Pregnancy Lounge

Category: Labor and Delivery

  • Preterm Causes

    Preterm Causes

    What triggers normal, full-term labor is not yet fully understood, so the actual cause of preterm labor is not completely understood. In over half of preterm labors, the cause is unknown. However, there are some factors which are known to increase a woman’s risk of experiencing preterm labor.

    Many preterm births (30-40%) are the result of preterm premature rupture of the membranes (PPROM), in which the amniotic sac that holds the baby breaks too soon, leading to preterm labor. Preterm labor usually begins shortly after PPROM occurs. Sometimes, when a slow leak is present and infection has not developed, contractions may not start for a few days. On occasion, a leak high up in the amniotic sac may reseal itself so that preterm labor does not start or subsides.

    A mother’s age may play a role in preterm labor. Women in their teens or women over 35 are at an increased risk. Also, some recent studies have found a link between severe stress and stressful life situations (including things like: domestic violence or death of a close family member) and preterm labor, as well as standing for long periods of time or extremely tiring jobs.

    Infections can cause preterm labor, including certain sexually transmitted diseases (STDs) such as: gonorrhea, syphilis, chronic active hepatitis, trichomoniasis and chlamydia, as well as any illness with a fever. Severe urinary tract infections (UTI), undetected or untreated, Group B Strep and bacterial vaginosis (BV) are also possible triggers of labor before term. Other conditions that may be related to preterm labor include certain chronic maternal illnesses such as: diabetes, high blood pressure, kidney disease/infection and sickle cell anemia.

    Illegal or non-prescription drug abuse (especially cocaine), cigarette smoking, alcohol consumption are all risk factors for delivering a preterm baby. Not gaining enough weight during pregnancy, having a pre-pregnancy weight of less than 100 pounds, and inadequate nutrition and prenatal care may cause preterm labor and delivery of a premature infant.

    A multiple pregnancy (expecting twins, triplets or more) puts you at a much higher risk for preterm labor. The increased size of the mother plays a role in the increased risk. Women who’ve had a previous preterm labor or premature baby, 3 or more first-trimester miscarriages or 1 second-trimester miscarriage are considered at a higher risk as well.

    Cervical trauma is a major cause for preterm birth, the most common being from cervical injury due to elective abortions. Women with a history of multiple first-trimester abortions or one or more second-trimester abortions are at a considerably increased risk of delivering before term. Uterine defects due to an incompetent cervix, uterine fibroids, excesses amniotic fluid (making the uterus extra large), previous cervical cone biopsy surgery, placenta previa and diethylstilbestrol (DES) exposure can lead to preterm labor, as well as a pregnancy that occurred while using an IUD (contraceptive device).

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  • Preterm Labor and Complications

    Preterm Labor and Complications

    asthma-pregnancy1-163x140Prematurity is the most common cause of sickness and death among newborns. Babies born before the 37th week of pregnancy are often called preterm or “premature”, babies born before the 32nd week are considered very premature, babies born before the 28th week are considered extremely premature. Generally, babies born after the 25th week of pregnancy have a survival rate of between 50-60% (although they will stay an extended period of time in intensive care), which increases dramatically to over 90% after the 28th week.

    Premature Babies

    Babies born earlier at the 22nd week of pregnancy have less than a 2% chance of survival, while babies born before the 20th week are said to be miscarried and cannot survive outside the womb, even with our improved medical technology. The more mature babies are at birth, the more likely they are to survive and the less likely they are to have health problems. In addition to age, the baby’s size tends to influence how well he or she does; larger babies generally do better.

    Many times, babies born preterm face weeks and sometimes even months in the neonatal intensive care unit (NICU), depending on their gestational age, size and overall medical condition. Usually, premature babies are too sick and too small to go home until close to their original estimated due date.

    Preterm Health Problems

    Preterm babies are at risk for a variety of health problems, serious complications and even death. Some have lasting disabilities (depending on their degree of prematurity) such as cerebral palsy, mental retardation, reading and learning problems (or developmental delay), chronic lung disease and blindness or deafness.

    Other babies, usually those born closer to term, have no long-term problems and grow up completely healthy. Sometimes, babies born closer to term (34-36 weeks) still have certain complications, as well as suffer 2-3 times the infant mortality rate during the first year as full-term babies. Mortality rates during the first year for babies 32-33 weeks are 6 times higher than those born full-term.

