In labor having a baby

Childbirth | Stages of Labor | Effacement

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When you are ready to have your baby, you'll go through labor. Labor is the process of giving birth. Signs that you might be going into labor include:

Contractions that are regular then start to come closer together
Leaking fluid or bleeding from the vagina
Low, dull backache
Abdominal cramps

Call your health care provider if you have any of these signs, even if it is before your due date. Preterm labor can start before 37 completed weeks of pregnancy.

Labor happens in three stages. The first stage begins with contractions. It continues until your cervix has become thinner and dilated (stretched) to about 4 inches wide. The second stage is the active stage, in which you begin to push downward. Crowning is when your baby's scalp comes into view. Shortly afterward, your baby is born. In the third stage, you deliver the placenta. The placenta is the organ that supplied food and oxygen to your baby during pregnancy.

Mothers and babies are monitored closely during labor. Most women are able to have a baby through normal vaginal delivery. If there are complications, the baby may need to be delivered surgically by a Cesarean section.

NIH: National Institute of Child Health and Human Development

Labor and Birth (Department of Health and Human Services, Office on Women's Health) Also in Spanish
Stages of Labor (March of Dimes Birth Defects Foundation) Also in Spanish
What Is Labor? (Eunice Kennedy Shriver National Institute of Child Health and Human Development) Also in Spanish

Contractions and Signs of Labor (March of Dimes Birth Defects Foundation)
Cord Blood Testing and Banking (National Library of Medicine) Also in Spanish
Monitoring Baby's Heart Rate during Labor (American Academy of Family Physicians) Also in Spanish
Water Breaking: Understand This Sign of Labor (Mayo Foundation for Medical Education and Research) Also in Spanish

Dealing with Pain during Childbirth (Nemours Foundation) Also in Spanish

Apgar Scores (American Academy of Pediatrics) Also in Spanish
Birthing Centers and Hospital Maternity Services (Nemours Foundation) Also in Spanish
Birthing Classes (American Academy of Family Physicians) Also in Spanish
Elective Deliveries Before 39 Weeks: Is It Worth It? (American Academy of Pediatrics)
Why at Least 39 Weeks Is Best for Your Baby (March of Dimes Birth Defects Foundation)

Assisted Vaginal Delivery (American College of Obstetricians and Gynecologists)
Cesarean Section: MedlinePlus Health Topic (National Library of Medicine) Also in Spanish
Episiotomy: When It's Needed, When It's Not (Mayo Foundation for Medical Education and Research) Also in Spanish
Induction of Labor at 39 Weeks (American College of Obstetricians and Gynecologists)
Labor Pain (American Society of Anesthesiologists)
Natural Childbirth (Nemours Foundation) Also in Spanish

FastStats: Births -- Method of Delivery (National Center for Health Statistics)
PeriStats: Perinatal Statistics (March of Dimes Birth Defects Foundation)

ClinicalTrials. gov: Delivery, Obstetric (National Institutes of Health)
ClinicalTrials.gov: Labor, Obstetric (National Institutes of Health)

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Department of Health and Human Services, Office on Women's Health Also in Spanish
Find an Ob-Gyn (American College of Obstetricians and Gynecologists)

Labor & Delivery Tips from an OBGYN for First-Time Moms

Giving birth can be both exciting and terrifying for first-time moms. Just as the rest of your pregnancy has differed from others’, your birth experience will be unique to you and your baby. As you think about the big day when you’ll finally meet your little one, you probably have questions about what to expect!

Here are some of the most common questions I’ve been asked about giving birth for the first time.

Getting Ready for Baby

How important are birthing classes?

Prenatal classes or birthing classes can help you understand what to expect during your labor and delivery. You’ll learn about creating a birth plan, common things that happen in a hospital, and how to manage pain. At Madison Women’s Health, we refer our patients to Unity Point Meriter for prenatal classes. You can begin taking prenatal classes at the start of your second trimester. We recommend completing them before your 37th week of pregnancy.

Prenatal classes can be online or in person. Check with the hospital to see what they currently offer. Prenatal classes typically include a birth center tour. There are classes for singletons and multiples. They are helpful in understanding various things that can happen in labor and delivery that are not common things you see on TV (like ways to monitor your baby’s heart rate and the use of forceps or a vacuum if needed to safely deliver your baby).

