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What a First-Time Mom Can Expect During Labor
by Carol Nelson, RN

There is an incredible amount of variation in what labor is like for a first-time mom. The length of labor is extremely variable, with the average length of active labor being 12 hours. Some labors are "harder" or "easier" than others due to things like the position and size of the baby, shape and size of the pelvis and a myriad of other physical, emotional and psychological factors that come into play. Each woman has her own perceptions about labor as well. It is viewed by some as a necessary evil, a means to an end that must be endured with the least amount of discomfort possible. Others view it as a natural, spiritual, miraculous event that they want to experience fully with minimal intervention. The common thread is that parents-to-be want a healthy mother and baby. Since labors vary so much, go into labor with an open mind and a trust that your health care provider will help you with decision making should something unexpected come up. Childbirth classes are very helpful in educating parents about what "normal" labor is like and the choices available to them during labor.

Each hospital and doctor or certified nurse midwife have guidelines and personal preferences they follow in regards to fetal monitoring, placement of IVs during labor, activity during labor, pain medication, position for delivery, etc. It is important to discuss these issues with your health-care provider.

The first phase of labor is called early or latent labor. Latent labor ends and the active phase of labor begins when the cervix is about four centimeters dilated. The duration of this phase of labor is the most variable, lasting from a few hours to a couple of days. It is characterized by cramping, increased vaginal discharge and contractions. The contractions may be painless or painful; irregular or regular; they often go away or decrease with a change in activity. It is difficult to determine whether someone is in early labor or false labor. The only way to know for sure is by having serial cervical exams that show that the cervix is dilating. For a first-time mom it is sometimes difficult to know when to go to the hospital. Talking to your health care provider or the labor and delivery nurses can help you decide when it's appropriate to go to the hospital. Walking is a good activity for early labor as gravity helps the baby's head to press on the cervix which can cause the contractions to become closer and more regular. If a couple hours of walking hasn't caused any cervical change or a change in the intensity or frequency of contractions it may be helpful to take a warm bath and rest so you're not exhausted when active labor begins. In some ways the first phase of labor can be the toughest because the timing is so variable and pain medication often isn't an option because it can slow down the labor process.

When you arrive at the hospital, your baby's well-being and your contractions will be evaluated with a fetal monitor. The monitor has two disc-shaped pieces that are held on your abdomen with cloth belts. One monitors the baby's heart rate, the other shows how often your contractions are coming and how long they are lasting (it does not show how strong the contractions are). This information is printed out on paper and gives a lot of information about how your baby is tolerating labor. Your health care provider will do a cervical exam to determine whether you are in active labor, (he/she can also check to see if you've broken your bag of water if you've been leaking fluid).

Your family and support people are encouraged to be with you during your labor and delivery. It is your decision who you want with you, so don't feel pressured to have people in your room if it makes you uncomfortable.

Once admitted to labor and delivery you may have blood drawn and/or have an IV started, a health history will be obtained, prenatal records reviewed, and admission paperwork completed. If your baby's monitor strip is reassuring you have several options. A warm shower or hot tub can help you relax during contractions. Some women prefer to be up walking, which may help labor progress faster. Some women are very anxious to receive pain medication. Usually you have a choice between IV pain medicine or an epidural. IV pain medications are easily administered and work quickly. They will not completely take your pain away but will decrease the perceived intensity of the contractions and help you relax. IV medications can be repeated throughout labor but shouldn't be given when delivery is imminent as some of the medication will get to the baby. An epidural is a small tube placed in the epidural space (not the spinal cord) in your lower back. Once in place, medication is injected that bathes the nerves that go to the lower half of your body and is very effective in blocking out pain. It is placed by either an anesthesiologist or certified nurse anesthetist. The medication injected into the epidural doesn't get to the baby. There are some risks associated with an epidural. Talking to your health care provider prior to labor is helpful. If you are receiving pain medication you must have an IV and the baby's heartbeat must be monitored continuously.

Occasionally labor doesn't progress at what is considered a normal rate or the baby doesn't tolerate the stress of labor. It is good to be aware of possible interventions. The average dilation during the active phase of labor for a first time mom is a centimeter of dilation an hour. If labor is not progressing normally, or if your bag of water breaks and you don't go into labor on your own, your doctor or midwife might want to start a medication called pitocin. Pitocin is a hormone administered through the IV that causes contractions to become stronger and closer together. If there is any concern about your baby's well-being internal monitors may be placed. A tiny wire can be placed on the top of the baby's head to more accurately trace the baby's heartbeat. A small tube can be inserted into the uterus through the cervix to determine how strong the contractions are.

Once your cervix is dilated to ten centimeters it is time to start pushing. Average duration for a first labor is 50 minutes, but can range from 10 minutes to three hours. Pushing is hard work, and it's the time of your labor when good coaching is important. Women that don't have an epidural often get an incredibly strong urge to push once they are completely dilated. The pushing phase can last longer when an epidural is in place because that strong urge is absent and effective pushing is harder to learn when feeling is decreased. Sometimes pushing isn't effective, the baby is big or the baby is showing signs of distress during pushing. A suction cup applied to the baby's head or forceps are sometimes used to help facilitate delivery. Within 30 minutes of delivery of the baby the placenta will deliver and, if necessary, stitches will be used to repair a tear or episiotomy. Finally, after all your hard work, labor is over and parenthood begins.

Editorial provided by Carol Nelson, RN at University Hospital in Denver, Colorado.

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