Birth and Delivery - Postpartum

If Hollywood told the truth, labor pains would start and the baby would be born just minutes later. Thanks to the art of editing, this is also how reality shows often depict birth. In true reality, labor is broken up into several stages.&nbsp;
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After the initial stage of labor moves from light contractions to stronger ones that last a minute or more, the cervix may start to open and efface. This is when the woman should head off to the hospital.
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The first stage of labor starts with light contractions that come at 20 to 25-minute intervals. These contractions may only last 15 to 30 seconds, but the woman will soon realize there is a pattern to the pain. Once the pattern is recognized, heading to the hospital may seem like the next best step.
Stage one of labor can last a long time and most doctors and hospitals will just send mom back home until the contractions start getting stronger and closer together.&nbsp;
After the initial stage of labor moves from light contractions to stronger ones that last a minute or more, the cervix may start to open and efface. This is when the woman should head off to the hospital. There is still plenty of time before birth, so there is no need to race through red lights and stop signs.

The first stage, when mom starts feeling real labor pains, can last
between 10 and 14 hours. Once through this first stage, it is time for
mom to head off to the hospital.

When Should I Head To The Hospital?

An <a href="/labor-delivery/anesthesia-during-labor-and-delivery" target="_self">epidural</a> is an injection&nbsp;in the lower back&nbsp;of a body numbing local anesthetic into the space around the spinal nerves. The anesthetic numbs the area below the point of injection as well as the legs, and allows you to remain awake during the delivery.
<h2>How an epidural is done </h2>
First, the skin area of your back where the needle is inserted is cleaned with a special solution. The area may also be numbed with a local anesthetic.&nbsp;The&nbsp;anesthesiologist injects medicine just outside of the sac of fluid around your spinal cord. This is called the epidural space. 
The medicine numbs or blocks feeling in a certain part of your body so that you cannot feel pain. The medicine begins to take effect in about 10 to 20 minutes and works well for longer procedures. A small tube (catheter) is often left in place. You can receive more medicine through the catheter to help control your pain during or after your procedure.
<h2>How spinal anesthesia is administered</h2>
The doctor injects medicine into the fluid in your spinal cord. This is usually done only once, so you will not need to have a catheter placed. The medicine begins to take effect right away. It works well for shorter and simpler procedures. Your pulse, blood pressure and oxygen level in your blood are checked during the procedure. After the procedure, you will have a bandage where the needle was inserted.

<h2>Benefits of an epidural</h2>
The benefit of choosing an epidural for <a href="/labor-delivery-birth-guide" target="_self">labor and delivery</a> is the constant stream of pain medication that can be delivered. Unlike the spinal block, which is a one-time pain medication dose, the amount of medication with an epidural can be increased or decreased as needed. With an epidural, you are 100% awake during labor and delivery and your mental awareness remains intact. You can listen to the doctor, understand all commands and push as needed.
One advantage of the epidural is that it allows most women to fully participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. The epidural can be placed before or anytime during labor.
When choosing an epidural during labor and delivery it may take some time for the pain medication to fully work. Typically it takes 10-15 minutes for an epidural to reach peak performance. If you are in the advanced stages of labor, there may not be enough time to administer the epidural with any effectiveness. In those cases, a combined spinal-epidural may be placed to hasten the pain relief.
<h2>Effects on the mother and baby</h2>
Epidurals, if done by experts, are safe and present little health risk. A sudden drop in blood pressure is not uncommon. The sudden drop can lead the fetal heartbeat to change. That is why your blood pressure and fetal heartbeat will be monitored closely after the placement of the epidural. IV fluids are given the entire time you are taking the epidural to prevent this drop in blood pressure. Medications to raise blood pressure can also be administered through the IV.
The effects of an epidural on the baby are linked to the birthing process and not directly to the baby’s health. In some cases, with an epidural, it may take longer to push, especially if this is the first delivery. You may also be more likely to need an assisted birth via vacuum or forceps, and there is an increased risk of having a <a href="/cesarean-section-and-delivery" target="_self">C-section</a> versus vaginal birth.

