Labor and Normal Delivery-Learn the basics and holistic approaches

What is labor and normal delivery?

Normal delivery is the natural process by which your baby is born after you reach your term. The pains during your delivery process that bring out your baby, placenta and umbilical cord from your uterus through your vagina are called labor pains. They start as contractions which increase in frequency, duration and intensity till your baby is delivered. In this article, we will summarize what you should expect during your labor and how will your delivery be.

Before we go into the details of labor and normal delivery, let us first understand how the pregnancy is categorized based on gestational age and when is the ideal time for delivery:

• Term pregnancy: is defined as a pregnancy between 37 completed weeks to 42 completed weeks of gestation. This period is the time when you are most likely to go into labor and deliver your baby. This is also the time which is considered best for delivery in terms of both maternal and fetal outcomes. It is also called full term pregnancy.
• Preterm Delivery: When a baby is born before completion of 37 weeks of gestation, it is called Preterm delivery and the baby born is called Preterm baby. Preterm babies may have lot of serious complications, depending on how early they are born.
• Postterm delivery: When a baby is born after 42 completed weeks of gestation, it is called Postterm delivery. The complication rate significantly increases both for mother and baby in a postterm delivery. So if a pregnant woman does not go into labor by the end of 37-42 week window, then your obstetrician may admit you for artificial induction of labor or perform a C-section, as deemed appropriate by your doctor.

Stages of labor

Labor begins with the onset of regular, rhythmic uterine contractions (true labor pains) which cause the mouth of uterus or cervix to soften and thin out (effacement) and also cause gradual opening up (dilatation) of the cervix. When cervix achieves it’s maximal dilatation of 10 cm, the baby gets delivered and is followed shortly after by the delivery of placenta and umbilical cord.

This whole process of labor is a continuum which, for the sake of understanding, is divided into three stages namely stage 1 (complete cervical dilatation), stage 2 (delivery of baby) and stage 3 (delivery of placenta and umbilical cord). A fourth stage is now recognized by obstetricians in which you are observed for bleeding for a few hours after your delivery.

Stage1: This stage of labor starts with the onset of true labor pains and ends with complete opening of mouth of uterus (cervical dilatation of 10 cm). This stage prepares the body for delivery by softening, thinning and dilatation of cervix so that the baby can come out. This is the longest of all the stages. It is further subdivided into a latent phase and an active phase.

• Latent phase: The latent phase begins with the onset of labor pains and ends with cervical dilatation of 3 cm. This is called as latent phase as it is a slow and steady phase in which the uterine contractions slowly increase in frequency, duration and intensity to cause thinning and dilatation of cervix till it reaches 3 cm. The intensity of labor pains is mild to moderate and changes in mouth of uterus happen very slowly. Latent phase of labor usually lasts for 18 to 20 hours if it is your first pregnancy and 14 to18 hours if you have delivered before. However, the duration is highly variable.
• Active phase: The active phase is the accelerated first stage of labor in which the labor pains become more active and their intensity also increases. The uterine contractions become more frequent, longer in duration and stronger. It begins with the end of latent phase and ends with complete cervical dilatation of 10 cm. The cervix dilates at the rate of about 1 cm/hour and takes about 4-8 hours to complete. In addition to the pain of uterine contractions, you may have symptoms like backache, diarrhoea, leg cramps etc. in this stage. You may also feel a sudden gush of water pouring down your legs. This is when your waters break.

In this phase, you need to be monitored for your heart rate, blood pressure and progress of labor by repeated pelvic exams. Your doctor or midwife will also monitor your baby’s heartbeat more frequently in this phase by machines like fetal doppler or cardiotocography. So, when you feel that you are in active phase, you should go to the hospital for admission. In case you want to take labor analgesia, this phase is the right time to do it.

Stage 2: The second stage of labor starts with complete dilatation of cervix and ends with delivery of the baby. This is the stage when you are asked to bear down and delivery of the baby happens. This stage usually last for about 1 to 2 hours. It may take longer if this is your first baby or if you have an epidural in place for your pains. In the second stage of the labor, you may feel an urge to pass stools due to the pressure of baby’s head on your rectum. When the baby is passing out through the birth canal, it can feel like a stretching or burning sensation in the vagina.

Stage 3: This is a stage where delivery of placenta takes place. Placenta usually delivers within 15 to 30 minutes after your childbirth. The uterine contractions cause the placenta to separate from the uterine wall which is indicated by a sudden gush of blood, lengthening of umbilical cord and a globular shape of uterine fundus. If placenta does not deliver by 30 minutes, your obstetrician may manually extract the placenta.

Stage 4: This is the stage when you are kept in observation for about two hours after the delivery of baby and placenta, to watch for signs of excessive bleeding. If excessive bleeding happens, it is called Postpartum Hemorrhage.

True vs False Labor pains: How to know the difference?

