Labor and Delivery- The Ultimate Guide for the Mother-to-be

Labor and delivery is a very crucial time in the pregnancy timeline. This is an ultimate guide to labor and delivery which includes signs and stages of labor, pain management, types of delivery, care during delivery, fetal position during delivery, etc. Read till the end to get a birds-eye view of the entire process of labor and delivery.

What is Labor?

At the end of the third trimester of pregnancy, the body begins to shows signs that its time for the baby to be born. The process that leads to the birth of the baby is called labor and delivery.

Labor is a physiological process during which progressive, continuous contractions of the uterus help the cervix to open, allowing the fetus with the amniotic membrane, umbilical cord, and placenta to be expelled from the birth canal.

Although each labor and delivery is different, mostly it follows a general pattern. Therefore it is always possible to explain to the expectant mother what changes her body will go through during labor and delivery and procedures followed to help her deliver. Detailed information before delivery helps to get emotionally and psychologically ready and gives a feeling of confidence.

She also has several choices to make. Whether she wants her partner to stay with her in the early phase of labor and of course if she wants to have labor analgesia.

Signs of labor

• Lighting or Dropping

The process of the baby lowering into the pelvis just before labor is called lightening. It may make walking difficult for pregnant ladies. Breathing difficulties ease as the baby drops down in the pelvis reducing pressure on the lungs. In some cases, lightning may occur a few weeks before delivery.

• Show / Vaginal mucous discharge

The mucus plug at the cervical opening discharges in the vagina as the cervix gradually dilates for the impending labor. It is known as a show or bloody show. It may be colorless, odorless or pink or reddish.

• Increase in the urge to urinate

Lowering of the fetal head in the pelvis puts pressure on the bladder causing this symptom.

• Lower abdominal and back pain

Pregnant women may have intermittent contractions in the lower abdomen or a dull ache in the lower back. Most of the time contractions start from the back and radiates in front of the abdomen and pelvis. To start with it may be mild for a few seconds but gradually increases in strength and frequency.

When you start having contractions lookout for…

1. How long contractions last

Actual contractions may last from 30 to 60 seconds.

2. Are your contractions regular?

Contractions of real labor become progressively stronger and closer.

3. Do contractions stop in-between?

Actual labor contractions will continue regardless of your activity and rest.

• Rupture of membrane/ Leaking

The bag of amniotic sac membrane which contains the baby ruptures either due to the pressure of contractions or otherwise. It causes amniotic fluid to discharge from the vagina which is known as Leaking. Whenever you experience leaking, urgently notify your doctor. The time between the rupture of the membrane to delivery is crucial as it may increase the chances of infection if not delivered early.

• Diarrhea  

Few pregnant women can have loose motions in early labor.

Dear expectant mothers, if you have any of the above signs please notify your doctor urgently and fix an emergency appointment with your caretaker.

Stages of labor and delivery

As mentioned earlier, each patient’s labor is unique but grossly it can be divided into 3 stages.

Stage 1: Early and active labor

The first stage of labor starts when you begin to feel regular contractions which allow the cervix to soften and dilate allowing the baby to move in the birth canal. It is the longest of the three stages and it is divided into 2 parts

1)Early labor

You will have mild contractions and may have bloody discharge from the vagina.

Its duration is unpredictable, from a few hrs to one day.

What you can do in early labor

• Take a walk
• Take a warm water shower
• Listen to music
• Practice breathing exercises
• Be calm and confident
• Drink sufficient water and keep liquid intake adequate.
• If hungry prefer soups and a light diet
• Even if no contractions occur but if you have a leaking or ruptured water bag, contact your doctor and go to the hospital.

2) Active Labour

In this, your contractions become stronger, frequent, and painful. You may have leg cramps and may feel nauseated. The water bag may rupture if not previously ruptured. Active contraction dilates your cervix from approximately  4cm to 10 cm and pushes baby deep in the birth canal. Before its too late head to your hospital if you are at home.

The last part of active labor is intense making you feel to push. Listen to your doctor. Pushing baby early may make you tired and it may cause the cervix to swell. So be patient ladies!

