Information about Labor in Southern New England

Labor begins when the cervix begins to open (dilate) and thin (called effacement). The muscles of the uterus tighten (contract) at regular intervals. During contractions, the abdomen becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft.

Some women experience very distinct signs of labor, while others don’t. No one knows what causes labor to start, but several hormonal and physical changes might indicate the beginning of labor. These changes include:

Lightening:

The process of your baby settling or lowering into your pelvis is called lightening. Lightening can happen a few weeks for a few hours before labor. Because the uterus rests on the bladder more after lightening, you might feel the need to urinate more frequently.

Mucous Plug:

The mucous plug accumulates at the cervix during pregnancy. When the cervix begins to open wider, the mucus is discharged into the vagina. It might be clear, pink or slightly bloody. Labor might begin soon after the mucus plug is discharged or might be a few weeks later.

Contractions:

Labor is characterized by contractions that come at regular intervals and increase in frequency (how often contractions occur), duration (how long contractions last), and intensity (how strong the contractions are) over time. As time progresses, the contractions come at closer intervals.

Labor contractions cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Some women describe contractions as strong menstrual cramps. You might have a small amount of bleeding from your vagina. Labor contractions are not stopped by changing your position or relaxing. Although the contractions might be uncomfortable, you will be able to relax between contractions.

This part of the first stage of labor (called the latent phase) is best experienced in the comfort of your home.

Write down the time at the beginning of one contraction and again at the beginning of the next contraction. The time between contractions includes the length or duration of the contraction and the minutes between the contractions (called the interval).

Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than five minutes apart. Active labor (the time you should come into the hospital) is usually characterized by strong contractions that last 45 to 60 seconds and are three to four minutes apart.

The following suggestions might help you cope during contractions.

• Try to distract yourself: take a walk, go shopping or watch a movie.
• Soak in a warm tub or take a warm shower. Ask your health care provider if you should take a tub bath if your water has broken.
• Try to sleep if it is in the evening. You need to store up your energy for labor.

The rupture of the amniotic membrane (the fluid-filled sac that surrounds the baby during pregnancy) is also referred to as your “bag of water breaking.” The rupture of the amniotic membrane might feel either like a sudden gush of fluid or a trickle of fluid that leaks steadily. The fluid is usually odorless and might look clear or straw-colored.

If your “water breaks,” tell your health care provider. Tell your health care provider what time your bag of water broke, how much fluid was released, and what the fluid looked like. Labor might or might not start soon after your bag of water breaks.

It is also common to be in labor without your water breaking.

Your cervix gets shorter and thins out in order to stretch and open around your baby’s head. The shortening and thinning of the cervix is called effacement and is measured in percentages from 0 percent to 100 percent. The stretching and opening of your cervix is called dilation and is measured from 1 to 10 centimeters.

Effacement and dilation are a direct result of effective uterine contractions. Progress in labor is measured by how much the cervix has opened and thinned to allow your baby to pass through the vagina.

Please call your health care provider during early labor when you have questions or concerns. Also call:

• If you think your water has broken (if there is a sudden gush of fluid or a trickle of fluid that leaks steadily)
• If you are bleeding (more than spotting)
• When your contractions are very uncomfortable and have been coming every three to five minutes for an hour.

Your health care provider will give you specific guidelines about when you should get ready to come to the hospital. Be sure to drive carefully.

When you get to the hospital, you will go to the Triage unit. You will be asked to wear a hospital gown. Your pulse, blood pressure and temperature will be checked. A monitor will be placed on your abdomen for a short time to check for uterine contractions and to assess the baby’s heart rate. Your health care provider will also examine your cervix to determine how far labor has progressed.

An intravenous (IV) line might be placed into a vein in your arm to deliver fluids and medicines.

