Category: Childbirth

Water-breaking is just one possible sign. Learn the real and false signs of labor here. 

There are a few signs that differentiate true labor from false labor:

REAL Labor	FALSE Labor
Contractions are regular and come at increasingly shorter intervals and become longer and more intense.	Timing of the contractions are irregular and do not become more frequent or more intense.
Breaking of waters that result in a trickle or a gush of fluid. Contractions may start before or after.	Contractions stop during rest, when mother stops what she is doing, walking, or changing position.
Passing the mucus plug. Labor could still be a few days away, but it is coming.	Contractions are inconsistent in strength (strong one minute then weak the next).
Persistent pain in the lower back, especially if accompanied by a cramping, premenstrual feeling.	Location of pain is in the front only.

What is a postpartum checkup and why is it important?

A postpartum checkup is a medical checkup you get after having a baby to make sure you’re recovering well from labor and birth. Go to your postpartum checkups, even if you’re feeling fine. They’re an important part of your overall pregnancy care. Postpartum care is important because new moms are at risk of serious and sometimes life-threatening health complications in the days and weeks after giving birth. Too many new moms have or even die from health problems that may be prevented by getting postpartum care.

Postpartum checkups are important for any new mom. They’re especially important for moms who have experienced a loss, including:

• Miscarriage: This is when a baby dies in the womb before 20 weeks of pregnancy.
• Stillbirth: This is when a baby dies in the womb after 20 weeks of pregnancy.
• Neonatal death: This is when a baby dies in the first 28 days of life.

When these things happen, your postpartum checkups may help your health care provider or a genetic counselor learn more about what happened and see if you may be at risk for the same condition in another pregnancy. A genetic counselor is a person who is trained to help you understand about genes, birth defects, and other medical conditions that run in families, and how they can affect your health and your baby’s health.

What’s changed in postpartum care guidelines?

The American College of Obstetricians and Gynecologists (also called ACOG) has released new guidelines calling for changes to improve postpartum care for women. In the past, ACOG recommended that most women have a postpartum checkup 4 to 6 weeks after giving birth. ACOG now says that postpartum care should be an ongoing process, rather than a one-time checkup. ACOG now recommends that all women:

• Have contact with their health care provider within 3 weeks of giving birth
• Get ongoing medical care during the postpartum period, as needed
• Have a complete postpartum checkup no later than 12 weeks after giving birth

Many of the discomforts and body changes women have in the weeks after giving birth are normal. But sometimes they’re warning signs or symptoms of a health problem that needs treatment. Seeing your provider sooner and more often can help you and your provider spot these signs and symptoms and may help prevent serious medical problems. Your postpartum care should meet your personal needs so you get the best medical care and support.

What is a postpartum care plan?

A postpartum care plan is a plan that you and your health care provider make together. It helps you prepare for your medical care after giving birth. Don’t wait until after you have your baby to make your plan. Make it during pregnancy at one of your prenatal care checkups.

To make your plan, talk to your provider before you give birth about:

• Contact information for your health care provider. How do you get in touch with your provider after your baby’s born if you’re worried or have questions?
• Your postpartum checkups. Based on the new guidelines, ACOG recommends contacting your provider within 3 weeks of giving birth and a complete checkup within 12 weeks of giving birth. Talk with your provider to make sure this timing is right for you. Find out if your health insurance plan covers all your postpartum checkups. Look at the company’s website or call the number on your insurance card.
• Your reproductive life plan, including birth control. A reproductive life plan helps you think about if and when you want to have more children. For most women, it’s best to wait at least 18 months (1½ years) between giving birth and getting pregnant again. Too little time between pregnancies increases your risk of premature birth (before 37 weeks of pregnancy). Talk to your provider about birth control so you don’t get pregnant again too soon. Ask your provider before you give birth about getting an intrauterine device (also called IUD) or implant right after you have your baby. IUDs and implants are the most effective kinds of birth control.
• Health conditions or pregnancy complications that need treatment after you have your baby. Your provider can help you manage these conditions. You may need extra postpartum checkups to make sure you’re healthy. Your provider may want to refer you to other providers who specialize in treating certain conditions.
• Feeding your baby. Are you planning to breastfeed your baby or feed your baby formula? If you’re planning to breastfeed and you’re going back to work or school after your baby’s born, what’s your plan for feeding? Your provider can help you find a lactation consultant to help with breastfeeding. A lactation consultant is a person trained to help women breastfeed.
• Common physical and emotional changes after pregnancy. What can you expect after giving birth? What’s normal and how do you know when something’s more serious? What are signs and symptoms of serious health conditions to look for after giving birth?
• Postpartum depression (also called PPD) and other mental health conditions after pregnancy. Postpartum depression is a kind of depression that some women get after having a baby. It’s strong feelings of sadness, anxiety (worry), and tiredness that last for a long time after giving birth. PPD is a medical condition that needs treatment to get better. Talk to your provider about looking out for signs and symptoms of PPD.

What happens at a postpartum checkup?

