While it takes nine months to grow a full-term baby, labor and delivery occurs in a matter of days or even hours. However, it’s the process of labor and delivery that tends to occupy the minds of expectant parents the most. Read on if you have questions and concerns around the signs and length of labor, and how to manage pain.
Signs of Labor
Labor has started or is coming soon if you experience symptoms such as:
- increased pressure in the uterus
- a change of energy levels
- a bloody mucus discharge
Real labor has most likely arrived when contractions become regular and are painful.
Many women experience irregular contractions sometime after 20 weeks of pregnancy. Known as Braxton Hicks contractions, they’re typically painless. At most, they’re uncomfortable and are irregular.
Braxton Hicks contractions can sometimes be triggered by an increase in either mother or baby’s activity, or a full bladder. No one fully understands the role Braxton Hicks contractions play in pregnancy. They may promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Braxton Hicks contractions don’t cause the cervix to dilate. Painful or regular contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of contractions that should lead you to call your doctor.
Labor and delivery are divided into three stages. The first stage of labor incorporates the onset of labor through the complete dilation of the cervix. This stage is further subdivided into three stages.
This is normally the longest and least intense phase of labor. Early labor is also called the latent phase of labor. This period includes the thinning of the cervix and dilation of the cervix to 3-4 cm. It can occur over several days, weeks, or just a few short hours.
Contractions vary during this phase and can range from mild to strong, occurring at regular or irregular intervals. Other symptoms during this phase can include backache, cramps, and a bloody mucus discharge. Most women will be ready to go to the hospital at the end of early labor. However, many women will arrive at the hospital or birthing center when they are still in early labor.
The second phase of labor occurs as the cervix dilates from 3-4 cm to fully dilated (10 cm). Contractions become stronger and other symptoms may include backache and blood.
This is the most intense phase of labor with a sharp increase in contractions. They become strong and occur about two to three minutes apart, and average 60 to 90 seconds. The last 3 cm of dilation usually occur in a very short period of time.
During the second stage, the cervix is fully dilated. Some women may feel the urge to push right away or soon after they’re fully dilated. The baby may still be high up in the pelvis for other women. It may take some time for the baby to descend with the contractions so that it’s low enough for the mother to start pushing.
Women who don’t have an epidural typically have an overwhelming urge to push, or they have significant rectal pressure when the baby is low enough in the pelvis. Women with an epidural may still have an urge to push and they may feel rectal pressure, although typically not as intensely. Burning or stinging in the vagina as the baby’s head crowns is also common.
It’s important to try to stay relaxed and rest between contractions. This is when your labor coach or doula can be very helpful.
Delivery of the Placenta
The placenta will be delivered after the baby has been born. Mild contractions will help separate the placenta from the uterine wall and move it down towards the vagina. Stitching to mend a tear or surgical cut (episiotomy) will occur after the placenta is delivered.
Modern medicine can provide a variety of options to manage pain and complications that can occur during labor and delivery. Some of the medications available include the following.
Narcotic medications are used frequently for pain relief during labor. Use is limited to the early stages because they tend to cause excessive maternal, fetal, and neonatal sedation.
Narcotics are generally given to women in labor by intramuscular injection or through an intravenous line. Some centers offer patient-controlled administration. That means you can choose when to receive the drug.
Some of the most common narcotics include:
Inhaled analgesic medications are sometimes used during labor. Nitrous oxide, often called laughing gas, is most commonly used. It can provide adequate pain relief for some women when used intermittently, particularly in the early stages of labor.
The most common method of pain relief during labor and delivery is the epidural blockade. It’s used to provide anesthesia during labor and delivery and during a cesarean section (C-section).
The pain relief results from injecting an anesthetic drug into the epidural space, located just outside the lining the covers the spinal cord. The drug blocks the transmission of pain sensations through the nerves that pass through that portion of the epidural space before connecting with the spinal cord.
The use of combined spinal-epidurals or a walking epidural has gained popularity in recent years. This involves passing a very small pencil-point needle through the epidural needle prior to placement of the epidural anesthetic. The smaller needle is advanced into the space near the spinal cord and a small dose of either a narcotic or local anesthetic is injected into the space. This affects only sensory function, which enables the patient to walk and move about during labor. This technique is normally used during the early stages of labor.
