Gear
- Rear-facing infant car seat or infant-toddler (convertible) car seat-not compulsary in India, but certainly a safer bet to have.
- Portable crib or playard
- Sling or soft carrier
- Stroller (look for one with full recline)
Safety
- Monitor
- Safety gate
Diapering
- Diapers
- If cloth diapers, plastic pants and/or Velcro covers (6 to 12)
- Diaper bag
- Diaper pail and liners
- Rash ointment and powder
- Wipes (at least 2 packs at all times)
Layette (for newborn to 6 months)
- Absorbent bibs (4 to 8)
- Booties or socks (3 to 6 pairs)
- Gowns or stretchies (5 to 7)
- Hats (2 to 4)
- One-piece, footed rompers or tops/pant sets (5 to 7)
- Shirts and one pieces (6 to 8)
- Blankets (4 to 6)
- Sweaters (2)
- T-shirts or kimonos (3 to 4)
Nursery
- Changing pads (2 to 4)
- Changing table
- Crib or bassinet
- Crib bedding set
- Crib blankets (4 to 8)
- Crib mattress
- Dresser/armoire
- Fitted bedsheets (2 to 4, cotton and/or flannel)
Baby Care
- Brush and comb
- First aid supplies
- Nail clippers
- Thermometer
- Humidifier/vaporizer
Toys & Activity
- Bouncer seat
- Stroller, crib, or car-seat toys (2 to 3)
- Swing
- Rattles and Teethers (2 or more)
- Developmental Toys
- Gym or playmat
- Jumper or stationary entertainer
Feeding
- Bottles (6 to 8 of various sizes) and nipples
- Breast pads, shields, and cream
- Lap pads (4 to 6) and burp cloths (3 to 4)
- Breast pump
- Highchair (not needed until your child is eating solids at approximately 4 to 6 months)
- Infant spoons (3 to 4)
- Spill-proof cups (1 to 2)
- Bottle sterilizer
Bathing
- Baby lotion
- Bathtub or contoured sponge (to fit in standard bath tub)
- Bath (or waterproof) toys
- Gentle shampoo or body wash
- Hooded terry cloth towels (2)
- Washcloths (2 to 3)
Books, Music & More
- Books on pregnancy and childbirth, breastfeeding and parenting
- Colorful board books for baby
- Classical or lullaby music
- Camera (digital, video, or film)
- Baby book or journal
Thursday, February 7, 2008
Sunday, December 9, 2007
From Pre-conception to Pregnancy to Delivery - in stages
The following has been compiled from various sources - internet, personal experiences. hope it helps.
It really helped me understand what I'm in for, the possible experiences and the mental preparation.
More to come on pre-conception and pregnancy..............
LABOR and DELIVERY:
What is false labor?
As you approach your due date, the painless and infrequent Braxton Hicks contractions that you may have been feeling since mid-pregnancy might sometimes become more rhythmic, relatively close together, and even painful, at times fooling you into thinking you are in labor. But unlike true labor, this so-called "false labor" doesn't cause significant progressive dilation of your cervix, and the contractions don't grow consistently longer, stronger, and closer together.
Note: Not every woman experiences bouts of false labor. And in some cases, the strong, regular contractions of true labor come on with little or no warning.
How can I tell if I'm in false labor or true labor?
Sometimes it's very hard to tell false labor from the early stages of true labor. If you're 37 weeks or more, here are some things that might help you sort it out:
• False labor contractions are unpredictable. They come at irregular intervals and vary in length and intensity. Although true labor contractions may be irregular at first, over time they start coming at regular and shorter intervals, become increasingly more intense, and last longer.
• With false labor, the pain from the contractions is more likely to be centered in your lower abdomen. With true labor, you may feel the pain start in your lower back and wrap around to your abdomen.
• False labor contractions may subside on their own, or when you start or stop an activity or change position. True labor contractions will persist and progress regardless of what you do.
What should I do if I feel contractions?
If you're not yet 37 weeks, don't waste precious time trying to figure out what's going on. If you notice any signs of labor, call your doctor or midwife right away in order to rule out preterm labor. After 37 weeks, you can sit out the contractions (whether false or from true early labor) at home and see what develops, unless your practitioner has advised you otherwise.
False labor contractions can be a real drag, interfering with your sleep and making you tired and cranky. Taking warm baths and drinking lots of liquids can sometimes help. You might also feel anxious, wondering when true labor will start. And if you have an older child, you might be constantly wondering if it's time to call the babysitter. (When in doubt, call the babysitter — there's no harm done even if you don't end up needing to go in, and you may be able to rest more easily knowing that help is at hand.)
Keep a stopwatch nearby to time your contractions for a while until you get a sense of what's going on. And don't hesitate to call your doctor or midwife to check in if you're concerned, confused, or just need a little encouragement.
What are Braxton Hicks contractions?
Braxton Hicks are sporadic uterine contractions that actually start at about 6 weeks, although you won't be able to feel them that early. You probably won't start to notice them until sometime after midpregnancy, if you notice them at all (some women don't). They get their name from John Braxton Hicks, an English doctor who first described them in 1872.