At your postpartum checkup, your provider makes sure you’re recovering well after giving birth and adjusting to life as a mom. Here’s what to expect:

Physical exam

• Your provider checks your blood pressure, weight, breasts, and belly. If you had a cesarean birth (also called c-section), your provider may want to see you about 2 weeks after you give birth so she can check on your c-section incision (cut). A c-section is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. Most c-section incisions heal without any problems, but they can get infected.
• You get a pelvic exam. Your provider checks your vagina (birth canal), uterus (womb), and cervix. The cervix is the opening to the uterus that sits at the top of the vagina. If you had an episiotomy or a tear during birth, your provider checks to see that it’s healed. An episiotomy is a cut made at the opening of the vagina to help let the baby out. Your provider can tell you when it’s safe to have sex again.
• Your provider checks on any health conditions, like diabetes and high blood pressure, you had during pregnancy. For example, if you had gestational diabetes, your provider may give you a blood glucose test to check your blood sugar. Gestational diabetes is a kind of diabetes that some women get during pregnancy. If you’re breastfeeding, ask your provider to make sure any medicine you take is safe for your baby. You may need to stop taking a medicine or switch to one that’s safer during breastfeeding. Don’t stop taking any medicine without talking to your provider first.
• Your provider makes sure your vaccinations are up to date, including vaccinations for flu and pertussis. By getting vaccinated, you can help keep from getting sick and passing an illness to your baby.

Birth control. If you didn’t talk about birth control with your provider before you had your baby, talk about it at your postpartum visit. Talk to your provider about birth control options and how they fit with your plans about having more children. Ask about using an IUD or implant to help keep you from getting pregnant again too soon.

Problems you had during pregnancy, labor, and birth that may affect your health after pregnancy. This is the time to talk about how you may be able to prevent problems in future pregnancies, even if you’re not thinking about having another baby now. For example, if you had a premature birth, you’re at increased risk of having a premature birth in another pregnancy. Talk to your provider about what you can do to reduce the risk of premature birth and other complications in your next pregnancy. Even if you don’t plan to have more children, ask your provider if any problems you had during pregnancy may affect your health in the future. For example, if you had a premature birth, gestational diabetes, gestational hypertension (high blood pressure), or a condition called preeclampsia, you may be at increased risk of cardiovascular disease (also called heart disease) later in life. Heart disease affects the heart and blood vessels and can lead to serious problems, like a heart attack or stroke. It’s also a leading cause of pregnancy-related death.

Feelings about being a new mom. Tell your provider about how things are going. It’s OK to tell her how you feel. It’s normal to feel tired and stressed in the weeks after birth. You may have questions about breastfeeding and caring for your baby. Tell your provider if you have feelings of sadness or worry that last for a long time. If you have postpartum depression, it can make it hard for you to take care of yourself and your baby. It’s a medical condition that needs treatment to get better.

What is a postpartum care team?

You may need postpartum care from providers other than your prenatal care provider. For example, if you have chronic health conditions, you may need to see other providers after pregnancy to treat those conditions. These providers are part of your postpartum care team. A postpartum care team is a group health care providers and other postpartum care experts who help you get medical care and support after you give birth.

A chronic health condition is one that lasts for a long time or that happens again and again over a long period of time. Chronic health conditions include:

• High blood pressure. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. If the pressure in your arteries becomes too high, you have high blood pressure (also called hypertension). High blood pressure can put extra stress on your heart and kidneys. This can lead to heart disease, kidney disease, and stroke.
• Obesity. If you’re obese, you have an excess amount of body fat, and your body mass index (also called BMI) is 30.0 or higher before pregnancy. BMI is a measure of body fat based on your height and weight. To find out your BMI, go to www.cdc.gov/bmi.
• Preexisting diabetes. This is a medical condition in which your body has too much sugar (called glucose) in your blood. Preexisting diabetes (called type 1 or type 2 diabetes) means you had diabetes before you got pregnant. Diabetes can damage organs in your body, including blood vessels, nerves, eyes, and kidneys.
• Thyroid conditions. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food. If it makes too little or too much of these hormones, you can have health problems.
• Kidney disease. Your kidneys filter your blood, removing waste and extra water. They also keep your body’s chemicals balanced, help control your blood pressure, and make hormones. If you have chronic kidney disease (also called CKD), your kidneys are damaged and can’t filter blood like they should. This can cause waste to build up in your body. Untreated kidney disease can lead to kidney failure.
• Mood disorders. A mood disorder is a mental health condition that affects your emotions. Depression (also called major depression or clinical depression) is an example of a mood disorder. Depression causes feelings of sadness and a loss of interest in things you like to do. It can affect how you feel, think, and act and can interfere with your daily life. It’s a medical condition that needs treatment to get better.

