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Labour Issues

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Labor and Delivery
When you are 37 weeks pregnant, your due date draws near. The actual day of delivery may happen two weeks before or two weeks after this date. You should watch for any signs which show that labor is about to begin. The baby will turn head downwards into the pelvic cavity to face the birth canal in preparation for delivery. This is termed as baby drop or lightening. It relieves pressure in upper abdomen and makes breathing easy.  The navel may “pop” out as the uterus drops down from the upright position to accommodate the baby. You may also have increased frequency of passing out urine. This is becomes the new position of the baby exerts pressure on the bladder.  Your doctor will feel the head of the baby in the lower abdomen or at the top of the birth canal.  The cervical examination will reveal dilation and thinning of the membranes of the cervix.


Dilation is measured in centimeters and thinning (efface) is measured in percentage. During delivery, the cervix will be about 10 cm dilated and 100% effaced.
Some women may display tendencies to like a particular activity like cooking or cleaning. This type of behavior is termed as “nesting”. It indicates that you are soon going to labor.

If statistics are any index, most pregnancies are uncomplicated and do not manifest any major labour issues. However there could well be instances where complications may arise and it is in situations such as these that it is imperative that appropriate medical interventions are instituted by the treating doctor.

These changes and associated symptoms may be a source of irritation or may even translate into alarming signs at times, however more often than not it may not be a cause for concern. The more discerning of expectant mothers learn to recognize these changes and touch base with their midwife or doctor when apprehensive.

Thus should you feel that there is something amiss all that you need to do is to contact your doctor if you should experience some or more of these:



When antenatal care is meticulously implemented labour issues or complications can be identified or predicted well in advance and your treating doctor would ensure that they are neutralized well in advance. Some of the more important labour issues or complications could well include:

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•    Breaking of the amniotic fluid sack membranes commonly referred to as water break. This can be in form of a stream of water or drops. When it comes out as drops, it can easily be confused with leaking urine. Your doctor may carry out a test to determine if the leaking water is amniotic fluid. Labor should start immediately after this. If this does not happen naturally within 24 hours, your doctor will induce labor to prevent infections and complications.
•    The uterine contractions are regular and increasingly getting stronger. The labor pain radiates to your back.
•    Continuous backache after 37 weeks may indicate that labor is about to begin.
•    Diarrhea: watery discharge may indicate that labor is near.
•    The mucus plug which closes the cervix and protects the uterus from infections may come out as bloody mucus discharge. This indicates that the cervix is slowly dilating and thinning. Labor may occur immediately or a few days later.


It is not uncommon for an expectant mother to experience excruciating pain in the lower back during the phase of labour. When labour contractions are associated with low back pain, it could well be attributed to the stretching of the cervix.

One of the more typical of situations is when the position of the head of the baby is posterior with the back of the head resting against the spine. This is commoner than one would realize considering the fact that medical statistics indicate that one out of every ten babies lie in this position.


Second Stage Labor
This is called the pushing stage. During this stage, the cervix is fully dilated. The baby’s head is at the cervix. It may last between one to two hours. The doctor will ask you to push when the uterus is contracting and rest when it is relaxing. You may change positions to relieve contraction pain. Studies have demonstrated that the best position is when your head is upright. This maintains the orientation of the reproductive system and shortens the duration of labor. The gravity helps the baby to descend. Try sitting down or squatting. However, when you feel like your pelvis is overstretching, change to antigravity position. Try lying down or kneeling on your four limbs.

Strong rhythmic uterine contractions are experienced every 7 minutes. One contraction may last for about 90 seconds. After the contractions, you will feel the urge to push. Take time and relax between contractions. You may have backaches and increased pressure in the abdomen. You may even feel like voiding.

A good labor position should:
•    Present adequate monitoring of the baby.
•     Gravity friendly.
•    Tilt the pelvis to allow for greater stretching of the pelvic muscles.
•     Help in rotation of the baby to anterior position, stimulate the urge to pull and helps relieve backache.

