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Having Your Baby: The Labor Process

WHAT YOU SHOULD KNOW:

Labor is a group of steps your uterus (womb) goes through to deliver (push out) your baby. There are three stages of labor. The stages begin with contractions, and end with the birth of your baby and the release of the placenta (afterbirth). It is not known for sure what causes labor to begin. There is no way to know when labor will start and when your baby will be born. Timing your contractions is a good way to find out if you are in true labor. You will be asked to stay in the hospital or birth center if your contractions are strong, getting closer together, and your cervix is opening. Other reasons for going into the hospital or birth center are if your water has broken, or if you are bleeding.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Activity:

Ask your caregiver if it is OK to walk and move around while you are in labor. Caregivers may suggest that you try kneeling, squatting, sitting, standing or walking during labor. Positioning aids may be available to use to help make you more comfortable while you are in labor. These aids include birthing balls, cushions, squat bars, and birthing stools. Your partner can help you by holding you in a sitting position, and rubbing your shoulders, neck, and back. If you are not able to walk or use other positions during labor, lie on your side. This keeps the weight of your uterus off the blood vessels in your abdomen. Walking and changing positions may help in the following ways:

  • Increase the size of the inside of your pelvis (birth canal) to make it possible for your baby to get through.
  • Shorten the length of the second stage of labor.
  • Decrease the amount of pain you have.
  • Decrease the injury to your perineum (the area between your legs).
  • Greater satisfaction (happiness) with your birthing experience.

Anesthesia:

This is medicine to help make you comfortable during labor. You have the right to ask for, or refuse anesthesia (an-es-THEE-zah). If you want this medicine, caregivers work with you to decide which anesthesia is best. Do not make important decisions for 24 hours after having anesthesia. Also, do not drive or use heavy equipment. The medicine may make you drowsy and your thinking unclear. An adult should drive you home and stay with you after you have had anesthesia.

  • Epidural Anesthesia:
    • This is medicine put into your back through a tiny tube. The tube may be left in place to give you more medicine later, if needed. Anesthesia should control the pain, while allowing your body to work at pushing during delivery. You may be able to walk during labor with the epidural, but always ask caregivers before you get up. Feeling returns to your legs when the medicine wears off.
    • This medicine can be used during vaginal or Cesarean (se-ZAR-ee-an) delivery (C-section), or if you need an episiotomy. If your perineum tears during labor, this medicine may help decrease pain while your caregiver repairs the tear.
  • Intrathecal Anesthesia: This type of anesthesia is very similar to epidural anesthesia except that a medicine called an opiate (OH-pee-at) is used. Intrathecal anesthesia may help to control the pain of labor and delivery. This medicine will not make you lose feeling in your legs.
  • Spinal anesthesia: This is medicine given through a shot into your back. This medicine will make you lose feeling below your waist. Feeling usually returns in about two hours.

Call Button:

Use the call button to call your caregiver. Call if you need help moving around or getting out of bed. Call if you feel the need to push, or feel like your baby is coming. Call if you feel your water break, if the pain of the contractions is too strong, or if you have other pain in your body.

External fetal heart monitoring:

Caregivers may use this to monitor your baby's heartbeat, and the contractions of your uterus. A small metal disc (monitor) with gel on it is placed on your abdomen. A belt will be fastened around your waist to hold the monitor in place. The monitor may need to be moved as your baby moves inside you. It may also be put on and taken off, or left in place. The monitor is attached to a machine with a TV-type screen, or a printer. The screen or the paper print out shows a tracing of your uterus contracting, and the baby's heartbeat.

Internal fetal heart monitoring:

An internal fetal monitor allows caregivers to carefully watch your baby's heartbeat while you are in labor. It may also measure your contractions. To place the internal monitor, your caregiver will first make sure your bag of waters has broken. The opening to your birth canal must also be dilated (open) a little. Your caregiver will use a small plastic tube to guide a special wire through your birth canal. This small wire is attached to your baby's scalp (the skin covering the head). Then, the plastic guide is removed. This wire is attached to a machine with a TV-type screen. The screen shows a tracing of the baby's heartbeat and may also show your uterus contracting. Ask your caregiver about the risks and benefits of an internal fetal monitor.

Fetal ultrasound:

This test uses sound waves to show pictures of your baby (fetus) inside your uterus. Jelly-like lotion is put on your abdomen, and a small handle is gently moved through the lotion. As this is done, pictures of your baby can be seen on a TV-like screen. Caregivers can learn the age of your baby, and see how fast he is growing. The movement, heart rate, and position of your baby can also be seen. Caregivers can see your placenta, and can tell if you have more than one baby.