Members of your postpartum care team can include:

• Your prenatal care provider. This is the provider who takes care of you during pregnancy, labor, and birth.
• Health care providers who treat women with pregnancy complications or chronic health conditions. For example, you may need to see a maternal-fetal medicine specialist (also called an MFM). MFMs are doctors with special education and training to take care of women who have high-risk pregnancies. Or if you have depression, you may need to see a mental health professional. A mental health professional is a provider who helps people cope with emotional or mental health problems. Mental health providers include social workers, therapists, counselors, psychologists, psychiatrists, and psychiatric nurse practitioners.
• Your baby’s health care provider. Your baby’s health care provider has medical training to take care of babies and children. Your baby’s provider may be:
  • A pediatrician. This is a doctor who has training to take care of babies and children.
  • A family practice doctor (also called a family physician). This is a doctor who takes care of every member of the family. A family practice doctor can be your health care provider before, during, and after pregnancy, and your baby’s provider, too.
  • A neonatologist. This is a doctor who takes care of sick newborns, including premature babies (babies born before 37 weeks of pregnancy) and babies with birth defects.
  • A pediatric nurse practitioner (also called PNP). This is a registered nurse who has advanced training to take care of babies and children.
  • A family nurse practitioner (also called FNP). This is a registered nurse with advanced training to take care of every member of your family.
• Breastfeeding help. You and your baby may need time and practice to get comfortable breastfeeding. Don’t be afraid to ask for help! You can get breastfeeding help from:
  • A lactation consultant. You can find a lactation consultant through your health care provider or your hospital. Or contact the International Lactation Consultants Association.
  • A breastfeeding peer counselor. This is a woman who breastfed her own children and wants to help and support mothers who breastfeed. She has training to help women breastfeed but not as much as a lactation consultant. You can find a peer counselor through your local WIC nutrition program. Or visit womenshealth.gov/breastfeeding or call the National Breastfeeding Helpline at (800) 994-9662.
  • A breastfeeding support group. This is a group of women who help and support each other with breastfeeding. Ask your provider to help you find a group near you. Or go to La Leche League.

Other members of your postpartum care team can include:

• Case manager or care coordinator. This is a nurse, social worker, or other trained professional who works with members of your postpartum care team to make sure you and your baby get the care, resources, and services you need.
• Home visitor. This is a nurse, social worker, or other trained professional who makes regular visits to your home to help you and your baby. Home visitors can help you learn how to care for your baby and understand your baby’s developmental milestones. These are skills or activities that most children can do at a certain age. Milestones include sitting, walking, talking, having social skills, and having thinking skills. A home visitor also can help connect you to community resources and services. The Nurse-Family Partnership and Healthy Start are examples of community health programs that offer free home-visiting services.
• Family and friends. Your family and friends can help you care for your baby or older children. Tell them if you need help with meals, chores around the house, or a ride to your postpartum checkups. Family and friends can keep an eye out for warning signs of health problems you may have after birth, including signs and symptoms of postpartum depression or other mental health conditions.

What health problems can premature babies have after birth?

Health problems that may affect premature babies include:

• Apnea: This is a pause in breathing for 20 seconds or more. Premature babies sometimes have apnea. It may happen together with a slow heart rate.
• Respiratory distress syndrome (RDS): This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing.
• Intraventricular hemorrhage (IVH): This is bleeding in the brain. It usually happens near the ventricles in the center of the brain. A ventricles is a space in the brain that’s filled with fluid.
• Patent ductus arteriosus (PDA): This is a heart problem that happens in the connection (called the ductus ateriosus) between two major blood vessels near the heart. If the ductus doesn’t close properly after birth, a baby can have breathing problems or heart failure. Heart failure is when the heart can’t pump enough blood.
• Necrotizing enterocolitis (NEC): This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly, and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth.
• Retinopathy of prematurity (ROP): This is an abnormal growth of blood vessels in the eye. ROP can lead to vision loss.
• Jaundice: This is when a baby’s eyes and skin look yellow. A baby has jaundice when his liver isn’t fully developed or isn’t working well.
• Anemia: This is when a baby doesn’t have enough healthy red blood cells to carry oxygen to the rest of the body.
• Bronchopulmonary dysplasia (BPD): This is a lung condition that can develop in premature babies as well as babies who have treatment with a breathing machine. Babies with BPD sometimes develop fluid in the lungs, scarring, and lung damage.
• Infections: Premature babies often have trouble fighting off germs because their immune systems are not fully formed. Infections that may affect a premature baby include pneumonia, a lung infection; sepsis, a blood infection; and meningitis, an infection in the fluid around the brain and spinal cord.

How can you best care for your premature baby?

Talk to your baby’s health care providers about any health conditions your baby has. He may be healthy enough to go home soon after birth, or he may need to stay in the NICU for special care. Your baby can probably go home from the hospital when he:

• Weighs at least 4 pounds
• Can keep warm on his own, without the help of an incubator. An incubator is an enclosed unit that helps premature babies stay warm.
• Can breastfeed or bottle-feed
• Gains weight steadily (1/2 to 1 ounce each day)
• Can breathe on his own

Your baby may need special equipment, treatment, or medicine after he leaves the hospital. Your baby’s provider and the staff at the hospital can help you with these things and teach you how to take care of your baby. They also can help you find parent support groups and other resources in your area that may be able to help you care for your baby.

There are five very important signs that mean you need to go to the hospital.

Go to the hospital when contractions start to be painful and close together (regularly at five minutes apart), unless you live a long distance from the hospital, in which case you should leave sooner. In any case, it’s always best to call your doctor to check when you should go to the hospital.

There are five very important signs that mean you need to go to the hospital immediately:

1. Your water breaks or you are leaking amniotic fluid and it is yellow/brown/greenish or bloody.
2. Baby is less active than normal.
3. You have vaginal bleeding (unless it’s just bloody show), constant severe abdominal pain, or fever.
4. Contractions before 37 weeks (not Braxton Hicks contractions).
5. You have severe or persistent headaches, vision changes, intense pain, or tenderness in your upper abdomen, or abnormal swelling. These are signs of preeclampsia.

