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Pushing through Labor & Delivery

Pushing through

Your body spends 280 days getting ready for its most awesome undertaking yet: ushering baby from womb to world.

A quick look down at your burgeoning belly makes it all too obvious that your body is undergoing some pretty remarkable transformations in preparation for baby’s debut. Although the bump is the most obvious change, what’s going on inside—and out of sight—is perhaps even more stunning. And it all culminates in the final frontier of pregnancy: labor. Here’s a look at what happens during each stage of the process, from the Wait, was that a contraction? to the big Hello, baby! at the end.

Easy as 1,2,3

Labor can be broken down into three stages. The first consists of early labor, active labor and transition. This is the time during which contractions take place, and your cervix thins out (effacement) and opens (dilation) to prepare for the big event. Stage two happens when you are fully dilated and actively working to push baby into the world. The third and final stage takes place immediately after baby’s birth and ends with the delivery of the placenta.

The duration of each stage is anyone’s guess. Average estimations for the total length of labor for first-time moms fall somewhere between 16 and 20 hours, but the truth is, it can vary greatly in either direction.

First up
In the last month of your pregnancy, you’ll be seeing a lot of your care provider —most obstetricians and midwives like to see their patients once a week upon reaching the 36th week of gestation. At some point, a physical check down below is typical, and your practitioner might report that you are dilated and/or effaced to a small degree. For a gal looking to get the show on the road, that’s great news— but don’t get too excited just yet. Although it’s a good sign that your body is on the right track, it doesn’t necessarily mean baby will be making her grand entrance the next day.

Your first real sign that baby is on her way will most likely come by way of contractions. They’ll feel similar to the Braxton Hicks contractions you had in your final trimester, but they might not hit hard and fast right off the bat. For many moms, labor starts with a kind of crampy, uncomfortable feeling that eventually leads to the moment of realization: This is the real thing! When that happens, you’re in early labor.

Early labor.
It’s a little different for every mom, every time, but most women know they’re officially in early labor when they begin feeling contractions at somewhat regular intervals. Although you might be experiencing discomfort (it can range from bothersome to painful), most care providers encourage mothers to hang tight at home in early labor. (Note: If you’re high-risk, preterm or experiencing complications, go ahead and make your way to the hospital for safety’s sake.)

Many moms opt to stay active during this time. Light walking can keep your mind off things (plus, it can help labor progress), and you might also be taking care of a few last-minute tasks, like putting the finishing touches on your delivery bag or tossing one last load of laundry into the dryer.

If you need some relief, try getting wet. “Water is a wonderful comfort,” says Margaret Buxton, CNM, clinical director of Baby+Company birth center in Nashville, Tennessee. So, consider hopping in the shower or soaking in a warm tub. Buxton suggests setting the mood, too: “Keeping the lights dim, listening to good music, and eating light snacks are also helpful comforts.”

Eventually, you’ll notice that the contractions have become longer, stronger and closer together. This is normally your sign that it’s time to hit the road. If you haven’t already checked in with your doctor or midwife, put her on alert. Buxton and her fellow midwives at Baby+Company encourage families to call and check in with them during early labor; some doctors might prefer you to call when your contractions are occurring consistently
in a specific pattern, such as five minutes apart. Ask your provider at one of your prenatal appointments when she’d like to be notified. If you’re ever in doubt, don’t hesitate to pick up the phone.

At some point—normally when your cervix has dilated between 4 and 6 centimeters—you’ll notice that the tone of your labor changes. That means you’ve moved on to the next phase of stage one: active labor.

Active labor.
Most women easily recognize when they move into active labor. “Active labor brings a change in intensity,” explains Buxton. Not only will your contractions grow stronger, but “many women feel the sensations deeper in their pelvises and down into their groins,” she says.

Dealing with these contractions might be more challenging than those of early labor. Some women opt for pain medication or an epidural at this point in the game; others continue with the same natural methods they exercised in early labor. Breathing techniques can be useful, and mobility is still a great help, although you’ll most likely find yourself leaning against a wall or your partner during contractions rather than walking through them, as you could before. Rocking or bouncing can provide further relief.

The changes won’t just be physical, though. “Mother’s mood often changes as well,” says Buxton. “Going from cheerful and talkative to quiet and focused during a contraction is a sure sign that she is settling into active labor.”

Transition.
When your cervix opens from 8 to 10 centimeters, you’re in what’s often considered the most challenging part of labor: transition. The contractions are real here, ladies—very intense and right on top of each other. You might shake, shiver, feel nauseated or vomit. “Transition is the most intense part of labor, and it takes everything a mom has to stay focused and present in the experience,” says Buxton.

Your previous methods of pain management might not be as effective here, and you might get pretty snippy. (No worries, everyone will forgive you!) According to Buxton, “Women often become very focused on each contraction, are easily annoyed by distractions in the room, may not want to be touched, and need a lot of support from their providers and support people.”

As your baby moves lower into position, you’ll feel intense pressure in your rectum. Some moms who are delivering drug-free have an undeniable urge to push when this happens, which escorts you right into the next stage of labor. This is where things get exciting.

Second act
Once your cervix is fully dilated, it’s go time. You’ll work with your contractions, bearing down during each one, to move baby through the birth canal.

When it comes to pushing, one size doesn’t necessarily fit all. Your caregivers might walk you through a counting and pushing routine. (This is almost guaranteed if you received an epidural because you won’t have full feeling down below.) Others might encourage you to push when you feel ready. The more you allow your uterus to work and move baby into position, the less physical exertion you have to put in—but it can be hard to wait when you feel the urge to bear down.

Pushing is tiring, but it’s also a really encouraging time because you’re finally able to take action. You have a sense of control now that you didn’t have before. As you continue to work on moving baby down, his head will become visible. The pressure on your perineum will be intense, and you’ll experience that “ring of fire” that means baby is almost here. Your mid-wife or OB might guide you through the next few pushes to help minimize tearing.

Baby’s head will make its appearance, followed by his body, and you’ll finally come face-to-face with the most amazing person you’ve ever met. Emotions will be high! Soak up that sweet baby, and allow your little one to latch on for his first breastfeeding session if you’re up for it. Baby’s cord will be cut shortly after his birth, but the timing might vary depending on whether you’re delaying cord clamping and/or storing baby’s cord blood.

Three’s company
The third stage brings both good and bad news. The bad news is your job isn’t done just yet—there’s still a placenta to be delivered. The good news: It’s a whole lot easier than delivering the baby.

“The placenta is soft and squishy, so it won’t cause any tearing or pain,” assures Buxton. “[It] usually comes out between five and 15 minutes [after baby], but some- times can take up to 30 minutes. Providers will usually give the cord a gentle pull to see if it has released from the uterine wall. If it has, gentle traction and a small push from the mother will allow it to deliver easily.”

Once placenta delivery is complete, you’re officially in the recovery zone. If your care provider has any work to do down below (like stitching up a tear), she’ll take care of it now. Otherwise, your uterus will continue contracting as it begins shrinking back to its normal size. It takes a bit of time, so you’ll feel crampy afterbirth pains in the days following labor. Rest assured, though, they are nothing compared to what you just went through. You’ve conquered the hard part, and now you’re on to the next (and best) stage of the whole ordeal: motherhood.