This topic provides basic
information about normal labor and delivery and about the postpartum period. If
you need information on pregnancy or other types of childbirth, see the
following topics:
At the end of the
third
trimester of pregnancy, your body will begin to show
signs that it is time for your baby to be born. The process that leads to the
birth of your baby is called labor and delivery. Every labor and delivery
includes certain stages, but each birth is unique. Even if you have had a baby
before, the next time will be different.
Giving birth to a baby
is hard work. That’s why it’s called labor. It can also be scary, thrilling,
and unpredictable. Learning all you can ahead of time will help you be ready
when your time comes.
What are the stages of labor?
There are three
stages of labor. The first stage of labor includes early labor and active
labor. The second stage continues the active labor and lasts through the birth,
with the baby traveling down and out of the birth canal. The third stage is
after the birth, when the placenta is delivered.
During
early labor, the muscles of the
uterus start to tighten (contract) and then relax.
These contractions help to thin (efface) and open (dilate) the
cervix so the baby can pass through the
birth canal. (See a picture of
cervical effacement.) Early contractions are usually irregular, spaced from 5 to
20 minutes apart, and usually last less than a minute.
Early
labor can be uncomfortable and long, sometimes lasting 2 or 3 days. Walking,
watching TV, listening to music, or taking a warm shower may help you manage
the discomfort.
During the first part of active labor, contractions become strong and regular. They happen every 2 or 3
minutes and last longer than a minute. This is the time to go to the hospital
or birthing center.
The pain of contractions may be moderate or
intense. Having a support person, trying different positions, or using
breathing exercises may help you cope. Many women ask for pain medicine during
this time. Even if you plan on natural childbirth, it can be comforting to know
that you can get pain relief if you want it.
After the cervix is
fully effaced and dilated, your body changes to "push" mode. During this second
stage of active labor, the baby is born. Pushing to deliver the baby may take
from a few minutes to several hours. It is likely to be faster if you have had
a baby before.
The third stage is after the baby is born, when
you have contractions until the
placenta is delivered.
How can you prepare for labor and delivery?
Getting regular exercise during pregnancy will help you handle the
physical demands of labor and delivery. Try adding
Kegel exercises to your daily routine. They strengthen
your pelvic floor muscles. This helps prevent a long period of pushing during
labor.
In your sixth or seventh month of pregnancy, consider
taking a childbirth education class with your husband, partner, or support
person. A class can reduce your stress both before and during labor and
delivery by preparing you to deal with what might happen. It can teach you ways
to relax and the best ways for your support person to help you.
There are many decisions to make about labor and delivery. Before your
last weeks of pregnancy, be sure to talk to your doctor or nurse-midwife about
your birthing options and what you prefer. Things to talk about include:
Where you want to have your baby. Most women
choose to work with a doctor and have their baby delivered in a hospital.
Hospitals offer experienced staff in case problems arise and also a wide range
of pain relief options. Women at low risk for problems may choose to work with
a midwife or have their baby at a birth center.
Who you want to be
with you. You may want to have family and friends around you or only the baby’s
other parent or another support person.
What comfort measures you
want to try. Breathing techniques, laboring in water, trying different
positions, and having one-on-one support may help you manage pain.
Your preferences for medical treatments. Consider what type of
pain medicine you would prefer, even if you do not think you will need it. It
is a good idea to learn about the medical options ahead of time. Just keep in
mind that you may not always get to choose.
How your baby will be
cared for after delivery. This might include having your baby stay in the room
with you rather than going to the nursery, delaying some tests and procedures,
and getting help with starting to breast-feed.
You can write down all of your preferences as a birth
plan. This gives you a chance to state how you would most like things to be
handled. Just keep in mind that it is not possible to predict exactly what will
happen during labor and delivery. Sometimes there are quick decisions that only
your doctor or nurse-midwife can make.
What can you expect after childbirth?
Now you get
to hold and look at your baby for the first time. It is common to feel excited,
tired, and amazed all at the same time.
If you plan to
breast-feed, you may start to put your baby to your breast soon after birth.
Don't be surprised if you have some trouble at first. Breast-feeding is
something you and your baby have to learn together. You will get better with
practice. If you need help getting started, ask a nurse or breast-feeding
specialist (lactation consultant).
