Stages of Labour and delivery
No two labors are alike. Labor may be long and difficult or it may be short and uncomplicated. Unfortunately, there is no way to predict what your labor will be like or how you will respond to it. When labor begins, you may feel the contractions as mild cramps or they may be very uncomfortable. As labor progresses, the contractions become stronger and more frequent. In active labor the contractions usually occur about every 2 to 3 minutes and last from 45 to 90 seconds.
Usually the membranes rupture spontaneously either before or during labor. But if they do not, they are ruptured artificially before the delivery. The cervix, the lowermost portion of the uterus, must open so that the baby may be born. During most of pregnancy the cervix is firm, thick, and long, with only a very small opening in the center.
Late in pregnancy the cervix becomes softer, thinner, and may begin to open before the onset of labor. When labor begins, the changes in the cervix take place much more rapidly. The contractions of the uterus push the baby’s head against the cervix and cause it to open. In order for the baby to be born, the cervix must be fully dilated to 10 centimeters (about 4 inches)
The first stage of labor is the time from the onset of labor to the time when the cervix is fully dilated. The length of this stage of labor varies greatly from woman to woman. It averages 8 to 12 hours in most women having their first child, but it can be much shorter or much longer. In subsequent pregnancies it is usually shorter.
Near the end of the first stage of labor, when the cervix is almost fully dilated, the contractions are usually quite strong. The contraction causes the woman begins to feel the urge to push with them. This part of labor is called transition. After complete dilation, with pushing and the force of the contractions the baby descends in the pelvis. In many cases baby usually turns to the most favorable position as it descends.
It is sometimes necessary to induce labor instead of waiting for it to start spontaneously. For example, if the mother develops severe pre-eclampsia or has diabetes, if the baby is long overdue, if fetal monitoring indicates that the baby’s life is in jeopardy, or if labor does not begin spontaneously after the membranes rupture, labor may have to be induced. In some cases it is induced by the artificial rupture of membrane. In most cases an infusion of a solution of pitocin (oxytocin), which causes the uterus to contract, is necessary. Intravenous pitocin may also be administered to stimulate spontaneous labor that is progressing very slowly. This solution is given intravenously in gradually increasing amounts. Induced labor may be both faster and stronger than spontaneous labor.
A difficult and painful labor may require some anesthesia or analgesia. Anesthesia may also be required for medical reasons or for a forceps delivery. The most commonly used medications for labor are pain-killing drugs such as Demerol. With small doses many women are less uncomfortable but still wide awake and able to participate in and enjoy the delivery of their child. However, some women find that even small doses of these medications make them drowsy or nauseated.
Epidural anesthesia involves the insertion of a needle in the mother’s back. The injection of a Novocaine drug into the space next to the spinal canal. An epidural will normally eliminate pain from approximately your waist to your toes and will make it difficult to move your legs. This technique allows you to be completely awake but free from pain. Caudal anesthesia is similar to an epidural but the needle is inserted at a point much lower on your back.
Epidural or caudal anesthesia requires a specially trained anesthesiologist and is not available at all hospitals. These anesthetics do not always work perfectly and they may have undesirable side effects. Some women are numbed on only one side of their body or not at all. Some times this type of anesthesia can cause the contractions to become less frequent and it often interferes with the mother’s urge to push during the second stage of labor. By lowering the mother’s blood pressure, epidural or caudal anesthesia can even cause a temporary slowing of the baby’s heartbeat.
Unlike epidural or caudal anesthesia, spinal anesthesia is used to provide relief only for delivery. Saddle block is a type of spinal anesthesia. A needle is inserted into the back and the medication is injected into the space that contains the spinal fluid. Under spinal anesthesia most women are completely numbed from their waist to their toes. When spinal anesthesia is given for a cesarean section, the numbness usually extends to the lower part of the ribcage. The numbness may last for several hours after delivery. This is also depending on the type of anesthetic used and the individual’s sensitivity to it. A small percentage of women may have a severe headache for several days after spinal anesthesia.
Local anesthetics can be used in various ways during labor and delivery to provide pain relief. Para-cervical block is the injection of local anesthetic into the tissue adjacent to the cervix during labor. Para-cervical block involves the numbing of the nerves that supply the lower vagina and perineum. This technique is often used in order to perform a forceps delivery. Finally, local anesthesia may be injected directly into an area where an episiotomy is to be cut or a tear is to be repaired.
The second stage of labor extends from full dilatation to the delivery of the baby. The length of this stage also varies. It may last two hours or more with the first baby but is usually much shorter in subsequent pregnancies.If an episiotomy is necessary, it will be done after the top of the baby’s head becomes visible.
An episiotomy is an incision made in the perineum to expand the vaginal opening. This allow the baby to be born without extensive stretching or tearing of the muscles and tissues in this area. Some physicians and midwives believe that an episiotomy should be performed as infrequently as possible. This is because it’s not always necessary and may be uncomfortable. Others believe that it should be done in most cases to avoid the stretching and tearing. In countries where episiotomy are seldom used, there is an increased incidence of protrusions of the bladder or rectum into the vagina in older women who have had several children.
The first part of the baby to emerge is usually its head. Then the shoulders are delivered and the rest of the body slips out easily. After emerging, the baby will take a first breath and cry a first cry. When the baby begins breathing, oxygen is received through the lungs rather than through the placenta and the umbilical cord. At this time the cord is clamped and cut.
There is no need to become alarmed if forceps are used to assist in the delivery of your baby. Forceps are metal instruments, shaped somewhat like a pair of large spoons. It fit against the sides of the baby’s head and are used to guide it through the birth canal. Marks commonly caused by the forceps may remain on the baby’s cheeks for several days and are not indicative of any problem. Forceps are often used if an emergency delivery is necessary as in the case of “fetal distress” or bleeding.
However, if these problems occur early in labor, before the cervix is fully dilated, a cesarean section may be necessary. Sometimes forceps are used because the mother is too exhausted to push the baby out. And there are times when the baby’s head is tilted in a position that makes spontaneous delivery very difficult. Some doctors believe that premature babies should always be delivered with forceps to protect the head from the pressure of the birth canal.
A device sometimes used as a substitute for forceps is a vacuum extractor. It is a suction cup that is placed over the baby’s head to guide it through the vagina. A vacuum extractor does not leave marks on the baby’s cheeks. Howeer, it may leave a temporary swelling or bruising of the top of the head.
Recently some hospitals have modified the environment provided for labor and delivery. In some places routine deliveries may be done in a bed rather than on a delivery table. There are other places the delivery room is darkened and soft music played. In still others an attempt is made to give the delivery room a more homelike atmosphere by the installation of curtains, carpeting, and pictures. Such rooms are called birthing rooms.
Generally only women who have uncomplicated pregnancies and wish to deliver without anesthesia are permitted to give birth in a birthing room. One or two support persons (visitors) are encouraged to be with her through labor, delivery, and recovery. In many places a support person can be present in a regular delivery room, even during a cesarean section.
This delivery technique requires lights and noise are kept to a minimum. The child is placed on the mother’s abdomen for several minutes before the umbilical cord is clamped. The baby is promptly given a bath in warm water. This technique was devised to try to ease the trauma of the newborn’s entry into the world.
The third stage of labor involves the delivery of the placenta. Usually within a few minutes after the delivery of the baby the placenta separates itself from the wall of the uterus and is expelled. After this point the episiotomy or any tears are repaired. Dissolving sutures are usually used; there are no stitches to be removed.