Labor & Delivery for Pregnancy
At NYU Langone, our doctors and nurses guide you through the labor and delivery process. They work with you to make sure your birthing experience reflects your wishes and to ensure the safe and successful delivery of your baby.
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During labor, a woman’s body prepares for childbirth. NYU Langone doctors assist women in labor and those having vaginal births. They also perform cesarean deliveries.
There are three stages of labor. In early labor, the cervix—which is the opening between the uterus and the vagina—begins to thin and open, also called effacing and dilating, to prepare for birth. During this time, many women begin to feel contractions of the uterus. Contractions typically last about 30 to 45 seconds and occur between 5 and 30 minutes apart.
In active labor, the cervix continues to efface and dilate, and contractions—which are stronger and longer than during early labor—occur more often, typically every three to five minutes.
In the transition phase of labor, the cervix fully dilates to 10 centimeters and contractions can last up to 90 seconds, with 30 seconds to 2 minutes between each contraction. You may feel pressure in the lower back and rectum and experience nausea, shaking, shivering, and sweating. Though intense, this is the shortest phase of labor.
A first labor typically occurs between 37 and 42 weeks of pregnancy.
Signs of Labor
Signs of labor may be evident several weeks to several hours before labor and delivery. These signs may include lightening, which indicates the baby has moved toward the birth canal. Because the baby can put pressure on the bladder, you may feel an increased urge to urinate during lightening.
In addition, the cervix may efface, or thin, and dilate, or open. When this occurs, some women also notice a clear, pink, or blood-tinged discharge, sometimes referred to as the “mucus plug.” This has protected the cervix during pregnancy and is dislodged during the effacement and dilation of the cervix during labor.
You may feel labor contractions, which include a hardening and relaxing of the abdomen, pain in the lower back, pressure in the pelvis, and menstrual-like cramps. Braxton Hicks contractions, which are sometimes referred to as practice contractions or false labor, stop when you change positions. True labor contractions do not.
At NYU Langone, our experts recommend that you contact your doctor when you notice signs of labor, including regular contractions, which are those that typically occur every 5 minutes for an hour after 37 weeks of pregnancy, and painful contractions that progressively become stronger.
You should also call your doctor if you see blood, mucus, or fluid leaking from the vagina. This can be a sign that the fluid-filled amniotic sac that surrounds your baby has ruptured in preparation for birth, which is commonly referred to as your “water breaking.”
If these signs of labor occur before 37 weeks of pregnancy, it is especially important that contact your doctor immediately, as these may be signs of preterm labor. You should also contact your doctor if you experience bleeding from the vagina or if the baby appears to be moving less. The doctor may tell you to go to the hospital.
After you are admitted to the hospital during labor, a physical exam is performed to check your cervix. A fetal monitor may be strapped to your abdomen to check the baby’s heart rate.
Fluids may be administered through a vein with intravenous (IV) infusion to prevent dehydration during labor. Pain medications or a hormone that induces contractions may also be provided through a vein with IV infusion.
If your cervix hasn’t begun to efface or dilate, you may be told to remain at home until the contractions are stronger and occur more often.
Pain Management During Labor
Labor and delivery is different for every woman. Prior to labor, your doctor discusses your plans for pain relief. Keep in mind that your plans may change as labor and delivery progresses.
You may choose not to have pain medication. Techniques for managing labor pain can include changing your body position during labor, performing relaxation or breathing exercises, taking a shower, massaging the lower back, using heat or cold compresses, listening to music, and walking.
Some women choose to be accompanied by a doula. A doula is a birth companion who provides physical and emotional assistance during labor and after birth.
You may decide to have pain medications delivered through an IV in your arm or via an injection into a muscle in the arm or leg. These medications lessen pain but do not eliminate it. They cannot be given too soon before delivery, because they can cause drowsiness in the baby and slow or stop labor. Side effects in the mother may include nausea, vomiting, and drowsiness.
You may opt for epidural anesthesia to help relieve pain during delivery. Epidural anesthesia can relieve all pain in the lower part of the body. An obstetric anesthesiologist numbs an area of the spine by injecting a local anesthetic and then inserts another needle. A thin, hollow tube called a catheter is attached to this and taped to the skin to provide regional anesthesia to the lower back and abdomen during labor.
