Labor, delivery and the postpartum period

At the end of the third trimester of pregnancy, your body will give you signals that it is time to give birth to your baby. The process by which a baby is born is called labor and delivery. All labor and delivery have certain stages, but each person experiences them differently.

Giving birth to a baby requires a lot of effort, which is why contractions are also called pushing. Childbirth can be scary and exciting, but it can also be unpredictable. So do your homework so you can be prepared for anything when it's time to give birth.

[ 1 ]

Where and how to give birth to a child?

During your prenatal visits, discuss all your birth options and decide how and where you will deliver your baby. Decide what you want and write down a detailed birth "plan." Of course, this is not exactly a plan, but rather an accurate representation of what will happen. Everyone's birth is different and it is impossible to predict all the details, so remember that things may not go as planned. Be aware of possible complications and allow yourself to make adjustments at any time. Be prepared for the fact that the birth will not go as planned.

The birth "plan" is not a contract for the doctor on what to follow in case of unforeseen situations, as the doctor himself makes the decision for the safety of the mother and the child. You will have your say, but the deciding vote will be with the doctor.

When making a birth "plan," think about where you would like to have the baby, who will deliver the baby, and who will be with you - a friend, family member, or a female caregiver. If you have not attended a school for expectant mothers before, it is time to sign up in the 6th or 7th month of pregnancy. After that, decide whether you will need pain medication, fetal monitoring, or special medical procedures. Don't forget about where the baby will be after birth.

Periods of childbirth

The first period begins with the first regular contraction and lasts until the cervix is fully dilated. The second period begins with the full dilation of the cervix and ends with the birth of the baby. During the third period, the placenta is born.

At the beginning of contractions, the muscles of the uterus begin to contract and relax, as a result of which the cervix opens and the baby can move along the birth canal. The first contractions are usually irregular, last less than a minute and occur with a frequency of 5-20 minutes.

They can last for a long time, up to 2-3 days, so women are advised to walk, watch TV, take a warm shower, which significantly alleviates discomfort. At the beginning of the second period, uterine contractions become more intense and regular, with contractions lasting more than a minute and occurring every 2-3 minutes. Now is the time to go to the hospital. The intensity of pain during contractions varies from moderate to severe, so it is important for a woman to have a loved one nearby who can support her in difficult times. In addition, during contractions, specialists usually recommend changing positions frequently and doing breathing exercises. Many women ask for painkillers at this time.

When the cervical canal is fully opened, the body switches to "pushing" movements. During the second stage of labor, the baby is born. This happens in different ways - from several minutes to several hours. It is believed that the second stage of labor lasts less if the woman already has children. During the third stage of labor, the uterus continues to contract until the placenta comes out.

How to prepare for contractions and childbirth?

• Exercising throughout your pregnancy will prepare your body for the grueling labor. Try doing pelvic floor exercises to help speed up the second stage of labor.
• In the sixth or seventh month of pregnancy, sign up with your partner for special courses for pregnant women. Specialists will teach you how to best deal with stress before and during childbirth, and will also tell you what to expect during this period. You will learn to relax, and your partner will learn how to help during this difficult time.
• Shortly before the birth, discuss with your doctor the important aspects of the birth itself, since you yourself must decide where and how you will give birth to your baby.
• Determine the place of birth. Most women cooperate with doctors and give birth to children in medical institutions. This is where you will always find qualified assistance in case of unforeseen circumstances.
• Think about who you would like to be with during labor and delivery. This could be friends, family members, a spouse, or someone else.
• What relaxation techniques will you use during contractions: practice breathing exercises, dive into water, change positions, or wish to see a loved one.
• Your medication preferences. Consider whether you will need pain medications and learn about alternatives in advance.
• Postpartum care: Your baby may be in the room with you. Consult a specialist about breastfeeding and latching techniques.

Make a kind of birth plan and write down all your preferences. This way you will have a clear picture of what is happening. But remember that it is impossible to predict everything, especially when it comes to contractions and the birth itself. Sometimes in emergency situations the doctor has to make an important decision within a few minutes.

Should you use an epidural during labor?

Some painkillers are prescribed only by a doctor in an emergency when surgery is required. However, a woman should still be aware of such medications.