This phase lasts from 4 hours to 8 hours and the cervix approximately dilates one cm per hour.

What you can do to ease pain

• Talk to your doc about pain relief and if you have opted for epidural analgesia, they may administer it in this stage.
• Don’t hesitate to call for help if in trouble or stress.
• Keep on doing breathing exercises and relaxing techniques taught to you.
• Listen to soothing music.
• You can have a gentle back massage in between contractions.
• Change position frequently.
• Be calm and confident. You will sail through it.
• Keep on sipping liquids and juices.

If your doctor thinks you may need a Caesarean section, they may advise you to take clear fluids, to avoid the risk of anesthesia.

Stage 2:: Birth of your baby

Hurray…! You are going to deliver your baby now. Though this is the hardest of all stages but rewarding too. So cheer up.

It may last from a few minutes to a few hours.

What you can do in this stage of labor and delivery

• Cooperate with your care provider. Listen to their advice.
• Push! You may be asked to bear down during the contraction.
• Though you may have a continuous urge to push, do it when said. This will help you to relax in between and ease pressure on the vagina too. This may help the vagina to stretch and not tear up.
• Once the baby’s head is delivered, the body follows.
• Once the baby is delivered, the umbilical cord is cut and the baby’s airways are cleared.
• After cleaning and clearing the baby airways from secretions, the baby is put to the mother’s breast.

Stage 3:: Delivery of Placenta

After your baby is born, you will be relaxed as pains of contractions eases. They can put the baby in your arms.

 I love cherishing those moments of love, affection and gratitude on the mother’s face once the baby is given to mothers for the first time..!  I  love that moment.. and that’s why I love my profession so much.

  In this stage, the placenta is separated from the uterus and expelled out.

How long it can last?

Expulsion of the placenta generally takes 30 minutes after delivery of the baby but it may take an hour sometimes.

What you can do?

• Relax and cherish this time with your baby.
• If you like, you can breastfeed the baby.
• Few may feel tired after delivery and want to relax.
• You may feel light contractions that will help the placenta to separate from the uterus.
• You will be asked to push one more time to deliver the placenta.
• Medication shall be administered to help contract the uterus.
• If the doctor has given episiotomy ( surgical small cut in the vagina to aid delivery) they may suture it under local anesthesia.

Pain Relief Techniques And Methods during Labor and Delivery

In early labor and part of active labor following methods can help you relax and decrease your pain. Though you may discuss pain-relieving methods before your delivery date with your doctor, some times things may change during labor. Few methods to help reduce your pains are.

• Walking in early labor as well as inactive labor help you ease the pain.
• Listening to music helps calm your nerves.
• Breathing exercises and relaxing techniques are your go-to things.
• Lamaze breathing is a rhythmic breathing exercise, if practiced during labor it will help you reduce anxiety and pain perceptions in active labor.
• Bradley’s method of natural childbirth encourages expectant mothers to focus on exercises and the right nutrition throughout pregnancy and manage labor through deep breathing exercises with the support of a partner.
• Taking hot showers may decrease your back pains.
• Ask your partner to lightly massage your back. It helps in reducing pain.
• A mild analgesic may help in reducing pain to some extent in early labor.
• You can opt for epidural analgesia during labor. Discuss these methods before your delivery so that you are aware of its advantages as well as disadvantages. Though it is safe, in some cases, it may hamper your ability to push down actively in the second stage of labor.
• Spinal Anesthesia is generally used if the Cesarean section is to be done for delivery.

Induction of labor::

When uterine contractions are stimulated before labor begins on its own, to help deliver vaginally is known as induction of labor. Mostly recommended when there is a concern for the mother or baby’s health.

Reasons for inducing labor are:

1)Post-term pregnancy by 2 weeks of the due date.

2)Pre labor rupture of membrane and no pains.

3)Intrauterine growth retardation of the fetus …means baby is not growing as required and your baby is safer outside than in the uterus.

4)Oligohydramnios..amniotic fluid around the baby is reduced giving risk to the fetus.

