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Childbirth

What to expect

After nine long months of waiting, the prospect of giving birth can be both exciting and daunting. But being prepared for labor and birth can go a long way to ease fears.
Once you reach the third trimester, you should talk to your physician or nurse midwife about labor and delivery, your options for pain relief, and how to reach him or her if you go into labor.
Before you reach the last few weeks of pregnancy, you and your partner should visit the hospital. Make sure you know how to get there, where to park and where to check in. Find out if you can pre-register so that your insurance information is already in the computer when you arrive. Most hospitals offer free tours of their maternity areas; call and take a tour.

Signs of Labor

Many women, especially with their first babies, think they are in labor when they're not. This is called false labor. Don't feel embarrassed if you go to the hospital thinking you're in labor, only to be sent home!

If you think labor has begun, you should call your doctor or nurse midwife. They can decide if it's time to go to the hospital or if you should be seen at the office first. Learn the signs of labor so you will know when the time has come:
- Contractions come at regular and increasingly shorter intervals. Contractions should become stronger over time.
- You have lower back pain that doesn't go away. You may also feel premenstrual and crampy.
- Your water breaks. This can be a large gush or a continuous trickle.
- You have a bloody mucous discharge.
This is probably the mucous plug that blocks the cervix. Losing your mucous plug usually means your cervix is dilating and becoming thinner and softer. Labor could start right away or be days away.

Who Should Deliver Your Baby

Women can choose what type of health care provider they would like to deliver their baby.

Obstetrician:
A medical doctor who has advanced training in pregnancy and women's health care. Obstetricians provide prenatal care and perform deliveries for low- and high-risk women, including c-sections, if needed. Obstetricians are licensed by the state with advanced training and hospital affiliations.

Family Medicine Physician:
A medical doctor who has the training and education required to care for the whole family. Family medicine physicians may provide prenatal care and deliver babies, usually when there are no complications. In some cases, a family practitioner will refer a pregnant patient to an obstetrician.

Certified Nurse Midwife:
A registered nurse with advanced training and education to provide prenatal care and perform uncomplicated deliveries. Certified nurse midwives are usually associated with an obstetrician that can assist with problems or complications, and often perform deliveries in hospitals. Certified nurse midwives are also licensed by the state.

Certified Professional Midwife:
A person trained and certified in the care of pregnant women. Certified professional midwives perform low-risk deliveries at clinics or at home. They must pass a test to become certified.

Lay Midwife:
A person who does deliveries at the pregnant woman's home, or at their clinic. There is no standardized training or certification required to become a lay midwife, and so there is no specific standard of care for their pregnant patients.

Managing Pain

Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for everyone, so no one can predict how you will feel. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotional status, and the strength of the contractions.

Natural Pain Relief

Many women choose to deliver their babies without using medicine for pain relief. Some of these women use other techniques to help them cope. Things women do to ease the pain include using breathing techniques, warm showers or baths, massages, labor balls and music, and use of a doula or other support person.
Taking a childbirth class that focuses on Natural pain relief or a class on HypnoBirthing can be a great tool for mom and her partner.

Medical Pain Relief

While you're in labor, your doctor or nurse will ask if you need pain relief. It is their job to help you decide what option is the best for you. There are many different kinds of pain relief. Not all options are available at every hospital. Plus, your health history, allergies, and any problems with your pregnancy will make some options better than others.
Types of pain relief include intravenous or intramuscular analgesic. This option does not get rid of all the pain. Instead it usually just makes the pain bearable. After getting this kind of pain relief, you can still get an epidural pain relief later.
Epidural anesthesia is another option. In this procedure, a doctor injects medicine into the lower part of your back. The medicine blocks pain in the parts of the body below the shot. During a contraction, the feeling of pain travels from the uterus to the brain along nerves in the backbone. Epidurals block the pain of contractions by numbing these nerves.
Epidurals allow most women to be awake and alert with very little pain. Many women who get epidurals do not feel any pain during contractions and childbirth. Medicines used in epidurals include novocaine-like drugs that block the pain in that region combined with opioids like fentanyl.

Cesarean Section

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the rate of babies born by cesarean section (c-section) in the United States is on the rise. In 2004, 29.1 percent of babies were born by c-section in this country. This is an increase of more than 40 percent since 1996.
Many experts think that up to half of all c-sections are unnecessary. Thus, the U.S. government is trying to reduce the rate. It is important for pregnant women to get the facts about c-sections before they deliver. Women should why c-sections are performed, and the pros and cons of this surgery.

What is a C-Section?

During a c-section, the doctor makes a cut in the mother's abdomen and uterus and removes the baby. The baby is delivered through surgery instead of coming out of the vagina. Most women get spinal or epidural anesthesia during a c-section, allowing her to stay awake without feeling pain. But sometimes general anesthesia is needed. With general anesthesia the woman is asleep during the procedure.
A c-section can save the life of a baby or mother. If health problems come up before or during labor and delivery, a c-section can deliver the baby very quickly. Most c-sections result in a healthy mother and baby.
Still, a c-section is major surgery. And all surgeries have risks. These include infection, dangerous bleeding, blood transfusions and blood clots. Women who have c-sections stay at the hospital longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections should only be done when the health or the mother of baby is in danger.

Whatever your concerns or situation, your healthcare provider can help you choose what options are best for you and your baby.

Information Provided by the National Women's Health Information Center