6. L
abor and Delivery
Childbirth is a natural process that each woman handles differently. The more you understand the childbirth
process, the more relaxed and effective you will be during labor and delivery.
SIGNS OF LABOR
The labor experience varies by individual. You may experience one, two or all of the common signs listed below:
§§ Bloody show. A thick, blood-tinged vaginal discharge is the result of the cervix thinning and dilating or
opening. It can happen at the beginning of labor or up to one week prior to labor. If you experience any
bright red bleeding, call your physician for evaluation.
§§ Loss of mucus plug. The thick, gelatin-like mucus sealing the cervix and uterus can be dislodged as
labor approaches. However, passing the mucus plug does not mean you are in labor or even that you’ll
go into labor in the next few hours.
§§ Ruptured membranes. Your water may break as a sudden gush or slow trickle of amniotic fluid that
you cannot control. This amniotic fluid may be clear, yellow-, green- or pink-tinged in color. Please call
the hospital birthing unit when your water breaks.
§§ Contractions. This tightening or cramping sensation spreads across your entire belly, though some
women feel contractions in their lower back. Timing your contractions – from the beginning of one
contraction to the beginning of the next – can indicate your labor progression.
§§ Diarrhea. Contractions may irritate your bowel, causing loose stools.
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IS IT PRE-LABOR OR TRUE LABOR?
At times you may feel tightening, contractions or cramps, but it isn’t true labor until your cervix begins to
dilate (stretch and thin). A few of the differences between pre-labor contractions (false labor) and true labor
contractions are:
TRUE LABOR CONTRACTIONS
PRE-LABOR CONTRACTIONS
(False Labor)
w Grow regular and closer in timing
w Remain irregular and do not get closer together
w Become increasingly intense
w Do not increase in intensity
w Grow progressively longer (up to 60 seconds)
w Are short in duration (15 to 45 seconds)
w Do not stop with activity or position changes
w May stop with activity or position changes
w Cause cervix to thin and dilate
w Cause no cervical change
IT’S TIME TO LEAVE FOR THE HOSPITAL IF:
§§ Your water breaks.
§§ If it’s your first baby, when your contractions are five minutes apart for at least one hour
and are gradually becoming stronger.
§§ If you’ve had a baby before, when your contractions are six to eight minutes
apart for one hour.
Please call us before you come so we can prepare for your arrival. If you are unsure if it’s time to come to
the hospital, call and speak with a nurse who can help you decide. During regular business hours, please call
your clinic. After hours, please call the hospital birthing unit at 608-324-1291.
WHEN YOU ARRIVE AT THE HOSPITAL:
§§ Between 6 a.m. and 8 p.m., go directly to the birthing unit.
§§ Between 8 p.m. and 6 a.m., enter through the emergency department and a Monroe Clinic employee
will accompany you to the birthing unit.
After arrival, the nursing staff will evaluate your labor and notify your physician. A fetal monitor will be
used to evaluate your labor contractions and baby’s heart rate. A vaginal exam will be done to determine
cervical dilatation.
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BABY STEPS ~ Your Pregnancy Guide
LABOR DURATION, STAGES AND STRATEGIES
It is impossible to predict how long your labor will last, as the experience is unique to each
mother and baby. However, the “average” labor for a first baby lasts 12 to 17 hours. A
woman who has already had one or two children will probably have a shorter labor.
FIRST STAGE
The first stage of labor begins with the onset of
active labor and ends when the cervix is fully dilated
(10 centimeters) and 100 percent effaced, or thinned.
The first stage of labor is divided into three phases:
early, active and transition.
EARLY PHASE
The cervix dilates, or opens to 3 to 4 centimeters
and begins to efface or thin.
§§ W hat it feels like: mild contractions,
“crampy” feeling, diarrhea, excitement,
ambition, apprehension.
§§ W hat to do: rest and relax to conserve energy,
eat and drink lightly, take a warm bath or
shower, change positions for comfort and
time contractions.
§§ W hat your partner can do: offer a massage,
encourage rest, listen to music or get some sleep.
ACTIVE PHASE
The cervix will dilate to 4 to 7 centimeters and
efface/thin more.
§§ W hat it feels like: stronger, longer contractions,
increased perineal pressure, more serious, more
concentration needed to relax.
§§ W hat to do: use slow or shallow breathing,
change positions frequently, walk if comfortable,
use hospital’s whirlpool or shower, request pain
medication or epidural.
§§ W hat your partner can do: help you
focus, assist with position changes, offer
encouragement or affirmations, provide comfort
with pillows, dimmed lights or cool cloth.
TRANSITION PHASE
The cervix will dilate to 8 to 10 centimeters and be
100 percent effaced.
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§§ W hat it feels like: strong contractions, intense
rectal pressure, lower backache, urge to push,
nausea or vomiting, aching thighs, leg cramps,
tired, irritable, ready to give up.
§§ W hat to do: try to remain focused, take one
contraction at a time, find your most comfortable
position, rest between contractions, visualize
cervix opening and baby descending down,
remember this is the shortest phase of labor.
§§ W hat your partner can do: help you focus,
offer encouragement, place cool cloth on
forehead, keep lips and mouth moist, tell you
the baby is almost here and you are doing great.
