Perhaps the most worrisome part of pregnancy for a first time mother is wondering what to expect during labor and delivery. This is a very natural worry, and one that you can help calm with a bit of information and real life perspective.
Labor in the different stages
The early stage of labor may actually start before you realize what is happening. You may have been having Braxton Hicks contractions for some time, so when they become real labor contractions you might not recognize the difference right away. As labor gets going, though, you will start to notice the contractions are of a different intensity.
True labor contractions feel like someone is pulling a belt very tight around your waist. They start in the small of your back and wrap around your entire abdomen, squeezing tight. The early contractions will usually not be intensely painful, but will grow in intensity over time. On average, labor begins with contractions about ten minutes apart and lasting 30 to 40 seconds each. By the time you reach the end of early stage labor they will average 40 to 60 seconds (or more) in length and occur every few minutes or less.
Early stage labor officially ends when your cervix is completely dilated, which can take what seems like a very long time. The first four or five centimeters of dilation typically take the longest to achieve, so don't be alarmed if you seem to be making slow progress. At about five centimeters or so, your contractions will become stronger and occur closer together. This is called active labor and is an increasingly intense part of the birth process. The last bit of dilation, from eight to a full ten centimeters, is called transition. It is the most intense time, during which you might shake, shiver, or otherwise feel somewhat out of control. The best way to get through it is to try to relax, practice coping techniques with the help of your birth coach, and follow the guidance of your nurse or midwife.
Time to push
Once your cervix is fully dilated, you will probably feel the urge to push; most women describe it as feeling like they need to have a bowel movement. There are a number of different positions for pushing, ranging from on your back with assistance holding your legs up to squatting on your heels and pushing straight down. Work with your doctor, midwife, or labor nurse to find the position that works best for you, and don't be afraid to use several different positions during this process.
If this is your first vaginal delivery, it will likely take a little longer for you to push the baby from the uterus down through the birth canal because it has never been stretched this far before. Listen to the guidance of your doctor or midwife, and let the process unfold at its own speed. When the baby's head gets close to emerging, the perineum and vaginal opening will bulge and you may feel a stinging or burning sensation. Your doctor or midwife may ask you to hold off on pushing at this point to allow your perineum to stretch and avoid tearing.
When the baby's head finally emerges from the birth canal, the doctor or midwife will suction mucous out of the nose and mouth several times to help clear the airway in preparation for breathing. The baby will rotate slightly, allowing the shoulders to emerge, followed closely by the rest of the body and the legs. Congratulations!
You've just given birth to your baby.
After delivery
After your baby is delivered, the umbilical cord will be clamped and cut; most doctors and midwives invite the father or birth coach to do the actual cutting. The baby will be taken to a warming table for evaluation and to be cleaned up while your doctor or midwife focuses on delivering the placenta. Your uterus will start to contract once again, separating the placenta from the wall of the uterus so it can be expelled. You may be asked to push gently to move the placenta out through the birth canal, but this time you usually have to do nothing more than one brief and easy push.
Once the placenta is delivered, your uterus will quickly start to contract and become quite firm. This helps to close off the blood vessels where the placenta was attached and prevent you from bleeding too much. During your recovery and while you remain in the hospital or childbirth center, your uterus will be checked periodically for firmness by gently pushing on your stomach just below your navel.
You can begin breastfeeding at any time, depending on whether your baby is hungry or not. Most experts recommend giving it a try early on, but don't get discouraged if your baby is tired and not all that interested. He or she has just been through an exhausting process (as you have, too) and may prefer to rest a bit before being eager to nurse.