False labor pains are also called as Braxton Hick’s contractions. These contractions sometimes mimic labor pains and you might feel as if you are in labor. When you go to your doctor with these pains and you are examined, your doctor will notice that there are no changes in the mouth of the uterus. This is because the braxton hick’s contractions are not meant to deliver the baby. So we should be looking out for true labor pains to find out if it is the right time to visit hospital. Let us understand the difference between true and false labor:

• True labor pains usually start near your term as they are aimed at delivering your baby whereas false labor pains may be present anytime through out your pregnancy and they have nothing to do with your delivery.
• True labor pains are regular, rhythmic contractions with a fixed duration and interval between them. As labor progresses, the frequency of contractions increases and the duration between them decreases. However, false labor pains are weaker, irregular, do not have any rhythm and do not progress.
• As the true labor sets in, the mouth of uterus (cervix) starts to soften and thin out (effacement) and also starts opening up (dilating). The effacement and dilatation of cervix also speed up as the true labor pains increase in intensity and become stronger and more frequent in the active phase of labor. However, false labor pains are nor associated with any effacement or dilatation of cervix.
• True labor pains are nor affected by rest, standing up, sitting, walking or any other any change of position. However, the false labor pains can go away with walking, resting or changing positions.
• True labor pains will be a accompanied by tightening of your belly which becomes hard and soft intermittently. Hardness of the belly will feel as hard as tip of your nose and softness will feel like side of your nose.
• True labor pains are usually associated with small amount of bleeding called as Show. This is due to pressure on the mouth of the uterus which leads to breaking of blood vessels and bleeding. False labor pains are not associated with show.
• In true labor, your water bag may rupture which is seen as sudden, watery discharge through your vagina. This is actually amniotic fluid which has started leaking out due to rupture of the amniotic bag which carries the baby. This is called Leakage and is not seen with false labor.

How do I prepare myself for labor?

Every human is different and so is every labor. It is totally unpredictable how your uterus, it’s mouth, the uterine contractions and baby will behave during this time. In general, you must be very positive and patient during all the phases of labor.

• Remember that the preparation of your body for labor starts during pregnancy itself. You should remain active in your pregnancy and keep exercising, unless medically contraindicated for some reason. Avoid being sedentary for long durations.
• Breathing exercises, also called as Pranayama help a lot to achieve a positive outlook as well as maintain good oxygen levels to the baby in abundant amounts. Pranayama will also help you in tolerating pains. Not all Pranayama breathing techniques are safe for pregnancy. They must be practiced under supervision and you must talk to your healthcare practitioner to understand which breathing exercises are suitable for you.
• Eat well and take your prescribed health supplements regularly. If you eat well, exercise regularly and take your supplements, you improve both your own and your baby’s health and chances of good outcomes increase for both of you during your delivery and thereafter.
• Attend your prenatal checkups regularly and get your vaccinations and ultrasounds done at prescribed times. Regular prenatal checkups help your doctor to evaluate your pregnancy progression at regular intervals, so that problems at any stage can be picked up and treated early.
• Watch for signs of labor and report to hospital immediately when in labor. Keep your carry baggage ready at all times after your eighth month as you can set into labor anytime.
• Most importantly do not worry. The process of labor is a natural process meant to deliver your baby. Nature has perfected it over thousands of years and in case of problems, your doctor is there for you.

How will my doctor monitor my baby’s health during labor?

Along with the mother’s health, assessment of fetal well being is an essential part of labor management. Assessment of fetal health is done by monitoring the fetal heart rate. This is done by using a fetal Doppler. Fetal Doppler is a small radio sized device which can amplify fetal heart sound and helps your doctor assess the heart rate of your baby. There is another advanced piece of equipment which is known as CTG (cardiotocography). This is a machine which simultaneously measures the uterine contractions and also the fetal heart rate.

How do I monitor my contractions?

When labor starts, initially the labor pains are not very strong, are less frequent and do not last long. But they are rhythmic and regular. As labor progresses, the pains become stronger, more frequent and increase in duration. So it’s very important for you to monitor your pains. You can do this by noting:

• Frequency of pains: Note the time from the beginning of one contraction to the beginning of the next contraction. This tells you the time interval after which the next pain comes after the previous one. More time interval between pains means less frequency of pains. As labor progresses, this interval between pains decreases and the frequency of pains increases.
• Duration of pains: Note down the time when a contraction begins and when it ends. This interval is called the duration of pain. As labor progresses, the pains last longer and their duration increases.

You must report immediately to your doctor if you stop feeling pains that were otherwise progressing or you feel that the pains that were progressing, have slowed down or become weaker.

Tips for normal delivery

Normal delivery is the best way for a baby to be born. It is the safest method of delivery for both mother and baby. It also has the advantage of early recovery, early mobility and early initiation of breast feeding for the mother. There are a lot of factors that determine whether you have a normal delivery or an operative delivery. These are best judged by your obstetrician, keeping in view the best interests of both you and your baby. However, there are a few things that you can do to increase your chances of normal delivery:

• Eat healthy and well balanced home made diet.
• Avoid street food and other outside food.
• Take your health supplements regularly
• Drink lots of water and stay hydrated

• Stay active and exercise regularly
• Get adequate sleep; at least 7-8 hours of sleep. Sleep early and wake up early.
• Stay positive and avoid negative thoughts. It’s good to meditate and do yoga.
• Practice breathing exercises; they are very helpful when you are in labor.
• Attend birthing classes: They help you a lot by preparing you for your delivery.
• Talk to your obstetrician during your prenatal visit. Inform your doctor about your inclination for a normal delivery. And if your doctor thinks that you can go ahead with a normal delivery, then develop a birthing plan in consultation with your doctor.

For more such interesting information on women's health, kindly visit our website Expert Gynae Care and our YouTube channel @drnidhigarg

To consult Dr. Nidhi Garg, please visit us at Kamal Hospital, Doaba Chowk, Jalandhar-144004 or Visit our website kamal Hospital jalandhar or Expert Gynae Care