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Labor and Delivery: How Do I Know When Labor Will Begin?
Labor and Delivery: How Do I Know When Labor Will Begin?
labor. Remember, your body was built to carry, nourish, and safely
With your pregnancy coming to a close, you are beginning to
deliver your baby. Some of the factors that affect the course of
anticipate the birth of your baby. Activities such as attending
labor include your health, nutrition, size and shape of your pelvis,
childbirth classes, having regular physician appointments, reading
size and presentation of the baby, your educational preparation for
books, talking to others, and asking lots of questions will help you
labor and birth, and the practice of exercises, relaxation and
prepare for the birth of your baby. Learning as much as possible
breathing techniques. During labor, the emotional support you
about labor and delivery, and learning what to expect will help you
receive, along with medical interventions, may also affects the
through this next step of your pregnancy.
course of labor.
• Comfort and pain management Each labor is unique. No one can predict exactly what your
• Various forms of labor individual labor will be like, or when it may begin. However, prior to
• How to recognize the early signs of labor andwhen the onset of labor, you will notice some signs that are nature's way
you should go to the hospital of telling you that labor is approaching. If you are not sure, call
• Helpful suggestions and tips for your partner in your physician or midwife to discuss your labor signs. In the event
how to support you through your labor you are evaluated at the hospital as being in very early labor and
sent home, it is common to feel disappointed, maybe even
embarrassed. It is common for first-time mothers to make more
Special Tips for First Time Mothers than one trip to the hospital. If you are in early labor and sent
Having your first baby is an extraordinary experience. We have home, the following may be helpful: walking, showering, resting,
compiled some specific information about labor and childbirth and drinking fluids, renting a video, listening to music, etc.
The Process of Labor • The baby "drops" or engages into the pelvis, which
is called lightening. Lightening may occur two to four
weeks prior to labor in first-time mothers and often not may be sufficiently strong and regular to be confused with
until labor begins if you have previously had children. true labor. This is referred to as false labor.
• Your abdomen usually appears lower and more • Possible "bloody show" or the release of slightly
protruding. brown, pink or blood-tinged mucus from effacement and
• You may experience a greater ease in breathing, dilation (the thinning and opening) of the cervix, causing
relief from heartburn and an ability to eat larger portions. the mucus plug to be released from the cervix.
• However, the lower position of the baby together • Some women notice a sudden burst of energy,
with its greater size, can lead to: sometimes called a "nesting instinct" approximately 24-48
• Increased backache and sacroiliac hours before the start of labor. You may feel a strong
discomfort desire to clean the house and prepare for the baby. Try not
to tire yourself as nature gives you this extra energy to
• Increased awkwardness in walking
help you during labor. If you must be active, be careful not
• Increased frequency of urination
to overexert yourself!
• Frequent bowel movements may be experienced
• A loss or leveling off in weight may be noticed in
within 48 hours of labor, cleansing the lower bowel in
the last few days before labor begins. It is common to lose
preparation for birth.
1-3 pounds of fluid before labor begins as a result of
• Diarrhea or flu like symptoms without fever. hormonal shifts.
Indigestion, nausea, or vomiting are common a day or so
• Mother just feels "different," not quite herself.The
before labor begins.
bag of water may break. Depending on the location of the
• Increased vaginal discharge during the last few break in the amniotic sac, the break can feel like a gush, or
weeks of pregnancy as the body prepares for the passage an uncontrolled trickle of fluid coming from the vagina.
of the baby through the birth canal. Anxiety and disappointment are very common feelings for mothers
• Increased Braxton-Hicks contractions during the as the "due date" approaches or passes without labor beginning.
last weeks of pregnancy, which are "practice" contractions Try to keep occupied and active, but do not wear yourself out!
that prepare the uterus for labor and may cause some
effacement and dilation (thinning and opening) of the
cervix. These contractions do not ordinarily cause pain but
Variations of Labor indication as to whether or not this is really labor. Also, there may
be residual back pain
between contractions. The pushing stage may be longer due to the
Prodromal Labor
extra effort needed to rotate the baby to an anterior position (face
In a prodromal labor, the early phase of labor (cervix dilates from
towards mother's back). Some babies may not rotate and may
closed to approximately three-to-four centimeters) is prolonged
deliver in the posterior position.
with contractions that do not increase in intensity.
labor to progress. applied to your lower back where the pain is localized. This
can be given by your partner or nurse or by leaning against
a firm object, such as a rolled towel or tennis balls.
