Your uterus now has a peak blood flow of about one-half liter flowing through it every minute, preparing you and your baby for the physical trauma of birth. The increased blood volume and clotting abilities protect you from losing too much blood, and the increased blood flow allows both you and your baby to get the necessary amount of oxygen during contractions. The muscle cells in your uterus have increased in size and number, and every muscle fiber is enhanced so that muscle contractions can occur more consistently.
You may lose the plug of mucus that has tightly sealed the inside of your uterus from the vagina. This mucus plug looks like a big glob of slime and is usually brownish in color. Most women notice it on toilet paper or in their panties. This does not necessarily mean you will begin labor immediately; it is just one of the stepping stones. When labor is about to begin, women will often notice a small amount of bright red bleeding that may require wearing a panty liner.
About 15 percent of women will start the labor process with their water breaking. This is the amniotic sac leaking fluid. When this occurs, you may notice either a large gush of fluid or a small trickle of fluid. Sometimes, the only thing a woman notices is that their panties are wet. Amniotic fluid should not have a foul odor and should be clear. If your water breaks, it may catch you a little off guard. Notice what color the fluid is and if it has an odor. Call your care provider immediately, describe the amount of fluid and its characteristics. Your care provider may have you come to the hospital at this point.
Pay close attention to your baby's activity. Their movements may be a little different in the confined uterus, but they should still be present. If they seem to be decreased, or if you don't recall feeling the baby move, eat and drink something, lie down on your side, and begin counting movements for an hour. You may stop at ten movements. If the baby does not move ten times during that hour, call your care provider.
Amniotic fluid that has a foul odor or is yellow or green indicates infection or the presence of meconium, or ''little baby poop." This will require close evaluation of the baby during labor and thorough attention to protecting the baby from breathing the amniotic fluid into the lungs during the birth.
Contractions will begin slowly with the hardening or balling up of your uterus. You can feel the strength of the contractions by placing your hand on the top of your belly. The pain will come from the back, down around to the front of your belly, and just above the pubic bone.
If your water does not break but your contractions begin to come more frequently over a few hours, it may be a good idea to call your care provider and describe what's happening. At this point, if it is during office hours, your care provider may have you come in to check your cervix for dilation. If contractions begin after office hours, you may be asked to go to the hospital and have a doctor or a nurse check your cervix. They will also check your blood pressure, pulse, respiration, and temperature. Usually, you will be asked to lie down so that they can evaluate the baby's heart rate and your contractions with a fetal monitor, which gives a constant reading of the baby's heart rate.
The people caring for you in the hospital will evaluate the readout of the baby's heart rate pattern, as these patterns can provide some indication of how the baby is doing at a given point. The fetal monitor cannot tell everything, but it can tell how your baby is tolerating labor, how the placenta is working well, and if the umbilical cord is getting pressed. If there has been no change in your cervix, they will probably have you walk around for a couple of hours and then recheck your cervix. If there still has been no change, they may even send you home for a while. Don't get discouraged if this happens -- many women make several trips to the hospital before the real thing; the excitement of going into the hospital stops the contractions, or getting to the hospital and rehydrating with fluids stops them. Labor is an "all or nothing" game. All the pieces need to be in place before it will actually happen.
A Few Words About Inducing Labor
The process of inducing labor involves stimulating the cervix to soften and dilate and the uterus to contract. Many high-risk pregnancies must be induced for the safety of the mother or baby, and many women ask to have their labor induced around thirty-eight weeks, primarily because they are too big, too tired, and too stressed about waiting for something to happen. This is not an acceptable reason for induction. Medical reasons, such as high blood pressure or diabetes, or if you are past your due date, are reasons for induction of labor.
If your cervix is not soft, thin or open enough, a prostaglandin preparation may be placed into your vagina or a small balloon inserted into your cervix. These will initiate the breakdown of the collagen that is keeping your cervix tightly closed. You will need to have an intravenous catheter, better known as an IV, in your hand or forearm. When your cervix is soft, thinning, and starting to open, an IV preparation containing the hormone oxytocin (Pitocin is the brand name) will be started. As the levels of oxytocin rise, your contractions will begin to increase. Your nurse will continue to increase the amount of oxytocin until your contractions are strong, are two to three minutes apart, and last about sixty seconds. This combination will help dilate your cervix. Patience, perseverance, and pleasant thoughts will be a blessing right now.
