Very few, if any, experiences in a woman's life can be as scary and exciting at the same time as when she goes into labor, knowing that soon she is going to delivery a child into the world. It is important for you to understand the facts about labor and delivery so that you can reduce the physical and emotional stress and turbulence by being prepared.

Labor and Delivery: Introduction

Many women do not know the signs of labor and do not understand the labor and delivery process. It can be a very emotional and frightening experience unless you are prepared for it. The best thing to do is to talk to your health care provider and educate yourself in other ways.

It is important to know the signs of labor and learn about the different options available for giving birth so you feel confident and comfortable with your experience. Signs of true labor can include contractions at regular and increasingly shorter intervals that also become stronger in intensity, lower back pain that does not go away, your water (amniotic sac) breaks, you experience a bloody, brownish or blood-tinged mucous discharge, and your cervix begins dilating (opening up) and becoming thinner and softer.

It is important to know that you have several options available such as where you will have your baby (home birth, birthing center or hospital), who will assist in the delivery (midwife, doctor, doula, significant other), what kind of delivery you have (vaginal, C-section, episiotomy, waterbirth), what kind of pain management (drugs, hypnosis, natural) and even post delivery options.

Before you reach the last few weeks of pregnancy, it is a good idea to review your birth plan and pain relief issues with your doctor or midwife and visit the hospital you have selected or the birthing center where you plan to deliver. Don't get short on time and remember that your due date is only an estimate of the date of delivery and that most women do not deliver on the estimated due date.

What is Labor?

Many women think they are in labor when they are not. These false labor contractions are called Braxton-Hicks contractions, or false labor pains. However, If you think you in labor, do not hesitate to call your health care provider, no matter what time of day or night. It is much better to be safe and call your doctor or midwife if you experience any of the following:

Contractions 5-10 minutes apart that come at regular and increasingly shorter intervals.
You can no longer walk or talk during contractions.
Your water breaks (can be a large gush or a continuous trickle).
You experience vaginal bleeding.
You have a bloody. brownish or red-tinged mucous discharge.
You have lower back pain (back labor) that does not go away.
You feel reduced fetal movement

A woman is in labor when she has short, regular contractions of the uterus. The frequency and duration of these contractions varies with each individual woman and the onset of these contractions may be very gradual or may occur very suddenly. These contractions lead to changes in the narrow, outer end of the uterus called the cervix which becomes softer and shorter, thins out, and then opens before birth.

During delivery, the baby comes through the cervix into the vagina (birth canal). The baby is most commonly born head-first but in some cases the baby is "breech" meaning either the feet or buttocks are the first to exit the vagina. In the final stage, the placenta (afterbirth) is expelled. After the birth, the medical condition of the child is assessed with the APGAR score.

For additional information about labor and delivery please visit the page Labor and Birth website Pregnancy And Children.

Birthcenters.org
Labor and Delivery: 4Woman
March of Dimes: What to take to the hospital
University of Michigan: How to tell when labor begins

Inducing Labor

Sometimes, if labor has not started on its own, your health care provider may start your labor so that you can deliver the baby vaginally. Some women may prefer to have labor induced even without medical need. The March of Dimes (Induction by request) recommends that labor be induced only when the health of the woman or baby is at risk.

The most common reason for labor induction is that the pregnancy has gone 2 weeks or more past the due date. Your doctor might also recommend that labor be induced if you have high blood pressure caused by pregnancy, if you have an infection in her uterus, if your water has broken (the amniotic sac has been ruptured) but contractions have not begun, if you have health problems, or there is a potential problem with the baby.

Your health care provider may use one or more of the following common techniques to induce labor:

Separating the amniotic sac from the wall of the uterus: the health care provider gently puts a gloved finger through the woman's cervix and separates the amniotic sac from the uterine wall.
Ripening the cervix: the provider places a small tablet or suppository in the vagina up against the cervix.
Giving the woman a drug; the most commonly used is oxytocin (Pitocin).
Breaking the woman's water: The doctor uses a small instrument to break the amniotic sac that contains the baby.

Do-it-yourself techniques to induce labor have not been proven to be both safe and effective. Below are some of the techniques you may have heard about, but should avoid:

Nipple stimulation: twisting or pinching your nipples
Sexual intercourse: having sexual intercourse will not induce labor.
Castor oil: castor oil is a strong laxative but no good studies have proven it consistently effective.
Herbal remedies: these can be are risky and may be unsafe for your baby for other reasons as well.

Like any medical procedure, induction has side effects and risks. The primary risk you face is that if your labor does not start after induction, you might need to have a cesarean section. This risks and other problems with inducing labor are discussed in detail on the page Inducing Labor of the website PregnancyAndChildren.com. You may also want to visit the websites March of Dimes: Inducing labor and Family doctor: Labor induction.

Cesarean (C-section) Birth

During a C-section, the doctor makes a cut in the woman's abdomen and uterus and removes the baby so that the baby is delivered through surgery instead of being delivered vaginally. A c-section can save the life of a baby or mother but should be used only when medically needed.

Most healthy pregnant women delivery their babies vaginally but the rate of babies being born by C-section is increasing in the U.S. The International Cesarean Awareness Network believes that the rise in C-sections is alarming and notes that the World Heath Organization estimates that 50% of all U.S. performed cesarean sections are unnecessary. Given the correct support and education it is estimated that 90-95% of women can deliver vaginally. Many experts, and even the U.S. government, are concerned enough that they are trying to reduce the rate at which caesarian sections are being performed.

If you are considering a planned C-section for medical reasons or think you may want to have your baby be delivered by C-section, talk with your doctor. It is important for you to get the facts about C-sections before you go into labor. You should find out exactly what a C-section is. why they are performed, the pros and cons of this surgery, and understand the reasons why a cesarean birth may be used. Make sure to carefully consider the risks and benefits.

For additional information please visit the website PregnancyAnd Children.com page Cesarean section. You may also find the following websites helpful:

March of Dimes: Cesarean birth for medical reasons
March of Dimes: Cesarean birth by request
4woman: Cesarean sections
Medem: Cesarean birth issues

Waterbirthing

In a water birth the woman in labor gets into a tub of water that is between 90-100 degrees Fahrenheit. Some women get out of the tub to give birth. Others remain in the water for delivery. The water helps women feel physically supported. It also keeps her warm and relaxed. This eases the pain of labor and delivery for many women. Plus, it is easier for laboring women to move and find comfortable positions in the water.

The phenomenon of waterbirthing is relatively new in this country. Ask your doctor or midwife if you are a good candidate for waterbirthing. Water birth is not safe for women or babies who have health issues. For additional information about water birthing, visit the websites:

Natural Child
Childbirth.org
Waterbirth Info
WaterBirth International

Episiotomy

An episiotomy is a surgical procedure where the skin between the vagina and the anus is cut. This is done to enlarge the vaginal opening so that it will not tear and so the baby can be more easily delivered. When your baby's head is stretching the opening of your vagina, your doctor will make sure the area has been numbed and will then make an incision into the tissue between the opening of your vagina and your rectum (called the perineum). After delivery, the doctor will put a few stitches in to close up the incision.

In general, the benefits of an episiotomy are that it may result in easier and better repair than a jagged tear and it may shorten the second stage of labor by relieving muscle tightness in this area. At one time, an episiotomy was a routine procedure but currently there is a great deal of controversy regarding the procedure since it can lead to infection, can increase perineal pain resulting in trouble defecating, and it may cause sex after pregnancy to be painful.

For additional information regarding an episiotomy, please visit the page Episiotomy and Pregnancy and the websites below:

University of Michigan: All about episiotomy
National Institutes of Health: Episiotomy