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Obstetics:
Am I Pregnant?
If you're unusually tuned into your body, you might begin to suspect that you're pregnant within the first few
days of pregnancy. But, most women don't suspect they are pregnant until they miss a period, and a few
don't suspect or believe they are pregnant for months after conception.
Here are 5 common signs of early pregnancy. You may experience all, some or none of these symptoms.
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A Missed Period: Missing your period is the most clear-cut sign of pregnancy. But it is not
definitive, as stress or other factors may cause irregular periods.
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Frequent Trips to the Bathroom: Even before missing a period, most pregnant women
report having to go to the bathroom more often. You may even have to get up during the
night! This occurs after the embryo has implanted in the uterus and begins producing the
pregnancy hormone called human chorionic gonadotropin (hCG). This hormone triggers
frequent urination.
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Fatigue: Utter exhaustion is a very early sign of pregnancy. Fatigue is a result of high levels
of the hormone progesterone.
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Morning (and Noon and Night!) Sickness:
Guess what? That queasy feeling isn't limited to
mornings. Most pregnant women who experience morning sickness feel slightly nauseated at
other times during the day as well. About half have vomiting, but very few have severe
enough morning sickness to develop dehydration and malnutrition.
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Sore (and Enlarged) Breasts: If you're pregnant, your breasts will probably become
increasingly tender to the touch, similar to the way they feel before your period, only more
so. Once your body grows accustomed to the increase in hormones, the pain will subside.
If you have any of the above symptoms, consider taking a pregnancy test as soon as possible.
Now that you're pregnant, taking care of yourself has never been more important. Of course, you'll probably
get advice from everyone — your doctor, family members, friends, co-workers, and even complete strangers
— about what you should and shouldn't be doing.But staying healthy during pregnancy depends on you, so
it's crucial to arm yourself with information about the many ways to keep you and your baby as healthy as
possible.
Prenatal Health Care
Is prenatal care important?
Prenatal care is very important. You can help make sure that you and your baby will be as healthy as
possible by following some simple guidelines and checking in regularly with your doctor.
What will happen during prenatal visits?
After you find out you are pregnant, you should make an appointment with your doctor. Your first prenatal
visit will likely be when you are 10 to 13 weeks pregnant.
Prenatal Visits
Prenatal visits allow your doctor to closely watch your health and your baby's progress. During these visits,
you will be examined and the growth of the baby will be checked.
An early prenatal checkup may be longer and more involved than later visits. This visit will include a detailed
health history, a physical exam, lab tests, calculation of your due date, and a schedule for your prenatal
care. Throughout your pregnancy you will see your doctor on a regular basis. These visits provide a good
chance to discuss any questions or concerns and learn more about your pregnancy.
History. A review of your health history and any previous pregnancies can help your doctor provide any
special care you may need during your pregnancy. Each pregnancy is different and problems may arise
without warning. The more information you can provide, the better equipped your doctor will be to plan your
care.
Physical Exam. After your health history is obtained, your height, weight, and blood pressure will be
measured. You will then have a general physical exam. A pelvic exam and a Pap test also may be done.
Due Date
The day your baby is due is called the "estimated date of delivery," or EDD (also known as estimated date of
confinement or EDC). A typical pregnancy lasts 40 weeks from the first day of your last menstrual period.
Although only about 1 in 20 women deliver on their exact due date, the EDD is useful for many reasons. It is
used as a guide for checking the baby's growth and the progress of your pregnancy. Your due date also
affects the timing of prenatal tests. In some cases, the test results depend on the stage of pregnancy.
There are a number of ways to figure your due date. They often are used together to help predict when your
baby will be born. Most women go into labor within 2 weeks of their due dates—either before or after.
Tests
During pregnancy, certain routine lab tests are done on all women. Depending on your health history and the
results of your routine tests, your doctor may recommend that you have other tests.
To confirm a pregnancy, your blood or urine may be tested for the hormone human chorionic gonadotropin
(hCG). Also, the doctor can order lab tests to check for any diseases or infections. These tests may include:
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Urine tests. A urine sample is checked to look for sugar, protein, and bacteria, which can
signal diabetes or a bladder or kidney problem.