Tip: Prenatal classes will help you think of questions you may want to ask your OB during your prenatal check-ups. Keep a list! Classes are a good supplement to your 10-15 minute prenatal visits.

Who can be with me at the birth?

Before the COVID-19 pandemic, there were no restrictions on how many people could be with you during the birth. During any Public Health Emergency, guidelines may change. It’s always a good idea to verify how many people can be there with you.

At the time this article was written, Meriter allowed one support person (in addition to a doula) to be with you. This person can be anyone — your partner, a friend, or a relative. Choose someone who will be supportive and encouraging. Currently, your support person must be the same person throughout the birthing experience. In other words, your support person cannot be your spouse for a few hours, then your mother, and then your sister.

Tip: A doula is considered part of the medical team and is therefore allowed to be involved in your care during the pandemic.

What is the difference between a midwife and a doula?

Midwives have been trained in obstetric procedures. They can interpret fetal monitoring, make recommendations on labor management, and recommend a C-section if it is needed.

Doulas have been trained in the emotional, psychological, and physical support of moms throughout pregnancy, delivery. and postpartum. They have not been medically trained, but their attention and focus on the mom has been shown to improve birth outcomes. Women who use a doula are more likely to have a delivery without pain medications and their labors tend to be shorter.

Tip: A doula does not make medical recommendations or replace your midwife or doctor, but rather they offer extra services and individualized prenatal and labor support

What will the labor and delivery room or birthing room look like?

Our patients deliver their babies at Meriter Hospital, which has large birthing rooms. You’ll appreciate having more space to walk around in early labor or sit on a birthing ball. You’ll be able to control the temperature and dim the lighting. Your room will have a couch, perfect for your support person to nap on if needed.

Tip: Meriter’s birth rooms also include a comfortable tub. While we don’t offer water births (in accordance with ACOG recommendations), water immersion during labor can help with relaxation and easing labor pain.

What should I pack in my hospital bag?

If you have to drop what you’re doing and immediately go to the hospital, they will have all the essentials. I usually tell patients, however, that it’s a good idea to have a bag ready to go around 36 weeks. There are things you will want to help make your stay more comfortable.

Here are some ideas for your hospital bag:

- Toiletries: Shampoo, conditioner, soap, toothbrush and toothpaste, hair brush, deodorant. While we have these things at the hospital, you’ll probably prefer your own.
- Comfy clothes for you.
  - Slippers, socks, or flip-flops.
  - Robe and/or nightgown. If you plan to breastfeed, choose a nightgown that opens in the front (although the hospital ones are great for this!)
  - Clothes to wear home. Comfortable maternity clothes are usually your best bet. Include a nursing bra if you plan on breastfeeding.
- Going home outfit for your baby. Your baby will be swaddled and diapered during the hospital stay, but most parents want a photo-worthy outfit for the big trip home.l
- Snacks for your partner / your support person. The hospital has a cafeteria (open during the day) and vending machines, but your partner may want to consider anything special they want. Sometimes light snacks are okay in early labor, but we recommend against eating in active labor for safety reasons (and you usually won’t feel like it!).

Phone charger. Family and friends will want frequent updates and you will fill up your camera roll quickly.

It’s Time!

At what point do I need to go to the hospital? How long should I labor at home?

Most women can spend time in early labor at home. We recommend calling if you have painful contractions every 5 minutes for 1-2 hours to keep us in the loop. Call sooner if your doctor has given you more specific instructions due to medical conditions. If you have had a more complicated pregnancy or if you live far from the hospital, you may be asked to come in sooner. If you think your water has broken, we recommend calling to discuss the best time to come in, which is usually early for safety reasons.

Tip: Everyone has a different pain threshold. A good measure of “painful contractions” means you need to stop and breathe through them without focusing on anything else.

How long is labor for first-time moms?

There are three stages of labor and how long each lasts is very unpredictable for first-time moms. The whole event can last hours or days. Your first labor will be the most unpredictable, while second labors are generally faster.

What are the stages of labor?

