Labor and Delivery, Vaginal Birth
(Vaginal Birth; Labor and Delivery)En Español (Spanish Version)
Most women give birth after 38-42 weeks of pregnancy. However, there is no way to know exactly when you will go into labor. Birth often occurs either two weeks before or after your expected due date.
Risk Factors for Complications During the Procedure
- If you have one of these conditions:
- Multiple gestation (two or more babies)
- High blood pressure
- Pre-eclampsia (high blood pressure and protein in the urine)
- Group B streptococcal infection
- Diabetes (type 1 , type 2 , or gestational)
- Bleeding disorder
- Lung or heart disease
- Infectious disease (eg, active genital herpes infection, HIV )
- Rh-negative incompatibility with baby
- Premature rupture of membranes
- Placenta previa (placenta positioned over the cervical opening)
- Abruptio placentae (early separation of the placenta from the uterine wall)
- Umbilical cord prolapse (umbilical cord slips out of the cervical opening before the baby's head)
- Small size giving birth to a large baby
- Baby with congenital disease
What to Expect
Prior to Procedure
During pregnancy you should:
- Read about giving birth and take a childbirth class.
- Choose a support person to be with you during labor and delivery.
- Write a "birth plan" that explains what you want and helps you to think about possible complications.
- Eat nutritiously and drink eight, 8-ounce glasses of water a day.
- Get as much sleep as possible.
During this process, you prepare to deliver a baby. At the beginning of labor, the uterus (where the baby grows during pregnancy) begins to contract, moving the baby down the vagina (birth canal). The cervix, the opening of the uterus into the vagina, enlarges to a final diameter of about 10 centimeters. This allows the baby to pass through and be delivered through the opening of the vagina. Babies are delivered this way unless a cesarean delivery (C-section) is necessary.
Signs of Early Labor
Signs of early labor include:
- Uterine contractions
- "Water breaks" (amniotic fluid that surrounds the baby leaks out through the vagina)
- Back pain
- Slight vaginal bleeding
True Versus False Labor
Before "true" labor begins, you may have periods of "false" labor. These are irregular contractions of your uterus, called Braxton Hicks contractions. They are normal, but can be painful. Timing the contractions is a good way to tell the difference between true and false labor. Note how long it is from the start of one contraction to the start of the next one. Keep a record for an hour. If the contractions are getting closer together, longer, and stronger, then it may be true labor. If you think you're in labor, call your doctor.
Topics to Discuss
- Ways to contact the doctor after hours
- When should you should call your doctor
- Steps you should take when in labor
- Whether you want pain relief during labor
- How you will travel to the hospital
- Arrangements for home and work
Labor can cause severe pain. While planning the delivery, talk to your doctor about your options for pain relief. In the beginning stages of labor, relaxation techniques (like meditation and rhythmic breathing) may be helpful. Even if you've chosen a pain reliever, many times the exact kind of medication isn't known until you are ready to deliver. Keep in mind that every woman's labor is different and everyone experiences pain differently.
All treatments to relieve pain during labor have risks and benefits.
- Given when contractions become stronger and more painful
- Can be given through an intravenous (IV) catheter or injected into muscle
- Can cross into the baby's bloodstream
- If baby is born soon after injection, he may need treatment for breathing problems
- Epidural block
- Given in small amounts by an anesthesiologist
- Injected near spinal cord
- Does not cross into baby's bloodstream
- May not be used depending on your condition
- Provides good pain relief and allows you to continue with delivery
- Can cause headaches and drop in blood pressure, as well as changes in baby's heartbeat
- Spinal block
- Injected into spinal fluid
- Used for pain relief during delivery, especially if forceps or vacuum extraction is needed
- Often used for C-section
- Numbs lower half of the body and reduces your ability to push
- Provides good pain relief and works quickly
- Can cause headaches and drop in blood pressure, as well as changes in baby's heartbeat
- Local anesthesia
- Injected into vagina or surrounding area
- Used if an episiotomy (cut made in the perineum) is needed
- Also used when vaginal tears are stitched
- Usually no complications after and rarely affects baby
- Do not relieve pain of contractions during labor
- General anesthetics
- Causes you to be asleep during delivery
- Rarely used for routine vaginal deliveries
- Often used for C-sections or emergencies
Description of the Procedure
When the cervix is fully dilated (opened) and the baby seems to be heading down the birth canal, you may be moved to a delivery room. The nurse will drape you with cloths and clean your vulva and perineum with antiseptic solution.
You may put your legs into holders, especially if you have an epidural. Or, you may not want to use the holders. The nurses and your support person may hold your legs in a comfortable position to help you push. Your doctor may encourage you to find a position that's right for you.
"Crowning" is when the baby's head is seen at the opening to the vagina. When this happens, you may be asked to slow your pushing. Depending on your delivery plan, the doctor may massage your perineum to gently stretch it. This is to fit the baby's head through without tearing your perineum. Episiotomies (incisions in this area) are not routinely done.
