When Push Comes To Shove

Not sure what to expect during childbirth? Here, our guide from your first contraction to your baby's first breath.

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While your birth experience will be as unique to you as your new baby, the phases of labor and delivery are the same for everyone. During pregnancy the opening of your uterus, the cervix, is firm and closed. As your due date approaches, you may experience mild contractions that help prepare your cervix for delivery: It becomes soft, stretchy and thin, a process called effacement. These early contractions also help your baby engage, or move into position to come through the birth canal, says Chris Kenlan, a certified nurse-midwife at Legacy Medical Group-Midwifery in Portland, Ore.

Many women experience these for hours, or even days, before actual labor begins, with contractions coming at irregular intervals. "Latent labor can be uncomfortable, exhausting and confusing. Patients rush to the hospital thinking, 'This is it!' then get sent home," says OB-GYN Catherine Harth, M.D., an assistant professor of obstetrics and gynecology at the University of Chicago. You can help your labor progress by taking walks, but be sure to stay hydrated and well nourished and get some rest.

Kenlan advises her patients to follow the "511 Rule" before heading to the hospital. "Contractions should be strong, consistent and approximately five minutes apart, lasting one minute, for at least one hour," she says. If you lie down to rest or take a bath and the contractions slow down, you're not yet in actual labor. Your "bag of waters" can break spontaneously or your doctor or midwife can rupture the membranes any time before or during labor. (Note: If you are less than 37 weeks and having regular contractions, your water breaks with or without contractions, you experience vaginal bleeding that is heavier than spotting or you have severe constant pain, go to the hospital immediately.)

Real Labor Starts

You'll know you've progressed to true labor when your contractions get closer together, longer and don't slow down when you're resting. Labor actually consists of three stages: dilation, pushing (and the birth of your baby!) and, finally, delivery of the placenta.

Stage 1: The cervix opens Your cervix will dilate from zero (closed) to 10 centimeters (fully open). On average, you can expect it to change 1 centimeter an hour. "Early labor—before 4 centimeters—feels like ever-increasing cramping, and women sometimes experience diarrhea, spotting and discharge," says Kenlan. "Active labor— after 4 centimeters—means contractions are regular and strong and cause cervical change."

During active labor your contractions will be two to three minutes apart, lasting about one minute each. Most women say contractions hurt, though some describe them as a feeling of intensity, pressure or tightening. To help manage the pain, Kenlan recommends patterned breathing—rhyth- mic, slow and deep—or try a warm shower or bath, walking or changing position, e.g., lying on your side or moving onto your hands and knees.

If you want pain medication, request it now. "The best time for analgesia is when a woman is in active labor," says OB-GYN Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital. "Early in labor when there are contractions but no cervical change, an epidural could slow down the process." If you're planning a natural birth without drugs, expect the intensity of your contractions to increase at this point.

As your cervix reaches 8 centimeters, you'll enter the transition phase. "It's intense but brief," says Kenlan. "Many patients ask for epidurals now or will feel breakthrough pain if they already have had an epidural."

Stage 2: Time to push! When you hit 10 centimeters, you've officially entered the second stage of labor— and you'll finally hear the word, "push!" For a first-time mom, pushing usually lasts one to three hours, says Riley. Without pain medication, you'll feel a strong urge to push when a contraction hits. If you had an epidural, your doctor or midwife will tell you when one is coming. (She'll keep a close eye on the fetal heart monitor, which tracks your baby's heartbeat and your contractions.)

In both cases, she'll help coach you through contractions.

With each push the baby makes his way down the birth canal until his head crowns, or becomes visible. At this point, an episiotomy, a cut made in the perineum to enlarge the vaginal opening, is possible but unlikely. "They are only done when the baby is in trouble or too big," says Harth. After your baby's head is out, your doctor or midwife will check to see if the umbilical cord is around his neck (she'll simply unwrap it if it is). Your next push should bring out your baby's shoulders, quickly followed by his body. The umbilical cord is then clamped and, if he's up to the task, Dad can make the final cut.

Stage 3: The afterbirth While you and your partner are marveling at your new baby, your doctor or midwife will deliver the placenta, which may happen immediately or take as long as 30 minutes. Once it's out, any tears or episiotomy will be stitched up and you'll be monitored for excess bleeding or infection. This is also when you may first breastfeed your baby—and it will start to sink in that you're no longer a mom-to-be but a new mother.

Pitocin Primer

Used to induce labor or to help labor progress, Pitocin is the synthetic form of oxytocin, the hormone that causes contractions. Given intrave- nously, it will cause your contractions to become stronger and closer together. If the risk of continuing a pregnancy is high for you or your baby or your labor is slow, Pitocin is a useful tool. But, inductions scheduled for convenience can lead to health risks for you and your baby. "Induction increases the risk for C-sections, prolonged labor, infection and the need for pain medication," says certified nurse-midwife Chris Kenlan.

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