The beginning of labor

Toward the end of your pregnancy, the waiting may seem very tedious. Your doctor will not want you to go far from home alone and you will be limited in what you can do by the awkwardness of your body. But the day does finally come when you pick up the bag you've kept packed in your closet for this occasion, and start for the hospital.

No one knows exactly what sets the birth process off. When the baby is ready to be born, a whole series of events goes in motion.

The first sign you are aware of comes sometime during the last month of your pregnancy. Then you may notice that the baby seems to be settling down, lowering himself in your abdomen. This is called "lightening," and is more apparent with a first child. It means that the baby in the uterus is moving down a little into the bony canal of your pelvis to be in a better position when labor begins. Sometimes this can happen so suddenly that it is startling.

Early contractions

Preparations for labor have been going on for some time. All during pregnancy, the muscles of the uterus have been getting ready to help the baby leave your body. From time to time, they have tightened and let go. This process of growing tight and then relaxing is called a contraction.

These early contractions do not ordinarily cause discomfort. You may not even feel them. Late in your pregnancy, they may be quite strong, coming and going irregularly over a period of several hours or even days. This may be what doctors call "false labor." It is much less common in first than in later pregnancies and is nothing to worry about. In false labor, contractions are chiefly in the abdomen. They do not change much in intensity, the intervals between them are longer and they may be relieved by walking. Sometimes it is hard to tell regular from irregular contractions, so be sure to let your doctor know whenever yours become severe.

Some signs of true labor

You will probably not be in much doubt about what is happening when you are actually in labor. The contractions of the uterus become more and more frequent and intense. You may notice them first as a feeling of pull or tightness in your back that gradually spreads around over your abdomen, or of increased pressure spreading up from the lower part of it. When they come to a steady rhythm, you may be virtually certain that your labor has begun.

At first, these contractions are usually 15 or more minutes apart. The time between them gets shorter and shorter as your labor progresses. They may be perfectly regular or they may come in regular series—10, 8, 7 minutes, then 10, 8, 6, then perhaps 10, 8, 7 again, and so on. They are not affected by changes in your position or activities. If they come during the day, there is no reason not to go on with whatever you are doing, as long as you feel like it. It relaxes some women at this time to watch television, knit, read or do a crossword puzzle. At night, you will probably feel sleepy during the intervals. You may even be able to doze.

During pregnancy, the cervix softens and relaxes. By the time labor begins it is thin, and has opened to about 1/2 to 3/4 of an inch. Usually a small amount of mucus is present in this opening, as a sort of plug.

As the baby is pushed against the cervix by the strong contractions of the uterus, this opening gradually gets larger until it is finally about four inches wide, big enough for the baby to get through. As the cervix opens, the mucus plug comes loose and passes out, often with a small amount of blood. This usually means that labor is soon to begin.

A sudden rush of water from the vagina means that the bag of waters surrounding the baby has broken. This may happen at the beginning of labor or not until just before the baby is born. Whether it breaks early or later makes very little difference to either you or your child. The time when it breaks has nothing to do with the length of your labor. Your doctor will want you to let him know at once if your bag of waters breaks. It is wise for you to go to bed while someone is getting in touch with him about this.

Duration of labor

Your doctor cannot tell you exactly how long your labor will last. The time differs for every woman and for every pregnancy. Eight to 15 hours after the beginning of labor is an average for first children. Later babies may come more quickly, perhaps in 4 to 8 hours.

Women who have had a good diet and good care during pregnancy tend to have a shorter labor. Some doctors say that prenatal education also helps to cut down the time, especially if this includes exercises properly taught and practiced under competent supervision. Your own attitude has a lot to do with it, too. If you are relaxed, you will find it easier to get some rest between the contractions and your labor may actually be shorter.

Eating and drinking after labor begins

Do not eat any solid food after labor has started. When labor begins, eating may cause nausea and vomiting. Also, a full stomach interferes with a general anesthetic, should you need one. You may drink such liquids as fruit juice, clear soup, black coffee, or tea at any time during the early part of your labor, unless your doctor says otherwise. Water is good to drink at all times unless it nauseates you.