In the hours after
delivery, you may feel sore and need help going to the bathroom. You may have
sharp, painful contractions called afterpains for several days as your uterus
shrinks in size.
During the first weeks after giving birth
(called the postpartum period), your body begins to heal and adjust to not
being pregnant. It's easy to get overtired and overwhelmed. Take good care of
yourself. Make sure you get as much rest and help as you can.
Try to sleep when your baby does.
Let family and friends bring you meals or do chores.
Eat healthy meals to build up your strength.
Drink
extra fluids if you are breast-feeding.
It is common to feel very emotional during the postpartum
period. But if you have "baby blues" that last more than a few days or you have
thoughts of hurting yourself or your baby, call your doctor right away.
Postpartum depression needs to be treated right
away.
Your doctor or midwife will want to see you for a checkup 2
to 6 weeks after delivery. This is a good time to discuss any concerns, such as
birth control. If you do not want to get pregnant, be
sure to use birth control, even if you are breast-feeding. Talk to your doctor
about which type of birth control is best for you.
Frequently Asked Questions
Learning about labor, delivery, and postpartum period:
During
your prenatal visits, talk with your health professional about your labor and
delivery options. As you identify your preferences, you may want to write them
down as a birth plan. A birth plan is not so much a "plan" as it is an ideal
picture of what you would like to happen. Since no labor and delivery can be
predicted or planned in advance, be flexible. As you consider how you'd handle
possible complications, give yourself permission to change your mind at any
time. And be prepared for your childbirth to be different than you
planned.
A birth plan isn't a contract for your health
professional to follow—if an emergency situation arises, he or she has a
responsibility to ensure both your safety and your baby's safety. You may still
be allowed to share in some decisions, but your choices may be limited.
When you are writing your birth plan, first consider the
location of your delivery,
who will deliver your baby, and whether you want continuous labor support
from a designated health professional or a
doula, a friend, or family members. If you haven't
already, this is also a good time to decide whether you'll attend a
childbirth education class, starting in your 6th or
7th month of pregnancy. After you've set the stage, think through your
preferences for comfort measures, pain relief, and medical procedures and fetal
monitoring, as well as how you'd like to handle your first hours with your
newborn.
Comfort measures
There are many ways to reduce the
stresses of labor and delivery. Consider:
Continuous labor support from early
labor until after childbirth, which has a proven, positive effect on
childbirth. Women who have continuous one-on-one support (for example, from a
mother's support person, or
doula; nurse; midwife; or childbirth educator) are
more likely to give birth without pain medication and are less likely to
describe their birthing experience negatively.1
Although there is not a proven direct connection between continuous support and
less labor pain, having a support person does help you feel more control and
less fear, which are strong elements of mental pain
control.
Walking during labor, including whether you prefer
continuous
electronic fetal heart monitoring or occasional
monitoring. Most women prefer the freedom to walk and move around, but a
high-risk delivery would require constant monitoring.
Nonmedication pain management ("natural" childbirth),
such as continuous labor support, focused breathing, distraction, massage, and
imagery, which can reduce pain and help you feel a sense of control during
labor.
Early laboring in water, which helps with pain,
stress, and sometimes slow, difficult labor (dystocia).2, 3 Giving birth in water needs more
study to show how safe or risky it is for mother and baby.2
Issues about eating and drinking during labor.
Some hospitals allow you to drink clear liquids while others may only allow you
to suck on ice chips or hard candy. Solid food is often restricted because the
stomach digests food more slowly during labor. An empty stomach is also best in
the rare event that you may need general anesthesia.
Playing music
during labor.
Acupuncture and hypnosis, which are low-risk ways of managing
pain that work for some women.4
Pain relief with medication
Your medication
options for pain relief may include:
Opioids (narcotics), which are used to
reduce anxiety and partially relieve pain. An opioid is less likely than
epidural anesthesia to lead to an assisted (forceps or vacuum)
delivery.5 But they are usually used well before
delivery, since an opioid can affect a newborn's breathing.
Epidural anesthesia, which is an ongoing injection of pain medication into the
epidural space around the spinal cord. This partially or fully numbs the lower
body. A "light" epidural allows you to feel enough that you can push, which
reduces full-dose epidural risks of stalled labor and
assisted (forceps or vacuum) delivery.6
Pudendal and paracervical blocks, which
are injections of pain medication into the pelvic area to reduce labor pain.