Stage 1a: Latent Labor

Contractions during early labor will feel mild, like deep menstrual cramps, and will be irregular. Early labor helps soften, shorten, and thin your cervix. It can start a few days or a few hours before birth.

Stage 1b: Active Labor

During active labor, your contractions become more frequent, regular, and painful. You are considered to be in active labor when your cervix has dilated to 6 cm. The rate of cervical change is more consistent and predictable from this point to “complete” dilation (10 cm). Your doctor will check your cervix to let you know when it’s ok to begin pushing. If you push too soon, before your cervix has fully dilated, you are at risk of tearing your cervix and having significant bleeding.

Stage 2: Pushing Stage / Birth

The second stage is the pushing stage. This stage can last a few minutes or many hours (up to 4 or more if the baby is making progress through the birth canal).

You may think, “how will I know when to push?” If you don’t have an epidural during labor, the urge to push is often very strong. If you have an epidural, you may not notice the urge to push in the same way. We will help you know how and when to push with your contractions.

Stage 3: Placenta Delivery

The placenta generally delivers within 30 minutes of giving birth. We sometimes massage your uterus to help with this (although we say massage, this can be uncomfortable). We strongly recommend every woman receive oxytocin as well. These steps are important to decrease the risk of excess bleeding following delivery.

What should my partner do during labor?

Talk about this with your support person ahead of time so expectations are clear. Some women prefer their partner help with coping with labor pain. Others prefer a more hands off approach. Talk together ahead of time to determine what you are comfortable with.

Tip: Your support person can be supportive in many ways. This can be giving you sips of water and ice chips, holding your hand, being responsible for music, rubbing your back, etc. Do what works best for both of you.

Can I eat and drink while I’m in labor?

If you are undergoing an induction or are at the hospital in early labor, sometimes light snacks are reasonable. A lot of women get nauseous and throw up in labor and are at risk for aspiration, a serious complication. We therefore recommend against eating in active labor. If there’s a possibility of needing a C-section, it is safest to have not had food recently. Most women are not hungry anyway! Water, clear juice, and ice chips are satisfying.

Tip: If you have an I/V, you will be properly hydrated. If your lips get dry from your breathing exercises, ask for some chapstick.

Pain Management

What does giving birth feel like?

Labor pain feels different for everyone, but some general principles include:

Braxton Hicks contractions — These are common, even as early as the second trimester. You’ll feel your uterus gradually tighten and get soft. This is not painful.
Early labor — Contractions can feel like strong menstrual cramps lasting 30 to 60 seconds (like a charley Horse in your uterus). Some women feel these contractions in their back.
Active labor — These are cramps that can’t be described by words. You may feel intense pelvic pressure as you “transition” to 10 cm and your baby descends into the birth canal.
Pushing stage — Along with the muscle pain of contractions, you will feel stretching and pressure in your vagina.

What are my options to treat labor pain?

Non-Pharmacologic Pain Control:

Changing positions: You may feel better standing up, resting on your hands and knees, or sitting on a birthing ball. Your body will tell you what is working!
Taking a warm shower or bath: The warm water can relax tense muscles. Water immersion has been shown to lower pain scores.
Massage: Your support person, nurse, or doula can massage your back and provide counter pressure during contractions
Breathing techniques: You’ll learn breathing techniques during your prenatal classes. Staying relaxed and calm helps with pain control.

Pharmacologic Pain Control:

I/V Narcotic: Some women have good pain relief with an IV or subcutaneous injection of a narcotic medication. We don’t recommend this option if we suspect you will deliver within an hour. This is to let the medication clear from you and your baby’s system before delivery. .
Epidural: You can request an epidural at any time you are in pain in labor. Some women request an epidural almost immediately, while others choose to have it done later. Medication from an epidural does not transfer to the baby. Learn more FAQs about epidurals for labor pain.

Tip: Each woman has different anatomy and experiences pain differently, so please be careful not to put pressure on yourself to make decisions about your labor based on others experiences. Women who give birth with an epidural have no less of a “natural birth” than someone who did not use pain medication. Each birth is equally as beautiful!

Special Circumstances & Preparing for Unexpected

What about giving birth to twins? How is labor different?