Back Labor
• A hot water bottle or an ice pack applied to your
Back labor refers to labor in which much of the pain or discomfort
back may offer some relief.
is felt in the mother's back. Sometimes, the baby is in a posterior
A warm shower or bath may be helpful.
position (facing the mother's abdomen).
• Sterile water injections into the skin of the lower
back. Discuss this with your healthcare provider
How is Back Labor Different?
With back labor, the onset of labor may be felt completely in your
Prolonged Labor
back and may create some confusion about whether labor has
In a prolonged labor, the entire labor progresses at a rate that is
really begun. Feeling your abdomen for "hardening or tightening"
slower than average. A prolonged labor may be due to many
when experiencing rhythmic back discomfort may offer some
factors such as the size or position of the baby or having an
epidural very early in labor. The four stages of the childbirth process are based on changes in
the uterus and cervix as labor progresses. The beginning and end
Relax as much as possible and avoid tiring yourself. Change of each stage are described below:
positions frequently and use gravity-assisted positions (such as
standing and squatting) during a contraction. Walking and relaxing First Stage of Labor
in the shower or tub may be helpful. Every woman and her labor • Begins at the onset of labor and ends when the
are unique. If your progress is slower than cervix is 100 percent effaced and completely dilated to 10
anticipated, try not to be discouraged. Recognize that this is the centimeters.
natural progression for your particular labor. Relax and allow • Average length ranges for a first-time mother is
yourself to work with each contraction one at a time. from ten-to-fourteen hours and shorter for subsequent
births.
How Contractions are Timed The easiest way to time contractions is to write down on paper the
Contractions are intermittent, with a valuable rest period for you, time each contraction starts and its duration, or count the seconds
your baby, and your uterus following each one. When timing the actual contraction lasts, as shown in the example below.
contractions, start counting from the beginning of one Writing down the time and length of the contraction is extremely
contraction to the beginning of the next. helpful for describing your contraction pattern to your physician,
midwife or hospital labor and delivery personnel.
2. Medicine may be used to cause the uterus to indicates distress, a cesarean delivery (C-section)
3. A balloon catheter (such as a Foley catheter) may 3. Dinoprostone (such as Cervidil or Prepidil Gel) can
be used to help the cervix open. be inserted as a suppository into your vagina
(intravaginally). It can also be given as a gel that is
4. If your cervix is soft and slighty open, sweeping the
gently squirted into the opening of the cervix
membranes or rupturing theamniotic
(intracervically). When the cervix is ripe, labor may
sac (amniotomy) may start or increase
start on its own.
contractions.
5. If labor does not progress after an amniotomy,
The cervix is considered ripe and ready for active labor when it is
medicine such as oxytocin (Pitocin) can be used to
soft, well-dilated, and effaced, and when the cervix and baby are
stimulate contractions.
positioned low in the pelvis. If the cervix is not ripe enough,
medicines may be continued until it is.
Medicine to ripen the cervix and induce labor
1. Misoprostol (Cytotec) is a pill taken by mouth or
Balloon catheter to help induce labor
placed in the vagina (using a smaller dose). It is a medicine
A balloon catheter, such as a Foley catheter, is a narrow tube with
currently approved for treating ulcers. Using it for cervical
a small balloon on the end. The doctor inserts it into the cervix and
ripening is a widely accepted but unlabeled use of this
inflates the balloon. This helps the cervix open (dilate). The
medicine.