Once your baby's head is out, you'll be asked to stop pushing. The baby's nose and mouth are then cleaned of all fluids. Then you can push the rest of the baby out. If the baby appears healthy and is breathing well, he is often laid on your stomach. The umbilical cord will be clamped and cut. Within the next 20 minutes, the placenta will be delivered.
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Sometimes the baby's head doesn't move as expected through the birth canal. If this happens, your doctor may use forceps or vacuum extraction to move the baby.
You may have the following:
- Stitches if the perineum is cut or torn
- Abdominal massage to help uterus clamp down and decrease bleeding
- Cleansing of the vaginal area, perineum, and rectum
- Ice pack to soothe and decrease swelling of the perineum
- Shot of oxytocin (Pitocin) to help decrease bleeding
- Pain medications
How Long Will It Take?
This varies, but the average time for you to deliver your first baby and the placenta is 12 hours. This is once you are in active labor.
Will It Hurt?
Yes, but there are relaxation techniques and pain medications.
Average Hospital Stay
After your baby arrives, you'll notice you've changed both physically and emotionally.
Physically, you might have the following:
- Sore breasts—Your breasts may be painfully engorged when your milk comes in, and your nipples may be sore.
- Constipation—You may not be able to move your bowels until the third or fourth day after delivery.
- Episiotomy—Stitches may make it painful to sit or walk.
- Hemorrhoids—Hemorrhoids are common. They may make it painful for you to move your bowels.
- Hot and cold flashes—Your body's adjustment to new hormone and blood flow levels can wreak havoc on your internal thermostat.
- Urinary or fecal incontinence—During delivery, your muscles were stretched. This may make it hard for you to control your urine and bowel movements.
- "After pains"—The shrinking of your uterus can cause contractions. These can worsen when your baby nurses or when you take medication to reduce bleeding.
- Vaginal discharge (lochia)—This is heavier than your period and often contains clots. The discharge gradually fades to white or yellow and stops within two months.
- Weight—Your postpartum weight will probably be about 10 pounds below your full-term weight. Water weight drops off within the first week as your body regains its sodium balance.
Emotionally, you may be feeling:
- "Baby blues"—About 80% of new moms experience irritability, sadness, crying, or anxiety , beginning within days or weeks postpartum. These feelings can result from hormonal changes, exhaustion, unexpected birth experiences, adjustments to changing roles, and a sense of lack of control over your new life.
- Postpartum depression (PPD)—This condition is more serious and happens in 10%-20% of new moms. It may cause mood swings, anxiety, guilt, and persistent sadness. Your baby may be several months old before PPD strikes. It is more common in women with a family history of depression.
- Postpartum psychosis—Postpartum psychosis is a rare, but severe condition. Symptoms include difficulty thinking and thoughts of harming the baby. If you feel this way, call our doctor immediately.
- Sexual relations—You may not feel physically or emotionally ready to begin sexual relations right away.
Ways to Take Care of Yourself
- When your baby sleeps, take a nap.
- Set aside time each day to relax with a book or listen to music.
- Shower daily.
- Get plenty of exercise and fresh air.
- Schedule regular time for you and your partner to be alone and talk.
- Make time each day to enjoy your baby. Encourage your partner to do so, too.
- Clean less and have easier meals. Take a break from having visitors if you feel stressed.
- Ask for help when you need it.
- Talk with other new moms and create your own support group.
Call Your Doctor If Any of the Following Occurs
- An unexplained fever of 100.4°F (38°C) or above in the first two weeks
- Soaking more than one sanitary napkin an hour or if the bleeding level increases
- Incisions that become red or swollen or drain pus (if you had a C-section or episiotomy)
- New pain, swelling, or tenderness in your legs
- Hot-to-the-touch, significantly reddened, sore breasts
- Any cracking or bleeding from the nipple or areola (the dark-colored area of the breast)
- Foul-smelling vaginal discharge
- Painful urination or a sudden urge to urinate, inability to control urination
- Increasing pain in the vaginal area
- Cough or chest pain, nausea, or vomiting.
- Depression, hallucinations, suicidal thoughts, or any thoughts of harming your baby
The American College of Obstetricians and Gynecologists
American Pregnancy Association
Women's Health Matters
Depression during and after pregnancy. Womens Health.gov website. Available at: http://www.womenshealth.gov/faq/postpartum.htm. Updated April 2005. Accessed June 11, 2008.
Epidural anesthesia. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/epidural.html. Updated August 2007. Accessed June 11, 2008.
Obstetrics: Normal & Problem Pregnancies. 3rd ed. New York, NY: Churchill Livingstone; 1996.
Spinal block. American Pregnancy Association website. Available at: http://www.americanpregnancy.org/labornbirth/spinalblock.htm. Updated December 2006. Accessed June 11, 2008.
Last reviewed January 2008 by Jeff Andrews, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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