As your pregnancy progresses, Braxton Hicks contractions tend to come somewhat more often, but until you get to your last few weeks, they should remain infrequent, irregular, and essentially painless. Sometimes, though, Braxton Hicks are hard to distinguish from early signs of preterm labor. Play it safe and don't try to make the diagnosis yourself. If you haven't hit 37 weeks yet and you're having four or more contractions in an hour, or have any other signs of preterm labor, call your caregiver immediately.
By the time you're within a couple of weeks of your due date, these contractions may get more intense and more frequent, and cause some discomfort. Unlike the earlier painless and sporadic Braxton Hicks contractions that caused no obvious cervical change, these may help your cervix "ripen": gradually soften and efface, and maybe even begin to dilate a bit. This period is sometimes referred to as "pre-labor."
How can I tell the difference between Braxton Hicks and true labor contractions?
In the days or weeks before labor, Braxton Hicks contractions may intermittently become rhythmic, relatively close together, and even painful, at times fooling you into thinking you're in labor. But unlike true labor, during this so-called "false labor" the contractions don't grow consistently longer, stronger, and closer together.
What can I do if my Braxton Hicks contractions are making me uncomfortable?
If you're within a few weeks of your due date, try these measures:
• Change your activity or position. Sometimes walking provides relief, and other times resting eases your contractions. (Real labor contractions, on the other hand, will persist and progress regardless of what you do.)
• Take a warm bath to help your body relax.
• Try drinking a couple glasses of water, since these contractions can sometimes be brought on by dehydration.
• Try relaxation exercises or slow, deep breathing. This won't stop the Braxton Hicks contractions, but it may help you cope with the discomfort. (Use this opportunity to practice some of the pain-management strategies you learned in your childbirth preparation class.)
When should I call my doctor or midwife?
Call your caregiver right away if you haven't reached 37 weeks and your contractions are becoming more frequent, rhythmic, or painful, or if you have any of these possible signs of preterm labor:
• Abdominal pain, menstrual-like cramping, or more than four contractions in an hour (even if they don't hurt).
• Any vaginal bleeding or spotting.
• An increase in vaginal discharge or a change in the type of discharge — if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged).
• Increased pelvic pressure (a feeling that your baby's pushing down).
• Low back pain, especially if it's a new problem for you.
If you're past 37 weeks, there's no need to call your doctor or midwife until your contractions last 60 seconds each and are five minutes apart, unless your caregiver has advised you otherwise.
Is there any way to predict when I?m going to go into labor?
Not really. Experts don't fully understand what triggers the onset of labor, and there's no way to predict exactly when it will start. Your body actually starts "preparing" for labor up to a month before you give birth. You may be blissfully unaware of what's going on or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
* Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
* You note an uptick in Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. However, if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called "false labor."
* Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts — but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor's imminent.) When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
* You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that's sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor. The plug may come out all at once in a lump, or as increased vaginal discharge over the course of several days. The mucus may be tinged with blood (which may be brown, pink, or red), which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some bloody discharge even when labor isn't going to start in the next few days. In either case, if you see more than a few spots of blood, be sure to call your caregiver immediately because it could be a sign of a problem.
* Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, the fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions sometime before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby will be at increased risk for infection without the amniotic sac's built-in protection against germs.
How can I tell if my labor has actually started?
It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks. It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together. In some cases, though, the onset of strong, regular contractions comes with little or no warning — it's different for every woman and with every pregnancy.
When should I call my doctor or midwife?
Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when it's time to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center. These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — and your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job. And the truth is, your practitioner can tell a lot by the tone and tenor of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, be sure to call your practitioner right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, and is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby's less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), fever, severe headaches, vision changes, or abdominal pain.
• You start having contractions before 37 weeks or you have any other signs of preterm labor.
===================================================================
What stages will I go through during labor and childbirth?
The process you'll go through during labor and childbirth can be divided into three stages:
The first stage begins with the onset of contractions and the gradual effacement (thinning out) and dilation (opening) of the cervix. That's followed by active labor, when your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. In the last part of active labor (and the end of the first stage), called transition, your cervix dilates fully to 10 centimeters.
The second stage of labor begins once you're fully dilated and ends with the birth of your baby. This is often referred to as the pushing stage.
The third and final stage begins right after the birth of your baby and involves the separation and delivery of the placenta.
For first-time moms who are at least 37 weeks along, labor and delivery takes an average of 15 hours, although for plenty of women it lasts more than 20 hours, and for a lucky few it's over much sooner. For women who've been through labor before, deliveries average around eight hours.
First stage: Early labor
Once your contractions are coming at relatively regular intervals and your cervix begins to progressively dilate and efface, you're officially in early labor. But unless your labor starts very suddenly and you go from no contractions to fairly regular contractions right away, it can be tricky to determine exactly when true labor starts. That's because these early labor contractions are sometimes hard to distinguish from the inefficient Braxton Hicks contractions that may immediately precede them and contribute to so-called "false labor." (If you're not yet 37 weeks and you're noticing contractions or other signs of labor, call your caregiver immediately so she can determine whether you're in preterm labor.)
During early labor, your contractions will gradually become longer, stronger, and closer together. While the experience of labor varies widely, typically it might start with contractions coming every ten minutes and lasting 30 seconds each. Eventually they'll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labor. Some women have much more frequent contractions during this phase, though the contractions will still tend to be mild and last less than a minute.