    Preterm Labor Treatment

    Babies born before 34 weeks often need to be on a ventilator (and may need a medication called surfactant) to help them breathe, because of respiratory problems. A common condition for these preterm babies is called respiratory distress syndrome (or hyaline membrane disease), which is a serious breathing problem caused by immature lungs, making it difficult or impossible for their air sacs to stay open, due to the lack of surfactant in the lungs.

    Apnea is also common, especially in babies born before 30 weeks. Apnea causes babies to stop breathing for short periods of time, due to their immature respiratory and nervous systems. Intraventricular hemorrhage (IVH) sometimes happens in the first few days of life and is quite common in very premature babies. This condition is when bleeding in the brain occurs, which can potentially cause seizures and brain damage.

    Certain blood and metabolic problems may occur in babies born before term. Anemia (low blood counts), which may require a blood transfusion is not uncommon.

    Early babies may develop jaundice, due to their livers being too immature to normally process bilirubin, which may turn them yellow or orange in color. Cardiovascular conditions may occur, such as patent ductus arteriosus (PDA), which is a heart condition that causes blood to divert away from the lungs. With this, a blood vessel near the heart (that normally closes after delivery) stays open and may need to be closed with surgery, if medication doesn’t work.

    Feeding difficulties are common for preterm babies, since many are unable to suck, due to undeveloped suck and swallow reflexes. Often, they require tube feedings, in which a tube is placed in the mouth or nose that goes down into the stomach. You can still pump your breast milk for your baby, which is ideally the best for your tiny little one. Preterm babies typically are cared for under special heaters or in enclosed incubators that help maintain a stable body temperature, due to temperature instability from low body fat and thin skin.

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  • Preterm Labor

    Labor that begins anytime before the 37th week of pregnancy is preterm labor (or “premature labor”). Ideally, pregnancies (under normal circumstances), last for approximately 40 weeks from the first day of the last menstrual period, give or take 2 weeks. Most babies are considered “full-term” if they are born after the 37th week of pregnancy. If you have contractions sufficient enough in strength and frequency to start to efface (thin out) and dilate (open up) your cervix or if your water breaks (preterm premature rupture of the membranes or “PPROM”) between 20-37 weeks along, you’d be considered in preterm labor.

    It is estimated that as many as 10-12% of pregnant women in the U.S. will suffer from preterm labor, not including twin or triplet pregnancies. Approximately 60% of twins and about 90% of triplets are born preterm. Overall, the rate of preterm births are rising, mainly due to the large numbers of multiple births in recent years. Twins and other multiples are six times more likely to be preterm than single birth babies. The rate of premature single births is slightly increasing each year. Between 1992 and 2002, the rate of babies born before 37 weeks increased almost 13%. In 2002, there were over 480,000 preterm births (about 1 in 9 live births). The preterm birth rate was highest for black babies (over 17%), followed by Native American babies (almost 13%), Hispanic babies (over 11%), Caucasian babies (over 10%) and lowest for Asian babies (over 9%).

    Early detection of preterm labor is very important, so steps can be taken to stop labor from progressing and to prevent preterm delivery. Being informed and aware of early warnings signs can make all the difference. The early signs of labor can be subtle and hard to detect; some women experience preterm labor without noticing any uterine contractions at all. Don”t hesitate to call your doctor or midwife immediately if you think you are experiencing any symptoms of labor and you are less than 37 weeks along. Always call if you have any reason to suspect you might have preterm labor or you are confused or concerned about what you are feeling. Some symptoms can be especially confusing, because they may occur normally as typical pregnancy discomforts (including pelvic pressure and lower backache).

    Symptoms of preterm labor that you want to watch for include: uterine contractions that are fairly regular (whether they are painless or not) that occur 4 times or more within an hour and abdominal menstrual-like cramping (constant or occasional), with or without diarrhea. It may be difficult to tell the difference between Braxton-Hicks (or “practice”) contractions and the real thing. Monitor your contractions, by timing them (from beginning of one to the beginning of the next) and writing down your results. More than 4 in an hour, especially accompanied by other symptoms definitely warrants a call to your doctor or midwife, to be on the safe side. Other common preterm labor symptoms include: persistent, lower back pain (especially if you don’t typically have back pain), sudden increase in vaginal discharge (particularly gushes or a trickle of watery, mucus-like or blood-tinged fluid), any vaginal bleeding or spotting (some spotting is common after pelvic exams), persistent and/or increased pelvic pressure (painless or not) and frequent diarrhea.

