Labor and Delivery

When the time comes for the arrival of your little bundle of joy our team will do everything we can do to safely provide you with the experience that meets your needs. If you are scheduled for an induction, external version or cesarean section please call ahead to the unit at 928-283-2629 before leaving home to confirm arrival time. Our staff is experienced in caring for many types of patients.

Types of Patients

• Uncomplicated pregnancies
• Vaginal Birth after Cesarean (VBAC) VBAC Story
• Diabetic Mothers (GDM, Type 1 and Type 2) 
• Gestational Hypertension
• Preeclampsia
• Breech
• Deliveries from 34 weeks gestation and above
• Cesarean section

Signs of labor

The last weeks of Your pregnancyv

Your body during this phase of your pregnancy is going through rapid changes and you may notice several things that may feel as if you are beginning labor.

• Lightening occurs which is when the baby’s head “drops” into the pelvis. This may happen weeks before any other signs of labor.
• You may notice a “bloody show”, which is a brownish or blood tinged mucus discharge.  If you pass the mucus plug that blocks the cervix, labor could be starting—or it could be several days away

How to tell when labor begins

Labor is different for every woman, and pinpointing exactly when it begins is not really possible. It’s more a process than a single event and there are many changes in your body that work together to help to deliver your baby. When you are in labor you can expect that all of these things will happen:

• Contractions occur at regular intervals, and become longer and stronger. You can feel the uterus or womb get tight and hard when your hands are placed on top of your abdomen during the contraction.
• Persistent lower back pain occurs, especially accompanied by a crampy premenstrual feeling.
• When your water breaks there may be a large gush or the water around the baby may just start to leak out in a trickle. It’s usually happens with contractions. This water is called amniotic fluid

When to call the midwife or doctor

By your third trimester, you and your provider have probably talked about what to do when you’re in labor long before you really are. But if you think the time has come, don’t be embarrassed to call the nurse midwife. There is a midwife available 24 hours a day, 7 days a week on the labor and delivery unit. They are used to getting calls from women who are uncertain if they’re in labor and who need advice. Your midwife will want to know how close together your contractions are, whether you can talk through a contraction, and any other symptoms you may have.

If your bag of waters breaks, or if you think you might be leaking amniotic fluid, call or come in right away to the labor and delivery unit. You should call the labor and delivery unit at 928-283-2629 if you notice any of the following danger signals:

• vaginal bleeding
• haven’t felt baby move after attempting kick counts
• fever or chills
• severe headaches
• changes in your vision (flashes of light, spots in your vision, blurry vision)
• pain in your abdomen that isn’t contractions
• vomiting for more than 24 hours

False Labor

Sometimes, for many women, the uterus will have “practice” contractions in the last few weeks of pregnancy called Braxton Hicks contractions. This tightening and hardening of the uterus may feel like the real thing to women whether they are first time mothers or not. Many women come to the hospital only to be sent home.

There are a few ways to tell if you are in true labor. During true labor your contractions will get more frequent, regular and stronger. Braxton Hicks do not have a regular pattern, get weaker and will stop. Sometimes doing something different will make them stop like lying down or walking. Use a watch or clock to time the contractions. Note the time from start of one contraction to the time of the start of the next contraction and how long the contraction lasts. If you are unsure do not hesitate to call your doctor or the midwife on the labor and delivery unit.

Stages of Labor

There are three stages of labor. The length and progress of labor is different for each woman and each pregnancy. Certain features of the labor stages are the same for every woman. The contractions become more regular, the baby moves into the pelvis and the cervix effaces (thins) and dilates (opens). Each stage and phase of labor is distinguished by different physical and emotional challenges.

First stage is typically considered from onset of true labor (regular contractions that cause the cervix to open) until the cervix is dilated to 10cm. Second stage is after the cervix is dilated to 10cm until the baby is delivered. Third stage is after the baby is delivered until the placenta is delivered.

First Stage

During the early phase of labor, try to relax in your familiar setting and conserve your energy. Most women choose to stay home during this phase to watch tv, rest, go for walks with family. Drink plenty of water, have small snacks and pack your bag if you haven’t already. Time your contractions from the start of one to the start of the next one and how long the contraction lasts. Feel free to call the Labor and Delivery Unit at 928-283-2629 to speak to a midwife. Typically you do not have to come to the hospital until the contractions are 5 minutes apart, strong and regular or if your water has broken.

Once at the hospital the midwife will evaluate your cervix and the baby’s location in the birth canal. The Midwife may let you go home if she determines that you are not in labor or admit you if you are in true labor. Your nurse will ask questions for the admission paperwork, start an IV and obtain a blood and urine sample.

Your nurse will place fetal monitors on your abdomen to monitor how baby is handling the labor process. Fetal monitoring may be continuous or intermittent and is important to monitor the blood supply to your baby. There will be two straps on your abdomen, one to monitor the frequency and strength of your contractions and one to monitor how baby’s heart rate reacts to contractions.

As the contractions get more intense your support persons will become more important. Let them know how they can assist you through this time. Ask them to rub your legs, shoulders and lower back, offer ice chips or cool washcloths, change the music playlist, etc. Attempt to find comfortable positions during contractions and relax your body between contractions. Don’t forget to breathe during the contractions. You may also walk during this phase even if your water is broken.

At this stage many women may want pain medication. But there are other non pharmacological pain control methods. Try hydrotherapy, hypnotherapy, birthing ball, shower, music, backrubs and walking.

As you start transitioning into second stage and the cervix opens the last few centimeters you may feel nauseated or shaky.

Second Stage

During this stage of labor your cervix will be fully dilated to ten centimeters. You will start to push and soon deliver your baby. The length of time for this stage varies greatly for women. Your support team will help you focus your timing and energy.  You will be pushing hard with the contractions and relaxing your body between contractions. A midwife and labor and delivery nurse will be present to assist you through the birthing process. A nursery nurse will also be present to take care of baby.

Third Stage

Following the delivery of your baby, your placenta (afterbirth) will need to be delivered. This can happen rapidly or it can last up to 30 minutes. After the placenta is delivered you may receive medications to control any bleeding. The midwife will then repair any lacerations from the delivery. We will continue to monitor you closely for the next 3 hours after delivery

Dealing with Labor Pain

Most women have concerns regarding managing labor pain. The intensity of pain during labor and delivery is different for every women and every pregnancy. Remember that labor pain has purpose, the delivery of your baby. Talk with your support team about your emotions and fears and try to relax and breathe between contractions.

• Breathing and relaxation techniques
• Hydrotherapy such as baths and showers
• Massages
• Hot packs to lower back or cool washcloths to forehead
• Support team of family friends and nurses
• Find a comfortable position like standing and rocking, squatting, walking, sitting
• Birthing ball
• Music therapy

You may also talk with your doctor or midwife regarding pharmacological pain relief.

Cesarean Birth

Sometimes your Midwife and Doctor may decide that you and your baby will be safer with a c-section (baby will come out through the abdomen by surgical incision). There are risks to c-sections and the healing time is longer than with vaginal births. Some of the reasons for c-sections are:

• Baby is showing signs of distress
• There is a problem with the placenta
• There is a problem with the umbilical cord
• Mother blood pressure is too high
• Baby is breech
• Mother carrying multiples
• Mother had previous c-section

Vaginal birth after c-section (VBAC)

Many women have VBAC delivery successfully here at Tuba City Regional Healthcare Corporation. You can speak with your doctor during your prenatal visits to determine if VBAC is a safe option for you and your baby.

Related story: www.nytimes.com

Related link: www.womenshealth.gov