Sometimes early labor contractions are quite painful (though they may be dilating your cervix much more slowly than you'd like!). If your labor is typical, though, your contractions now won't require the same attention that later ones will. You'll probably find that you can still talk through them and putter around the house. You may even feel like taking a short walk. If you feel inclined to relax instead, take a warm bath, watch a video, or doze off between contractions if you can.
You may also notice increasing mucousy vaginal discharge, which may be tinged with blood — the so-called "bloody show." This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver. Also call if your water breaks, even if you're not having contractions yet.
Otherwise, if you're at least 37 weeks along, and unless your caregiver has advised you differently, expect to sit out early labor at home. (When to call your midwife or doctor and when she's likely to have you go to the hospital or birth center are things to discuss ahead of time at your prenatal visits.) Early labor ends when your cervix is 3 to 4 centimeters dilated and your progress starts to accelerate.
How long it lasts
It's not easy to say how long this phase typically lasts or even (after the fact) how long it lasted for a particular woman. The length of early labor depends in large part on how ripe your cervix is at the beginning of labor and how frequent and strong your contractions are. With a first baby, if your cervix isn't effaced or dilated to begin with, this phase may take about eight hours, though it can be longer or significantly shorter. If your cervix is already very ripe or if this isn't your first baby, it's likely to go much more quickly.
Coping tips
Don't become a slave to your stopwatch just yet — it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead you may want to time them periodically to get a sense of what's going on. In most cases, your contractions will let you know in no uncertain terms when it's time to take them more seriously.
Meanwhile, it's important to do your best to stay rested, since you may have a long day (or night) ahead of you. Be sure to drink plenty of fluids so you stay well hydrated. And don't forget to go to the bathroom often even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
First stage: Active labor
Active labor is when things really get rolling. Your contractions become more frequent, longer, and stronger, and your cervix begins dilating faster — going from 3 to 4 centimeters to 10 centimeters. In contrast to early labor, you'll no longer be able to talk through the contractions. Toward the end of active labor your baby may begin to descend, though he might have started to descend earlier or he might not start until the next stage.
As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth center. (Some prefer a call sooner, so clarify this with your caregiver ahead of time.) In most cases, the frequency of contractions eventually increases to every two-and-a-half to three minutes, although some women may never have them more often than every five minutes, even during transition.
How long it lasts
Labor varies widely, but on average it takes about six hours for a woman having her first baby to go from 4 centimeters to full dilation. That's if she's not being given oxytocin (Pitocin) or using an epidural, though. Pitocin generally speeds up the active phase, while epidurals tend to make it last longer. If you've already had a vaginal birth, active labor is likely to go much more quickly.
Coping tips
Breathing exercises, relaxation techniques, and a good labor coach can be a huge help now. Massage and lots of gentle encouragement are lifesavers, too. When you get to the hospital or birth center, you should be able to move freely around the room after your caregiver evaluates you, as long as you don't have any medical or obstetric complications. You may find that it feels good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to take a warm shower or bath, if you have access to a tub, or to ask your partner for a massage. If you've already decided you want pain medication or you're having a hard time coping with contractions and nothing else seems to help, now's the time to talk to your provider about getting an epidural or systemic medication.
First stage: Transition
The last part of the active phase — when your cervix dilates from 8 to a full 10 centimeters — is called the transition period because it marks the transition to the second stage of labor. This is the most intense part of labor. Contractions are usually very strong, coming about every two-and-a-half to three minutes and lasting a minute or more, and you may find yourself shaking and shivering.
By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously — to "push" — and may even start making deep grunting sounds at this point. There's often a lot of bloody discharge. You may also feel nauseated or even vomit now.
On the other hand, some babies descend earlier and the mom feels the urge to push before she's fully dilated. And some babies don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It's different for every woman and every birth.
If you've had an epidural, you'll feel varying amounts of pressure, depending on the type and amount of medication you're getting, and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.
How long it takes
Transition can last anywhere from a few minutes to a few hours. It is much more likely to be fast if you've already had a vaginal delivery.
Coping tips
If you're laboring without an epidural, this is when you may begin to lose faith in your ability to cope, so you'll need lots of extra encouragement and support from those around you. The good news is that if you've made it this far without medication, you can usually be coached through transition — one contraction at a time — with constant reminders that you're doing a great job and that the end is near.
Second stage: Pushing
Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them. Many women find their contractions in the second stage easier to handle than during active labor because bearing down offers some relief. Other women don't like the sensation of pushing.
If your baby's very low in your pelvis, you may feel an involuntary urge to push early in the second stage (and sometimes even before). But if your baby's still relatively high, you won't have this sensation right away. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. So if everything's going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push.
Waiting a while may make you less exhausted and frustrated in the end. However, in many hospitals it's still routine practice to coach women to push with each contraction in an effort to speed up the baby's descent — so let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. If you have an epidural, the loss of sensation makes it hard to feel what you're doing, so you'll need explicit coaching to help you to push effectively.
Your baby's descent may be rapid or, especially if this is your first, gradual. With each contraction, the force of your uterus — combined with the force of your abdominal muscles if you're actively pushing — exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression. Try different positions for pushing until you find one that feels right and is effective for you. It's not unusual to use a variety of different positions during the second stage.
