Labor and Birth

This page is intended to be a big picture overview of labor and birth – there are links to more details in each section.

Signs that Labor May Begin Soon / Has Begun.

Possible Signs that labor may begin in the next few days or weeks.

  • Irritable Backache
  • Cramps
  • Nesting Urge
  • Diarrhea. Flu-like symptoms.

Preliminary Signs that labor may be about to begin.

  • Bloody show, or increased vaginal discharge.
  • Trickle of fluid from vagina.
  • Increased Braxton-Hicks Contractions
    • Mostly felt in the belly, may be uncomfortable but not painful
    • Contractions may stop if you walk, change activity, eat, drink, or pee.
    • Pre-labor contractions don’t progress: they stay the same length, strength, and frequency. Usually irregular.

Positive Signs that Labor has begun.

  • Gush of amniotic fluid from vagina.
  • Progressing contractions: Getting longer, stronger, and/or closer together. Usually described as ‘very strong’ or ‘painful’, felt in the belly, back, or both.  Usually increase if you walk.
  • Dilation of cervix seen in vaginal exam.

Learn more about signs of labor here.

Early Labor

Contractions are 5 – 30 minutes apart. They last 30 – 45 seconds. Early labor can last 2 hours to 24 hours or more. There is usually no need to go to the hospital in early labor.

At first, if contractions are mild, the laboring mother may not need to do anything special to cope. Rest if you can. If not, distract yourselves from labor: watch a movie, go for a walk, go shopping, or work on a project. Eat, drink, and go to the bathroom once an hour.

When contractions get hard enough that she can’t ignore them, start using comfort techniques. Take a deep cleansing breath at the start and end of every contraction, and breathe deeply through the contraction. Try visualizing a relaxing scene. Try massage or a warm shower. Instead of laying in bed, try walking, slow dancing, or a rocking chair.

The partner’s main role is to help mom feel relaxed, safe, and loved. When we feel loved and loving, safe and nurtured, the hormone oxytocin flows, and this helps the uterus to contract, and the cervix to dilate. It also produces endorphins which reduce pain.

Learn more about early labor.

Active Labor

What’s Happening: Cervix completely effaced, dilates from 6-8 cm. Contractions 3-4 minutes apart, 40-70 seconds long, more painful. Active labor may last 30 minutes to 8 hours.

Change in Mom’s mood: During contractions, mom is not able to walk or talk, and is focused on contraction. In between, mom wants to focus on labor, and does not want to be distracted.

When to go to the hospital: Contractions are no more than four minutes apart, lasting one minute, with that pattern established for at least one hour, and mom’s mood has changed.

Where you’ll be / Who will be there: At hospital (or planned birth place). Nurse, or midwife, will check on you frequently throughout labor. Doula and support people are there continuously.

Breathing Techniques: Deep abdominal breathing for as much of the contraction as is comfortable. Over the peak of the contraction, use hee-hee breathing or hee-hee-blow.

Positions. Upright. Be active, in ways that change and shift the shape of your pelvis (like swaying, walking, climbing stairs, hula dance or belly dance motions.) It’s easier for your baby to rotate and descend if you’re moving. Almost all women like to lean forward during labor: this helps take the weight of baby off of your back. See diagrams here.

Comfort Techniques for Active Labor: Warm bath. Touch: Massage, Effleurage (light stroking on belly), Counterpressure for back pain (support person places the palm of his hand on her lower back and provides firm pressure during contractions), Double Hip Squeeze. Hot/Cold: Heating Pads on back or belly, Ice Packs, cool cloths on her forehead and back of neck. Making noise: Singing, Moaning. Sensory Distraction: Music, Aromatherapy, Pictures. Relaxation Techniques: Touch Relaxation, Visualization, Encouragement and Support. Learn more here.

What should support people do? Remind mom to drink after each contraction, and go to the bathroom once an hour. Help with Comfort Techniques. Establish Rituals by doing the same thing on each contraction, for as long as that works, then switching to new ritual. Let her rest when she needs to, but remind her that being physically active can help labor progress.