Your doctor should advice you on the best position depending on the location of the baby.
You should push slowly to allow the cervix to dilate and the pelvis to stretch. You may cry or groan loudly as this may relieve some pain. The doctor may slit the base of the vagina to widen the opening. This is called episiotomy. Some doctors also guide the baby to the vaginal opening using a forceps. Once the baby is born, the umbilical cord is cut. Usually the baby should face towards the back of the mother. This is termed as the anterior position. A posterior position is when the baby is facing towards the mothers abdomen. This position makes it hard for the baby to pass through the cervix. This can make the labor distressing and tiresome.  Worse still, you may experience burning sensation when the baby is passing through the vagina. The duration of the second stage is dependent on the position of the baby (anterior or posterior), the size of the baby and your capability to push.

Passive delivery
Some doctors administer anesthesia during labor to delay pushing. This is called passive delivery where the mother does not push. She waits for the baby to descend through the cervix and the vagina.

Third stage of labor
This period lasts for about 30 minutes. It starts when the baby is born and ends when the placenta and its membranes are delivered. The doctor should do a thorough examination to confirm that the placenta and its membranes have all been expelled. The vagina should also be checked of damage and repaired. Management of third stage labor is divided into active and physiological management.

Active management of third stage labor
 Active care involves controlling cord traction, administering drugs to contract the uterus and prevent bleeding and cutting the cord. It takes about 30 minutes.  Active management reduces chances of having post partum hemorrhage (PPH) which is a leading cause of maternal death. This is the most preferred method.

Physiological management of third stage labor
Physiological management involves the mothers own effort in delivering the placenta without administration of any medicine. The uterus will contract to slough off the placenta from the walls of the uterus. The mother will then push it out through the vagina. This lasts for about one hour. If it extends, then active management should be started immediately.

Induction of labor
In most normal pregnancies, labor begins spontaneously between week 37 and week 42. Labor induction is a procedure of initiating labor by stimulating the uterus. It is artificial induction of labor. Another similar procedure is augmenting labor which is done to intensify uterine contractions once the labor has started. Induction is only done when the benefits outweigh the risks involved.

Indications of labor induction:
•    Complications of pregnancy by diabetes before term.
•    Gestation after 41 weeks. The risks of still births increase from 42 weeks.
•    If the doctor suspects that the fetus has retarded growth.
•    When the water breaks prematurely at 37 weeks. This constitutes about 15% of pregnancies. The doctor can either induce the labor immediately or wait for a maximum of four days. Normally, after the water has broken, 84% of pregnancies go into labor within 24 hours. If the labor does not start after the fourth day, the risks of infections increase to both the mother and the baby.
•    About 49% of women with pre-eclampsia (hypertension) are induced.
•    Multi pregnancy that goes beyond 38 weeks.
•    Medical abortion
•    In case of the death of the fetus in the uterusContra- indications of labor induction
•    The baby lies in a breech or in a transversal position
•    Placental praevia.
•    Infection with genital herpes
•    When there is a risk of cord prolapsed

Induction process
The doctor will explain to you the methodology involved and the side effects. Probably you will need to sign a written consent. If this procedure fails, the doctor will recommend a caesarian section to deliver the baby.

The following factors should be scrutinized before inducing labor
•    The degree of thinning, dilating and effacing of the cervix. In readiness for the labor, the cervix shortens and softens. This is known as ripening of the cervix. If this measure is more than eight on a Bishop’s scale, then the successful rate of delivery is the same as that of spontaneous labor.
•    The position of the baby and the uterus.
•    The quantity of the amniotic fluid.
•    Evaluate maturity of the lungs of the fetus.

The methods include:
•    Use of prostaglandins- the prostaglandin tablet, gel or pessary is inserted deep in the vagina. It is absorbed into the blood stream. It is circulated to the uterus where it stimulates uterine contractions.
•    Membrane sweeping- this involves mechanically stripping or stretching the membranes surrounding the baby from the cervix. It is done intravaginally. The doctor inserts his finger through the vagina into the cervix and separates the membranes. This procedure stimulates the release of natural prostaglandins to initiate uterine contractions. This should be the first method to be carried out. You may bleed but it does not harm your baby or increase risks of infections. However, it is not recommended when your water has broken.
•    Oxytocin- this drug stimulates the uterus to contract. It is analogue of the oxytocin hormone produced in the body.
If the water is not yet broken, the doctor may drill a hole through the membranes to break the water. It is done through the vagina. This procedure is termed as amnniotomy. During labor induction, the mother may feel intense pain. Ask your doctor to give you analgesics (pain killers) 30 minutes before the procedure is started.

Caesarean Section
Caesarean section also called C- section constitutes two surgical procedures. The first one is called laparatomy. It involves making an incision through the abdomen. The second one is hysterotomy and involves incising through the uterus to deliver a baby. The C- section can also be done to deliver a dead baby. It is medically preferred when vaginal delivery would put the baby or the mother at risk. However, it may be performed at the request of the mother. About 28% of pregnancies are delivered through C- section in the US. When a C- section is planned in advance, it is referred to as an elective C- section. Caesarean deliveries vary in technique. The best is a smart horizontal uterine incision at the bikini line. This can allow you to have vaginal birth after cesarean (VBAC). Before C – section delivery, the doctor should evaluate lung maturity of the baby. It should be preferably carried out when the baby is term after 38 weeks. A woman who has had a caesarian section may prefer it in her subsequent deliveries.

Indications of caesarean section:
•    Rapture of the uterus
•    Placenta previa where the placenta is low at the bottom of the uterus and covers the cervix.
•    When the labor is not progressing
•    Prolapsed cord- this is when the umbilical cord protrudes through the cervix into the birth canal before the baby is born. It is normally a medical emergency to save the life of the baby.
•    When the fetus is distressed
•    Severe hypertension after rupturing of the amniotic fluid.
•    Breech or transverse presentations of the baby
•    To prevent mother to child transmission of HIV/ AIDs.
•    When the mother is carrying multiple babies.
•    When delivering a large baby. This is common if have gestational diabetes or you have a history of delivering such baby. This condition is referred to as macrosomia.

Anesthesia during cesarean delivery
Anesthesia is used to relieve pain sensation. It inhibits the conduction of signals in nerves from the brain to the target tissue. It enables a cesarean section to be carried out without feeling the pressure involved. The drugs used to bring about anesthesia are called anesthetics. They do not have any adverse effect to the baby. Antibiotics may be used concurrently during caesarian section. These may be harmful to the baby and the doctor must only use safe antibiotics.
There are two types of anesthesia that can be used during C- section:

•    Regional anesthesia- this is used to numb a wider area. The mother will remain conscious during the operation. A small curtain is normally put around your chest to separate you from the operating team. You will be awake and even interact with the doctors during the surgery. Most women prefer this method.
•    General anesthesia- this is systemic anesthesia and makes you unconscious. It may present with anesthesia side effects such as feeling of pulmonary aspiration, dizziness, headache and vomiting.

There are three types of regional anesthesia: epidural, spinal or combined epidural and spinal anesthesia. The anesthesia is administered concurrently with narcotic analgesics such as pethidine. This ensures complete pain relief. Regional anesthesia is administered in about 90% of elective C- section deliveries (planned C- section) in the US. Inform you doctor in advance on the type of anesthesia which you prefer.

Recovery Time
After c- section, you will stay in hospital for about 2 days for monitoring after which you will be discharged. Full recovery takes about 5 weeks. During this time you should avoid extraneous exercises. The doctor will give you systemic antibiotics and analgesics (pain killers) to take while at home.  You should recover quickly and have minimal pain so that you take care of the baby effectively.
Disclaimer: Information contained on this Web site is intended solely to make available general summarized information to the public. It should not be substituted for medical advice. It is your responsibility to consult with your pediatrician and/or health care provider before acting on any advice on this web site. While OEM endeavors to provide up-to-date and accurate information, it is not liable for any advice whatsoever rendered nor is it liable for the completeness or timeliness of any information on this site.
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