Labor and Delivery
While it takes nine months to grow a full-term baby, labor and delivery occurs in a matter of days or even hours. However, it’s the process of labor and delivery that tends to occupy the minds of expectant parents the most.
Signs of labor
Labor has started or is coming soon if you experience symptoms such as:
- increased pressure in the uterus
- a change of energy levels
- a bloody mucus discharge
Real labor has most likely arrived when contractions become regular and are painful.
Braxton Hicks contractions
Many women experience irregular contractions sometime after 20 weeks of pregnancy. Known as Braxton Hicks contractions, they’re typically painless. At most, they’re uncomfortable and are irregular.
Braxton Hicks contractions can sometimes be triggered by an increase in either mother or baby’s activity, or a full bladder. No one fully understands the role Braxton Hicks contractions play in pregnancy.
They may promote blood flow, help maintain uterine health during the pregnancy, or prepare the uterus for childbirth.
Braxton Hicks contractions don’t cause the cervix to dilate. Painful or regular contractions aren’t likely to be Braxton Hicks. Instead, they’re the type of contractions that should lead you to call your doctor.
First stage of labor
Labor and delivery are divided into three stages. The first stage of labor incorporates the onset of labor through the complete dilation of the cervix. This stage is further subdivided into three stages.
Early labor
This is normally the longest and least intense phase of labor. Early labor is also called the latent phase of labor. This period includes the thinning of the cervix and dilation of the cervix to 3-4 cm. It can occur over several days, weeks, or just a few short hours.
Contractions vary during this phase and can range from mild to strong, occurring at regular or irregular intervals. Other symptoms during this phase can include backache, cramps, and a bloody mucus discharge.
Most women will be ready to go to the hospital at the end of early labor. However, many women will arrive at the hospital or birthing center when they are still in early labor.
Active labor
The next phase of the first stage of labor occurs as the cervix dilates from 3-4 cm to 7 cm. Contractions become stronger and other symptoms may include backache and blood.
Transitional labor
This is the most intense phase of labor with a sharp increase in contractions. They become strong and occur about two to three minutes apart, and average 60 to 90 seconds. The last 3 cm of dilation usually occur in a very short period of time.
Second stage of labor
Delivery
During the second stage, the cervix is fully dilated. Some women may feel the urge to push right away or soon after they’re fully dilated. The baby may still be high up in the pelvis for other women.
It may take some time for the baby to descend with the contractions so that it’s low enough for the mother to start pushing.
Women who don’t have an epidural typically have an overwhelming urge to push, or they have significant rectal pressure when the baby is low enough in the pelvis.
Women with an epidural may still have an urge to push and they may feel rectal pressure, although typically not as intensely. Burning or stinging in the vagina as the baby’s head crowns is also common.
It’s important to try to stay relaxed and rest between contractions. This is when your labor coach or doula can be very helpful.
Third stage of labor
Delivery of the placenta
The placenta will be delivered after the baby has been born. Mild contractions will help separate the placenta from the uterine wall and move it down towards the vagina. Stitching to mend a tear or surgical cut (episiotomy) will occur after the placenta is delivered.
Pain relief
Modern medicine can provide a variety of options to manage pain and complications that can occur during labor and delivery. Some of the medications available include the following.
Narcotics
Narcotic medications are used frequently for pain relief during labor. Use is limited to the early stages because they tend to cause excessive maternal, fetal, and neonatal sedation.
Narcotics are generally given to women in labor by intramuscular injection or through an intravenous line. Some centers offer patient-controlled administration. That means you can choose when to receive the drug.
Some of the most common narcotics include:
- morphine
- meperidine
- fentanyl
- butorphanol
- nalbuphine
Nitrous oxide
Inhaled analgesic medications are sometimes used during labor. Nitrous oxide, often called laughing gas, is most commonly used. It can provide adequate pain relief for some women when used intermittently, particularly in the early stages of labor.
Epidural
The most common method of pain relief during labor and delivery is the epidural blockade. It’s used to provide anesthesia during labor and delivery and during a cesarean delivery (C-section).
The pain relief results from injecting an anesthetic drug into the epidural space, located just outside the lining the covers the spinal cord. The drug blocks the transmission of pain sensations through the nerves that pass through that portion of the epidural space before connecting with the spinal cord.
The use of combined spinal-epidurals or a walking epidural has gained popularity in recent years. This involves passing a very small pencil-point needle through the epidural needle prior to placement of the epidural anesthetic.
The smaller needle is advanced into the space near the spinal cord and a small dose of either a narcotic or local anesthetic is injected into the space.
This affects only sensory function, which enables you to walk and move about during labor. This technique is normally used during the early stages of labor.
