well for others. Some women prefer to get on their hands and knees or kneel while a labor coach supports their upper body. Try different positions until you find one that feels best. When you push, don't hold tension in your face. Bear down and concentrate on pushing where it counts.

At some point, you may be asked to push more gently — or not at all. Slowing down gives your vaginal area time to stretch rather than tear. To stay motivated, you may be able to feel the baby's head between your legs or see it in a mirror.

After your baby's head is delivered, his or her airway will be cleared and your health care provider will make sure the umbilical cord is free. The rest of your baby's body will follow shortly.

After your baby is born, you'll likely feel a great sense of relief. You may hold the baby in your arms or on your abdomen. Cherish the moment. But a lot is still happening. During the third stage of labor, your health care provider must deliver the placenta and make sure your bleeding is under control.

How long it lasts: The placenta is typically delivered in about five to 10 minutes. In some cases, it may take up to 30 minutes.

What you can do: Relax! By now your focus has shifted to your baby. You may be oblivious to what's going on around you. You may even want to breast-feed your baby.

You'll continue to have mild contractions. Your health care provider may massage your lower abdomen to encourage your uterus to contract and expel the placenta. You may be asked to push one more time to deliver the placenta, which usually comes out with a small gush of blood.

Your health care provider will examine the placenta to make sure it's intact. Any remaining fragments must be removed from the uterus to prevent bleeding and infection. If you're interested, ask to see the placenta.

Your health care provider will also determine whether you need stitches or other repair work. If you do, you'll receive an injection of local anesthetic in the area to be stitched if it's not numb already. You may also be given medication to encourage uterine contractions and minimize bleeding.

Cesarean 

A cesarean section, also known as a c-section, is a method used to surgically deliver a baby. It is considered to be a major surgery. A cesarean can be planned but more often it is performed as an emergency procedure when complications arise during a vaginal birth. Although there is some controversy over the necessity of cesareans, delivering a baby by cesarean can sometimes be safer for a mother and her baby.

A cesarean involves a surgeon making a horizontal incision in your stomach and uterus, usually just above the pubic hairline. Your baby is then lifted out through this incision. However, prior to the actual surgery, there are a number of steps taken to ensure the safety of the procedure.

First, your abdomen will be cleaned and possibly shaven with an antiseptic solution. You will also have a catheter inserted to empty your bladder.

Next, you will receive an I.V. in your arm or hand to make sure you have enough fluids and medication throughout the procedure. You will also receive either a general anesthetic, which will render you completely unconscious for the entire surgery, or a local anesthetic, which will numb only part of you while you remain alert throughout the cesarean. You will not be able to see the procedure yourself since you will have surgical drapes arranged just above the surgery site, blocking your view. If you have a partner joining you during the delivery, they will be suited up in sterile medical gowns and may watch the surgery if they wish.

Once the baby is delivered, its nose and mouth will be suctioned and the umbilical cord will be clamped and cut. The doctor will then remove the placenta.

Pain Meds

Epidural An epidural delivers continuous pain relief to the lower part of your body while allowing you to remain fully conscious. Medication is delivered through a catheter, a very thin, flexible, hollow tube that's inserted into the epidural space just outside the membrane that surrounds your spine. The medication is usually a combination of a local anesthetic and a narcotic. Local anesthetics block sensations of pain, touch, movement, and temperature, and narcotics blunt pain without affecting your ability to move your legs. Used together, they provide good pain relief with less loss of sensation in your legs and at a lower total dose than you'd need with just one or the other.

 Systemic medications Systemic painkillers such as narcotics dull your pain but don't completely eliminate it. You may also be given a tranquilizer — alone or in combination with a narcotic — to reduce anxiety or nausea, or to relax you. Systemic drugs are either delivered through an IV line to your bloodstream or injected into a muscle, and they affect your entire body rather than concentrating pain relief in the uterus and pelvic area. They may make you feel sleepy, but unlike the general anesthesia that's often given for surgery, they won't make you unconscious.