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Phase 1: Early (Latent) Labor The first of the three stages of labor is usually the longest, but (thankfully)

it's also the least intense, by far. Over a span of time from several hours to several weeks, your cervix will dilate (open) to three centimeters and will begin to thin out (a process known as effacement). You'll experience mild to moderate contractions that last 30 to 45 seconds and are spaced five to 20 minutes apart although you may not even notice them until the final two to six hours (if you're dilating gradually over a period of days or weeks, you probably won't feel them at all until labor starts in earnest), and they might not come in perfectly spaced intervals. It's possible that your amniotic membranes will rupture now, but it's more likely to happen later in labor and not without a little help from your practitioner. What you probably will feel now is a backache or cramps, and you'll also probably notice a blood-tinged mucous discharge (also known as the bloody show). What you can do during early labor: Of course you're excited (and nervous) as can be, but it's important to try to relax as much as you can during the early phases of labor you'll need to save your strength for later on. If it's nighttime, do what you can to get some sleep (when your contractions become more insistent, you won't be able to). If it's daytime, keep yourself busy. Cook a few more dishes to add to your freezer stash, fold some baby clothes, and do the rest of the laundry so you can come home to an empty hamper (it'll fill up again soon enough). You can also try taking a walk (or a waddle), which might even kick up the contractions a notch (just don't stray too far from home, and don't go anywhere without a cell phone). Eat a light snack if you're hungry, but avoid fatty foods and don't overeat. (SeeEating Well During Labor.) Don't worry about obsessively timing contractions at this point (you'll just get bored and frustrated), but do check periodically to see whether they're getting closer together. Lastly, make sure you use the bathroom often a full bladder can get in the way of labor. Most women (and their nervous coaches) will head to the hospital between the first two phases of labor as the early phase ends and the active phase begins. Important note: Contact your practitioner right away if your discharge becomes bright red or if you think you've released more than two tablespoons of it. Actual bleeding could indicate a problem with the placenta, like placenta previa or another condition that needs to be addressed as soon as possible. Phase 2: Active Labor Your contractions will grow stronger and longer during active labor, a phase that usually lasts from two to three and a half hours. You'll usually be in the hospital or birthing center by this phase (or if you're delivering at home, your midwife will be with you by now). As your cervix dilates to seven centimeters, contractions will come every three to four minutes and will typically last 40 to 60 seconds (although they may not follow a regular pattern). You'll probably notice a distinct peak halfway through each contraction. What you can do during active labor: Do your best to stay relaxed and comfortable, and don't be shy about asking your coach for whatever you need to stay that way, whether it's a back rub or a washcloth to cool your face (he's going to have a hard time anticipating your needs especially if this is his first time, too). If you're having an unmedicated birth, your contractions will soon become too strong for you to talk through them (this is when you'll start your breathing exercises, if you're planning on using them). You might be offered a light snack and clear beverages or ice chips to keep you hydrated, or you might get an IV to maintain fluids if you want. Between contractions, walk around a bit (if you can) or change positions. Make sure you continue to urinate regularly, too. Staff at the hospital will be on hand to take your blood pressure, time your contractions, and monitor the baby's position and progress either with a Doppler or with intermittent electronic fetal monitoring. If you want to get an epidural, now would be a good time to ask for one (though there's nothing wrong with getting one as early as you want during the three stages of labor). If you do opt for an epidural (or if it's hospital policy), you'll be hooked up to an IV to maintain your fluids and you'll also probably be hooked up to a continuous fetal monitor. You probably won't be able to walk around (unless you have a walking epidural), but do try to change positions if you can. Phase 3: Transitional (Advanced) Labor During transitional labor, the last, most intensive, and fortunately the shortest of the phases of labor (generally lasting from 15 minutes to an hour), your cervix will dilate from seven to its final ten centimeters. Contractions are very strong at this point usually 60 to 90 seconds long, and with intense peaks. Because they're spaced only about two or three minutes apart, it may seem as though you barely get to relax before the next contraction begins. During transition, you're likely to feel strong pressure in the lower back and rectum, nausea, fatigue, tightness in the throat and chest area, shakiness, chills, or sweats (or alternating between them). You'll also notice more blood-tinged show as capillaries in the cervix rupture. What you can do during transitional labor: The last of the three stages of labor, this is a physically demanding and draining time and you may feel exhausted, frustrated, impatient, and overwhelmed. Hang in there, though soon, you and your newborn will be meeting face to face. If you feel the urge to push before your cervix is fully dilated, ask your practitioner (or doula, if you're using one) for some guidance. Panting and/or blowing can help stop you from pushing if your practitioner says you're not ready for pushing yet. Pushing before dilation is complete could cause your cervix to swell, which can complicate delivery. Episiotomy An episiotomy is a surgical incision made in the perineum (the area between the vagina and the rectum) to enlarge the vaginal opening. An episiotomy may or may not be needed. Techniques such as perineal massage or warm compresses may assist in softening and stretching the skin of the perineum. However, if the delivery is imminent, the numbing effect of the babys head pressing against the perineum may enable the incision to be performed without discomfort and the use of local anesthesia. Discuss management of pushing with your physician or midwife prior to delivery. Activities to try in the prenatal period that may assist relaxation of the perineum are: Kegels/Pelvic-Floor Bulging