An epidural is the most popular choice among women during labor and delivery. It is delivered through a needle and catheter which usually stays in place until the baby is born.

Epidural and Spinal Anesthesia During Labor

General <a href="/labor-delivery/anesthesia-during-labor-and-delivery">anesthesia</a> is rarely used during labor and delivery. When a woman is given a “general”, as it is commonly called, she loses consciousness and feeling. This prevents her from interacting with the attending physician and leaves her unable to push during labor. Typically, general anesthesia is reserved for C-section deliveries that have complications. Benefits of General Anesthesia If there is a complication with a vaginal birth, general anesthesia may be used so the doctor can quickly perform a C-section. General anesthesia takes only a few moments to place the woman into a deep sleep so doctors can remove the baby through an abdominal incision. Negatives of General Anesthesia General anesthesia comes with a long line of potential risks and side effects for the woman and her baby. The most important are cardiovascular function and oxygen exchange. The anesthesiologist will monitor both the woman and her baby, with the help of doctors and nurses, during the C-section delivery under general anesthesia. Risks to baby may include a decrease in blood flow from the uterus and neonatal depression. Administration of General Anesthesia After choosing to place the woman “under”, the anesthesiologist will give her a sedative through an IV leaving her in a semiconscious state. Then, nitrous oxide is given via mask to achieve the unconscious state needed for quick delivery of the baby. Once “under” a tube will be run down the throat to prevent inhalation of vomit and to maintain a clear airway. There are very few reasons to choose a general anesthesia over other forms of pain management during labor and delivery. Due to the potential health risks to woman and her baby, doctors typically choose some other form of medication if a quick delivery is needed.
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General anesthesia is rarely used during labor and delivery. General anesthesia is reserved for C-section deliveries that have complications.

General Anesthesia

During <a href="/labor-delivery-birth-guide" target="_self">labor and delivery</a>, nearly every woman will be given a choice of available pain medications. If she chooses to skip these medications, she is choosing to have, what is called, natural childbirth. While some women may believe natural childbirth is safer for her baby, there can be some common side effects she did not plan on when making her decision to skip pain medication.
<h2>Benefits of natural childbirth</h2>
Leaving pain medication behind during labor and delivery is a very personal choice. Some women <a href="/labor-delivery/labor-and-delivery-birthing-choices" target="_self">choose natural childbirth</a> over a medicated delivery for the safety of the baby or because they simply want to experience natural childbirth. There is no doubt that no medication is safer than any approved medication, as long as the woman practices good breathing techniques. If breathing techniques are not used as part of the natural childbirth pain management plan, going natural could hold higher risks than choosing pain medication.

<h2>Cons of natural childbirth</h2>
The most prominent negative of natural childbirth is the woman's inability to concentrate on the task at hand. When the final stage of labor begins, the woman needs to be strong and focused on pushing the baby through the birth canal. If natural pain management for hours before active labor has left her exhausted, she may not have the strength to push the baby through the birth canal. This could lead to an assisted birth via <a href="/childbirth-class/vacuum-assisted-birth-and-forceps" target="_self">forceps or vacuum</a>, which hold a higher side effect risk than some pain management options.
Breathing is also important during natural childbirth. If mom does not breathe effectively, she can inhibit oxygen intake and flow to the baby. This is especially important during the pushing phase of childbirth. Breathing is required to oxygenate the blood and if the woman holds her breath to combat pain, she will be limiting the oxygen passed to the baby.
<h2>Preparation</h2>
Natural childbirth is a choice that women need to prepare for and educate themselves about thoroughly. Birthing classes are a great start, but the woman will also need to perform daily <a href="/postpartum/kegel-and-pelvic-floor-exercises" target="_self">Kegel exercises to strengthen the pelvic floor</a> for pushing. Breathing techniques and alternative therapies like massage and acupuncture can also help during childbirth.

