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Normal Labor

Normal Labor

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 Today we are joined by Maggie Power, a midwife, who talks to us about the normal labor process. We answer the following questions: What is labor? Labor is when a pregnant person has uncomfortable contractions of their uterus, or womb, and their cervix starts to open. If everything goes as expected, at the very end, the person is able to push and deliver their baby (or babies) vaginally. There can be many reasons for contractions other than labor. Some are normal and expected, like Braxton-Hicks contractions. Braxton-Hicks are practice contractions, which feel like painless tightening of the uterus, which is preparing your uterus for labor, but doesn’t open the cervix. Other reasons for contractions may include things like dehydration. If you are less than 37 weeks along and having more than four contractions in an hour that don’t go away with rest and hydration, constant pain or if you are having painful contractions, and don’t feel that it is normal, please call your provider or come into the hospital to be evaluated. How do I know when I’m in labor? This is a common worry, especially if it’s your first baby. Most of the time, when someone is in labor, they will have consistent, painful contractions that get more and more intense with time. Usually, these contractions don’t go away or get better with anything you do and take your full attention. Most low-risk, first time moms can follow the 5-1-1 rule. If you are having painful contractions every five minutes, each contraction lasts a minute or more, and this has been happening for an hour, it may be time to call your provider or come in. The contractions should be intense. You may have to breathe through them, and you may not be able to talk through them. Of course, you should always have a discussion with your provider if you have any further questions or concerns. While contractions may be uncomfortable, it does not always mean that the cervix is opening. A cervical exam may be discussed to assess for labor progress. A cervical exam involves placing two fingers into the vagina and measuring with the fingers how dilated (or open) the cervix is. If you are in labor, the cervix will gradually open eventually to about 10cm. Sometimes, even if you’re having contractions, your cervix may not yet be open, or may only be open a few centimeters. Depending on your comfort level and your provider’s, they may let you know that you’re still early in labor, and can likely go home and be more comfortable there. The reason we don’t recommend admitting everyone as soon as they start to have contractions is that sometimes in early labor, contractions can go away or get less intense. This early part of labor is called “latent labor,” and for some people, contractions might start and stop over the course of several days. We wouldn’t want to keep people in the hospital for days unless we absolutely have to! There are many ways and tools to stay more comfortable at home. That’s why your provider might tell you to go home and come back if the contractions become closer together or more intense. When will I be admitted? Some people might hear that if you’re 4 cm or 6 cm you’ll definitely get admitted, and while it’s more likely you’ll be admitted the more dilated your cervix is, there are no definitive answers. This is because some people may be walking around very comfortable at 3 or 4 cm dilated at full term, and they don’t necessarily have to be admitted. However, sometimes, if we see issues with the baby or if a person has a higher risk pregnancy, we might admit them even earlier, like at 2 cm. Everyone is different. For most patients without previously discussed risks, I recommend to call or come to the hospital if you are experiencing the 5-1-1 rule, vaginal bleeding, think that your water is broken, or if the baby is not moving normal for you (kick counts less than 10 in 1-2 hours). However, if you have broken your water, and we have confirmed it, we would usually recommend admission. What should I expect to happen when I come to the hospital in labor? First, we have to do a lot of stuff upfront to make sure that you and your baby are safe and comfortable during your hospital stay. This MAY include putting in an IV in case we need to give fluids or medicine later. We also usually get bloodwork unless you have bloodwork that is up to date. This bloodwork includes blood counts, what blood type you have, and tests for some sexually transmitted infections, like HIV and syphilis. We also usually do an ultrasound to make sure that baby is head down. We also check on your baby. This can be done by different types of monitoring which can be continuous or intermittent. Many people will also get two monitors on their belly: one is to listen to the baby’s heartbeat, and the other is to monitor your contractions. If you are low risk, and don’t have an epidural in place, we can ...

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