Pregnancy and Giving Birth

Labor and delivery mark the beginning of your baby's life and your new life as a parent. The onset of labor can understandably make you anxious. But, with proper preparation and planning, giving birth to your child can be what it should be -- one of the most magnificent moments of your life. To make it go as smoothly as possible, learn as much as you can about the process. Read, talk to others (including your doctor), take childbirth classes and practice the techniques you learn. You should talk about and learn techniques to deal with the pain of labor and delivery, such as focused breathing, distraction, massage, relaxation, visualization and hypnosis.

While every woman's labor is unique, labor usually follows one or more of the following signs:

• Mucous plug detaches: This blood-tinged mucous discharge occurs when the mucous plug that has sealed the cervix during your pregnancy is disengaged as the weight of the fetus pushes against the cervix and the cervix opens. Labor usually occurs within a day or two, but some women don't notice the passage of the mucous plug.

• Water sac breaks: Either as a trickle or a gush, the amniotic fluid that bathes the fetus during pregnancy escapes from the membranes of the amniotic sac. The water breaks either before labor begins or during its first stage. If the water breaks but labor does not begin, or if the amniotic fluid is dark (because the fetus has had its first bowel movement in the uterus), your doctor might want to induce labor. Call your doctor immediately.

• Contractions begin: Contractions spaced by regular intervals that progressively get stronger indicate labor has begun. Some women feel labor contractions in their lower back, while others feel pain in the lower abdomen. Braxton-Hicks contractions, which are common during the last 12 weeks of pregnancy, are not strong or regular, and don't signal the beginning of labor. You also might be experiencing false labor if the contractions do not get stronger when you get up and walk, or if the pain is in the lower part of your belly. When you experience contractions, write down the time at the beginning of each contraction. If they start to occur consistently every 10 minutes, labor usually has begun. At this time, you might have slight cramping in your lower abdomen or anus, as well as diarrhea and some nausea.

Contractions that occur every three to four minutes and last for 40 to 60 seconds indicate that "active labor" is under way. The only way to be sure you're in labor is to verify that your cervix has begun to dilate and thin out. Your doctor or midwife can determine that in his or her office or in the hospital or birthing center, wherever you are told to go. If your bag of water hasn't ruptured by the time your cervix is dilated 3 to 5 centimeters, your doctor or midwife might rupture it manually.

As your cervix begins to near 10 centimeters, your uterus will be contracting strongly. This "transition phase" is the most physically and emotionally taxing period of labor. Emotionally, you could be exhilarated or exhausted. The baby will be moving into your vagina, and you might feel a strong urge to push. But you have to hold back until you are fully dilated.

When your cervix is fully dilated, you have entered the "second stage" of labor. You'll be asked to push every time you feel a contraction. You might feel more clearheaded and physically revived at this time. Your doctor will tell you when to push and when not to push. Short breaths can help you resist the urge to push. After a few minutes or several hours of pushing, you will deliver your baby. If the area between your vagina and anus doesn't stretch enough prior to the delivery, you might need an episiotomy -- an incision in that area that widens the vaginal opening.

Afterward, continuing uterine contractions will separate the placenta from your uterine wall and expel it. If that doesn't occur within 30 minutes, your doctor might remove it manually.

What to Do

Be alert for any signs of the beginning of labor. Read, and talk to your doctor beforehand about what you can expect throughout the entire labor and delivery process. When signs of true labor do appear, call your doctor or midwife. It's better to call about what turns out to be a false alarm than to wait until the last minute to be rushed to the hospital to give birth.

Use Medicine Effectively

In talking with your doctor or midwife, you should familiarize yourself with pain relief medication options that might be available to you. These include analgesic painkillers, local anesthetics and epidural blocks.

Self-care Steps for Giving Birth

• Make the necessary plans well ahead of time. These include packing an overnight bag for yourself and deciding how you will get to the hospital, who to call (doctor and close relatives) and, if you have older children, who will take care of them.

• Talk ahead of time with your doctor or midwife about when you should call them if you think you are in labor.

• Know the signs of labor and false labor. Don't be fooled by Braxton-Hicks contractions, which are common during the last 12 weeks of pregnancy. These contractions are not strong or regular, and don't signal the beginning of labor.

• When you experience contractions, write down the time at the beginning of each contraction. If they start to occur consistently every 10 minutes, labor usually has begun.

During the early stages of labor, before your doctor or midwife advises you to go the hospital or birthing center:

• Walk around or lie down: whichever makes you feel better.

• Try to relax and reserve your strength for the active labor.

• Use breathing exercises during your contractions, and try focused relaxation techniques in between your contractions.

Also:

• If you haven't done so already, call your doctor or midwife when your contractions begin to occur every three to four minutes and last for 40 to 60 seconds.

• Once "active labor" begins, follow your doctor's instructions on when to push and when not to push; short breaths can help you resist the urge to push.