Labor & Delivery
During labor and delivery, Capital Women’s Care Howard County is dedicated to providing comprehensive and safe medical care that addresses the health needs of both you and your baby. Our practice delivers babies at Howard County General Hospital.
Normal Labor
When it is time for your baby to be born, your body will go through a series of changes to prepare for and complete the birthing process. Like pregnancy, your labor and delivery will be different from any other woman's. In fact, each time you give birth, your labor and delivery will probably be different.
Early Labor
Labor is divided into two phases: early, or latent, labor and active labor. Early labor may last as many as twenty hours, especially during your first pregnancy. While no one knows what causes labor to start or can predict when labor will start or how long it will last, there are several hormonal and physical changes that indicate you are in early labor:
Lightening
Irregular contractions
Water breaking
Effacement and dilation of the cervix.
Lightening
The process of your baby settling or lowering into your pelvis is called lightening. Lightening can occur a few weeks or a few hours before labor begins.
Passing of The Mucus Plug
During your pregnancy, a mucus plug accumulates at the cervix to seal off the cervix and protect your baby from infection. When your cervix begins to open wider to prepare for the birth of your baby, the mucus may be discharged into your vagina. The mucus can be clear, pink, or slightly bloody.
Irregular Contractions
During early labor, you will most likely experience irregular contractions that are mild enough that they do not interfere with your normal activities. These early, unpredictable contractions begin the process of opening (dilating) your cervix so that your baby can be born.
Water Breaking
As your body prepares for childbirth, the amniotic sac that has surrounded your baby during pregnancy usually breaks, releasing the amniotic fluid it contains. When this happens, you may feel either a sudden gush or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored. If your "water breaks," write down the time, approximately how much fluid is released, and what the fluid looks like. Call you doctor with this information. Not all women have their water break during labor. Many times, your doctor will rupture the amniotic membrane in the hospital.
Effacement and Dilation of The Cervix
During early labor, your cervix will gradually thin and stretch (called effacement) and open (called dilation) to prepare for the passage of your baby through the birth canal. How fast your cervix opens and thins varies from woman to woman and cannot be predicted with any certainty until active labor begins. In some women, this process may occur over a period of weeks. Cervical effacement is described as a percentage, with 100% being completely thinned. Dilation is expressed in centimeters from 0 to 10, with 10 being completely dilated or open.
How Do I Know When I'm In Labor?
Many women experience what is known as "false" labor pains or Braxton Hicks contractions. These irregular uterine contractions are perfectly normal and generally start during your third trimester of pregnancy.
When Do I Go To The Hospital?
If you think you are in true labor, begin timing your contractions. Write down the time each contraction starts and stops. The time between contractions, called the interval, includes the length/duration of the contraction and the minutes in between the contractions.
Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. You should go to the hospital once you reach active labor. For most women, active labor is characterized by strong contractions that last 45 to 60 seconds and occur three to four minutes apart. Talk with your doctor about the best time for you to go to the hospital.
Call your doctor if:
You think your water has broken.
You are bleeding.
Your contractions are very uncomfortable and have been coming every five minutes for an hour.
Staying Comfortable During Early Labor
For most women, the early stages of labor -- before active labor begins - are best experienced in the comfort of their own home. While you are at home, there are several things you can do to help cope with any discomfort you feel:
Take a walk, read a book, or watch a movie.
Soak in a warm tub or take a hot shower.
Try to sleep, if possible.
Labor has three stages:
Strong, frequent, and regular contractions (latent phase until 4cm, active phase to 10 cm)
The birth of your baby
The delivery of the placenta
Strong, Frequent Contractions
Contractions move in a wave-like motion from the top of the uterus to the bottom and are different for each woman. Compared with early labor, the contractions that occur once you enter active labor are more intense, more frequent (every two to three minutes) and longer lasting (50 to 70 seconds each). As your contractions intensify, you may:
Feel restless and excited
Find it difficult to stand
Have food and fluid restrictions
Want to start using any breathing techniques or other calming measures to manage pain and anxiety
Feel the need to shift positions
Want pain medication, such as epidural anesthesia
Be given intravenous (IV) fluids
The Birth of Your Baby
The strong contractions you experience during active labor are your body's way of pushing your baby through the birth canal. During the birth process, your contractions may slow down to every two to five minutes, lasting 60 to 90 seconds. Other things you may feel as your baby passes through the birth canal include:
A strong urge to push or bear down with each contraction
The baby's head creating great pressure on your rectum
The need to change positions several times to find the position in which you feel most comfortable
Burning pain when the baby’s head passes through your vagina, or crowns. The head is the largest part of the baby and the hardest part to deliver.
