Going Through Labor

Expectant mothers, especially those pregnant for the first time, often have doubts about when labor begins and what it feels like. That's natural. Only experience can inform a woman exactly what it is, and even then one childbirth will vary from another. But being prepared by acquiring guidance can help ease concerns.

Once labor begins, you'll need to prepare yourself mentally for the day. For some women, especially after a first child, this is a very easy task. For others, anxiety builds and builds. The best way to relieve that tension is to find out what to expect on that golden day.

Once the first stage of labor is passed, the placental sac has broken, the cervix has dilated and contractions are regular and frequent, the second stage of labor - actual delivery - begins. Of course, there's no bright line dividing the first from the second. Where one leaves off and the other begins will vary from woman to woman and birth to birth.

Labor, Signs and Actions

False labor is one of the trickiest issues pregnant women have to deal with. Packing the car, rushing to the hospital, disrupting a mate at work and more are all normal parts of delivery. Not generating false alarms is going to be high on anyone's wish list.

The first step is simply to accept an inescapable fact: no one can predict with certainty when labor begins (yet). A due date is nothing more than a best estimate. Those estimates have improved with the greater accuracy of early pregnancy tests, but they are still not 100% reliable.

Only about 5% of women who carry their babies to term actually deliver on the estimated date. Dates vary from a few days to a few weeks before or after. That doesn't mean that delivering early is necessarily delivering prematurely. There is simply a natural variation in how long pregnancy lasts. Due dates are specified for the average, that's all.

There are some signs to look for that labor has begun, however.

During a first pregnancy, babies will often move slightly into the birth canal two to three weeks before the onset of labor. An attentive mother can detect that movement. It may be easier to breathe, due to the shift away from the diaphragm. At the same time, pressure on the bladder may increase, leading to more frequent urination.

Past the first child, this movement may be less pronounced, and will tend to occur much later, sometimes only a few hours before labor begins.

Throughout pregnancy, it's normal to experience contractions. The baby moves, your muscles react. Hormonal changes induce neural events that lead to contraction. These random events don't indicate much. But as the third trimester advances, they can increase in frequency and intensity.

As they come more often and stronger, mothers report they experience heightened energy and may feel compelled to take on projects around the house. Working off some of that energy is a healthy thing, particularly since (as the day approaches) they often just 'want it to be over'.

A small mucus plug that sealed the cervix during pregnancy can stretch and break apart, even before 'water breaks'. This pinkish mucus is a normal discharge. Deep red fluid or blood should be investigated at once as a possible sign of tearing of the placenta from the uterus.

Now is the time to get prepared for the final stages.

What To Do When Labor Arrives

It can be difficult to know exactly when labor begins in earnest. But some signs are unmistakable. One such occurs when your new baby's head exerts pressure on the amniotic sac and it breaks. When your 'water breaks' (the liquid isn't just water, but amniotic fluid), labor is imminent.

Unfortunately, 'imminent' doesn't mean 'will occur within 10.5 hours' or any exact amount of time. The time to the beginning of regular contractions and actual delivery, can vary enormously from woman to woman and even child to child.

Nevertheless, when you feel that trickle or gush of colorless fluid flow down your leg, it's time to get ready. On average, labor will begin within 12 to 24 hours later. For some, the time is much sooner.

Note the time, wipe away the fluid and clean the vagina to minimize the risk of infection. Don't bathe. Look for any green or brownish fluid, the meconium, which is from your baby's bowel movement. That's an indicator of fetal stress and should be reported to your physician immediately.

Contractions will follow shortly.

The uterus is a muscle and one of its roles is to force the baby out into the world through the birth canal. The contractions you feel are that muscle tensing. They will usually be preceded by dull cramps in the lower back or pelvis. When they happen regularly for an hour, lasting at least 30 seconds each, gaining in intensity, actual labor has started.

Since they can vary from woman to woman, try to verify that the contractions are labor by varying your position. Move around and sit. See if they still occur. Remember to keep a close eye on the clock or your watch. Timing the events is important.

First pregnancies will often take a little longer, so try to avoid any sense of panic. When contractions are coming five minutes apart for an hour, it's time to head to the hospital. Err on the side of caution, though. The number is just an average and it's best to avoid complications by being too early, rather than too late.