• Local anesthesia is an injection of a painkiller that numbs an area of skin. It is given before an epidural or an episiotomy (an incision in the perineum to facilitate childbirth).
• Spinal anesthesia is an injection of an anesthetic into the cerebrospinal fluid, which causes complete numbness of the exit plane from the pelvis (used for cesarean section or vacuum extraction of the fetus, or the application of forceps to extract the fetus). The woman in labor cannot push.
• General anesthesia is an intravenous or inhalation anesthesia in which the woman in labor is unconscious. It has more negative consequences, but is considered more effective than epidural or spinal anesthesia. General anesthesia is used in extreme cases when there is a need for immediate extraction of the fetus, when, for example, epidural anesthesia was not applied in time.

The position of a woman during childbirth

The woman in labor can take different positions, for example, sitting, squatting, bending over, lying in a special birthing chair or bed.

Medical procedures that are performed during childbirth

• Fetal heart rate monitoring is a routine procedure, but a number of others are performed if needed.
• Stimulation of labor involves rupturing the amniotic sac, using medications to soften the cervix and stimulate uterine contractions. Labor is not always stimulated, but when a woman is more than two weeks along or in the case of an urgent extraction of the fetus.
• Use of antibiotics.
• Electronic fetal heart rate monitoring (continuous or intermittent).
• Episiotomy (cutting the perineum to facilitate labor). It is often done when there is a need for emergency extraction of the fetal head in distress syndrome. (To prevent ruptures, perineal massage is performed or the woman in labor is monitored as she pushes).
• Forceps or vacuum extraction of the fetus is performed when a woman is unable to give birth, for example, when labor has ceased or there is fetal distress syndrome, when emergency fetal extraction is indicated.
• The need for a cesarean section during labor is determined by the health of the mother and child.
• If you have already had a cesarean section, you have a choice between attempting a vaginal birth or planning a repeat cesarean section.

Newborn care

Before the birth of a child, you need to think everything through and plan in advance.

• Keeping your baby with you for the first hour of its life. Do you want your baby to be in the room with you after birth? Some maternity hospitals have special mother-and-baby units where the newborn stays with the mother. This policy also allows for the mother to sometimes need time to rest.
• Prevent breastfeeding problems. Think about who you can turn to for help if needed. Get to know a lactation specialist. Sometimes maternity hospitals offer their services. Talk to the medical staff about giving your baby formula only if absolutely necessary.
• Postpone certain medical procedures - vitamin K injections, pricking your baby's heel for blood tests, and using eye drops - to make his transition to a new stage of life less painful.
• Let your relatives know when you would like to see them after the birth.
• Do you want to store your baby's cord blood (stem cells) after birth for possible future treatment? (This requires planning early in pregnancy).
• Enroll in and attend a school for young mothers, go on a tour of a maternity hospital and see where women spend different stages of labor. This will help you feel more confident when the time comes to give birth.

[ 2 ], [ 3 ]

How to reduce stress during labor and childbirth?

There are many ways to reduce stress during labor and birth.

Long-term support from the first contractions until the postpartum period has a positive effect on the woman in labor. Women who have close people or caregivers with them are less likely to use painkillers and describe the process less negatively. Although it has not been proven that support helps reduce pain, a woman in labor is still more likely to have self-control and confidence when a loved one is nearby.

• Walking during contractions, despite prolonged or intermittent fetal monitoring. Most women prefer freedom of movement, but if risk factors exist, continuous monitoring is recommended.
• Natural (non-drug) pain control and "natural" childbirth: constant support, breathing exercises, distraction, massage, etc.
• The first stage of water birth helps relieve tension and sometimes helps slow, difficult labor progress normally. Water birth has not yet been fully studied in terms of maternal and infant safety.
• Eating and drinking during labor. Some maternity hospitals allow women to drink water, while others only allow them to suck on ice chips. Eating solid foods is often discouraged because the stomach digests them very slowly during labor. An empty stomach is desirable in case general anesthesia is needed.
• Listen to music.
• Acupuncture and hypnosis are considered less dangerous and quite effective means of relieving pain. Pain-relieving medications
• Opioids are used to relieve tension and, to some extent, pain. They are used before labor because they affect the newborn's breathing. Opioids are less likely than general anesthesia to cause labor to stop, requiring the fetus to be removed with assisted means.
• Epidural anesthesia is a continuous injection of a medical drug into the epidural area near the spinal cord, which leads to complete or partial numbness of the lower body. Light epidural anesthesia allows you to feel your body and the woman in labor can push, which reduces the risk of side effects of general anesthesia, namely, the cessation of labor and the need to extract the fetus using auxiliary means (vacuum extraction or forceps).
• Pudendal and paracervical anesthesia are used to relieve pain during contractions and are considered the safest form of anesthesia in the birth canal. It does not harm the baby. Paracervical anesthesia is usually replaced by epidural anesthesia, which is considered more effective.