While some women may believe natural childbirth is safer for her baby, there can be some common side effects she did not plan on when making her decision to skip pain medication.

Natural Childbirth

<html><head></head><body>Bringing a new life into the world is a profound journey, often requiring immense physical effort. If you find yourself near the end of labor feeling drained, remember that this is a natural part of the birthing process. Sometimes, when energy levels hit their limit, or the baby’s head presents a challenge due to size, medical interventions like vacuum-assisted birth or the use of forceps can be your allies in safely completing the birth. While these methods have associated risks, under the right circumstances, they provide invaluable support.

<h2>Vacuum-Assisted Birth</h2>
Occasionally, you may need a bit of help during delivery. The vacuum-assisted method can be a useful tool when complications arise. Here's how it works: a gentle vacuum is applied to the baby's head, aiding in delivery as you continue to push. Your healthcare team is trained to minimize any effects on the baby, such as the temporary "conehead" shape. Rest assured, the pliability of a newborn's skull allows easy correction. Be informed about potential risks, including scalp bruising, neonatal jaundice, and rare cases of hemorrhage, so you can make empowered choices.

<h2>Forceps Delivery</h2>
Forceps, skillfully shaped like two fitted spoons, serve as an extension of your own birthing efforts. They are designed to gently hold your baby’s head to assist while you push with precision. Like the vacuum method, this comes with similar risks—plus, potential skin tears where the forceps make contact. These tools are reserved for moments when they are essential to facilitate safe delivery. Your healthcare team will closely monitor your baby’s vital signs, engaging these methods only when the baby’s wellbeing calls for expedited delivery.

Both vacuum-assisted births and forceps deliveries are intended as last-resort options, activated when the safety and health of you and your baby are at the forefront. Your medical team is there to guide you, using their expertise to make life-enhancing decisions. Their goal is to ensure a healthy start for your baby, balancing immediate needs with expected risks. Empowered with this information, you and your partner can have informed discussions and a clear understanding of these options during your birthing experience.
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When energy levels are low or the baby’s head is a bit too large to push through the vaginal opening, vacuum-assisted birth or forceps may be used to help in the birthing process.

Vacuum Assisted Birth and Forceps

When baby moves out of the vaginal opening, the stretched skin can tear easily. Natural tears are common during childbirth and tend to heal just as quickly as surgical cuts or episiotomies. There are four degrees of vaginal tearing during pregnancy:
<ol>
<li>First Degree Vaginal Tearing – The least painful of all the vaginal tears is the first degree tear. Only the skin around the vagina is affected and tears may be less than one half inch in length. While there is typically some pain associated with the tear during urination, the tear will heal within a few weeks.</li>
<li>Second Degree Vaginal Tearing – When vaginal tears reach the second degree, vaginal tissue and perineal muscles are affected. Stitches are often required to close the wound. The length of the tear can be one inch or longer. Most second degree vaginal tears will heal in a few weeks.</li>
<li>Third Degree Vaginal Tearing – Similar to a second degree vaginal tear where tearing involves vaginal tissue and perineal muscles. In addition to these tissues and muscles being torn, the anal sphincter is also torn. Stitches are required to close the wound and healing time is extended to six weeks or more. Surgical repair of the torn muscles may be required.</li>
<li>Fourth Degree Vaginal Tearing – The worst case of vaginal tearing involves vaginal tissues, perineal muscles, anal sphincter muscles and the rectum. Surgical repair of the tear is required for healing to begin. Women may require additional surgery to treat fecal incontinence. Rectal tearing increases the risk of infection so it is important to follow an approved cleansing regime very strictly during the healing process. After surgery, the wound will take six to eight weeks to heal.</li>
</ol>