Blood tests. Blood samples are checked for anemia and certain infections. Your blood
type and Rh factor also are noted.
Pap test or cervical culture. The cells from the cervix collected during a pelvic exam may
be checked for signs of infection, cancer, or conditions that could lead to cancer.
Glucose screening test. The sugar level in the woman's blood is measured to test for
gestational diabetes.
Group B streptococcus (GBS) testing. The cells from the woman's vagina and rectum are
tested for the presence of GBS, which can be passed to the baby during delivery and
cause infection.
Human immunodeficiency virus (HIV) test. A blood sample is checked for HIV
antibodies. If the test result is positive, another test is used to confirm the results. If you
have HIV, you could pass it to your baby during pregnancy, labor, delivery, and
breastfeeding. There are things you can do to help prevent this from happening.
You and your doctor will discuss your results and decide what treatment and other tests, if any, are best for
you.
Testing for Birth Defects and Genetic Disorders
Tests can be done to help detect certain birth defects. These tests are done at various times during
pregnancy. Some may need to be done in a special center equipped to perform them.
Some tests are offered to all women to help assess the risk of certain birth defects. These screening tests
do not diagnose birth defects, but they may tell if there is an increased risk for a problem. Types of screening
tests include:
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First trimester screening. The results of special ultrasound tests and blood tests are
combined to determine your baby's risk for Down syndrome and trisomy 18 . These tests
are done between 10 and 14 weeks of pregnancy.
Maternal serum screening. A group of blood tests (also called "triple" or "quad" screen)
that check for abnormal levels of substances linked with certain birth defects, such as
Down syndrome and neural tube defects . These tests are done between 15 and 20
weeks of pregnancy.
Cystic fibrosis testing. A lab test done on a sample of blood or saliva to see if a couple is
at an increased risk for giving birth to a child who will have cystic fibrosis. This test can be
done before pregnancy or early in pregnancy.
Other tests may be done if the results of a screening test or other factors raise concerns about your baby.
The results of these tests often can show whether the fetus has certain birth defects:
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Detailed ultrasound exam. A type of ultrasound exam that can help explain abnormal
results and provide more detailed information.
Amniocentesis. A procedure in which a needle is used to withdraw a small amount of
amniotic fluid and cells from the sac surrounding the fetus. This fluid and cells are then
sent to a lab and tested. This procedure most often is done between 15 and 20 weeks of
pregnancy.
Chorionic villus sampling (CVS). A procedure in which a small sample of cells is taken
from the placenta and tested. This is done between 10 and 12 weeks of pregnancy.
No test is perfect. A test may not find a birth defect that is present. Or, your baby may have a problem that
the test was not meant to find. The tests cannot find all birth defects.
Exercise
Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of
pregnancy. It may give you more energy and make you feel better. Most women should exercise 30 minutes
or more each day. Talk with your doctor before starting an exercise program. Your center of gravity shifts and
your balance changes while you are pregnant. This may put you at a greater risk for falls. You tire more
easily. It also takes longer to recover. Caution should be the rule:
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Avoid getting overheated.
Limit outdoor exercise in hot weather.
Avoid exercise that makes you very tired, or with a high risk of falling or abdominal
trauma.
Drink lots of water.
Wear good support shoes and bra.
The type of exercise you can do during pregnancy depends on your health and on how active you were
before you became pregnant. This is not a good time to take up a new, hard sport. But if you were active
before, you can continue to be, within reason. If, for example, you played tennis, you can likely still play
unless you have special problems or feel very tired. The following activities, in moderation, are especially
good during pregnancy:
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Swimming
Brisk walking
Prenatal exercise classes
Work
Most of the time, a healthy woman with a problem-free pregnancy can keep working if her job poses no
more risk than daily life. Discuss with your doctor the type of work you do both at your workplace and at
home.
There could be hazards in your workplace:
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Do you work around chemicals, gas, dust, fumes, or radiation?
Do you have to lift heavy loads, work at heights, or use high-speed machines?
How much weight should I gain during pregnancy?
It's different for everyone, but most women gain about 25 to 30 pounds. If you don't weigh enough when you
get pregnant, you may need to gain more. If you're overweight when you get pregnant, you may need to
gain only 15 to 18 pounds.