If you’re pregnant with twins, we recommend that you deliver in an operating room instead of the birth room, even if delivered vaginally. While it may not feel as cozy as a birth room, an operating room allows for more room to meet these babies safely. Your OBGYN will counsel prenatally on the safest way to meet your twins, as having two babies at one time comes with more risk than one.

In the United States, the primary Cesarean section (C-section) rate is just over 30%. At Madison Women’s Health, the C-section rate for first-time moms is well under 20%.

What is the likelihood I will need a C-Section?

In the United States, the primary Cesarean section (C-section) rate is just over 30%. At Madison Women’s Health, the C-section rate for first-time moms is well under 20%.

In the United States, the most common reason a woman delivers by C-section is that labor does not progress. In most cases, this is due to cephalopelvic disproportion (when a baby does not fit). The second most common reason is because we see signs a baby is in distress in labor. The recommendation for C-section is made when the benefit of meeting a baby by surgery outweighs the risks.

Tip: Our primary goal in caring for you is a healthy mom and a healthy baby and we will explain our recommendations for that each step of the way. We also want you to have a vaginal birth! We only recommend C-sections if we think the benefit is greater than the risk.

What is an episiotomy? Will I need one?

An episiotomy is a rarely performed medical procedure that involves cutting the perineum to help the baby deliver. Historically, an episiotomy was thought to decrease severity of tearing with delivery. We know through research that letting tearing happen naturally is more beneficial to the mom.

Tip: Episiotomies are only performed in emergency situations, with your consent, when it will help the baby deliver more quickly (a rare occurrence).

Will I tear? How is it treated?

Approximately 90% of women have a vaginal/perineal tear with delivery. Tears are graded as 1st through 4th degree, with 1st as the least amount of tearing. We recommend suturing tears to help them heal appropriately. We do this with stitches that dissolve.

Tip: A new technique, called perineal massage, has been proven to decrease the amount of tearing with delivery.

What about the embarrassing things….like pooping and pubic hair?

Most worry or feel embarrassed about these things, but we don’t even notice!

If you like to wax, I don’t recommend this past the 37th week. We don’t recommend shaving before delivery because it increases your risk of infection. Trust us, we are not paying attention to grooming!

Most women will have a bowel movement in labor or with pushing. This is good! it means you are pushing correctly.

Tip: Trust us. We really don’t care or remember!

Recovery

How long does it take to recover from giving birth?

Every woman is different in how she recovers, too. Postpartum is an awesome time, but also stressful! It is often referred to as the 4th trimester. Your sleep schedule changes, your body changes, and your interpersonal relationships change. If you choose to breastfeed, read up on our breastfeeding tips for new moms.

Vaginal Birth:

Many moms are surprised to know there is still a recovery period. You may have cramping, tailbone pain, and pain as a tear heals. Sometimes sitting and walking are tricky! There are no true lifting restrictions after a vaginal delivery, but I recommend avoiding heavy lifting for about two weeks, especially from the ground. This puts a lot of stress on your pelvic floor as it heals. Helpful tips for going home include sitting on soft surfaces, using a spray bottle after you void, using ice pads, taking ibuprofen and Tylenol, and keeping an area of all the things you will need most to care for you and baby in your home.

C-section:

The recovery from a C-section is longer because it is a major surgery. Wait six weeks before lifting anything greater than 10-15 lbs. We will teach you how to care for your incision in the hospital and will send you home with pain medication.

Final Recommendations

What are your recommendations about giving birth at home?

Home births double your risk of complications, with two times the risk of perinatal mortality and three times the risk of neonatal seizures. We, along with the American Academy of Pediatrics and ACOG, believe the hospital is the safest place to give birth. If you decide to give birth at home, you should have a low-risk pregnancy, the help of a certified midwife, and be reasonably close to a hospital.

Tip: Our first priorities are the health and safety of you and your baby. We will give you information and recommendations about safety and labor so you can make informed decisions throughout the process.

Bring a list of questions to your next OB visit!

Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

What does the child feel during childbirth?

Children, unlike mothers, cannot share their birth stories…maybe it is not in vain that this is provided by nature?

