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Signs of labor

As you approach your due date, you will be looking for any little sign that labor is about to start. You might notice that your baby has "dropped" or moved lower into your pelvis. This is called "lightening." If you have a pelvic exam during your prenatal visit, your doctor might report changes in your cervix that you cannot feel, but that suggest your body is getting ready. For some women, a flurry of energy and the impulse to cook or clean, called "nesting," is a sign that labor is approaching.

Some signs suggest that labor will begin very soon. Call your doctor or midwife if you have any of the following signs of labor. Call your doctor even if it's weeks before your due date — you might be going into preterm labor. Your doctor or midwife can decide if it's time to go to the hospital or if you should be seen at the office first.

You have contractions that become stronger at regular and increasingly shorter intervals.
You have lower back pain and cramping that does not go away.
Your water breaks (can be a large gush or a continuous trickle).
You have a bloody (brownish or red-tinged) mucus discharge. This is probably the mucus plug that blocks the cervix. Losing your mucus plug usually means your cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start right away or may still be days away.

What are the advantages of natural childbirth?


A natural, unmedicated approach to labor and birth will suit you best if you want to remain in control of your body as much as possible, be an active participant throughout labor, and have minimal routine interventions such as continuous electronic monitoring.
If you choose to go this route, you accept the potential for pain and discomfort as part of giving birth. But with the right preparation and support, women often feel empowered and deeply satisfied by natural childbirth.
Here are the pros:
Most natural childbirth techniques are not invasive, so there's little potential for harm or side effects for you or your baby.
Many women have a strong feeling of empowerment during labor and a sense of accomplishment afterward. Despite having to endure pain, many report that they'll choose an unmedicated birth again the next time. For some women, being in charge helps lessen their perception of pain.
There's no loss of sensation or alertness. You can move around more freely and find positions that help you stay comfortable during labor. And you'll remain able to participate in the delivery process when it's time to push your baby out.
You're less likely than women who get epidurals to need interventions such as oxytocin (Pitocin) to make your contractions stronger, bladder catheterization, or a vacuum extraction or forceps delivery
Your partner can be involved in the process as you work together to manage your pain.
You can use the breathing exercises, visualization, and self-hypnosis you learn both during labor and later on. Many new mothers find themselves drawing on their relaxation techniques in the early days of breastfeeding, while coping with postpartum discomfort, or during those times when caring for a newborn feels especially stressful.

Stages of labor


Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). How labor progresses and how long it lasts are different for every woman. But each stage features some milestones that are true for every woman.

First stage
The first stage begins with the onset of labor and ends when the cervix is fully opened. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. You might want to rest, watch TV, hang out with family, or even go for a walk. Most women can drink and eat during labor, which can provide needed energy later. Yet some doctors advise laboring women to avoid solid food as a precaution should a cesarean delivery be needed. Ask your doctor about eating during labor. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center.

At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby's position and station (location in the birth canal). Most babies' heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up, towards the mother's abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own.

As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. Many of the positioning and relaxation tips you learned in childbirth class can help now. Try to find the most comfortable position during contractions and to let your muscles go limp between contractions. Let your support person know how he or she can be helpful, such as by rubbing your lower back, giving you ice chips to suck, or putting a cold washcloth on your forehead.

Sometimes, medicines and other methods are used to help speed up labor that is progressing slowly. Many doctors will rupture the membranes. Although this practice is widely used, studies show that doing so during labor does not help shorten the length of labor.

Your doctor might want to use an electronic fetal monitor to see if blood supply to your baby is okay. For most women, this involves putting two straps around the mother's abdomen. One strap measures the strength and frequency of your contractions. The other strap records how the baby's heartbeat reacts to the contraction.

The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last, few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters.

Second stage

The baby twists and turns through the birth canal.

The second stage involves pushing and delivery of your baby. It usually lasts 20 minutes to two hours. You will push hard during contractions, and rest between contractions. Pushing is hard work, and a support person can really help keep you focused. A woman can give birth in many positions, such as squatting, sitting, kneeling, or lying back. Giving birth in an upright position, such as squatting, appears to have some benefits, including shortening this stage of labor and helping to keep the tissue near the birth canal intact. You might find pushing to be easier or more comfortable one way, and you should be allowed to choose the birth position that feels best to you.

When the top of your baby's head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy (uh-peez-ee-OT-oh-mee), to enlarge the vaginal opening. Most women in childbirth do not need episiotomy. Sometimes, forceps (tool shaped like salad-tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After your baby is born, the umbilical cord is cut. Make sure to tell your doctor if you or your partner would like to cut the umbilical cord.

Third stage
The third stage involves delivery of the placenta (afterbirth). It is the shortest stage, lasting five to 30 minutes. Contractions will begin five to 30 minutes after birth, signaling that it's time to deliver the placenta. You might have chills or shakiness. Labor is over once the placenta is delivered. Your doctor will repair the episiotomy and any tears you might have. Now, you can rest and enjoy your newborn!

Managing labor pain

Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for everyone. So no one can predict how you will feel. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook.

Some women do fine with natural methods of pain relief alone. Many women blend natural methods with medications that relieve pain. Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. It is important to realize that labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing your baby down and out of the birth canal. In other words, labor pain has a purpose.

Try the following to help you feel positive about childbirth:

Take a childbirth class. Call the doctor, midwife, hospital, or birthing center for class information.
Get information from your doctor or midwife. Write down your questions and talk about them at your regular visits.
Share your fears and emotions with friends, family, and your partner.
Natural methods of pain relief
Many natural methods help women to relax and make pain more manageable. Things women do to ease the pain include:

Trying breathing and relaxation techniques
Taking warm showers or baths
Getting massages
Using heat and cold, such as heat on lower back and cold washcloth on forehead
Having the supportive care of a loved one, nurse, or doula
Finding comfortable positions while in labor (stand, crouch, sit)
Using a labor ball
Listening to music

Medical methods of pain relief
While you're in labor, your doctor, midwife, or nurse should ask if you need pain relief. It is her job to help you decide what option is best for you. Nowadays women in labor have many pain relief options that work well and pose small risks when given by a trained and experienced doctor. Doctors also can use different methods for pain relief at different stages of labor. Still, not all options are available at every hospital and birthing center. Plus your health history, allergies, and any problems with your pregnancy will make some methods better than others.

Methods of relieving pain commonly used for labor are described in the chart below. Keep in mind that rare, but serious complications sometimes occur. Also, most medicines used to manage pain during labor pass freely into the placenta. Ask your doctor how pain relief methods might affect your baby or your ability to breastfeed after delivery.

Videos:

Childbirth Stations of Presentation

Soft Signs of Labor Video

Induction of Labor Video

Labor Precautions Video