catheter is left in place until the cervix has opened enough for the
2. Oxytocin (Pitocin) can be given through a vein balloon to fall out (about 3 cm).
(intravenously) in small amounts to ripen the
cervix. But it usually is given after the cervix Sweeping of the membranes to help induce labor
softens, to cause the uterus to contract. Labor that Sweeping, or stripping, of the amniotic membranes is a simple first
is induced by oxytocin usually starts off harder and step used to try to start labor. Sweeping of the membranes
progresses faster than labor that starts on its own, separates the amniotic membrane from the uterus enough so that
the uterus starts makingprostaglandins. This type of chemical To rupture your amniotic sac (amniotomy), your doctor inserts a
helps trigger contractions and labor. After the cervix is open a sterile plastic device into your vagina. This device may look like a
little, this step can easily be done in your doctor's or nurse- long crochet hook or may be a smaller hook attached to the finger
midwife's office. of a sterile glove. The hook is used to pull gently on the amniotic
sac until the sac breaks. This procedure is usually not painful. A
Sweeping the membranes works in 1 out of 8 women. This means large gush of fluid usually follows the rupture of the amniotic sac.
that it starts labor without needing to use oxytocin or artificially The uterus continues to produce amniotic fluid until the baby's
2
rupture the membranes. To sweep the membranes, your doctor or birth, so you may continue to feel some leaking, especially right
nurse-midwife reaches a gloved finger through the cervix. He or after a hard contraction.
she then "sweeps" the finger around the inside edge of the
opening. Augmentation
If active labor has started on its own but contractions have slowed
Sweeping the membranes is low-risk. It does not raise your risk of down or completely stopped, steps need to be taken to help labor
infection. You may start to feel uncomfortable afterward, with progress (augmentation). Augmentation will be done when:
2
irregular contractions and some bleeding. 1. Active labor has started, but your contractions are
weak or irregular or have stopped entirely.
Artificial rupture of the membranes to induce labor 2. You have gone into active labor, but the amniotic
sac has not ruptured on its own. In this case, your
To help start or speed up labor, your doctor may rupture your doctor or nurse midwife may rupture the amniotic
amniotic sac (rupture of the membranes). This should only be done sac (amniotomy) to augment labor. If labor still
after your cervix has started to open (dilate) and the baby's head does not progress, oxytocin (Pitocin) may be given
is firmly descended (engaged) in your pelvis. If the membranes are to make the uterus contract.
ruptured too early, there is a risk of the umbilical cord slipping
3. Active labor has started and the amniotic sac has
down around or below the baby's head (cord prolapse). If the cord
ruptured on its own, but labor still is not
gets squeezed between the baby's head and the pelvis bones, the
progressing. Oxytocin (Pitocin) may be given to
blood supply to the baby may be reduced or stopped.
make the uterus contract.
For some women, laboring in a warm tub or whirlpool (under True Labor
medical care) helps with a slow labor. This can make augmentation Contractions
unnecessary. • May be irregular at first
Pre Labor vs. True Labor • Lying down does not make them go away
If you have never experienced labor before, you may find it difficult • Often begin in your back and move to the front
to know if you are in labor. Before heading to the hospital, call your Cervix
physician or midwife to discuss your labor symptoms. • Changes by becoming thinner and starts to open
(dilates)
It is common for first time mothers to make more than one trip to
the hospital. If you are in early labor and sent home, the following False (or "Practice") Labor
activities may be helpful: walking, showering, resting, drinking Contractions
fluids, listening to music, etc.
• Usually are irregular and short
internal examination of the cervix. True labor contractions become cause them to stop
stronger, difficult to talk through, last longer, and are closer • Lying down may make them go away
together as labor progresses. These will effect changes in the • May be felt more in the front area and in the groin
cervix, causing it to thin out and open while encouraging the area
descent of the baby through the pelvis. • Beneficial in preparation for true labor
Cervix
• Very little change or no change; does not thin or • Nerve impulses from the uterus to the posterior
open pituitary gland may bring about release of oxytocin (a
hormone which causes the uterus to contract).
Prodromal Labor • Decrease in the level of the hormone pregesterone,
Contractions may cause uterine changes.
• May begin irregular and become regular • Adrenal glands of the fetus, when mature, may
• Usually stay five or greater minutes apart release a substance to stimulate labor.