Severe pain, rather than regular (even if uncomfortable) contractions can be a sign of placenta previa. This is a condition in which the placenta can block the exit from the uterus. Or, the pain can be the result of placental abruption, where the placenta separates but limits the baby's oxygen supply. Call your doctor.

Almost all labors proceed without incident. Stay calm, execute your plan and get ready for a healthy baby.

The First Stage of Labor, What to Expect

During labor the cervix will dilate to about 4 cm (1.5 in) and contractions begin lasting 30 to 60 seconds about five minutes apart. This stage can last anywhere from a couple of hours to all day, so be prepared to go a little hungry. Eating during this time is not recommended.

The baby's head is waiting at the inner end of the cervix.

As labor progresses, cervical dilation will increase from 4 cm to about 8 cm (3 in) and the contractions will come quicker, about two minutes apart. Time to kick into mental gear and make use of that training you spent so much time to acquire and practice. Breathing properly will help oxygenate your tissues and minimize pain.

The baby's head, assuming a 'normal' (not breech) birth, moves forward toward the birth canal.

At the hospital, you may feel cold. That's probably not just because they keep the place well air conditioned and you are in a flimsy gown. Hormone changes can also produce this. It's normal. Don't worry about a sense of loss of control. You've got plenty of people to help you and you are the center of attention.

Your physician will check your status, along with that of your baby. They'll examine heart rate, and ensure that everything is positioned normally. Hospitals will often use some form of electronic FHR (fetal heart rate) monitoring for half an hour after you're admitted. They're looking for a baseline to measure against changes that will come soon.

If your membranes have ruptured, they may choose instead to monitor internally. If so, they'll insert a small electrode through the vagina. They may also insert a catheter in the uterus to measure contractions. Not to worry! It's safe for you and your baby.

Continuous monitoring is necessary only in those rare cases where there's a problem. Discuss with your physician in advance of labor about removing the devices as soon as possible to maximize your comfort.

Now your baby moves into position and your abdomen 'drops'. This is sometimes called 'lightening', since you feel lighter. The baby has moved away from the diaphragm, which makes breathing easier. Your doctor may report that you are '100% effaced', which means your cervix has dilated to about 10 cm (4 in). Contractions are longer and coming rapidly now, almost together.

Time to get ready to push.

Delivery, What to Expect

There's a wide variation among women in many aspects of the process. The length of time is different for everyone and from child to child. The amount of pain differs. And the post-birth consequences will vary for each individual person and baby. In 75% of women who carry to term, delivery is within 12 hours. Only 2% will be in labor for more than 24 hours.

During the active delivery phase contractions are frequent, though there are breaks in between. Here that training you spent so many hours to practice kicks in. Proper breathing technique differs between the resting phase and the contraction and pushing phase. Use both.

Drugs are an option but both mothers and physicians try to keep them to a minimum. Anything the mother receives still makes its way into the child. Pain medication crosses the placenta and can slow the baby's heart rate and make breathing sluggish.

Analgesics are enough for most women, but they can produce side effects such as rapid heartbeat or nausea. A regional block may be appropriate for some women. This can offer pain relief without interfering with the ability to push, but it's not for everyone. Hot pads, ice packs and a hand to hold can often substitute for the time needed to get through the toughest phases.

Develop a plan with your physician well in advance to cover all the possibilities.

Transition is the interval during which the cervix dilates the final two centimeters (about an inch). It produces the most intense and frequent contractions, but may last only a few minutes. Rarely is it longer than an hour. Here again, breathing techniques and a good partner are great aids to staying focused and minimizing pain.

Deep breaths are best for those resting periods, short and sharp ones for the period of active pushing. Shallow chest breathing is best for the most intense contractions. This helps keep the blood well oxygenated and the mother focused as well as possible on something other than the pain.

When the widest part of the baby's head has moved into the birth canal, the second stage has begun in earnest. Contractions slow to four or five minutes apart. When the head is even with the lower pelvic bones, it's said to be at '0' station. It will progress through 1, 2, 3, and so on, measured by the baby's exit.

The excitement rises as the baby becomes clearly visible. Tiring by this time is normal, but adrenaline helps keep most mothers at it during this final stage. Then, success!