7800 Wolf Trail Cove, Germantown, TN 38138 • (901) 682-9222 • Open Weekdays 8:00 - 5:00
LABOR AND DELIVERY
During the last month of your pregnancy, there are lots of signs that your body is preparing you for delivery. You may or may not experience the following:
- "Nesting" instinct or a sudden energy boost and desire to organize
- Increased Braxton-Hicks contractions
- A lightening or dropping of the baby that results in an increase in the frequency of urination and allows you to breath easier.
- Upset stomach with/without diarrhea
- Loss of mucous plug that may cause some spotting
- Spotting due to the opening of the cervix (cervical exams may cause spotting)
How can I tell when I am in labor?
The game of guessing if it is really labor or just Braxton-Hicks will get old quickly as you near your due date. Do not despair. Every practice contraction is pushing your baby closer to the real thing. Here are some signs that you might really be in labor:
- Timing of your contractions is regular and the time in between gradually gets smaller and smaller. Contractions should be timed from the beginning of one to the beginning of the next.
- Movement or walking makes the contractions stronger.
- Back pain
- Membranes rupture (water breaks)
Ruptured membranes can occur before the onset of labor. If you suspect that your membranes have ruptured you should call your doctor. It is not always obvious and sometimes it can be confused with incontinence or normal vaginal discharge. Undetected or ignored ruptured membranes can lead to infection. Often, if labor does not begin within a few hours of your water breaking, then the physician may choose to induce labor with medications such as pitocin.
The Three Stages of Labor
- Stage One: Beginning of Labor until the cervix is dilated to about 5cm. The first stage of labor can last from 3 weeks to 1 hour. The mucous plug is disengaged from the cervix and passed through the vagina. Effacement (the thinning of the cervix) and dilation (opening of the cervix) begins to occur. Normally, the cervix is 2 inches thick. A cervix that is 80% effaced is only one inch thick. Contractions will be mild, lasting less than a minute and several minutes apart. You should make your way to the hospital at this time.
- Stage Two: Active Labor (5 to 8cm dilated). During this stage, the baby begins to move down the birth canal until it crowns (the head is visible), and you will feel an urge to push. The baby's head is usually delivered face down, and then the rest of the body follows after the shoulders have been turned. The second stage of labor lasts on average 2 hours and 45 minutes. Contractions are now 3 to 4 minutes apart and last a little over a minute.
- Stage Three: Baby Delivery to Placenta Delivery. The hardest work is over now and you may be holding and enjoying your baby already. During this phase your contractions subside, the umbilical cord is cut, the placenta is delivered and any repairs from an episiotomy will be performed. This phase usually lasts no more than half an hour.
Pain Management During Labor and Delivery
Natural childbirth is very often a goal for many women during delivery. However, it is important to know what pain relief options are available and be prepared to instruct your caregiver of your choice. The following is a partial list of pain relief options you may or may not choose:
- Epidural - one of the most common choices, the epidural numbs the lower half of the body while still allowing you to maintain control of your muscles. It is an injection into the back. Often a line is left in so that additional pain medication can be delivered if needed. Potential side effects include heaviness in the legs, numbness, and sometimes a drop in the mother's blood pressure.
- Intravenous injection - pain medication can be delivered directly into the vein. This type of medication will often be used to take the "edge" of the pain but may cause drowsiness and a lack of concentration.
- Local anesthesia - numbing a small area by injection. This is often used during the episiotomy or during the episiotomy repair.
- Spinal block - this differs from the epidural in that it totally numbs the lower half of your body and is only temporary. Additional relief would require another shot. Potential side effects may include headaches, nausea, and a drop in blood pressure.
These are the most common pain relief options. Your doctor may offer you additional options.
If you have additional questions or need information on another topic, please take note and ask the nurse or doctor at your next appointment.
Pregnancy-related Pain
Aches and pains are extremely common during normal pregnancy. For example, back pain during pregnancy occurs in up to 50% of pregnant women, and in some cases, may be severe and debilitating. As the pregnancy progresses, the baby grows and the uterus expands to accommodate the growing fetus. This not only causes discomfort in various parts of the body, but it also changes the balance for the mother. Other common symptoms include muscle fatigue, pelvic pain, discomfort in the buttocks area, as well as generalized muscle spasms.
Causes of Pain in Pregnancy
There are several reasons why a normal pregnancy is accompanied by many aches and pains. An understanding of the sources of pregnancy-related pain is extremely helpful in moving toward avoiding and/or alleviating the discomfort.
- Weight - A typical pregnancy adds 20 to 30 pounds, much of it located in the lower abdominal area. This extra weight puts additional pressure on the hip, knee, and ankle joints, common areas where pregnant women have problems.
- Hormonal changes - Under the influence of pregnancy hormones, ligaments throughout the body become looser and less supportive for joints. Because it is the ligaments that hold bones together, this is a critical factor in creating pains that are normally felt in pregnancy. In fact, this is a useful change, as the joints of the pelvic area need to ultimately be more flexible to allow the baby to pass through the birth canal during the process of a vaginal delivery. Unfortunately, the looseness or laxity of these joints also results in loss of stability of the pelvic and low back joints. The woman, as a result, is more likely to have sprains in this area and may require additional physical activity to support these areas.
- Posture - As the baby grows, the body accommodates. In the upper portion of the back, the ribs change how they move and how they are attached. In addition, the breasts become heavier as they are prepared for possible breastfeeding. These changes result in an altered posture of the upper back. At the same time, in the lower back, the normal curvature is exaggerated as the center of gravity of the body shifts forward with the growth of the uterus and the baby inside.
- Muscle changes - Because of the many changes, and because the mother must change how she accomplishes simply activities, muscles are overworked or are used in ways that they had never been used before. They are used to compensate for changes in posture, to hold together loose joints, and to carry the extra weight of pregnancy. The muscles involved include those of the neck, shoulders, back, buttocks, and legs.
Helpful Hints
To help prevent problems, some of the following may be of benefit:
- Do not lift heavy objects. If it is necessary, ask for help.
- Sleep on a firm mattress. Sometimes having a board placed between the box spring and mattress may help make the mattress firmer.
- Wear low-heeled shoes. Neither high heels shoes nor flat shoes are good for your posture.
- Sleep on your side with a pillow or two between your legs for support.
- Application of cold or heat to the painful area may relieve the pain. Massaging the area may also help.
- When sitting in a chair, choose one with good back support. If this cannot be accomplished, place a small pillow behind the lower portion of the back for support.
- When lifting, bend your knees, squat, and keep your back straight. Do not bend over at the waist.
- If you must stand for a long period of time, place one foot on a box or stool to help relieve discomfort.
- If pain persists, a maternity girdle, back brace, or similar device may be recommended to relieve some of the discomfort.
Thomas G. Stovall, M.D.
Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women's Health Specialists, Inc.
Date Published: 2004-03-04
7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505