Pudendal is one of the safest forms of anesthesia for numbing the area where
the baby will come out. It can be helpful with fast labor when a little pain
medicine is needed close to delivery. It does not affect the baby. Paracervical
has been generally replaced by epidural, which is more effective.
Some pain relief medications are not the type that you
would request during labor. Rather, they are used as part of another procedure
or for an emergency delivery. But it's a good idea to know about them.
Local anesthesia is the injection of
numbing pain medication into the skin. This is done before inserting an
epidural or before making an incision (episiotomy) that widens the vaginal opening for the
birth.
Spinal block is an injection of pain medication into
the spinal fluid, which rapidly and fully numbs the pelvic area for assisted
births, such as a
forceps or
cesarean delivery (no pushing is
possible).
General anesthesia is the use of inhaled or
intravenous (IV) medication, which makes you
unconscious. It has more risks, yet it takes effect much faster than epidural
or spinal anesthesia. General anesthesia is therefore only used for some
emergencies that require a rapid delivery, such as when an epidural line
(catheter) has not been installed in advance.
Birthing positions
Birthing positions
for pushing include sitting, squatting, reclining, leaning on a ball, or using
a birthing chair, stool, or bed. See illustrations of various birthing
positions:
While
fetal heart monitoring is a standard practice during labor, other procedures
are used as needed.
Labor induction and augmentation
includes a simple "sweeping of the membranes" just inside of the cervix,
rupturing the
amniotic sac, using medication to soften (ripen) the
cervix, and using medication to stimulate contractions. This is not always, but
can be, a medically necessary decision—such as when a mother is about 2 weeks
past her due date or when the mother or her baby has a condition that requires
immediate delivery.
Electronic fetal heart monitoring may
be either continuous for a high-risk delivery or periodic to check for signs
that the baby might be in distress.
Episiotomy widens
the
perineum with an incision. This is sometimes used to
deliver the baby's head more quickly, when there are signs of distress.
(Perineal massage and controlled pushing can also prevent or reduce
tearing.7)
Forceps delivery or vacuum extraction is used to assist a vaginal delivery, such as when labor is
stalled at the pushing stage or when the baby shows signs of distress at the
pushing stage and needs to be delivered quickly.
The
need for a cesarean birth during a labor in progress
is primarily based on the baby's and mother's conditions. (For more
information, see the topic
Cesarean Section.)
If you have had a cesarean delivery before, you may have
a choice between a vaginal trial of labor and a planned cesarean birth. For
more information, see the topic
Vaginal Birth After Cesarean (VBAC).
Newborn care decisions
Before your baby is born,
plan ahead about:
Keeping your baby with you for at least 1
hour after birth, for bonding. (Many hospitals allow rooming-in, with no
mother-baby separation during the entire hospital stay. A rooming-in policy
also allows you to request time alone for rest, if you need it.)
Preventing breast-feeding problems. You can plan ahead for
breast-feeding support in case you need it. Check around for a
lactation consultant. Some hospitals have them
in-house. You can also make sure that hospital staff knows not to give your
baby supplemental formula, unless there is a medical need.
Delaying
certain procedures, such as a vitamin K injection, a heel prick for a blood
test, and the use of eye medicine, so that your newborn has a more calm
transition after delivery.
Whether and when you'd like visitors,
including children in your family.
Whether to
bank your baby's umbilical cord blood after the birth for possible use as a
stem cell treatment. (This requires advance planning early in your pregnancy.)
Consider taking a
childbirth education class, and tour the labor and
delivery area of your hospital or birthing center. This will help you feel more
comfortable when the time for delivery comes.
Have had fluid gushing or
leaking from your vagina (the
amniotic sac has ruptured) AND
you know or think the umbilical cord is bulging into your vagina (cord
prolapse). This is quite rare, but if it happens, immediately get down on your
knees, dropping your head and upper body lower than your buttocks to decrease
pressure on the cord until help arrives. Cord prolapse can cut off the baby's
blood supply.
Call your health professional now or go to your hospital's labor and delivery unit immediately if you:
Severe headache that does not go away with
acetaminophen (such as Tylenol).
New visual problems (such as
dimness or blurring).
Sudden swelling of your face, hands, or
feet.