Labor is divided into three stages. The first stage begins with the onset of contractions and the dilation of your cervix and ends with complete cervical dilation. This stage is further broken down into latent phase and active phase. In early labor, your contractions are regular, but still quite far apart. Cervical dilation in latent labor is from 0 to 6 centimeters and the dilation is gradual. During the active phase of labor, your cervix will dilate more rapidly. The second stage of labor is the pushing stage where you push through to the birth of your baby.The third stage of labor is the delivery of the placenta.
In early labor, you probably won't need to breathe through your contractions in a focused way. However, you may want to try some relaxation breathing techniques before the pain becomes too strong. Begin and end every contraction with a deep, cleansing breath. When you breathe during a contraction, try using your belly muscles. Practice by putting your hand on your belly and letting it rise and fall with your breaths. This forces the muscles that instinctively tense with a contraction to relax. Some women find this method of breathing helpful throughout their entire labor. You may want to establish a visualization meditation during your contractions.
- Begin with a deep cleansing breath.
- Close your eyes.
- Relax every part of your body: head and neck, shoulders, arms, hands, fingers, chest, back, belly, hips, bottom, legs, feet, and toes.
- Picture a place in your mind where you feel warm and safe (this may be in your home, a place where you went as a child, or a warm sandy beach on an island with the breeze blowing and the rhythmic sound of the water in the background). Formulate the details in your mind, so that when a contraction gets closer, you can call on this image and have all the details in place.
- Slowly breathe with your contraction.
- When the contraction ends, take a deep cleansing breath and return to reality.
- Open your eyes.
As your labor progresses and your cervix opens, you may find your contractions are stronger and longer lasting. They may also occur more frequently. You may notice that the bloody mucous plug from your cervix and your membranes eventually break. Focused breathing will make a tremendous difference in your ability to deal with contractions. If you feel that you would like medication or an epidural, be sure to communicate your wishes to your nurses and care providers. It is everyone's goal to help you get through this labor, and medication or an epidural may actually help your labor. Listen to your body, and it will tell you what it needs in the way of breathing, pain relief, and rest.
The pressure of the contraction inside the uterus increases 100 percent during the active phase of labor. When you are sitting up, rocking, walking, squatting, or kneeling, your abdominal wall relaxes and allows the top of your uterus to fall forward. This directs the baby's head toward your cervix, increasing pressure, allowing it to stretch, and reducing the length of labor. Lying on your side is a good position when laboring as your heart is more efficient, your uterus gets more blood flow to it, and your baby gets more oxygen. Positions that reduce the length of labor but allow the contractions to be most efficient are best for the baby.
Towards the end of the active phase you may feel nauseated, cold, shaky, restless, discouraged, and scared. You The uterus is working extremely hard, and it is very difficult to relax. You will notice an increase in bleeding from your vagina and an almost unbearable pressure in your rectum. You may find that you want to stop breathing during your contraction and grunt or bear down as with a bowel movement. Let your nurse know what you are feeling. Try to stay focused and keep breathing. Only think of one contraction at a time; each contraction is one less than you will ever feel again. If you feel the urge to bear down and push, try blowing quick breaths as if you are blowing out a candle.
When your cervix is completely dilated, your care provider will tell you to go ahead and push. Rest between the contractions, but when the contraction begins, take a couple of deep, cleansing breaths. Try to keep your face relaxed and your eyes open during pushing. All energy should be focused on your bottom. A wrinkled face, eyes squeezed tightly shut, a mouth losing air through screams all take precious energy that needs to be used to push out your baby. Babies are under much stress at this point, so it isn't a good idea to prolong the pushing phase.