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  • Preterm Labor Treatment

    Depending on how far along you are in your pregnancy, your doctor or midwife may not attempt to stop your preterm labor. If you aren’t close to term, one of the first things that may be done is re-hydration. You may be given fluids and possibly an IV. Preterm contractions can many times be directly related to dehydration. If your contractions stop after re-hydration, you will more than likely be discharged with orders to increase your fluid intake and follow up with a visit with your doctor or midwife, without any medications. If you are thought to be in labor preterm (before the 37th week of pregnancy), you may be given antibiotics to prevent (or treat) possible infection, especially if your membranes have ruptured.

    If re-hydrating you doesn’t stop contractions, then you will most likely be given medication. There are typically two types of medications given to women who are having preterm labor. The first type helps to slow down or stop labor contractions if given early enough (they are called “tocolytics”) .The second type helps the baby’s lungs mature before birth (“corticosteroid” medications).

    Tocolytic medications often used include terbutaline (or brethine), ritodrine, nifedipine, magnesium sulfate, or indomethacine. Each of these medications work in a different way, but the goal is to minimize the strength and number of contractions which may cause the cervix to dilate and efface. They may be given in an injection, by IV, under the skin or in the form of a pill. Your doctor or midwife may prescribe your medication to be administered by a ‘pump’, which delivers a small amount automatically through a device similar to that used by insulin dependent diabetics, while you stay in the hospital. Tocolytic medications are not as successful later in labor, if your membranes have broken, or if your cervix is already dilated beyond 2 centimeters. Tocolytics are not used if you have chorioamnionitis (an infection in the membranes around the baby), bleeding, abruptio placenta, severe preeclampsia or eclampsia, cardiac disease or other severe medical illnesses.

    Like other drugs, these medications are associated with side effects for you, as well as your baby. Before choosing a medication, you and your doctor or midwife must weigh the risks and benefits of each. Possible side effects of some of these drugs include (but are not limited to): drowsiness, dizziness, headaches, muscle weakness, irregular or fast heartbeat, nausea, vomiting, nervousness, restlessness, insomnia, shaking, shortness of breath, hyperglycemia (high blood sugar) and hypokalemia (low blood potassium), double vision, fluid in the lungs, fever, hallucinations and heart attack. Possible side effects for the baby include: fast heart rate, high or low blood sugar after birth, loss of muscle tone, slow breathing, drowsiness, enlarged heart, jaundice and bleeding within the brain or heart. You and your baby should be monitored very closely while taking any of these medications.

    By delaying preterm labor with tocolytic medications, doctors and midwives can use other medications to help speed up the baby’s lung development and improve the baby’s chance of survival. Corticosteroid (or steroid) medications are given, particularly if delivery appears to be inevitable. Betamethasone (also called celestone) or dexamethasone are given by injection into muscle tissue.

    Sometimes, if an incompetent cervix has been diagnosed, a cervical cerclage may be done. This is a procedure where the cervical opening is stitched to keep it closed. Early cerclage placement has a significantly higher success rate than those performed after effacement and dilation have occurred. Bedrest (either at home or in the hospital) may be recommended, with varying levels of activity (from limited to none). It is important for you to discuss with your doctor or midwife what range of activity you may participate in when bedrest is prescribed.

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  • Do-It-Yourself Labor Induction

    If your doctor or midwife has recommended labor induction, you may want to consider asking whether it would be appropriate for you to try some natural, non-medical methods of induction before moving on to medication. There are many ways to induce labor, but none of them have been proven consistently effective, and some aren’t safe to try at home. Any method you are interested in should be discussed with your doctor or midwife, prior to attempting. Never try do-it-yourself techniques unless you are full-term and have your doctor or midwife’s approval due to the increased risk of possible serious complications.

