WomensHealth.gov: "Stages of Labor.", Mayo Clinic: "Stages of labor and birth: Baby, it's time!", Cleveland Clinic: "Cesarean Birth (C-Section)."
After months of anticipation, your baby's due date is near. Here's what you can expect from the start of labor until the first days and weeks with your new baby.
Signs of Labor
No one can predict with certainty when labor will begin -- the due date your doctor gives you is merely a point of reference. It is normal for labor to start as early as three weeks before that date or as late as two weeks after it. The following are signs that labor is probably not far away:
- Lightening. This occurs when your baby's head drops down into your pelvis in preparation for delivery. Your belly may look lower and you may find it easier to breathe as your baby no longer crowds your lungs. You may also feel an increased need to urinate, because your baby is pressing on your bladder. This can occur a few weeks to a few hours from the onset of labor.
- Bloody show. A blood-tinged or brownish discharge from your cervix is the released mucus plug that has sealed off the womb from infection. This can occur days before or at the onset of labor.
- Diarrhea . Frequent loose stools may mean labor is imminent.
- Ruptured membranes. Fluid gushing or leaking from the vagina means the membranes of the amniotic sac that surrounded and protected your baby have ruptured. This can occur hours before labor starts or during labor. Most women go into labor within 24 hours. If labor does not occur naturally during this time frame, doctors may induce labor to prevent infections and delivery complications.
- Contractions . Although it's not unusual to experience periodic, irregular contractions (uterine muscle spasms) as your labor nears, contractions that occur at intervals of less than 10 minutes are usually an indication that labor has begun.
Stages of Labor
Labor is typically divided into three stages:
Stage 1. The first stage of labor is divided into three phases: latent, active, and transition.
The first, the latent phase, is the longest and least intense. During this phase, contractions become more frequent, helping your cervix to dilate so your baby can pass through the birth canal. Discomfort at this stage is still minimal. During this phase, your cervix will begin to dilate and efface, or thin out. If your contractions are regular, you will probably be admitted to the hospital during this stage and have frequent pelvic exams to determine how much the cervix is dilated.
During the active phase, the cervix begins to dilate more rapidly. You may feel intense pain or pressure in your back or abdomen during each contraction. You may also feel the urge to push or bear down, but your doctor will ask you to wait until your cervix is completely open.
During transition, the cervix fully dilates to 10 centimeters. Contractions are very strong, painful, and frequent, coming every three to four minutes and lasting from 60 to 90 seconds.
Stage 2. Stage 2 begins when the cervix is completely opened. At this point, your doctor will give you the OK to push. Your pushing, along with the force of your contractions, will propel your baby through the birth canal. The fontanels (soft spots) on your baby's head allow it to fit through the narrow canal.
Your baby's head crowns when the widest part of it reaches the vaginal opening. As soon as your baby's head comes out, your doctor will suction amniotic fluid, blood, and mucus from his or her nose and mouth. You will continue to push to help deliver the baby's shoulders and body.
Once your baby is delivered, your doctor -- or your partner, if he has requested to do so -- clamps and cuts the umbilical cord.
Stage 3. After your baby is delivered, you enter the final stage of labor. In this stage, you deliver the placenta, the organ that nourished your baby inside the womb.
Each woman and each labor is different. The amount of time spent in each stage of delivery will vary. If this is your first pregnancy, labor and delivery usually lasts about 12 to 14 hours. The process is usually shorter for subsequent pregnancies.
Just as the amount of time in labor varies, the amount of pain women experience is different, too.
The position and size of your baby and strength of your contractions can influence pain, as well. Although some women can manage their pain with breathing and relaxation techniques learned in childbirth classes, others will need other methods to control their pain.
Some of the more commonly used pain-relief methods include:
Medications . Several drugs are used to help ease the pain of labor and delivery. Although these drugs are generally safe for the mother and baby, as with any drugs, they have the potential for side effects.
Pain-relieving drugs fall into two categories: analgesics and anesthetics.
Analgesics relieve pain without the total loss of feeling or muscle movement. During labor, they may be given systemically by injection into a muscle or vein or regionally by injection into the lower back to numb your lower body. A single injection into the spinal fluid that relieves pain quickly is referred to as a spinal block. An epidural block continuously administers pain medication to the area around your spinal cord and spinal nerves through a catheter inserted into the epidural space. Possible risks of both include decreased blood pressure, which can slow the baby's heart rate, and headache.
Anesthetics block all feeling, including pain. They also block muscle movement. General anesthetics cause you to lose consciousness. If you have a cesarean delivery, you may be given general, spinal, or epidural anesthesia. The appropriate form of anesthesia will depend on your health, your baby's health, and the medical conditions surrounding your delivery.
Non-Drug Options. Non-drug methods for relieving pain include acupuncture, hypnosis, relaxation techniques, and changing position frequently during labor. Even if you choose non-drug pain relief, you can still ask for pain medications at any point during your delivery.
What to Expect After Delivery
Just as your body went through many changes before birth, it will go through transitions as you recover from childbirth.
Physically you may experience the following:
- Pain at the site of the episiotomy or laceration. An episiotomy is a cut made by your doctor in the perineum (the area between the vagina and the anus) to help deliver the baby or prevent tearing. If this was done, or the area was torn during birth, the stitches may make walking or sitting difficult. It also can be painful when you cough or sneeze during the healing time.
- Sore breasts. Your breasts may be swollen, hard, and painful for several days as your milk comes in. Your nipples may also be sore.
- Hemorrhoids . Hemorrhoids (swollen varicose veins in the anal area) are common after pregnancy and delivery.
- Constipation . Having a bowel movement may be difficult for a few days after delivery. Hemorrhoids, episiotomies, and sore muscles can cause pain with bowel movements.
- Hot and cold flashes. Your body's adjustment to changing levels of hormones and blood flow can cause you to perspire one minute and reach for a blanket to cover yourself the next.
- Urinary or fecal incontinence. Muscles stretched during delivery, particularly after a long labor, may cause you to leak urine when you laugh or sneeze or may make it difficult to control bowel movements,causing accidental bowel leakage.
- "After pains." After giving birth, you will continue to experience contractions for a few days as your uterus returns to its pre-pregnancy size. You may notice contractions most while your baby is nursing.
- Vaginal discharge (lochia). Immediately following birth you will experience a bloody discharge heavier than a regular period. Over time, the discharge will fade to white or yellow and then stop entirely within two months.
Emotionally you may experience irritability, sadness, or crying, commonly referred to as the "baby blues," in the days or weeks after delivery. These symptoms occur in up to 80% of new mothers and may be related to physical changes (including hormone changes and exhaustion) and your emotional adjustment to the responsibilities of caring for a newborn.
If these problems persist, inform your doctor or other health professional; you could be experiencing postpartum depression, a more serious problem that affects between 10% and 25% of new mothers.