Have belly pain or cramping.
Have a fever of
100.4°F (38°C) or
higher.
Have had regular contractions for an hour. This means about 4 or
more in 20 minutes, or about 8 or more within 1 hour, even after you have had a
glass of water and are resting.
Have a sudden release of fluid from your vagina. It is possible
to mistake a leak of
amniotic fluid for a problem with bladder
control.
Have low back pain or pelvic pressure that does not go
away.
Have noticed that your baby has stopped moving or is moving much
less than normal.
If you are between 20 and 37 weeks pregnant, call your health professional immediately or go to the hospital now if you have:
Concern that the baby has stopped moving or is
moving much less than normal. See
kick counts for information on how to check your
baby's activity.
Any vaginal
bleeding.
Uterine tenderness, unexplained fever, or weakness
(possible symptoms of infection).
Loss of a large amount of fluid
from your vagina [a cup (240 mL) or more].
Some of these symptoms could mean you are having preterm
labor.
Call your health professional right away if you have:
Regular contractions for an hour. This means
about 4 or more in 20 minutes, or about 8 or more within 1 hour, even after you
have had a glass of water and are resting.
After 37 weeks of pregnancy, call your health professional immediately or go the hospital if you have:
Concern that the baby has stopped moving or is
moving much less than normal. See
kick counts for information on how to check your
baby's activity.
Any vaginal
bleeding.
Regular contractions (about 4 or more in 20 minutes, or about 8
or more within 1 hour).
A sudden release of fluid from the
vagina.
At any time during pregnancy, call
your health professional if you have new steady or heavy discharge from the
vagina along with symptoms of itching, burning, or odor.
After delivery
After you have delivered,
call 911 if:
You have sudden, severe pain in your
belly.
You pass out (lose
consciousness).
After you have delivered, call your health professional now or seek medical care right away if:
You have severe vaginal bleeding. You are
passing blood clots and soaking through a new sanitary pad each hour for 2 or
more hours.
Your vaginal bleeding seems to be getting heavier or is still
bright red 4 days after delivery or you pass blood clots larger than the size
of a golf ball.
You feel dizzy or lightheaded, or you feel as if
you may faint..
You are vomiting or you cannot keep fluids
down.
You have a fever.
You have new or more belly
pain.
You pass tissue (not just blood).
You have a
severe headache, visual problems, or sudden swelling of your face, hands, or
feet.
Watch closely for changes in your health, and be sure to
contact your doctor if:
The birthing process is known as labor
and delivery. No one can predict when labor will start. One woman can have all
the signs that her body is ready to deliver, yet she may not have the baby for
weeks. Another woman may have no advance signs before she goes into active
labor. First-time deliveries are more difficult to predict.
Signs of approaching early labor
Signs that early
labor is not far off include the following:
The baby settles into your pelvis. Although
this is called
dropping, or lightening, you may not feel
it.
Your cervix begins to thin and open (cervical effacement and dilatation). Your health professional checks for this
during your prenatal examinations.
Braxton Hicks contractions become more frequent and stronger, perhaps a little
painful. You may also feel cramping in the groin or rectum or a persistent ache
low in your back.
Your amniotic sac may break (rupture of the membranes). In most cases, rupture of the membranes occurs after
labor has already started. In some women, this happens before labor starts.
Call your health professional immediately or go to the hospital if you think
your membranes have ruptured.
Early labor (latent phase of labor)
Early labor is often the longest part of the
birthing process, sometimes lasting 2 to 3 days. Uterine contractions:
Are mild to moderate (you can talk while they
are happening) and last about 30 to 45 seconds.
May be irregular (5
to 20 minutes apart) and may even stop for a while.
Open (dilate)
the
cervix to about
3 cm (1 in). First-time
mothers can experience many hours of early labor without the cervix dilating.
It's common for women to go to the hospital during early
labor and be sent home again until they progress to active labor or until their
"water" breaks (rupture of the membranes). This phase of labor can be long and
uncomfortable. Walking, watching TV, listening to music, or taking a warm
shower may help you through early labor.
Early labor that is progressing
If you arrive at the hospital or
birthing center in early labor that is dilating and effacing the cervix or is
progressing quickly, you can expect some or all of the following:
In the birthing room, you will change into a
hospital gown.
Your blood pressure, pulse, and temperature will be
checked.
