Childbirth: What To Expect
If you have never experienced labor before, you may find it difficult to know whether you are in labor. Before heading to the hospital, call your physician or midwife to discuss your labor symptoms.
It is common for first-time mothers to make more than one trip to the hospital. If you are in early labor (cervix is less than 3 centimeters) and sent home, the following activities may be helpful: walking, showering, resting, drinking fluids, renting a video, listening to music, etc.
Once you are in active labor, we have found that admitting a first-time mother to the hospital is best for helping labor progress with minimal interventions and having a vaginal delivery. In active labor, the contractions are less than 5 minutes apart, lasting 45 to 60 seconds and the cervix is dilated 3 centimeters or more.
Although inducing labor may be needed for certain medical problems or prolonged pregnancies, induction for a first-time mother carries additional risk. Induction of labor for a first-time mother, (especially with a cervix that is nearly closed), doubles or triples the length of labor and possibility of a Cesarean birth. However, in subsequent pregnancies, the chances for a Cesarean delivery after induction are lower.
Comfort and Pain Management
Although pain is a natural part of labor, every person is unique in the level of pain that can be tolerated. Because of this, success varies with the kind of activities or interventions that can help decrease labor pain and increase comfort. Described below are three types of activities and interventions: comfort measures, medication and regional anesthesia.
There are several effective approaches to pain relief that should be tried throughout labor. Any of the following approaches in which you feel comfortable can be used during your labor:
- Keeping a restful environment in your labor room (quiet, low lighting, soothing music). Carefully select support people for a calm environment
- Water therapy (e.g., shower or tub)
- Sitting or leaning on a birthing ball or rocking chair
- Using various positions (e.g., all fours, sitting on the toilet, kneeling, squatting, pelvic rock) and supporting with pillows if necessary
- Massage/back rubs by support person
- Effleurage (light massage of abdomen)
- Having your partner or a support person rub a tennis ball over your lower back
- Applying warm or cold compresses
- Using relaxation/breathing techniques
- Prayers or religious ceremonies
- Guided meditation using calming imagery
Using several comfort techniques is an excellent way to involve first-time partners in supporting and working with you in the childbirth process.
For some women, as labor progresses and contractions become stronger, or they get too tired to cope, comfort measures no longer provide enough relief. Pain medications are commonly used at that point, and your physician or midwife will explain the benefits of each type and will help you select the appropriate medication that is safe for you and your baby. You may want to discuss medications in advance of labor with your doctor or midwife.
Medication may not totally eliminate labor pain, but can help ease it so you can better rest and cope with the discomfort. Continue to use comfort measures that help you relax as much as possible between contractions. Except in early labor, the most commonly used medications are short acting, minimizing the effect on the baby. For some women, no other medications are necessary to help cope with labor pains.
Regional Anesthesia (Epidural, Spinal or Intrathecal Medications)
If you reach a point in active labor that comfort measures and/or medication are no longer giving you adequate pain relief, your physician or midwife may order regional anesthesia to provide stronger pain relief. The anesthesiologist inserts a needle in your lower back to administer regional anesthesia. The goal of regional anesthesia, especially after your cervix is completely dilated, is to reach a balance between easing your feeling of pain and still feeling the urge to bear down to actively participate in delivering your baby. The various methods of regional anesthesia are discussed in the section on medications. Talk to your physician or midwife in advance of labor about regional anesthesia, and tour the hospital in order to find out what types of regional anesthesia are available.
- Over the last 10 years, the national trend has been to avoid routine episiotomies, only performing the procedure when necessary. What used to be a national episiotomy rate of 60 to 80 percent for first-time mothers has decreased to less than 20 percent.
- The main concern is that the episiotomy will extend into the rectum during delivery. This may lead to greater problems with bowel control (loss of gas or stool) both short and long term. Twenty years ago, the teaching was that episiotomy might prevent these problems. We now know that is not the case and episiotomy appears to actually increase the rate of these problems.
- For your first delivery, you are encouraged to discuss with your physician or midwife (and their partners if in a group practice) at one of your last prenatal appointments, or when you are in early labor, their use of episiotomies.
- Close to 70 percent of women will have a natural tear with the birth of their first baby, usually involving less tissue and trauma than an episiotomy.
- Also known as the second stage of labor, pushing starts sometime after the cervix is completely dilated (10 centimeters).
- It is important to wait for the natural urge to bear down before starting active pushing. For years, women have been encouraged to push by "holding your breath and push as long and hard as you can." Research has suggested that a woman's spontaneous urge to push occurs 3 to 5 times during a contraction while the woman is exhaling and bearing down. If you use an epidural, you may be encouraged to rest until you have the sensation to push. Women who receive epidural anesthesia for labor may have difficulty pushing, especially if the strength of the anesthetic numbs the sensation to bear down. The practice of "delayed pushing" while waiting for the baby to passively come through the birth canal is currently being studied in women using epidurals as an alternative to routine pushing at 10 centimeters.
- There may be circumstances, such as having a strong regional anesthetic, or an arrest of labor, where you may not feel the urge to push. In the event of such a circumstance, you will be assisted with pushing.
- Upright positioning of sitting, squatting or standing allows gravity to help you push.
- Allowing the baby's head to gradually stretch the tissue at the outlet of the vagina (perineum) will reduce the risk of a significant tear. Delivering on your side is associated with fewer significant tears.
- During second stage labor, your uterus pushes the baby down the birth canal (passive descent).
- Perineal massage (gradual stretching of the vaginal and perineal tissues) from 36 weeks on has been associated with fewer perineal tears. Ask your physician or midwife for information on perineal massage.
- If your obstetrician or midwife is concerned about you or your baby's health, he or she may opt to shorten the second stage of labor by using a vacuum extractor or forceps on the baby's head (performed by the physician). These procedures rarely carry a health risk to you or your baby.
- The breathing techniques used for pushing vary and depend upon what works best for you.
- It is important to put the baby to breast 30 to 60 minutes after birth.
- Within the first hour of life, your baby is most alert and interested in nursing. Your baby is eager to meet you and needs the colostrum (initial fluid from your breast) for energy and protection against infection.
- After the first 1 to 2 hours, your baby will become sleepy and more difficult to nurse.