Difficult Labor

Signs: Some women have especially difficult labors – this often means there’s an issue with baby’s position. The most common sign is back pain: during contractions mom has a lot of pain in her lower back. Another sign is contractions that “couple”: there will be two or three contractions very close together, then a long pause with no contractions, then two or three in a row. Another is that your labor is very painful, but the cervix is slow to dilate.

Why is it a problem: It can mean that baby is posterior or otherwise not lined up well with the cervix and birth canal. With posterior babies, labor is more painful, it takes much longer to dilate to 10 cm, and pushing is slower and more difficult.

What can support people do: Positions: Have mom lean forward as much as possible. Have mom get on her hands and knees and do pelvic tilt exercises. Or mom gets in the “open knee chest” position (*see picture on the right above), and sways her hips back and forth during contractions. Alternate between pelvic tilts and open knee chest for 25-30 minutes. When mom returns to a more upright position, often the baby will move into a better position, and the signs of back labor will fade. Comfort techniques: Hot packs, ice packs, or massage on her lower back (esp. counterpressure or double hip squeeze) will help with discomfort.

Transition

What’s Happening: Cervix dilates to 10 cm. Contractions 2-3 minutes apart, 60-90 seconds long. Intense. Mom may be discouraged, scared, angry. May be trembling, hot/cold, nauseous. May last 10 minutes to 2.5 hours. Average is 1 hour in first time moms.

Breathing Techniques: Hee-hee breathing or hee-hee-blow. Counted hee-hee-blow, where partner tells mom how many hee-hees to do before each blow. Partners breathe with her.

Comfort Techniques: Any of the techniques and positions from active labor. Follow her cues.

What should support people do? Stay very close to mom, establish eye contact. Give short and simple directions, don’t ask a lot of questions. Speak calmly. This is the most painful part of labor for many moms, and mom needs lots of support and reassurance!

 

Second Stage: Birth

What’s Happening: Cervix has dilated, baby has descended and is ready to be delivered. Contractions continue, 3-5 minutes apart, lasting 45-90 seconds. Contractions may be accompanied by a strong urge to push. Mom’s vocalizations may change to deep grunts or groans. May last anywhere from a few minutes to three hours. Typically 1-2 hours.

When should mom start pushing? Check with nurse or doctor before starting to bear down.

Where you’ll be / Who will be there: At most hospitals, you deliver in the same room you labored in. Some may move you to a delivery room. A doctor (or midwife) and one or more nurses will be there. And, of course, doula and support people.

Breathing and Bearing Down: Caregivers will guide you. Generally: With each contraction, take in a deep breath, then bear down for five to seven seconds, while exhaling or gently holding breath. Then relax briefly, take in a quick breath. Bear down again. Bear down three or four times per contraction. In between contractions, take nice deep breaths and rest.

Comfort: Any of the ideas above. A cold cloth on her forehead or neck is especially popular. A warm washcloth on the perineum may help avoid tears or episiotomy.

What should partners do: Help support mom in chosen position. Help guide pushing efforts and breathing. Lots of encouragement and reassurance. Reinforce caregivers’ suggestions.

Third Stage / Newborn Procedures

Immediately after birth, they may place the baby up on mom’s belly, or may take it over to a warming table, depending on the condition of the baby and on hospital policy. The doctor will deliver the placenta: you may need to do a few more light pushes. Then the doctor will examine your perineum, and will repair any tears or episiotomy.

Hospital policies vary regarding immediate newborn care, but most hospitals in the Seattle area attempt to leave the baby in its parents’ arms for as much of the first hour as possible, to allow for initial bonding, and first breastfeeding. At the end of one hour, some mandatory procedures are done, including antibiotic eye ointment, and a Vitamin K shot. Typically, the baby is also weighed and measured at this time, and may be given its first bath.

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