After a time, your perineum (the tissue between your vagina and rectum) will begin to bulge with each push, and before long your baby's scalp will become visible, a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.
Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch. At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vagina and perineum. A slow, controlled birth can help prevent you from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it.
Your baby's head continues to advance with each push until it "crowns" — the time when the widest part of his head is finally visible. The excitement in the room will grow as your baby's face begins to appear: his forehead, his nose, his mouth, and, finally, his chin.
After his head emerges, your doctor or midwife will suction his mouth and nose and feel around his neck for the umbilical cord. (No need to worry. If the cord is around his neck, your caregiver will either slip it over his head or, if need be, clamp and cut it.) His head then turns to the side as his shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as his shoulders emerge, one at a time, followed by his body.
Once he hits the atmosphere, your baby needs to be kept warm and will be dried off with a towel. Your doctor or midwife may quickly suction your baby's mouth and nasal passages again if he seems to have a lot of mucus. If there are no complications, he'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he'll be covered with a warm blanket — and perhaps given his first hat — to prevent any heat loss. Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over. Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
How long it lasts
The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and 20 minutes if you've had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.
Third stage: Delivering the placenta
Within minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall. When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that's not at all difficult or painful.
How long it lasts
On average, the third stage of labor takes about five to ten minutes, though it can last up to 30 minutes or more.
And then what?
After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel. Your caregiver, and later your nurse, will periodically check to see that it remains firm, and massage your uterus if it isn't. This is important because, as it contracts, the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels.
If you're planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but hold your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse within the first hour or so after birth if given the chance. Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers your body to release oxytocin, the same hormone that causes contractions, and helps your uterus stay well contracted.
If you're not nursing or your uterus isn't firm, you'll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you're bleeding excessively, you'll probably be given other medications as well.
Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you. If this is your first baby, you may feel only a few contractions after you've delivered the placenta. (If you've had a baby before, you may continue to feel occasional contractions for the next day or two.) These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also find that you get a case of the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.
Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to see if you have any tears that need to be stitched. If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches — it can be a great distraction. Or, if you feel too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.
If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. (This takes just a second and doesn't hurt.) Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of his/her birth.
It really helped me understand what I'm in for, the possible experiences and the mental preparation.
More to come on pre-conception and pregnancy..............
LABOR and DELIVERY:
What is false labor?
As you approach your due date, the painless and infrequent Braxton Hicks contractions that you may have been feeling since mid-pregnancy might sometimes become more rhythmic, relatively close together, and even painful, at times fooling you into thinking you are in labor. But unlike true labor, this so-called "false labor" doesn't cause significant progressive dilation of your cervix, and the contractions don't grow consistently longer, stronger, and closer together.
Note: Not every woman experiences bouts of false labor. And in some cases, the strong, regular contractions of true labor come on with little or no warning.
How can I tell if I'm in false labor or true labor?
Sometimes it's very hard to tell false labor from the early stages of true labor. If you're 37 weeks or more, here are some things that might help you sort it out:
• False labor contractions are unpredictable. They come at irregular intervals and vary in length and intensity. Although true labor contractions may be irregular at first, over time they start coming at regular and shorter intervals, become increasingly more intense, and last longer.
• With false labor, the pain from the contractions is more likely to be centered in your lower abdomen. With true labor, you may feel the pain start in your lower back and wrap around to your abdomen.
• False labor contractions may subside on their own, or when you start or stop an activity or change position. True labor contractions will persist and progress regardless of what you do.
What should I do if I feel contractions?
If you're not yet 37 weeks, don't waste precious time trying to figure out what's going on. If you notice any signs of labor, call your doctor or midwife right away in order to rule out preterm labor. After 37 weeks, you can sit out the contractions (whether false or from true early labor) at home and see what develops, unless your practitioner has advised you otherwise.
False labor contractions can be a real drag, interfering with your sleep and making you tired and cranky. Taking warm baths and drinking lots of liquids can sometimes help. You might also feel anxious, wondering when true labor will start. And if you have an older child, you might be constantly wondering if it's time to call the babysitter. (When in doubt, call the babysitter — there's no harm done even if you don't end up needing to go in, and you may be able to rest more easily knowing that help is at hand.)
Keep a stopwatch nearby to time your contractions for a while until you get a sense of what's going on. And don't hesitate to call your doctor or midwife to check in if you're concerned, confused, or just need a little encouragement.
What are Braxton Hicks contractions?
Braxton Hicks are sporadic uterine contractions that actually start at about 6 weeks, although you won't be able to feel them that early. You probably won't start to notice them until sometime after midpregnancy, if you notice them at all (some women don't). They get their name from John Braxton Hicks, an English doctor who first described them in 1872.
As your pregnancy progresses, Braxton Hicks contractions tend to come somewhat more often, but until you get to your last few weeks, they should remain infrequent, irregular, and essentially painless. Sometimes, though, Braxton Hicks are hard to distinguish from early signs of preterm labor. Play it safe and don't try to make the diagnosis yourself. If you haven't hit 37 weeks yet and you're having four or more contractions in an hour, or have any other signs of preterm labor, call your caregiver immediately.
