Labor and Delivery (cont.)
IN THIS ARTICLE
Types of Delivery
Most babies are born in a vaginal delivery. But in some cases, other types of delivery occur by choice or because of an emergency.
During labor, the uterus contracts regularly to thin and open (efface and dilate) the cervix and push the baby out through the birth canal. It can take many hours or days for the cervix to open all the way so you can begin pushing.
A cesarean section is the delivery of a baby through a cut (incision) in the mother's belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward.
A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. For more information, see the topic Cesarean Section.
Vaginal birth after cesarean
In the past, a woman who had one C-section delivery had to have all of her other babies by C-section. But depending on the reason for your first C-section and the type of incision that was made, you may be able to deliver your next baby vaginally.
For more information, see the topic Vaginal Birth After Cesarean (VBAC).
Stages of Labor
The process of having a baby occurs in several stages over many hours or even a few days—from early labor through delivering the baby and the placenta. During labor, contractions in your uterus open your cervix and move the baby into position to be born.
Stage one: Early, active, and transition
Early labor is often the longest part of the birthing process, sometimes lasting 2 to 3 days. Uterine contractions:
It's common for women to go to the hospital during early labor and be sent home again until they are in active labor or until their "water" breaks (rupture of the membranes). This phase of labor can be long and uncomfortable.
The active stage of labor starts when the cervix is about 3 cm (1.2 in.) to 4 cm (1.6 in.) dilated. This stage is complete when the cervix is fully effaced and dilated and the baby is ready to be pushed out. See a picture of cervical effacement.
Compared with early labor, the contractions during active labor are more intense and more frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing center. If your amniotic sac hasn't broken before this, it may now.
As your contractions get stronger, you may:
To learn more about pain medicine, see Managing Pain.
The end of active labor is called the transition phase. As the baby moves down, your contractions become more intense and longer and come even closer together.
When you reach transition, your delivery isn't far off. During transition, you will be self-absorbed, concentrating on what your body is doing. You may be annoyed or distracted by others' attempts to help you but still feel you need them nearby as a support. You may feel increasingly anxious, nauseated, exhausted, irritable, or frightened.
A mother in first-time labor will take up to 3 hours in transition, and a mother who has vaginally delivered before will usually take no more than an hour. Some women have a very short, if intense, transition phase.
Stage two: The baby is born
The second stage is the actual birth, when the baby is pushed out by the contractions. This pushing stage can be as short as a few minutes or as long as several hours. You are more likely to have a fast labor if you have given birth before. During the second stage:
Your medical staff will be ready to handle anything unexpected. This is a time when your doctor or nurse-midwife will be deciding what is best for you and your baby.
Stage three: The placenta is delivered
After your baby is born, your body still has some work to do. This is the third stage of labor, when the placenta is delivered. You will still have contractions. These contractions make the placenta separate from the inside of the uterus, and they push the placenta out. Your medical staff will help you with this. They will also watch for any problems, such as heavy bleeding, especially if you have had it before.
You may be given some medicine to help the uterus contract firmly. Oxytocin (such as Pitocin) may be given as a shot or in a vein (intravenously) after the placenta is delivered. Oxytocin is given to make your uterus shrink and bleed less. (This is the same medicine that is sometimes used to make contractions more regular and frequent during labor.) Breast-feeding right away can also help the uterus shrink and bleed less.
The third stage can be as quick as 5 minutes. With a preterm birth, it tends to take longer. But in most cases, the placenta is delivered within 30 minutes. If the placenta doesn't fully detach, your doctor or nurse-midwife will probably reach inside the uterus to remove by hand what is left inside. Your contractions will continue until after the placenta is delivered, so you may have to concentrate and breathe until this uncomfortable process is complete.
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