The pushing stage of labor can be as short as a few minutes or can last for several hours, especially for your first birth. The doctors and nurses will be there to make you feel as comfortable as possible and to offer support, guidance, and pain relief.
The Delivery of the Placenta
After you deliver your baby, your mind and your body may have different agendas. You will want to hold your baby; however, your uterus will be busy contracting as the placenta detaches and passes through the birth canal. Your contractions will continue until after the placenta is delivered. Your doctor will make sure the entire placenta has been detached and delivered.
Pain Management
Each woman's labor is unique. Pain depends on many factors, such as the size and position of the baby and the strength of contractions. Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications. The decision to use medical pain relief is entirely yours and there is no "right" or "wrong" choice. During prenatal visits, talk with your doctor about your labor and delivery options. To make your preferences clear, create a written birth plan bearing in mind that labor and delivery are unpredictable, so it is best to be flexible with your choices.
There are two types of pain-relieving drugs that can be used during labor and delivery - - analgesics and anesthesia. Analgesics relieve pain without total loss of feeling or muscle movement. They do not always stop pain completely, but they do lessen it dramatically. Anesthesia blocks all feeling, including pain, and some cause you to lose consciousness. Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. Talk with your doctor about your options.
Natural ways to relieve discomfort during labor include:
Relaxation and breathing techniques taught in childbirth class
Having your partner massage or firmly press on your lower back
Changing positions often
Taking a shower or bath, if permitted
Placing an ice pack on your back
Using tennis balls for massage
Regional anesthesia tends to be the most effective method of pain relief during labor and causes few side effects. Types of regional anesthesia used to decrease labor pain include epidural anesthesia, spinal blocks, and combined spinal-epidural blocks.
Epidural anesthesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. Your doctor will determine the proper time to give the epidural. Pain relief will begin within 10 to 20 minutes after the medication has been injected.
A spinal block, like an epidural block, is an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. A spinal block brings good relief from pain and starts working fast, but it lasts only an hour or two. A spinal block usually is given only once during labor, so it is best suited for pain relief during delivery.
A combined spinal-epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor.
Unlike analgesics or regional anesthesia, general anesthetics are medications that make you lose consciousness. If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness; therefore, it is often used when an urgent cesarean delivery is needed.
Normal Delivery
Most women give birth between 37 and 42 weeks of pregnancy. To help you prepare for the birth of your baby, we suggest doing the following prior to going into labor:
Talk with your doctor about exactly what to expect.
Consider taking a childbirth class.
Choose a support person to be with you during labor and delivery.
Consider writing a "birth plan" outlining your ideal birth would occur.
Once you reach active labor, it is just a matter of time until your baby is born. Of course, no one knows exactly how much time. First babies generally take longer to be born than subsequent babies.
The Birthing Process
When your doctor determines that your cervix is fully dilated and that your baby is moving down the birth canal, you will most likely be moved to a delivery room. However, in some hospitals, you will remain in the room in which you've been laboring for your actual delivery. The doctor and nurses will be there to make you feel as comfortable as possible and to assist with the delivery of your baby. Your selected support person(s)will also be there to offer assistance and comfort.
After preparing for the birth by washing your vaginal area with an antiseptic solution, you will be encouraged to get into the position that feels the most comfortable to you. The nursing staff and your support person may hold your legs in a comfortable position to help you push. Your doctor will instruct you when and how hard to push.
The first view you see of your child will most likely be the tip of his/her head, seen with the help of a mirror. When your baby's head is first seen at the opening of your vagina, it is called "crowning." Once your baby has crowned, the doctor may ask you to push more slowly.
Depending on what you have requested and your doctor's recommendation, your doctor may massage your perineum (the area between the bottom of the vagina and the top of the rectum) and gently try to stretch it in order to fit your baby's head through without tearing this area. If necessary, you may be given an episiotomy – or surgical incision to widen the vaginal opening - so that your baby can be delivered without tearing your perineum.