What is a c-section?

A c-section (short for cesarean birth) is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus (womb). Most babies are born through vaginal birth. But if there are problems with your pregnancy or with your baby’s health, you may need to have your baby by c-section.

A c-section may be planned (also called scheduled). This means you and your health care provider decide when to schedule the c-section based on your health and the health of your baby. Or a c-section may be an emergency c-section. This is when you need a c-section immediately because your health or your baby’s health is in danger. A c-section should be for medical reasons only.

What are the risks of having a c-section?

A c-section is major surgery, so it may have more complications for you than a vaginal birth, including:

• Your incision (cut), uterus, and other parts of your body, like your belly and bladder, may get infected.
• You may lose a lot of blood and need a transfusion. A blood transfusion is when you have new blood put into your body.
• Organs near the uterus, like the bladder and intestines, may get injured during surgery.
• You may get blood clots in your legs, pelvic organs, or lungs. A blood clot is a solid mass or clump of blood.
• You may have bad reactions to certain medicines, including anesthesia you get during surgery. Anesthesia is medicine that makes you numb so you can’t feel pain.
• You may have an amniotic fluid embolism. This is a rare condition that usually happens during or right after a tough labor and birth. It happens when some of your baby’s cells, hair, or amniotic fluid (fluid that surrounds your baby in the uterus) gets into your bloodstream and moves to your lungs. This can cause the arteries in your lungs to become narrow, which can cause problems like a fast heart rate, irregular heartbeat, heart attack, or death.
• Although it’s rare, you’re more likely to die during a c-section than during vaginal birth.

A c-section can cause complications for you after giving birth, too. For example:

• You may have trouble breastfeeding. Women who have a c-section may be less likely to breastfeed than women who have a vaginal birth. Talk to your provider about what you can do to start breastfeeding as soon as possible after your c-section.
• It may cause problems in future pregnancies. Once you have a c-section, you may be more likely in future pregnancies to have a c-section. The more c-sections you have, the more problems you and your baby may have, including problems with the placenta. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord. Some women who’ve had a c-section may be able to have a vaginal birth after c-section (also called VBAC). VBAC isn’t safe for all women, though. If your pregnancy is healthy and you’re planning to have more children later, it’s best to have your baby through vaginal birth unless there are medical reasons to have a c-section.

A c-section also can cause problems for your baby, including:

• Your baby may be born before 39 weeks. Babies need at least 39 weeks in the womb to grow and develop before they’re born. If you have your c-section too early, your baby may be born premature (before 37 weeks of pregnancy). This can cause health problems for your baby at birth and later in life.
• Your baby may have breathing problems and other health problems
• Your baby may be affected by anesthesia you get during your c-section. This may cause him to be inactive or sluggish.
• Your baby may be injured during the surgery.

What happens during a c-section?

Here’s what you can expect when you have a c-section.

Anesthesia: Most likely you can have regional anesthesia (like an epidural or spinal block) that lets you stay awake for your baby’s birth. This means you’re numb from below your breasts all the way down to your toes. If you have an emergency c-section, you may need general anesthesia. General anesthesia makes you go to sleep during surgery.

Before surgery:

1. The nurse washes and may shave your belly so the area is clean for surgery.
2. You get a catheter (tube) in your bladder to drain urine.
3. You get an IV (needle) in your hand or arm to give you fluids and medicine.

During surgery:

1. When you’re numb, the doctor makes the first cut in your belly. In most cases, it’s a low transverse cut (also called a bikini cut) that goes across your belly, just above your pubic bone.
2. The doctor makes the next cut in the uterus. A horizontal (across) cut is best because it doesn’t bleed too much and heals well. Sometimes, the doctor has to make a vertical (up and down) cut because of your baby’s size or position.
3. The doctor opens the amniotic sac and takes out the baby. You may feel some tugging, pulling, and pressure.
4. The doctor cuts the umbilical cord and removes the placenta.
5. The doctor closes the incisions with stitches or staples.

What’s recovery like after a c-section?

It usually takes longer to recover from a c-section than vaginal birth. You can expect to stay 2 to 4 days in the hospital after a c-section. Full recovery usually takes 4 to 6 weeks.

Here’s what you can do to feel better faster:

1. Talk to your health care provider about pain medicine. She can recommend one that won’t hurt the baby while you’re breastfeeding.
2. If your provider says it’s OK, get out of bed and walk around within 24 hours after surgery. This can help you have a bowel movement and prevent blood clots. Make sure a nurse or another adult is there to help you the first few times you get out of bed.
3. Call your provider if you have a fever or if your incision swells, is painful, or gets more and more red. These could be signs of infection.
4. To prevent infection, don’t have sex or put anything (including tampons) in your vagina for a few weeks after your c-section. Ask your health care provider when it’s safe to do these things again.
5. Take it easy. Avoid hard activities, like lifting heavy things, for a few weeks. Try to sleep when your baby does.

How can you get ready for a c-section?

Here’s what you can do to prepare for your c-section:

1. Learn as much as you can about c-sections. Ask your provider about what to expect and about different kinds of anesthesia. Talk to friends and family members who have had a c-section.
2. Get help at home. Ask friends or family to be there after your baby’s born to help take care of the baby, other children, and household tasks.
3. Ask if your partner can be with you in the operating room.
4. If you think you want to watch your baby’s birth, tell your provider and the nurses at the hospital.
5. Tell your provider and the nurses that you want to hold the baby right after birth. This should be OK unless your baby needs medical attention. You can breastfeed right after birth, too.

What if you feel badly about needing to have a c-section?

Some women who have a c-section may feel disappointed that they didn’t have a vaginal birth. Their partners may feel this way, too. If you feel disappointed, angry, or depressed after having a c-section, here’s what you can do:

1. Remember that having a healthy baby is more important than how the baby is born.
2. Ask your provider to explain why you needed a c-section. This can help you understand why it was best for you and your baby.
3. Remember that you can’t control everything. Sometimes unexpected events make a c-section the safest choice.
4. Don’t worry if you get emotional after your baby’s birth. Some of your feelings may be caused by hormonal changes that many women experience after having a baby.
5. Share your feelings with your partner, family, friends, or provider.
6. If you have feelings of sadness or anger that don’t go away after 2 weeks, tell your provider.

What are preterm labor and premature birth?

Preterm and premature mean the same thing — early. Preterm labor is labor that begins early, before 37 weeks of pregnancy. Labor is the process your body goes through to give birth to your baby. Preterm labor can lead to premature birth. Premature birth is when your baby is born early, before 37 weeks of pregnancy. Your baby needs about 40 weeks in the womb to grow and develop before birth.

Babies born before 37 weeks of pregnancy are called premature. Premature babies can have serious health problems at birth and later in life. About 1 in 10 babies is born prematurely each year in the United States.

What are the signs and symptoms of preterm labor?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. Learn the signs and symptoms of preterm labor so you can get help quickly if they happen to you.

If you have even one of these signs and symptoms of preterm labor, call your provider right away:

• Change in your vaginal discharge (watery, mucus, or bloody) or more vaginal discharge than usual
• Pressure in your pelvis or lower belly, like your baby is pushing down
• Constant low, dull backache
• Belly cramps with or without diarrhea
• Regular or frequent contractions that make your belly tighten like a fist. The contractions may or may not be painful.
• Your water breaks

When you see your provider, he may do a pelvic exam or a transvaginal ultrasound to see if your cervix has started to thin out and open for labor. Your cervix is the opening to the uterus (womb) that sits at the top of the vagina (birth canal). A transvaginal ultrasound is done in the vagina instead of on the outside of your belly. Like a regular ultrasound, it uses sound waves and a computer to make a picture of your baby. If you’re having contractions, your provider monitors them to see how strong and far apart they are. You may get other tests to help your provider find out if you really are in labor.

If you’re having preterm labor, your provider may give you treatment to help stop it. Or you may get treatment to help improve your baby’s health before birth. Talk to your provider about which treatments may be right for you.

Are you at risk for preterm labor and premature birth?

We don’t always know for sure what causes preterm labor and premature birth. Sometimes labor starts on its own without warning. Even if you do everything right during pregnancy, you can still give birth early.

We do know some things may make you more likely than others to have preterm labor and premature birth. These are called risk factors. Having a risk factor doesn’t mean for sure that you’ll have preterm labor or give birth early. But it may increase your chances. Talk to your health care provider about what you can do to help reduce your risk.

Because many premature babies are born with low birthweight, many risk factors for preterm labor and premature birth are the same as for having a low-birthweight baby. Low birthweight is when a baby is born weighing less than 5 pounds, 8 ounces.

These three risk factors make you most likely to have preterm labor and give birth early:

1. You’ve had a premature baby in the past.
2. You’re pregnant with multiples (twins, triplets, or more).
3. You have problems with your uterus or cervix now or you’ve had them in the past. Your uterus (also called the womb) is where your baby grows inside you.

Medical risk factors before pregnancy for preterm labor and premature birth

• Being underweight or overweight before pregnancy. This can include having an eating disorder, like anorexia or bulimia.
• Having a family history of premature birth. This means someone in your family (like your mother, grandmother, or sister) has had a premature baby. If you were born prematurely, you’re more likely than others to give birth early.
• Getting pregnant again too soon after having a baby. For most women, it’s best to wait at least 18 months before getting pregnant again. Talk to your provider about the right amount of time for you.

Medical risk factors during pregnancy for preterm labor and premature birth

Having certain health conditions during pregnancy can increase your risk for preterm labor and premature birth, including:

• Connective tissue disorders, like Ehlers-Danlos syndromes (also called EDS) and vascular Ehlers-Danlos syndrome (also called vEDS). Connective tissue is tissue that surrounds and supports other tissues and organs. EDS can cause joints to be loose and easy to dislocate; skin to be thin and easily stretched and bruised; and blood vessels to be fragile and small. It also can affect your uterus and intestines. vEDS is the most serious kind of EDS because it can cause arteries and organs (like the uterus) to rupture (burst). EDS and vEDS are genetic conditions that can be passed from parent to child through genes.
• Diabetes. Diabetes is when your body has too much sugar (called glucose) in your blood.
• High blood pressure and preeclampsia. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. This can stress your heart and cause problems during pregnancy. Preeclampsia is a kind of high blood pressure some women experience during or right after pregnancy. If not treated, it can cause serious problems and even death.
• Infections, including sexually transmitted infections (STIs) and infections of the uterus, urinary tract, or vagina.
• Intrahepatic cholestasis of pregnancy (ICP). This is the most common liver condition that happens during pregnancy.
• Thrombophilias. These are conditions that increase your risk of making abnormal blood clots.

