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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.
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.
Labor is divided into two phases: early, or latent, labor and active labor. Early labor may last many 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:
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.
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.
As your body prepares for childbirth, the amniotic sac that has surrounded your baby during pregnancy can break, releasing the amniotic fluid it contains. If 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," call your doctor with this information. Not all women have their water break during labor. In many cases, your doctor will rupture the amniotic membrane in the hospital.
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 dilates and effaces 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.
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:
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.
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. If your contractions become regular and your cervix has dilated to 6cm or more, you are in active labor.
Active labor 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 and are longer lasting. As your contractions intensify, you may:
Non-Medical Pain Relief: These methods are highly recommended to keep you as comfortable as possible during labor.
Medical Pain Relief Options: Labor can be intense, and we offer several options for pain relief.
The strong contractions you experience during active labor are your body’s way of dilating your cervix and helping to push your baby through the birth canal. As you reach complete dilation, you may feel:
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.
Sometimes, a baby does not move as expected through the birth canal during the pushing process. If this happens or your doctor feels that your baby needs to be born more quickly due to fetal distress, a vacuum delivery may be performed. This type of delivery is known as an operative vaginal delivery. Your doctor places a soft, flexible cap on your baby's head and then applies slight traction to help move your baby through the birth canal. There is a slight risk of complication with operative deliveries. Your doctor will explain these to you prior to the procedure so that you feel comfortable.
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 may 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. There is a slight risk of complication with operative deliveries. Your doctor will explain these to you prior to the procedure so that you feel comfortable.
After you deliver your baby, your placenta will still need to be delivered. While you hold your baby, 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.
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 pelvis and uterus.
There are many reasons why a cesarean birth may be used to deliver your baby, including:
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. If you have questions or concerns about cesarean birth, talk to your doctor.
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.
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, an anesthesiologist will explain the types of anesthesia.
The doctor will make an incision through your skin and the wall of the abdomen. The skin incision usually is horizontal, 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 low transverse incision in the uterus is preferred because it is done in the 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 skin glue are used to close the skin.
You will be taken to a postoperative recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, and abdomen will be checked regularly. You will receive IV fluids and postpartum Pitocin to prevent hemorrhage.
A few hours after surgery, the catheter will be removed from your bladder.
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 nights. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover.
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:
To prevent infection after your cesarean birth, you should not place anything in your vagina or have sex for at least 6 weeks. Allow time to heal before doing any strenuous activity. Call your doctor if you have a fever, heavy bleeding, or the pain gets worse.
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:
