Labor & Delivery

Use these tips to get started on your breastfeeding journey:

• Put the baby to breast within the first hour after birth.
• Within the first hour, your baby is most alert and interested in nursing. Your baby is eager to meet you and needs the colostrum (initial fluid from your breast) for energy and protection against infection.
• After the first hour or two, your baby will become sleepy and more difficult to nurse.

Get more breastfeeding support; from BID Plymouth experts.

There are several effective approaches to pain relief that you can try throughout labor, such as:

• Apply warm or cold compresses.
• Carefully select your support people for a calm environment.
• Effleurage (light massage of your abdomen).
• Guided meditation using calming imagery.
• Have your partner or a support person rub a tennis ball over your lower back.
• Keep a restful environment in your labor room, such as quiet, low lighting and soothing music.
• Massage/back rubs by a support person.
• Pray or enjoy other religious ceremonies.
• Sit or lean on a birthing ball or rocking chair.
• Try various positions (such as all fours, sitting on the toilet, kneeling, squatting or pelvic rock) and support with pillows if necessary.
• Use relaxation/breathing techniques.
• Use water therapy (shower or tub).
• Walk.

Using several comfort techniques is an excellent way to involve first-time partners in supporting and working with you in the childbirth process.

If you’ve never experienced labor before, you may find it difficult to know whether you are in labor. Before heading to the hospital, call your physician or midwife to discuss your symptoms.

For first-time pregnancies, early labor is best managed at home in order to help your labor progress with minimal intervention. Once in active labor, your contractions will be fewer than five minutes apart — lasting 45 to 60 seconds — and the cervix is dilated three centimeters or more.

Over the last 10 years, the national trend has been to avoid routine episiotomies (a surgical cut to avoid tearing of tissues), only performing the procedure when necessary. What used to be a national episiotomy rate of 60–80% for first-time mothers has decreased to less than 20%.

The main concern is that the episiotomy could extend into the rectum during delivery. This may lead to greater problems with bowel control (loss of gas or stool) both short and long term. Close to 70% of women will have a natural tear with the birth of their first baby, usually involving less tissue and trauma than an episiotomy. During an emergency, or if your anatomy suggests you may encounter a larger laceration without an episiotomy, we will discuss this option at length with you prior to moving forward.

Although inducing labor may be needed for certain medical problems or prolonged pregnancies, induction during first-time pregnancies carries added risk. Inducing labor for during a first time pregnancy — especially with a cervix that is nearly closed — doubles or triples the length of labor and possibility of a cesarean birth. However, in later pregnancies, the chances for a cesarean delivery after induction are lower.

As your labor progresses and contractions become stronger, you may request medication to manage your pain. Your physician or midwife can explain the benefits of each type and help you select the best and safest medication for you and your baby. Our options include nitrous oxide, oral pulls, intravenous pain medicine and epidurals. It’s best to discuss medications with your doctor or midwife at an earlier appointment before you’re in labor.

If you already have an epidural in place for labor and you require a cesarean, you may be given a stronger dose of local anesthetic through your epidural catheter. Alternately, your anesthesiologist may give you spinal anesthesia to keep you comfortable during the surgery. If you need an emergency cesarean section, you may have to undergo general anesthesia.

Most often, your doctor adds a small amount of narcotics to your spinal block before your cesarean. This medication allows for prolonged pain relief after the procedure (about 24 hours).

Also known as the second stage of labor, pushing starts sometime after the cervix is completely dilated (10 centimeters). It’s important to wait for the natural urge to bear down before starting active pushing. There may be circumstances, such as having a strong regional anesthetic or labor stops, when you may not feel the urge to push. If that happens, our staff will help you with pushing.

Allowing the baby's head to gradually stretch the tissue at the outlet of the vagina (perineum) will reduce the risk of a significant tear. Delivering on your side is associated with fewer significant tears. Perineal massage (gradual stretching of the vaginal and perineal tissues) from 36 weeks on has been associated with fewer perineal tears. Ask your physician or midwife for details on perineal massage.

If your obstetrician or midwife is concerned about you or your baby's health, we may offer to help you shorten the second stage of labor by using a vacuum extractor or forceps on the baby's head (performed by the physician). These procedures rarely carry a health risk to you or your baby.

If you reach a point in active labor where your medication is no longer relieving your pain, you may decide to ask for a regional anesthesia to provide stronger pain relief. The goal of regional anesthesia — especially after your cervix is fully dilated — is to reach a balance between easing your feeling of pain and still feeling the urge to bear down to actively participate in delivering your baby.

You have safe options for pain management during labor, including a water birth. Many women benefit from the relaxation and freedom of movement offered by our birthing tub.

We offer water labor and water birth to low-risk women who meet certain criteria. Speak with your provider during your pregnancy to see if you may be a candidate.