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Labor and Delivery

(Also Called 'Childbirth')

It is normal for you to feel both excited and scared about labor and delivery. We hope that this handout helps answer your questions so you will know what to expect during labor.

When does labor begin?

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.

How will I know if I’m in labor?

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 may 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 or a few hours before labor. Because the uterus rests on the bladder more after lightening, you may feel the need to urinate more frequently.

Mucus plug

The mucus plug accumulates at the cervix during pregnancy. When the cervix begins to open wider, the mucus is discharged into the vagina and may be clear, pink, or slightly bloody. Labor may begin soon after the mucus plug is discharged or might begin one to two 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.

Timing your contractions

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 may help you cope during contractions:

  • Try to distract yourself: take a walk, go shopping, 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.
Rupture of the amniotic membrane

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 may feel either like a sudden gush of fluid or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored.

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

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

Effacement and dilation of the cervix

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 zero percent to 100 percent. The stretching and opening of your cervix is called dilation and is measured from one to 10 centimeters.

Effacement and dilation are direct results 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.

When should I call my health care provider or go to the hospital?

Please call your health care provider during early labor or 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 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.

What happens when I get to the hospital?

When you get to the hospital, you will check in at the Labor and Delivery Desk. Most patients are first seen in the Triage Room for admission to the hospital or for testing. Please have only one person go with you to the Triage Room.

From the Triage Room, you will be taken to the Labor, Delivery, and Recovery (LDR) room.

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 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 medications.

Types of delivery

Vaginal delivery is the most common type of birth.

Although vaginal delivery is the most common type of delivery, sometimes cesarean delivery is necessary for the safest outcome for you and your and baby. A cesarean delivery may 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.

What are the stages of labor?

The average labor lasts 12 to 24 hours for a first birth and is usually shorter (8 to 10 hours) for other births. Labor happens in three stages—early to late or first to third stage. You will be guided through these stages by your health care provider.

References
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/12/2012...#9676


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