Pregnancy Lounge

Category: Labor and Delivery

  • Signs of Labor

    It’s not known what brings labor on, but it’s believed that hormones such as prostaglandins stimulate uterine activity and trigger oxytocin release, softening and thinning the cervix. Your body goes through a series of changes when it’s preparing for labor. Although the signs vary from woman to woman (as well as from pregnancy to pregnancy), once your labor has begun, the strong, painful contractions will ultimately give you a clue that it’s time for your little one to be born.

    At first, especially if this is your first pregnancy, you may not know the difference between true labor and false labor signs, making you unsure of what exactly you are experiencing. Becoming familiar in advance with the signs of labor will help you to distinguish the difference when the time comes. If you think you may be going into labor, don’t feel embarrassed to call your doctor or midwife to ask questions, no matter what time of day or night, or go to the hospital.

    Diarrhea, Nausea, Increased Energy

    Labor can start out with signs as simple as experiencing frequent diarrhea and nausea/upset stomach. Some women find themselves suddenly flooded with energy, when the nesting instinct kicks in full-force. Lower back pain and abdominal cramping aren’t uncommon either.

    Rupture of Membranes

    If you’re water breaks, that’s a definite sign that your time is drawing near of holding your little one. When your membranes rupture, it can feel like a little trickle or a big gush of fluid. This is the amniotic fluid that has surrounded your baby in the amniotic sac for nine months. Many times, your water won’t break until later stages of labor, or may even have to be broken manually by your doctor or midwife at the hospital. If you think your water has broken, call your doctor or midwife, because they will most likely want you to come to the hospital. The longer between when your water breaks and when delivery occurs, the greater chance of infection. Use a towel or pad to make you feel more comfortable, never use tampons while pregnant.

    Loss of Mucus Plug

    You may experience the loss of your mucus plug or “blood show” at the onset of labor, although it can occur as early as 2-3 weeks before delivery. This mucus-like discharge may be thick, bloody and stringy. This “plug” is the barrier that seals the opening of your cervix throughout pregnancy, preventing infection. Sometimes it dislodges as your cervix begins to thin and dilate (open). Make sure to let your doctor or midwife know if this happens, especially if it’s heavy and bright red, which could indicate something serious.

    Contractions

    Labor contractions start out similar to Braxton-Hicks contractions, beginning mild and relatively painless. But unlike Braxton-Hicks, they progressively get stronger and longer in duration. Also, true labor contractions will not let up by changing positions or resting, which false labor contractions tend to do. They continue and don’t go away, no matter what you do, they may even get stronger and intensify with activity. When you are really in labor, your contractions gradually become more regular and typically develop a pattern. They commonly begin in your lower back and radiate forward, like waves. False labor contractions are usually just centered in your abdomen and stay there. Your abdomen will feel very hard (usually much harder than Braxton-Hicks), like a basketball during these contractions, which you can feel by placing your hand on your belly. And unlike false labor contractions, real contractions will dilate and efface your cervix.

    Back to Labor Stages

  • Stages of Labor

    Every woman’s labor is different, following it’s own pattern (even from pregnancy to pregnancy) and there are some things that can’t be anticipated. Although every labor and birth is unique and your labor will unfold in a very special way, the process is remarkably and beautifully constant. You can expect a sequence of events, when everything goes smoothly.

    Labor is typically divided into three distinct stages. The first stage being when your cervix softens, dilates and thins out (effacement), ending in full dilation.

    The first stage can be divided into three “phases”: the early (or latent phase), the active phase and the transition phase. The second stage of labor is when your baby passes through the birth canal and is born. During the third stage, the placenta (afterbirth) is delivered.

    —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 First Stage of Labor – Active Labor

    During the second part of the longest stage of labor, your cervix really opens up, continuing to dilate from about 4 centimeters up to 8 centimeters. Your contractions continue to become more intense, more regular and last longer, as your labor progresses. They get closer together, eventually about 3-5 minutes apart and may last over a minute each, as your baby gets in position for birth. Read more on labor below:

    Active Labor

    Physically, you may be feeling increasing pressure and pain in your back. You may be much less comfortable than the earlier phase, as your labor pains intensify and become more frequent. During this phase, you may feel more fatigue, leg discomfort and increasing mucousy discharge (bloody show), as well as diarrhea. If your water didn’t break earlier, it will now or your doctor or midwife may choose to rupture your membranes sometime during this phase. During active labor, some women request an epidural or other pain medication.

