Labor & Delivery

Early Signs of Labor

You may experience some signs to let you know labor is approaching. They may be noticeable several days or even weeks before your due date:

• Braxton Hicks, or false labor, contractions prepare the uterus for labor and may cause some effacement (thinning) and dilation (opening). During the last weeks of pregnancy, they may become stronger and more regular.
• Effacement and dilation may start before the beginning of labor. A vaginal exam performed during a routine office visit can check for effacement and dilation.
• Leveling off or weight loss may be noticed in the last few days before labor begins. Some women lose as much as 1 to 3 pounds of water weight.
• Lightening or “baby dropping” is the moving of your baby’s head into the pelvis. After your baby drops, your abdomen appears lower. Afterwards, it may be easier to breathe and you may have less heartburn. As your baby moves down, you might feel pressure in your pelvic area, experience backaches, and have to urinate more often.
• Loose bowel movements can happen 24–48 hours before labor
• Nesting is a spurt of energy some women may experience before labor begins. You may want to clean the house, wash clothing, or shop for groceries.
• Vaginal secretions may increase to lubricate the birth canal before delivery.

Recognizing Labor

You can recognize labor by uterine contractions occurring every 10 minutes or more frequently (six or more in 1 hour). These contractions may not hurt but can include:

• Menstrual-like cramps felt in the lower abdomen (may come and go or be constant)
• Dull, lower back ache felt below the waistline (may come and go or be constant)
• Pelvic pressure that feels like your baby is pushing down (pressure comes and goes)
• Abdominal cramping with or without diarrhea
• Ruptured membrane or a small leak or gush of fluid from the vagina
• Mucus plug, or thick mucus discharge, usually has a pink tinge

Call your doctor immediately if you have any of these signs of labor before your 37th week of pregnancy.

Relaxation

When you recognize you may be going into labor, it is important to relax. Labor is hard work. By relaxing your muscles you will have an easier and more comfortable labor. Practicing relaxation techniques while you are pregnant will make using them easier when you need them. The only muscle that should be tense is the contracting uterus.

Relaxation techniques should begin with distraction:

• Light housework
• Watching TV
• Reading a book
• Packing a suitcase.

Benefits of relaxation:

• Reduces pain by releasing natural pain relievers
• Increases likelihood of shorter labor
• Helps conserve energy
• Reduces tension response to pain

Suggestions for relaxation:

• Get in comfortable surroundings, wearing loose clothing and take your shoes off.
• Position yourself comfortably. Lie on your favorite side or sit in a comfortable chair.
• Support head, arms and legs with pillows.
• Play soothing, low-key music in the background and dim lights.
• Breathe slowly and deeply during relaxation. Don’t hold your breath.
• If you have distracting thoughts, repeat a word or phrase to yourself to clear your mind.
• Each person relaxes in her own way. Practice will help you find what works best for you.
• Practice regularly until you can become relaxed and focused with several slow, deep breaths.

Comfort Measures for Labor

Relaxation and breathing techniques will help you work with your labor. Other techniques you may also want to use are:

Acupressure

Acupressure is an ancient method of using pressure over a particular point to relieve tension and discomfort. This can be used for pregnancy and labor.

Hydrotherapy

Hydrotherapy is the use of warm water to relax muscles and to relieve stress and tension. During labor, hydrotherapy helps decrease tension in the working muscles and can help stimulate labor as well as increase the pace of cervical dilation. Laboring mothers using hydrotherapy tend to use less medication for pain relief. Talk with your doctor about the use of hydrotherapy for labor.

Aromatherapy

Aromatherapy is the use of oils to promote health and well-being for your body, mind and emotions. Aromatherapy works in a very natural way by using your sense of touch and smell. These oils can be used during massage, in a bath, as a lotion, with a compress or in a vaporizer. Aromatherapy helps you deal with stress, promotes relaxation and relieves minor discomforts.

Medication Choices for Vaginal Birth

Use of relaxation and breathing are all some women need to cope with labor; however, in some cases, it does not provide enough pain relief or relaxation. If you find you need medication or anesthesia, it is important you are aware of the choices available to you, including:

• Analgesics (narcotics)
• Regional anesthesia (local)
• Pudenda
• Epidural

Labor Breathing

Learn more about the benefits and technique of labor breathing.

Role of the Labor Coach

Learn more about the labor coach’s role in delivery.

Delivering Multiple Pregnancies

The likelihood of premature delivery increases with each additional baby in a pregnancy. More than half of twins are born prematurely (before 37 weeks). Premature labor and delivery present a serious risk, so it is important to understand the warning signs for early labor. All of the following should immediately be reported to your doctor:

• Pelvic pressure
• Lower back pain
• Increased vaginal discharge
• Change in the frequency of false labor pains

Sometimes premature delivery can be delayed with bed rest and the use of certain medications, if it is detected early. Each day gained provides your babies valuable fetal growth and development. Not all but most multiple pregnancies arrive early. An early delivery is mainly caused because multiple babies stretch the womb quicker than a single child and the cervix may begin to loosen earlier than expected.

Delivery of multiples requires planning by the full medical team, and full intensive care support following the birth. Cesarean section delivery is an option prepared in advance. If any complications are found with ultrasound, such as stressful heart rate or bad position, a Cesarean delivery is often the best way to ensure a satisfactory outcome. Twins may be delivered vaginally if the first twin is positioned correctly (head-first presentation). But if the twins are positioned differently or are otherwise interlocked, a Cesarean section is recommended. Almost all higher-order multiple pregnancies (triplets, quadruplets) are delivered via Cesarean section.