Looking ahead: Labor and Delivery

Knowing what to expect when it comes time for labor and delivery can help ease any anxiety you may have about the birth process, especially if this is your first baby. Reviewing these facts will help, as taking advantage of childbirth classes.

When You Arrive at the Hospital

Before you are formally admitted to your hospital's labor and delivery area, you will probably be given a vaginal exam to determine the progress of your labor. This exam will determine your cervical effacement and dilation, and how far your baby has descended into your pelvic cavity. You will be asked for general information that includes the following:

  • Review of your medical benefits coverage
  • Determination of pre-registration
  • Your partner's or support person's name
  • The name of the doctor you have chosen for your baby
  • Your participation in any type of childbirth classes
  • Your plans for breast feeding
  • Your plans for circumcision if the baby is a boy
  • Any plans for postpartum sterilization

You will be asked for specific information that includes the following:

  • The date and time your contractions began and the average length (duration) of your contractions.
  • How frequently your contractions are occurring.
  • The date, time, color, and amount of vaginal discharge.
  • The date, time, and color of fluid if your "water broke" (amniotic membranes rupture).
  • When you last ate, had a bowel movement, and any occurrence of diarrhea.
  • Your complete medical and prenatal history will be reviewed.

Typical Procedures

  • A hospital patient I.D. bracelet will be attached to your wrist.
  • Measurements will be taken of your temperature, pulse, breathing rate, and blood pressure.
  • Blood and urine samples and vaginal cultures may be taken.
  • A test may be performed to determine whether your amniotic membranes ("bag of water") has broken or is still intact.
  • An estimation of fetal age and weight and presentation of your baby will be made.
  • You may receive an intravenous (IV) line that can be used to give fluids that prevent dehydration and/or administer medication quickly.
  • You probably will not be allowed to eat during labor. Ice chips are usually allowed.

Fetal Monitors

Your provider may use one particular method, or possibly a combination of methods, to help them determine how your baby is reacting to labor.

  • Auscultation Monitoring - This method involves listening to the fetal heartbeat with a Doppler device or stethoscope and recording it at specific intervals between contractions. Our doctors and nurses will also place their hands on your stomach to feel for uterine contractions.
  • Electronic Monitoring - This method measures the response of your baby's heart rate to the contractions of your uterus, and provides a continuous printout of information that can be read by our doctors and nurses. Monitoring is done through one of two different methods:
    • The external monitor is secured to your abdomen with two elastic belts, one holds a sensor that measures your contractions, and the other secures an ultrasound device that uses sound waves to pick up your baby's heartbeat.
    • Internal monitoring is done by attaching an electrode (a thin spiral wire) to your baby's scalp to provide a recording of his heart rate. At the same time, a catheter (thin tube) or transducer (pressure gauge) is placed in your uterus to measure the strength and frequency of your contractions. Internal monitoring can't be used until your amniotic sac has ruptured and your cervix has begun to dilate.

Stages of Labor and Delivery

The length and difficulty of each woman's labor and delivery will vary. Factors that play a role include the size and shape of your pelvis, the size and position of your baby, your cervical status at the time labor begins, and the strength and frequency of your contractions.

Labor is described as having four stages. The first stage is defined as the time from the onset of progressive labor contractions until the cervix is completely dilated. The second stage is from complete dilation of the cervix until the baby is born. The third stage is from the birth of the baby until the placenta is delivered. And finally, the fourth stage is from the delivery of the placenta until the mother's medical condition is stable and safe.

The progression through the four stages of labor varies among women. For some women, labor starts slowly and then speeds up unexpectedly, while for others labor starts rapidly and then slows down. In some cases, our doctors may decide that it is time for your baby to be born even though true labor has not yet started. Induction of labor is the process of starting labor artificially by the use of medication, primarily oxytocin.

