The agony and the ecstasy

The lowdown on labor and delivery

Most first time mom to be are naturally apprehensive and curious about labor and delivery. Concerns include: How will I know when I’m actually in labor? Will it hurt, and how much? When should I go to the hospital? Will I lose control and scream like a banshee, embarrassing everyone in the room?

Compared with the slow, quiet days of pregnancy, labor—with its minute-to-minute changes —can be both disconcerting and exhilarating. While each woman’s labor and delivery is different, we can address some of the more common questions and concerns.

What is Labor?

Early labor starts with the first contraction and can last more than 24 hours. Contractions gradually increase in intensity as the cervix opens. This stage is often broken into three smaller phases: the latent phase, in which pain typically feels like strong menstrual cramps and the cervix dilates from –4 centimeters; active labor, in which contractions accelerate and the cervix dilates from 5–6 centimeters; and transition, during which your cervix dilates from 7–10 centimeters. Transition is usually short —15–30 minutes—but can involve the most intense contractions.

Pushing and delivery, the second stage, begins when it’s time to push and includes the actual birth. This can take anywhere from 30 minutes to three hours.

Delivery of the placenta occurs soon after the baby is born and also can be painful.

The First Signs Of Labor While labor feels different for every woman, signs that it has started can include the following:

  • Regular, consistent contractions
  • Appearance of “bloody show” —a pinkish vaginal discharge or actual blood
  • Nausea
  • Gastric upset and the desire to have a bowel movement
  • Restlessness and a vague feeling that something is not quite right
  • A desire to be alone
  • Backache
  • Leaking of amniotic fluid (your “water breaks”)

Women who think they are experiencing early labor shouldn’t rush to the hospital, says Patricia Burch, M.D., an obstetrician and gynecologist in Lafayette, La. She suggests timing the contractions, from the beginning of one to the beginning of the next. “If you detect a pattern of contractions every 10–15 minutes and the pain isn’t intense, conserve energy and sleep, if possible,” says Burch. “Many women will wake up at night in light labor, stay up, and then come rushing into the hospital the next morning, exhausted.”

Should I Stay, Or Should I Go? When to go to the hospital will depend on how your labor is progressing. In general, according to Burch, you should go when the contractions have become strong enough to take your breath away and are coming regularly, at five- to 10-minute intervals. At this point, the cervix is usually 3–4 centimeters dilated and completely effaced.

Some childbirth experts believe it is unwise to go into the hospital too soon. “Many studies have shown that a woman is better off, and requires less medical intervention, when she stays home and remains in contact with her doctor or midwife by telephone until she’s further along in labor,” says Marsden Wagner, M.D., a Washington, D.C., reproductive-health research scientist who spent 15 years as director of women’s and children’s health for the World Health Organization.

If you choose not to go to the hospital right away, call your health practitioner to inform her that you think labor has begun. Rest and keep your strength up by eating a snack, because it’s likely to be a long time before you can eat again, says Giselle Genillard, a licensed midwife in Santa Fe, N.M. She suggests light, nutritious foods such as yogurt and toast.

Although physicians used to ask women to report to the hospital as soon as their water broke, opinions on the subject currently run the gamut. “Some doctors will have women wait 12 hours to see if labor starts, while others will give you 24,” says Burch. “Others, like myself, prefer to check the woman out in the office and put her on a fetal monitor for 20 minutes to make sure everything is OK. Find out your health care practitioner’s policy on this before you go into labor.”

Common Questions

Q: I’ve read that it is good to walk around during delivery, but I’ve heard that as soon as you get to the hospital, they strap on a baby monitor. What should I do?

A : Baby-monitoring policies vary from hospital to hospital. Some hospitals require intermittent monitoring, which allows a woman to walk around until the last part of labor, while others require constant monitoring, which prevents this. Check with the hospital where you plan to deliver regarding its policy on the matter.

Q: What’s the best position for delivery?

A: Doctors vary on what they will allow for delivery, so inquire before labor begins. The most common position is propped up on one’s back, with knees open wide and high. Squatting is considered one of the best positions because it helps open up the pelvis. You can squat with support from a partner or hang onto a birthing bar, which is hooked onto a birthing bed. This type of bed allows you to squat in bed and then lean back in between contractions. Birthing beds also break down and become what looks like a delivery table so the woman can push and deliver the baby without being moved. Birthing chairs are often used by midwives. They are helpful for a woman having trouble getting the baby down the birth canal. Sitting in a birthing chair helps open up the pelvis wider than in a birthing bed.

Delivering while lying on one’s side works well, opening the pelvis, as does all-fours delivery, which works particularly well for women experiencing back labor.

Q: I’m hoping to have a drug-free delivery, but what if I change my mind and want medication? A: It’s natural to be disappointed if you’d planned on a natural birth but then had pain medication. Remember that you’ve done your best. The outcome is what counts most.

Q: What if I do something embarrassing, like poop? A: “Having a bowel movement during labor is quite common,” says Burch. “Obstetricians and labor-and-delivery nurses are used to being pooped, peed and bled on; it’s just part of the job and nothing for a woman to worry about.”

Q: What does labor really feel like? What does pushing feel like?A: Labor feels like extremely strong menstrual cramps that take your breath away and make you unable to talk. As labor continues and the pain worsens, the woman tunes out stimuli and adopts a tunnel vision, focusing on the labor and getting the baby out. Eventually the woman’s cervix dilates completely; at this point, she is ready to push and give birth. During this phase, some women feel clingy, not wanting their husbands or birth partners to leave their sides; some yell and become uncharacteristically demanding; some tremble and feel overwhelmed and anxious; and some lose all sense of modesty. To some people, pushing feels like you are having a large bowel movement. When the baby finally starts to come out, many women think they’ve pooped.

Q: What if I have to have a Caesarean section?A: Twenty-five percent of women in the United States have a C-section, so you wouldn’t be alone. Although the recovery time is longer and more painful, women who deliver this way are just as able to hold their babies after delivery and breastfeed soon after. During a Cesarean, the woman is typically awake and able to watch the baby being removed from her uterus. She also can be accompanied by her husband or other loved one. Having a C-section does not mean that you can’t deliver vaginally the next time around.