    Emotionally, you may feel increasingly restless and anxious, especially if this phase lasts a long time. Your mood may become more serious and your initial excitement may begin to wane as your pain gets worse. You may find it very difficult to concentrate, while dealing with contractions and your support person can help keep you focused.

    At this point, you will be headed for the hospital or there already. To reduce your growing discomfort, try breathing exercises and relaxation techniques (the ones that you may have learned in childbirth class), if you feel like doing them. Concentrate on resting and relaxing, because the more relaxed you are, the easier and quicker your labor may be. Soaking in a warm bath or taking a shower, may be helpful at this time. Experiment with different positions to find ones that are more comfortable. Discomfort can often be helped by positions that allow gravity to speed dilation, including walking, squatting or rolling on a birth ball. If you are confined to bed, try lying on your side.

    If your doctor or midwife agrees that it’s alright to do so, drink clear liquids or suck on ice chips to keep from becoming dehydrated and also to keep your mouth from becoming dry. If you become hungry, you can ask if it’s okay to have a light snack, such as Jell-O, although many hospitals won’t allow you to eat anything during labor. In between contractions, get up and walk around, if possible. Take this time to use the bathroom, because urinating regularly will allow your baby’s head to move down more easily into the birth canal. A gentle massage from your partner (or support person) may be welcomed, although some women prefer not to be touched during this phase of labor.

    Back to Labor Stages

  • More on Episiotomies (continued)

    Many recent studies have shown that routine episiotomies shouldn’t be performed, because they are not helpful to the majority of women, although there are certain circumstances when they are needed. Having an episiotomy can increase pain during the postpartum period, leading to a longer recovery time. In addition, women who have episiotomies may have weaker pelvic floor muscles as well as more pain when resuming intercourse postpartum.

    Episiotomy rates have declined over the years, but the number still remains high. Despite all the evidence against routine episiotomy use, close to 50- 80% of first time moms end up with an episiotomy in the U.S. The majority of women having them done are young white women, who have private insurance, according to a recent study.

    There are a few situations when an episiotomy may be medically necessary. If there is a sign that your baby is in distress while in the birth canal, such as slowing of your baby’s heart rate, an episiotomy may be unavoidable for the sake of your baby’s well-being. If your baby’s shoulders get stuck, if your baby has a very large head that cannot fit through the vaginal opening or if delivery happens too quickly for the skin of your perineum to stretch naturally, you may need an episiotomy.

    Perineal message helps reduce the chance of tearing during birth and the need for an episiotomy. It can make the perineum more flexible and increase elasticity, in preparation for birth. It’s a good idea to start doing perineal massage around the 34th week of pregnancy or before. To perform perineal massage, wash your hands thoroughly (or your partner). Place K-Y jelly, vitamin E oil or another mild lubricant on one or two fingers and gently stretch the lower part of the vagina until you feel a slight burning sensation. Hold the pressure steady for about 2 minutes or so. Repeat this daily for about 8-10 minutes.

    Warm compresses during labor (especially during the pushing stage) encourage the stretching and relaxing of the perineum. Make sure they are only warm, but not hot, which can cause some swelling. Positioning during labor and birth may contribute to whether you need an episiotomy or not. Squatting can help reduce tearing. Avoid laying directly on your back, if possible and keep changing positions if you can. Talk to your doctor or midwife early about your feelings regarding episiotomies, especially if you wish to avoid one.

  • Episiotomy

    A small incision during delivery is an episiotomy. Right before your baby’s head emerges during delivery, in the pushing stage of labor, you may be given an injection of local anesthetic and your doctor or midwife may make a small incision in the skin between your vagina and anus (your perineum). This is called an episiotomy. An episiotomy is usually a second degree cut in both the skin and muscle of your perineum made for the purpose of enlarging your vaginal opening to assist in delivering your baby. The incision is closed with stitches after your baby and the placenta have been delivered. It is one of the most common medical procedures performed on women and also one of the most controversial.

    There are two main types of cuts: a midline (the most common), which is a cut directly towards the anus and a mediolateral, which is a diagonal cut toward the side. The most common are second degree and the least common are fourth degree cuts.

