Labor and Delivery

Preparing for the Birth

There are many decisions you'll have to make in regards to forming a birth plan. Make a list of all the common decisions about pregnancy, labor, and delivery with a description of available options. Don't prepare your birth plan anticipating complications but consider variations from the usual such as a C-section. Disagreements between mother and father or between the couple and the physician should be discussed during prenatal visits, not during labor.

Natural Childbirth

Natural Childbirth is the belief that childbirth is a natural biological function and only requires medical intervention in rare situations. Mothers seeking natural childbirth avoid medical pain relief and assisted delivery when possible. There are a variety of reasons for this choice, one being that postpartum recovery is easier when she doesn't have to recover from things like abdominal surgery.

Assisted Delivery

An epidural refers to getting epidural anesthesia injected into the spine to reduce or stop the pain. Epidural procedures are associated with longer labor and more medical interventions such as a caesarean section, but part of that may be related to varying degrees of medical staff quality and the fact that women in more difficult labors are more likely to have an epidural.

Sometimes doctors use forceps (tongs) to help pull the baby out. This has some risks involved and should only be used when medically necessary. Since caesarean sections can now be performed more safely, the use of forceps in childbirth is becoming less common.

A caesarean section (c-section) is a major surgery where the mother's abdomen and uterus are cut open to deliver the baby. There are situations when a c-section is necessary for the mother and child's safety, such as when the baby is very large, the mother has a sexually transmitted disease that could pass to the child during a vaginal birth, etc.

An episiotomy is one or more incisions made in the perineum to enlarge the vagina. It was once used routinely under the mistaken impression that it reduced the chances of various problems such as pelvic tears, pelvic floor muscle relaxation, or fetal brain damage, but episiotomies either have no effect or can actually cause these problems.

Birth Locations

Generally parents have three choices about where to have their baby:

In a hospital is the most common practice and is preferable in emergency situations. However, many hospitals have restrictive policies that are potentially harmful, such as routine unnecessary medical interventions or forbidding a woman to eat while laboring. Hospital births tend to be the most expensive, although they are often the only type covered by insurance, which makes them the most economical choice for many parents. Characteristics of birthing centers have become more common in hospitals in recent years, so you may be able to get the same experience.
In a birthing center. Birthing centers are staffed with midwives or obstetricians and are designed to look more like a home than a hospital. They are independent from hospitals but have hospital back-up in case of emergencies. They allow more freedom than traditionally available at hospitals and encourage active labor. In most cases, birthing centers only allow women with low-risk pregnancies. It is becoming more common for insurance companies to cover delivery at a birthing center.
At home. You may be able to get an obstetrician, or more commonly, a midwife, to assist the birth in your home using portable equipment and supplies. Insurance rarely covers home births, but if you don't have insurance, home birth is probably the least expensive.

Childbirth Techniques

There are a few different methods for undergoing natural childbirth. Of those listed below, the Lamaze method is by far the most popular in the United States, but all are based around relaxation techniques and philosophy of Grantly Dick-Read, who popularized natural childbirth with his book Childbirth Without Fear. The idea is that fear creates stress, stress increases pain, and pain causes more fear, but fear can be reduced by education and stress can be reduced by relaxation.

The Lamaze Method

The Lamaze method was created by Fernand Lamaze and popularized by a book written by Majorie Karmel. People can be conditioned to react to certain things a certain way without thinking, and the Lamaze method uses this to trigger relaxation. A woman focuses her vision on something, practices rhythmic breathing, has a light fingertip massage, and listens to voice cues from her labor coach.

Lamaze classes also involve other ways of controlling pain, such as hot and cold compresses and different positions.

There are many classes available to help expectant parents learn and practice the Lamaze method.

Dr. Robert Bradley's Husband-Coached Childbirth Method

Dr. Bradley was inspired by seeing farm animals give birth without drugs and came to believe that most women can give birth naturally without drugs. While beginning to implement his ideas, he learned that a loving, supporting labor coach was significant in reducing pain and anxiety.

About 86% of mothers who give birth vaginally using the Bradley method do so without drugs.

The Hypnosis Method

Guided by a hypnotherapist, the mother uses self-hypnosis to relax herself, thereby reducing pain and speeding labor. Some mothers say they feel no pain at all. The hypnosis method leaves mothers fully aware and alert during the birth, and studies show that it also reduces pregnancy-related problems such as trouble sleeping while pregnant and postpartum depression. It can be used along with other methods such as Lamaze.

Go to Easybirthing.com and Hypnobabies.com for more information.

Water Birth

It has been shown that being submerged in warm water helps to provide relaxation and is very effective at alleviating pain. Many people are concerned that a baby being born underwater will inhale too soon and drown, but babies are safe for biological reasons.

Birthing tubs are becoming increasingly common in hospitals and birthing centers, and you can rent one if you're having a home birth.

Before Labor

When you start to go into labor, your baby will drop down, which allows you to breath more easily but feel pressure on your pelvis.

You will drop your mucus plug, which previously sealed your cervical opening. It may come out as increased vaginal discharge or as a lump.

If your water breaks, call your doctor or midwife right away.

Labor

Recognizing the Start of Labor

Sometimes you can get signs of going into labor even when your labor is not actually starting. Here are some tips.

Try to go to sleep. You won't be able to sleep through real labor, and if this is a false alarm, you may appreciate getting the sleep now.

If your contractions are 2-5 minutes apart (from the start of one to the start of the next) for an hour or if the contractions are so strong that you have to change your activity to get through them, you are probably going into labor. Write down the time that each begins.

If your contractions last for 45 to 60 seconds. False labor contractions can often last around a minute and a half.

If your contractions are so strong that others around you would notice them affecting your facial expression or breathing even if you didn't want to be noticed.

