What to Expect During Labor and Delivery [Dr. Tara Haarsma]

My name is Dr. Tara Haarsma. I am an OBGYN, and I chose obstetrics and gynecology as a profession because I really enjoy woman's health, and I enjoy delivering babies.

What is a birth plan?

Every pregnant woman will have an idea of how their labor and delivery process should go. It's not a bad idea to have kind of a written birth plan, or a birth plan in your mind, and it's important to speak to both your physician and your labor and delivery nurse and, kind of let them know the things that you had planned or the things that you desire, and we try to stick to those as close to possible. 

As an OBGYN we really recommend to have an open mind because things can change in a flash in labor and delivery. Our primary goal is, you know, to have a healthy mom and a healthy baby.

When does labor typically begin?

So no one can predict when labor will start. Your due date is merely a reference point to determine when baby is considered full term. Labor can begin anywhere from three weeks prior to due date to up to one or two weeks after your due date. If you do end up going a week or two over your due date, your doctor may recommend an induction, and this is to help prevent any risks that can be associated with a post date pregnancy.

What are the main signs of labor?
 
There are five main signs of labor, and not every woman will experience every sign. The first one is called lightening, and this is when the fetal head will drop into the maternal pelvis. You may notice that your belly appears lower. It might be easier for you to breathe and you'll probably notice an increased need to use the rest room. And this is due to the baby's head being so low in the pelvis. 

What are additional signs of labor?

Another sign is what we call bloody show, and this is a red tinged or brownish discharge, that's coming from the cervix. And it may be mixed with your mucus plug, which is kind of a thick yellow mucus-type discharge that usually indicates that the cervix is starting the dilation and the softening process. 
 
Another sign would be diarrhea. So frequent loose stools usually means that delivery is eminent. Rupture of membranes. So this is when you experience a big gush of fluid or you might notice continuous leaking of fluid and this fluid is coming from the amniotic sac. The amniotic sac is the protective barrier of fluid that was surrounding the baby in pregnancy. Labor typically will occur within 24 hours of your water breaking. If labor does not start then your doctor will talk to you about starting the medication to help get contractions and labor progressing so that we can decrease the risk of infection to both you and the baby.

When should I come to the hospital? 

It can be hard to determine when you are in full labor. So if you, you know, are experiencing any symptoms that you are not certain about or have any questions about you can always call your healthcare provider, or else you can go always go to labor and delivery to be evaluated. If you present to labor and delivery and they end up sending you home, what we call false labor, we just recommend... try not to be discouraged or embarrassed, you know, it commonly occurs and you can just be reassured that labor is on its way.

What are contractions?

So at some point most mothers will experience contractions. So a contraction is the tightening and relaxing of your uterus, and this motion is gonna help dilate the cervix and bring the baby through the birth canal. 
 
You may notice around the third trimester of pregnancy, you have some tightening in your belly, which is called the Braxton Hicks contractions. Typically these are not painful and they occur infrequently. In the, kind of pre-phase or early phase of labor you may notice some painful contractions that are very irregular. Typically these contractions are not causing cervical change or dilation, and it's just the body preparing to go into full labor. 
 
Labor contractions are considered when you have painful contractions that sometimes start from the back and radiate around to the front, and they occur usually every three to five minutes, and you've been having them consistently for an hour. That's a good sign that these contractions are actually making cervical change and labor is here.

What are the stages of labor?

There are three stages of labor and an early stage of labor. The stage of labor is usually determined by how far dilated your cervix is. So the early stage or kind of pre-phase of labor is when your cervix is zero centimeters to about four to five centimeters dilated. This stage, or phase, I guess, is usually associated with some irregular contractions, as well as an increase in vaginal discharge. 
 
The first official stage of labor is called the active phase, and this is once your cervix is five to six centimeters dilated and your usually having regular, painful, predictable contractions. Your water may break or might be bulging, and typically you're making cervical change at a rate of 1.2 centimeters per hour to 1.5 centimeters per hour, depending on if it's your first baby or not.

The second stage of labor is what we call the pushing stage, or phase 2. And this is once your cervix has become 10 centimeters, or what we call complete, and the baby's head has dropped down into the pelvis, at an appropriate station we will have you begin pushing. And for most moms it can be anywhere from 5 to 10 minutes or it can last up to a couple of hours, depending on if you've had a baby or not before.  
 
The third stage of labor is delivery of the placenta. This will usually take about 5 to 10 minutes after delivery of the baby, but in some people it can take up to 30 minutes.

What happens after baby arrives?

After delivery of the baby we like to do what we call skin to skin, and this is where we will place the infant on the maternal abdomen or chest, and this has been shown to improve maternal-infant bonding, as well as help the baby transition to the outside world.  
 
Once the baby has been placed on the abdomen we will clamp the cord and then we will ask either the father or someone, a support member, with the mother to cut the cord. And then once the cord has been cut, this is when we will deliver the placenta and do any repairs necessary. At some point the labor and delivery nurse will take the infant over to the warmer, where we will measure the baby and weigh the baby, and make sure its meeting all its milestones. 

Would you recommend Brookings Health System for deliveries?

So here in Brookings we have three OBGYNs, who manage both normal and high-risk pregnancies. We deliver babies that are over 35 weeks gestation. However, if there was that situation where a mother came in in labor, and it wasn't safe to transport her, and she happened to be less than 35 weeks pregnant, you can be reassured that all of our staff, the labor and delivery staff, anesthesia, as well as the OBGYN physicians, are all certified and trained to manage neonatal resuscitation and pre-term infants.