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6. Labor and Delivery

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6. Labor and Delivery Chapter 6 LABOR and DELIVERY 6. Labor and Delivery Childbirth is a natural process that each woman handles differently. The more you understand the childbirth process, the more relaxed and effective you will be during labor and delivery. SIGNS OF LABOR The labor experience varies by individual. You may experience one, two or all of the common signs listed below: § Bloody show. A thick, blood-tinged vaginal discharge is the result of the cervix thinning and dilating or opening. It can happen at the beginning of labor or up to one week prior to labor. If you experience any bright red bleeding, call your physician for evaluation. § Loss of mucus plug. The thick, gelatin-like mucus sealing the cervix and uterus can be dislodged as labor approaches. However, passing the mucus plug does not mean you are in labor or even that you’ll go into labor in the next few hours. § Ruptured membranes. Your water may break as a sudden gush or slow trickle of amniotic fluid that you cannot control. This amniotic fluid may be clear, yellow-, green- or pink-tinged in color. Please call the hospital birthing unit when your water breaks. § Contractions. This tightening or cramping sensation spreads across your entire belly, though some women feel contractions in their lower back. Timing your contractions – from the beginning of one contraction to the beginning of the next – can indicate your labor progression. § Diarrhea. Contractions may irritate your bowel, causing loose stools. monroeclinic.org 19 IS IT PRE-LABOR OR TRUE LABOR? At times you may feel tightening, contractions or cramps, but it isn’t true labor until your cervix begins to dilate (stretch and thin). A few of the differences between pre-labor contractions (false labor) and true labor contractions are: TRUE LABOR CONTRACTIONS PRE-LABOR CONTRACTIONS (False Labor) w Grow regular and closer in timing w Remain irregular and do not get closer together w Become increasingly intense w Do not increase in intensity w Grow progressively longer (up to 60 seconds) w Are short in duration (15 to 45 seconds) w Do not stop with activity or position changes w May stop with activity or position changes w Cause cervix to thin and dilate w Cause no cervical change IT’S TIME TO LEAVE FOR THE HOSPITAL IF: § Your water breaks. § If it’s your first baby, when your contractions are five minutes apart for at least one hour and are gradually becoming stronger. § If you’ve had a baby before, when your contractions are six to eight minutes apart for one hour. Please call us before you come so we can prepare for your arrival. If you are unsure if it’s time to come to the hospital, call and speak with a nurse who can help you decide. During regular business hours, please call your clinic. After hours, please call the hospital birthing unit at 608-324-1291. WHEN YOU ARRIVE AT THE HOSPITAL: § Between 6 a.m. and 8 p.m., go directly to the birthing unit. § Between 8 p.m. and 6 a.m., enter through the emergency department and a Monroe Clinic employee will accompany you to the birthing unit. After arrival, the nursing staff will evaluate your labor and notify your physician. A fetal monitor will be used to evaluate your labor contractions and baby’s heart rate. A vaginal exam will be done to determine cervical dilatation. 20 BABY STEPS ~ Your Pregnancy Guide LABOR DURATION, STAGES AND STRATEGIES It is impossible to predict how long your labor will last, as the experience is unique to each motherandbaby.However,the“average”laborforafirstbabylasts12to17hours.A woman who has already had one or two children will probably have a shorter labor. FIRST STAGE § What it feels like: strong contractions, intense The first stage of labor begins with the onset of rectal pressure, lower backache, urge to push, active labor and ends when the cervix is fully dilated nausea or vomiting, aching thighs, leg cramps, (10 centimeters) and 100 percent effaced, or thinned. tired, irritable, ready to give up. The first stage of labor is divided into three phases: § What to do: try to remain focused, take one early, active and transition. contraction at a time, find your most comfortable position, rest between contractions, visualize EARLY PHASE cervix opening and baby descending down, The cervix dilates, or opens to 3 to 4 centimeters remember this is the shortest phase of labor. and begins to efface or thin. § What your partner can do: help you focus, § What it feels like: mild contractions, offer encouragement, place cool cloth on “crampy” feeling, diarrhea, excitement, forehead, keep lips and mouth moist, tell you ambition, apprehension. the baby is almost here and you are doing great. § What to do: rest and relax to conserve energy, eat and drink lightly, take a warm bath or SECOND STAGE shower, change positions for comfort and The cervix is fully