PRESSURE for uterine contractions. The child is not endangered; during normal childbirth, it is protected by amniotic fluid. When passing through the birth canal, the anatomy (bone mobility) helps to compensate for pressure and prevent injuries to the child. nine0003

STRESS , in a good way. During childbirth, the mother's body produces a hormone that helps to cope with pain. It stimulates the production of the stress hormone in the baby, which mobilizes the body to “eliminate the threat” and prepares it for life outside the womb.

SON . The baby can maintain the sleep cycle it is used to in the womb and sleep up to 50 minutes every hour.

DISTRESS fetus. If the pregnancy did not go very smoothly, the condition of the child during childbirth may worsen. For example, oxygen delivery may decrease, and the heartbeat will worsen. Therefore, during childbirth, KTG . If so, the doctors take the necessary measures.

PAIN during the period of exile. With a normal birth, it is not very strong. If, for example, a child is born with a birth tumor, it is logical that he was not well. But the sensations experienced by the child are not comparable with the sensations of the mother. This is due to the fact that the pain receptors in the newborn are not yet fully developed.

MOOD mother. It is necessary to remain calm and positive not only during pregnancy, but also during childbirth. It has been proven that the baby's heartbeat slows down, and he calms down when he hears the mother's voice. No matter how the birth goes, the child understands that “something is wrong”, so it is important for him to hear his mother. There are also studies that prove the positive effect of mother's laughter on the child. Women in childbirth don't often laugh, but having a partner help create the right atmosphere would be great! nine0003

EFFECTS OF DRUGS . Much that enters the mother's body crosses the placental barrier. With general anesthesia, the child may fall asleep or even stop breathing. Therefore, the preferred method of pain relief is epidural anesthesia. The absorption of its components is minimal, so we can say that it practically does not enter the bloodstream of the fetus and does not have a systemic effect on its body.

FIRST BREATH . The crying of a baby after birth speaks of the health of his lungs. During the first breath, the lungs begin to expand, and this mechanism is accompanied by a cry. At the same time, the first breath and cry allow you to clear the lungs of amniotic fluid. nine0003

SENSOR OVERLOAD . After giving birth, everything around becomes colder, noisier and brighter.

TEMPERATURE CHANGE . Amniotic fluid facilitates the transition from uterine temperature to ambient temperature, and the physiology of the newborn compensates for temperature changes. Moreover, in rodboxes we maintain a comfortable temperature for mother and child, and we put newborns on special heated tables.

nine0002 CONTACT WITH MOM . It is proved that the first hour after childbirth plays a fundamental role in the further development of the baby. Therefore, the procedures for weighing, washing, etc. are postponed in favor of the soonest establishment of skin-to-skin contact.

Mom is the only person a child knows in this world, and their quick separation can be traumatic for the child. The child calms down, lying on the mother's chest and hearing her voice immediately after birth. In the future, the moments when his mother takes care of him, breastfeeds are very important for him. It is imperative to talk with the child, then he will understand that the voice that accompanied him 9months, still with him.

A child's attachment to his mother develops in the womb. The child not only hears the voice, but even feels the mother's smell. After the child is born, attachment grows, growing into love.

We give birth like at home - articles from the specialists of the clinic "Mother and Child"

Zimina Natalya Nikolaevna

Obstetrician-gynecologist

MD GROUP 9 Clinical Hospital0003

How home birth is represented

The most typical arguments of supporters of home births:

A woman's body is designed specifically to give birth to children. By nature, it has all the necessary strengths and capabilities to give birth to a healthy child on its own, which means that the help of a doctor in this process is completely unnecessary.
The maternity hospital is not needed, because the atmosphere in it is official, hospital, and this does not contribute to relaxation in contractions and the opening of the cervix. nine0072
When giving birth at home, you can take any position that is comfortable for the woman.
And at home, you can give birth in the water (in the bath), or at least just relieve contractions by immersion in water.
During home birth, not strangers (doctors, midwives) will be nearby, but the husband, relatives or friends.
From the first minutes of birth, the child will be constantly next to his mother, he will not be supplemented, he will not be subjected to unnecessary manipulations and examinations. nine0072