Informed Consent:

You have the right to understand your labor and delivery options in words you can understand. You should be told what may be done to help you have a safe labor and delivery. Your doctor should also tell you about the risks and benefits of any treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Labor:

The labor process may take hours, or even days. Ask your caregiver what is happening while you go through labor. Your caregiver may be able to tell you what stage you are in, and how long the labor may last. Your body will go through three stages (parts) of labor:

  • Stage 1: Your uterus contracts to prepare your cervix for delivery, and to push your baby out of the birth canal. Caregivers may need to give you medicine to help make your contractions stronger, and make them come more often. Caregivers will explain the risks and benefits of using medicine during labor. The contractions help your cervix dilate (DEYE-layt) and efface (ee-FAYS). When your cervix is dilated 10 centimeters, and effaced one-hundred percent, your body is ready to have the baby.
    • Dilation: Your cervix begins to dilate (open) during the last phase of pregnancy and when you are in labor. Dilation (deye-LAY-shun) of the cervix is measured in centimeters from zero to 10. Your cervix is fully open when it is dilated to 10 centimeters (nearly four inches).
    • Effacement: A woman's cervix is about one and one-half inches thick. Your cervix thins and softens as it gets ready for birth. Effacement (ee-FAYS-ment) of the cervix is measured in percents. Your cervix is half its original thickness when it is 50 percent effaced, and is completely thinned out when it is 100 percent effaced.
  • Stage 2: The uterus continues to contract to push your baby through the birth canal during this stage of labor. This stage ends with the birth of your baby.
    • Pushing: Pushing starts at the end of Stage 1 when it is time to deliver your baby. You may have the urge to push early in your labor when it is not yet time to push. You will need to stop pushing if it is too early to push to avoid injuring your cervix. Caregivers will show you other ways to cope with the urge to push, such as special ways to breathe. When you are completely dilated and fully effaced you will be able to push, and your baby will be delivered.
  • Stage 3: This is the last stage of labor. It is when the placenta (afterbirth) is delivered out of your uterus through your vagina. It is the tissue (skin) that joined you to your baby when your baby was growing inside your uterus. Its job was to bring food and oxygen to your baby, and take away wastes.

Medicine:

  • Pain Medicine: Caregivers may give you medicine to decrease your pain. Tell caregivers if the pain does not go away or if it comes back. Some medicines can cross into the baby's bloodstream, which may cause the baby's heart rate to decrease. Some medicines may also cause breathing problems after the baby is born.
  • Induction medicines: Some medicines can help your cervix get ready for delivery, or help labor start. These medicines may be put into your vagina, or into an IV (intravenous line).

Methods to help the cervix get ready for delivery:

Medicine, tools, or other methods may be used to help your cervix efface or dilate enough to have the baby. The following are some methods that may be used:

  • Natural and artificial hygroscopic (heye-groh-SKOP-ik) dilators can be placed in the cervix. They absorb (suck up) fluid and swell to dilate the cervix.
  • A catheter with a deflated balloon on the end may be put into your cervix. Then the balloon is slowly inflated to dilate the cervix.
  • Your caregiver may strip or separate the amniotic membranes from the bottom part of the inside of your uterus.

Labor support:

Labor and delivery can be an exciting but scary time. Having someone help you through the process can make it easier. You may have taken childbirth classes with a support person to prepare for your baby's birth. If not, caregivers can guide your support person as they help you. Being the support person for a woman in labor can be very tiring. The support person often feels many of the same things you are feeling. Caregivers will help by making sure your support person has a chance to rest, eat, and drink. Try to tell your support person what you want and do not want. Following are some of the things that your support person can do to help you during labor:

  • Ask for a massage. Having your shoulders, neck, and back massaged (rubbed) may decrease the pain of labor. Some women want their muscles massaged during contractions. Others would rather be massaged between contractions. Tell your support person what areas you want to be massaged, and when to do it. Effleurage (ef-loo-RAHZH) is a type of light massage that glides over the skin, but does not cause pressure. You can do this type of massage yourself by drawing circles with your fingertips on your abdomen or thighs. Your support person can do the same on your arms and legs.
  • Breathe correctly. You may have learned different ways to breathe through contractions if you attended childbirth classes. Caregivers can show you ways to breathe through contractions. Your support person can breathe with you, and remind you about your breathing.
  • Change bed sheets and gowns. Having the linens or gown changed when they become wet or soiled can make you more comfortable during labor. Have your support person tell caregivers when you need these changed.
  • Eat ice chips. If your caregiver says it is okay, you may want to eat ice chips and sip liquids. Ask your caregiver to get these things, or feed these things to you.
  • Place wet cloths on body areas. Your support person can place cool or warm wet cloths on your forehead or the back of your neck. Ask your support person to replace the cloths as often you want or need.
  • Practice imagery. Imagery is a way to think about something else (something beautiful or peaceful to you) during intense contractions. If you brought special pictures with you, place them where you can see them.
  • Talk and listen to music. Talking and music may help decrease fear and discomfort. Talk to your support person. Let the person know what music you want to listen to. Talk about your baby and the things you will do together after the birth. Your support person should encourage you. It is very important to know that you are doing well during labor and that the discomfort you feel is real. Telling your support person what you are feeling lets them be a part of the labor process.
  • Use hydrotherapy (heye-droh-THER-ah-pee). This is a treatment using water to help you relax. It may also decrease labor pain and blood pressure. You may be able to sit in a whirlpool tub, or a chair in the shower during labor. Ask your caregiver if hydrotherapy is available at your institution, and what types are available.
  • Walk and change positions. Your support person can walk with you and help you move to different positions. Walking and changing positions can help your labor go faster.

© 2016 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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