Every delivery is as unique and individual as each mother and infant. In addition, women may have completely different experiences with each consecutive labor and delivery. Giving birth is a life-changing event that will leave an impression on you for the rest of your life. Obviously, you will want this to be a positive experience and would like to know what to expect. Here are some ideas about what may happen as you deliver your baby.
Birth Plans: Should You Have One?
As you approach the latter part of your pregnancy, you may want to write a birth plan. Consider carefully what is important to you. The overall goal is for a healthy mother and baby. The birth plan outlines your ideal birth and may need to be adjusted as the actual situation unfolds. Talk with your partner and decide who you want to attend the birth. Some couples feel that this is a private time and prefer not to have others present.
Early Phases of Labor
The amniotic sac is the fluid-filled membrane surrounding your baby. This sac will almost always rupture before the baby is born, though in some cases it remains intact until delivery. When it breaks, it’s called the water breaking. In most cases, your water will break before you go into labor or at the very beginning of labor. Most women experience their water breaking as a gush of fluid. It should be clear and odorless — if it’s yellow, green, or brown, contact your doctor right away.
Contractions are the tightening and releasing of your uterus. These motions will eventually help your baby push through the cervix. Contractions can feel like heavy cramping, or pressure that begins in your back and moves to the front. Contractions are not a reliable indicator of labor. You might already have felt Braxton-Hicks contractions beginning as soon as your second trimester. A general rule is that when you’ve had contractions lasting for a minute, five minutes apart, for an hour, you are in true labor.
The cervix is the lowest part of the uterus that opens into the vagina. The cervix is a tubular structure approximately 3 to 4 centimeters in length, with a passage that connects the uterine cavity to the vagina. During labor, the role of the cervix must change from maintaining the pregnancy to facilitating delivery of the baby. The fundamental changes that occur near the end of the pregnancy result in softening of the cervical tissue and thinning of the cervix. True, active labor is considered to be underway when the cervix is dilated 3 centimeters or more.
Labor and Delivery
Eventually, the cervical canal must open until the cervical opening itself has reached 10 centimeters in diameter and the baby is able to pass into the birth canal. Though significant injuries are not common, during this process the cervix may tear and ultimately require repair.
Although vaginal tissues are soft and flexible, when delivery occurs rapidly or with excessive force, the tissues can tear. In most cases, the lacerations are minor and easily repaired; occasionally, though, they may be severe and result in long-term problems.
Normal labor and delivery often result in injury to the vagina and/or cervix. Up to 70 percent of women having their first baby will have an episiotomy or some sort of vaginal trauma requiring repair. Fortunately, the vagina and cervix have a rich blood supply; therefore, injuries in these areas heal quickly and leave little or no scarring that could result in long-term problems.
Pain and Other Sensations During Delivery
If You Opted for a Natural Childbirth
If you decide to have a natural childbirth (delivery without pain medication), you will feel all types of sensations. The two sensations you will experience the most are pain and pressure. When you begin to push, some of the pressure will be relieved. As the baby descends into the birth canal, though, you will go from experiencing pressure only during the contractions to experiencing constant and increasing pressure. It will feel something like a strong urge to have a bowel movement as the baby presses down on those same nerves.
If You Choose to Have an Epidural
If you have had an epidural, what you feel during labor will depend on the effectiveness of the epidural block. If the medication properly deadens the nerves, you may not feel anything. If it is moderately effective, you may feel some pressure. If it is mildly so, you will feel pressure that may or may not be uncomfortable to you. It depends on how well you tolerate pressure sensations. You may not feel the stretching of the vagina, and you probably will not feel an episiotomy.
As the baby enters the vagina, your skin and muscles stretch. The labia and perineum (the area between the vagina and the rectum) eventually reach a point of maximum stretching. At this point, the skin may feel like it is burning. Some childbirth educators call this the ring of fire because of the burning sensation felt as the mother's tissues stretch around the baby's head. At this time, your healthcare provider may decide to perform an episiotomy. You may or may not feel the episiotomy because the skin and muscles can lose sensation due to how tightly they are stretched.
As the baby's head emerges, there is a great relief from the pressure, although you will probably still feel some discomfort. Your nurse or doctor will ask you to stop pushing momentarily while the baby's mouth and nose are suctioned to clear out amniotic fluid and mucus; it is important to do this before the baby starts to breathe and cry.
Usually the doctor will rotate the baby's head a quarter of a turn to be in alignment with the baby's body, which is still inside you. You will then be asked to begin pushing again to deliver the shoulders. The top shoulder comes first, then the lower shoulder. Then with one last push, you deliver your baby!
Delivering the Placenta
The placenta and the amniotic sac that supported and protected the baby for nine months are still in the uterus after the delivery. These need to be delivered and this can happen spontaneously or it may take as long as half an hour. Your midwife or doctor may rub your abdomen below your belly button to help tighten the uterus and loosen the placenta. Your uterus is now about the size of a large grapefruit. You may need to push to help deliver the placenta. You may feel some pressure as the placenta is expelled, but not nearly as much pressure as when the baby was born.
Your healthcare provider will inspect the delivered placenta to make sure it was delivered in full. On rare occasions, some of the placenta doesn't release and may remain adhered to the wall of the uterus. If this happens, your provider will reach into your uterus to remove the leftover pieces in order to prevent heavy bleeding that can result from a torn placenta. If you would like to see the placenta, please ask. Usually, they will be happy to show you.
It’s not impossible to prepare yourself for labor and delivery, but it is a famously unpredictable process. Understanding the timeline, and hearing about other mothers’ experiences can go a long way to making childbirth less mysterious. Many expectant mothers find it helpful to write out a birth plan and share it with the medical team and their partner. If you do create a plan, be prepared to change your mind when necessity arises. Remember that your goal is a healthy baby, and to have a healthy, positive experience.