Well, ideally, supporters of home births present them like this: effective contractions begin at 40 weeks, the first stage of labor lasts no longer than 10-12 hours. At this time, the woman in labor behaves in a way that is convenient for her, takes comfortable postures, uses techniques to anesthetize contractions (massage, breathing, water). Then comes the complete opening of the cervix, water spontaneously pours out, there are attempts, during which a healthy baby is born without much effort. The child is immediately applied to the mother's breast - he sucks it as much as he wants, the umbilical cord is cut only after the end of the pulsation. Mom has no breaks, the child is absolutely healthy. In general, everyone is satisfied and happy. nine0003

Actually

The picture of home birth is presented, of course, idyllically. And how happy ordinary women would be, and doctors too, if every birth went that way. But it’s not always possible to give birth the way you breathe. In childbirth or immediately after them, various unpleasant situations can arise with a woman or a child. We will not list them so as not to upset anyone. Let's just say that often the life and health of mother and baby depend precisely on how quickly they received medical assistance . But what can be done at home in such a situation? The only thing is to call an ambulance, because it is impossible to help a child with asphyxia or a woman with bleeding or high blood pressure without certain drugs, equipment, and simply medical skills. But after all, one of the specialists will be present at the birth with the expectant mother? Good obstetricians and gynecologists are well aware of the high risk of home births, so they do not accept births at home, and a midwife, even with experience, will only cope with the simplest situation. In addition, many so-called spiritual obstetricians, as a rule, do not even have a higher, often secondary medical education, and, of course, they do not bear any legal responsibility for the outcome of childbirth. And it happens that sometimes in home births there is no midwife at all (did not come or the woman was convinced that she was not needed). Therefore, of course, we can agree that the home environment helps a lot, but will it be possible to give birth in it in the event of some non-standard or difficult situation? nine0003

Natural childbirth is possible

But how then to ensure naturalness in childbirth and are there such childbirth at all? In fact, today, natural childbirth is widely carried out in most maternity hospitals, and is not only carried out, but also actively promoted . If everything goes well, if the birth proceeds correctly, if the baby’s heart beats evenly, and the mother feels good, the doctors of the maternity hospital do not interfere with the birth, but simply observe their course. A woman gives birth on her own, as nature dictates. But what about the notorious home comfort in childbirth? Turns out Today, natural childbirth "at home" is provided by many maternity hospitals :

Almost everywhere now free behavior during childbirth is actively practiced : a woman in labor does not have to lie on the bed all the contractions, but can choose any position.
In many maternity hospitals there are various devices to facilitate contractions : transforming beds, balls, ropes (with their help you can take different positions in fights), and in some, in addition to the shower, there is even a jacuzzi in which you can spend the first stage of childbirth. nine0072
Of course, not all, but already many Russian maternity hospitals have either been renovated or built in accordance with modern ideas about beauty and comfort . Even in free maternity hospitals there are cozy double rooms with a private bathroom, fresh renovation and beautiful linens. What can we say about childbirth under a contract or in a commercial clinic - the conditions there are more than excellent.
According to the order of the Ministry of Health of the Russian Federation, in any maternity hospital where there are separate maternity boxes, a husband, girlfriend, personal midwife or even a psychologist can be present at the birth, and absolutely free of charge . So, the expectant mother will not be left without support.
Today, in all maternity hospitals, babies are immediately applied to the mother's breast; it is also possible for mother and baby to stay together in the postpartum department.
Now you can easily find a maternity hospital where you can live together with your husband after childbirth in a comfortable family room . All this, of course, is not free - but if you really want it, then it is quite feasible.

So do not be afraid of the maternity hospital: it has all the conditions for natural and safe childbirth. And home birth is an unjustified risk and an unknown result.

Have you read at least one story about childbirth at home that ended unsuccessfully? Unlikely. And if they read it, it is not enough. And the reason for this, as a rule, is the same: with an unfavorable development of childbirth and problems with the child, a woman is aware of her carelessness and simply keeps silent about it.

“They used to give birth in the field” is one of the popular arguments of supporters of home births. They gave birth, but only the mortality rate in childbirth (both children and mothers) was extremely high.

An individual approach to the expectant mother and her baby, living together, free behavior during childbirth, the opportunity to choose a doctor and midwife, take a husband to give birth - all this is now available in many Russian maternity hospitals

5 signs that you are having a natural birth in the hospital