The baby’s head is the most difficult part of the delivery. Once the head is out, you will be asked to stop pushing while your baby's nose and mouth are suctioned clean of all fluids. The doctor will then instruct you to push so you can deliver the rest of your baby. After another, more thorough suctioning of your baby's nose and mouth, your baby will be handed to you. The umbilical cord will be clamped and cut, a process that is totally painless for your baby and can often be performed by your support person.
The pushing stage of your labor can be as short as a few minutes or can last for several hours, especially for your first birth. The average length of time for a first baby and the placenta to be delivered once you are in active labor is about 12 hours.
Even after your baby is born, you will continue to experience contractions. This is your body's way to deliver the placenta - the tissue that has protected and nourished your baby throughout your pregnancy. Within about 20 minutes of the baby’s birth, the placenta will detach and pass through the birth canal.
Your Baby's Appearance
When the doctor hands you your baby, do not be surprised to see a white substance, or vernix, covering your baby. This protective coating is produced toward the end of pregnancy by the sebaceous (oil-producing) glands in your baby's skin. Your baby will also be wet with amniotic fluid from the uterus. Your baby's skin, especially on the face, may be quite wrinkled from the wetness and pressure of birth. The skin color may be a little blue at first, but will gradually turn pink as breathing becomes regular. In addition, your baby's head may be slightly cone-shaped from passing through the birth canal.
You may also notice that your newborn's breathing is irregular and very rapid. While adults normally take 12 to 14 breaths per minute, your newborn may take as many as 60. An occasional deep breath may alternate with bursts of short, shallow breaths followed by pauses. Don't be alarmed - this is normal for the initial days after birth.
After The Birth
After your baby is born, the following may be done before you are moved to your room:
If there were no complications, you will most likely stay in the hospital one or two nights.
If your perineum has torn or if you had an episiotomy, the incision or wound will be closed with stitches.
A nurse may massage your abdomen to help your uterus clamp down and decrease bleeding.
Your vaginal area, perineum, and rectum will be washed to remove all of the birth fluids and blood.
You may be given an ice pack to apply to your perineum to reduce pain and decrease swelling.
You may require a shot of Pitocin to help decrease bleeding.
You may be given pain medications by mouth, injection, or IV.
Operative Delivery
Sometimes, a baby's head does not move as expected through the birth canal. If this happens or your doctor feels that your baby needs to be born more quickly, a forceps or vacuum extraction delivery may be performed. This type of delivery is known as an operative vaginal delivery.
In a forceps delivery, the doctor slips the rounded forceps instrument around either side of your baby's head and uses light traction to deliver the baby. The procedure is usually performed during a contraction while you are pushing. Once your baby's head has crowned, the forceps are usually removed and the rest of the delivery proceeds normally. You will most likely require an episiotomy if you have a forceps delivery.
Like a forceps delivery, a vacuum extraction is a procedure in which you are assisted with the delivery of your baby. Your doctor places a soft, flexible cap around your baby's head and then applies slight traction to help move your baby through the birth canal.
Your doctor may decide to use an operative delivery if:
Your baby is in fetal distress
You are in distress
Lack of progress in late labor
To aid in the delivery of your baby's head in a breech delivery
An operative vaginal delivery is performed if a spontaneous birth is judged to pose a greater risk to mother or child than an assisted one. There is a slight risk of complication with both types of operative deliveries. Your doctor will explain these to you prior to the procedure so that you feel comfortable about the type of delivery assistance being used. Potential complications include: Perineal tearing that may cause damage to the vagina or rectum, bleeding, or reflex retention of urine Bruising and swelling of your baby's scalp, which will disappear in a few days
Shoulder Dystocia
Though it very rare, shoulder dystocia can lead to complications for both you and your baby. This condition occurs when one, or less frequently both, of your baby's shoulders do not pass under the pubic bone during birth.
While this potentially dangerous condition has been the focus of many studies, there is no one factor that can predict who will have a shoulder dystocia. The best predictor of this condition may be a combination of factors, such as size of the baby, a small-framed mother, complications during pregnancy, and previous babies with shoulder dystocia.