    Sexual intercourse may not necessarily induce labor, but it may be helpful in preparing your body for labor. Semen contains a small amount of the hormone prostaglandin, which is used in the synthetic form of gel or a suppository to medically induce labor in the hospital many times. Prostaglandins help ripen the cervix, making it softer and thin out (efface). On the other hand, it’s questionable whether semen actually contains enough prostaglandins to have any real affect on the cervix. Also, having an orgasm may bring on a few contractions, because they produce the hormone oxytocin (which your body produces during labor to make your uterus contract). On a side note: don’t try intercourse to speed up labor, if your water has already broken.

    Walking may not bring on labor, but it uses gravity to put pressure on your cervix and encourages your baby to descend down into your pelvis, which will lead to thinning and dilation. Exercise in general is good for you, as long as it’s not strenuous and you don’t over-do it. An added benefit is it may also help contract your uterus.

    Nipple stimulation can sometimes start labor. Rolling or massaging the nipple and areola produces oxytocin, which in turn causes contractions. You can do this yourself or it can be done by your partner. You can even use a breast pump to stimulate your nipples. For this method if induction, it must be done over a period of time, for approximately 15-20 minutes each hour until contractions begin (if they begin). The problem with nipple stimulation is that the contractions can be very strong, much like contractions produced from Pitocin and therefore you run the risk of stressing your baby. This method should not be done without the supervision and/or knowledge of your doctor or midwife.

    Castor oil is many times used as a strong laxative. By stimulating the bowels it may also cause uterine contractions, although it will more likely cause severe diarrhea, painful cramping and may possibly lead to your baby passing meconium before or during labor. Plus, the taste is very unpleasant. Enemas also tend to have the same effect, causing bowel contractions to stimulate the uterus.

    There are a number of herbs which are thought to be useful for labor induction. Some of these include: black and blue cohosh, evening primrose oil, red raspberry leaf tea, cumin tea and goldenseal. The safeness and effectiveness of these herbs remains unproven, therefore they should not be taken without the recommendation and supervision of your doctor or midwife.

    Acupressure , acupuncture, bumpy car rides, certain foods (such as spicy foods, eggplant parmesan and pineapple), visualization or self-hypnosis and relaxation or stress-relief techniques are all some other methods thought to possibly induce labor.

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  • Labor Induction Risks

    The question of labor induction is really about weighing the benefits against the possible risks. If you’re having medical problems or your baby’s health is in danger, induction can begin labor at a crucial time. When the benefit is convenience, most doctors and midwives would advise against it. If done properly, and by a doctor or midwife who has carefully considered your situation, it can lead to the safe delivery of a healthy baby or allow timely treatment of a baby who needs medical assistance. Your doctor or midwife will recommend inducing your labor only when he or she believes that the risks to you and your baby of continuing the pregnancy are higher than the risks of waiting for labor to begin on its own. It’s important to clearly discuss these issues with your doctor or midwife. If the induction is being done for non-medical purposes then the benefits of induction may not outweigh the risks.

    The most common risk you face if you’re induced is that the induction won’t work (after about 24 to 48 hours ) and you’ll need a cesarean. There is an increased risk of cesareans associated with labor inductions, particularly with first-time moms, whose risks increase by two to three times. Pitocin (synthetic form of the hormone oxytocin) use substantially heightens this risk of needing a c-section during labor. Due to the fact that Pitocin may make your contractions too strong, which can put stress on your uterus and on your baby, at which point your doctor or midwife may decide that a cesarean is necessary. There’s no sure way to know whether you’ll need to have a cesarean in the event that you’re induced. Discuss your concerns with your doctor or midwife, to identify any risk factors that could make a cesarean delivery more likely for you.

    Such techniques as Pitocin and prostaglandin gel can occasionally hyper-stimulate your uterus (because of the stronger, more powerful contractions they tend to bring on), which can lead to possible uterine rupture and placental abruption, particularly if you’ve had a previous cesarean or uterine surgery. A recent study found that between 15 – 25% of women who received Pitocin, experienced uterine hyper-stimulation, the rates depending on the dosage amount given. In addition, the stronger, more painful contractions (which are also typically longer in duration) that these forms of induction may cause often leads to pain medication use that may not otherwise be needed. Epidural rates are much higher for women who’s labors were induced.

    The more powerful contractions brought on by certain methods of induction can limit blood flow and oxygen supply to the baby, leading to drops in the baby’s heart rate. You’ll need to have continuous electronic monitoring during an induced labor to assess both the frequency and length of your contractions as well as your baby’s heart rate, because of these risks, which may restrict mobility. Also, induced labors are often longer (as well as require longer hospital stays typically), require stricter bed rest and may require an internal monitor, which further restricts mobility. Labor inductions many times also mean administration of IV fluids.