Even if your pregnancy was previously uncomplicated, contact your health care provider immediately if you experience any of the following:

Your water breaks (or you suspect it has). Describe the appearance to the doctor.
You notice that the baby is less active.
You have vaginal bleeding. (A lost mucus plug or bloody show is okay. It looks like mucus with a bloody streak in it.
Constant severe abdominal pain.
You have a fever.
You start having contractions before 37 weeks.
Any symptoms of preeclampsia, including severe or persistent headaches, vision changes, intense pain in your upper abdomen, or abnormal swelling.
Severe or persistent vomiting.
Fainting, dizziness, or a rapid heartbeat.
Persistent itching.

The Stages of Labor

The entire process from the start of labor to the baby's birth averages 14.25 hours, but this varies a lot from mother to mother. There is a wide range of time that can be considered “normal." Likewise, the symptoms and reactions listed below are a variety of things you could experience; you will most likely not experience all of them.

Your doctor or midwife will give you instructions on what to do and when to go to the hospital when you go into labor. In uncomplicated pregnancies, your doctor will want you to come in when contractions start to last about a minute and have been coming five minutes apart for about an hour.

Latent Labor

Generally, the early (latent) labor, wherein the cervix dilates to 3 cm, commonly takes 6 to 8 hours. You will have short (20-60 seconds) mild contractions which will start out several minutes apart (about 20) and gradually decrease to about 5 minutes apart.

You may experience the loss of the mucous plug, rupture of the membranes, leaking of amniotic fluid, increased frequency of urination, soft stools, constipation, increased vaginal discharge, increased pelvic pressure, or leg cramps.

You may feel excited and lively, but it's also normal to feel frustrated because you're not sure if this is true or false labor.

A mother should maintain her activity but conserve energy in this phase. If labor starts during the day, do something light and relaxing. If it starts at night, try to sleep. Consider taking a shower if someone is home with you. Urinate frequently and eat easily digested foods such as gelatin, tea, ginger ale, toast, fruit juice, and bouillon. Keep track of your labor symptoms. Change positions frequently and perhaps go for a walk. If you haven't done so already, pack the bag you will take to the hospital. Start your special breathing only if it's necessary.

The mother's labor coach should also try to conserve energy. Eat a good meal, shower, and make arrangements to miss work. Make plans for the care of your children and pets, and call the photographer if you've arranged for one. Stay calm and help the mother assess her labor. Help her relax in ways such as giving her a massage, helping with her breathing patterns, and encouraging her to engage in some relaxing activities. Stay with her when she showers or gets ready to go to the hospital. Bring towels in case the membranes rupture on the way there.

Active labor

During active labor, the cervix dilates from 3 to 7 cm, which takes about 2 to 3 hours on average. Contractions are between 2 to 7 minutes apart, and get increasingly stronger, longer, and closer together.

As the baby descends deeper into the pelvis, you may feel uncomfortable pressure in your hips and legs. Your membranes may rupture now if they haven't already. Sometimes your physician will rupture them for medical reasons; ask if it's possible to leave them intact, as labor is usually more manageable that way. You may experience nausea, vomiting, backache, muscle tension, fatigue, and stress.

You will need to concentrate on dealing with contractions, so you may find distractions annoying. You may be very interested in medical details. You may feel worried by the contractions near the end of this phase and be in need of strong coaching and frequent encouragement.

Try not to nap between contractions so that you can be prepared for them and breath appropriately. Change positions frequently and avoid lying on your back. Use first-level breathing for as long as possible.

The labor coach becomes even more important. Remind her of which breathing pattern she needs to use and how to do them. Watch for signs that she is hyperventilating. Keep watch on all body parts to make sure they're relaxed. Encourage her to urinate periodically and do your best to make her more comfortable. Keep her informed on her progress and give her a lot of encouragement and praise.

Transition Labor

Transition labor takes about 2 hours on average and is the phase during which the cervix finishes dilating to a full 10 cm. It is often the hardest but shortest part of labor. Contractions are usually sudden and last 60 to 90 seconds with a 30- to 90-second rest between them.

The mother may experience nausea and vomiting, trembling legs, leg cramps, backaches, or recklessness. She may feel restless or need to burp. Due to the stress caused by the contractions, she may feel discouraged, panicky, or disoriented. She may become distressed enough to feel ungrateful toward or verbally abuse her coach or nursing staff, but she may become frightened if any of them show any signs of leaving even for a moment.

The mother must focus on one contraction at a time. Don't be alarmed or think that something has gone wrong if the contractions are very strong, frequent, or irregular. Realize that contractions are the method by which your cervix dilates to allow the baby through; do not panic. Express any needs you have with your coach or the birthing staff, such as if you want to change position or have the room temperature adjusted. Even though it's difficult, concentrate on relaxing. Only increase your breathing rate if necessary. You may get an urge to push during contractions, but you shouldn't do so yet.

The coach should stay with the mother during this difficult period and continue to comfort her and do whatever it takes to alleviate her anxiety. Remember how much stress she is under and don't react negatively if she's rude to you, vomits, or cries. He affectionate and encouraging, and see if you can correct any situations that are bothering her.

The Delivery

Once the cervix has dilated a full 10 cm, it's time for the baby to travel out through the birth canal (vagina). Some women feel that this stage is reasonably pleasant while some find it harder than transition.

The baby is moved through the birth canal by the mother's pushing as well as by continued contractions. In recent years, it has become more common for mothers to deliver babies in an upright position so that gravity helps the baby out as well. Since it will take a while for the baby to move through the birth canal, you can try different pushing positions before deciding on one during the birth.

The mother's job is to push during contractions and rest between them. You can try to watch your baby being born with a mirror if you like.

The coach needs to help Mom with maintaining her pushing position and proper breathing patterns.