Giving birth and starting a family

The most common way to help with pain during delivery is an epidural block, also known as an epidural. An anesthesia doctor gives this through a tube in your lower back.

With an epidural, you'll temporarily lose feeling from the waist down but you’ll still be awake and aware of your surroundings. Your pain will be more manageable and you’ll be conscious of your contractions and vaginal exams as labor progresses.

For you and your baby's safety, you may not be able to get an epidural the hour before delivery.

Like any medication, you may have side effects. Since an epidural block has opioids in it, many women have a feeling of itchiness. Other less common side effects include nausea, vomiting and breathing problems. 

Your team will regularly check on you. Be sure to voice any concerns you have about side effects with your team. We may be able to prescribe medications to help.

As with all pain medications that contain opioids, the opioids in an epidural block raise the possibility your baby may have short-term effects, such as: 

• Change in heart rate
• Breathing problems
• Drowsiness
• Reduced muscle tone
• Trouble breastfeeding 

While less common, other possible side effects include: 

• Decreased blood pressure
• Fever
• Headache
• Lower back soreness  

Serious but rare side effects can include: 

• Injury to your spinal cord or nerves
  
• Breathing problems, if the anesthetic affects your breathing muscles
• Numbness, tingling or rapid heartbeat if your shot goes into a vein instead of a nerve

In the main stages of early labor:

• Your amniotic sac will break.
• You’ll begin to have contractions.
• Your cervix (lower part of your uterus, also known as your womb) will dilate (open).
• You'll lose your mucus (thick fluid) plug.

When the amniotic sac (surrounding your baby) breaks, this is actually your water breaking. This doesn't harm you or your baby. In many cases, it breaks before you go into labor and will feel like a gush of fluid. 

This fluid should be clear and odorless. If the fluid is yellow, green or brown, contact your care team right away. 

Contractions are motions that help push your baby through your cervix. Contractions are the tightening and releasing of your uterus. This often feels like cramping and/or pressure. 

While contractions can be a sign of labor, they aren't always the most reliable sign of labor. If you're in your second trimester, it’s likely you're having Braxton-Hicks contractions. 

Braxton-Hicks contractions are false signs of labor that can feel like menstrual cramps. It doesn't mean that labor has started or is about to start. It's your body’s way of getting you ready for true contractions. 

Dilating means the cervix is opening. Your cervix opens to create room for the baby to move through during the delivery process. The cervix changes roles throughout your pregnancy. 

At first, the cervix keeps the uterus closed and the baby inside. During labor, it opens for delivery. The tissue surrounding the cervix will also begin to soften and grow thin to help prepare your body. 

The first stage of labor ends when your cervix fully dilates to 10 centimeters and the tissue thins out completely.  

The mucus plug seals the opening of your cervix. As your cervix begins to open, the plug will break and fall apart as the cervix continues to open. 

When the plug falls away completely, it will look like discharge (liquid) coming out. The color ranges from clear to pink and may even be bloody. After losing your mucus plug, you may go into labor in a matter of days or weeks.

You‘re likely in labor and should begin to follow your birth plan if your contractions: 

• Last for one minute
• Are five minutes apart
• Have been going on for about an hour 

If you have any questions or concerns during your pregnancy, please contact your doctor right away.

Usually, the first 3 centimeters slowly dilate over a period of weeks. Most first-time mothers don't dilate until active labor begins. 

As you get closer to your due date, your doctor will check your cervix to see how much you have effaced (how much the cervix is relaxing and thinning out) and dilated. Once you’ve reached 3 centimeters, it can take 30 minutes to 18 hours for labor to fully progress.

You may not fully dilate for a number of reasons. Some of these reasons include:

• Weak contractions 
• Previous cervical tears or surgery
• Your baby is large

Hormones are natural chemicals that help the body work. A hormone drip can help strengthen your contractions if they are weak. If your baby is big, your baby's head may stay high instead of lowering into your pelvis.

If these methods don't work, you may not be able to have a safe vaginal delivery. At this point, your doctor will talk to you about a cesarean. 

Cesarean birth, also called a C-section, is the delivery of a baby through cuts in the abdomen (middle of the body) and uterus. 

Once you’ve dilated 10 centimeters, the baby can safely pass through the vagina. As the baby’s head emerges, you will feel a release of pressure.  

Your care team will ask you to stop pushing and suction out the baby’s mouth and nose to clear out any amniotic fluid or mucus.  

Once the baby is in the right position, your team will instruct you to push again. This same process will happen for the top shoulder, the lower shoulder and the lower half of the baby.

As the baby enters your vagina, your muscles and skin will stretch. The labia and perineum (the area between the vagina and anal area) will reach the greatest point of stretching. This can feel like a burning sensation.

To prevent further tearing, your doctor may do an episiotomy. 

An episiotomy is a small cut to widen the opening of the vagina. This can help the delivery and can help prevent further tearing if the baby is stressed. The same treatment plan for vaginal and perineal tears works for an episiotomy. 

Learn more about how we can help you with vaginal and perineal tears.

After delivering your baby, you’ll deliver the placenta though a series of contractions. Usually these contractions happen quickly and aren't as strong. If you want to save your placenta, be sure to talk with your care team beforehand, so the proper arrangements can be made. 