Natural pain relief options
There are many options for women seeking a nonmedical pain relief for labor and delivery. They focus on reducing the perception of pain without the use of medication. Some of these include:
- patterned breathing
- Lamaze
- hydrotherapy
- transcutaneous electrical nerve stimulation (TENS)
- hypnosis
- acupuncture
- massage
Induction of labor
Labor can be artificially induced in several ways. The method chosen will depend on several factors, including:
- how ready your cervix is for labor
- whether this is your first baby
- how far along you are in the pregnancy
- if your membranes have ruptured
- the reason for the induction
Some reasons your doctor may recommend induction are:
- when a pregnancy has gone into week 42
- if the mother’s water breaks and labor doesn’t begin shortly thereafter
- if there are complications with the mother or baby.
Induction of labor is usually not recommended when a woman has had a previous C-section or if the baby is breech (bottom down).
A hormone medication called prostaglandin, a medication called misoprostol, or a device may be used to soften and open the cervix if it’s long and hasn’t softened or started to dilate.
Stripping the membranes may induce labor for some women. This is a procedure in which your doctor checks your cervix. They will manually insert a finger between the membranes of the amniotic sac and the wall of the uterus.
Natural prostaglandins are released by separating or stripping the lower part of the membranes from the uterine wall. This may soften the cervix and cause contractions.
Stripping the membranes can only be accomplished if the cervix has dilated enough to allow your doctor to insert their finger and perform the procedure.
Medications like oxytocin or misoprostol can be used to induce labor. Oxytocin is given intravenously. Misoprostol is a tablet placed in the vagina.
Fetal position
Your doctor regularly monitors your baby’s position during prenatal visits. Most babies turn into a head-down position between the week 32 and week 36. Some don’t turn at all, and others turn into a feet- or bottom-first position.
Most doctors will try to turn a breech fetus into a head-down position using external cephalic version (ECV).
During an ECV, a doctor will try to gently shift the fetus by applying their hands to the mother’s abdomen, using an ultrasound as guidance. The baby will be monitored during the procedure. ECVs are often successful and can reduce the likelihood for a C-section delivery.
Cesarean section
The national average of births by cesarean section has gone up dramatically over the last few decades. According to the Centers for Disease Control and PreventionTrusted Source, about 32 percent of mothers in the United States give birth by this method, also known as a cesarean delivery.
A C-section is often the safest and quickest delivery option in difficult deliveries or when complications occur.
A C-section is considered a major surgery. The baby is delivered through an incision in the abdominal wall and uterus rather than the vagina. The mother will be given an anesthetic before surgery to numb the area from the abdomen to below the waist.
The incision is almost always horizontal, along the lower portion of the abdominal wall. In some situations, the incision may be vertical from the midline to below the belly button.
The incision in the uterus is also horizontal, except in certain complicated cases. A vertical incision in the uterus is called a classical C-section. This leaves the uterine muscle less able to tolerate contractions in a future pregnancy.
The baby’s mouth and nose will be suctioned after delivery so that they can take their first breath, and the placenta will be delivered.
Most women won’t know if they’ll have a C-section until labor begins. C-sections may be scheduled in advance if there are complications with mother or baby. Other reasons a C-section may be necessary include:
- a previous C-section with a classical, vertical incision
- a fetal illness or birth defect
- the mother has diabetes and the baby is estimated to weigh more than 4,500 g
- placenta previa
- HIV infection in the mother and high viral load
- breech or transverse fetal position
Vaginal birth after C-section (VBAC)
It was once thought that if you’ve had a C-section, you’ll always need to get one to deliver future babies. Today, repeat C-sections are not always necessary. Vaginal birth after C-section (VBAC) can be a safe option for many.
Women who have had a low-transverse uterine incision (horizontal) from a C-section will have a good chance at delivering a baby vaginally.
Women who have had a classic vertical incision should not be allowed to attempt a VBAC. A vertical incision increases the risk of a uterine rupture during a vaginal birth.
It’s important to discuss your previous pregnancies and medical history with your doctor, so they can assess whether VBAC is an option for you.
Assisted delivery
There are times towards the end of the pushing stage where a woman may need a little extra help in delivering her baby. A vacuum extractor or forceps may be used to assist in delivery.
Episiotomy
An episiotomy is a downward cut at the base of the vagina and perineal muscle to increase the opening for the baby to come out. It was once believed that every woman needed an episiotomy to deliver a baby.
Episiotomies are now typically only performed if the baby is distressed and needs help getting out fast. They are also done if the baby’s head delivers but the shoulders get stuck (dystocia).
An episiotomy may also be performed if a woman has been pushing for a very long time and can’t push the baby past the very lower part of the vaginal opening.