Going to the hospital

You may wonder whether you will have time to get to the hospital after labor begins. If this is your first child, you will ordinarily have plenty of time to call the doctor, the hospital, your husband, a friend, or a taxicab and ride a reasonable distance, after the contractions become regular, before you need help. After the first child, babies usually come more quickly.

You will be glad now if you have made ready in advance: Bag packed and in a convenient place, telephone numbers posted where you can see them at a glance. No matter how well you know them, you may not remember these numbers when you are excited or in a hurry. But don't start for the hospital until the doctor tells you to.

Admission procedures at the hospital

You are taken at once to the admitting office. If there is plenty of time, you are registered here and the information needed-for your record is obtained. Then you are taken to the maternity admissions room to be prepared for delivery. In some hospitals, maternity patients are sent here immediately, without a stop at the admitting office. In still others, they are admitted directly to the labor room.

As soon as you have been admitted, you undress and put on a hospital gown. You are checked over by a doctor much as you were on your prenatal visits to your own physician. To protect not only yourself but other mothers, you are observed for signs of a possible infection, such as a cold. A rectal examination is made.

If labor is underway, the hair is shaved from the lower part of your abdomen and from around the vaginal opening. This part of your body is carefully cleansed to prevent infection when the baby is born. You may be given an enema to clean out your rectum and lower bowel. This all makes delivery safer and easier.

When all necessary preparations for your delivery have been made, you settle down in the labor room to stay until it is time for your delivery.

The stages of labor

Labor is divided into three stages. In the first stage, the contractions of the uterus stretch the opening at its lower end, the cervix, so the baby can pass out into the birth canal. In the second stage, the baby passes down through the birth canal and out through the vaginal opening, which also stretches to let him get by. In the third stage, the placenta and membranes (the afterbirth) are loosened and expelled. The first stage is the longest.

During this first stage, the doctor may make several rectal examinations to find out how fast the cervix is opening. By placing his gloved finger in your rectum, he can feel the cervix through the thin wall that separates the vagina from the rectum. On some occasions he may make a vaginal examination with a sterilized glove.

Throughout the early stages of labor, you will have a feeling of "crampiness" in your abdomen and your back may ache. As you come nearer to delivery, you will feel pressure especially in the lower pelvis, and you may have an urge to "bear down" or to move your bowels. This is because the baby's head is pressing on the rectum. Since your bowels were emptied when you were prepared for labor, you could not have a movement now, so don't be concerned about that.

While you are in the labor room someone will be with you or within call all of the time. Your own doctor will check on you as well as one or more of the doctors on the hospital staff. It is becoming more common, in some parts of the country for a husband to stay with his wife in the labor room. This is something the hospital usually decides.

Delivery

Sometime during the second stage of labor, you will be moved to the delivery room. This stage is usually only about 1 1/2 to 2 hours with first babies. The strong muscles of the abdomen and the diaphragm begin to help the muscles of the uterus push the baby out and you have a strong urge to push with each contraction. Pushing at the right time helps, but if you try to bear down too soon you may tire yourself needlessly. The doctor or nurse will tell you when to do it.

You have probably wondered how a baby can get safely through a channel as narrow as the birth passage. Your body is prepared for this. The bony cavity in the center of your pelvis is normally filled with organs made of very soft tissues: the vagina, the uterus, the rectum, the bladder and the tube from the bladder, the urethra. During pregnancy, the uterus and the bladder are pulled up out of the way into your abdomen. The tissues of other organs become softer and the joints in the pelvic bones become more flexible.

During labor, the vagina stretches enough to let the baby through, pressing the urethra and rectum flat against the walls of the bony cavity. Often the doctor enlarges the exit by making a small cut, called an episiotomy, in the vaginal opening. He does this if the thinks the tissues might tear a little as the baby comes out. This cut heals better than a tear. It is closed with a few stitches after the baby is born. The stitches are made of catgut and do not need to be removed. Neither the cut nor the stitches are painful because the doctor uses either a local or a general anesthetic. You may have some soreness later. An episiotomy is more likely to be necessary with first than with later babies. Some doctors do this routinely because the stitches give the pelvic organs more support.