• May feel strong, but usually do not get closer • The release of prostaglandin from the wall of the
together uterus may initiate labor.
others. It is not normal to have frequent contractions (more than If you think that you may be in premature labor, call your
five in an hour) before your baby is due.Call your health care health care provider immediately and:
provider immediately if you think you may be in premature • Empty your bladder
• Lie down on your left side and drink fluids • History of cervical change and/or excessive uterine
contractions at less than 33 weeks in a previous pregnancy
Risk factors associated with premature labor • Serious infections with fever (greater than 101
Some risk factors have been associated with a higher chance of degrees Fahrenheit) during this pregnancy
premature labor. However, just because you have some risk • Recurring bladder and/or kidney infections
factors does not mean that you will experience premature labor.
• Excessive amount of amniotic fluid
Review the following risks factors and let your health care provider
• Unexplained vaginal bleeding after 20 weeks of
know if any apply to you.
pregnancy
• Using recreational drugs, such as cocaine or
Possible risk factor for premature labor:
amphetamines
• Premature labor or delivery during a previous
• Domestic violence
pregnancy
• Misshapen uterus • Smoking more than 10 cigarettes per day
• DES (Diethylstilbestrol) daughter (If your mother • Extreme emotional or physical stress
DES has been linked to shortening of the cervix.) Your physician or midwife may consider initiating your labor for
several reasons:
• Abdominal surgery during pregnancy and/or
cervical cerclage (a stitch in your cervix) • To decrease the risk of infection if your bag of
waters has broken
• More than two second trimester miscarriages or
elective abortions • You are more than one week overdue
• Previous Cone Biopsy or LEEP (procedures used to • You have other medical conditions such as
diagnose and/or treat the cervix of women with abnormal diabetes or high blood pressure (pre-eclampsia).
Pap tests) Inductions can occur either by your physician or midwife initially
• Carrying more than one baby breaking your bag of water or by intravenous administration of a
medication calle pitocin. Pitocin is a synthetic form of the natural
• Dehydration
hormone oxytocin, which stimulates the uterus to contract. Often a tolerating it. Normally, the baby is born with his face looking
medication, misoprostol, is inserted vaginally prior to induction to toward mother's back (referred to as an anterior position).
increase elasticity of the cervix, to stimulate the contractions and However, some babies are facing the mother's abdomen (referred
enhance the effect of the pitocin. to as a posterior position). Posterior babies may have a more
difficult time passing through the pelvis, which may cause pushing
Continuous fetal monitoring is necessary when pitocin is used. An to be more difficult or require more than two hours of pushing.
intravenous pump carefully controls the quantity of pitocin given.
Usually, the pitocin is increased in small increments to gradually Contractions during the Pushing Stage
intensify the quality of contractions, somewhat like a spontaneous During the second stage of labor, the uterus continues to contract
labor. Many women, however, find contractions with pitocin are about every five minutes and each contraction lasts 45-to-90
stronger, peak more rapidly, and are more intense and painful. seconds. The contractions are usually strong and forceful and may
Because of these intense contractions, the labor may also be or may not be accompanied by an urge to push. This can make this
shorter. First-time mothers refer toSpecial Tips for First-Time phase somewhat more enjoyable since you are now working with
Mothers for more information. each contraction. A renewed sense of energy may occur as you
feel the closeness of your baby's birth!
Pushing: The Second Stage of Labor
The pushing stage occurs after the cervix is completely dilated and However, sometimes after a long or difficult labor, the pushing
no longer in front of the baby's head. A smooth passageway now stage can be exhausting and uncomfortable.
exists through which you can push your baby from the uterus and
down through the birth canal to delivery. Most women will feel increased pressure in their perineum, rectum,
and low back at this stage. For many women, the rectal pressure
Your contractions may decrease just prior to getting the urge to feels the same as having a bowel movement.
push. You should take this time to rest prior to pushing. The length
of this stage varies with the position and size of the baby and your As the baby's head begins to appear, you may feel a stretching or
ability to push with the contractions. For first-time mothers the burning sensation. You may want a mirror positioned so that you
average length of pushing is one-to-two hours. In some instances, can see your progress.
pushing can last longer than two hours if mother and baby are
Delayed Pushing Stopping your Pushing
Pushing is most effective when the mother feels the urge to push. There may come a time when you may be asked not to push with a
Women who receive epidural anesthesia may have the sensation contraction. This is for reasons such as the cervix is not fully
to bear down numbed by the anesthetic. The practice of "delayed dilated or the baby is crowning and the perineum needs to stretch
pushing" (waiting for the baby to passively come through the birth gradually. Usually these situations require you to stop pushing for
canal) has been studied as an alternative to start pushing at 10 a short time. During this time, relax your neck, shoulders and legs
centimeters. If you and your baby are doing well, a one-to-two hour and pant or blow out during the contraction. Visualize blowing out
period of "passive descent" is safe and may make your pushing candles. Your partner may need to hold your face, look directly in
more effective. your eyes, and pant or blow with you to keep you from pushing.