Remember that pregnancy is not the time to diet or deprive yourself! It's best to gain about 2 to 3 pounds
during the first 12 weeks and about 1 pound a week after that. Talk to your doctor about how much weight
you should gain.
Medications During Pregnancy
The following medications can be used for minor symptoms. Be sure to take the medication only as directed
by your health care provider or as written on the label. If your symptoms are not relieved or get worse,
contact the office.
Symptoms
Headache
Cold
Constipation
Diarrhea
Indigestion
Hemorrhoids
Nausea and Vomiting
Yeast Infection
Over the Counter Medication:
Tylenol (plain), regular or extrastrength. Do not take aspirin or
ibuprofen (Advil, Motrin or Aleve).
Tylenol (plain), regular or extrastrength for aches and fever.
Sudafed (plain) for nasal congestion.
Robitussin (plain), Robitussin DM for
cough. Rest and drink plenty of
fluids.
Metamucil, Fiber-all, Milk of
Magnesia, bran, Colace, Citracel
Kaopectate or Immodium. Drink lots
of water.
Tums, Rolaids, Maalox, Mylanta
II, Zantac, Tagamet
Preparation H, Anusol HC.
Vitamin B6 (up to 75 mg. a day),
Emetrol, Dramamine
Monistat, Gyne-Lotrimin, Femstat.
Consult your physician before use.
Herbal remedies and supplements have not been proven by the FDA to perform as described. Please talk
to your physician about herbal remedies/supplements prior to using during pregnancy.
You feel great. You’re energized and looking forward to a last getaway before baby’s arrival. Caution and
common sense will help ensure your trip as a memory maker.
Guidelines for comfort and well being while away from home:
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Get permission from your Doctor—With an uncomplicated pregnancy, most physicians
approve of second trimester travel
Plan for relaxation—Don’t make elaborate plans leading to stress and over-exertion. Plan
an itinerary that allows rest and renewal.
Eat well—Bring nutritious snacks and fluids—try not to skip meals, wash fruits and
vegetables well, and avoid unfamiliar foods
Try to stay well hydrated. Drink bottled water, about a glass an hour. Avoid sodas and
caffeinated drinks. Don’t forget a good supply of your prenatal vitamins
Airline Approval--If flying to your destination, check with the airline about travel close to
the third trimester. Most carriers refuse boarding after 34-36 weeks
Stay mobile—Whether flying or driving, allow for time to move around to promote
circulation and reduce swelling. Walking and stretching every two hours is best for overall
comfort
Dress appropriately. Comfortable, loose clothes are a necessity. Low heeled shoes and
support hose will do your legs a favor
Plan for surprises—Due dates are educated guesses. Take a short version of your
medical history with you. Find the location of the closest hospital or health care provider.
No Go Destinations—Avoid locations that may cause risk to you and baby. Some
developing countries may require immunizations that are hazardous during pregnancy.
Some medications for intestinal upsets should be avoided. Check with your Doctor
regarding safety issues or change vacation plans to minimize risk
Alcohol, Tobacco, and Other Drugs
Alcohol can harm the fetus. How much alcohol it takes to harm the fetus is not known. Therefore, it is best
not to drink at all in pregnancy. Drinking alcohol can lead to fetal alcohol syndrome. Babies who have fetal
alcohol syndrome may have many problems, including mental retardation, heart defects, and defects of their
joints and limbs.
Women who smoke during pregnancy are more likely to have certain problems, such as vaginal bleeding,
stillbirth, and small babies. Less oxygen and nutrients may reach the fetus. Babies born to women who
smoke have an increased risk of asthma and sudden infant death syndrome (SIDS). If you smoke, now is a
good time to quit. It is a good idea for other family members to quit, too. Secondhand smoke also is bad for
the baby.
Illegal drugs—such as crack or cocaine, heroin, PCP; methamphetamines and marijuana; and tranquilizers
—also can harm the fetus. Use of these drugs can cause problems with the placenta, preterm birth, and
birth defects. The baby can have learning problems and be addicted to drugs.
Changes During Pregnancy
As your fetus grows and changes, it is normal for you to have some discomforts. Some of these may occur
only in the early weeks of pregnancy. Others may occur only at the end. Still others may appear early, then
go away, and then return.
