Normal Labor, Birth & Early Postpartum

Stages of labor and birth: Baby, it's time!

Labor is a natural process. Here's what to expect during the three stages of labor and birth and what you can do to promote comfort.

Stage 1: Early labor and active labor: The first stage of labor and birth occurs when you begin to feel regular contractions, which cause the cervix to open (dilate) and soften, shorten and thin (effacement). This allows the baby to move into the birth canal. The first stage is the longest of the three stages. It's actually divided into two phases of its own — early labor (latent phase) and active labor.

Early labor: During early labor, your cervix dilates and effaces. You'll feel mild, irregular contractions. As your cervix begins to open, you might notice a clear, pink or slightly bloody discharge from your vagina. This is likely the mucus plug that blocks the cervical opening during pregnancy.

How long it lasts: Early labor is unpredictable. For first-time moms, the average length varies from hours to days. It's often shorter for subsequent deliveries.

What you can do: Until your contractions increase in frequency and intensity, it's up to you. For many women, early labor isn't particularly uncomfortable. Try to stay relaxed.

To promote comfort during early labor: Go for a walk

Take a shower or bath

Listen to relaxing music

Try breathing or relaxation techniques

Change positions

Active labor: Now it's time for the real work to begin. During active labor, your cervix will dilate from 6 centimeters (cm) to 10 cm. Your contractions will become stronger, closer together and regular. Your legs might cramp, and you might feel nauseated. You might feel your water break — if it hasn't already — and experience increasing pressure in your back. Leaving for the hospital around this time would be a great option, however -this decision is based upon the mom’s discretion. If you choose to remain home a little longer, it is completely safe as long as mom and baby are not at risk. Doula’s are trained to recognize body language of laboring moms and will be able to distinguish symptoms of distress.

Don't be surprised if your initial excitement wanes as labor progresses and the pain intensifies. Ask for pain medication or anesthesia if you want it. Remember, you're the only one who can judge your need for pain relief. Doula’s are trained to provide massage and techniques to relieve some discomfort in laboring moms. Techniques include:

Constant Moving- Pain is the body's signal to move. When we are uncomfortable sitting, we readjust our posture without giving it much thought. We may uncross our legs or even stand up. This natural response to discomfort in our daily lives is the same one we use during labor and birth. If you are confined to bed during labor, it will increase your pain level -- thus, potentially creating a need for pain medication, when movement would have sufficed to reduce your pain to a manageable level. Movement also shortens the length of labor. So, get up and move as your body tells you. You will feel better for it. Swaying, walking, and use of the birthing ball.

Indulge the Senses - I work through the five senses with my clients to determine what can help make them feel the most comfortable at each stage of labor. For example: visualization, focal pictures, eye contact; ice pops, teas; soothing music, sounds; oils, candles; and gentle massage with hands or tools.

Counter Pressure - Counter-pressure is one important tool doulas have in our arsenal. My favorite example of this is the double hip squeeze, which is where the mother is in the hands and knees position, and the doula or birth partner rotates her hands inward on mom's hips to apply pressure. This can be especially helpful for moms with lower back pain in labor.

How long it lasts: Active labor often lasts four to eight hours or more. On average, your cervix will dilate at approximately one centimeter per hour. Each woman is different.

The last part of active labor — often referred to as transition — can be particularly intense and painful. Contractions will come close together and can last 60 to 90 seconds. You'll experience pressure in your lower back and rectum. Tell your health care provider if you feel the urge to push.

Women who choose to have a non-medicated vaginal birth typically feel the urge to push more than women who have an epidural. It is best to practice kegels and perineal massage to help gain control your pelvic floor muscles while transitoning. Pushing too soon because you feel the urge can cause complications such as cervical swelling, and a cervical tear. It will increase your risk for a postpartum hemorrhage.

Stage 2: The birth of your baby

It's time! You'll deliver your baby during the second stage of labor.

How long it lasts: It can take from a few minutes up to a few hours or more to push your baby into the world. It might take longer for first-time moms and women who choose a medicated birth.

What you can do: Push! Your health care provider will ask you to bear down during each contraction or tell you when to push. Or you might be asked to push when you feel the need.

When you push, don't hold tension in your face. Take a deep breath and bear down as if you are having a bowel movement but don’t worry about too much, the midwife or provider will cover your rectum to ensure the baby is not contaminated with feces. Make sure concentrate on pushing where it counts. If possible, experiment with different positions until you find one that feels best. You can push while squatting, sitting, kneeling — even on your hands and knees.

At some point, you might be asked to push more gently — or not at all. Slowing down gives your vaginal tissues time to stretch rather than tear. This is also called the ring of fire. To stay motivated, you might ask to feel the baby's head between your legs or see it in a mirror.

After your baby's head is delivered, the rest of the baby's body will follow shortly. His or her airway will be cleared if necessary and baby will be placed on your chest to initiate skin-to-skin. Dad will be coached on how to appropriately cut the cord.

Stage 3: Delivery of the placenta:

After your baby is born, you'll likely feel a great sense of relief. Cherish the moment. But a lot is still happening. During the third stage of labor, you will deliver the placenta.

How long it lasts: The placenta is typically delivered in five to 30 minutes, but the process can last as long as an hour. There are instances where the placenta may not come out right away. This is called Retained Placenta. Retained placenta can occur if the placenta becomes stuck behind the cervix. If a lot of time has elapsed the provider may have to manually extract your placenta because retained placenta can cause complications such as hemorrhaging, sepsis, and even infection. The manual placenta removal procedure, the provider places his or her hand on the mother's abdomen and applies pressure to the uterus within. The other hand follows the umbilical cord up the birth canal, through the cervix and into the uterine cavity. With a wide sweeping motion within the uterus, the physician inserts his or hand between the placenta and the wall of the uterus, similar to loosening the peel from an orange.

What you can do: Relax! By now your focus has likely shifted to your baby. You might be oblivious to what's going on around you. If you'd like, try breast-feeding your baby. You'll continue to have mild contractions. They'll be close together and less painful. You'll be asked to push one more time to deliver the placenta. Immediately after delivery the nurse will start a medication called Pitocin. Pitocin is given to induce labor and to encourage uterine contractions and minimize bleeding after delivery.

Your provider will examine the placenta to make sure it's intact. Any remaining fragments must be removed from the uterus to prevent bleeding and infection. If you're interested, ask to see your placenta. After you deliver the placenta, your uterus will continue to contract to help it return to its normal size. Your doctor will initiate a fundal massage on your abdomen to make sure the uterus feels firm. A firm uterus is an indication that no excess bleeding or hemorrhaging should be expected.

If you begin hemorrhaging there are medications used to stop the bleeding.

Methergine is used just after a baby is born, to help deliver the placenta (also called the "afterbirth"). It is also used to help control bleeding and to improve muscle tone in the uterus after childbirth. Methergine injection is given into a muscle or into a vein through an IV. You will receive this injection while you are in the delivery room.

Hemabate is used to treat severe bleeding after childbirth (postpartum).

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