Pushing, for many mothers, is a powerful reflex that requires
Positions for Pushing considerable effort to breathe through rather than to push through.
There are many different positions that may be used for pushing.
In all positions, keep your chin down and use a rounded back to Breathing Techniques for Pushing
help your abdominal muscles assist your uterus in pushing your The breathing techniques used for pushing are varied and depend
baby. upon which works best for you. Your health care provider and labor
nurse(s) will offer suggestions and are your most valuable
The following suggestions of various positions for pushing and resources in evaluating your progress as you push your baby
advantages of each one. You may be able to speed the progress of through the birth canal.
the labor if you try positions where gravity assists you (i.e. sitting,
or squatting). However, if the baby is delivering quickly, you may Work with your contractions to enable yourself to maximize your
be able to slow the stretching of the perineum by trying positions efforts at the peak of the contraction. Grunting or groaning may be
where gravity is neutral (i.e. lying on your side, or getting on your helpful while pushing. Allow yourself the freedom to make the
hands and knees). It is important for your comfort to experiment sounds that come naturally. It is unnatural and possibly damaging
with pushing in different positions. Many women find pulling a to you and your baby to hold your breath for a long time. Holding
towel or sheet held by a partner or tied on the squat bar to be very your breath while pushing is fine to do if you feel it assists with
effective during a pushing contraction. bearing down.
separately. In terms of electronic fetal monitoring, it is either
Breathing and Relaxation external or internal.
During labor you will find that there are several tools available for
you to use that might make the labor more comfortable and more Fetal monitoring is a valuable tool for measuring fetal well being
efficient. As labor becomes stronger, and the contractions more and assessing labor progress. Due to the sensitivity of the monitor,
intense, you may find the following three tools very helpful: it may indicate a contraction is diminishing even before you notice
1. Relaxation — This is the main key for labor. It the pain subsiding. This information can be a very useful energy
allows you to save energy for the stronger, harder labor to saving tool and source of encouragement for you and your partner.
come, and provides increased oxygen for you and your Continuous electronic fetal monitoring does limit your mobility
Episiotomy
Internal Fetal Monitoring
An episiotomy is a surgical incision made in the perineum (the area
If your physician, midwife or labor nurse(s) feel a need to observe
between the vagina and the rectum) to enlarge the vaginal
the baby's heartbeat more closely, internal monitoring may be
opening. An episiotomy may or may not be needed. Techniques
used. A smallelectrode is attached to the baby's scalp to directly
such as perineal massage or warm compresses may assist in
monitor the baby's heartbeat. This is possible only after the bag of
softening and stretching the skin of the perineum. However, if the
water has/or is broken. Internal fetal heart rate monitoring may be
delivery is imminent, the numbing effect of the baby’s head
more comfortable since one of the pieces places around the
pressing against the perineum may enable the incision to be
mother's abdomen will be removed, which allows more freedom of
performed without discomfort and the use of local anesthesia.
movement.
nurse(s) during the birth (i.e. lie back and blow if instructed
not to push to allow your baby to come out slowly, and Cesarean Birth (C-section)
stretch the perineum gradually). Having a cesarean birth, means your baby is delivered through
incisions in the abdominal wall and uterus instead of being
• Warm compression on perineum by your coach.
delivered vaginally. Some cesarean births are planned because it is
known prior to labor that a vaginal delivery is not recommended
Episiotomy or perineal tear
for the safety of the mother and/or baby. Many however are not
An episiotomy is an incision made in the tissue between the vagina
planned and occur because of events in labor that indicate a
and anus (perineum). It is sometimes done just before a baby's
vaginal delivery is not possible or may jeopardize the safety of the
head emerges from the birth canal to speed up delivery of the
mother and/or baby. Because many cesarean births are not
baby. The incision is stitched up after delivery. Episiotomies are
planned, it is important to discuss this with your healthcare
more commonly used during first-time deliveries.
provider or childbirth educator and become familiar with the
Routine episiotomy is not recommended. Experts say that
procedures involved in a cesarean birth at your hospital.
episiotomy:1
1. Usually is not needed, especially during routine
Indications for Cesarean Birth
deliveries.