Physical Changes
Breast Changes. Early in pregnancy, your breasts begin to grow and change to prepare for breastfeeding
your baby. They will feel firm and tender. As your breasts grow, wear a bra that fits well and provides
support. Your nipples may stick out more and get darker. This will help your baby to breastfeed.
Frequent Urination. Throughout pregnancy, the kidneys work harder to flush waste products out of your
body. Also, as your uterus grows, it puts pressure on the bladder. Your bladder may be nearly empty but still
feel like it is full. The weight of your uterus on your bladder may even cause you to leak a little urine when
you sneeze or cough.
Coffee, tea, and cola drinks contain caffeine, which makes you urinate more. If you consume less of these
drinks, you will urinate less often. Do not cut back on other liquids. Drinking less will rob your body of vital
fluids.
Mouth and Tooth Changes. Pregnancy hormones can make your gums swell and bleed. Switching to a
softer toothbrush may help lessen irritation.
A dental checkup early in pregnancy will help ensure that your mouth stays healthy. Pregnant women are at
an increased risk for cavities and gum disease. When you go to the dentist, be sure to let him or her know
that you are pregnant.
Lower-Abdominal Pain. As the uterus grows, the muscles that support it are pulled and stretched. You may
feel this stretching as either a dull ache or a sharp pain on one side of your belly. The pains are most
common between 18 and 24 weeks of pregnancy. Resting or changing your position may help relieve the
pain.
Numbness and Tingling. Some women have pain, numbness, or tingling in certain parts of their bodies
during pregnancy. As your uterus grows, it presses on some of the nerves connecting your legs to your
spinal cord. This may cause chronic pain in the hip or thigh (sciatica).
Nerves also can get pressed if your legs swell during pregnancy. This pressure can cause your legs or toes
to tingle or feel numb. Most often, these symptoms are minor and go away after the baby is born.
Your arms or hands also may tingle as a result of tissue swelling. For instance, a condition called carpal
tunnel syndrome is common in pregnant women. It causes a burning, tingling feeling in one or both hands. It
also may make your fingers numb. Wearing a special wrist splint can help.
Shortness of Breath. Later in pregnancy your uterus takes up more room in your abdomen. By about 31–
34 weeks of pregnancy, the uterus is so large that it presses the stomach and the diaphragm (a flat, strong
muscle that aids in breathing) up toward the lungs. Slowing down and sitting or standing up straight can help
you breathe easier.
Skin Changes. The hormones in your body often cause some changes on your skin. Some women have
brownish, uneven marks around their eyes and over the nose and cheeks. This is called chloasma. These
marks usually disappear or fade after delivery or breastfeeding, when hormone levels go back to normal.
Being in the sun tends to make the marks darker.
In many women, a line running from the top to the bottom of the abdomen becomes dark. This is called the
linea nigra. Also, streaks or stretch marks may appear on the abdomen and breasts as they grow. This is
caused by the skin tissue stretching to support the growing fetus. There is no way to prevent stretch marks.
They may slowly fade after pregnancy.
Easing Discomforts
Backache. One of a pregnant woman's most common problems, especially in the later months, is
backache. One cause is the strain on your back muscles from carrying extra weight. Another is the posture
women often assume during pregnancy to offset the weight. Exercises to stretch and strengthen your back
muscles can help relieve this pain. Here are some other tips to help ease back pain:
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Wear low-heeled (but not flat) shoes with good arch support.
Avoid lifting heavy objects.
Bend at the knees to pick things up.
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Sit in chairs with good back support, or tuck a small pillow behind your lower back.
Sleep on your side rather than on your back.
Apply a heating pad using the lowest temperature setting, warm-water bottle, or cold
compress to ease the pain.
Congestion and Nosebleeds. During pregnancy, your hormone levels increase, and your body makes
extra blood. Both of these changes cause the mucous membranes inside your nose to swell, dry out, and
bleed easily. As a result, you may have a stuffy or runny nose. Try using saline drops to relieve congestion.
Using a humidifier to moisten the air in your home also may help.
Constipation. Most pregnant women get constipated at some point. When that happens, gas can build up
and cause bloating and pain.