Childbirth: When to Call the Doctor?

You or people around you should call an ambulance immediately if you have:

• loss of consciousness;
• heavy vaginal bleeding;
• acute pain in the abdominal cavity or pelvic organs;
• leakage of amniotic fluid (if the amniotic sac ruptures) and you are sure that the umbilical cord has fallen out. This happens quite rarely, but if it does happen, immediately drop to your knees, lower your head and torso below your buttocks to reduce the pressure on the umbilical cord and do not change position until help arrives.

Go to the maternity ward if:

• any vaginal bleeding;
• symptoms of late toxicosis of pregnancy:
• severe headache that does not go away with acetaminophen (Tylenol);
• visual disturbances (blurred or cloudy vision);
• sudden swelling of the face, hands or feet;
• abdominal pain;
• temperature above 38 degrees Celsius;
• regular contractions of the uterus over the course of an hour - 4 or more contractions over the course of 20 minutes or 8 per hour, even if you are currently resting and drinking water;
• sudden release of fluid (amniotic fluid is often confused with involuntary leakage of urine);
• prolonged back pain or pressure in the pelvic area;
• no fetal movement or fewer kicks.

Between 20 and 37 weeks of pregnancy, go to the hospital immediately if:

• you suspect that the baby has stopped moving or is moving significantly less than before;
• observe any vaginal bleeding;
• you feel pain in the uterus, weakness and a rise in temperature (for no reason) (possible signs of infection);
• vaginal leakage of fluid (large amount - more than 240 ml).

The following symptoms may indicate premature labor:

• regular contractions of the uterus over the course of an hour - 4 or more contractions over the course of 20 minutes or 8 per hour, even if you are currently resting and drinking water;
• unexplained pain in the back or pelvic organs;
• bowel contractions (with or without diarrhea).

After 37 weeks of pregnancy, go to the maternity ward immediately if you:

• you suspect that your baby has stopped moving or is moving less than usual;
• observe any vaginal bleeding;
• experience regular contractions (4 or more within 20 minutes or 8 within an hour);
• you notice sudden vaginal discharge.

At any time during pregnancy, contact your doctor if you experience heavy or moderate vaginal discharge that is accompanied by twitching, burning, or a distinct odor.

After childbirth

After giving birth, call an ambulance if:

• sudden sharp pain in the abdominal cavity;
• loss of consciousness.

Seek immediate medical attention if:

• you notice heavy vaginal discharge with blood clots, and you need to change your pad every two hours;
• vaginal discharge becomes heavy and still bright red 4 days after delivery or blood clots larger than a golf ball;
• you feel dizzy and it seems like you are losing consciousness;
• vomiting occurs and you cannot drink liquids;
• the temperature rises;
• a new type of abdominal pain appears;
• vaginal discharge is accompanied by muscle tissue (not just blood clots);
• experience severe headache, visual impairment, swelling of the face, hands and feet.

Monitor your health closely and contact your doctor if:

• You do not feel better within 2-3 days;
• vaginal discharge has an unpleasant odor;
• symptoms of postpartum depression are observed (feelings of despair for several days, restless or dangerous thoughts, or hallucinations);
• The mammary glands become painful and the temperature rises - symptoms of engorgement of the mammary glands and mastitis.

[ 4 ]

Contractions

The process of giving birth involves contractions and labor. No one can say exactly when contractions will begin. Sometimes a pregnant woman may have symptoms that her body is ready to give birth to a child, but nevertheless, the child may be born several weeks later. Also, labor may often begin without contractions. It is very difficult to predict the first birth.

Signs of contractions

Harbingers of approaching labor

• the baby moves to the lower part of the pelvis;
• thinning and opening of the cervix;
• uterine contractions become more frequent and intense, possibly more painful; involuntary bowel movements and constant pain in the lower back;
• rupture of the amniotic sac: in most cases, this happens during labor, so you need to go to the maternity hospital immediately at the slightest suspicion.

Precursors of contractions (latent phase of contractions)

The first contractions are often the longest period of labor, sometimes lasting up to 2-3 days. Uterine contractions:

• mild to moderate (the woman is able to speak during contractions) and last from 30 to 45 seconds;
• irregular (every 5-20 minutes), and sometimes they can stop altogether;
• provoke the opening of the cervix to 3 cm (women who are giving birth for the first time may experience a long latent phase without opening of the cervix).

This phase of labor is long and painful, so women are advised to walk, watch TV, listen to music, or take a warm shower.

Progressive phase of contractions

When you go to the maternity hospital in the latent phase of labor, which provokes the opening of the cervix:

• You will be changed into a special hospital gown;
• Your blood pressure, pulse and temperature will be measured;
• Review your previous pregnancy history;
• You will be asked in detail about the frequency and intensity of contractions, and they will also look at how much the cervix has opened;
• They will monitor the fetal heart rate during contractions (the heart rate indicates the baby’s condition);
• Depending on your condition, you may be given an IV drip with medications.

Maternity hospitals have wards for all stages of labor. If there are no complications, a woman can stay in one ward for the entire period. In emergency cases, a woman is transferred to specially equipped wards where she will receive emergency care.

After you have been admitted to the maternity hospital and undergone an initial examination, you will:

• they will tell you to walk more, since movement helps the contractions go more smoothly;
• fetal heart rate monitoring will be performed frequently;
• You will be allowed to have visitors, but as your contractions progress, you may want to see only your partner.

Active phase of contractions, first stage

When the cervix opens 3-4 cm, the first stage of the active phase of contractions begins, which ends when the cervix is fully opened and the baby is ready to move along the birth canal. At the last stage, contractions are most intense.

Compared to the first contractions, contractions of the uterus in the active phase are characterized by greater intensity and frequency (every 2-3 minutes), while lasting 50-70 seconds. If the amniotic sac has not yet ruptured (this happens precisely at this stage), with increasing intensity of contractions:

• women feel tired and restless, have difficulty standing, do not want to drink or eat; sometimes they are allowed to drink water, but are prohibited from eating food, since if surgery is necessary, general anesthesia will be required;
• You can use breathing relaxation exercises, acupuncture, hypnosis, or other techniques to relieve pain and anxiety;
• women change positions, which helps to increase blood circulation;
• Women in labor may request anesthesia, such as an epidural;
• Sometimes they put in an IV.

[ 5 ], [ 6 ]

Transition phase

The end of the first stage of active contractions is called the transitional phase. The baby moves down, while the contractions become more intense and frequent, and sometimes with a very short break. In the transitional phase, it already becomes clear that the baby will soon be born. At this stage, you need to listen to your body, sometimes women are irritated by outside help, but still, you should not push it away. Irritation, nausea, anxiety and fear increase.

Women giving birth for the first time spend up to 3 hours in the transition phase, while those women who have already given birth in the past spend no more than an hour. Sometimes the transition phase is short, although more intense.

Active phase of seizures, second stage

The second stage of active contractions is associated with the birth of the baby, when it moves along the birth canal due to contractions of the uterine muscles. At this stage:

• contractions have a different character. If they are regular, they can slow down to 2-5 minutes and last 60-90 seconds; when labor stops, you should change your position. If this does not help, the doctor may prescribe labor stimulation.
• you may feel a strong urge to push with each contraction;
• the baby's head creates strong pressure on the rectum;
• You can change the position several times until you find the right one;
• When the baby's head passes through the birth canal, the woman feels a burning pain, since the head is the largest part of the body and is very difficult to deliver. If the baby moves too quickly, the doctor will advise not to push so that the perineum can stretch itself. Otherwise, an episiotomy is performed (usually only in extreme cases);
• a group of specialists will be on the alert for any surprises. In emergency cases, a team of doctors will immediately begin to act.

It is then that only the doctor can make the decision. This pushing phase can last from several minutes to several hours, with the second birth being faster.