As the contraction grows in strength, take a breath and hold it. Now, while holding your breath, bear down straight into your bottom with all of your might. Hold that push long and strong. It may be helpful to count to ten in your head if possible. Quickly grab more air, hold it, and bear down again, long and strong. Try to repeat this one more time during your contraction. Now let this contraction go, letting your whole body sink into the bed. Take a deep cleansing breath. You may want to have an ice chip and rest, even sleep, between contractions. As your baby's head is crowning, bulging on your perineum, you may want to reach down and touch your baby's head for the first time. If a mirror is available, it may be motivational for you to see your baby's head and even watch it move as you push.
As the skin and muscle around your vaginal opening does not stretch enough to allow the baby's head to come out, your care provider may make the opening larger by cutting an episiotomy. This small incision and any tears that occur are repaired with stitches after the birth of your baby, and they generally heal quickly.
After the baby's head is out, listen to the directions of your care provider who will coach you through the delivery of your baby’s shoulders and body. With your final push, open your eyes and see your baby enter this world. If the baby is doing well, the obstetrician may wait about 60 seconds before clamping the baby’s cord. If doing well, the baby can be placed on your abdomen for skin-to-skin contact. You may choose to hold or nurse the baby or let the specialized nursery staff look over the baby.
Many babies of high-risk mothers need to be in the neonatal intensive care nursery. You will be unable to accompany your baby to the intensive care nursery immediately after delivery; therefore, you may want your partner or another family member to stay by your baby's side and ask questions.
The remainder of your recovery and postpartum period will be similar to that of a mother who gave birth to a full-term infant that did not need the intensive care nursery. The biggest difference is being separated from your newborn for a short time.
A Few Thoughts on Cesarean Birth
For many mothers, surgical delivery is necessary. This is most commonly referred to as a cesarean section (C-section) delivery, where the baby is delivered through an incision made in the lower part of your abdomen and uterus. This, of course, is done under anesthesia so that you do not feel any pain, although some women may sense pressure as the surgeons remove the baby.
If a cesarean birth was necessary, your recovery will be a little different from a mother who gave birth vaginally:
- You may have a catheter in your bladder for several hours after surgery.
- You will be encouraged to change positions frequently, take deep breaths, and cough to help keep your lungs clear of fluid. The nurses will show you how to position a pillow over your incision for support and to decrease discomfort. This is important because moms who require a surgical delivery need to be able to take deeper breaths to help prevent any fluid build up in their lungs.
- Your doctor will let you know when you can eat. Depending on your situation, you may be able to eat soon after your cesarean section.
Do not let this surgery keep you from mothering your baby. If your baby is in the intensive care nursery, have instant snapshots taped to your bed. Talk with nursery personnel frequently for updates on your baby's condition. If you are stable, you should be able to visit the nursery very soon. You may need some extra help, but plan to hold, feed, and care for your baby.
- At what point do you recommend that I come to the hospital/birth center?
- How soon after I come to the hospital will my health care provider see me?
- How much time will the health care provider spend with me during labor?
- If I write a birth plan, will it be honored?
- How often are vaginal exams performed during labor?
- Are showering and bathing allowed during labor?
- Does this birth center/hospital allow water births? What facilities are available for water births?
- How many people are allowed to be with me during labor and delivery? How many people are allowed to be with me during a cesarean delivery?
- What is the birth center's or hospital's policy regarding other children attending the birth?
- Are eating and drinking allowed during labor?
- What laboring positions are recommended?
- Is videotaping allowed?
- Can my partner cut the umbilical cord?
- How long will I be able to stay in the hospital? Can I leave earlier if I want to?
- How long does the baby need to remain in the hospital after delivery?
Here are some questions pregnant women need to consider before the going into labor:
- Is there someone available who can take you to the hospital at any time?
- How will you get in touch with that person? (Note: many hospitals and birthing centers offer a pager service that allows you to rent a pager for a few months).
- Do you have your route to the hospital planned and an alternate route if needed?
- Who will care for your children when it is time to go to the hospital?
- If you work outside the home, have you discussed your maternity leave with your supervisor?