open and you will push the baby time contractions. down and out of the birth canal. Pushing can last from several minutes to several hours, depending § What your partner can do: offer a massage, on the baby’s position and size, the effectiveness of encourage rest, listen to music or get some sleep. pushes and if you’ve given birth before. ACTIVE PHASE § What it feels like: contractions every 3 to 5 The cervix will dilate to 4 to 7 centimeters and minutes, lasting 60 to 90 seconds, overwhelming efface/thin more. urge to push, increased perineal pressure, § What it feels like: stronger, longer contractions, energized and empowered. increased perineal pressure, more serious, more § What to do: find comfortable and effective concentration needed to relax. pushing position (semi-upright holding knees, § What to do: use slow or shallow breathing, side-lying, squatting or on all fours), push when change positions frequently, walk if comfortable, you feel the urge. use hospital’s whirlpool or shower, request pain § What your partner can do: help you position medication or epidural. yourself, support your legs, remind you to relax § What your partner can do: help you between pushes, cheer you on and share in the focus, assist with position changes, offer miracle of birth. encouragement or affirmations, provide comfort THIRD STAGE with pillows, dimmed lights or cool cloth. The placenta (or afterbirth) is expelled. Your uterus TRANSITION PHASE will continue to contract mildly until the placenta The cervix will dilate to 8 to 10 centimeters and be is completely out. This occurs between five and 20 100 percent effaced. minutes after the birth of your baby. monroeclinic.org 21 LABOR AND DELIVERY INTERVENTIONS Pain management Labor pain is a sign that your body is working well and working hard to deliver successfully. Women experience different degrees of labor pain. While you may have heard stories and advice from friends and family, be sure to choose pain relief options based on your own needs and preferences. NON-DRUG PAIN MANAGEMENT OPTIONS BREATHING TECHNIQUES IN DETAIL § Changing your position frequently. § Deep breathing helps you manage contractions. Begin each contraction with a deep cleansing § Walking. breath (a slow deep breath in through the nose § Whirlpool bath or warm shower. and a full exhale out through the mouth). Try to do six to nine breaths per minute, ending with a § Massage. full, cleansing breath. Breathing should be slow, § Apply ice or warm packs to your back. steady and controlled. § Conscious relaxation decreases labor discomfort, § Modifiedbreathing stills the diaphragm enhances labor progress and conserves precious through shallow breathing. With open mouth, energy. The ability to focus on relaxing take a light, shallow breath and exhale with the contributes to a calm frame of mind. sound “hee”. Increase and decrease your rate of § Visualization uses your mind to access the breathing as contractions get stronger or lessen autonomic nervous system. It usually begins in intensity. Ending with a cleansing breath. with a relaxation exercise and then progresses § Transition breathing helps you work through to a deeper level by imagining sights, sounds, the urge to hold your breath or push during smells, sensations or tastes connected to strong contractions. Begin with a quick personal memories. cleansing breath and take four to eight shallow § Breathing techniques ease discomfort caused breaths followed by a short sharp blow (sounds by tightened muscles that can slow the labor like “he-he-he-he-whoo-he-he-he-he-whoo”). process. They are best used when you can no Continue this pattern through each contraction. longer walk or talk during contractions. PAIN-RELIEF MEDICATION § Intravenous(IV)medications typically “take the edge off” the pain and help you relax, though you may still experience pain with contractions. § Labor epidural anesthetic almost eliminates labor pain. An anesthesiologist will place a thin plastic tube into your lower back next to the membrane that covers the spinal cord. Numbing medicine is delivered to your nerves through the tube. 22 BABY STEPS ~ Your Pregnancy Guide LABOR INDUCTION (inducing labor) CESAREAN SECTION Induction starts the labor before it happens naturally. A Cesarean section (C-section) is a surgery to deliver One of the main reasons to induce labor is mom or your baby. Many C-sections are scheduled prior to baby would be healthier if the baby were delivered hospitalization, but there are times when they are sooner. Several methods are used to induce labor: unexpected and need to be performed. Common reasons for an unplanned C-section include: § Amniotomy breaks the bag of water that holds the baby to offer the uterus natural § Fetal distress. chemical signals to start labor. This option § Labor fails to progress. depends on cervical dilatation, effacement and the baby’s position.
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