By the time you're within a couple of weeks of your due date, these contractions may get more intense and more frequent, and cause some discomfort. Unlike the earlier painless and sporadic Braxton Hicks contractions that caused no obvious cervical change, these may help your cervix "ripen": gradually soften and efface, and maybe even begin to dilate a bit. This period is sometimes referred to as "pre-labor."
How can I tell the difference between Braxton Hicks and true labor contractions?
In the days or weeks before labor, Braxton Hicks contractions may intermittently become rhythmic, relatively close together, and even painful, at times fooling you into thinking you're in labor. But unlike true labor, during this so-called "false labor" the contractions don't grow consistently longer, stronger, and closer together.
What can I do if my Braxton Hicks contractions are making me uncomfortable?
If you're within a few weeks of your due date, try these measures:
• Change your activity or position. Sometimes walking provides relief, and other times resting eases your contractions. (Real labor contractions, on the other hand, will persist and progress regardless of what you do.)
• Take a warm bath to help your body relax.
• Try drinking a couple glasses of water, since these contractions can sometimes be brought on by dehydration.
• Try relaxation exercises or slow, deep breathing. This won't stop the Braxton Hicks contractions, but it may help you cope with the discomfort. (Use this opportunity to practice some of the pain-management strategies you learned in your childbirth preparation class.)
When should I call my doctor or midwife?
Call your caregiver right away if you haven't reached 37 weeks and your contractions are becoming more frequent, rhythmic, or painful, or if you have any of these possible signs of preterm labor:
• Abdominal pain, menstrual-like cramping, or more than four contractions in an hour (even if they don't hurt).
• Any vaginal bleeding or spotting.
• An increase in vaginal discharge or a change in the type of discharge — if it becomes watery, mucousy, or bloody (even if it's only pink or blood-tinged).
• Increased pelvic pressure (a feeling that your baby's pushing down).
• Low back pain, especially if it's a new problem for you.
If you're past 37 weeks, there's no need to call your doctor or midwife until your contractions last 60 seconds each and are five minutes apart, unless your caregiver has advised you otherwise.
Is there any way to predict when I?m going to go into labor?
Not really. Experts don't fully understand what triggers the onset of labor, and there's no way to predict exactly when it will start. Your body actually starts "preparing" for labor up to a month before you give birth. You may be blissfully unaware of what's going on or you may begin to notice new symptoms as your due date draws near. Here are some things that may happen in the weeks or days before labor starts:
* Your baby "drops."
If this is your first pregnancy, you may feel what's known as "lightening" a few weeks before labor starts. You might detect a heaviness in your pelvis as this happens and notice less pressure just below your ribcage, making it easier to catch your breath.
* You note an uptick in Braxton Hicks contractions.
More frequent and intense Braxton Hicks contractions can signal pre-labor, during which your cervix ripens and the stage is set for true labor. Some women experience a crampy, menstrual-like feeling during this time.
Sometimes, as true labor draws near, Braxton Hicks contractions become relatively painful and strike as often as every ten to 20 minutes, making you wonder whether true labor has started. However, if the contractions don't get longer, stronger, and closer together and cause your cervix to dilate progressively, then what you're feeling is probably so-called "false labor."
* Your cervix starts to ripen.
In the days and weeks before delivery, Braxton Hicks may do the preliminary work of softening, thinning, and perhaps opening your cervix a bit. (If you've given birth before, your cervix is more likely to dilate a centimeter or two before labor starts — but keep in mind that even being 40 weeks pregnant with your first baby and 1 centimeter dilated is no guarantee that labor's imminent.) When you're at or near your due date, your practitioner may do a vaginal exam during your prenatal visit to see whether your cervix has started to change.
* You pass your mucus plug or notice "bloody show."
You may pass your mucus plug — the small amount of thickened mucus that's sealed your cervical canal during the last nine months — if your cervix begins to dilate as you get close to labor. The plug may come out all at once in a lump, or as increased vaginal discharge over the course of several days. The mucus may be tinged with blood (which may be brown, pink, or red), which is why it's referred to as "bloody show." Having sex or a vaginal exam can also disturb your mucus plug and cause you to see some bloody discharge even when labor isn't going to start in the next few days. In either case, if you see more than a few spots of blood, be sure to call your caregiver immediately because it could be a sign of a problem.
* Your water breaks.
When the fluid-filled amniotic sac surrounding your baby ruptures, the fluid leaks from your vagina. And whether it comes out in a large gush or a small trickle, you should call your doctor or midwife.
Most women start having regular contractions sometime before their water breaks, but in some cases, the water breaks first. When this happens, labor usually follows soon. If you don't start having contractions on your own within a certain amount of time, you'll need to be induced, since your baby will be at increased risk for infection without the amniotic sac's built-in protection against germs.
How can I tell if my labor has actually started?
It's often not possible to pinpoint exactly when "true" labor begins because early labor contractions might start out feeling like the Braxton Hicks contractions you may have been noticing for weeks. It's likely that labor is under way, however, when your contractions become increasingly longer, stronger, and closer together. They may be as far apart as every ten minutes or so in the beginning, but they won't stop or ease up no matter what you do. And in time, they'll become more painful and closer together. In some cases, though, the onset of strong, regular contractions comes with little or no warning — it's different for every woman and with every pregnancy.