[ 7 ]

The third stage, postpartum

After the baby is born, your body will continue to cleanse itself. In the third stage, the placenta is born, while the uterus is still contracting. As a result of these contractions, the placenta separates from the walls of the uterus and is pushed out, and bleeding may occur. The doctor or midwife should carefully examine the uterus for any remnants of the placenta, which provoke bleeding. In extreme cases, the midwife can press on the abdomen, helping the uterus push out the placenta. Medicines or putting the baby to the breast also contribute to better contractions of the uterus and less bleeding. The third stage lasts 5 minutes, sometimes longer. But in most cases, the placenta comes out within 30 minutes. If its birth is incomplete, the doctor removes its remnants manually. Contractions stop only after the placenta is completely born.

Post-term pregnancy

A baby is considered full-term if it is born at 37-42 weeks of pregnancy (weeks are counted from the last menstrual period). If a woman does not give birth at 42 weeks or more, it is considered post-term pregnancy.

Sometimes post-term pregnancy is not considered as such, because the weeks are often counted incorrectly. If ovulation occurs later in your cycle, then pregnancy occurs later. An ultrasound can determine the date of birth based on the size of the fetus, but these calculations are still approximate.

In most cases, the reason for post-term pregnancy is unclear.

What should you worry about when you are going past your due date?

As a rule, a post-term baby is born healthy, but a small number of cases of post-term pregnancy are associated with the freezing and death of the baby. This risk increases with each week and reaches 10% of 1000 cases after 43 weeks. Therefore, the doctor monitors the child's condition at 40-41 weeks.

Many doctors reduce the risk of death by inducing labor before 42 weeks. In most cases, they simply observe, since no one knows what the best solution is for a pregnancy that is 2 weeks overdue:

• in case of post-term pregnancy, if monitoring shows a threat to the child’s health, labor must be stimulated;
• If the cervix thins and opens, many doctors induce labor by puncturing the amniotic sac. Observation until 42 weeks is also considered appropriate. There is no evidence that one option is better for mother and baby than others.
• If the cervix does not become thin and open, observation is the correct solution. Induction of labor does not provide any more benefits. According to statistics, induction of labor after 41 weeks of pregnancy reduces the risk of neonatal mortality and stillbirth.

In order to preserve the health of mother and baby, most experts agree that it is better to induce labor before 42 weeks. It is believed that the risks of carrying the pregnancy beyond 42 weeks are greater than the benefits.

What happens after childbirth?

At this moment you can look at your baby for the first time and hold it in your arms. This is a very exciting moment, as the woman looks at her child with amazement after the grueling ordeal.

If you planned to breastfeed your baby, you can start right after birth. Don't worry if you don't succeed right away. Breastfeeding is a long and mutual process that both mother and baby learn. Skills will come with time, but you can consult a specialist about the correct feeding technique.

In the first hours after birth, women usually feel pain and need help to shower. Sharp and painful contractions of the uterus are observed for several days, as the uterus returns to its normal size.

During the first weeks after childbirth (postpartum period), the woman's body begins to recover and adapt to a new state - the state of "non-pregnancy". Women often get tired and upset, so family members need to create optimal conditions for the young mother to rest.

• Try to sleep when your baby sleeps.
• Ask family members or friends to cook food or do housework.
• Drink plenty of fluids if you are breastfeeding.

During the postpartum period, women are very emotional, but with prolonged depression, dark thoughts (harming yourself or the baby), you need to consult a specialist, since postpartum depression needs to be treated.

The doctor should conduct an examination 2-6 weeks after delivery. This is the time to discuss all the issues of concern, including contraceptives. If you are not planning to have another child, you should take contraceptives even while breastfeeding. The doctor will prescribe medications that are right for you.

When the baby is already born

Women after childbirth are often overcome by conflicting feelings - excitement, surprise and fatigue. When, finally, the child is in your arms, and you can talk to him and look at him carefully, you feel calm and great relief in your soul. During the first hour after childbirth, the baby can be brought to you for the first attachment to the breast and feeding, if, of course, you plan to breastfeed the child.

Breast-feeding

Breastfeeding is beneficial for both mother and baby. But don’t be upset if you and your baby find it difficult the first time. Breastfeeding skills come with time, and minor failures can be easily corrected at home by simply consulting with a specialist. Almost every maternity hospital has at least one lactation specialist who will answer all your questions. In the first days of feeding, your nipples may become engorged, painful, and cracked, but these symptoms usually go away with time.

