Soon, you'll experience the amazing process of childbirth! Find out the signs of labor and learn about your options for giving birth. Once you reach the third trimester, you should talk to your doctor about labor and delivery. Learn your options for pain relief. Find out how to reach her if you go into labor. And ask her at what point in labor should you call. Before you reach the last few weeks of pregnancy, you should visit the hospital or birthing center. Find out if you can pre-register so that your insurance information is already in the computer when you arrive.
Signs of Labor
Many women, especially with their first babies, think they are in labor when they're not. This is called false labor. Do not feel embarrassed if you go to the hospital thinking you're in labor, and then you get sent home.
If you think you are in labor call your doctor. Call your doctor if you experience any of the following :
- Contractions that come at regular and increasingly shorter intervals. Contractions will become stronger over time.
- You have persitant lower back pain. You might also feel cramps as if you were premenstrual.
- Your water breaks in a large gush or a trickle.
- You have a brown or red-tinged mucous discharge. This is most likely your mucous plug. Losing your mucous plug usually means your cervix is dilating and becoming thinner and softer. Labor could start right away or could be a few days away.
Choosing Where to Deliver
Many women carefully choose the kind of environment in which to deliver her baby. Not all insurance companies will cover birth at a birth center and even less will cover planned homebirths. The three ways women can choose to deliver are at a hospital, birth center or at home. Most hospitals and birth centers offer birthing classes and breastfeeding support.
Laboring in a Hospital
If you have health problems, pregnancy complication,s or are at risk for problems during labor and delivery, you should give birth in a hospital. Hospitals offer the most advanced medical equipment and highly trained doctors for labor and deliver. In a hospital, a doctor can do a cesarean section if needed. Epidurals or many other pain relief options are also available.
Only certain doctors have admitting privileges at each hospital. So before you choose your doctor learn about their affiliated hospital. When choosing a hospital you might consider:
- Is it close to your home?
- Is an anesthesiologist on staff at the hospital 24-hours a day?
- Do you feel comfortable in the labor and delivery rooms?
- Are private rooms available?
- How many people can you have in the room with you?
- Does it have a neonatal intensive care unit in case of serious problems with the baby?
- Can your baby stay in the room with you?
Laboring in a Birth Center
Healthy women who are at low-risk for problems during pregnancy, labor and delivery may choose to deliver at a birth or birthing center. Birth centers give women a more relaxed, home-like environment in which to labor and give birth. A birth center will focus on making labor and delivery a natural, family-focused process. Usually certified nurse-midwives deliver babies at birth centers.
Birth centers do not do any routine medical procedures which means you will not automatically be hooked up to an IV when you are in labor. You also will not have an electronic fetal monitor around your belly the whole time. Instead, the midwife or nurse will check in on your baby from time to time with a handheld machine. When your baby is born, all examinations and care for the baby will occur in your room. You cannot receive an epidural at a birth center although some pain medicines may be available. If a cesarean section becomes necessary,you will be moved to a hospital for the procedure. Basic emergency care can be done on a baby with problems while they are being moved to a hospital.
Many birthing centers have showers or tubs in their rooms for laboring women. They also tend to have comforts of home like large beds and rocking chairs. Birth centers usually allow more people in the delivery room than do hospitals. A birth center can be affiliated with a hospital, inside of hospitals, or completely separate facilities.
Homebirth – Labor at Home
Healthy pregnant women with no risk factors for complications during pregnancy, labor or delivery can consider a planned homebirth. Some certified nurse midwives and physicians will deliver babies at home. If you are considering this choice you should ask your insurance company about their policy on homebirths and if they cover costs.
Homebirths are common in many parts of Europe, but in the United States, planned homebirths are still controversial. If you are considering a homebirth, you should fully research the pros and cons. The main advantage is that you will be able to experience labor and delivery in the privacy and comfort of your own home. Since there will be no routine medical procedures, you will be in complete control of your experience. The main disadvantage of a homebirth is that in case of a problem, there is not immediate hospital/medical care in the event of an emergency. Care would have to wait until a transfer to a hospital. Women who deliver at home have no options for pain relief.
To ensure your safety and that of your baby, you must have a highly trained and experienced midwife to assist you. If you live far away from a hospital, homebirth may not be the safest choice. Your midwife must be experienced and have the necessary training and supplies to perform emergency care for you and your baby if need be. Your midwife should also have access to a physician 24 hours a day.
Who Should Deliver Your Baby?
Women can also choose what type of health care provider they would like to deliver their baby. An obstetrician is a medical doctor who specializes in the care of pregnant women and in delivering babies. Obstetricians also have special training in surgery so they are capable of doing episiotomies and cesarean sections. Women who have health problems or pregnancy complications should see an obstetrician.