Pregnancy hormones may slow digestion and cause constipation. Toward the end of pregnancy, the weight
of the uterus puts pressure on your rectum, adding to the problem. Some things may help:
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Drink plenty of liquids. Drink eight glasses of liquid per day. Prune or other fruit juice also
can help relieve constipation.
Eat high-fiber foods. Raw fruits, vegetables, beans, whole-grain bread, and bran cereal
are good choices.
Exercise. Exercising every day aids your digestive system.
Pregnant women who are constipated often have hemorrhoids. These are painful and itchy enlarged veins in
the rectal area. Constipation can make these swollen, itchy veins worse. Talk to your doctor about using
creams and suppositories to provide relief.
Even if hemorrhoids improve during pregnancy, straining during delivery can bring them back. Products for
treating pain from hemorrhoids and the tips on avoiding constipation should help.
Leg Cramps. During pregnancy, a sharp, painful cramp or "charley horse" in the calf may be a bother—
especially at night. Stretching your legs before going to bed can help relieve cramps. Avoid pointing your
toes when stretching or exercising.
Heartburn. Heartburn is a burning feeling in the throat and chest. This is often caused by pregnancy
hormones, which relax the muscle valve between your stomach and esophagus (the tube leading from the
throat to the stomach). As your uterus grows, it adds to the problem by pressing up against your stomach.
For relief:
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Eat six small meals per day instead of three big ones.
Do not drink a lot of liquid with your meals. Drink fluids between meals instead.
Stay away from fried, greasy, and fatty foods.
Avoid fizzy drinks, citrus fruits or juices, and spicy or fatty foods.
Do not eat or drink within a few hours of bedtime.
Do not lie down right after meals.
Ask your doctor about using antacids or other medications.
Insomnia. After the first few months of pregnancy, you may find it hard to sleep at night. As your abdomen
grows larger, it may be hard to find a comfortable position. These suggestions may help you get the rest you
need:
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Take a shower or warm bath at bedtime.
Try using relaxation techniques, such as yoga.
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Lie on your side with one pillow under your abdomen and another between your legs.
Limit naps during the day.
Nausea and Vomiting. Nausea and vomiting are common during the first 12–14 weeks of pregnancy. This
often is called "morning sickness," although it can occur at any time of the day. It often occurs when your
stomach is empty. Until the nausea and vomiting go away, there are some things you can do that might help
you feel better:
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Eat dry toast or crackers before you get out of bed in the morning.
Eat foods that are low-fat and easy to digest. The "BRATT" diet (bananas, rice,
applesauce, toast, and tea) may help. This diet will provide vital nutrients that will replace
those you have lost.
Get plenty of fresh air. Take a short walk or try sleeping with a window open.
Drink fluids often during the day. Cold drinks that are bubbly or sweet may help.
Eat five or six small meals each day. Try not to let your stomach get empty, and sit upright
after meals.
Avoid smells that bother you.
Swelling. Some swelling (called edema) in the hands, face, legs, ankles, and feet is normal during
pregnancy. It is caused by the extra fluid in your body. It tends to be worse in late pregnancy and during the
summer.
For relief, put your feet up often and sleep with your legs propped up on pillows. This keeps fluid from
pooling in the lower half of your body.
Let your doctor know if you are badly swollen or if you have sudden swelling in your face or hands (hint: your
rings will be too tight). This could signal a problem, such as high blood pressure.
Varicose Veins. The weight of your uterus pressing down on a major vein can slow blood flow from your
lower body. The result may be sore, itchy, blue bulges on your legs and vulva called varicose veins. In most
cases, varicose veins are not a problem.
You cannot prevent varicose veins. However, taking these steps will help relieve swelling and soreness and
may stop varicose veins from getting worse:
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If you must sit or stand for long periods, be sure to move around from time to time.
Do not sit with your legs crossed.
Prop up your legs——on your desk, a couch, a chair, or a footstool—as often as you can.
Exercise—walk, swim, or ride an exercise bike.
Wear support hose.
Emotional Changes
Your body is going through many changes now, and so are your emotions. These emotions—good and bad
—are normal. Ask loved ones or close friends to support you and be patient. Rest and relax as often as you
can. You will feel better, emotionally and physically, if you do.
