Labor Day!

The big day is finally here; your baby is ready to make his or her debut! So what happens between the first signs of labor and the arrival of your newborn?

            Every labor and birth is different, just as every pregnancy is different. While the details will vary in each circumstance, women in labor can expect a similar chain of events, from the first contraction to Baby’s first cry.

Signs of Labor

            When it comes to labor, how do you distinguish between the real thing and a false alarm? Some signs that you are probably in labor:

Contractions. Irregular contractions (Braxton-Hicks) are common toward the end of pregnancy, but regular ones a few minutes apart are a sign that Baby is coming soon.

Ruptured membranes. Commonly referred to as your “water breaking,” the amniotic sac that surrounds your baby ruptures and could feel like a trickle or a gush.

Bloody or brownish discharge. As your cervix dilates and effaces (thins out), the mucus plug that blocks the womb from infection is expelled. Labor could begin right away or still be days away.

When to Call the Doctor

First-time moms may have the urge to head to the hospital at the initial sign of contractions. However, if you show up too early, you will likely be sent back home. Labor can take hours, even a couple of days, for first babies. Spending those first few hours in the familiar setting of home, where you can walk, take a warm shower and rest, will make the early stages more comfortable and may ease anxiety.

            Dr. Peter J. Caruso, M.D., Ob./Gyn. at Saint Luke’s South, says, “For first-time moms, the doctor should be called in the early stage of labor when contractions are five minutes apart and lasting 30 to 60 seconds, bleeding becomes more than just spotting, or if she is leaking fluid that has the scent of bleach. Also, call the doctor if the patient develops significant pain which is not easily controlled with breathing techniques.”

            If you are experiencing any of these symptoms, your physician will likely tell you to head to the hospital.

What Happens at the Hospital?

            Once you arrive, you will be checked to make sure you are in active labor. A nurse will check your vital signs, take a urine sample and ask questions about the baby’s movements, your contractions, pain management, birth plan and more. Be prepared to answer a lot of questions; the medical team wants to give you the best care possible.

            Dr. Peter Engelman, D.O., of Meritas Health Obstetrics & Gynecology (North Kansas City Hospital), explains, “When women arrive in labor, we set them up in a room to monitor contractions so we get a sense of the baby’s heart tones and frequency of contractions. From that point, we continually check the mom’s vitals and assess contractions and help manage pain.”

            Most women are monitored through disks on their bellies, but sometimes the situation calls for a different method. Dr. Engelman says, “If at any point we feel we need to observe the baby more closely, we can put internal monitors on the baby to measure its fetal heart rate and strength and frequency of contractions.”

            Throughout labor, women will have cervical exams to determine how much the cervix is dilated and effaced.

            Dr. Tara N. Chettiar, M.D., Ob./Gyn., at Saint Luke’s South, says, “When you are dilated less than 4 to 6 centimeters, the cervical exams can be about four hours apart. Once you get past that 4 to 6 centimeter mark, things move more quickly! The nurse or provider will be checking closer to every two hours to make sure that you are making good progress.”      

            If you choose pain medications, talk to your doctor beforehand about your options. Remember, you can change your mind during labor (up until a certain point and depending on your circumstance).

Time to Push!

When you are dilated 10 centimeters, it’s time for the final descent and birth of your baby. Your doctor will let you know when it’s time to push, depending on how comfortable you are, how the baby is doing and other factors.

Some doctors use a technique called “laboring down.” As Dr. Chettiar explains, “That means even though your cervix is fully dilated, we think you could get some benefit from letting your body do the work for a while and waiting to start pushing. Remember, that’s what your contractions are for!”   

The pushing stage can last from a few minutes to a few hours. With each contraction, you will bear down to help the baby move through the birth canal. After the baby’s head emerges, your doctor will suction the nose and mouth. Your baby's head will turn to the side as her shoulders rotate inside your pelvis. You'll be coached to push as her shoulders emerge, one at a time, followed by her body.

Final Phases

            If there are no complications, your baby will be placed on your belly and toweled off. Your partner can cut the umbilical cord, or your doctor can do it.

Minutes after giving birth, your uterus will start contracting again, in preparation for delivering the placenta. You may be asked to give a push or two; this is usually quick and not painful.

            Dr. Chettiar sums it up: “Sometimes this whole labor and delivery process can feel like it takes an eternity, but just remember—you already made it through the whole pregnancy. This is just that last sprint to the finish line! You can do it!”

Tools that may be used during delivery:

  • Forceps: Shaped like large salad tongs, they are used to shift the baby’s position or guide the head out.
  • Amniotic hook: This long crochet-like hook is used in the early stages of delivery to break your water if it doesn’t happen naturally.
  • Hemostat: This is for holding sutures and clamping the umbilical cord.
  • Scissors: These are used in an episiotomy (incision in the perineum to help the baby fit through).
  • Scalpel: Used to make an incision in the event of a c-section.

Tisha Foley’s labor days are over; her children are 7 and 11. She writes from her home in Belton.

As always, please consult your healthcare provider with any questions or concerns.

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