A certified nurse-midwife (CNM) and a certified professional midwife (CPM) specialize in prenatal care, labor, and delivery. Either one can offer a different care choice for healthy women at low-risk for problems during pregnancy, labor, or delivery. A CNM does not need experience delivering babies in home settings. Most CNMs practice in hospitals and birth centers. A CPM is required to have experience delivering babies in home settings because they deliver in homes and birthing centers. Both should have a back-up arrangement with an obstetrician in case of a problem or emergency.
Some women also choose to have a doula assist with labor and delivery. A doula is a professional labor coach who gives physical and emotional support to women during labor and delivery. The doula offers advice on breathing, relaxation, and positioning. Doulas also give continuous emotional support and comfort to women and their partners during labor and birth. Doulas and midwives often work together during a woman's labor. Check with your health insurance company to find out if they will cover the cost of a doula.
Managing the 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, and the strength of the contractions.
Natural Pain Relief During Labor
Many women choose to deliver their babies without using medicine for pain relief. Things women do to ease the pain include:
- use breathing and relaxation techniques
- take warm showers or baths
- receive massages
- have the supportive care or a loved one, nurse, or doula
- find comfortable positions while in labor (stand, crouch, sit, walk, etc)
- use a labor ball
- listen to music
- Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. Labor pain is caused by contractions of the uterus that are pushing your baby down and out of the birth canal.
- Take a childbirth class. Call the doctor, hospital or birthing center for childbirth class information.
- Get information from your doctor. Write down your questions and talk about them at your regular visits.
- Talk about your fears and emotions with friends, family and your partner.
More and more women in the United States are using water to find comfort during labor and delivery. In waterbirthing, a woman in labor gets into a tub of water that is between 90 and 100 degrees. Some women get out of the tub to give birth while others remain in the water for delivery. The water helps women feel warm and relaxed which helps to ease the pain of labor and delivery for many women. It is also easier for laboring women to move and find comfortable positions in the water.
Waterbirthing is relatively new in this country which means there is very little research on its benefits. However, many women say giving birth in the water is faster and easier. Waterbirthing may be gentler for your baby as it can ease the baby's transition from the womb to the new world. The baby is born into an environment that is similar to the womb it inhabited for 9 months. Make sure you discuss waterbirthing with your doctor or midwife to see if you are a good candidate for waterbirthing. Water birth is not safe for women or babies who have health issues or a woman in a higher risk pregnancy.
What to Expect – Labor and Delivery
Medical Pain Relief
While you're in labor, you will have the option for pain relief. There are many different kinds of pain relief available, but not all options are available at every hospital and birthing center. Your health history and any problems with your pregnancy will make some options better than others.
Types of pain relief used for labor and delivery include:
Intravenous or Intramuscular Analgesic
A doctor gives you the pain medicine through a tube inserted in a vein or by injecting the medicine into a muscle. These medicines go into your blood. This type of pain relief does not get rid of all the pain but it usually makes the pain bearable. After getting this kind of pain relief, you can still get an epidural later on. Some disadvantages of getting intravenous or intramuscular analgesics are that they make you feel sleepy and drowsy and can cause nausea and vomiting. They can also make you feel itchy. Another issue is that the medicines cross into the baby's bloodstream. They can affect the baby's breathing, heart rate and cause him/her to be very sleepy for a while after birth.
A doctor injects medicine into the lower part of your spine. The medicine blocks pain in the area of the body below the shot. Epidurals allow most women to be awake and alert with very little pain. Medicines used in epidurals include novocaine-like drugs that block the pain in that area combined with opiods like fentanyl. Some disadvantages of getting an epidural include shiveingr uncontrollably and they can lower your blood pressure. It can also make you feel very itchy. An epidural can cause headaches. An epidural also may not numb the entire painful area, which means women continue to feel pain in some parts of the abdomen and back.
A doctor injects a medicine into the lower part of your backbone. This medicine numbs the entire body below where the medicine was injected. Spinal anesthesia gives immediate pain relief so it is often used for women who need an emergency Cesarean section. Spinal anesthesia uses numbing medicines similar to novocaine combined with opiods like fentanyl. Some disadvantages of spinal anesthesia are that it numbs the body from the chest down to the feet. It makes you feel short of breath and can lower your blood pressure.
Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. However, the rate of babies born by cesarean section in the United States is on the rise. In 2004, 29.1 percent of babies were born by c-section in the U.S which is an increase of more than 40 percent since 1996. Many experts think that up to half of all c-sections are unnecessary. It is important for pregnant women to get the facts about c-sections before they deliver such as finding out what c-sections are, why they are performed, and the pros and cons of this surgery.
What is a Cesarean-Section?
