You will be directed to push with each contraction in order to move the bay down and out the birth canal. An episiotomy, if necessary, is usually done at this time. This incision is made into the area between your vagina and rectum (perineum). It enlarges the vaginal opening for delivery of your baby and protects the surrounding area from tearing. As your baby's head is being delivered, you may be asked to stop pushing so that excess mucus can be suctioned from the baby's nose and mouth. This is an exciting and intense time. You know that the baby is almost here and may be tempted to push as hard as you can to get the baby out quickly. It is important for you not to push hard at this time because a sudden push could make the baby come out too quickly and may also damage your perineum. Wait until your provider instruct you to push again, and then let your uterus do most of the work. This will allow safe delivery your baby and perinial integrity. Babies usually begin to cry on their own, and you can now see and perhaps hold your baby.

The Third Stage - This stage begins after the delivery of your baby and ends with the delivery of the placenta, which usually occurs within 5 to 30 minutes. You will continue to have mild contractions during this stage and you may be asked to push to assist in the delivery of the placenta. The placenta will be examinedto make sure the entire placenta is delivered. After the delivery of the placenta, the episiotomy or any tear will be repaired (sutured) if necessary.

The Fourth Stage, - This is the 1 to 4 hour period of time after delivery of the placenta. During this stage, the mother's body systems stabilize. Your pulse, blood pressure, and respiratory rate will be taken frequently, and your vaginal area will be checked for bleeding. A nurse may massage your uterus or instruct you to do so. This helps the uterus to contract and will help to reduce blood loss. After the excitement and the work of the delivery is done, you may feel tired, thirsty, and even hungry. Now is the time to relax and take pride in you accomplishment.

Special Care After Delivery

For Mother - Your provider will:

• Monitor your temperature, pulse, respiratory rate, and blood pressure
• Massage your uterus
• Check for vaginal bleeding and change pads
• Check for urination and bowel movements
• Check Episiotomy or Cesarean incision
• Check for hemorrhoids
• Evaluate ambulation (ability to turn over, walk, etc.)
• Administer an analgesic, stool softener or laxative as prescribed
• RhoGam immunization is given as prescribed (if your blood type is Rh negative)
• Monitor blood pressure (gestational hypertension can occur after delivery)
• Check breast feeding status
• Check appetite, diet, and fluid intake
• Discontinue intravenous fluids and/or urinary catheter as indicated
• Monitor your admission to the recovery or postpartum area, unless you delivered in a LDRP unit

For Baby

• Nose and throat suctioned
• Umbilical cord clamped
• Dried and warmed
• Apgar score taken (performed at 1 minute and 5 minutes after birth, this is a method of evaluation a newborn's state of well-being, including respiratory effort, heart rate, muscle tone, skin color, and reflex irritability)
• Hospital I.D. bracelet attached to wrists or ankles
• Overall physical exam performed
• Weighed on a special scale for babies
• Measured for body length
• Antibiotic eye ointment applied
• Temperature, blood pressure, and pulse taken
• May be taken to the nursery, unless you have delivered in an LDRP unit
• Gestational age determined
• Blood glucose level measured
• Vitamin K (for normal blood clotting) given
• Umbilical cord treated to prevent infection and promote drying

Reprinted by Pregnancy.org, LLC from Her HealthCare.