Education - Know what to expect during the pushing stage and effective pushing techniques Activities to try during the pushing stage to help relax the perineum: Release the perineum by doing a Kegel squeeze and relax. Use various positions. Gravity assisted positions are the most advantageous. Cooperate with your physician, midwife and labor nurse(s) during the birth (i.e. lie back and blow if instructed not to push to allow your baby to come out slowly, and stretch the perineum gradually). Warm compression on perineum by your coach. Fetal Monitoring Fetal monitoring is by and large done electronically in birthing facilities. Electronic Fetal Monitors are used to detect and trace the fetal heart rate and uterine contractions. These are usually monitored at the same time however, each one can be obtained separately. In terms of electronic fetal monitoring, it is either external or internal. Fetal monitoring is a valuable tool for measuring fetal well being and assessing labor progress. Due to the sensitivity of the monitor, it may indicate a contraction is diminishing even before you notice the pain subsiding. This information can be a very useful energy saving tool and source of encouragement for you and your partner. Continuous electronic fetal monitoring does limit your mobility regarding walking around, however, if you are able, sitting up in a chair or on the side of the bed with your legs supported are options to staying confined to the bed. External Fetal Monitoring

Internal Fetal Monitoring

External Fetal Monitoring External fetal monitoring means that the baby's heartbeat is detected by placing a small round ultrasound (high-speed sound waves) disc with ultrasound gel on your abdomen and held in place by a lightweight stretchable band or belt. Uterine contractions are recorded from a pressure-sensitive device that is placed on your abdomen and also held by a lightweight stretchable band or belt. External monitoring of contractions in this manner only tells how often your contractions are occurring and how long each is lasting, but not their actual strength. When you first arrive at the hospital or birthing center, part of the initial assessment of you and the baby is 20-30 minutes of externally monitoring your uterine contraction pattern and the baby's heart rate in response to them. Usually, if the initial fetal heart rate and contraction pattern show that both mom and baby are doing well, the monitor is removed and used intermittently. If there are no indications for continuous fetal monitoring, it is OK to ask the nurse to remove the monitor to allow you to walk.

Internal Fetal Monitoring If your physician, midwife or labor nurse(s) feel a need to observe the baby's heartbeat more closely, internal monitoring may be used. A smallelectrode is attached to the baby's scalp to directly monitor the baby's heartbeat. This is possible only after the bag of water has/or is broken. Internal fetal heart rate monitoring may be more comfortable since one of the pieces places around the mother's abdomen will be removed, which allows more freedom of movement. Depending on your labor progress, it may also become necessary for your provider and labor nurse(s) to know the actual strength of your contractions. This is done internally by performing a vaginal exam and placing a thin, catheter-shaped monitoring device inside the uterus. Internal fetal monitoring is a valuable tool for measuring fetal well-being and strength of contractions. Due to the sensitivity of the monitor, it may indicate a contraction is diminishing even before you notice the pain subsiding. This information can be seen on the fetal monitor graph paper and can be a very useful energy saving tool and source of encouragement for you and your partner. Continuous electronic fetal monitoring does limit your mobility regarding walking around. However, if you are able, sitting up in a chair or standing at the bedside are options to staying confined to lying in the bed. 1. Be sure the cord has stopped pulsing for most births. 2. Ensure that there are two clamps on the cord. 3. Hold the section of cord to be cut with a piece of gauze under it. 4. Using sterile scissors cut between the two clamps. 5. Dab excess blood. 6. Place scissors away. Tips: 1. The gauze keeps excess blood from splattering. 2. Remind everyone that mom and baby can't feel the cord being cut. 3. The cord is thicker and harder to cut, more like meat gristle. Don't be surprised. What You Need A newborn baby Gauze What is fetal monitoring? During labor, your healthcare practitioner and nurse will be checking your baby's heart rate to keep tabs on how he's doing and see how he's tolerating your contractions. This is called fetal monitoring. It's usually done with an electronic fetal monitor or a handheld Doppler device like the one your caregiver used to listen to your baby during your prenatal visits. A stethoscope-like device called a fetoscope is sometimes used instead. Your baby's heart rate can be checked continuously with an electronic fetal monitor or periodically (this is called intermittent auscultation). Most women who give birth in U.S. hospitals are hooked up to an electronic fetal monitor more or less continuously throughout labor. What is continuous electronic fetal monitoring like? Wide, stretchy bands hold two electronic disks called transducers against your abdomen. One monitors your baby's heartbeat and the other tracks your contractions. The transducers are connected to a machine near your bed that records this information on paper. You'll hear the galloping sound of your baby's heart if the monitor's volume is turned up. If you or your partner is interested, ask your nurse or practitioner how the machine works and how to tell when it registers a contraction. Electronic fetal monitoring itself isn't painful. That said, some moms-to-be find it quite uncomfortable to have the transducers strapped to their belly during labor. Being tethered to a monitor can limit your movement and may make it harder for you to cope with contractions, too. Some hospitals have devices that work wirelessly so you can walk around while you're being monitored. How is intermittent auscultation done? Your provider or labor nurse will hold the Doppler or fetoscope against your belly and listen to your baby's heartbeat, just as she did during prenatal visits, and she'll assess your contractions by laying her hands on your belly. She'll check at specific intervals, such as every 15 to 30 minutes in the active phase of thefirst stage of labor and every five minutes during the second (pushing) stage. She'll count your baby's heart rate between contractions when he's not moving to determine his "baseline" heart rate (normal is between 110 and 160 beats per minute). She'll also listen throughout some contractions and for a short time afterward to get a sense of how the baby is tolerating them. In addition to the planned interval checks, your baby's heart rate will be evaluated as needed, such as before and after vaginal exams or when your water breaks. If your caregiver suspects a problem is developing, she'll check the heart rate more frequently. You may end up with electronic fetal monitoring for a time or, if necessary, for the duration of your labor. How does continuous monitoring compare to intermittent auscultation? Experts disagree over whether routine continuous electronic fetal monitoring is more effective than intermittent auscultation. One analysis of 12 randomized research studies showed that compared to intermittent auscultation, continuous electronic fetal monitoring was associated with fewer newborn seizures but no significant improvement in Apgar scores or reduction in deaths or longterm problems such as cerebral palsy. A large study that looked at birth certificate records found that electronic monitoring was associated with a lower rate of newborn deaths. However, more than a few experts have criticized this study because of problems with the quality of the data and important factors that were not taken into account, which may have affected the results. And false-positive electronic fetal monitoring readings which indicate a problem when the baby is actually fine are common. For the mother, continuous monitoring is associated with more deliveries by c-section and more assisted deliveries, using forceps and vacuum. Why would I have to have continuous electronic fetal monitoring? You'll have continuous electronic fetal monitoring if: You have pregnancy complications or develop any during labor