Cephalopelvic Disproportion (CPD) — Occurs when the
2. Does not tend to heal faster than a perineal tear
baby's head will not fit through the pelvis. This diagnosis may also
and typically causes more pain.
be used to indicate a labor that fails to progress, (a prolonged
3. Can cause more damage to the muscles around labor, an extended period of time since rupture of membranes or
the vagina and rectum than a tear does. weak, ineffective contractions.)
There are times when an episiotomy is urgently necessary. The
decision about whether to have an episiotomy cannot be made
Fetal Distress — The baby is not receiving enough oxygen. It
until delivery. If your health professional decides that an
may be indicated by an abnormal fetal tracing, or a drop in the
episiotomy is necessary, it will be just before delivery.
fetal heart rate when your healthcare provider or labor nurse
listens to the rate during or after a contraction. his/her oxygen supply.
There is no such thing as a "dry birth." Approximately one third of If you are lying down when your membranes break, you are more
the liquid is replaced every hour. likely to experience the rupture as a gush of liquid. If it happens
when you are standing up, it's more likely to be just a trickle
Rupture of the membranes because the baby's head gets pushed down against the cervix and
During pregnancy, your membranes break (rupture) when a hole or acts like a cork when you stand.
tear develops in the fluid-filled bag (amniotic sac) that surrounds
and protects the fetus. The rupture of the membranes is also called If you believe your membranes have ruptured:
“breaking of the waters.” 1. Contact your health professional. Your health
Your membranes can break by themselves (spontaneous rupture of professional may want to evaluate you as soon as your
the membranes), or they may be ruptured by the doctor or nurse- membranes rupture.
midwife to start or speed up labor (artificial rupture of the 2. Avoid letting anything enter your vagina. Do not
membranes). The spontaneous rupture of the membranes most have sexual intercourse or flush the vagina with
often happens once active labor has started, not prior to the start fluid (douche).
of labor.
Your contractions may get stronger after your membranes rupture. You can also go to the place you have selected for the delivery of
A large gush of fluid usually follows the rupture of the membranes. your baby. The health professionals there will test the drainage to
The uterus continues to produce amniotic fluid until the baby's determine if it is amniotic fluid.
birth, so you may continue to feel some leaking, especially right Amniotic fluid is normally a cloudy-white to an amber-straw color.
after a hard contraction (tightening of the muscles of the uterus). Let your health professional know if the leaking fluid is:
1. Dark or greenish. Meconium (from a baby's first
bowel movement) may be present. Bloody show
2. Foul-smelling. This could be a sign of infection in Bloody show is blood-tinged mucus that may come from the vagina
the uterus. as labor begins. When the cervix thins (effaces) and opens (dilates)
during early labor, the mucus plug that has been in the cervix will
3. Bloody. Small streaks of blood are normal, but if
loosen and pass out of the vagina, along with a small amount of
the entire fluid is stained with blood, it could be a
blood.
sign of a problem with the placenta.
Cervix
Artificial rupture of the membranes to induce labor
The cervix is the lower part of the uterus that opens into the
To start (induce) or speed up labor, the health professional may
vagina. It is also called the neck of the uterus.
rupture your membranes. This should only be done after
your cervix has started to open (dilate) and the baby's head is
Amniotic sac
firmly descended (engaged) in your pelvis. If the membranes are
The amniotic sac, or amnion, is a lining (membrane) inside the
ruptured too early, there is a risk of the umbilical cord slipping
uterus that contains the fetus and the fluid that cushions the fetus
down around or below the baby's head (cord prolapse). If the cord
(amniotic fluid). The amniotic sac is also called the “bag of waters.”
gets squeezed between the baby's head and the pelvis bones, the
blood supply to the baby may be decreased or stopped.
