Having a baby is a special event

On television, during a tidy one-hour time slot, couples decide which house to buy, single people find true love, and women deliver babies. If only major life events were really that quick and easy. When it comes to having a baby, Cortez family physician Kathy Lynch, MD, says the typical nine-month pregnancy culminates in labor and delivery that can actually unfold over the course of several days.

Some woman have early labor which can last up to a week. During this phase, contractions are not frequent or terribly painful and a woman can go about her daily activities, within reason. "Women are understandably really excited, but they need to save their energy for active labor," said Lynch. During early labor, a woman should try to relax, take warm baths and short walks, stay hydrated, eat light meals, and get as much rest and sleep as possible.

"When contractions are three to five minutes apart, getting stronger and stronger, and don't go away when a woman rests, that's active labor and it's time to go to the hospital," said Lynch. Other reasons a woman should report to the hospital during late pregnancy include having her water break, discharging bright red blood, or if she hasn't felt the baby move.

Upon arrival at the hospital, the woman is examined by an obstetrical nurse and put on a fetal monitor to see how the baby is doing. If a patient's cervix is dilated (open) by 4 cm. or more (about an inch), she will most likely be admitted. During labor, the cervix with eventually open to a full 10 cm. to allow for delivery.

Once active labor begins, contractions become more frequent and much stronger. The belly area tightens and is hard to the touch. "During a contraction, a woman isn't going to want to talk. Between contractions, she should rest and focus on relaxing," said Lynch.

Mothers everywhere compare notes about how long their labors lasted, but no two women are exactly the same. That said, in general a first-time mother can expect six to ten hours of active labor and up to two hours of pushing at the end as the baby is born (this may be up to four hours if she's chosen epidural anesthesia - more on that in a moment). For moms who are delivering a second or third baby, two to six hours of labor and an hour or less of pushing is the norm. "It's usually much faster after the first baby," said Lynch.

Women have options for how to manage labor pain. Some opt for no medication and experience natural childbirth. "In this case, she's hopefully attended childbirth education classes which have been shown to reduce labor pain," said Lynch. "Having a husband, partner, or birthing coach present is also helpful. They can rub the patient's back, give them cool clothes for their head, offer support, and make them more comfortable," said Lynch. Some women like music in the room, want the lights turned down low, get in the shower, or sit on a birthing ball to help them relax. If a woman chooses natural childbirth and then changes her mind during labor, she can ask for pain medication anytime during the process except for the last hour of labor when that window closes.

Many women opt for light IV medication during labor which doesn't numb the body but does take the edge off the pain. "This medication crosses the placenta, so we have to stop it an hour before delivery for the safety of baby," said Lynch.

The most popular method of labor pain control is epidural anesthesia. "Some women are afraid of this because they think a needle is used, but it's really just a small flexible catheter that's inserted into the back, not actually into the spinal cord," said Lynch. This catheter delivers medication that numbs the body from the upper abdomen to the upper thighs, but does not interfere with a woman's ability to push when it's time for the baby to arrive. "This method is very safe and effective and mom is fully awake and involved in the delivery," said Lynch.

Another effective pain control option is the pudendal block. Similar to the local pain medication that dentists use, it numbs only the area around where the baby comes out. "This is a good method for when a woman is too far along to have an epidural or IV, but when pain control is needed," said Lynch.

Having a baby is an exciting and special event. "We're all here to support both mom and baby and encourage women to work with their doctors to create birthing plans ahead of time. As long as it's medically safe, we'll try to do whatever a woman wants and make her birth experience as comfortable as possible," said Lynch.