Other medical risk factors during pregnancy include:

• Getting late or no prenatal care. Prenatal care is medical care you get during pregnancy.
• Not gaining enough weight during pregnancy. This can include having an eating disorder, like anorexia or bulimia.
• Bleeding from the vagina in the second or third trimester.
• Preterm premature rupture of the membranes (also called PPROM). Premature rupture of membranes (also called PROM) is when the amniotic sac around your baby breaks (your water breaks) before labor starts. PPROM is when this happens before 37 weeks of pregnancy. If you have any fluid leaking from your vagina, call your provider and go to the hospital.
• Being pregnant after in vitro fertilization (also called IVF). IVF is a fertility treatment used to help women get pregnant.
• Being pregnant with a baby who has certain birth defects, like heart defects or spina bifida. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops, or how the body works. Spina bifida is a birth defect of the spine.

Risk factors in your everyday life for preterm labor and premature birth

• Smoking, drinking alcohol, using street drugs, or abusing prescription drugs.
• Having a lot of stress in your life.
• Low socioeconomic status (also called SES). SES is a combination of things like your education, your job, and your income (how much money you make).
• Domestic violence. This is when your partner hurts or abuses you. It includes physical, sexual, and emotional abuse.
• Working long hours or having to stand a lot.
• Exposure to air pollution, lead, radiation, and chemicals in things like paint, plastics, and secondhand smoke. Secondhand smoke is smoke from someone else’s cigarette, cigar, or pipe.

Age and race as risk factors for preterm labor and premature birth

Being younger than 17 or older than 35 makes you more likely than other women to give birth early. In the United States, black women are more likely to give birth early. Almost 17 percent of black babies are born prematurely each year. Just over 10 percent of American Indian/Alaska Native and Hispanic babies are born early, and less than 10 percent of white and Asian babies. Researchers are still working to understand why race plays a role in premature birth.

Can you reduce your risk for preterm labor and premature birth?

Yes, you may be able to reduce your risk for early labor and birth. Some risk factors are things you can’t change, like having a premature birth in a previous pregnancy. Others are things you can do something about, like quitting smoking.

Here are some things you can do to reduce your risk for preterm labor and premature birth:

• Get to a healthy weight before pregnancy and gain the right amount of weight during pregnancy. Talk to your provider about the right amount of weight for you before and during pregnancy.
• Don’t smoke, drink alcohol, use street drugs, or abuse prescription drugs. Ask your provider about programs that can help you quit.
• Go to your first prenatal care checkup as soon as you think you’re pregnant. During pregnancy, go to all your prenatal care checkups, even if you’re feeling fine. Prenatal care helps your provider make sure you and your baby are healthy.
• Get treated for chronic health conditions, like high blood pressure, diabetes, depression, and thyroid problems. Depression is a medical condition in which strong feelings of sadness last for a long time and interfere with your daily life. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food.
• Protect yourself from infections. Talk to your provider about vaccinations that can help protect you from certain infections. Wash your hands with soap and water after using the bathroom or blowing your nose. Don’t eat raw meat, fish, or eggs. Have safe sex. Don’t touch cat poop.
• Reduce your stress. Eat healthy foods and do something active every day. Ask family and friends for help around the house or taking care of other children. Get help if your partner abuses you. Talk to your boss about how to lower your stress at work.
• Wait at least 18 months between giving birth and getting pregnant again. Use birth control until you’re ready to get pregnant again. If you’re older than 35 or you’ve had a miscarriage or stillbirth, talk to your provider about how long to wait between pregnancies. Miscarriage is the death of a baby in the womb before 20 weeks of pregnancy. Stillbirth is the death of a baby in the womb after 20 weeks of pregnancy.

Source: www.marchofdimes.com

What is inducing labor?

Inducing labor (also called labor induction) is when your health care provider gives you medicine or uses other methods, like breaking your water (amniotic sac), to make your labor start. The amniotic sac (also called bag of waters) is the sac inside the uterus (womb) that holds your growing baby. The sac is filled with amniotic fluid. Contractions are when the muscles of your uterus get tight and then relax. Contractions help push your baby out of your uterus.

Your provider may recommend inducing labor if your health or your baby’s health is at risk or if you’re 2 weeks or more past your due date. For some women, inducing labor is the best way to keep mom and baby healthy.

If there are medical reasons to schedule induction, talk to your provider about waiting until at least 39 weeks of pregnancy. This gives your baby the time she needs to grow and develop before birth. Inducing labor should be for medical reasons only.

How is labor induced?