Perineum
The perineum is the muscle and tissue near the anus. In a woman,
To rupture your amniotic sac (amniotomy), your health
the perineum is between the anus and the vulva, while in a man, it
professional inserts a sterile plastic device into yourvagina; the
is between the anus and the scrotum.
device may look like a long crochet hook, or it may be a smaller
hook attached to the finger of a sterile glove. The hook is used to
Intravenous
pull gently on the amniotic sac until the sac breaks. This procedure
Intravenous means occurring within or by way of a vein.
is usually not painful. A large gush of fluid usually follows the
Medications or fluids may be given by inserting an intravenous (IV)
rupture of the amniotic sac. The uterus continues to produce
needle into a vein, usually in the back of the hand or on the
amniotic fluid until the baby's birth, so you may continue to feel
forearm
some leaking, especially right after a hard contraction.
A cesarean section is a surgical procedure, and recovery takes
Cesarean section longer than after a vaginal delivery. A woman recovering from a
A cesarean section, or C-section, is the surgical delivery of an cesarean delivery requires extra help during the first week or so
infant through an incision in the mother's abdomen and uterus. after delivery.
Some cesarean sections are planned when a known medical
problem would make labor dangerous for the mother or baby, High blood pressure (hypertension)
while others are done when a quick delivery is needed to ensure High blood pressure, or hypertension, is a condition in which the
the mother's and infant's well-being. force of blood against artery walls is too strong. Over time, high
Situations in which a cesarean section may be used include: blood pressure can damage the arteries, heart, and kidneys and
• Fetal distress. can lead to heart disease and stroke.
High blood pressure can be treated effectively with lifestyle
• Stalled labor that doesn't respond to medications or other
changes and medications that can reduce the risk of complications.
methods.
Blood pressure readings consist of an upper number and a lower
• Breech delivery.
number (such as 120 over 90 or 120/90). The upper number is
• Placenta problems.
systolic blood pressure; the lower number is diastolic blood
• A mother's HIV or active genital herpes infection. pressure. Blood pressure readings are measured in units called
• Some multiple pregnancies. millimeters of mercury (mm Hg). Normal blood pressure is 119 mm
• Umbilical cord problems that reduce blood flow to the Hg systolic over 79 mm Hg diastolic or below.
The incision may be made across the bottom of the abdomen • The bottom number (diastolic) is 90 mm Hg or higher.
above the pubic area (transverse) or, in certain cases, in a line
from the navel to the pubic area (vertical). In many cases, a Placenta abruptio
woman delivering by cesarean can remain awake during the Placenta abruptio is the separation of the placenta from the uterus
childbirth and be with her newborn soon afterward. before a baby is delivered, typically in the third trimester of
pregnancy but sometimes earlier. This can lead to preterm birth,
low birth weight [at or below 2500 g (5.5 lb)], and major maternal Signs of preeclampsia include:
blood loss. • Elevated blood pressure (generally 140/90 millimeters of
Since the placenta delivers oxygen and nutrients from the mother's mercury [mm Hg] or higher). This could be higher systolic
bloodstream to the fetus and carries waste products away from the blood pressure (the first number), or higher diastolic blood
fetus, placenta abruptio can be life-threatening for a mother (from pressure (the second number), or both. Any large increase
severe bleeding), her fetus, or both. in blood pressure should alert a woman and her doctor to
Separation of the placenta from the uterus may be partial or possible risk.
complete. A partial separation may cause only minor bleeding and • Persistent headache.
not endanger the lives of the fetus or mother. In rare cases, a
• Vision problems.
complete separation may lead to fetal death and severe bleeding
• Pain in the upper right abdomen.
that can endanger the mother's life.
