It's Go Time! Understanding the A-Z's of Labor and Delivery

In movies and TV, pregnant women seem to always know when it’s the time! Real-life is less clear-cut, but there are definite signs of labor you can watch for as you get close to your due date. One is called lightening, or the feeling that the baby has “dropped” lower into your pelvis. Then, of course, there are contractions.

You should know that false labor—irregular uterine contractions that aren’t the actual start of labor—is common. How to tell the difference: In actual labor, contractions start in the back and “move” to the front; get stronger and closer together over time, and don’t stop when you move around. False labor contractions (also called Braxton Hicks contractions) are usually only felt in the front and may stop if you change position.

The Three Stages

Once labor is underway, it progresses in stages—three in all. How long you spend in each stage is unique to you. Here’s what happens:

Stage One: This has two steps. Early labor is when you start feeling contractions that get closer and stronger. The contractions are gradually opening up your cervix. Then, there’s active labor. Now, your contractions will be even stronger, often with little to no space in between. You’ll reach 10 cm dilation of your cervix during this stage, which is when your baby’s ready to be born.

Stage Two: You’ll feel the urge to push now, which feels like a lot of pressure in your rectum and perineum. Your healthcare provider will guide you on pushing, timed to your contractions. Once your baby’s head “crowns,” which is when it’s visible at the entrance to your vagina, you’re nearly there. Soon, your baby will be born, and the umbilical cord cut.

Stage Three: After the birth, you’ll have more contractions that help you deliver the placenta, which is what your baby was attached to in your uterus. As soon as possible, after your baby is born, they can go straight into your arms so you can lie skin-to-skin and start breastfeeding right away.

Pain Management

Every woman’s experience with childbirth pain is different. Though you can’t predict what will happen when you do go into labor, you can make certain decisions beforehand about what, if any, pain relief you want to use. That plan may well change, but at the very least, you’ll know what your options are and will have talked to your healthcare provider about your wishes and concerns. Here are your options:

Natural remedies: There are a few ways to cope with and relieve pain without drugs, such as various breathing techniques, warm baths or showers, changing positions (sitting, walking, squatting, using an exercise ball) and massage. Mom and her support partner are encouraged to attend the childbirth preparation class offered at our hospital. The idea here is to help you relax, distract you from pain, and help your body release endorphins, which are natural painkillers. You also might want to consider hiring a doula, a support person (in addition to your partner and healthcare provider) who stays with you throughout the process.

Narcotics: These are drugs that dull pain. You can get a narcotic through an IV or by injection. The pros of narcotic pain relief are that they may allow you to rest without making you lose feeling entirely. Among the cons is that if you receive too many narcotics, your breathing and your baby may slow down. They may also make you dizzy or upset your stomach.

Epidural: In this pain-relief procedure, a catheter is inserted into your epidural space, and medication that decreases feeling in your lower body is continuously delivered directly into your epidural space where nerves live. It takes about 15 minutes to take full effect and can be left in place for hours. While you’re awake and aware of contractions, you can’t usually walk around once you have an epidural.

Spinal block: A spinal block eliminates feeling in the lower half of your body. But unlike an epidural, it’s a single injection put directly into your spinal column that works immediately but that only lasts 1 to 2 hours. A block is something you may have if you have a C-section.

When You Need a C-section

Sometimes, a cesarean section (C-section), or surgical birth, is necessary. Reasons for a C-section include:

• A breech presentation
• Labor that fails to progress
• A very large baby
• Fetal distress (your baby doesn't get enough oxygen or his heart rate slows too much)
• Placenta problems
• Carrying multiples

Most C-sections are done with an epidural or spinal block.

If Your Baby is Premature

Any baby born before 37 weeks gestation is considered premature. Every effort will be made to avoid delivery before that time, but if your baby is a preemie, here’s what is likely to happen: your baby will likely be cared for in the neonatal intensive care unit (NICU) and be monitored for health issues common to premature babies, such as breathing problems and difficulty feeding, and regulating body temperature. How long they stay depends on how early they are born. In general, preemies can go home when they reach 4 lbs., breathe on their own, feed well, and stay warm without an incubator.

What to Pack for the Hospital

As you approach your due date, it’s wise to toss some essentials in a grab-and-go bag, so you’re ready to head to the hospital with no delay.

What you need for yourself: Toiletries, a nightgown, robe, slippers, socks, underwear, a bra or a nursing bra. Your pillow, music, phone and camera (and a charger), snacks, personal comfort items and clothes to wear home.

What you need for your baby: Not much! The hospital provides diapers and swaddling blankets, so pack a going-home outfit for those all-important photos (you’ll also need a car seat).

Other items: Insurance info and your birth plan, if you have one. Please leave all jewelry and valuables at home.

What Happens After Delivery

If you have a vaginal delivery, you can expect to stay in the hospital for about two days. If you have a C-section, your stay will be a day or two longer to allow you to recover from surgery.

Expect contractions as your uterus returns to normal size; vaginal tenderness; breast soreness; vaginal bleeding; and overall soreness and tiredness. Get as much rest as you can during your hospital stay. Limit visitors and take advantage of scheduled "quiet" times.

After being cleaned, weighed, and measured, your baby will get several tests and treatments.

This assessment includes a heel stick to collect blood used to test for a range of disorders, antibiotic ointment in his eyes in case of an infection, and a vitamin K shot (to prevent a rare bleeding disorder).

Ideally, your baby's first feeding will occur during skin-to-skin contact within the first hour after birth if you plan on breastfeeding.

Sources:
National Library of Medicine
Cleveland Clinic
Mayo Clinic
American Pregnancy Association
American Society of Anesthesiologists
March of Dimes