When should I call my doctor or midwife?
Toward the end of your pregnancy, your practitioner should give you a clear set of guidelines for when it's time to let her know that you're having contractions and at what point she'll want you to go to the hospital or birth center. These instructions will depend on your individual situation — whether you have pregnancy complications or are otherwise considered high-risk, whether this is your first baby, and practical matters like how far you live from the hospital or birth center — and your caregiver's personal preference (some prefer an early heads-up).
If your pregnancy is uncomplicated, she'll probably have you wait to come in until you've been having contractions that last for about a minute each, coming every five minutes for about an hour. (You time a contraction from the beginning of one to the beginning of the next one.) As a rule, if you're high-risk, she'll want to hear from you earlier in labor.
Don't be afraid to call if the signs aren't clear but you think the time may have come. Doctors and midwives are used to getting calls from women who aren't sure whether they're in labor and need guidance. It's part of their job. And the truth is, your practitioner can tell a lot by the tone and tenor of your voice, so verbal communication helps. She'll want to know how close together your contractions are, how long each one lasts, how strong they are (she'll note whether you can talk through a contraction), and any other symptoms you may have.
Finally, whether or not your pregnancy has been problem-free up to now, be sure to call your practitioner right away (and if you can't reach her, head for the hospital) in the following situations:
• Your water breaks or you suspect that you're leaking amniotic fluid. Tell your practitioner if it's yellow, brown, or greenish, because this signals the presence of meconium, your baby's first stool, and is sometimes a sign of fetal stress. It's also important to let her know if the fluid looks bloody.
• You notice that your baby's less active.
• You have vaginal bleeding (unless it's just bloody show — mucus with a spot or streak of blood), fever, severe headaches, vision changes, or abdominal pain.
• You start having contractions before 37 weeks or you have any other signs of preterm labor.
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What stages will I go through during labor and childbirth?
The process you'll go through during labor and childbirth can be divided into three stages:
The first stage begins with the onset of contractions and the gradual effacement (thinning out) and dilation (opening) of the cervix. That's followed by active labor, when your cervix begins to dilate more rapidly and contractions are longer, stronger, and closer together. In the last part of active labor (and the end of the first stage), called transition, your cervix dilates fully to 10 centimeters.
The second stage of labor begins once you're fully dilated and ends with the birth of your baby. This is often referred to as the pushing stage.
The third and final stage begins right after the birth of your baby and involves the separation and delivery of the placenta.
For first-time moms who are at least 37 weeks along, labor and delivery takes an average of 15 hours, although for plenty of women it lasts more than 20 hours, and for a lucky few it's over much sooner. For women who've been through labor before, deliveries average around eight hours.
First stage: Early labor
Once your contractions are coming at relatively regular intervals and your cervix begins to progressively dilate and efface, you're officially in early labor. But unless your labor starts very suddenly and you go from no contractions to fairly regular contractions right away, it can be tricky to determine exactly when true labor starts. That's because these early labor contractions are sometimes hard to distinguish from the inefficient Braxton Hicks contractions that may immediately precede them and contribute to so-called "false labor." (If you're not yet 37 weeks and you're noticing contractions or other signs of labor, call your caregiver immediately so she can determine whether you're in preterm labor.)
During early labor, your contractions will gradually become longer, stronger, and closer together. While the experience of labor varies widely, typically it might start with contractions coming every ten minutes and lasting 30 seconds each. Eventually they'll be coming every five minutes and lasting 40 to 60 seconds each as you reach the end of early labor. Some women have much more frequent contractions during this phase, though the contractions will still tend to be mild and last less than a minute.
Sometimes early labor contractions are quite painful (though they may be dilating your cervix much more slowly than you'd like!). If your labor is typical, though, your contractions now won't require the same attention that later ones will. You'll probably find that you can still talk through them and putter around the house. You may even feel like taking a short walk. If you feel inclined to relax instead, take a warm bath, watch a video, or doze off between contractions if you can.
You may also notice increasing mucousy vaginal discharge, which may be tinged with blood — the so-called "bloody show." This is perfectly normal, but if you see more than a tinge of blood, be sure to call your caregiver. Also call if your water breaks, even if you're not having contractions yet.
Otherwise, if you're at least 37 weeks along, and unless your caregiver has advised you differently, expect to sit out early labor at home. (When to call your midwife or doctor and when she's likely to have you go to the hospital or birth center are things to discuss ahead of time at your prenatal visits.) Early labor ends when your cervix is 3 to 4 centimeters dilated and your progress starts to accelerate.
How long it lasts
It's not easy to say how long this phase typically lasts or even (after the fact) how long it lasted for a particular woman. The length of early labor depends in large part on how ripe your cervix is at the beginning of labor and how frequent and strong your contractions are. With a first baby, if your cervix isn't effaced or dilated to begin with, this phase may take about eight hours, though it can be longer or significantly shorter. If your cervix is already very ripe or if this isn't your first baby, it's likely to go much more quickly.