Your previous health, pregnancy, and labor history will be
reviewed.
You will be asked about the timing and strength of your
contractions and whether your membranes have ruptured.
Electronic fetal heart monitoring will be used to record the fetal heart rate in response
to your uterine contractions. Fetal heart rate is an indicator of whether the
baby is doing well or is in trouble.
You will have
sterile vaginal exams to check whether your cervix is
thinning and opening (effacing and dilating).
Depending on your own
physical needs and your health professional's preference, you may have an
intravenous (IV) needle inserted in case you need
extra fluids or medication later on.
Most hospitals and birthing centers have birthing rooms
where women can labor, deliver, and recover. Providing that you have an
uncomplicated birth, you can probably be in the same birthing room for your
entire stay. If your delivery becomes complicated, you can be quickly moved to
a delivery room equipped to handle the problem.
After you have
been admitted to the hospital and you have had your initial examination, you
will be:
Encouraged to walk. Walking helps many women
feel more comfortable during early labor. Although walking is thought to help
labor progress, recent research suggests that walking doesn't actually speed or
slow labor.8
Briefly
monitored every hour or so (at the least) to check
your contractions and the baby's heart rate. You may be monitored throughout
your labor.
Allowed visitors. As your labor progresses and you
become more uncomfortable, you may want to limit visitors to your partner or
labor coach.
The first stage of active
labor starts when the cervix is about
3 cm (1.18 in) to
4 cm (1.58 in) dilated. This
stage is complete when the cervix is fully
dilated and effaced and the baby is ready to be pushed
out. See a picture of
cervical effacement. During the last part of this stage (transition), labor
becomes particularly intense.
Compared with early labor, the
contractions during the first stage of active labor are more intense and more
frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is
the time to be at or go to the hospital or birthing center. If your
amniotic sac hasn't broken before this, it may now.
As your contractions intensify, you may:
Feel restless or excited.
Find it
difficult to stand.
Have food and fluid restrictions. Some
hospitals allow you to drink clear liquids while others may only allow you to
suck on ice chips or hard candy. Solid food is often restricted, because the
stomach digests food more slowly during labor. An empty stomach is also best in
the rare event that you may need general anesthesia.
Want to start using
breathing techniques,
laboring in water, acupuncture, hypnosis, or other
calming measures that you've chosen to manage pain and anxiety.
Feel the need to shift positions often. This is good for you,
because it improves your circulation. You may not know which
birthing position is right for you for a while.
The end of the first stage of
active labor is called the transition phase. As the baby moves down, your
contractions become more intense and longer and come even closer together than
before. When you reach transition, your delivery is not far off. During
transition, you will be self-absorbed, concentrating on what your body is
doing. You may be annoyed or distracted by others' attempts to help you but,
nevertheless, feel you need them nearby as a support. You may feel increasingly
anxious, nauseated, exhausted, irritable, or frightened.
A mother
in first-time labor will take up to 3 hours in transition, and a mother who has
vaginally delivered before will usually take no more than an hour. Some women
have a very short, if intense, transition phase.
The second stage of
active labor is the actual birth, when the baby is pushed out by the tightening
uterine muscles (contractions). During the second stage:
Uterine contractions will feel different.
Though they are usually regular, they may slow down to every 2 to 5 minutes,
lasting 60 to 90 seconds. If your labor stalls, changing positions may help. If
not, your health professional may recommend using medication to stimulate
(augment) uterine contractions.
You may have a strong urge to push or bear down with each
contraction.
The baby's head is likely to create great pressure on
your rectum.
You may need to change position several times to find
the right
birthing position for you.
You can have a
mirror positioned so you can watch your baby crown and emerge from the birth
canal.
When the baby's head passes through the vagina (crowns), you will
feel a burning pain. The head is the largest part of the baby and the hardest
part to deliver. If this is happening quickly, your health professional may
advise you not to push every time, which may give the
perineum, or area between the
vulva and the
anus, a chance to stretch without tearing. Or he or
she may make an incision in the perineum (episiotomy).
This is not recommended unless there is a medical need.
Your
medical staff will be ready to handle anything unexpected. If an urgent problem
comes up, people will move quickly. You may suddenly have more people and
equipment in the room than before. This is a time when your doctor or
nurse-midwife will be deciding what is best for you and your baby.
