Overview

What is labour and delivery?

The process that leads to childbirth is called labour and delivery. There are three stages of labour. In the first stage, uterine contractions help thin and open the cervix. The second stage is the actual birth. The third stage is delivery of the placenta.

How can you manage pain?

Your pain relief choices for childbirth may include medical and non-medical treatments. Medical choices can include I.V. medicines or epidural pain relief. Massage and focused breathing are some of the non-medical options. Sometimes both kinds of pain relief are used. Knowing your options can help you prepare for childbirth. Talk about pain medicine options with your healthcare provider.

How can you prepare for childbirth?

You can get ready for labour and delivery by taking a childbirth education class and writing a birth plan. A childbirth class can help reduce your stress both before and during labour and delivery. A birth plan tells others what your wishes are for your labour and delivery.

Planning for Birth

Two good ways to prepare yourself for labour and delivery are by taking a childbirth education class and writing a birth plan.

Childbirth education class.

A childbirth education class can reduce your stress both before and during labour and delivery. That's because the class can prepare you to deal with what might happen.

A good time to start the class is in your sixth or seventh month of pregnancy. If your partner or a friend is going to be your labour coach, they can come too.

Birth plan.

A birth plan is a document that states your wishes for labour and delivery. It includes who and where you'd like to deliver your baby and what kinds of pain relief you'd like to try. You can give copies of your plan to your healthcare provider or midwife, your support person, and the hospital or birthing centre.

Writing a birth plan

A birth plan lets you write down your vision of an ideal birth and share it with your support person, the hospital or birth centre, and your healthcare provider or midwife.

Your birth may not go as planned. But the process of making a plan can be a great way to get everyone on the same page about what you think you'd prefer.

Here are some ideas for making a birth plan.

• Choose where you want to have your baby.

  It could be a hospital, a birthing centre, or your home. The setting may depend on your level of risk for problems during delivery, and if you're working with a healthcare provider or midwife.

• List the comfort measures you want to try.

  Think breathing techniques, labouring in water, or trying different positions.

• Include the medical treatments you prefer to have.

  Think about pain medicine you'd want, even if you don't think you'll need it. And think about your options if you end up needing a C-section.

• Include cultural traditions you would like to follow during your birth experience.
• Say how you want your baby to be cared for after delivery.
  • You might want your baby to stay in the room with you rather than in the nursery.
  • You might want to delay some tests so you can hold your baby and start breastfeeding right away.
  • Holding your baby skin to skin as soon as possible after delivery for at least 1 hour of uninterrupted time helps newborn health, bonding, and early frequent feeding. If you plan to breastfeed, the first feed will most likely happen during this special hour.
• List who you want to be there with you.

  Maybe you want family and friends in the room, or maybe you only want the baby's other parent or a support person like a doula.

As you think about your plan, give yourself permission to be flexible. It's hard to know what will happen. The most important thing is to make sure you and your baby are healthy and safe.

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Signs of Labour

Late in your pregnancy, your healthcare provider or midwife will tell you what to do when you think you are in labour. Early labour can be different for every person. At first, your contractions may not be regular, and they may happen only now and then.

You may have signs that early labour is not far off.

• The baby may settle into your pelvis. Although this is called dropping, or lightening, you may not feel it.
• Your cervix may begin to thin and open (cervical effacement and dilation). Your healthcare provider or midwife may check for this during your prenatal exams.
• Braxton Hicks contractions may become painful, more frequent, and stronger. You may also feel cramping in the groin or rectum or an ongoing ache low in your back.
• Your amniotic sac may break (rupture of the membranes). In most cases, rupture of the membranes occurs after labour has already started. In some people, this happens before labour starts. Call your healthcare provider or midwife immediately or go to the hospital if your membranes have ruptured.

When you're in labour, the contractions get longer, stronger, and closer together. You will feel them even when you change positions and walk or move around. After a while, it will become hard for you to talk during a contraction. You may have to stop to focus on your breathing.

When to call a doctor

You, your partner, or a friend should call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have a seizure.
• You have severe vaginal bleeding.You have severe pain in your belly or pelvis that doesn't get better between contractions.
• You have had fluid gushing or leaking from your vagina and you know or think the umbilical cord is bulging into your vagina. If this happens, immediately get down on your knees so your rear end (buttocks) is higher than your head. This will decrease the pressure on the cord until help arrives.