Symptoms of placenta abruptio can include light or heavy vaginal • Lab results indicating elevated uric acid and/or protein in
bleeding, uterine tenderness or pain, or signs of preterm labor. A the urine (proteinuria).
pregnant woman with any of these symptoms must seek • Swelling of the hands and face that does not go away
emergency medical attention. during the day. This symptom of normal pregnancy may be
Certain factors increase the risk of placenta abruptio, including a sign of preeclampsia if it is accompanied by other signs
high blood pressure, a previous placenta abruptio, smoking or drug of preeclampsia.
use while pregnant, injury to the abdomen, multiple pregnancy, a
blood-clotting disorder, and a fibroid or scar tissue on the uterus Preeclampsia typically occurs after the 20th week of pregnancy. It
where the placenta grows. can develop much earlier in a multiple or molar pregnancy than in
a normal pregnancy. Preeclampsia can develop gradually or
Preeclampsia suddenly and may remain mild or become severe. If untreated,
Preeclampsia (which used to be called toxemia of pregnancy) is a preeclampsia may damage the mother's liver or kidneys, deprive
pregnancy-related blood circulation problem that causes high the fetus of oxygen, and cause eclampsia (maternal seizures).
blood pressure and affects the mother's kidneys, liver, brain, and A woman with any signs of preeclampsia is closely monitored by
placenta. Its cause is unknown. her doctor or nurse-midwife. Preeclampsia can be treated in the
Preeclampsia most commonly occurs during first pregnancies. hospital with bed rest, medication, and close monitoring of the
mother and fetus. If not treated, preeclampsia may damage the Diabetes is treated with diet and lifestyle changes and with
mother's liver or kidneys and can cause seizures (eclampsia). In medications (such as insulin or oral medications). If blood sugar
rare cases, coma and death of the mother and fetus can follow. levels are kept within the recommended range, the risk for many
Delivery is the only true “cure” for preeclampsia. This has to be complications from diabetes decreases.
balanced with how far along the pregnancy is and whether it is
safe for the fetus to be delivered. Within the first few days Unlabeled use
following delivery, the mother's blood pressure usually returns to An unlabeled use of a drug is when a doctor prescribes a
normal. With severe preeclampsia, it may take at least 6 weeks for medication for a purpose other than that for which it has been
blood pressure to return to normal. specifically designed and approved. Sometimes a drug is
prescribed for a specific unlabeled use so often that doctors
Diabetes consider it a common practice.
Diabetes is a lifelong condition in which sugar (glucose) remains in In the United States, the Food and Drug Administration (FDA)
the blood rather than entering the body’s cells to be used for approves drugs for specific uses.
energy. This results in persistently high blood sugar, which, over
time, can damage many body systems. Intravenous
Symptoms of diabetes include increased thirst and frequent Intravenous means occurring within or by way of a vein.
urination (especially at night); unexplained increase in appetite; Medications or fluids may be given by inserting an intravenous (IV)
unexplained weight loss; fatigue; erection problems; blurred vision; needle into a vein, usually in the back of the hand or on the
and tingling, burning, or numbness in the hands or feet. forearm.
People who have diabetes are at increased risk for many serious
health problems, including hardening of the arteries Vulva
(atherosclerosis) and heart problems, eye problems that can lead The vulva is the area surrounding the opening of the vagina. The
to blindness, circulation and nerve problems, and kidney disease vulva includes the small, sensitive structure (clitoris) that becomes
and kidney failure. stimulated during sexual activity and the folds of skin or lips (labia)
Pregnant women with uncontrolled diabetes have an increased risk that cover the vagina and the opening of the tube leading from the
of miscarriage and birth defects. bladder (urethra).
Rectum, Anus, and Anal Sphincter
The rectum is a muscular tube about 5 in. (12.7 cm) long that is at
the end of the large intestine (colon). The rectum connects the
colon to the anus, which is the opening where stool exits the body.
The internal and external anal sphincters are rings of muscle at the
opening of the anus. The sphincters keeps the anus closed as stool
collects in the rectum. Eventually the pressure on the rectum wall
causes the internal anal sphincter to relax. Conscious control over
the external anal sphincter allows stool to pass out of the body
through the anus.
Episiotomy
An episiotomy is an incision made in the tissue between the vagina
and anus (perineum) during childbirth, just before the baby's head
is delivered. An episiotomy may be done to help deliver the baby
or to help prevent the muscles and skin from tearing.
After delivery, an episiotomy incision is stitched closed.
Episiotomies can be different depths. For instance, a second-
degree episiotomy is a relatively small incision, while a fourth-
degree episiotomy extends from the vagina into the rectum.
Smaller episiotomies heal faster and with less pain.