This pushing stage can be as short as a few minutes or as
long as several hours. You are more likely to have a fast labor if you have
given birth before.
After your baby
is born, your body still has some work to do. This is the third stage of labor,
when the
placenta is delivered. You will still have
contractions. These contractions make the placenta separate from the inside of
the uterus, and they push the placenta out. Your medical staff will help you
with this. They will also watch for any problems, such as heavy bleeding,
especially if you have had it before.
Your doctor's or
nurse-midwife's goal is for the third stage to proceed normally, and for all of
the placenta to leave the uterus. This is what keeps your bleeding down. At the
least, you can expect to have a nurse press down on your belly to help the
uterus release the placenta. You may be given some medicine to help the uterus
contract firmly. Breast-feeding right away can also help the uterus shrink up
and bleed less.
The third stage can be as quick as 5 minutes. With
a
preterm birth, it tends to take longer. But in most
cases, the placenta is delivered within 30 minutes. If the placenta does not
fully detach, your doctor or nurse-midwife will probably reach inside the
uterus to remove by hand what is left inside. Your contractions will continue
until after the placenta is delivered, so you may have to concentrate and
breathe until this uncomfortable process is complete.
Full-term babies are delivered
sometime between 37 and 42 weeks of pregnancy. (Those weeks are counted from
the first day of your last menstrual period, or LMP.) A pregnancy that has
reached 42 or more weeks is called a "post-term" or "post-date pregnancy." You
might also call it "overdue." Pregnancy that lasts beyond the due date is
fairly common.
Some post-term pregnancies are not truly post-term.
A common "cause" is an incorrect
due date. (Your due date is 40 completed weeks after
your LMP. If you ovulated late in your cycle, your pregnancy didn't start as
early as this due date says.) An ultrasound measurement of your fetus during
the first
trimester can give the most accurate due date. But
even that due date is an estimate of when you might deliver.
In
most cases, there is no obvious cause of a post-term pregnancy.
What concerns are linked to post-term pregnancy?
Most often, a post-term baby is born in good health. But a very small
number of post-term pregnancies are linked to stillbirth and infant death. This
risk increases with each week, up to 10 per 1,000 post-term pregnancies after
43 weeks.9 This is why your doctor or nurse-midwife
will monitor your baby after 40 to 41 weeks.
Many health
professionals want to lower risks for the post-term baby by delivering by or
before 42 weeks. In most cases, watching and waiting is also fine. It is often
hard to know which choice is best during the 2 weeks after the due
date:9
Any time after the due date that a fetal
problem shows up in testing, it is time to deliver.
For a
cervix that is "favorable" for delivery—is softening,
thinning, or opening—many doctors speed up the process by
inducing labor. This may start in the doctor's office
with a simple
sweeping of the membranes. Watching and waiting until
42 weeks is also a reasonable choice, as long as there are no signs of
problems. (There is no research that shows one choice to be better than the
other for mothers and babies.9 Discuss this with your
health professional.)
For a cervix that has not started to soften, thin, or open, watching and waiting is
a reasonable choice. But giving medication to soften the cervix and induce
labor does seem to have some advantages. A review of studies has shown that
softening and inducing labor after 41 completed weeks lowers the rate of
stillbirths and infant deaths (though, either way, deaths are very
rare).10 And the rate of
cesarean delivery, pain medicine use, and
forceps or vacuum delivery does not increase.9
For safety reasons, most health professionals will plan
to deliver a baby by 42 weeks, inducing labor if necessary. Generally, the
risks of waiting for natural labor beyond 42 weeks are thought to outweigh the
benefits.
It is normal to feel excited,
tired, and amazed all at the same time after delivery. You may feel a great
sense of calm, peace, and relief as you hold, look at, and talk to your baby.
During the first hour after the birth, you can also expect to introduce your
baby to feeding by breast, if you plan to breast-feed.
Breast-feeding
Breast-feeding provides significant
health benefits to both you and your baby and is strongly encouraged by the
American Academy of Pediatrics.11 If you breast-feed,
don't be surprised if you and your baby have some difficulty at first.
Breast-feeding is a learned technique—you will get better at it with practice.