During a c-section, the doctor makes a cut in the mother's abdomen and uterus and removes the baby surgicially. Most women get spinal or epidural anesthesia during a c-section which allows her to stay awake without feeling pain but in some cases general anesthesia is needed. With general anesthesia the woman is asleep during the entire procedure. A c-section can save the life of a baby or mothe by allowing the doctor to get the baby out very quickly. A cesarean section is major surgery and all surgeries have risks. This includes infection, dangerous bleeding, blood transfusions and blood clots. Women who have c-sections stay at the hospital for longer than women who have vaginal births and recovery time is longer and is often more painful than that after a vaginal birth. C-sections should only be done when the health or the mother of baby is in danger.
When is a Cesarean Section Recommended?
Doctors recommend c-sections when the health of the baby or mother is in danger. However, there are risks of delivering by c-setions. Limited studies show that the benefits of having a c-section may outweigh the risks when:
- the mother is carrying more than one baby (twins, triplets, etc.)
- the mother has health problems including HIV infection, herpes infection, and heart disease
- the mother has dangerously high blood pressure
- the mother has problems with the shape of her pelvis
- there are problems with the placenta.
- there are problems with the umbilical cord
- there are problems with the position of the baby (e.g. breech presentation)
- the baby shows signs of distress (e.g. slowed heart rate)
- the mother has had a previous c-section
Elective C-Sections: Can Women Choose?
A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth while some others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems. Is it safe and ethical for doctors to allow women to make medical decisions? The answer is unclear and further research on both types of deliveries will provide the answer. Many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.
Experts who believe c-sections should only be performed for medical reasons point to the risks. C-sections can be dangerous for the mother and baby because it is major surgery which increases the risk of infection, bleeding and pain in the mother. C-sections also increase the risk of problems in future pregnancies and c-sections cause a higher risk of uterine rupture. If the uterus ruptures, the the baby's and mother's lives are in danger. Babies born by c-section have more breathing problems right after birth and are very rarely cut during the surgery.
Those who support elective cesarean sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery.
Vaginal Birth after a Cesarean Section (VBAC)
Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women have various reasons for wanting a vaginal delivery after c-section. Some want to avoid the risks and long recovery of surgery while others want to experience a vaginal delivery.
Studies show that vaginal delivery after c-sections are more risky for the woman and baby than a repeat c-section. The most serious danger of vaginal delivery after c-sections is the chance that the c-section scar on the uterus will open up during labor and delivery, or uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Uterine rupture can lead to life-threatening bleeding for the mother and brain damage or even death for the baby.
The biggest and best study on vaginal delivery after c-section was published in the New England Journal of Medicine in 2004. The researchers studied more than 30,000 women who had had a c-section and were pregnant again. Some of these women chose to have a vaginal birth after c-section while others decided on a repeat c-section. The doctors compared the health of the women and babies after both types of delivery. Almost three-quarters (73%) of women had a successful vaginal delivery after c-section. The other 27% of women who tried to deliver vaginally ended up having another c-section. While rare, problems with the woman and baby were more common among vaginal delivery after c-sections compared with repeat c-sections. Only 0.8 % of women had a uterine rupture. Women who tried vaginal delivery after c-sections had more blood transfusions and a greater risk of endometriosis than those who had repeat c-sections. Babies born by vaginal delivery after c-section had a higher risk of brain damage than those born by repeat c-section.
The percentage of vaginal delivery after c-sections is dropping in the United States for many reasons. There are worries about the rare, yet possible problems of vaginal delivery after c-sections. A growing number of doctors and hospitals are not allowing vaginal delivery after c-sections because they are afraid of lawsuits that might follow vaginal delivery after c-sections that go wrong. In 2004 the American College of Obstetricians and Gynecologists recommended that hospitals have a surgical team standing by whenever a woman is having a vaginal delivery after c-section .
Doctors are also discouraging or flat out refusing to perform vaginal delivery after c-sections. Sometimes this is because their affiliated hospital does not allow them. In other cases, doctors can not get malpractice insurance to cover claims related to vaginal delivery after c-sections. And some doctors admit they are afraid of getting sued if a vaginal delivery after c-section goes wrong. Choosing to try a vaginal delivery after c-section is a difficult decision for many women. If you are interested in a vaginal birth after a c-section, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. Both vaginal birth after cesarean and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your decision.
The American College of Obstetricians and Gynecologists (ACOG) recommends that doctors consider vaginal delivery after c-section when:
- a woman has had 1 previous planned c-sections done with a low, horizontal cut or incision (“bikini” incision)
- a woman has no other uterine scars (aside from the prior c-section) or problems
- a woman has no known problems with her pelvis
- a doctor is present during all of labor and delivery and can perform an emergency c-section if needed
- an anesthesiologist and other members of a surgical team are standing by in case an emergency c-section is needed