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  • Labor Induction Procedures

    There are several different ways to induce labor. The methods your doctor or midwife uses will ultimately depend on the condition of your cervix. Your doctor or midwife will check to see if your cervix is getting soft, thinning out and opening up (effacing and dilating). If your cervix hasn’t yet, then it’s considered “unripe” and not ready for labor. In that case, your doctor or midwife may insert medicine containing the hormone prostaglandin close to your cervix to help it along before the induction. Quite often, your doctor or midwife may break your water soon afterwards to jump-start labor. Many times oxytocin will be given through an IV to start contractions and help them to get stronger and regular. Hospitalization and close fetal monitoring are mandatory during a labor induction. Inductions are often done overnight for women whose cervix isn’t ready to go into natural labor, while other times when a woman’s body is ready to go into labor, induction may not take long at all.

    Stripping (or “sweeping”) the membranes is one induction procedure that is often done in your doctor’s office and then you are sent home. This is basically an aggressive pelvic exam where your doctor or midwife manually separates your amniotic sac from the lowest part of your uterus (or cervix), by inserting a gloved finger and “sweeping” it in a circular motion around the inside of your cervix. Stripping the membranes is supposed to stimulate the release of prostaglandin hormones to bring on contractions. It is believed that labor starts as a result of this procedure typically within a few days, although it may need to be repeated before labor develops and no one knows if this is just coincidence or the result of the stripping. Many times this procedure is uncomfortable and sometimes brings on cramping and spotting.

    Many times during an induction, your doctor or midwife may help your cervix to become soft and pliable to move things along. This is often done by having a prostaglandin medication (gel or suppository) placed in or near your cervix, often more than once. Dinoprostone (Cervidil or Prepidil ) is a common prostaglandin gel used to soften the cervix. Cervidil is typically given in the form of a removable vaginal insert, with a retrieval cord and resembles a tampon. Prepidil is typically given in the form of a gel, sometimes smeared on the cervix. Some doctors use Misoprostol (Cytotec) to induce labor, however it’s a controversial method and is more riskier than Prepidil and Cervidil, due to the increased possibility of uterine hyper-stimulation and uterine rupture, as well as fetal distress. So far the FDA has not approved Cytotec for use to induce labor, only for treatment of ulcers. Cytotec is typically given in the form of a tablet inserted vaginally near the cervix or a pill ingested orally.

    Another common technique for labor induction is rupturing the amniotic sac or “breaking your water” (amniotomy). If your cervix is very ripe and ready for labor, this alone might get your contractions going. Your doctor or midwife uses a small hook instrument (that resembles a crochet hook) to make a hole in the amniotic sac, during a pelvic exam and it’s not generally uncomfortable. This causes the amniotic fluid to begin leaking out, which usually brings on contractions within hours. Once your water has broken, most doctors and midwives will want you to deliver within the next 12 to 24 hours because the risk of infection for you and your baby increases over time. Breaking your water should only be done if your cervix is starting to dilate and your baby’s head is firmly engaged in your pelvis, which reduces the risk of cord compression or cord prolapse, leading to decreased or stopped blood flow to your baby.

    If prostaglandin medication and/or having your water broke doesn’t get labor well on it’s way, your doctor or midwife may decide to give you oxytocin (Pitocin) intravenously (through an IV) to produce uterine contractions. Pitocin is a synthetic form of oxytocin, which is a hormone that your body produces naturally during labor to make your uterus contract. The amount of Pitocin used depends on how your body accepts it and the levels are generally slowly increased until the contractions reach the desired strength and frequency, about every 15-30 minutes. A low-dose that allows at least 30-45 minutes between dose increases is best. If you start contracting well enough on your own, the medication may be decreased or shut off, which is less painful for you and easier on your baby. Many women (80% who’ve had Pitocin) say that it causes more intense, more painful contractions that last longer and many times have double peaks.

