As Labor Nears
As pregnancy nears its end, there is natural concern about getting to the hospital in time and recognizing the signs of imminent events.
During the final weeks of pregnancy (thirty-eighth to fortieth weeks) there is frequently no increase in weight. Even the baby may seem to be preparing for his advent by some reduction of activity. The patient may notice an increased sense of well-being, less discomfort from heavy weight of the uterus, and more energy for her usual household activities.
Mild, fleeting, irregular uterine contractions coming every ten or 15 minutes or so and lasting ten or 15 seconds may be noted. Most women do not notice these mild contractions, but some feel slight pain, or occasional association with mild, transient low backache. If contractions come more frequently than every ten minutes, and last for 30 seconds, the obstetrician should be notified. It is advisable that neither fluids or solid food be taken once labor has begun.
A woman about to go into labor often notices the discharge of a mucus plug. This plug extrudes from the small remnant of the cervical canal which remains at the onset of labor, and when it is passed the surface of the fetal membranes is in direct contact with the vagina. Also, at the onset of labor there may be a discharge of clear watery material, which does not indicate rupture of the membranes but that rupture is imminent. A small amount of reddish or pink discharge known as “show” frequently indicates onset of labor.
Though contractions at tenminute intervals are a warning to inform the doctor, the real beginning of labor is measured from the onset of contractions which occur at five-minute intervals and last at least 30 seconds. In general, a woman whose office examinations have been normal can wait at home until 30second contractions occur every five or six minutes. However, if she has given birth before, it is advisable to have her in the hospital when contractions occur at ten-minute intervals.
In some patients (ten to 20 per cent) the membranes rupture spontaneously. This speeds up the entire mechanism of labor. If the membranes rupture and labor does not commence in a few hours, the doctor should examine the patient to determine whether labor is in progress. In a first pregnancy, the cervix may be long and thick and take two or three days to thin out. This is called cervical effacement which precedes the onset of labor.
Decisions as to whether the patient may stay at home, in bed or up and about, or in a hospital where frequent nursing observations can be made, are of course made by one’s doctor. In a woman who has had more than one baby, labor usually commences from three to 25 hours after the membranes rupture.
Understanding Labor
It is important for a pregnant woman to have some understanding of the mechanism of labor, which means “work” the bringing forth of a child.
Labor usually takes between six and 12 hours for a first baby, three to six hours in subsequent pregnancies. Labor under two hours, which is rare, is called very rapid labor and it is usually desirable to slow it down. A slow progressing type of labor is less likely to tear tissues than a fast labor.
The first stage of labor is the period from onset of dilation of the cervix, when complete thinning has taken place, to full dilation up to ten centimeters (one inch equals two and a half centimeters) to allow the baby’s head to go through. Usually the head is down in the pelvis at about the level of the spine, a landmark about midway down the pelvis.
Intensity of contractions usually increases as the first stage progresses. When the cervix is slightly dilated, contractions will be mild to moderate but toward the end of the first stage will be more severe. Severe contractions last 40 to 50 seconds at the most, compared to ten to 20 seconds early in the first stage. If the membranes have not ruptured by the time the cervix is dilated about two inches, the doctor will rupture them. This improves the quality of contractions and lessens the duration of labor.
Transition in labor is the stage when the cervix is almost fully dilated. There is a tendency, even though dilation is not complete, for feelings of pressure and pushing to occur during contractions.
The second stage of labor is the time between full dilation of the cervix and the birth of the baby. This lasts from 30 minutes to two hours for a first baby, and from five or ten to 30 minutes in subsequent deliveries. The infant is born at the end of the second stage.
The third stage of labor is the period between the birth of the baby and delivery of the placenta. This usually takes five to ten minutes but may last as long as half an hour. If the placenta has not separated in half an hour, the obstetrician removes it manually. This manual removal usually requires ten or 15 minutes of general anesthesia.