Sterile scissors

You get an epidural

You require oxytocin (Pitocin) to induce or augment labor Many practitioners and hospitals insist that laboring women be attached to an electronic fetal monitor continuously throughout active labor and birth regardless of risk factors. That said, if you have a low-risk pregnancy and no complications during labor, the American Congress of Obstetricians and Gynecologists considers intermittent auscultation an acceptable method. And it's the preferred method of the American College of NurseMidwives for women with no risk factors since it's associated with fewer c-sections and forceps and vacuum deliveries, and there's no proof that it makes any difference for the babies. So if you're planning a natural childbirth and don't have any high-risk conditions, and you'd rather not be hooked up to a machine for the duration of your labor, discuss your preference with your practitioner. Find out ahead of time about her views, the hospital policy, and whether or not there's typically enough staff available for the intermittent checks. In some practices in which intermittent monitoring is an option, your provider may still want to connect you to the monitor for an initial 15- to 30-minute check when you're admitted to the hospital in labor. If you're laboring in a birth center or at home, you'll definitely be monitored intermittently. (Birth centers don't have electronic fetal monitors.) You'll have a caregiver with you at all times so the checks can be performed as frequently as needed. If you develop a condition that requires continuous monitoring, you'll need to be transferred to a hospital. When is internal fetal monitoring used? If the external monitor isn't picking up well (which sometimes happens if you're moving around a lot or are obese) or your practitioner has some concerns and wants a more accurate reading, she may choose to do internal fetal heart rate monitoring. In this case, an electrode with a tiny spiral wire on the end is inserted through your cervix and screwed into the surface of your baby's scalp. Your practitioner may also decide to get more information about the strength of your contractions by inserting a special catheter-like gauge through your cervix for internal uterine monitoring. What will my practitioner do if she has concerns about my baby's heart rate? Your practitioner will be evaluating your baby's heart rate frequently throughout labor and watching for anything that could signal a problem. She'll be looking to see that your baby's baseline rate is normal and evaluating changes in his heart rate. Certain heart rate changes are considered a sign of well-being. For example, when your baby moves, his heart rate should go up, just as yours does when you exercise. But a persistently fast heartbeat can be cause for concern. And while some dips in a baby's heart rate are normal, others may be worrisome. Sometimes a few simple interventions such as changing your position, giving you more fluids through an IV, and giving you supplemental oxygen may be enough to improve things. Depending on your situation, other interventions may be necessary, too, which can include stopping oxytocin (Pitocin) if your labor is being induced or augmented; giving you medication to relax your uterus and decrease your contractions; or, if your membranes are ruptured, infusing sterile fluid into your uterus through a slender catheter. If your baby's heart rate continues to be questionable or takes a turn for the worse, and your practitioner is uncomfortable letting him stay in the birth canal any longer, you might have an assisted delivery or a c-section. And by the way, if you've been listening to the galloping of your baby's heartbeat and it suddenly stops, don't panic. Most likely, the transducer on your belly has shifted out of place and lost contact with the heartbeat. Call the nurse so she can adjust it.