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  • Induction of Labor

    For most pregnant women, labor starts spontaneously and there is no need to interfere with the natural progression of events, from the first contraction to birth. If labor doesn’t start on it’s own naturally and you and your doctor or midwife decide it’s not a good idea to wait any longer, they may use certain interventions (techniques and/or medications) to “induce” your labor to start artificially. These interventions cause uterine contractions to begin or your cervix to ripen and dilate, so you can deliver your baby vaginally.

    When induction of labor is being considered, your doctor or midwife should fully discuss your options with you before any decision is reached. This should include explaining the procedures and care that will be involved and whether there are any risks to you or your baby. During the induction of labor, your contractions, your blood pressure, how well your cervix is dilating, as well as your baby’s heart rate will be monitored carefully.

    Labor induction is an increasingly common procedure, with over 20% of births being induced (or about 1 in 5). This is a large increase from 1989, when only about 8% of all live births were induced (or close to 1 in 10). Inductions for non-medical (often convenience) purposes are the main reason for this rate increase. The pressure to schedule births for reasons of convenience (women, as well as their doctors) has resulted in growing numbers of “elective inductions”. Ideally, labor is induced when the risks of prolonging the pregnancy are more serious than the risks of delivering the baby right away.

    The most common reason for induction is when a pregnancy has gone 2 or more weeks past the estimated due date, which is often called “post-term gestation” or “post-date pregnancy”. Most studies have shown that it’s safer, in these instances, to deliver the baby at this time instead of waiting for labor to begin on its own, due to increased risks including possible uterine infection, decreasing amniotic fluid, stillbirth, aspiration of meconium, ossification of baby’s skull (making molding of the head during birth difficult or impossible) a very large baby (called “macrosomia”) and heightened chances of needing a cesarean.

    Your doctor or midwife may also recommend induction if your pregnancy is complicated by a health condition that presents a risk to you or your baby, including high blood pressure, diabetes, severe preeclampsia, kidney or lung disease and serious infection.

    There are a number of other reasons that induction may be offered or recommended: if you have placenta abruption, the placenta is not functioning properly, you have a small pelvis (and delivering a large baby vaginally may be impossible), your baby isn’t growing properly (IUGR), your baby’s heart rate has abnormal patterns, there’s too little fluid around your baby, your water breaks and your labor doesn’t start (often called “PROM”, which poses a risk of infection), you develop a uterine infection (“chorioamnionitis”) or you’ve had a previous full-term stillbirth. Induction under these circumstances may be your best option.

    Other possible (non-medical) reasons for labor induction include: prior history of rapid labor (which heightens risk of an unplanned home birth), living a long distance from a hospital, your doctor or midwife will be unavailable for an extended period of time; possibly on vacation near your due date and you’d rather not take the chance of getting the on-call doctor, as well as special family circumstances (such as partner going on military leave, etc).

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  • The First Stage – Phase Three

    During the third part of the longest stage of labor, your cervix dilates fully to 10 centimeters, usually quickly. Your contractions are powerful and effective at this point, making this phase relatively short. They may be 2-3 minutes apart and last for up to a minute and a half, although sometimes they become so close and last so long that they feel as though they never completely disappear. When this happens, you may barely have time for a breath before another contraction starts coming on. It’s still not too late to ask for certain pain medications, although it is for some. Ask your doctor, midwife or nurse what options are still available and safe, if you decide you need pain relief.

    Transition

    Physically, you may feel exhausted and down-right worn out, especially if you’ve been in labor for a long time. You may feel a lot of lower back and rectal pressure, as your baby’s head applies pressure on the perineum and rectal area. This pressure may cause you to have a strong urge to push, which you need to tell the nurse, because you may very well be fully-dilated and ready for your baby to come out. Hold back, though until you’re told that you are in fact fully-dilated, because pushing before it’s time can cause you to tear or swell, making delivery more difficult. Try panting or blowing through contractions to keep from pushing.

    Bleeding from your vagina may become heavier as more capillaries in your cervix rupture and your legs may tremble uncontrollably, feel cold and crampy at this point. You may feel shaky and shiver all over now, which is normal. You may experience nausea, as well as vomiting and chills one minute, but sweat the next (hot flashes).

    Women typically go through several emotions during this phase and it’s not uncommon to have mood swings, since this is the most emotionally challenging part of labor. You may experience increased irritability and feel overwhelmed, as well as panicked, crying easily. Lots of encouragement is needed now from the support person or partner. Thankfully, this phase of labor is usually very brief.