5) Pregnancy Induced Hypertension in pregnancy poses risk to the fetus as well as mothers.

6) Gestational Diabetes in pregnancy

7) Placental abruption

8) Chorioamnionitis…is the infection of the amniotic sac in the uterus giving risk to the baby.

How is the induction of labor done?

• By cervical ripening( Softening )…in which medication is inserted inside the vagina which helps the cervix to soften and dilate.
• By rupturing the amniotic membrane..it releases amniotic fluid and may start uterine contractions.
• Intravenous medication..which stimulates uterine contractions and cervical dilatation.

Contraindications of induction of labor

• Previous Cesarean section
• Placenta Previa
• Abnormal presentation of the baby like breech and transverse lie
• Umbilical cord prolapse in the vagina.

Fetal position during labor:

The most common position of a fetus during labor is the Cephalic position. This means the baby is head down in pelvis with back anterior and face towards the mother’s back. This is known as Cephalic presentation.

Throughout the pregnancy, the baby can move inside the uterus and may keep on changing position. But 32 weeks onwards baby takes to head down position. Movements and walking in pregnancy help the head to move down further in the pelvis thus aiding in normal vaginal delivery provided your bony pelvis is of adequate size for the baby’s head.

Though this is the most common presentation where the baby head is down in pelvis with the baby facing the mothers back and chin tucked to chest..there may be a different position which may pose risk to the baby.

Other presentation of fetus maybe

• Breech presentation:

Buttocks or legs descend in the pelvis n the head is high up. Chances of chord prolapse are more and in the first pregnancy, this presentation may require to do elective Cesarean section.

• Transverse lie:

Not a good position for the baby as it increases the chances of early membrane rupture and umbilical cord prolapse in the vagina. This surely calls for elective Cesarean delivery.

• Face presentation:

Sometimes baby descends in the pelvis with head down but with face down or sometimes facing towards the mother’s abdomen. This position requires expertise in diagnosing as well as delivering such babies. And very important is the decision of doing Cesarean when not possible for vaginal delivery.

Prolong labor not only causes maternal exhaustion but more concerning is impending birth asphyxia to the baby.

Types of Delivery

1)Vaginal delivery

When the baby is head down in cephalic presentation and the mother’s pelvis is assessed to be adequate for the baby head, this is the most common type of delivery.

Sometimes though the mother’s pelvis is of adequate size due to exhaustion they are unable to bear down in the second stage of labor. Here comes the role of aided delivery like vacuum applications to help deliver the head. Again expertise in such maneuvers plus timing of application is very very important.

Giving Episiotomy…A surgical cut in the vagina may help in vaginal delivery in the first pregnancy.

2) Cesarean section

Indications are

• When the mother’s pelvis size is not adequate.
• The baby is in a different position like a Transverse lie or Breech position.
• Placenta Previa…where placenta is positioned in the lower part of the uterus as compared to its position in the fundus of the uterus.
• Umbilical cord prolapse
• Fetal distress
• Though the pelvis is adequate cervix fails to open up despite medications.

Every patient is different and every pregnancy and labor calls for individualized advice and treatment. Do keep faith in your doctor and listen to their advice on labor and delivery. Believe in professional help than relying on other patient’s advice. Though it helped them,  it may not be right for you. If in doubt ask the doctor your queries. This is the most important phase of your life. Make it enjoyable and healthy for you as well as safe for your baby.

Good Wishes Dear Mothers!

Happy Parenting and Happy times ahead  !!

About the author

Dr. Meenal Dhabalia, M.D (Gynaecologist & Obstetrician) 

She has a robust experience of 25 years as an Infertility Consultant, Obstetrician, and Gynaecologist,

Laparoscopic surgeon. Her expertise in Infertility treatment, High-risk pregnancy, and Gynaec endoscopy is well known. She is the Medical Director of Aditi IVF and Medical Centre, Dattani Park, Kandivali East, Mumbai. She is also the Chief Consultant in Aditi Superspeciality Hospital, Asha Nagar, Kandivali East Mumbai.

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