Your health care provider uses one or more of these treatments to induce labor:

• Separating the amniotic sac from the wall of the uterus (also called stripping or sweeping the membranes). Your provider gently puts a gloved finger through your cervix and separates the amniotic sac from your uterus. The cervix is the opening to the uterus that sits at the top of the vagina. You can have this procedure done in your provider’s office. You may have some cramping or spotting.
• Ripening the cervix. Your provider gives you medicine called prostaglandins to help soften and thin your cervix so it will open during labor. You may get the medicine by mouth or it may be put in your vagina. You get the medicine at a hospital. Your provider also may use a medicine called laminaria in your vagina. It absorbs moisture and expands to help open the cervix. Or your provider may use an instrument called a Foley bulb. This is a thin tube with a balloon at the end. Your provider inserts it in the vagina to widen the cervix.
• Giving you medicines to start contractions. Providers often use a medicine called oxytocin to induce labor. This medicine is the man-made form of a hormone that helps start contractions. At the hospital, your provider gives you oxytocin through an IV (a needle into a vein). It may make you have really strong contractions. Ask your provider about pain medicine you may want to have during labor.
• Breaking your water (also called rupturing the membranes or amniotomy). Your provider uses a small hook that looks like a knitting needle to break the amniotic sac that holds your baby. This shouldn’t be painful, but you may feel a warm gush of fluid.

Inducing labor can take a few hours or a few days. It depends on how your body responds to your treatment.

What are the risks of inducing labor?

Risks include:

• Your due date may not be exactly right. Sometimes it’s hard to know exactly when you got pregnant. If you schedule an induction and your due date is off, your baby may be born too early. If your pregnancy is healthy, wait for labor to begin on its own. If you need to schedule an induction for medical reasons, ask your provider if you can wait until at least 39 weeks.
• Oxytocin and medicines that ripen the cervix can make labor contractions too close together. This can lower your baby’s heart rate. Your provider carefully monitors your baby’s heart rate when inducing labor. If your baby’s heart rate changes, your provider may stop or reduce the amount of medicine you’re getting.
• You and your baby are at higher risk of infection. The amniotic sac normally protects your baby and your uterus from infection. If labor takes a while to start after your membranes rupture, infections are more likely.
• There may be problems with the umbilical cord. If the amniotic sac is broken, the cord may slip into the vagina before your baby does. This is called umbilical cord prolapse. It’s more likely to happen if your baby is breech. This is when your baby’s bottom or feet are facing down before birth instead of being head-down. Umbilical cord prolapse can cause the umbilical cord to get squeezed during birth. If this happens, your baby doesn’t get enough oxygen, which can be life-threatening.
• Induction may not work so you may need a c-section (also called cesarean birth). C-section is surgery in which your baby is born through a cut that your provider makes in your belly and uterus.
• You may have a uterine rupture. This is when the uterus tears during labor. It happens rarely, but it can cause serious bleeding. If you’ve had a c-section in a prior pregnancy, you’re at higher risk of uterine rupture because a c-section leaves a scar in the uterus.
• You may be at higher risk of serious bleeding after birth (called postpartum hemorrhage). Inducing labor increases the chances that your uterine muscles don’t contract the right way after you give birth, which can lead to bleeding.

Source: www.marchofdimes.com

We show you positions and breathing and relaxation techniques to help manage labor pain.

Your body produces hormones naturally to help labor to be easier and you can increase these hormones by doing the following:

• Practice relaxation exercises: see below for a step-by-step guide.
• Get a massage: ask your husband or the midwife to rub your lower back, which many women feel comforting especially during a contraction.
• Take a shower or bath: you can do this if you stay at home during Early labor.
• Get support: if you stay at home during Early labor you can have a support partner (husband, mother, mother-in-law, friend) help.
• Change positions: lying flat on your back is not helpful, walk and change positions often if able.

Most importantly, believe in yourself! You can do it. Your body was made to do this. For centuries women have been giving birth. Don’t be afraid, it is a natural process.

Relaxation exercises

There is a range of different relaxation exercises you can practice to make labor easier.

1. Visualization

Try creating a comforting image in your mind, like the following:

• Use your imagination in a positive way to imagine a pleasant scene or place you would like to be.
• Visualize your cervix as a flower opening, imagine your cervix and baby opening and your baby moving downwards during each contraction.
• Create a focal point, a picture, a person, or an imagined/remembered route e.g. stairs or walking path.

2. Vocalization

Try repeating a comforting phrase aloud (or to yourself), like the following:

• I can, I can, I can.
• A breath for you, A breath for me.
• I love you, You love me.

You can also try counting aloud or to yourself.

3. Breathing techniques

Slow breathing

Begin slow breathing when contractions are intense enough that you can no longer walk or talk through them without pausing.

• Take an organizing breath—a big sigh as soon as the contraction begins. Release all tension (go limp all over—head to toe) as you breathe out.
• Focus your attention
• Slowly inhale through your nose and exhale through your mouth, allowing all your air to flow out with a sigh. Pause until the air seems to “want” to come in again.
• With each exhale, focus on relaxing a different part of your body.

Light Accelerated Breathing

Most women feel the need to switch to light breathing at some time during the active phase of labor. Let the intensity of your contractions guide you in deciding if and when to use light breathing. Breathe in and out rapidly through your mouth about one breath per second. Keep your breathing shallow and light. Your inhalations should be quiet, but your exhalation clearly audible.