Natural tears are common during childbirth and tend to heal just as quickly as surgical cuts or episiotomies. There are four degrees of vaginal tearing during pregnancy:

Vaginal Tearing

A spinal is not unlike an epidural during the administration process, but the effects on the body are far different. Spinals are pain medications delivered via the spinal column in one dose. The medication is fast acting and can achieve a complete block of pain in as little as 2-3 minutes. During labor and delivery, the total block means the woman giving birth cannot feel the lower half of her body, which can make pushing impossible. That's why a spinal anesthesia is usually given exclusively for a cesarean section, while an epidural is done for labor or cesareans. Benefits of Spinal Anesthesia Women who enter the hospital in the latter stages of labor and need a cesarean may not have enough time to get prepped for birth and receive an epidural. In these cases, pain spinal. Spinal pain relief can last up to two hours. Negatives of Spinal Anesthesia As is the case with any pain relief, there is potential health risks associated with a spinal. Most notably, there is a "high spinal" and women may experience a blocking of pain and feeling that spreads into the chest area. This can cause difficulty breathing. Other common side effects include dizziness, itching, convulsions, low blood pressure and severe headache. Localized infections can occur if spinal equipment is not sterilized properly. While this risk is extremely low, moms should always be aware of the risk associated with any medical procedure. Effects on the Baby The same increased risk of C-section and assisted birth that comes with an epidural, can also occur with a spinal. Other than this increased risk, there are no potential side effects for the baby. Spinal anesthesia is usually not chosen as pain relief during labor and delivery.because it&nbsp; blocks movement which can make giving birth vaginally more difficult. Epidurals provide the same pain relief without paralyzing the lower body.
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Spinals are pain medications delivered via the spinal column in one dose. The medication is fast acting and can achieve a complete block of pain in as little as 15 minutes. 

Spinal Anesthesia

You can take classes, watch movies and ask questions about pushing, but until you are in active <a href="/labor-delivery-birth-guide">labor</a>, you won't know exactly how strong the pressure and the need to push really is. Learning some tips for effective pushing can help lt lessen the time spent in labor.&nbsp;
<ul>
<li>Push as if you are trying to have a large bowel movement. The same muscles responsible for moving waste out of the body also work to push the baby out of the uterus.&nbsp;</li>
<li>Never hold your breath. As long as you are breathing, your baby is breathing. Holding your breath to push harder can actually cut off your baby’s oxygen supply.&nbsp;</li>
<li>Pull the chin to the chest. This is especially important when sitting up during labor. Looking at the pubic area can help you focus on where the brunt of your pushes should be located.&nbsp;</li>
<li>Rest between contractions. The female body can take a lot, but pushing is hard work. Resting between contractions does not mean you’ll be able to sleep, but closing your eyes and drifting away to a mental comfort spot may be helpful.&nbsp;</li>
<li>Stop pushing when burning starts. When the baby’s head crowns, the vagina needs a little time to stretch out. If you push too early, tearing could be more painful than it needs to be.&nbsp;</li>
<li>Don’t push unless you feel like pushing. More and more women are choosing a no push labor. As long as the baby is healthy and strong in the birth canal, contractions of the uterus should push the baby out on its own.</li>
<li>Don’t worry about pain medications and pushing. <a href="/labor-delivery/epidural-and-other-labor-anesthesia">Epidurals</a> only take away the worst of the pain, you will still feel the pressure associated with each contraction. At the peak of the contraction, the need to push will be strong in most cases.&nbsp;</li>
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Pushing a baby through the birth canal is an essential part of a vaginal birth. Whether you choose to have pain medications or natural birth, you will feel strong pressure that creates a sudden urge to “get it out”. Most women note that giving birth feels like having a large bowel movement.

You can take classes, watch movies and ask questions about pushing, but until you are in active labor, you won't know exactly how strong the pressure and the need to push really is. Learning some tips for effective pushing can help lt lessen the time spent in labor. 