Vaginal delivery is the most common and safest type of birth. When necessary in certain circumstances, forceps (instruments resembling large spoons) might be used to cup your baby’s head and help guide the baby through the birth canal. Vacuum delivery is another way to assist delivery and is similar to forceps delivery. In vacuum delivery, a plastic cup is applied to the baby’s head by suction and the health care provider gently pulls the baby from the birth canal.

Although vaginal delivery is the most common and safest type of delivery, sometimes cesarean delivery is necessary for the safest outcome for you and your baby. A cesarean delivery might be necessary if one of the following complications is present:

• Your baby is not in the head-down position
• Your baby is too large to pass through the pelvis

Most often, the need for a cesarean delivery is not determined until after labor begins.

The average labor lasts 12 to 24 hours for a first birth and is usually shorter for subsequent births. Labor happens in three stages.

First Stage

The first stage is the longest part of labor and can last several hours. It begins when your cervix starts to open and ends when it is completely open (fully dilated) at 10 centimeters. When the cervix dilates from 0 to 5 centimeters, contractions get stronger as time progresses. Mild contractions begin at 15 to 20 minutes apart and last 60 to 90 seconds.

The contractions become more regular until they are less than five minutes apart. This part of labor (called the latent phase) is best experienced in the comfort of your home.

When the cervix dilates from 5 to 8 centimeters (called the active phase), contractions get stronger and are about three minutes apart, lasting about 45 seconds. You might have a backache and increased bleeding from your vagina (show). Your mood might become more serious as you focus on the hard work of dealing with the contractions. You will also depend more on your support person.

Hints to help with the active phase:

• Try changing your position. You might want to try getting on your hands and knees. This helps ease the discomfort of back labor.
• Soak in a warm tub or take a warm shower
• Continue practicing breathing and relaxation techniques.
• If your amniotic membrane ruptures, the next contractions might be much stronger. When the cervix dilates from 8 to 10 centimeters (called the transition phase), contractions are two to three minutes apart and last about one minute. You might feel pressure on your rectum, and your backache might feel worse. Bleeding from your vagina will be heavier.

It might help to practice breathing and relaxation techniques such as massage or listening to soothing music. Focus on taking one contraction at a time. Remember that each contraction brings you closer to holding your baby.

Second Stage

The second stage of labor begins when your cervix is fully dilated at 10 centimeters. This stage continues until your baby passes through the birth canal or vagina and is born. This stage might last two hours or longer.

Contractions might feel different. They will slow to two to five minutes apart and last from about 60 to 90 seconds. You will feel as strong urge to push with your contractions. Try to rest as much as possible between intervals of pushing.

Here are some helpful hints for pushing.

• Try several positions (squatting, getting on your hands and knees).
• Take deep breaths in and out before and after each contraction.
• Curl into the push as much as possible. This allows all your muscles to work.

You might receive anesthetics (pain-relieving medicines) or have an episiotomy if necessary. An episiotomy is a procedure during which a small incision is made between the anus and vagina to enlarge the vaginal opening. An episiotomy might be necessary to assist the baby out quicker or to prevent large, irregular tears.

The location of your baby’s head as it moves through the pelvis (called descent) is reported in a number called station. If the baby’s head has not started its descent, the station is described at minus 3. When your baby’s head is at zero station, it is at the middle of the birth canal and is said to be engaged in the pelvis. The station of your baby helps indicate the progress of the second stage of labor.

When the baby is born, your health care provider will hold the baby with his or her head lowered to prevent amniotic fluid, mucus and blood from getting into the baby’s lungs. The baby’s mouth and nose might be suctioned with a small bulb syringe to remove any additional fluid. Your health care provider will place the baby on your stomach and shortly after, the umbilical cord will be cut.

Third Stage

The third stage of labor begins after the baby is born and ends when the placenta separates from the wall of the uterus and is passed through the vagina. This stage is often called delivery of the “afterbirth” and is the shortest stage of labor. It might last from a few minutes to 20 minutes. You will feel contraction but they will be less painful. If you had an episiotomy or small tear, it will be stitched during this stage of labor.