Call your healthcare provider, midwife, or nurse advice line now or seek immediate medical care if:

• You have new or worse signs of preeclampsia, such as:
  • Sudden swelling of your face, hands, or feet.
  • New vision problems (such as dimness, blurring, or seeing spots).
  • A severe headache.
  • New right upper belly pain.
  • New severe nausea and vomiting - vomiting more than 3 times a day or are too nauseated to eat or drink (especially if you also have fever or pain).
• You have any vaginal bleeding.
• You have belly pain or cramping.
• You have a fever.
• You have had regular contractions (with or without pain) for an hour. This means that you have 6 or more within 1 hour, even after you have had a glass of water and are resting. See Preterm Labour: Care Instructions for how to check if you are having contractions.
• You have a sudden release of fluid or leaking from your vagina.
• You have low back pain or pelvic pressure that does not go away.
• You notice that your baby has stopped moving or is moving less than 6 times in 2 hours.
• Follow your healthcare provider’s instructions on how often to count your baby’s movements. To keep track of your baby’s movements and for more information on how to count them, go to: Fetal Movement Count Chart.

Watch closely for changes in your health, and be sure to contact your healthcare provider, midwife, or nurse advice line if you have any problems.

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Managing Pain

You have many choices to relieve pain during childbirth. These include medical and non-medical options. You may use more than one of these choices.

Non-medical

Non-medical options may help reduce pain and help you feel a sense of control during labour. These techniques include:

• Support. Having a support person with you through childbirth may help you manage your pain better. This person could be your partner, a loved one, or a friend. Or you may use an experienced birth assistant, like a doula, whose only job is to give you constant support.
• Distraction. During early labour, you can walk, play cards, watch TV, take a shower, or listen to music to help take your mind off your contractions.
• Massage. Massage of the shoulders and lower back during contractions may help ease your pain.
• Changing positions during labour. Walking, kneeling, or sitting on a big rubber ball (birth ball) are good options. The position that feels best may change as you move through labour.
• Focused breathing techniques. Breathing in a rhythm can distract you from pain and relax your muscles and your mind. Childbirth education classes can teach you different methods of focused breathing.
• Imagery. This involves using your imagination to decrease your pain. For instance, you could imagine your contractions as waves rolling over you. Picture a peaceful place, such as a beach or a mountain stream, to help you relax between contractions.
• Labouring in water. Some hospitals and birthing centres offer tubs or whirlpools for labour. Showering or soaking in warm water may help ease the stress of labour.

Medical

Your options for pain relief with medicine may include:

• I.V. medicines. Examples include fentanyl and hydroxyzine. These medicines are used to make labour pain feel less intense and can be used throughout labour. Opioids may not be used when you are close to delivery, because they can affect a newborn’s breathing and breastfeeding.
• Spinal and epidural pain relief. This is a shot (spinal) or an ongoing supply (epidural) of pain medicine near the spinal cord. It partially or fully numbs the belly and lower body.
• Pudendal block. This is a shot of pain medicine to numb the vagina and perineum. It can help relieve pain from the second (pushing) stage of labour. It works quickly and usually doesn't affect the baby.
• Nitrous oxide. Entonox, inhaled gas mixture of nitrous oxide and oxygen that provides pain relief by taking your mind off the pain and helping. You can give yourself nitrous oxide through a mouthpiece or mask when you need pain relief during labour. You can decide when to use it.

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Types of Delivery

Vaginal birth

Vaginal birth means delivering a baby through the birth canal (vagina). During labour, the uterus tightens (contracts) regularly to thin and open the cervix and to push the baby out through the birth canal. It can take many hours or sometimes days for the cervix to open all the way so you can begin pushing. Most babies are born by vaginal delivery.

Caesarean section

Caesarean section (C-section) is the delivery of a baby through a cut (incision) in your belly and uterus. In most cases, you can be awake during the birth and be with your newborn soon afterward. It can take 4 to 6 weeks to recover completely from the surgery.

A C-section may be planned or unplanned. In most cases, doctors do caesarean sections because of problems that arise during labour.

Vaginal birth after caesarean

Vaginal birth after caesarean (VBAC) means delivering a baby through the birth canal after having had a C-section for a previous birth. In the past, if you had one baby by C-section, you had to have your next babies by C-section. But now you may be able to try for a vaginal birth. It depends on the reason for the first C-section and the type of incision that was made.

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Stages of Labour

There are three stages of labour that can occur over many hours or even a few days. The first stage is labour. During the second stage, you deliver the baby. The final stage is delivering the placenta.

