So, I'm Pregnant – How's this Baby Getting Out of Me?
For many moms-to-be, the focus is on getting pregnant, but once that happens, there isn't always great information on what to expect during labor. As the end of pregnancy looms, some expectant mothers don't have a clear idea of exactly the next step is going to be. So, here's a quick overview looking at the end of pregnancy and delivery.
​When should I expect pregnancy to end? Full term for pregnancy is beyond 37 weeks, and your due date is at 40 weeks. We offer induction for patients who haven't gone into labor spontaneously by their due date because we can begin to see an increase in the risk of stillbirth and need for cesarean section in pregnancies beyond a certain duration. In fact, the ARRIVE trial suggests that we may even see a reduction in risk for cesarean section with inductions as early as 39 weeks.
How does this labor thing work?
There are 3 main stages, and the first stage of labor has two parts. Latent labor, or the beginning of contractions, can last anywhere from hours to weeks. This process involves the cervical change from closed (0cm) to 4-6cm. For some women, these contractions may not be noticeable until near the end of latent labor whereas for others, there can be significant discomfort and even frustration if the intensity of contractions increases without cervical change. Active labor starts between 4-6cm and often progresses around 1cm per hour or sometimes even faster.
The second stage of labor begins following full dilation (10cm). This stage involves pushing and delivery of the baby. The second stage of labor can last anywhere from one contraction with pushing (usually a mom who's done this before) to as many as 3 hours for first-time mothers in certain situations.
After baby gets here, the last stage of labor is delivery of the placenta. This generally happens shortly after the delivery of the baby, although in some cases the delivering provider has to manually extract the placenta by placing his/her hand into the uterus to remove the placenta.
What conditions would cause the need for intervention for either my baby's health or my health? Sometimes, an intervention can be as simple as adding Pitocin to help labor progress. Since prolonged labor can result in increased risk for intrauterine infection, abnormal heart rate for baby, low oxygen levels for baby and increased need for cesarean delivery, we like to see contractions reach a level of intensity that will continue to cause the cervix to dilate. Sometimes, the pushing process can cause a lot of stress on the baby, and in this case, operative vaginal delivery (vacuum or forceps) may be indicated. Also, while we prefer to allow the vaginal tissue to stretch to minimize tearing, an episiotomy (cutting the vaginal tissue) may be required to speed the delivery of a baby in distress. A cesarean delivery is generally reserved for when all other options have either been tried or are not appropriate. Some reasons for cesarean delivery can include a baby that is too big to pass through the bones in mom's pelvis (i.e. mom has been pushing for a long time without having the baby move closer to delivery), a heart rate pattern for baby that suggests waiting for the entire labor and delivery process would increase risk of harm to the baby, or if mom's cervix stops dilating despite having adequate contraction strength from the uterus.
What can I do to prepare for delivery? I'd suggest making sure that you and your partner know how to get to the labor and delivery area of the hospital, especially after hours as some doors may be closed during the middle of the night. If your significant other takes you on the "scenic route" to labor and delivery, you may not appreciate the detour. I'd also suggest getting a bag together of the things you might want in the hospital for a several day stay. If you're not sure what to pack, you can check out a sample packing list here: https://www.tetonobgyn.com/blog/what-to-pack-for-the-other-labor-day4298355 Lastly, knowing the reasons to go to the hospital are very important. If you think you might be in labor (generally painful contractions every 5-7 minutes for an hour, although you can always go if you're not sure), if you think your water has broken (even if you're not in labor), if you're concerned that your baby isn't moving normally, or if you have heavy vaginal bleeding (more than a pad per hour), then you should go to labor and delivery. You don't have to call for permission in any of those cases as sometimes we can be busy in a delivery and not able to immediately return a call. We don't want you waiting on us to call back while you have your baby in the bathtub. Just head to the hospital, let the nurses know what's going on, and they will start an assessment while they get in touch with us.