Almost all difficulties that can develop with breast-feeding can be remedied
with home treatments and by talking to your health professional or a
breast-feeding specialist (lactation consultant). Most hospitals
have at least one lactation consultant available to help new mothers
breast-feed. Don't hesitate to ask for help.
During the first days
of breast-feeding, your nipples will probably become tender or sore and may
even develop painful cracks in the skin. But as breast-feeding becomes more
established, the soreness usually goes away. For more information, see the
topic
Breast-Feeding.
For helpful information
about getting a good start with breast-feeding and preventing complications,
see:
You may experience
shaking chills right after delivery. This is a common reaction in the hours
after delivery. A warm blanket may help you feel more comfortable.
During the first hours after the birth, your health professional or a
nurse will:
Massage your uterus by rubbing your lower abdomen about every
15 minutes. Later, you will be taught to massage your own uterus. This helps it
tighten (contract) and stop bleeding. If your uterus does not contract (boggy
uterus), it may bleed too much, or hemorrhage. (When hemorrhage occurs,
medication is used to slow the bleeding, and the uterus is checked for placenta
that hasn't detached, a common cause of heavy bleeding. You'll also be checked
for tears in the cervix and vagina, which can lead to hemorrhage. In severe
cases, surgery is used to stop bleeding, and fluid and blood transfusions are
used to prevent shock and blood loss.)
Check your bladder to make
sure it isn't full. A full bladder puts pressure on your uterus, which
interferes with contractions. You will be asked to try to urinate, which may be
difficult because of pain and swelling. If you cannot urinate, a tube (catheter) can be used to empty your bladder.
Difficulty urinating usually passes quickly.
Check your blood
pressure frequently for several hours.
Repair the area between your vagina and anus (perineum) if it tore or you had an incision (episiotomy).
Remove the small tube in your
back (epidural catheter) if you had
epidural anesthesia. If you plan to have a
tubal ligation surgery to prevent future pregnancy,
the catheter will be left in.
After childbirth
(postpartum period), your body goes through numerous changes, some of which
continue for several weeks during your postpartum period. Like pregnancy,
postpartum changes are different for every woman.
Shrinking of the uterus to its prepregnancy
size (uterine involution) starts when the
placenta is delivered and continues for about 2
months. Within 24 hours, the uterus is about the size it was at 20 weeks of
pregnancy, and after 1 week, it is half the size it was when you went into
labor. By 6 weeks after delivery, the uterus is nearly as small as it was
before pregnancy.12
Contractions called
afterpains shrink the uterus for several days after
childbirth. These sharp pains are usually not as problematic after a first
childbirth as they are after later deliveries. Afterpains typically improve
during the third day.
Sore muscles (especially in the arms, neck,
or jaw) are common after childbirth. This is a result of the hard work of labor
and should go away in a few days. You may also have bloodshot eyes or facial
bruising from vigorous pushing.
Difficulty with urination and bowel
movements (elimination problems) can occur for
several days after childbirth. Drink plenty of fluids and use stool softeners,
if necessary.
Recovery from an episiotomy or perineal tear in the area between the vagina and
anus can take several weeks. You can ease the pain with home treatment,
including ice, pain medicine, and
sitz baths. Pain, discomfort, and numbness around the
vagina are common after any vaginal birth.
Breast engorgement
is common between the third and fourth days after delivery, when the breasts
begin to fill with milk. This can cause breast discomfort and swelling. Placing
ice packs on your breasts, taking a hot shower, or using warm compresses may
relieve the discomfort of engorgement. For more information, see the topic
Breast Engorgement.
Recovery from pelvic bone problems, such as separated
pubic bones (pubic symphysis) or a fractured tailbone (coccyx), can take
several months. Treatment includes ice, nonsteroidal anti-inflammatory drugs
(NSAIDs), and sometimes physical therapy.
Call your health professional if you are concerned about
any of your postpartum symptoms. For more information, see the When to Call a
Doctor section of this topic.
Coping during the postpartum period
When you have
returned home, you may find it a challenge to meet the increased demands on
your limited energy and time. Take it easy on yourself. Pause for a moment, and
think of what you need. Tips for
coping during the postpartum period include accepting
help from others, eating well and drinking plenty of fluids, getting rest
whenever you can, limiting visitors, getting some time to yourself, and seeking
the company of other women with new babies.
