Normal labor and delivery process
After months of waiting, your
baby's due date is approaching. Here's what you can expect from the start of
labor to the first days and weeks with your newborn.
Labor signs
No one can predict with
certainty when labor will begin. Usually, labor begins three weeks before this
date or two weeks after it. Here are signs that labor is probably just around
the corner:
- Lighting.
This happens when your baby's head drops into the pelvis in preparation for
birth. Your belly may feel lower and you may be able to breathe easier because
your baby is no longer filling your lungs. You may also feel an increased need
to urinate when the baby presses on the bladder. This can happen from a few
weeks to a few hours after the onset of labor.
- Bloody show. A
bloody or brownish discharge from the cervix is a plug of mucus that has
isolated the uterus from infection. This can happen a few days before or at the
start of labor.
- Diarrhea.
Frequent loose stools may mean that labor is imminent.
- Ruptured membranes.
Fluid leaking from the vagina means that the membranes in the amniotic sac that
surrounded and protected your baby have ruptured. This can happen a few hours
before the onset of labor or during labor. Most women give birth within 24
hours. If labor does not occur naturally during this time, doctors may induce
labor to prevent infections and birth complications.
- Contractions. While it's not uncommon to have intermittent, irregular
contractions as labor approaches, contractions that occur less than 10 minutes
apart usually indicate that labor has begun.
Stages of labor
The labor is usually divided
into three stages:
Stage 1.
The first stage of labor is divided into three phases: latent, active and
transitional.
The first, latent phase, is
the longest and least intense. During this stage, contractions become more
frequent, helping the cervix to dilate so that the baby can pass through the
birth canal. Discomfort at this stage is still minimal. At this stage, the
cervix will begin to dilate and disappear or thin. If you have regular
contractions, you will likely be admitted to the hospital at this point and
will have frequent pelvic exams to determine how dilated your cervix is.
In the active phase, the
cervix dilates faster. You may feel intense pain or pressure in your back or
abdomen with each contraction. You may also feel the urge to push or press, but
your doctor will tell you to wait until the cervix is fully open.
During the transition, the
cervix fully dilates to 10 centimeters. The contractions are very strong,
painful and frequent, occur every three to four minutes and last from 60 to 90
seconds.
Stage 2.
Stage 2 begins when the cervix is fully open. At this point, your doctor will
give you permission to push. Your pushing, along with the strength of your
contractions, will propel your baby through the birth canal. The fontanelles
(soft spots) on your baby's head allow him to pass through the narrow channel.
Your baby's head is crowned
when the widest part reaches the entrance to the vagina. Once your baby's head
comes out, your doctor will suck out the amniotic fluid, blood, and mucus from
his nose and mouth. You will continue to push to help stretch the child's
shoulders and body.
Once your baby is out, your
doctor will clamp and cut the cord.
Stage 3.
After the baby is born, you enter the last stage of labor. At this point, you
expel the placenta, the organ that fed your baby in the womb.
Every woman and every job is
different. The time spent on each stage of delivery will be different. If this
is your first pregnancy, labor usually takes 12 to 14 hours. The process is
usually shorter for subsequent pregnancies.
Pain treatments
Just as the length of labor
varies, the amount of pain women experience also varies.
The position and size of your
baby, as well as the strength of your contractions, can also influence the
pain. While some women can manage their pain with the breathing and relaxation
techniques learned in prenatal classes, others will need other methods to
control their pain.
Some of the most commonly used
pain relief methods include:
Medications.
Some medications are used to relieve the pain of labor. While these medicines
are generally safe for both mother and baby, like any medicine, they can have
side effects.
Analgesics fall into two
categories: analgesics and anesthetics.
Analgesics relieve pain
without complete loss of sensation or muscle mobility. During labor, they can
be administered systemically by injection into a muscle or vein, or locally by
injection into the lower back to numb the lower body. A single injection into
the cerebrospinal fluid, which quickly relieves pain, is called a spinal block.
An epidural block continuously delivers pain medication to the area around the
spinal cord and spinal nerves through a catheter inserted into the epidural
space. Possible risks of both include low blood pressure, which can slow a
child's heart rate, and headaches.
Anesthetics block all
sensations, including pain. They also block muscle movement. General
anesthetics will make you pass out. If you are giving birth by caesarean
section, you may be given general, spinal, or epidural anesthesia. The
appropriate form of anesthesia will depend on your medical condition, the
health of your baby, and the medical conditions associated with your birth.
Non-drug options. Non-drug methods of pain
management include acupuncture, hypnosis, relaxation techniques, and frequent
position changes during labor. Even if you choose non-pharmacological pain
medication, you can still request pain medication at any time during labor.
What to expect after delivery
Just as your body went through
many changes before birth, it will go through transitions as you recover from
labor.
Physically, you may experience
the following:
- Pain at the site
of an episiotomy or laceration. An
episiotomy is an incision that a doctor makes in the perineum (the area between
the vagina and anus) to facilitate labor or prevent ruptures. If this was done
or the area was torn during labor, the stitches may make it difficult to walk
or sit. It may also hurt when you cough or sneeze while it heals.
- Chest pain.
Your breasts may be swollen, hard, and painful for a few days while your milk
is coming in. Your nipples may also hurt.
- Hemorrhoids. Hemorrhoids (swollen varicose veins in the anal area) often occur after pregnancy and labor.
- Constipation. It may be difficult to have a bowel movement for several days after giving birth. Hemorrhoids, episiotomy, and muscle pain can cause pain during a bowel movement.
- Hot and cold
flashes. Your body's adaptation to
changes in hormone levels and blood flow can leave you sweating one minute and
looking for a blanket to cover the next.
- Urinary or fecal
incontinence. Muscles stretched during
labor, especially after a long labor, may cause urine to leak when laughing or
sneezing, or may make it difficult to control bowel movements, causing
occasional urinary incontinence.
- "After pains.
After giving birth, you will continue to feel contractions for several days
until your uterus returns to its pre-pregnancy size. You may notice
contractions the most when your baby is breastfeeding.
- Vaginal discharge
(lochia). Immediately after giving
birth, you will feel more spotting than during normal menstruation. Over time,
the discharge will turn white or yellow, and then stop completely within two
months.
Emotionally, you may
experience irritability, sadness, or crying, commonly known as "baby
blues," in the days or weeks after giving birth. These symptoms occur in
80% of new mothers and may be related to physical changes and your emotional
adjustment to the responsibilities of caring for a newborn.
If these problems persist, tell your doctor or other healthcare professional; you may be suffering from postpartum depression, a more serious problem that affects 10% to 25% of new mothers.