Coping tips
Don't become a slave to your stopwatch just yet — it's stressful and exhausting to record every contraction over the many long hours of labor, and it isn't necessary. Instead you may want to time them periodically to get a sense of what's going on. In most cases, your contractions will let you know in no uncertain terms when it's time to take them more seriously.
Meanwhile, it's important to do your best to stay rested, since you may have a long day (or night) ahead of you. Be sure to drink plenty of fluids so you stay well hydrated. And don't forget to go to the bathroom often even if you don't feel the urge. A full bladder may make it more difficult for your uterus to contract efficiently, and an empty bladder leaves more room for your baby to descend.
First stage: Active labor
Active labor is when things really get rolling. Your contractions become more frequent, longer, and stronger, and your cervix begins dilating faster — going from 3 to 4 centimeters to 10 centimeters. In contrast to early labor, you'll no longer be able to talk through the contractions. Toward the end of active labor your baby may begin to descend, though he might have started to descend earlier or he might not start until the next stage.
As a general rule, once you've had regular, painful contractions (each lasting about 60 seconds) every five minutes for an hour, it's time to call your midwife or doctor and head to the hospital or birth center. (Some prefer a call sooner, so clarify this with your caregiver ahead of time.) In most cases, the frequency of contractions eventually increases to every two-and-a-half to three minutes, although some women may never have them more often than every five minutes, even during transition.
How long it lasts
Labor varies widely, but on average it takes about six hours for a woman having her first baby to go from 4 centimeters to full dilation. That's if she's not being given oxytocin (Pitocin) or using an epidural, though. Pitocin generally speeds up the active phase, while epidurals tend to make it last longer. If you've already had a vaginal birth, active labor is likely to go much more quickly.
Coping tips
Breathing exercises, relaxation techniques, and a good labor coach can be a huge help now. Massage and lots of gentle encouragement are lifesavers, too. When you get to the hospital or birth center, you should be able to move freely around the room after your caregiver evaluates you, as long as you don't have any medical or obstetric complications. You may find that it feels good to walk, but you'll probably want to stop and lean against something (or someone) during each contraction. If you're tired, try sitting in a rocking chair or lying in bed on your left side. This might be a good time to take a warm shower or bath, if you have access to a tub, or to ask your partner for a massage. If you've already decided you want pain medication or you're having a hard time coping with contractions and nothing else seems to help, now's the time to talk to your provider about getting an epidural or systemic medication.
First stage: Transition
The last part of the active phase — when your cervix dilates from 8 to a full 10 centimeters — is called the transition period because it marks the transition to the second stage of labor. This is the most intense part of labor. Contractions are usually very strong, coming about every two-and-a-half to three minutes and lasting a minute or more, and you may find yourself shaking and shivering.
By the time your cervix is fully dilated and transition is over, your baby has usually descended somewhat into your pelvis. This is when you might begin to feel rectal pressure, as if you have to move your bowels. Some women begin to bear down spontaneously — to "push" — and may even start making deep grunting sounds at this point. There's often a lot of bloody discharge. You may also feel nauseated or even vomit now.
On the other hand, some babies descend earlier and the mom feels the urge to push before she's fully dilated. And some babies don't descend significantly until later, in which case the mom may reach full dilation without feeling any rectal pressure. It's different for every woman and every birth.
If you've had an epidural, you'll feel varying amounts of pressure, depending on the type and amount of medication you're getting, and how low the baby is in your pelvis. If you'd like to be a more active participant in the pushing stage, ask to have your epidural dose lowered at the end of transition.
How long it takes
Transition can last anywhere from a few minutes to a few hours. It is much more likely to be fast if you've already had a vaginal delivery.
Coping tips
If you're laboring without an epidural, this is when you may begin to lose faith in your ability to cope, so you'll need lots of extra encouragement and support from those around you. The good news is that if you've made it this far without medication, you can usually be coached through transition — one contraction at a time — with constant reminders that you're doing a great job and that the end is near.
Second stage: Pushing
Once your cervix is fully dilated, the work of the second stage of labor begins: the final descent and birth of your baby. At the beginning of the second stage, your contractions may be a little further apart, giving you the chance for a much-needed rest between them. Many women find their contractions in the second stage easier to handle than during active labor because bearing down offers some relief. Other women don't like the sensation of pushing.
If your baby's very low in your pelvis, you may feel an involuntary urge to push early in the second stage (and sometimes even before). But if your baby's still relatively high, you won't have this sensation right away. As your uterus contracts, it exerts pressure on your baby, moving him down the birth canal. So if everything's going well, you might want to take it slowly and let your uterus do the work until you feel the urge to push.
Waiting a while may make you less exhausted and frustrated in the end. However, in many hospitals it's still routine practice to coach women to push with each contraction in an effort to speed up the baby's descent — so let your caregiver know if you'd prefer to wait until you feel a spontaneous urge to bear down. If you have an epidural, the loss of sensation makes it hard to feel what you're doing, so you'll need explicit coaching to help you to push effectively.
Your baby's descent may be rapid or, especially if this is your first, gradual. With each contraction, the force of your uterus — combined with the force of your abdominal muscles if you're actively pushing — exerts pressure on your baby to continue to move down through the birth canal. When a contraction is over and your uterus is relaxed, your baby's head will recede slightly in a "two steps forward, one step back" kind of progression. Try different positions for pushing until you find one that feels right and is effective for you. It's not unusual to use a variety of different positions during the second stage.
