Labor and Birth

Once you reach the third trimester, you should talk to your health care provider or midwife about labor and delivery. Learn your options for pain relief. Find out how to reach her/him if you go into labor. And ask them at what point in labor should you call.

Before you reach the last few weeks of pregnancy, it is a good idea to visit the hospital or birthing center. Make sure you know how to get there, where to park and where to check-in. Find out if you can pre-register so that your insurance information is already in the computer when you arrive.

The following has been adapted from the websites listed at the bottom of this page.

The most important thing to remember about a due date is that it is only an estimate. Women often do not give birth on their due dates. The beginning of labor is unpredictable and often happens a little early or late. This is no cause for anxiety or alarm. In fact, labor may begin as much as 2 weeks before or after your due date and still be considered normal.

Many women, especially with their first babies, think they are in labor when they're not. This is called false labor. So do not feel embarrassed if you go to the hospital thinking you are in labor, only to be sent home.

If you think labor has begun, you should call your doctor or midwife. They can decide if it is time to go to the hospital or if you should be seen at the office first. Learn the signs of labor so you will know when the time has come.

If you think you may be going into labor, do not hesitate to call your health care provider, no matter what time of day or night. Call your health care provider if you experience any of the following:

Contractions between 5 and 10 minutes apart that come at regular and increasingly shorter intervals. Contractions should also become stronger over time.
You can no longer walk or talk during contractions.
Your water breaks (can be a large gush or a continuous trickle).
You experience vaginal bleeding.
You have a bloody (brownish or red-tinged) mucous discharge. This is probably the mucous plug that blocks the cervix. Losing your mucous plug usually means your cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start right away or may still be days away.
You have lower back pain (back labor) that doesn't go away. You might also feel premenstrual and crampy. Back labor refers to the intense lower back pain that many women feel during contractions, and some even feel between contractions.
You have constant, severe pain--don't wait for a whole hour to pass
You feel reduced fetal movement

Stages of labor and delivery

Although labor is different for each birth, the basic process is the same. Labor occurs in three stages:

The first stage typically begins with the onset of contractions of the uterus. The frequency and duration of these contractions varies with the individual. The onset of labor may be sudden or gradual. During this stage, the expectant mother typically goes through several emotional phases. At first, the mother may be excited and nervous. Then, as the contractions become stronger, demanding more energy from the mother, mothers generally become more serious and focused. However, as the cervix finishes its dilation, some mothers experience confusion or self-doubt. The duration of labor varies widely, but averages some 13 hours for women giving birth to their first child ("primiparae") and 8 hours for women who have already given birth.

In the second stage of labor, the baby is expelled from the womb through the vagina by both the uterine contractions and by the mother's efforts of "bearing down," which many women describe as similar in sensation to straining to expel a large bowel movement. The baby is most commonly born head-first. In some cases the baby is "breech" meaning either the feet or buttocks are descending first. The length of the second stage varies and is affected by whether a woman has given birth before, the position she is in and mobility. The length of the second stage should be guided by the condition of the fetus and health of the mother.

In the final stage, the uterus expels the placenta (afterbirth). Breastfeeding the baby will help to cause this. It is essential that the placenta be examined to ensure that it was expelled whole. Remaining parts can cause postpartum bleeding or infection.

After the birth, the medical condition of the child is assessed with the Apgar score, based on five parameters: heart rate, respiration, muscle tone, skin color, and response to stimuli. Apgar scores are typically assessed at both 1 and 5 minutes after birth.

Choosing Where to Deliver

Many women carefully choose the kind of environment in which to deliver her baby. You will need to contact your health insurance to find out what options are available. In general, women can choose to deliver at a hospital, birth center or at home. Many hospitals and birth centers offer birthing classes like Lamaze and breastfeeding support.

Women with health problems, pregnancy complications or those who are at risk for problems during labor and delivery should give birth in a hospital. Hospitals offer the most advanced medical equipment and highly trained doctors for pregnant women and their babies. In a hospital, doctors can do a cesarean section if you or your baby is in danger during labor.

Healthy women who are at low-risk for problems during pregnancy, labor and delivery may choose to deliver at a birth or birthing center. Birth centers give women a "homey" environment in which to labor and give birth. They try to make labor and delivery a special, warm, family-focused process. Birth centers do not do any "routine" medical procedures. So, you will not automatically be hooked up to an IV. Once the baby is born, all examinations and care will occur in your room. By doing away with most high-tech equipment and routine procedures, labor and birth remain a natural and personal process. Birth centers can be inside of hospitals, affiliated with a hospital or completely independent, separate facilities.

Healthy pregnant women with no risk factors for complications during pregnancy, labor or delivery can consider a planned homebirth. Some certified nurse midwives and physicians will deliver babies at home. Homebirths are common in many countries in Europe. But in the United States, planned homebirths are still a controversial issue. The American College of Obstetricians and Gynecologists (ACOG) is against homebirths. ACOG states that hospitals are the safest place to deliver a baby.

Women can also choose what type of health care provider they would like to deliver their baby. An obstetrician-gynecologist (OB) is a medical doctor who specializes in the care of pregnant women and in delivering babies. Obstetricians also have special training in surgery so they are capable of doing episiotomies and cesarean sections.

A certified nurse-midwife (CNM) and a certified professional midwife (CPM) specialize in prenatal care, labor, and delivery. Both can be a good option for healthy women at low-risk for problems during pregnancy, labor, or delivery.

Some women also choose to have a doula assist with labor and delivery. A doula is a professional labor coach who gives physical and emotional support to women during labor and delivery. They offer advice on breathing, relaxation, movement and positioning. Doulas also give continuous emotional support and comfort to women and their partners during labor and birth.

Managing the Pain

Virtually all women worry about how they will manage the pain of labor and delivery. Childbirth is different for everyone. So no one can predict how you will feel. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, and the strength of the contractions.

Different women respond to the pain of labor and delivery in different ways. For some, contractions may seem like strong menstrual cramps. For others, the pain may be stronger and difficult to bear. Some women prefer to deal with the pain of childbirth naturally, using breathing and relaxation techniques. Childbirth education classes can help you learn these techniques. Most women, however, do get some form of pain relief through medication. For additional information please visit the page Managing pain.

Waterbirthing

More and more women in the United States are using water to find comfort during labor and delivery. In waterbirthing, laboring women get into a tub of water that is between 90 and 100 degrees. Some women get out of the tub to give birth. Others remain in the water for delivery.

The water helps women feel physically supported. It also keeps them warm and relaxed. This eases the pain of labor and delivery for many women. Plus, it is easier for laboring women to move and find comfortable positions in the water.

Waterbirthing is relatively new in this country. So there is very little research on its benefits. Even so, some women say giving birth in the water is faster and easier. Plus, women may tear less severely and need fewer episiotomies in the water.

Waterbirthing may be gentler for your baby too. It may ease the baby's transition from the womb to the new world. The baby is born into an environment that is similar to the womb. Plus, the water dulls the lights, sound and feel of the new world. Once the baby is born, it is brought to the surface of the water and wrapped in blankets.

Ask your doctor or midwife if you are a good candidate for waterbirthing. Water birth is not safe for women or babies who have health issues.

During a c-section, the doctor makes a cut in the mother's abdomen and uterus and removes the baby. So, the baby is delivered through surgery instead of coming out of the vagina. A c-section can save the life of a baby or mother. If health problems come up before or during labor and delivery, a c-section can get the baby out very quickly. Most c-sections result in a healthy mother and baby. For additional information about C-sections, please visit the page cesarean birth.

Labor and Birth

Preparing for Labor and Birth

Additional Information