• Take an organizing breath—a big sigh as soon as the contraction begins. Release all tension (go limp all over—head to toe) as you breathe out.
• Focus your attention.
• Inhale slowly through your nose and exhale through your mouth. Accelerate and lighten your breathing as the contraction increases in intensity. If the contraction peaks early, then you will have to accelerate early in the contraction. It if peaks more gradually, you will work up to peak speed more slowly. Keep your mouth and shoulders relaxed.
• As your breathing rate increases toward the peak of your contraction, breathe in and out lightly through your mouth. Keep your breathing shallow and light at a rate of about one breath per second.
• As the contraction decreases in intensity, gradually slow your breathing rate, switching back to breathing in through your nose and out through your mouth.
• When the contraction ends, take your finishing breath—exhale with a sigh.

Variable (Transition) Breathing

This is a variation of light breathing. It is sometimes referred to as “pant-pant-blow” or “hee-hee-who” breathing. Variable breathing combines light shallow breathing with a periodic longer or more pronounced exhalation. Variable breathing is used in the first stage if you feel overwhelmed, unable to relax, in despair, or exhausted.

• Take an organizing breath—a big sigh as soon as the contraction begins. Release all tension (go limp all over—head to toe) as you breathe out.
• Focus your attention on your partner or a focal point, such as a picture.
• Breathe through your mouth in light shallow breaths at a rate of 5-20 breaths in 10 seconds, throughout the contraction.
• After every second, third, fourth, or fifth breath, blow out a longer breath. You might try verbalizing this longer exhale with a “who” or “puh.”
• When the contraction ends take one or two deep relaxing breaths with a sigh.

Breathing To Avoid Pushing At The Wrong Time

There will be times throughout both stages of labor when you will want to push or bear down and it is not the right time. Most women want to hold their breath during these particularly difficult moments.

Avoid holding your breath by breathing in and out constantly or by raising your chin and blowing or panting. This keeps you from adding to the pushing that your body is already doing.

Expulsion Breathing

Used once the cervix is fully dilated and the second stage of labor has begun.

• Take an organizing breath—a big sigh as soon as the contraction begins. Release all tension (go limp all over—head to toe) as you breathe out.
• Focus on the baby moving down and out, or on another positive image.
• Breathe slowly, letting the contraction guide you in accelerating or lightening your breathing as necessary for comfort. When you cannot resist the urge to push (when it “demands” that you join in), take a big breath, tuck chin to chest, curl your body and lean forward. Then bear down, while holding your breath or slowly releasing air by grunting, moaning, or other verbalizing. Most importantly, relax the pelvic floor. Help the baby come down by releasing any tension in the perineum.
• After 5-6 seconds, release your breath and breathe in and out. When the urge to push takes over join in by bearing down. How hard you push is dictated by your sensation. You will continue in this way until the contraction subsides. The urge to push comes and goes in waves during the contraction. Use these breaks to breathe deeply providing oxygen to your blood & sufficient oxygen for the baby.
• When the contraction ends, relax your body and take one or two calming breaths.

Moving around, standing, and squatting are some of the best positions.

There is no one best position. In fact, most women end up changing positions frequently during labor. Let your body be your guide. It is best not to lie down for too long. Studies have shown that women who tended to walk or stay upright during early and active labor reduced their labor time by one hour.

Sometimes, a medical condition will dictate what’s best for you and your baby. If you have any complications that require continuous monitoring and you need to stay tethered to a monitor by a cord, your ability to move around will be limited. Occasionally a baby’s heart rate will indicate that he prefers you to be in one position or another.

Cesarean birth (also called c-section) is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. For some women and babies, a c-section is safer than vaginal birth. You may need a c-section because of medical reasons that affect your pregnancy.

If your pregnancy is healthy and you don’t have any medical reasons to have a c-section, it’s best to have your baby through vaginal birth.

What are medical reasons for having a c-section?

Your health care provider may suggest that you have a c-section because of complications that make vaginal birth unsafe. For example:

Pregnancy complications:

• You’ve had a c-section in a previous pregnancy or other surgeries on your uterus (womb).
• There are problems with the placenta. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord. Placental problems can cause dangerous bleeding during vaginal birth.
• You have an infection, like HIV or genital herpes.
• You’re having multiples (twins, triplets, or more).
• You have a chronic health condition, like diabetes or high blood pressure, that requires treatment.

Complications during labor and birth:

• Your baby is too big to pass safely through the vagina.
• Your baby is in a breech position (his bottom or feet are facing down) or a transverse position (his shoulder is facing down). The best position for your baby at birth is head down.
• Labor is too slow or stops.
• Your baby’s umbilical cord slips into the vagina where it could be squeezed or flattened during vaginal birth. This is called umbilical cord prolapse. The umbilical cord is the cord that connects your baby to the placenta. It carries food and oxygen from the placenta to the baby.
• Your baby has problems during labor, like a slow heart rate. This is also called fetal distress.
• Your baby has a certain type of birth defect. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops, or in how the body works.

Can you schedule your c-section?

Yes. If there are medical reasons for having a c-section, you and your provider can plan for and schedule it. If you’re scheduling your c-section, talk to your provider about waiting until at least 39 weeks of pregnancy. This gives your baby the time she needs to grow and develop before birth.