Most doctors suggest waiting for six weeks, but everyone is different. Be sure to talk with your doctor before resuming sexual activity. 

Several situations can cause your doctor to suggest a cesarean. These include:

• Failure to progress with labor
• Concern for the baby 
• Multiple babies
• Problems with the placenta
• The baby is large
• The baby is breech (not in the normal position)
• If the mother has an infection, such as human immunodeficiency virus (HIV) or herpes
• If the mother has health or medical problems

There can be complications with every surgery, but only a small number of women have problems when having a cesarean birth. 

Complications may include: 

• Infection
• Blood loss
• Blood clots in the legs, pelvic organs or lungs
• Injury to bowel or bladder
• A bad response to medications or anesthesia

You should talk with your doctor beforehand about your choices to find out if a cesarean is right for you. As with any surgery, there can be complications, including as a greater chance for medical problems and possible problems with future pregnancies. 

This depends on:

• Your previous cesarean
• Your current health 
• The resources available at the hospital where you plan to give birth

It’s entirely possible for you to have a vaginal delivery after a cesarean. This is known as VBAC. Your doctor will need to look at your situation to see if VBAC is right for you.

Your care team will use one of the following to help with pain during a cesarean:

• General anesthesia 
• Epidural block
• Spinal block

With general anesthesia, you’ll be asleep during the delivery. 

With an epidural block, the lower half of your body is numb after a shot is given in your lower back. The anesthesiologist may leave a small tube inserted so they can give you more medicine if needed.

With a spinal block, the lower half of your body is numb after a shot is given directly into your spinal fluid. 

Your doctor will make a horizontal or vertical cut in your skin and the wall of the abdomen. Next, your doctor separates the muscles in your abdomen. Your doctor will try not to cut your muscles. 

To deliver the baby, your doctor will make a final cut through the wall of the uterus. 

After removing the baby and cutting the umbilical cord, the final step in labor is removing the placenta. Once complete, your doctor will stitch your uterus using naturally dissolving stitches and close your abdominal skin using staples or stitches. 

If you're awake during surgery (meaning you received an epidural or spinal block), you may get the chance to hold your baby almost right away after giving birth. Once your doctor stitches you up, you’ll move to recovery or back into your room.

While you rest after surgery, your care team will:

• Remove your catheter (a thin tube that helps you pass urine)
• Regularly check for your blood pressure, pulse rate, breathing rate, and any bleeding in or around the abdomen

If you plan on breastfeeding, let your care team know, so you can start right away. A cesarean should not affect your milk supply.

Expect to stay in bed for the rest of the day. The first few times you get up, you’ll need someone to assist you. You’ll likely have pain around the cut made during surgery.

Your doctor may prescribe medication to help with your pain. If you prefer a holistic method, you may find a heating pad helpful. Be sure to talk with your doctor about your care and your doctor's suggestions based on your case. 

Your hospital stay will range anywhere from two to four days. The length depends on the reason you went with a cesarean birth and how your recovery process is progressing.

It’s important to remember that everyone’s body handles a cesarean differently, so don’t compare your healing process to someone else’s. Your care team is there to help you through recovery, so be sure to share your concerns with your team. 

While everyone’s recovery is different, typically women have:  

• Mild cramping, especially if you choose to breastfeed
• Bleeding or discharge for four to six weeks
• Bleeding with clots and cramps
• Pain in or around the cut

To prevent an infection, don't place anything in your vagina or have sex. Give your body time to heal before any strenuous activity or physical movement. If you have a fever, heavy bleeding, or if the pain increases, contact your doctor right away. 

It’s normal to have pain around the cut for a few weeks. If you’re looking for help with the pain, we suggest: 

• Taking medication as recommended by your doctor
• Using a heating pad or compression belt
• While breast-feeding, hold your baby in a way that puts less pressure on the cut

If you're breastfeeding, it’s important to make sure your medication is safe to take. Talk with your doctor about any concerns. 

Most doctors suggest waiting for six weeks. Before resuming normal sexual activity, talk with your doctor to be sure you’re ready. If the cut is still healing, you have a greater chance of infection and bleeding.  

You can't tell what type of cut you have by looking at your scar, only your medical records can give you this information. 

It's always a good idea to give your current ob/gyn doctor your previous medical records, so they can give you advice based on your past births and medical history. 

Giving birth vaginally can help with problems linked to multiple cesareans, such as:

• Bowel or bladder injury
• Hysterectomy (surgery to remove the uterus)
• Problems with the placenta in future pregnancies 

Other benefits include:

• No abdominal surgery
• A shorter recovery period
• Lower chance of infection and less blood loss

With any delivery, there is a chance for possible problems. With a VBAC, they include: 

• Infection
• Blood loss
• The cesarean scar breaking open

The cesarean scar breaking open is rare but very serious. If you have a greater chance of your scar breaking open, you should not have a VBAC. Your doctor can help you to make this decision. 

This means that you're trying to have a vaginal birth after a cesarean delivery. If it works, TOLAC will end in a vaginal birth. If it doesn't work, you doctor will do a cesarean. 

Your doctor’s job is to make sure the best care choices are made for the health of both you and your baby. If the risk outweighs the benefits, your doctor will ask you to think about other options.