If you and your doctor think that you may be at risk for should dystocia, you can use birthing positions known to pose less of a threat of this condition, such as kneeling on all fours. There are also several maneuvers your doctor can use to help your baby move through the lower birth canal.
After the birth, your doctor will be on the lookout for:
A baby who is slow to breathe and requires prompt assistance with breathing
Fractures of the baby's collarbone or humerus
Fetal brachial plexus injury
Maternal hemorrhage
Uterine rupture
While a shoulder dystocia is not very common, occurring in less than 1% of all births, knowing the potential risk factors can help you make wise choices for your labor and birth.
Cesarean Section Delivery
Sometimes it is not possible for a baby to be born through the birth canal. In such cases, a cesarean delivery is performed, in which the baby is born through surgical incisions made in your abdomen and uterus.
There are many reasons why a cesarean birth may be used to deliver your baby, including:
Delivering two or more babies
Your labor does not progress normally
Your baby is having trouble during labor
Problems with the placenta that can cause heavy bleeding, such as placenta previa and placental abruption
Previous cesarean deliveries and your doctor feels there is a threat of your uterus rupturing during a vaginal delivery
Your baby is too large to be born vaginally
Baby in the breech or feet first position
Maternal infections, such as human immunodeficiency virus or herpes that may be passed to the baby during vaginal delivery
Whether or not your cesarean delivery is planned in advance or decided upon during labor, your doctor will explain why this type of delivery is best for you and your baby and discuss how the birth will be performed. Many maternity centers have classes for couples who may need cesarean birth. If you have questions or concerns about cesarean birth, talk to your doctor.
The Cesarean Delivery
Before your cesarean birth, a nurse will prepare you for the delivery. Your abdomen will be washed and may be shaved. A catheter (tube) will be placed in your bladder, as keeping the bladder empty lowers the chance of injuring it during surgery. An intravenous (IV) line will be put in a vein in your arm or hand to allow you to receive fluids and medications during the delivery.
You will receive anesthesia so that you do not feel pain during the delivery. You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery. With both the epidural and spinal blocks, you will be awake while the lower half of your body will be numb.
The type of anesthesia used depends on many factors, including the well being of you and your baby. Prior to delivery, your doctor will explain the types of anesthesia and will take your wishes into account if possible.
The doctor will make an incision through your skin and the wall of the abdomen. The skin incision may be horizontal or vertical, just above the pubic hairline. The muscles in your abdomen are moved and, in most cases, do not need to be cut.
Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be either transverse or vertical. When possible, a transverse incision in the uterus is preferred because it is done in the lower, thinner part of the uterus and results in less bleeding and better healing.
Your baby will be delivered through the incisions, the umbilical cord will be clamped and cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your abdominal skin.
After The Delivery
If you are awake for your cesarean delivery, you can most likely hold your baby right away. You should also be able to begin breastfeeding right away if you choose.
You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, and abdomen will be checked regularly. Soon after surgery, the catheter will be removed from your bladder. You will receive IV fluids until you are able to eat and drink.
In most cases, your support partner will be with you during your cesarean delivery. You may need to stay in bed for a while. The first few times you get out of bed, a nurse or other adult should help you. Your abdominal incision will be sore for the first few days and the doctor can prescribe pain medication to alleviate as much of the pain and discomfort as possible.
The hospital stay after a cesarean birth is usually two to four days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover.
Recovery
When you go home, you may need to take special care of yourself and limit your activities. It will take a few weeks for your abdomen to heal.
While you recover, you may have:
Mild cramping, especially if you are breastfeeding
Bleeding or discharge for about four to six weeks
Bleeding with clots and cramps
Pain in the incision
To prevent infection, for a few weeks after your cesarean birth, you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Call your doctor if you have a fever, heavy bleeding, or the pain gets worse.
Possible Complications
Like any major surgery, cesarean birth involves risks, most of which can be managed and treated. Your doctor will discuss all risks with you prior to your cesarean delivery.
Complications from cesarean delivery, occurring in a small number of women and usually are easily treated, can include:
Infection in the uterus, nearby pelvic organs, or skin incision
Loss of blood, sometimes enough to require a blood transfusion
Blood clots in the legs, pelvic organs, or lungs
Injury to the bowel or bladder
Reaction to the medications or types of anesthesia that are used