    Many doctors believe that an incision heals more easily than a tear. Other claimed benefits of episiotomy include prevention of possible third or fourth degree lacerations, lacerations that reach the anus, incontinence later on, damage to the pelvic floor and injury to the baby, as well as shortening the pushing stage; leading to a quicker delivery. Some doctors say that episiotomies are preferred, because they are simply easier to repair.
    <<click here for the rest of the article on episiotomies.>>

  • Reasons for Cesareans

    There are many reasons for cesareans and they vary with the individual woman, as well as the individual pregnancy. The chance of needing a cesarean depends on how your pregnancy is progressing and what complications may arise as your due date draws near. Sometimes cesareans aren’t the only option and the reasoning is questionable, while other times there are legitimate medical reasons making a cesarean unavoidable. In some situations, cesareans can be life-saving for mothers and babies.

    Occasionally, an emergency arises when your baby may need to be delivered within a matter of minutes. An emergency cesarean may be caused from such things as: a prolapsed cord (when the umbilical cord comes through the cervix before the baby’s head, preventing blood flow and oxygen from reaching the baby), which occurs in close to 4% of births, placental abruption (when the placenta separates from the uterine wall before birth), placenta previa (when the placenta is low and covers the cervix either partially or completely) and uterine rupture (when the uterine tissue tears).

    Fetal distress is another cause for the need of a quick delivery leading to a cesarean. This happens when there are concerns about the baby’s health during labor. Changes in the baby’s heart rate (when it’s very fast, very slow or irregular) may signal a problem such as he or she is not responding ideally to contractions or is not getting enough oxygen, either because the umbilical cord is being compressed (pinched or wrapped around something) or the placenta isn’t functioning properly.

    If the baby is mal-positioned (not in a good position for vaginal birth), a cesarean may be recommended, although sometimes babies can be turned or can be delivered vaginally anyway. Some common positions include: transverse (lying sideways) and breech (feet or bottom first). Breech positions account for between 12- 15% of all cesareans.

    << click for the rest of the article on reasons for cesareans >>
    << Avoiding Cesareans >>

  • Cesarean – When is a Cesarean Delivery Necessary

    When pregnant women think about childbirth, they rarely envision having a c-section. Most assume they will deliver vaginally, although with the United States’ cesarean rate at an all-time high, the odds are good that you may, in fact, have a c-section. If you’ve had a previous cesarean, you are much more likely to have another, with a decline in vaginal birth rates following previous c-sections. A recent study found that 47% of moms who’ve had a previous c-section aren’t even considering a vaginal birth the next time. Also, pre-planned or “elective” c-sections are becoming more and more common, when many times there is no identifiable medical reason. Cesareans are the most common surgery performed and it’s believed that between 25- 50% are unnecessary. More below:

    If you live in the United States, there is about a one in four chance your baby will be delivered by cesarean, which is a very steep rise since 1970, when only 5% of all deliveries were by cesarean. In the late 1980s and early 1990s, there was an overall decline in the number of cesarean deliveries in the U.S.

    In the mid 1990s, the rates began to increase rapidly. From 1999 through 2001, the percent of “elective” c-sections grew from about 1.56% to 1.87%, which is a 20% rise. In 2002, cesarean deliveries increased by 67% among low-risk women. Low-risk, first-time moms who were 40 and older were more than five times more likely to have a c-section than first-time moms between the ages of 20 and 24. In 2002, the number of vaginal deliveries was less than 3 million, while the number of cesarean deliveries were about 1.1 million (approximately 634,000 were first time c-sections and 409,000 were repeat c-sections). Now the rate has jumped to well over 27% of all deliveries in the United States, which translates to about 27 c-sections for every 100 births. Some hospitals have a staggering cesarean rate of over 50%!

    Why the increasing cesarean rates? It is believed that the rates of c-sections among women in the United States are on the rise for a number of reasons including: increasing age of pregnant women, more underlying conditions such as diabetes and hypertension, for convenience purposes, fertility treatments yielding more twins and triplets, improved fetal monitoring (which has made it easier to tell if the baby is stressed), as well as liability reasons for doctors and hospitals, who may feel as if their risk of being sued is greater if complications occur during a vaginal delivery.