Pregnant women often have fears about pregnancy, labor and delivery, the effect a child will have on their
lives, and whether they will be good parents. This is normal. There are some things you can do to ease your
mind:
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Know what to expect during labor and delivery. Take a childbirth class to learn relaxation
methods, ways to ease labor pain, and the options you have for pain relief.
Get prepared by taking a newborn-care class before your due date. Many hospitals offer
these 1- or 2-day courses. Also, read up on infant care before your baby arrives.
Women who have a history of depression may need special care during and after pregnancy. If you find that
you have any of these symptoms, seek help:
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Depressed mood most of the day, nearly every day
Loss of interest in work or other activities
Feeling guilty, hopeless, or worthless
Thinking about death and suicide
Sleeping more than normal or lying awake at night
Loss of appetite or losing weight (or eating much more than normal and gaining weight)
Feeling very tired or without energy
Having trouble paying attention or making decisions
Having aches and pains that do not get better with treatment
How Your Baby Grows
The First Trimester:
0–13 Weeks
The placenta develops.
The major organs and nervous system
form.
The heart starts beating.
The lungs begin to develop.
Bones appear.
The head, face, eyes, ears, arms,
fingers, legs, and toes form.
Hair starts to grow.
Buds for 20 temporary teeth develop.
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The Second Trimester:
14–28 Weeks
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The organs develop further and begin to
function.
Eyebrows, eyelashes, and fingernails
form.
The skin is wrinkled and covered with a
waxy coating (vernix).
The genitals develop.
Fine hair (lanugo) covers its body.
The fetus moves, kicks, sleeps, and
wakes.
The fetus can swallow, hear, pass urine,
and suck its thumb.
The Third Trimester:
29–40 Weeks
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The fetus kicks and stretches. (This
activity may slow down as the fetus
grows and space in the uterus
decreases.)
Lanugo disappears.
With its major development
finished, the fetus gains most of its
weight—about half a pound each
week until birth.
Bones harden, but the skull
remains soft and flexible for
delivery.
Labor
You cannot predict when labor will start. Still, there are some things you can do ahead of time to be ready.
For instance:
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Pack your bag for the hospital. Leave jewelry and other valuables at home.
Plan your hospital route. Know how long it will take to get there. Consider distance, means
of transportation, time of year, time of day, who will take you, and if you need a babysitter.
Ask whether to call your doctor first or go to the hospital first when you go into labor.
Get a car safety seat to bring your baby home.
True Labor Versus False Labor
In the last weeks of pregnancy, your uterus might start to cramp. These cramps may become uncomfortable
or even painful as you get closer to your due date. These irregular cramps are called Braxton–Hicks
contractions, or false labor. Many women have them. Table 2 gives you some of the ways true labor and
false labor differ.
Table 2. Are You Really In Labor?
Hint
False Labor
True Labor
Timing of
contractions
Contractions come at
Contractions often are
regular intervals and
irregular; they do not get
get closer together.
closer together as time
They last 30–90
goes on.
seconds.
Change with
movement
Contractions may stop
when you walk, rest, or
change.
Strength of
contractions
Contractions often are
Contractions steadily
weak, and they tend to
get stronger.
stay that way; or strong
contractions are followed
by weaker ones.
Pain on
contractions
Pain usually is felt only
in the front.
Contractions keep
coming no matter what
you do.
Pain usually starts in
teh back and moves to
the front.
One good way to tell true labor from false labor is to time the contractions. Time how long each lasts and
how long it is from the start of one to the start of the next. It is hard to time labor pains if they are weak. Keep
a record for an hour. Ask your doctor when you should call him or her.
Usually, you do not need to go to the hospital as soon as your contractions begin. While you wait at home,
rest if you can. Some women may find it more comfortable to walk around or to take a shower or a warm
bath. Discuss eating during labor with your doctor. You may be told not to eat or drink anything once labor
has begun.
It is time to go to the hospital if:
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Your amniotic sac ruptures (your "water breaks"), even if you are not having any
contractions. Write down the time it happens.
You are bleeding from the vagina, more than spotting.
The contractions come 5 minutes apart or closer.
You have constant, severe pain. Call your doctor right away.