SECOND STAGE
The cervix is fully open and you will push the baby
down and out of the birth canal. Pushing can last
from several minutes to several hours, depending
on the baby’s position and size, the effectiveness of
pushes and if you’ve given birth before.
§§ W hat it feels like: contractions every 3 to 5
minutes, lasting 60 to 90 seconds, overwhelming
urge to push, increased perineal pressure,
energized and empowered.
§§ W hat to do: find comfortable and effective
pushing position (semi-upright holding knees,
side-lying, squatting or on all fours), push when
you feel the urge.
§§ W hat your partner can do: help you position
yourself, support your legs, remind you to relax
between pushes, cheer you on and share in the
miracle of birth.
THIRD STAGE
The placenta (or afterbirth) is expelled. Your uterus
will continue to contract mildly until the placenta
is completely out. This occurs between five and 20
minutes after the birth of your baby.
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LABOR AND DELIVERY INTERVENTIONS
Pain management
Labor pain is a sign that your body is working well and working hard to deliver successfully. Women experience
different degrees of labor pain. While you may have heard stories and advice from friends and family, be sure
to choose pain relief options based on your own needs and preferences.
NON-DRUG PAIN MANAGEMENT OPTIONS
§§ Changing your position frequently.
§§ Walking.
§§ Whirlpool bath or warm shower.
§§ Massage.
§§ Apply ice or warm packs to your back.
§§ Conscious relaxation decreases labor discomfort,
enhances labor progress and conserves precious
energy. The ability to focus on relaxing
contributes to a calm frame of mind.
§§ Visualization uses your mind to access the
autonomic nervous system. It usually begins
with a relaxation exercise and then progresses
to a deeper level by imagining sights, sounds,
smells, sensations or tastes connected to
personal memories.
§§ Breathing techniques ease discomfort caused
by tightened muscles that can slow the labor
process. They are best used when you can no
longer walk or talk during contractions.
BREATHING TECHNIQUES IN DETAIL
§§ Deep breathing helps you manage contractions.
Begin each contraction with a deep cleansing
breath (a slow deep breath in through the nose
and a full exhale out through the mouth). Try to
do six to nine breaths per minute, ending with a
full, cleansing breath. Breathing should be slow,
steady and controlled.
§§ Modified breathing stills the diaphragm
through shallow breathing. With open mouth,
take a light, shallow breath and exhale with the
sound “hee”. Increase and decrease your rate of
breathing as contractions get stronger or lessen
in intensity. Ending with a cleansing breath.
§§ Transition breathing helps you work through
the urge to hold your breath or push during
strong contractions. Begin with a quick
cleansing breath and take four to eight shallow
breaths followed by a short sharp blow (sounds
like “he-he-he-he-whoo-he-he-he-he-whoo”).
Continue this pattern through each contraction.
PAIN-RELIEF MEDICATION
§§ Intravenous (IV) medications typically
“take the edge off” the pain and help you
relax, though you may still experience pain
with contractions.
§§ Labor epidural anesthetic almost eliminates
labor pain. An anesthesiologist will place a
thin plastic tube into your lower back next to
the membrane that covers the spinal cord.
Numbing medicine is delivered to your nerves
through the tube.
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BABY STEPS ~ Your Pregnancy Guide
LABOR INDUCTION (inducing labor)
CESAREAN SECTION
Induction starts the labor before it happens naturally.
One of the main reasons to induce labor is mom or
baby would be healthier if the baby were delivered
sooner. Several methods are used to induce labor:
A Cesarean section (C-section) is a surgery to deliver
your baby. Many C-sections are scheduled prior to
hospitalization, but there are times when they are
unexpected and need to be performed. Common
reasons for an unplanned C-section include:
§§ A mniotomy breaks the bag of water that
holds the baby to offer the uterus natural
chemical signals to start labor. This option
depends on cervical dilatation, effacement
and the baby’s position.
§§ Cervidil is a medication with prostaglandins
that softens the cervix and stimulates the
uterus. A vaginal insert is placed near the
cervix by your physician and is typically
removed within 12 hours. Continuous
electronic fetal monitoring is required.
§§ Mistoprostel (Cytotec) is a tablet medication
placed near the cervix to soften the cervix and
stimulate the uterus. Continuous electronic fetal
monitoring is required.
§§ Pitocin is an IV drug used to stimulate
uterine contractions. Continuous electronic
fetal monitoring is required.
ASSISTED DELIVERY
§§ Fetal distress.
§§ Labor fails to progress.
§§ T he baby is positioned inappropriately for
vaginal delivery (malpresentation).
§§ T he baby cannot fit through the pelvic bones
(cephalopelvic disproportion).
§§ Other health complications that make a
C-section the safer option.
VAGINAL BIRTH
AFTER CESAREAN (VBAC)
In some cases, women who have delivered a baby by
C-section may have the option to attempt vaginal
birth. However, it is not the right choice for all
women. If you’ve had a C-section in the past and
are interested in attempting VBAC, discuss the risks
and benefits of VBAC and repeat C-section with
your physician.
Certain situations require healthcare providers to
help with a baby’s delivery. These situations include
the inability to push effectively due to anesthesia,
exhaustion or the baby’s size. These instruments
may be used:
§§ Forceps is a sterile tong-like instrument
placed on either side of the baby’s head
to assist with delivery.
§§ Vacuum device is a small cone-like cup
placed on the top of baby’s head to assist
the delivery with suction.
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