The First Stage of Labor - This stage is almost always the longest and may last approximately 8 to 20 hours if this is your first pregnancy, or 5 to 14 hours if you have previously given birth. Early, or latent, labor begins with the onset of regular contractions and ends when your cervix is approximately 3 centimeters dilated. Contractions last approximately 30 seconds and may occur every 10 to 20 minutes from the beginning of one to the beginning of the next, with your uterus relaxing between each one. Much of your time in this early phase of labor may be spent trying to figure out if you are in true labor or not. The most common sign and symptoms of this phase include backache, menstrual-like cramping, indigestion, diarrhea, and bloody show. You may experience all of these or just one or two.

Active labor begins when your cervix is dilated to 3 centimeters and ends when it is fully dilated to 10 centimeters (about 4 inches across). Effacement, or thinning of the cervix, is usually complete or almost complete. Contractions are stronger and longer (30 to 60 seconds) and occur every two to three minutes. You may become serious and quite, focused on only one thing, labor. At this point, support, encouragement, help, and comforting gestures from your partner will be appreciated. You may experience emotional ups and downs throughout your labor, at times even becoming weepy and frustrated. But if you know what to expect and accept labor as it comes, these periods will be easier to tolerate.

During your labor, the nurse or midwife may place her fingertips over your uterus and feel your contractions from the time one begins to the time another begins. This helps determine the timing and strengths of your contractions. If an electronic fetal monitor is used, contractions are measured from the peak of one to the peak of the next.

Membranes can rupture at any time during early or active labor, resulting in a gush, trickle, or leakage of fluid from your vagina. To determine whether your membranes have ruptured, an exam may be done to obtain a sample of amniotic fluid. In some cases, our doctors and nurses may choose to artificially rupture membranes. This procedure may speed up a slow labor. Vaginal exams may also be performed throughout the course of your labor to determine cervical effacement and dilation and/or to apply an internal fetal monitor. This examination may not be done if you are experiencing vaginal bleeding.

At some point during active labor, you may experience irritability, extreme heat or cold, trembling of your arms and legs, nausea, vomiting, and diarrhea. If you have chosen an epidural for pain management, it is generally given when your cervix is dilated to between 3 and 7 centimeters.

Changing positions every 20 to 30 minutes, kneeling on your hands and knees, alternating application of an ice pack and a hot pack, can relieve back pain and a firm massage with the fist or heel of the hand. Breathing and relaxation techniques learned in childbirth preparation classes may provide you additional relief.

The choice for body position during labor may be determined by custom, comfort, fetal well-being, and the need for certain procedures, such as listening to your baby's heart rate. Positions that may assist in the first stage of labor and in reducing pain include standing and walking, sitting or squatting, and laying on either your left or right side. For the safety of you and your baby, it is recommended that you avoid lying on your back for prolonged periods of time during labor. When your uterine contractions become very strong or you have been given pain medication, you will probably be asked to remain in bed to avoid injury.

As you complete labor and prepare for actual birth, known as the "transition phase", your cervix is dilated from 7 or 8 centimeters to 10 centimeters. You may feel almost out of control, as if you are being swept along in a wave of intense sensation. It becomes even more important for you to focus on relaxing; tensing up and fighting each contraction will only slow labor and exhaust you. However, you may feel the urge to push. Be sure to tell your midwife or nurse if you feel this urge. It is very important to resist the urge to push until your cervix is completely dilated and our doctors and nurses have instructed you to do so.

The Second Stage - Also called the "pushing stage" this stage of labor begins when your cervix is 10 centimeters dilated, and ends with the delivery of your baby. If this is your first baby, this stage may last about one to two hours. If you have previously given birth, it may last 15 to 60 minutes. The pushing stage is the most exhausting and demanding part of labor, but it is also an exciting time, with lots of cheering and praise for your efforts.

There are many positions for pushing and you may wish to discuss these with our doctors and nurses in advance. Lying on your side is a good position if the baby is coming fast, if you have painful hemorrhoids, or if you must lie down for some reason. Squatting allows more room for the baby to come down through your pelvis than any other position. Resting on your hands and knees may help if the baby is large. Semi-setting is a good position because you can see our doctors and nurses and the baby as he/she come out. Lying flat is the least effective and can cause problems with blood flow to the baby. You may use several different positions during the pushing phase. Whatever position helps you feel the most comfortable is most likely the one you should use.

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.