If you are having trouble
with postpartum blues that last more than a few days or you think you may be
developing signs of
postpartum depression, call your health professional
right away. For more information, see the topic
Postpartum Depression. For tips on how to cope with
postpartum depression, see:
Even if you have no significant postpartum problems,
your health professional will want to see you for a checkup 2 to 6 weeks after
delivery. This is a good time to discuss any ongoing concerns, including birth
control.
Sexuality, fertility, and birth control
Avoid
sexual intercourse and putting anything in the vagina (including tampons) until
you have stopped bleeding. After you have stopped bleeding, avoid having sexual
intercourse if it is still painful or uncomfortable. Your body needs at least 4
to 6 weeks to heal after the trauma of childbirth.
It is common to
have little interest in sex for a while after childbirth. During the time when
your body is recovering from childbirth and your baby has many needs, you and
your partner will need to be patient with one another. Talking together is a
good way to deal with the changes in your
sexuality after childbirth.
Your
menstrual cycle, and thus your ability to become pregnant again, will return at
your body's own pace. Remember that you can
ovulate and get pregnant during the month
before your first menstrual period, as soon as 2 to 3
weeks after childbirth. If you do not want to become pregnant right away,
use birth control even if you are breast-feeding.
If you do not breast-feed, your menstrual
periods may begin within a month or two after delivery.
If you
breast-feed full-time, your periods will probably not resume for a few months.
The average among women who breast-feed exclusively is 8 months. But
breast-feeding is not a dependable method of birth control. For more
information, see
Breast-feeding as birth control.
Most methods of birth control are safe and effective for
breast-feeding mothers. Talk to your health professional about which type is
best for you. For more information, see the topic
Birth Control.
The American Academy of Family Physicians produces a
variety of health-related educational materials. Its Web site offers a health
library and bulletin board, news, and comments sections.
Postpartum Support International
927 North Kellogg Avenue
Santa Barbara, CA 93111
Phone:
(805) 967-7636
Fax:
(805) 967-0608
E-mail:
PSIOffice@postpartum.net
Web Address:
www.postpartum.net
Postpartum Support International offers information and support not
only to women who are coping with postpartum depression and anxiety after
childbirth but also to their families. The Web site also includes the Mills
Depression and Anxiety Symptom-Feeling Checklist for evaluating your
symptoms.
Hodnett ED, et al. (2007). Continuous support for
women during childbirth. Cochrane Database of Systematic Reviews (1).
Cluett ER, et al. (2007). Immersion in water in
pregnancy, labour and birth. Cochrane Database of Systematic Reviews (1).
Cluett ER, et al. (2004). Randomised controlled trial
of labouring in water compared with standard of augmentation for management of
dystocia in first stage of labour. BMJ, 328(7435):
314–320.
Smith CA, et al. (2007). Complementary and
alternative therapies for pain management in labour. Cochrane Database of Systematic Reviews (1).
Cunningham FG, et al. (2005). Forceps delivery and
vacuum extraction. In Williams Obstetrics, 22nd ed., pp.
547–563. New York: McGraw-Hill.
Eltzchig HK, et al. (2003). Regional anesthesia and
analgesia for labor and delivery. New England Journal of Medicine, 348(4): 319–332.
Beckmann MM, Garrett AJ (2007). Antenatal perineal
massage for reducing perineal trauma. Cochrane Database of Systematic Reviews (1).
American College of Obstetrics and Gynecologists
(2003). Dystocia and augmentation of labor. ACOG Practice Bulletin No. 49.
Obstetrics and Gynecology, 102(6):
1445–1454.
American College of Obstetricians and Gynecologists
(2004). Management of postterm pregnancy. ACOG Practice Bulletin No. 55.
Obstetrics and Gynecology, 104(3): 639–646.
Gülmezoglu AM, et al. (2007). Induction of labour for
improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews (2).
American Academy of Pediatrics Work Group on
Breastfeeding (2005). Breastfeeding and the use of human milk. Pediatrics, 115(2): 496–506.
Resnik R (2004). The puerperium. In RK Creasy, R
Resnik, eds., Maternal-Fetal Medicine: Principles and Practice, 5th ed., pp. 165–168. Philadelphia: Saunders.
Other Works Consulted
Kettle C (2006). Perineal care, search date April
2006. Online version of Clinical Evidence
(15).
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