It typically takes 10 to 20 minutes for epidural anesthesia to start working. You must stay in bed after this procedure.
Epidural anesthesia can lower your blood pressure and lead to difficulty when you are pushing during labor, because of the reduced sensation in your lower body. Some women experience a headache after delivery. Use of epidural anesthesia does not increase the need for a cesarean delivery.
Your doctor discusses the benefits and possible side effects before administering any pain medication.
During a vaginal birth, our team of nurses and physicians monitors you and the baby, as well as the dilation of your cervix. When it is fully dilated—about 10 centimeters—and the baby has advanced into the birth canal, your doctor may tell you to push, using your abdominal muscles. This process can last minutes to hours.
After the baby has passed through the birth canal and out of the vagina, you may feel the contractions continue. This helps you to deliver the placenta, which is the temporary organ that carries oxygen and nutrients from the mother to the baby in the womb. This typically occurs within 30 minutes.
During delivery, the skin on your peritoneum, the area between the vagina and the rectum, may tear as the baby is born. If this occurs, your doctor stitches the tear soon after delivery.
At the same time, our team of maternity nurses applies an antibiotic to the baby’s eyes for protection against bacteria that may have been in the birth canal. They also inject vitamin K into one of the baby’s limbs to prevent irregular bleeding in the brain.
The umbilical cord is clamped and cut, and the baby’s health is evaluated with an Apgar score, which determines the baby’s activity level, heart rate, reflex response, skin color, and breathing rate.
The nurses dry the baby and swaddle him or her in a blanket and then hand the baby to you. You can breastfeed immediately.
Sometimes, a cesarean delivery is planned. This may occur if the baby is in a breech, or bottom first, position, or if the baby is known to have a birth defect called spina bifida.
Cesarean delivery may also be planned if you’ve had a previous cesarean delivery, particularly when a vertical incision was used in that procedure, or if you’ve had prior surgery on the uterus, such as a myomectomy to remove fibroids.
In addition, carrying more than one baby, having a baby that weighs more than nine pounds, and diagnosis with a condition that makes vaginal delivery risky, such as HIV, are all reasons for a planned cesarean delivery.
Sometimes, a cesarean delivery becomes necessary after labor begins. For example, your doctor may recommend surgery if you have a condition called placenta previa, in which the placenta is blocking the birth canal. A cesarean delivery may also be necessary if the umbilical cord prolapses, or “drops,” outside the birth canal, potentially cutting off the blood and oxygen supply to the baby.
If labor is not progressing, which is when contractions slow or stop, if the cervix doesn’t dilate, or if the baby shows signs of distress, your doctor may decide to perform surgery.
NYU Langone doctors are equipped to handle cesarean deliveries quickly and efficiently. One support person is welcome to remain in the room during the procedure.
In a cesarean delivery, an obstetric anesthesiologist provides regional anesthesia to numb the lower half of your body. Sometimes, general anesthesia is used in an emergency situation.
Fluids and medication are provided through a vein with IV infusion, and a catheter is inserted into the urethra to drain urine from the bladder. A screen is placed above your waist to block your view of the cesarean delivery incision. It can be lowered enough to see your baby being born.
Your doctor uses an antiseptic to clean your abdomen and makes a small, horizontal incision in the skin above the pubic bone. Then he or she cuts through tissue, separating muscles, and typically makes a horizontal cut in the bottom of the uterus called a low-transverse uterine incision. Your doctor lifts the baby from the uterus and cuts the umbilical cord.
Nurses perform the Apgar test and wrap a blanket around the baby, handing him or her to you. Your doctor closes the incision in your uterus with dissolvable stitches but may use staples to close the incision in the skin. These are removed by the doctor at a follow-up appointment. This can take 30 minutes.
After a cesarean delivery, you spend several hours in a recovery room while you are observed. If your baby doesn’t require special medical attention, he or she remains with you. You remain in the hospital for up to four days after delivery.
Because a cesarean delivery is an abdominal surgical procedure, it is associated with an increased risk of infection, blood clots, bleeding, and pain. After the procedure, your doctor monitors your condition and manages your pain with medication.
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