    Keep changing positions frequently, if you are able. Continue doing your breathing exercises and concentrate on getting through one contraction at a time. Distraction at this point, such as t.v. or the radio may be irritating as you try to concentrate. Soothing music may be a relaxing alternative. A cool washcloth on your forehead may be helpful, as well as continuing to suck on ice chips or sipping on water.

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  • Labor and Delivery

    Labor and Delivery

    labor and deliveryDuring labor and delivery, this is the longest stage of labor, your cervix gradually softens, thins and opens. Your cervix opens (dilates) up to about three to four centimeters. Over a period of several hours (or possibly days for first-time moms), you experience mild contractions that slowly get somewhat stronger and closer together. At first, they tend to be fairly irregular, but as time goes on, they become longer and more consistent. They can start out spaced as widely apart as 30 minutes, lasting about 25 seconds. They may become as close as 5 minutes apart, lasting up to 60 seconds.

    The First Stage- Phase One
    Early Labor (or Latent Phase)

    You may experience lower back pain, chills, leg cramps, lower abdominal cramping, nausea, a warm abdominal sensation or diarrhea. You may also experience leaking of fluid at this time (a big gush or a little trickle), although it’s more common for your water to break a little later on, or have to be broken by your doctor or midwife if it doesn’t break on it’s own. This is the bag of amniotic fluid that surrounds your baby.

    Mucous Plus Expulsion

    You may have a thick, bloody, mucous-like discharge, as your cervix begins to open and thin out. This is often called, “bloody show” or “losing your mucus plug”. This barrier blocks the opening to your cervix throughout pregnancy, to prevent bacteria from entering.

    Labor and Emotions

    Emotionally, in labor and delivery, you may be feeling excited, anxious and even scared. You may be more energetic and talkative, as well as relieved that your baby is finally on his or her way; the moment you have been waiting for so long. At this point, you may also be nervous about the upcoming phase of active labor. Physically, you may not be too uncomfortable during this phase, but you may need to keep your mind occupied and distracted.

    Even though you may feel increased energy now, it’s best to take it easy, rest and not overdo it. You can add last minute items to your labor bag or walk around, if you’d like, which may help make labor quicker in the long run (because gravity helps!) At this point, you’ll probably still be at home, unless your water has broke, so you could grab the remote, watch a movie and have a light healthy snack (one that can be easily digested), if you wish. Water, juice or clear liquids are very important to keep you hydrated, so make sure you are drinking plenty. A warm bath or shower may be just what you need to relax and feel more comfortable (as long as your water hasn’t broke).

    Labor and Delivery Relaxation Techniques

    At this stage of labor and delivery, you may be a good time to start using your relaxation techniques, such as slow, deep breathing while listening to relaxing music, especially if you find yourself getting stressed. Your husband (or support person) can give you a gentle massage and also start timing your contractions. Contractions are timed from the beginning of one to the beginning of the next. If it’s in the middle of the night, you may want to try and sleep some more if you can, since you’ll need to be well-rested for the next phase. Don’t forget to give your doctor or midwife a call.

    –Stages of Labor
    –Signs of Labor
    –Preterm Labor
    –Preterm Complications
    –Preterm Labor Causes
    –Preterm Prevention and Treatment
    –First Stage: Phase I
    –First Stage: Phase II
    –First Stage: Phase III
    –Second Stage
    –Third Stage
    –Induction of Labor
    –Induction of Labor Procedures
    –Labor Induction Risks
    –Do It Yourself Labor Induction

  • Third Stage of Delivery

    Third Stage of Delivery

    third-stageAfter your baby is born and the cord has been clamped and cut, you’re still not quite done, although the worse it over with. During the third (and last) stage of labor, your much milder contractions will continue to help your uterus to loosen the placenta from your uterine wall. Your uterus will then expel and deliver the placenta and membranes that have nourished your baby throughout your pregnancy. This is also called the “afterbirth”. This little organ weighs about one pound!

    Delivery of the Placenta

    You may even be asked to push one last time for this to happen and may feel a small gush of blood. Sometimes, your doctor, midwife or nurse may massage your lower abdomen to encourage your uterus to contract more to help expel the placenta. Occasionally, the doctor or midwife may pull the umbilical cord slightly with one hand, while pressing down gently on the top of your uterus.