Episiotomies are generally avoided if possible, but the skin and sometimes muscles may tear instead. Skin tears are less painful and heal faster than an episiotomy.
Natural Ways to Induce Labor
Waiting for baby?
Your due date is an educated guess for when your baby might make its arrival. While many women deliver perfectly healthy babies two weeks before or after this presumed due date, it’s recommended that women wait until 40 weeks for delivery.
It’s best to let mother nature decide when your baby comes.
In a 2011 study, 201 women who had recently delivered babies were surveyed about inducing labor at home. Of these women, 50 percent had tried some natural method of getting labor started.
If you are 40 weeks in, here are eight natural ways to get things moving along. Most of these methods are anecdotal and don’t have solid evidence that they work, so you should always talk to your healthcare provider before attempting any of these methods.
Your doctor may not be able to confirm that they work, but they can let you know if it’s safe to try with your pregnancy.
Be aware: Any type of labor induction increases the risk of cesarean delivery and other emergency interventions. Always talk to your doctor before trying to induce labor on your own.
1. Exercise
Exercise can be anything that gets the heart rate up, such as a long walk. Even if this method doesn’t work, it’s a great way to relieve stress and keep your body strong for the task ahead.
2. Sex
Theoretically, there are multiple reasons why having sex could induce labor. For example, sex can release oxytocin, which may help jumpstart uterine contractions.
Having sex is safe at full term, but you shouldn’t have sex after your water has broken. Doing so can increase your risk of infection.
3. Nipple stimulation
Stimulating your nipples can cause your uterus to contract and may bring about labor. Oxytocin is the hormone that causes the uterus to contract and milk to be ejected from the breast.
In fact, if you choose to breastfeed your baby right after delivery, this same stimulation is what will help your uterus shrink back to its original size. You or your partner may manually stimulate your nipples, or you can try using a breast pump.
4. Acupuncture
Acupuncture stimulates the release of oxytocin in the body. In a 2013 randomized trial in Denmark, more than 400 women were given acupuncture, membrane stripping, or both procedures before labor.
There were no significant differences in the outcomes of the groups, but the vast majority of these women did not require medical inductions.
5. Acupressure
Some practitioners believe that acupressure can start and restart labor. Prior to applying acupressure to yourself, make sure you get proper instruction from a trained acupressure professional.
If acupressure doesn’t get your labor going, it’s still an excellent way to alleviate pain and discomfort during labor.
6. Membrane stripping
Some providers will offer to strip your membranes to encourage labor. Though the procedure is done in the office, there are no medications involved. Your doctor will use a gloved finger to separate the amniotic sac from the area around the cervix.
This action releases hormones called prostaglandins, which help the body go into labor. If you have any vaginal infections, membrane stripping is not an option.
Following the procedure, you may experience cramps and spotting. If you experience bleeding similar to a menstrual period, contact your doctor.
There may be increased risk of your water breaking when membranes are stripped. Breaking of the water increases your risk of other medical interventions, including cesarean section.
If your water breaks, head to your birth center. They will want you to deliver within the next 24 hours.
7. Spicy foods
There is an old wives’ tale that eating spicy foods can put you into labor. However, no studies have made this connection. Do not eat spicy foods if they’re not part of your normal diet.
8. Red raspberry leaf tea
Midwives often recommend drinking red raspberry leaf tea as your due date nears. Tea may tone and strengthen the uterus in preparation for labor. Even if it doesn’t work, you’ll stay hydrated.
Perks of waiting for labor to start on its own
While most women at 40 weeks are ready to have their babies in their arms and out of their bellies as soon as possible, there are plenty of perks to waiting until your body naturally decides to go into labor — including recovery.
Women who weren’t induced typically recover more quickly than those who were. More time in the womb can mean both you and your new baby get to go home from the hospital sooner.
Infants who are born after a full-term pregnancy also experience other benefits. More time in the womb typically means:
- more time to build muscle and strength
- reduced risk of low blood sugar, infection, and jaundice
- improved breathing: infants born even as little as two weeks early can experience twice the number of complications
- better feeding once born
- increased brain development, with the brain growing a third of its size between weeks 35 and 40
Let your body do the work for a few more days, and take the time to get as much rest as you possibly can. We know, that’s easier said than done when you’re nine months pregnant. You and your baby will need all your energy soon enough!
Takeaway
Before trying anything that might induce labor, you’ll want to speak with your doctor to go over any risks or possible complications.
Though some of these methods are popular folklore among pregnant women, little scientific evidence supports their efficacy. In most cases, it’s best to let baby set their own birth date, even if it means waiting another week or two.
