Normal Labor

Today we are joined by Maggie Power, a midwife, who talks to us about the normal labor process. 

We answer the following questions: 

1. 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.

2. 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. 

3. 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.  

4. 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 also do something called “intermittent monitoring.” This is when your provider or nurse will listen to the baby’s heartbeat every once in a while to make sure that it is still normal with your contractions. When you get further in your labor, your provider will need to listen more often. Also, if there are any abnormalities in the baby’s heart rate, we would recommend that you be placed on the monitor continuously.

   • While labor is uncomfortable, it leads to meeting your baby which is often different than a lot of pain that we have experienced in our lives. It is typical that contractions are painful for about a minute and then go away.  It can be helpful for you and your support people to know what is normal to make the labor process a little less scary or overwhelming.  There are many ways to deal with discomfort in labor that don’t include an epidural. One way is to keep moving in different positions, even if you do have an epidural in place. There are also lots of different positions that people feel more comfortable in, like standing, rocking, sitting on a birth ball, being on all fours, side-lying, squatting or leaning over the bed. You don’t have to labor lying down! There may be circumstances where it is safer for you to remain in bed which will be discussed with your team. When an epidural is in place, it makes the legs heavy, and we can assist you to move around in your bed.  We can help you find a position that you are most comfortable.

     Some people also bring in things to help them relax. Always discuss with your provider if certain things are ok to bring, as we don’t allow for certain items like candles because of open flames (however, battery operated are ok!). Many people will bring music or essential oils. Some people might have their partners or support person give them a massage. We have aromatherapy scents and locations available for use- lavender and ginger. Also, heat packs can be very soothing to the back or lower abdomen. We also have lots of birthing balls that you can use as well. Also, hydrotherapy or water therapy can feel great.  I encourage this prior to coming to the hospital whether that is a shower or bath.  We also have showers in every room if monitoring allows.  Some people also find that a doula is helpful. A doula is a certified person that can provide guidance and support during your pregnancy and labor course. This can be arranged prior to labor or we can contact to see if one is available when you come to the hospital to deliver your baby.  (Could discuss TENS units, they were popular for pt’s to bring at my last hospital)

     And finally, if you do need to get an epidural, that is also ok. I think of it as another tool in the toolbox. Go check out our podcast on anesthesia in labor to find out more.

5. How long does labor last? 

   • Everyone is different. There are some people who are only in labor for a few hours, but there are some people who are in labor for much longer than that. Usually, we say that people who have had babies before tend to have shorter labors, but again, that is not always the rule! Even for many of us who have been doing this for many years, it is sometimes hard to predict how long someone will be in labor.

     Your provider will check your cervix periodically to see how you are progressing, and you should also tell us how you’re feeling during your labor.

     I will also add that some people may have some vomiting during labor, especially when they are close to having their baby. Also, some people may experience shaking right before, during, or after delivery. All of this is very normal, and we see it all the time.

6. What if things don't go normally? 

   • “Normal” has a wide range, so what is normal for you may not be normal for someone else. But if you or your provider are concerned about your progress in labor, there are certain things that we can do to help make the labor go a little quicker.

     One of those things is to break the bag of water around the baby. This may make the contractions more intense. Another thing we offer is a medication through the IV called Pitocin. Pitocin is just the brand name for the hormone that your own body makes called oxytocin. Oxytocin is something that a pregnant person makes during labor, and it helps to create contractions and continue the labor process. Essentially, we are just giving you a synthetic hormone your own body makes to put you into labor.

     If Pitocin is used, we do recommend that you and your baby be on the monitor at all times so we know how much of the medication should be given. Alternative options may include nipple stimulation.  This is when the nipple is stimulated either manually or with a breast pump.  This typically makes the body release more oxytocin hormone to bring on more contractions. 

   • Pitocin, when indicated, can be a helpful tool to increase the power or strength of the contractions to help the baby move towards delivery.  We have some studies that show that Pitocin or inducing labor itself does not increase the rate of C-section. But just like anyone who is in labor, there is always a risk of needing a C-section. For more information on that, please listen to our specific podcast on “Reasons for having a C-section”!

7. When is it time to push? 

   • Usually, once someone is 10 cm, the pregnant person may feel the urge to push. Sometimes, if an epidural is in place, there may be less of that sensation. You may feel the urge to push or if not, we will work together to starting pushing with your contractions to help your baby out. I want to highlight that pushing during the second stage can be a hard process. It requires lots of work, just like exercising! Also, for a first time parent with an epidural, it can be normal to push for up to four hours, as long as they are making progress and pushing the baby’s head down in the pelvis. Not everyone needs four hours, of course! But most first time parents need maybe one or two hours of pushing, especially with an epidural, before they give birth.

     With patients who have had babies before, this is usually a shorter process. It can still be normal to push for up to 3 hours with an epidural, but many times, for people who have had babies before, it can even be just a few pushes before birth.

     The time is also shorter for people who don’t have epidurals, simply because sometimes with an epidural, it may be difficult to feel exactly where and how to push.

     What is key here is that we want you to listen to your body, and we will work together as a team including your support people, nurse, midwife or doctors in this process of meeting your baby.