Although it’s not required, creating a birth plan can be a helpful tool for women to understand labor and delivery options.
Rebecca C. Garrett-Brown, a certified nurse-midwife for 29 years, encourages pregnant women and their partners to take a childbirth class at their hospital to learn about labor and ask questions.
The stages of labor
During the first stage of labor, the cervix will dilate and soften, known as effacement, in preparation for a vaginal delivery. Full dilation is approximately 10 centimeters. Ask when laboring women should go to the hospital — many hospitals won’t admit a woman until her water has broken and/or she’s in active labor, dilated at least 3 centimeters, and effaced.
Ask about pain management. For a natural birth without medication, women use controlled breathing, relaxation, and body positioning, such as counter back pressure and hip squeezes. An epidural is another option.
An expectant mother can learn labor strategies, too, like how moving around — sitting on a bouncy ball, taking a shower — can help labor advance naturally. Some hospitals have volunteer doulas, trained professionals who can guide and assist women through labor.
Labor can be long. Garrett-Brown says on average, a first-time mother will be in labor for 16 hours.
“Labor is kind of like running a marathon,” says Garrett-Brown, who works at UC San Diego Health Systems. “You need calories.” She suggests snacking lightly, such as eating peanut butter, sucking on popsicles, and drinking clear liquids.
According to Garrett-Brown, while full term is considered 40 weeks, some women don’t naturally go into labor until 41 or 42 weeks. In those instances, there may be increased maternal risk for difficult labor, postpartum hemorrhage, or infection. The risks for babies after 41 weeks can include stillbirth, placental disorders, delayed fetal growth, and umbilical cord complications.
Planned elective induction
One in 4 women have their labor induced. It used to be that only high-risk pregnancies were induced. Nowadays more doctors are inducing mothers-to-be at 39 weeks. This planned elective induction could improve maternal outcomes.
A medical study, known as the ARRIVE Trial, compared 3,062 women, who had their labor induced at 39 weeks, with 3,044 women, who were not induced and delivered via spontaneous labor. The study was designed to evaluate a range of safety outcomes in the newborn. Although the study did not show differences in these outcomes, there was a significant difference in cesarean delivery (C-section) between the two groups. Importantly, the induction group had a lower rate (18.6 percent) of C-section, compared to the women who were not induced (22.2 percent). Also, maternal pregnancy-related high blood pressure problems were lower in the induction group.
“From a practical perspective, less C-sections, less maternal complications, and a hint at probably less neonatal complications. From my perspective, those are exciting results that would lead us to do more deliveries in 39 weeks, rather than continuing pregnancies beyond that point,” says Dr. Rodney K. Edwards, the director of obstetrics at The Children’s Hospital at OU Medical Center and professor and section chief at the University of Oklahoma College of Medicine.
C-sections are considered major surgery and can have complications, including blood clots, hemorrhaging, infections, and more. Babies born by C-section may also have breathing problems.
During induction, if a woman’s cervix isn’t dilating fast enough, a doctor may use a medication to speed it up. A time-released medication may help a woman’s cervix gradually soften, thin, and dilate, making it easier for the baby to be born.
Once the cervix dilates, the rest of the labor and delivery process is standard.
Get ready
Every woman’s labor is different. Throughout the pregnancy, it’s important for pregnant women to talk with their doctor and ask questions.
Expectant mothers can start thinking about labor and delivery during the second trimester. It’s a starting point that can make everyone involved feel in-the-know and ready for the upcoming birth.