After a time, your perineum (the tissue between your vagina and rectum) will begin to bulge with each push, and before long your baby's scalp will become visible, a very exciting moment and a sign that the end is in sight. You can ask for a mirror to get that first glimpse of your baby, or you may simply want to reach down and touch the top of his head.
Now the urge to push becomes even more compelling. With each contraction, more and more of your baby's head becomes visible. The pressure of his head on your perineum feels very intense, and you may notice a strong burning or stinging sensation as your tissue begins to stretch. At some point, your caregiver may ask you to push more gently or to stop pushing altogether so your baby's head has a chance to gradually stretch out your vagina and perineum. A slow, controlled birth can help prevent you from tearing. By now, the urge to push may be so overwhelming that you'll be coached to blow or pant during contractions to help counter it.
Your baby's head continues to advance with each push until it "crowns" — the time when the widest part of his head is finally visible. The excitement in the room will grow as your baby's face begins to appear: his forehead, his nose, his mouth, and, finally, his chin.
After his head emerges, your doctor or midwife will suction his mouth and nose and feel around his neck for the umbilical cord. (No need to worry. If the cord is around his neck, your caregiver will either slip it over his head or, if need be, clamp and cut it.) His head then turns to the side as his shoulders rotate inside your pelvis to get into position for their exit. With the next contraction, you'll be coached to push as his shoulders emerge, one at a time, followed by his body.
Once he hits the atmosphere, your baby needs to be kept warm and will be dried off with a towel. Your doctor or midwife may quickly suction your baby's mouth and nasal passages again if he seems to have a lot of mucus. If there are no complications, he'll be lifted onto your bare belly so you can touch, kiss, and simply marvel at him. The skin-to-skin contact will keep your baby nice and toasty, and he'll be covered with a warm blanket — and perhaps given his first hat — to prevent any heat loss. Your caregiver will clamp the umbilical cord in two places and then cut between the two clamps or your partner can do the honors.
You may feel a wide range of emotions now: euphoria, awe, pride, disbelief, excitement (to name but a few), and, of course, intense relief that it's all over. Exhausted as you may be, you'll also probably feel a burst of energy, and any thoughts of sleep will vanish for the time being.
How long it lasts
The entire second stage can last anywhere from a few minutes to several hours. Without an epidural, the average duration is close to an hour for a first-timer and 20 minutes if you've had a previous vaginal delivery. If you have an epidural, the second stage generally lasts longer.
Third stage: Delivering the placenta
Within minutes after giving birth, your uterus begins to contract again. The first few contractions usually separate the placenta from your uterine wall. When your caregiver sees signs of separation, she may ask you to gently push to help expel the placenta. This is usually one short push that's not at all difficult or painful.
How long it lasts
On average, the third stage of labor takes about five to ten minutes, though it can last up to 30 minutes or more.
And then what?
After you deliver the placenta, your uterus should contract and get very firm. You'll be able to feel the top of it in your belly, around the level of your navel. Your caregiver, and later your nurse, will periodically check to see that it remains firm, and massage your uterus if it isn't. This is important because, as it contracts, the uterus helps cut off and collapse the open blood vessels at the site where the placenta was attached. If your uterus doesn't contract properly, you'll continue to bleed profusely from those vessels.
If you're planning to breastfeed, you can do so now if you and your baby are both willing. Not all babies are eager to nurse in the minutes after birth, but hold your baby's lips close to your breast for a little while. Most babies will eventually begin to nurse within the first hour or so after birth if given the chance. Early nursing is good for your baby and can be deeply satisfying for you. What's more, nursing triggers your body to release oxytocin, the same hormone that causes contractions, and helps your uterus stay well contracted.
If you're not nursing or your uterus isn't firm, you'll be given oxytocin to help it contract. (Some providers routinely give it to all women at this point). If you're bleeding excessively, you'll probably be given other medications as well.
Your contractions at this point are relatively mild. By now your focus has shifted to your baby, and you may be oblivious to everything else going on around you. If this is your first baby, you may feel only a few contractions after you've delivered the placenta. (If you've had a baby before, you may continue to feel occasional contractions for the next day or two.) These so-called afterbirth pains can feel like strong menstrual cramps. If they bother you, ask for pain medication. You may also find that you get a case of the chills or feel very shaky. This is perfectly normal and won't last long. Don't hesitate to ask for a warm blanket if you need one.
Your caregiver will examine the placenta to make sure it's all there. Then she'll check you thoroughly to see if you have any tears that need to be stitched. If you tore or had an episiotomy, you'll get an injection of a local anesthetic before being sutured. You may want to hold your newborn while you're getting stitches — it can be a great distraction. Or, if you feel too shaky, ask your partner to sit by your side and hold your new arrival while you look at him.
If you had an epidural, an anesthesiologist or nurse anesthetist will come by and remove the catheter from your back. (This takes just a second and doesn't hurt.) Unless your baby needs special care, be sure to insist on some quiet time together. The eyedrops and vitamin K can wait a little while. You and your partner will want to share this special time with each other as you get acquainted with your new baby and revel in the miracle of his/her birth.
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