Natural Pain Relief
There are many options for women seeking a nonmedical pain relief for labor and delivery. They focus on reducing the perception of pain without the use of medication. Some of these include:
- patterned breathing
- transcutaneous electrical nerve stimulation (TENS)
Labor can be artificially induced in several ways. The method chosen will depend on several factors, including:
- how ready your cervix is for labor
- whether this is your first baby
- how far along you are in the pregnancy
- if your membranes have ruptured
- the reason for the induction
Some reasons your doctor may recommend induction are:
- when a pregnancy has gone into week 42
- if the mother’s water breaks and labor doesn’t begin shortly thereafter
- if there are complications with the mother or baby.
Induction of labor is usually not recommended when a woman has had a previous C-section or if the baby is breech (bottom down).
A hormone medication called prostaglndin, a medication called misoprostol, or a device may be used to soften and open the cervix if it’s long and hasn’t softened or started to dilate.
Stripping the membranes may induce labor for some women. This is a procedure in which your doctor checks your cervix. They will manually insert a finger between the membranes of the amniotic sac and the wall of the uterus. Natural prostaglandins are released by separating or stripping the lower part of the membranes from the uterine wall. This may soften the cervix and cause contractions. Stripping the membranes can only be accomplished if the cervix has dilated enough to allow your doctor to insert their finger and perform the procedure.
Medications like oxytocin or misoprostol can be used to induce labor. Oxytocin is given intravenously. Misoprostol is a tablet placed in the vagina.
Your doctor regularly monitors your baby’s position during prenatal visits. Most babies turn into a head-down position between the week 32 and week 36. Some don’t turn at all, and others turn into a feet- or bottom-first position. Most doctors will try to turn a breech fetus into a head-down position using external cephalic version (ECV).
During an ECV, a doctor will try to gently shift the fetus by applying their hands to the mother’s abdomen, using an ultrasound as guidance. The baby will be monitored during the procedure. ECVs are often successful and can reduce the likelihood for a C-section delivery.
The national average of births by C-section has gone up dramatically over the last few decades. According to the Centers for Disease Control and Prevention, about 33 percent of mothers in the United States give birth by this method. A C-section is often the safest and quickest delivery option in difficult deliveries or when complications occur.
A C-section is considered a major surgery. The baby is delivered through an incision in the abdominal wall and uterus rather than the vagina. The mother will be given an anesthetic before surgery to numb the area from the abdomen to below the waist. The incision is almost always horizontal, along the lower portion of the abdominal wall. In some situations, the incision may be vertical from the midline to below the belly button.
The incision in the uterus is also horizontal, except in certain complicated cases. A vertical incision in the uterus is called a classical C-section. This leaves the uterine muscle less able to tolerate contractions in a future pregnancy.
The baby’s mouth and nose will be suctioned after delivery so that they can take their first breath, and the placenta will be delivered.
Most women won’t know if they’ll have a C-section until labor begins. C-sections may be scheduled in advance if there are complications with mother or baby. Other reasons a C-section may be necessary include:
- a previous C-section with a classical, vertical incision
- a fetal illness or birth defect
- the mother has diabetes and the baby is estimated to weigh more than 4,500 g
- placenta previa
- HIV infection in the mother and high viral load
- breech or transverse fetal position
It was once thought that if you’ve had a C-section, you’ll always need to get one to deliver future babies. Today, repeat C-sections are not always necessary. Vaginal birth after C-section (VBAC) can be a safe option for many.
Women who have had a low-transverse uterine incision (horizontal) from a C-section will have a good chance at delivering a baby vaginally. Women who have had a classic vertical incision should not be allowed to attempt a VBAC. A vertical incision increases the risk of a uterine rupture during a vaginal birth.
It’s important to discuss your previous pregnancies and medical history with your doctor, so they can assess whether VBAC is an option for you.
There are times towards the end of the pushing stage where a woman may need a little extra help in delivering her baby. A vacuum extractor or forceps may be used to assist in delivery.
An episiotomy is a downward cut at the base of the vagina and perineal muscle to increase the opening for the baby to come out. It was once believed that every woman needed an episiotomy to deliver a baby. Episiotomies are now typically only performed if the baby is distressed and needs help getting out fast. They are also done if the baby’s head delivers but the shoulders get stuck (dystocia).
An episiotomy may also be performed if a woman has been pushing for a very long time and can’t push the baby past the very lower part of the vaginal opening. Episiotomies are generally avoided if possible, but the skin and sometimes muscles may tear instead. Skin tears are less painful and heal faster than an episiotomy.