The afterbirth

The third stage of labor begins when the placenta starts to separate from its attachment to the lining of the uterus. In a short time, usually 5 minutes or less, the muscle wall of the uterus contracts once more and the placenta and the membranes are pushed out. There is usually a moderate amount of blood passed with the afterbirth from the place where the placenta was attached but this bleeding soon becomes slight.

The baby's position

Most babies are born head first. This is the easiest way, for a baby's head is the biggest part of its body and can be molded into a narrow, slightly elongated shape. The effects of this molding disappear in a day or two. It is most marked in firstborns. Some babies come down feet or buttocks first. This is called a breech presentation. A doctor is often able to turn the baby before he is born so that the head will come first.

Medicines to relieve discomfort

If the contractions cause you much distress, you may be given medicine that will make you feel them less. Drugs that do this are called analgesics. Later, when your muscles are being stretched by the actual birth of the baby, you will probably be given some kind of an anesthetic.

An anesthetic, as you probably know, is something that produces complete or partial loss of feeling. There are two principal kinds of anesthesia: general and conduction. A general anesthetic makes you unconscious for a short time. Some of them are gases; you breathe them through a mask. Some are given in a solution injected into a vein. Conduction anesthesia gets its name from the way it works. It interferes with the conduction of nerve impulses to the brain from the place where it is injected. When your nerves are blocked in this way, you have no feeling in the parts of the body with which they connect. But you do not lose consciousness. There are several different types of conduction anesthesia.

Each type of analgesic and anesthesia has certain advantages. Your doctor will explain these to you, if you ask him, so that you and he may decide together how much pain-relieving medicine, and what kind, you will have. Some mothers want very much to be able to follow what goes on, and to be awake when their babies are born. Others would rather be "knocked out." Knowing how you feel about this will help your doctor to make up his mind about what will be best for you and the baby.

If you have not had much anesthesia you may have the joy of hearing the baby's first cry and of learning, after all these months, whether you have a son or a daughter.

The use of instruments

Once forceps were used only in complicated cases when the baby could not be born naturally. For this reason, many women associated them with trouble, and the idea of a forceps delivery came to be rather generally dreaded. Doctors now frequently use forceps in normal births to lift out the baby's head. This makes delivery easier.

If the time comes when your doctor thinks it will help to use forceps, he will put you to sleep or make your pelvic region numb with a local anesthetic. This is something you definitely do not need to worry about. With careful handling, forceps should not hurt either you or the baby. They may sometimes make a little bruise on the baby's cheek, but this disappears within a few days.

The recovery room

Recovery rooms are becoming common in large hospitals. Some doctors refer to the time spent in them as the fourth stage of labor. This is the room to which you may be moved, after the baby is born, to be cared for until you are fully awake and a little rested. In many hospitals you are left in the delivery room for a while. After an hour or so, you are taken to your own room, perhaps for the first time since you entered the hospital.

In the recovery or delivery room, your blood pressure is taken, you are checked for bleeding and your uterus is gently massaged as it begins to retract. Your own doctor will see you here, if he can. Obstretricians often have to go directly from one case to another. If your doctor is delayed in coming back to you, do not worry. Someone will be with you to give any help you may need.

Your husband may not be allowed to see you until you are back in your own room. The doctor will decide how soon it is best for you to see your baby. Women who are not under a general anesthetic usually see their babies as soon as they are born.

Cesarean Section

Your doctor may have decided that it is advisable for you to have your baby by Cesarean Section. This means that he will bring the baby out through an incision in your abdomen, instead of through the birth canal. Obstetricians perform this operation frequently and with great skill. It almost always turns out well for both mother and child, and may be safely repeated several times. This is a major operation, however, and it will take longer for you to regain your strength afterwards than if you had had your baby in the more usual way. Your may have some trouble getting breast feeding started after a Cesarean Section, but, as a rule, the operation itself does not prevent a mother from nursing her baby.

If you have your baby by Cesarean Section, your stay in the hospital may be a bit longer than if you had had a vaginal delivery, because the abdominal wound must heal. Aside from this, your care will be about the same.

Marcus Siegel

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