Labor and Delivery

Quick look at labor & delivery

Labor and delivery is a unique process to each woman. Labor is the process a woman’s body goes through in delivering her baby. Giving birth is the end of pregnancy when a baby (or babies) leaves the uterus. For some women, the process occurs very quickly. For others, it may be a slower, more prolonged event lasting many hours.

Signs of labor include the thinning and opening of the cervix, water breaking and regularly timed contractions that increase in frequency and severity.

A birth plan allows a woman to discuss in advance of giving birth her birthing preferences with her doctor and healthcare providers, such as the desired approach to pain management.

Signs of labor

Some women experience a sudden onset of labor, while others experience the signs and symptoms of imminent birth more gradually. Normally, labor and birth occur at the end of pregnancy, approximately 35 to 40 weeks after conception. This section describes typical aspects of labor.

Water breaking

Throughout pregnancy, the fetus grows and develops within a protective fluid-filled membrane called the amniotic sac. Shortly before labor and delivery begin, the sac may break, allowing the amniotic fluid to flow out. This is often referred to as “water breaking,” and it is one of the tell-tale signs that labor is beginning. It may be experienced as a sudden gush of fluid from the vagina or a more gradual trickling.

Effacement and dilation of the cervix

The cervix is a tube that connects the uterus to the vagina. As the body prepares for birth, the cervix will stretch and become thinner in a process called effacement. It will also begin to open, or dilate. A doctor will assess how dilated a woman’s cervix is by performing a vaginal exam with a gloved hand. During the exam, the doctor will feel how open the cervix is and will describe it in terms of centimeters of dilation (from 1cm to 10cm).

During cervical effacement and dilation, a woman may experience some discomfort or a spurt of irregular, minor contractions. Another sign of cervical effacement and dilation is bloody mucus discharge from the vagina. During pregnancy, this so-called “mucus plug” seals the cervix and protects the fetus from infection. As the cervix opens and labor becomes imminent, this mucus releases. The release of the mucus plug does not indicate when the baby will be born.

Contractions

During the later stages of pregnancy, many women experience irregular contractions as the uterus tightens and releases. These are called Braxton Hicks contractions and they may or may not be painful. These types of contractions tend to occur without pattern and without increasing severity. They are a normal part of pregnancy and should not be cause for alarm.

Contractions that indicate the beginning of labor, on the other hand, occur with regularity and become increasingly longer, stronger and closer together. True active labor contractions last anywhere from 30 seconds to over a full minute, and will become more painful and frequent as the body prepares to give birth.

Distinguishing labor contractions from Braxton Hicks contractions can be difficult. One helpful trick is to follow the 5-1-1 rule. Contractions occurring every 5 minutes, lasting 1 minute in duration, and having continued for 1 hour indicate that labor may be beginning.

Labor & delivery: giving birth

Labor can last anywhere from a few minutes to many hours, and it is important to remember that every delivery is different. The approach to labor pain management varies based on the woman’s preferences. The route of delivery (vaginal or cesarean section) is based upon individual factors for each patient and her baby as discussed with her doctor.

An individualized birth plan

There are many things to weigh and consider before labor actually begins. Each expectant mother may have a number of concerns, questions and desires regarding the labor & delivery process. CU Medicine OB-GYN clinics place a high value on fully addressing every one of these concerns, taking the time to carefully craft an individualized birth plan based each woman’s needs and desires.

Each of our moms-to-be is presented with an array of options related to pain management, coaching methods, physical position during delivery, what will happen immediately after giving birth, and more.

All of our doctors have the same foundational birth plan for each family: healthy mom, healthy baby (or babies) and, to the best of our ability, a vaginal birth. Unfortunately, expectant parents cannot control all of the aspects of their labor and delivery experience, as their baby might have other plans! We are very open to a family’s requests and preferences for their birth experience, and we are happy to discuss specifics at their next appointment.

Natural birth

Some women opt to give birth without any type of pain medication. Natural birth, or an unmedicated birth, is a viable option for many women.

During natural birth, pain relief is achieved via non-narcotic methods including massage, rhythmic breathing such as the Lamaze technique, hypnotherapy, or bathing in warm water.

The decision to pursue a natural birth should always be made in close partnership with a trusted OB-GYN doctor.

Labor pain relief

Pain relief is one of the chief concerns that women have prior to giving birth. Our OB-GYNs thoroughly discuss with each patient during the birth planning process the risks, side effects and benefits of each method of pain relief.

• Epidural anesthesia is the most commonly used form of labor pain management. According to the American Pregnancy Association, epidurals are used in more than 50 percent of hospital deliveries. An epidural is a local anesthetic, meaning it blocks pain in just one region (in this case, the lower half of the body), while allowing the woman to remain awake and alert throughout the delivery. Epidurals are delivered via spinal injection, and a catheter is inserted so that medication can be delivered throughout labor. An epidural is also beneficial for pain relief if stitches need to be placed after a vaginal delivery.

• Spinal anesthesia is another type of local anesthetic, but differs from an epidural in that the injection is administered directly into the spinal fluid with a smaller needle and without a catheter. Because of these differences, spinal anesthesia provides faster relief than an epidural but lasts for a shorter period of time. Spinal anesthesia is often used for planned C-sections.

• Opiate medications may be used on their own or in conjunction with a local anesthetic. Opiates, which are analgesics that can be given locally or systemically throughout the whole body, operate differently than local anesthetics because they reduce pain without causing numbness. Opiate medications have a number of side effects that may impact both the mother and the baby, depending on the type and amount of drug used.

Midwives & doulas during labor & delivery

CU Medicine OB-GYN clinics can refer patients to a midwife. We also partner with an expert team of doulas, or labor assistants. Doulas are trained professionals who specialize in offering physical and emotional support throughout childbirth.

Doulas support families through aromatherapy, massage, touch, position, relaxation and breathing in conjunction with a medicated or non-medicated delivery.

C-section

A C-section (short for cesarean section delivery) is when the fetus is surgically removed from the uterus by way of the abdomen rather than being delivered vaginally. Sometimes, a C-section is planned in advance due to known pregnancy complications, health concerns or a prior C-section. Other times, the decision to perform a C-section is made during labor.

A C-section may be performed for a variety of reasons, including:

• Labor that is not progressing after many hours of regular contractions
• Lack of oxygen to the baby
• The baby is in an abnormal position
• Giving birth to multiple babies (twins, triplets etc.)
• Health concerns for the mother or the baby.

VBAC

VBAC, or vaginal birth after cesarean, is when a woman decides to deliver a baby vaginally after having a cesarean delivery in the past. A woman may choose a “trial of labor after cesarean” (TOLAC), which is an agreement between her and her doctor to attempt a vaginal birth when a cesarean delivery has occurred in the past.

Depending on medical history and the reason for the previous C-section, VBAC can be a very reasonable and safe approach. Women often choose to pursue VBAC due to the decreased pain, recovery time, infection risk and scarring of a vaginal birth compared with a C-section.