Labor and Delivery
The day you’ve been preparing for and anticipating for the last nine months has finally arrived. While every woman’s experience with labor and delivery is different, and even each birth experience for the same woman is different, there are many things that you can expect to happen during your labor and delivery.
There are three stages of labor in a routine vaginal birth, which is the most common and generally the safest delivery option.
Stage 1, the longest stage, can last hours or even days. Stage 1 is divided into three phases:
During the latent, or first phase of labor, you can expect:
- Contractions will be mild and 15 to 20 minutes apart at the beginning. They will become more frequent, less than five minutes apart, as this phase progresses.
- Your cervix will dilate to approximately 3 or 4 centimeters and efface, or thin.
- You’ll likely be at home, but expect to be admitted to the hospital toward the end of this phase. Talk to your WellStar obstetrician about when to plan to go to the Birthing Center.
During the active, or second phase of stage 1 labor you can expect:
- Your cervix to dilate from 5 to 8 centimeters
- Contractions to get stronger and closer together, to about three minutes apart
- To experience backache and increased vaginal bleeding
During the transition, or third phase of stage 1 labor you can expect:
- Your cervix to dilate from 8 to 10 centimeters
- Contractions will be very strong and 2 to 3 minutes apart
- To feel pressure on your rectum
- Your backache to worsen and bleeding to become heavier
Stage 2 labor begins when your cervix is fully dilated at 10 centimeters and continues until the birth of your baby. You can expect to:
- Experience Stage 2 anywhere from a few minutes to several hours. It often lasts longer for first-time mothers and women who have an epidural.
- Feel a strong urge to push during contractions to speed up the process
- Receive pain-relieving medications if necessary
- Have, if necessary, an episiotomy, a procedure in which a small incision is made between the anus and vagina to enlarge the vaginal opening to assist the baby’s birth or to prevent large, irregular tears
- Have your WellStar physician suction amniotic fluid, blood and mucus from your baby’s airway as soon as the head is delivered
- Continue to push to deliver the baby's shoulders and body
- Have your physician place your baby on your stomach and cut the umbilical cord shortly after delivery
Stage 3, the final stage, begins after your baby is born and can last up to about 20 minutes. During this stage you can expect to:
- Feel a great sense of relief. Enjoy these first moments with your baby
- Deliver the placenta or afterbirth, which involves mild contractions
- Have your episiotomy stitched, if you had one
Although vaginal delivery is the most common and safest option, sometimes a cesarean, or C-section, is necessary for your safety or your baby’s. A C-section is a surgical procedure involving an incision in your abdomen and uterus to deliver your baby.
Some C-sections are planned due to pregnancy complications or if you've had a previous C-section, but in many cases, the need for a C-section doesn't become obvious until labor has started. Complications leading to C-section can include:
- The most common reason for a C-section is that your labor is not progressing. Perhaps because your cervix isn't dilating or your baby's head is too big.
- Your baby isn’t getting enough oxygen, which can create the need for a prompt C-section
- Your baby’s feet or buttocks have entered the birth canal first, called a breech position, or your baby is horizontal in your uterus. Head first is the normal vaginal delivery position
- Multiple births, which often means one or more of the babies is not positioned properly for a vaginal delivery
- The placenta detaching from your uterus before the start of labor, known as placental abruption, or the placenta covering the opening of your cervix, known as placenta previa
- A loop of umbilical cord slipping through your cervix ahead of your baby, or the cord is compressed during contractions
- Your health conditions such as diabetes, heart disease or lung disease
If you’ve had complications with your pregnancy or a previous C-section and have a scheduled C-section, you’ll want to make plans before the delivery date. While C-sections have become fairly routine, they are still abdominal surgery. Things to consider ahead of surgery include:
- A discussion with your WellStar physician about: possible complications, and pain relief options during the surgery and recovery
- The 4-6 weeks you’ll need to recover from a C-section. Think about what kind of help you may need during this time, including childcare, if you have older children at home.
During the procedure, you can expect:
- A C-section to last 45 minutes to an hour
- Your spouse or partner to be allowed to stay with you in the operating room
- A catheter to collect your urine
- IV tubes in your hand or arm for fluid and medication
- A spinal block or epidural, which will numb only the lower part of your body, leaving you awake for the baby’s delivery
- Your WellStar obstetrician to make a horizontal incision through your abdominal wall near the pubic hairline
- Your physician to gently lift your baby from your uterus, clear your baby's airways of fluid, cut the umbilical cord, remove the placenta from your uterus and stitch the incisions
- Your baby to stay in the room with you and to go with you to the recovery room
Vaginal Birth After Cesarean (VBAC):
If you have had a C-section previously, you may still be able to deliver a baby vaginally, a delivery option called vaginal birth after cesarean (VBAC). If you and your WellStar obstetrician agree that you can try a VBAC, you will go through a trial of labor, meaning you will plan to labor and deliver vaginally. But, you need to know going in that you still may require a C-section.
You and your physician may consider a VBAC if:
- You have had only one C-section
- You have one low, horizontal C-section scar
- You have had two previous C-sections, but have also had a subsequent vaginal delivery
- You don't have a medical reason for a C-section with this pregnancy
Benefits of a VBAC include:
- Avoiding another scar on your uterus, which can mean a greater chance of problems with a later pregnancy
- Reduced pain following delivery
- Fewer days in the hospital
- Shorter recovery time at home
- Lower risk of infection and blood loss
- More active roles for you and your partner in the birth of your child
Risks of VBAC include:
- A previous C-section scar could open during labor, and increase risks of harm to you and your baby
- Higher risk of infection for an emergency C-section than if you had a scheduled C-section
- Need for emergency C-section
When preparing for a VBAC you may want to:
- Take a childbirth class on VBAC
- Discuss your concerns and expectations, including the expectation that your physician will be available throughout your labor, with your WellStar obstetrician
- Allow labor to begin naturally. Drugs that induce labor can make contractions stronger and more frequent, which may contribute to the risk of uterine rupture.
- Be prepared for a C-section if some complication makes it medically necessary
As labor begins, you can expect to:
- Report to the hospital as soon as your water breaks or you begin having contractions. Laboring at home when you have a C-section scar isn't recommended.
- Be able to choose pain medication if you’d like
- Have your medical team monitor your baby's heart rate. A fetal monitor may be attached to your baby's scalp.
- Have a C-section if your labor doesn’t progress well or your baby doesn't tolerate labor
Pain Relief Options
The pain each woman experiences with each pregnancy is different. For some, the pain is manageable with focused breathing, while other women want the pain controlled with medication. Be sure to discuss your pain relief options and preferences with your WellStar physician before labor begins, though circumstances during labor and delivery may dictate pain relief choices. There are several proven options for pain relief.
Regional anesthesia, also called an epidural or spinal, is injected into your lower back to block pain in your lower body while you stay awake. Regional anesthesia is the most common form of pain relief during labor and delivery:
- An epidural can be used during vaginal delivery or a cesarean birth, if necessary.
- An epidural provides relief 10 to 20 minutes after injection.
- Spinal anesthesia begins providing relief immediately.
- Regional anesthesia provides pain relief but you may still feel pressure from contractions and during exams.
- Regional anesthesia has been proven safe for you and your baby.
Local anesthesia may be used to numb the vaginal area if stitches are necessary. Local anesthetics do not reduce the pain or discomfort of labor.
General anesthesia may be used for emergency C-sections when there is not enough time to perform an epidural or spinal anesthesia.
- Have a car seat ready for your baby’s trip home from the hospital.
- Pack your bag for the hospital with items you and your baby will need.