    Delivery of the placenta happens generally within about 5-30 minutes of your baby’s delivery. After the placenta slips out, your uterus will continue to contract, shrink and become firm, as a natural way to prevent further bleeding. Your doctor or midwife will examine the placenta to make sure it’s intact and any remaining fragments left inside your uterus must be removed to prevent bleeding, infection and possible hemorrhage. Over the next several hours, a nurse will check your uterus to make sure it’s firming up and that you’re not experiencing heavier-than-normal bleeding.

    You may tremble and have chills at this point, or may become hungry or thirsty. You probably will feel a great sense of relief, but will likely be completely exhausted as well. Your doctor or midwife will examine your vagina and perineum, repairing any tears that may have occurred and stitching episiotomy (if you had one). You will receive a local anesthetic (if you are not numb already), to help make the repairs fairly painless. You may be offered cold compresses to apply to ease discomfort and reduce swelling. Your bleeding will be heavy, like a menstrual flow and is often called, “lochia”.

    You may want your baby to be placed on your chest as soon as possible, to begin bonding and spending time together. You may try breastfeeding your new little one at this time, which can also help tighten your uterus and decrease bleeding, because breastfeeding releases oxytocin. Congratulations! Now you’re on to the next stage: the rewarding stage of motherhood!

    More on Labor and Delivery

    Signs of Labor
    Preterm Labor
    Preterm Complications
    Preterm Labor Causes
    Preterm Prevention and Treatment
    First Stage: Phase I
    First Stage: Phase II
    First Stage: Phase III
    Second Stage
    Third Stage
    Induction of Labor
    Induction of Labor Procedures
    Labor Induction Risks
    Do It Yourself Labor Induction

  • The Second Stage of Labor

    During the second stage of labor, your cervix is fully-dilated to 10 centimeters and as your baby makes his or her way down the birth canal, your contractions may actually space out to about 2-4 minutes apart and become more regular. This may allow you to rest and take a breather briefly between contractions. Although it may be difficult, rest and save your strength for pushing.

    Pushing and Delivery

    At this point, the pressure on your rectum increases and the urge to push becomes overwhelming, as your baby descends. You may feel more in control once pushing begins, as well as a sense of relief to be able to play a more active role in the birth process. You may also experience a burst of renewed energy as delivery draws ever-so-close. The urge to push usually feels the strongest at the peak of a contraction, then fades toward the end.

    Positioning and breathing will impact your pushing. Unless you are making significant progress, you may be advised to change positions about every half hour, which may enhance progress. Allow your partner (or support person) to help you into a semi-sitting or a semi-squatting position, which allows gravity to work for you, not against you. Squatting utilizes gravity, helping your pelvis to open up and make more room for your baby. It can also take some pressure off your back. Some hospitals even have squat bars that you can hold onto, or you can use your partner for added support.

    The side-lying position may also help ease back pressure, if you are experiencing “back labor” during pushing. For this position, you or your partner may hold up your top leg. A common position for pushing is having your feet in stirrups, while lying on your back. This position is most convenient for your doctor or midwife if you need an episiotomy, although gravity doesn’t help you out much while using this position.

    Whatever position you choose when pushing, take a deep breath, hold it in, bear down and concentrate. Curl into the push as much as you can, rounding your shoulders, putting your chin to your chest, allowing all of your muscles to work to help ease your baby into the world. Don’t be alarmed if you pass small amounts of urine or feces during the pushing stage, because many women do and it’s completely normal. It can even mean you are pushing effectively. Remember, every push brings you that much closer to holding your baby in your arms.

    Birth

    Some women want to use a mirror to see their baby’s head and may want to touch it as well. Seeing or feeling your baby’s head crown may give you added inspiration to keep pushing. Just before your baby is born, you may feel a burning, stinging or stretching sensation at the opening of your vagina. This often happens as your perineum widens to allow your baby’s head to descend (often called “crowning”) and your baby to pass through the birth canal.

    As your baby’s head emerges, it typically turns to one side to allow the shoulders to align. Once your baby’s head is delivered, you may be asked to stop pushing, so his or her airway can be cleared of excess mucus, by suctioning your baby’s nose and mouth. After that’s done, your doctor or midwife may assist the rest of the body out, usually with one last push. Congratulations! You have a brand new baby!

    Back to Labor Stages