Labor, Delivery, and Postpartum Period

The birthing process is known as labor and delivery. No one can predict when labor will start. One woman can have all the signs that her body is ready to deliver, yet she may not have the baby for weeks. Another woman may have no advance signs before she goes into active labor. First-time deliveries are more difficult to predict.

Signs of approaching early labor

Signs that early labor is not far off include the following:

• The baby settles into your pelvis. Although this is called dropping, or lightening, you may not feel it.
• Your cervix begins to thin and open (cervical effacement and dilatation). Your doctor checks for this during your prenatal exams.
• Braxton Hicks contractions become more frequent and stronger, perhaps a little painful. You may also feel cramping in the groin or rectum or a persistent ache low in your back.
• Your amniotic sac may break (rupture of the membranes). In most cases, rupture of the membranes occurs after labor has already started. In some women, this happens before labor starts. Call your doctor immediately or go to the hospital if you think your membranes have ruptured.

Early labor (latent phase of labor)

Early labor is often the longest part of the birthing process, sometimes lasting 2 to 3 days. Uterine 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 3 cm (1 in.). First-time mothers can experience many hours of early labor without the cervix dilating.

It's common for women to go to the hospital during early labor and be sent home again until they progress to active labor or until their "water" breaks (rupture of the membranes). This phase of labor can be long and uncomfortable. Walking, watching TV, listening to music, or taking a warm shower may help you through early labor.

Early labor that is progressing

If you arrive at the hospital or birthing center in early labor that is dilating and effacing the cervix or is progressing quickly, you can expect some or all of the following:

• In the birthing room, you will change into a hospital gown.
• Your blood pressure, pulse, and temperature will be checked.
• Your previous health, pregnancy, and labor history will be reviewed.
• You will be asked about the timing and strength of your contractions and whether your membranes have ruptured.
• Electronic fetal heart monitoring will be used to record the fetal heart rate in response to your uterine contractions. Fetal heart rate shows whether the baby is doing well or is in trouble.
• You will have sterile vaginal exams to check whether your cervix is thinning and opening (effacing and dilating).
• Depending on your own physical needs and your doctor's preference, you may have an intravenous (IV) needle inserted in case you need extra fluids or medicine later on.

Most hospitals and birthing centers have birthing rooms where women can labor, deliver, and recover. Providing that you have an uncomplicated birth, you can probably be in the same birthing room for your entire stay. If your delivery becomes complicated, you can be quickly moved to a delivery room equipped to handle the problem.

After you have been admitted to the hospital and you have had your initial exam, you will be:

• Encouraged to walk. Walking helps many women feel more comfortable during early labor. Walking is thought to help labor progress, but recent research suggests that walking doesn't actually speed or slow labor.⁹
• Briefly monitored every hour or so (at the least) to check your contractions and the baby's heart rate. You may be monitored throughout your labor.
• Allowed visitors. As your labor progresses and you become more uncomfortable, you may want to limit visitors to your partner or labor coach.