First stage of labour

The first stage of labour is divided into three phases: early labour, active labour, and transition.

Early labour

Early labour is often the longest part of the birthing process, sometimes lasting 2 to 3 days. Contractions:

• Are mild to moderate (you can talk while they are happening) and last about 30 to 45 seconds.
• May be irregular (5 to 20 minutes apart) and may even stop for a while.
• Open (dilate) the cervix to about 4 to 6 cm (1.6 to 2.4 in.) . Those who are delivering for the first time can have many hours of early labour without the cervix dilating.

It's common for those in early labour to go to the hospital and be sent home until they are in active labour or until their "water" (amniotic sac) breaks.

Active labour

Active labour starts when the cervix is about 5 to 6 cm (2 to 2.4 in.) dilated. This stage is complete when the cervix is fully effaced and dilated and the baby is ready to be pushed out.

During this phase, contractions get stronger, are more frequent (every 2 to 3 minutes), and last longer (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing centre. If your amniotic sac hasn't broken before this, it may now.

You may be restless and excited, and you may feel the need to shift positions often. This is good because it improves your circulation.

As your contractions get stronger:

Transition

Transition is the end of active labour. As the baby moves down, contractions become more intense and longer and come even closer together. Delivery isn't far off.

During transition, you may be self-absorbed, focused on what your body is doing. You may want others nearby for support but be annoyed or distracted by their attempts to help. You may feel more and more anxious, nauseated, exhausted, or fearful.

If you're delivering for the first time, transition may take up to 3 hours. If you've had a vaginal birth before, it will usually take no more than an hour. Some people have a very short and intense transition.

Second stage of labour

The second stage is the actual birth, when the baby is pushed out by the contractions. This pushing stage can be as short as a few minutes or as long as several hours. You are more likely to have a fast labour if you have given birth before.

In the second stage:

• Your contractions may feel different. They are usually regular, but they may slow down to every 2 to 5 minutes and last 60 to 90 seconds.
• You may have a strong urge to push or bear down with each contraction.
• You may need to change position several times to find the right birthing position for you.

You may feel a burning pain when your baby's head comes through the vagina (crowns). You can have a mirror positioned so you can watch your baby's head crown.

If the baby is coming quickly, your healthcare provider or midwife may ask you not to push with every contraction. This may give the perineum a chance to stretch without tearing.

Then after a final push, your baby is born, and you get to hold and look at this new person for the first time. But your body still has some work to do: stage three, delivery of the placenta.

Third stage of labour

The third stage of labour is when the placenta is delivered. You will still have contractions. They make the placenta separate from the inside of the uterus, and they push the placenta out.

The third stage can be as quick as 5 minutes. But in most cases, the placenta is delivered within 30 minutes. Your contractions will continue until after the placenta is delivered, so you may have to focus and breathe until this uncomfortable process is complete.

Your care provider will help you during this time. If the placenta doesn't fully detach, your doctor or midwife may remove by hand what's left inside. You'll also be watched for any problems, such as heavy bleeding, especially if you have experienced problems before.

You may be given medicine after the placenta is delivered. Oxytocin (such as Pitocin) is used to make the uterus shrink and bleed less. (This is the same medicine that is sometimes used to make contractions more regular and frequent during labour.) Breastfeeding right away can also help the uterus shrink and bleed less.

Labour Positions

In most cases, you don't have to lie in bed while you're in labour. Your nurse, healthcare provider, or midwife may have you stay in bed or in a certain position if there are problems with your baby or your health. Or you may need to be in bed if you have an epidural.

If you don't need to be in bed, you can choose whichever position feels most comfortable. You may want to walk, sit on a big rubber ball, or kneel. The position that feels best for you may change as you move through labour.

Moving around and changing positions during labour may help you feel more comfortable.

Walking

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During early labour, walking can help ease discomfort or pain. Some people walk during much of their labour.

Leaning

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Leaning forward during each contraction can help ease discomfort or pain.

Sitting

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Sitting backward in a chair and leaning over the back of a chair is a comfortable position that lets you rest while staying upright. You can place a pillow between your belly and the chair back. Leaning over the back of a chair is also a good position for receiving a back rub.

Squatting

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Squatting opens the pelvis, especially when you hold onto something stable and stretch away from it. This position can be used for pushing during contractions and for delivering the baby.

Kneeling

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Kneeling over a chair, ball, or cushions is good for active labour and for when you need to rest. This position is easy to move into and out of when you feel the need to change position. You may find it eases back labour.