    << Reasons for Cesareans
    << Avoiding Cesareans

  • more Reasons for Cesareans

    Failure to progress, or “dystocia” accounts for close to 30% of all cesareans. When the cervix won’t dilate or if it slows down or stops altogether at some point and labor is taking longer than average, a cesarean may be suggested. Also, prolonged labor may be caused by the baby not descending or contractions that aren’t strong enough, even after an attempted augmentation with cervical ripening agents or Pitocin.

    If the baby’s head is too large to fit through the pelvis (which is often called cephalopelvic disproportion or “CPD”), either because the mother is too small or the baby is too big, a cesarean may be necessary. Sometimes a woman has a deformed pelvis because of a birth defect or a debilitating disease such as rickets or polio, which makes a vaginal delivery incredibly difficult or impossible.

    A cesarean may be necessary if certain maternal health conditions are present. Toxemia, high blood pressure, gestational diabetes (which can lead to an extra large-sized baby), pre-eclampsia, heart or pulmonary disease, HIV infection, obstruction of the birth canal by fibroids and active genital herpes lesions are all possible indicators that a cesarean may need to take place, but not in all situations. Maternal exhaustion accounts for a small number of cesareans.

    Problems with the baby such as genetic deformity, neural tube defects, hydrocephalus or heart problems can lead to a cesarean. Some babies may not survive the process of labor and vaginal birth. Also, multiple births run a higher risk of complications if a vaginal delivery is attempted. Cesareans are routinely performed with the delivery of twins, triplets (or more), since giving birth to multiples poses unique challenges. Multiples are much more common now, as a result of fertility treatments, which also contributes partially to the increase in the overall cesarean rates.

    Close to a third of all cesareans are repeat cesareans, although more and more women are electing to try VBAC (vaginal birth after cesarean). On the other hand, many hospitals and doctors are choosing not to offer VBACs any longer.

    The reason for the high number of repeat cesareans is partly because of the concern for a possible uterine rupture. Pre-planned or “elective” cesareans (for non-medical reasons) are becoming increasingly popular. The reason for this jump is mainly simply for convenience purposes (for the doctor, as well as the mother).

  • Avoiding a Cesarean

    A high percentage of cesareans done in the United States are medically unnecessary, therefore many are preventable. There are measures that can be taken to help possibly avoid an unnecessary cesarean. However, clearly there are times when cesareans are very necessary, such as instances of a prolapsed cord, placenta previa and uterine rupture, which would all lead to an emergency c-section to save the lives of the mother, baby or both.

    Become Cesarean Educated

    During your pregnancy, attend childbirth classes. This may allow you to talk with others who have been there and may also give you many great coping skills for labor to increase your comfort and decrease the need for medications and intervention. Read and learn as much as you can about the birth process, all of your birth options and what to expect during labor, which may help you to appropriately express your choices for birth to your doctor or midwife. When choosing a doctor or midwife, interview more than one and ask lots of questions, including what their philosophy is on cesarean birth. Ask them what their “primary cesarean rate” is in their practice. The number should preferably be no more than 10%. Ask them if there is a time limit for labor and the pushing stage and also ask what they feel can interfere with the normal labor process. If you’ve had a previous c-section, be sure to ask about the possibility of a VBAC (vaginal birth after cesarean).

    Delivery Options

    Once you choose a doctor or midwife, discussing your delivery wishes early on is extremely important. Preparing a flexible birth plan is also very helpful and important. After researching and creating a birth plan, make copies and give them to everyone who will be involved in your labor and delivery, including your labor support people, your doctor or midwife, as well as the hospital or birth facility. Discuss it extensively with your doctor or midwife and share your goal of avoiding a cesarean birth unless absolutely necessary.

    Choose a labor support person, such as a doula (an experienced labor companion who provides continuous emotion support and information during labor and delivery) . Cesarean rates for women who choose professional labor support are significantly lower. Professional doulas are trained in the ways of labor support using massage, relaxation (including aromatherapy), coping techniques and physical comfort measures.

    Labor Induction

    If possible, try to avoid an induction of labor, which can lead to an increased risk of needing a cesarean. For a labor that is progressing slowly, try other things such as nipple stimulation instead of Pitocin for augmentation. Explore your pain relief options. Epidurals and other anesthesia can slow down labor progression (especially if done too early during labor). With the use of an epidural, you cannot walk, therefore you can’t use gravity to help labor along and also because of the numbness, you may have trouble pushing effectively. If you feel the need for an epidural, wait until you are past 5 centimeters, if possible, and in active labor.