Your uterus is a powerful muscle that tightens and relaxes rhythmically during labor, allowing the cervix to stretch open and help to push your baby through the birth canal. Although every woman's labor is different, at the outset, you may begin to feel a pattern of dull cramps similar to menstrual cramps in your lower back or pelvis. If these remain regular for an hour or more, last at least 30 seconds, and gradually increase in intensity—even if you change position or move around—your labor has begun.
Your physician will probably have given you some guidelines about when to contact him or her once labor begins. If this is your first pregnancy, stay home awhile, so you can relax and remain unencumbered by the hospital routine and environment. Take a walk, catch a nap, enjoy a long shower, sip liquids (clear liquids only), read a book, or engage in any activity that will entertain and distract you and allow you to preserve your energy. Most physicians recommend that during a first labor, a woman wait until contractions are five minutes apart for an hour before coming to the hospital or birth center. In subsequent pregnancies, you may be advised to come sooner, since your labor can progress much more quickly.
You should contact your physician immediately if you notice any vaginal bleeding other than the pinkish “show,” if the baby doesn't move for an unusually long time, or if you have constant, severe pain rather than intermittent contractions. These signs can indicate such potentially serious conditions as placenta previa, in which the placenta may be blocking the exit from the uterus, or placental abruption, in which the placenta begins to prematurely separate from the uterus and limit the baby's oxygen supply. If your physician suspects any complications, you'll be asked to come to the birth center as quickly as possible so your condition can be checked and your baby can be monitored throughout the remainder of your labor.
After you are admitted to the hospital, your physician, nurse or birth attendant will want to discuss the events leading to labor. Your vital signs will be checked and recorded, and special attention will be paid to your baby's fetal heart tones and fetal heart rate (FHR), both important indicators of the baby's response to the stress of childbirth. You will be asked when you last ate and how much you consumed. Be sure to tell your physician if you want your partner or older children to be present at the delivery, or if you have made any other special arrangements.
Unless there's concern about complications such as placenta previa or the risk of infection, your doctor will perform a vaginal examination to check the baby's position, the dimensions of your pelvis, and the effacement and dilation of your cervix. A blood sample may be taken and a urine specimen may be tested for protein. You should challenge any hospital procedures that seem medically unnecessary, such as extensive shaving of your pubic area or administration of an enema. There is rarely any need for these outdated rituals, but though they have been eliminated in many birth centers, they persist in some institutions.
Depending on the status of your labor, your baby's position and heart rate, and additional factors such as a previous cesarean delivery or a post-term pregnancy, your physician may recommend electronic fetal monitoring now or at some point during your labor. Many hospitals routinely use external electronic FHR monitoring for 20 to 30 minutes after admission to establish the baby's baseline heart rate and check variations, such as beating slower during uterine contractions. If you need fetal monitoring, the doctor or birth attendant will place two belts around your abdomen to hold two small monitoring instruments in place.
Once your membranes have ruptured, the baby can be monitored internally with a small electrode threaded through your vagina. At the same time, if there's any question about the force of labor, your doctor may place a small plastic tube, or catheter, in your uterus to measure the strength of your contractions.
Numerous studies comparing continuous FHR monitoring and listening to the baby's heart rate with a stethoscope or other device have shown little difference in detecting fetal distress during labor in an otherwise uneventful pregnancy. If your baby's heart rate is normal and your labor is progressing steadily, continuous monitoring is probably unnecessary—and unduly restrictive. Instead, your birth attendant should encourage you to walk around, lean against your partner, urinate when necessary or simply change positions to stay as comfortable as possible.
Occasional intervals of FHR monitoring may still be recommended throughout labor. You will need continuous monitoring only if there are any signs of fetal distress, such as the presence of meconium-stained amniotic fluid, vaginal bleeding, a drop in your blood pressure, or an interruption in your cervical dilation despite regular contractions.
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