[ 8 ]

The first hours of recovery

You may feel chilly right after giving birth, but this is a normal reaction of the body after giving birth. Just wrap yourself up warmly. Right after giving birth, the doctor or midwife will:

• Massage the uterus for 15 minutes to help it contract and stop bleeding, later you will do it yourself. If the uterus does not contract, bleeding will continue, in which case medications are prescribed and the doctor will examine the uterus again for placental remnants (the most common cause of bleeding) and ruptures of the cervix or vagina. In severe cases, surgery and IVs are required to prevent blood loss and shock.
• Check the bladder, because an overfilled bladder presses on the uterus and prevents it from contracting. Sometimes a woman cannot urinate on her own because of pain and swelling, then a catheter is inserted. But do not worry, all functions will soon be restored.
• Measure the pressure several times.
• Will apply stitches to the site of cervical and vaginal tears.
• The epidural catheter will be removed (if you had an epidural). However, if you are planning to have your tubals tied, the catheter will be left in place to provide pain relief for the procedure.

[ 9 ], [ 10 ], [ 11 ]

Postpartum recovery period

Physical changes

During the postpartum period, a woman's body undergoes many changes, some of which last for a long time, but each woman experiences them in her own way.

• The uterus begins to return to its normal size from the moment the placenta is delivered, with the reduction (complete reduction) occurring within 2 months. After 24 hours, the uterus is the size of 20 weeks of pregnancy, a week later - half its size at the time of contractions. After 6 weeks, the uterus is the size before pregnancy.
• Postpartum contractions can last for two days, and their pain increases with each subsequent pregnancy. They usually pass on the third day.
• Women also experience muscle soreness (arms, neck and jaw) due to the woman's harder work during labor (this goes away after a few days), as well as bluish spots on the face and redness of the eyes due to strong pushing.
• For several days after giving birth, a woman may have difficulty emptying her bladder and bowels. You should drink plenty of fluids and take laxatives if necessary.
• Postpartum bleeding (lochia) can last from 2 to 4 weeks, appearing and passing over the course of 2 months.
• Recovery from an episiotomy takes about 2 weeks. Pain, swelling, and numbness around the vagina are common after a vaginal birth.
• On the third or fourth day, breast engorgement may occur as a result of the influx of milk, and the mammary glands will be swollen and painful. Take a warm shower and apply a warm compress.
• Reconstruction of the pelvic bones, such as a pubic symphysis or coccyx fracture, takes several months. Treatment involves ice, nonsteroidal anti-inflammatory drugs, and sometimes physical therapy.

If you are concerned about symptoms during the postpartum period, consult your doctor.

How to overcome postpartum problems?

After returning home from the hospital, it can be quite difficult to cope with new responsibilities due to lack of energy and time. Try to calm down. Take a break and think about what needs to be done. Experts recommend using the help of people around you, eating well and drinking plenty of fluids, resting whenever possible, limiting visits to relatives, taking some time for yourself and making friends with other mothers like you for communication and joint walks.

Postpartum depression

If you are in a depressed mood for a long time after giving birth and suspect that postpartum depression has begun, seek help from a specialist.

Even if there are no postpartum problems, you should visit your doctor for a scheduled check-up at 2 and 6 weeks after giving birth. This is a good time to think about contraception and discuss it with your doctor.

Sexuality, Fertility and Contraception

You should not have sexual intercourse or use tampons until the bleeding has stopped. If the bleeding has stopped, but you still experience pain during intimacy, wait a while. The body needs at least 4-6 weeks to recover after childbirth. Usually, women show little interest in sex after childbirth. During the period of recovery and increased needs of the baby, you and your partner need to be very tolerant of each other. Discuss everything with your partner, including changes in intimate relationships.

The menstrual cycle and fertility will resume on their own. Remember that ovulation occurs a month before the first cycle, that is, 2-3 weeks after childbirth. Therefore, if you are not planning to have another child yet, use contraception, even if you are breastfeeding.

• If you are not breastfeeding, your cycle will return within a month or two after giving birth.
• With full breastfeeding, there is no cycle for several months. As a rule, women breastfeed their child for 8 months, but this is not a reliable means of contraception.
• Most birth control methods are safe and effective for breastfeeding mothers. Talk to your doctor about which method is right for you.