If you are less than 37 weeks pregnant and having regular uterine contractions, you may be in preterm labor.
Call your doctor right away.
What Happens During Labor
Knowing what happens in labor makes it easier for you to relax and do your part. On average, labor lasts
about 12–14 hours for a first birth. In later births, labor may be shorter.
Labor is divided into three stages. During each stage, certain changes take place in your body. Labor begins
when the uterus contracts and the cervix starts to open. The uterus tightens and relaxes at regular intervals,
causing the abdomen to feel hard, then soft. These are contractions. They make the cervix thin out (efface)
and open as wide as it can (dilate). Early labor is often felt as a low backache that moves around to the
front. As labor continues, the contractions come closer together, last longer, and are usually felt in the lower
abdomen.
Contractions help the baby come through the vagina. Throughout labor, the baby moves deeper into the
pelvis and farther down in the vagina. The baby's head and body move and turn for the easiest fit through
your pelvis.
Stages of Labor
First Stage
This stage is usually
ends when it is
passed from the vagina
become longer and
the longest. It begins when the cervix starts to open and
completely open (fully dilated). Blood-tinged mucus is
("show" ). Near the end of this stage, contractions
stronger.
Second Stage
Once your cervix is fully dilated, the baby needs help to move down the vagina.
You will be asked to push the baby out by bearing down
during each contraction, until the baby is born. This is a lot
of work. The second stage may last up to 3 hours or longer,
especially during a first birth. It ends with the birth of the
baby.
Third Stage
After the baby is born, the
will be delivered. These
contractions that push out the
stage may last from just a few
uterus will continue to contract and the placenta
contractions are closer together than the
baby. They usually cause less pain. This last
minutes to 15–20 minutes.
Monitoring During Labor
The heart rate of the fetus usually is monitored during labor to help alert your doctor to warning signs. The
doctor and nurse can listen to the fetal heartbeat at certain intervals, often after a contraction. The heartbeat
can be heard with a type of stethoscope or an ultrasound device.
Electronic fetal monitoring uses electronic equipment to measure the fetus's heart rate and uterine
contractions. This monitoring can be done with instruments attached to the woman's abdomen (external). It
also can be done by having a small device attached to the scalp of the fetus (internal). Sometimes both
types of devices are used.
Pain Relief
For most women, having a baby involves some pain. There are several ways to help you deal with the pain.
Relaxation techniques give some women very good control of the discomfort of labor. These techniques
include breathing in certain patterns and imagining you are elsewhere. They are often taught in prenatal
classes. Your labor nurse also may be able to teach you.
Analgesics are drugs that ease pain. They can be injected into the muscle or vein. These may make you
more comfortable and allow you to rest between contractions.
Anesthetics are drugs that remove pain. Local anesthesia numbs a small area. Regional anesthesia (spinal
anesthesia or epidural anesthesia ) takes away painful feeling in the uterus and pelvic area. You may still
feel the baby move through the birth canal. This type of pain relief allows you to be awake and take part in
the birth of your baby without feeling as much pain.
Delivery
The hospital is the safest place to give birth to your baby. Ask to tour the hospital in advance so that you
know what to expect. That way, once you are in labor and arrive at the hospital, you will know where to go.
Vaginal Delivery
Most women give birth to their babies through the vagina. When your baby's head appears at the opening of
the vagina, the tissue of the vagina becomes very thin and tightly stretched. Sometimes it is not possible for
the baby's head to fit through without tearing the woman's skin and muscles. Your doctor may make a small
cut in the vaginal opening while it is numbed with an anesthetic. This is called an episiotomy.
Sometimes the doctor needs to help delivery along. In these cases, forceps or vacuum cups can be used.
Cesarean Delivery
In some cases, a cesarean birth may be needed. Cesarean birth is delivery of the baby through a cut made
in the woman's abdomen and uterus.
Sometimes the decision to have a cesarean birth can be made before labor begins. Other times a cesarean
birth may be needed during labor. The baby may be too large for vaginal delivery. Sometimes, opening of
the cervix may be slow or incomplete. The fetus's heart rate may decrease or slow for a long time. Cesarean
birth also may be needed because of a problem for the woman, such as heavy bleeding.