Kneeling on hands and knees

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Kneeling on your hands and knees can be used to reduce the intensity of contractions and to try to turn a posterior-facing baby. You may find that kneeling eases back labour.

Downward from knees

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Lowering yourself from hands-and-knees can help ease the physical and emotional intensity of labour. It is also used to take pressure off of the back and may help shift a baby to a more favourable position. You may find that it eases back labour.

Side-lying

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Lying on your side can give you needed rest during a long labour. Take care to prop up your upper leg and head.

Birthing positions during the pushing stage

Birthing positions for pushing include squatting, reclining, and using a birthing chair, stool, or bed. You may find that certain positions are more comfortable than others during the pushing stage. Speak to your healthcar provider or midwife about different birthing positions before your labour begins.

• Kneeling, getting down on your hands and knees, or leaning onto a birthing ball may help to take pressure off your back.
• Squatting feels comfortable for some people.
• Lying on your back in a semi-reclining position with your legs supported by stirrups is a common birthing position used in North America. While pushing, your healthcare provider or midwife may have you grab behind your knees and pull up.
• Lying on your side is another option.
• Some birthing centres use a birthing stool or chair during the pushing stage. A birthing chair may help you feel more comfortable.

Medical Procedures

Some exams and procedures are normally done during labour. Others are used as needed.

Sterile vaginal exams.

These are done to check how much your cervix has thinned and opened.

Fetal heart monitoring.

Your baby's heart rate will be checked during labour. The heart rate is a good sign of how your baby is doing. Fetal heart monitoring may be done at set times (intermittent) or all the time (continuous).

Labour induction.

Measures may be taken to start (induce) labour. This may be done by breaking (rupturing) the amniotic sac. Or medicine may be used to soften the cervix or cause contractions. These measures may be needed if labour doesn't start on its own and the baby needs to be delivered soon. They may also be used if active labour starts on its own but contractions slow or stop.

Antibiotics.

You will be given antibiotics if you tested positive for group B strep, syphilis, or other infections during your pregnancy or have symptoms of infection during labour.

In some cases, medical help is required to give birth.

Delivery assistance.

Forceps delivery or vacuum extraction can be used to assist a vaginal delivery. This may be needed at the pushing stage if labour is stalled. It may also be done if the baby shows signs of distress and needs to be delivered quickly.

Episiotomy.

An episiotomy is a cut (incision) to widen the perineum. This is sometimes done to deliver the baby's head more quickly, when there are signs of distress.

Sometimes what starts as a routine vaginal birth may end in a caesarean delivery (C-section). This may be done to make sure the mom and baby are safe.

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Right After the Birth

The first hours after childbirth

You may have shaking chills right after delivery. This is a common reaction in the hours after delivery. A warm blanket may help you feel more comfortable.

During the first hours after the birth, your health professional will:

• Massage your uterus by rubbing your lower belly about every 15 minutes. Later, you will be taught to massage your own uterus. This helps it tighten (contract) and stop bleeding.
• Check your bladder to make sure it isn't full. A full bladder puts pressure on your uterus, which interferes with contractions. You will be asked to try to urinate. This may be hard because of pain and swelling. If you can't urinate, a tube (catheter) can be used to empty your bladder.
• Check your blood pressure often.
• Repair the area between your vagina and anus (perineum) if it tore or if you had an incision (episiotomy).
• Remove the small tube in your back if you had epidural anesthesia. If you plan to have a tubal ligation surgery to prevent future pregnancy, the tube may be left in.

Bonding with your newborn

Close physical contact helps you bond with your baby and helps your newborn feel secure. One special way to bond with your newborn is "kangaroo care." This simply means holding your baby to your chest, skin to skin. Talking to, reading to, and caring for your baby also help to form a bond.

If you plan to breastfeed

It's best to start breastfeeding within 1 hour of birth. For each feeding:

• Get ready. Try to relax. Have some water or juice and support pillows ready.
• Find a position that's comfortable for you and your baby. Make sure the baby's head and chest are lined up straight and facing your breast. It's best to switch which breast you start with each time.
• Get the baby latched on well. Your baby's mouth should be wide open, so you may need to gently touch the middle of your baby's lower lip. When your baby's mouth is open wide, quickly bring the baby onto your nipple and areola.
• Let your baby decide how long to nurse. Burp your baby after each breast.

Breastfeeding doesn't always come easily at first. But it gets better with practice. Be patient. Talk to your healthcare provider, midwife, or lactation consultant if you have problems.

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