Rebornne Baby American Baby

5 Signs That You're in Labor
How will you know when you're really and truly in labor?

It's been a long nine months and you're anxiously awaiting the big moment. How will you know when you're finally in labor? According to the American College of Obstetricians and Gynecologists, the following symptoms indicate the onset of labor:

Bloody show: You notice a pink stain on your underwear or toilet tissue. This indicates that you lost the mucus plug.

Rupture of membranes: You feel fluid gush or trickle from your vagina, indicating that the bag of waters containing your baby has ruptured.

Regular contractions that intensify: You feel contractions that are frequent and increasingly painful. They don't go away but instead intensify with physical activity.

Pain in lower back: You feel a regular and intense pain in your lower back that radiates to your lower abdomen and sometimes even to your legs.

Cramps that feel like intestinal upset: You feel cramping that seems like the onset of diarrhea, and you may actually experience diarrhea.

If you're not sure you're in labor, call your doctor and discuss your symptoms. If you feel that you're definitely in labor, call your doctor and ask her for instructions or to meet you at the hospital.

Important note: Don't insert tampons, take a tub bath, or have intercourse after the rupture of membranes. If the fluid from the rupture is tinted green, brown, or gold, contact your doctor immediately. This is a possible sign of fetal distress.

Now the moment you've been waiting for all these months is imminent. Get ready to experience the most life-altering event you could ever imagine, and have faith in your body's ability to deliver its most precious cargo.

After Labor Begins
What should you expect once you finally go into labor?

How long will labor actually last? Is my baby doing all right? How bad is the pain going to be? Will I really be able to make it through this experience?

You can't know the answers to these questions in advance. But there are certain procedures you can learn about now that can help prepare you for what lies ahead.

It helps to understand the medical routine that will follow your admission to a hospital or birthing center before the process of childbirth is underway. It's a good idea to tour the medical center to become familiar with its facilities.

Print these general guidelines and review them with your health-care provider to ensure that you understand what to expect once you arrive at the hospital or birthing center.

When you get there, you will probably follow these steps:
You'll be admitted.

You'll be taken to an examination room or your birthing room.

You'll be interviewed by a nurse to assess which symptoms you're feeling.

You'll sign consent forms and other routine documents.

You'll be given an initial pelvic exam by a physician or nurse to determine how much your cervix has dilated and effaced.

You'll be hooked up to various monitors to ensure close monitoring of you and your unborn baby -- keeping you both safe during this crucial period.

An IV may be started. The purpose of the IV is to provide hydration if needed in the later stages of labor, and to allow intravenous medication if it's needed suddenly. An IV is necessary if epidural anesthesia is used.

Your physician or nurse will discuss with you the possibility of rupturing your membranes if they have not already ruptured.

You'll be invited to rock in a chair, walk around with your labor coach, or possibly take a warm shower. The key is to relax and communicate with your labor coach and medical staff so they can help make you as comfortable as possible.

The labor nurse and physician will monitor you to note your progress (or lack thereof) and also will monitor your baby's vital signs, but they may leave you alone with your coach. If you want to talk with your nurse or doctor, don't be shy about calling for them.

You'll be kept well hydrated during your labor and you'll be encouraged to urinate frequently. You may also have a catheter inserted to remove urine if labor isn't progressing as expected.

As labor progresses, you and your physician will discuss your progress, as well as any necessary interventions (should the need for them develop).

You should discuss use of pain medications or monitors with your care provider well in advance. Also write down your wishes or birth plan and let your labor partner remind your provider of these. Then you'll have the added peace of mind that comes from sharing clear communication with your provider and understanding what you can expect from the staff during the birthing process.

All About Episiotomies
What's an episiotomy, and why is it sometimes necessary?

Introduction

An episiotomy is an incision in the perineum (the area between the vagina and the anus) made just before the time of birth in order to enlarge the vaginal opening and prevent spontaneous tearing. The incision is stitched closed under local anesthesia after the baby has been delivered.

The number of American mothers getting episiotomies has decreased from 64 percent to 39 percent in the last 20 years. But many experts say the current figures are still too high.

Learn more about the pros and cons of this procedure by clicking the following links.

Do You Need an Episiotomy?

There are cases where an episiotomy can be beneficial: to hasten the delivery of a baby in trouble, ease a breech birth, enlarge a too-tight vaginal opening, or prevent painful tearing toward the front of the vagina.

But most of the time, with local massage and control of the delivery, the vaginal tissue will stretch and then return to normal on its own. And if natural tears occur, they typically require less extensive stitching than an episiotomy.

A review of existing studies recently published in Obstetrics and Gynecology found that not only is the procedure performed too frequently, but that benefits doctors have long attributed to routine episiotomy -- including that it helps women heal faster by reducing tearing, and prevents brain damage to the baby by reducing labor time -- appear not to be true.

What Are the Risks?

Research has long suggested that the risks of a routine episiotomy outweigh its claimed benefits. In fact, the American College of Obstetricians and Gynecologists doesn't recommend routine episiotomies. Unless the baby is in distress, studies show that an episiotomy may cause more pain and suffering for the mother than benefit for the baby. Possible problems for the mother include:

Tears to the anus or into the rectum, which may require surgery

Additional blood loss

Infection and swelling

Postdelivery pain

Weakness of pelvic-floor muscles

Fecal and urinary incontinence

Delayed ability to have intercourse

Avoiding an Unnecessary Episiotomy

Ask when and how often the individual doctors or midwives in your provider's group find it necessary to perform this procedure. Make sure that you're on the same page with them about when and if an episiotomy is necessary.

A caregiver who does few episiotomies will probably recommend several strategies to help you avoid an unnecessary cut:

Practice Kegels. Kegels are exercises that tone the vaginal muscles so they can stretch more easily for birth. To do a Kegel, tighten and relax the muscles around your urethra, vagina, and anus, as if you're trying to hold back urine. Keep the muscles contracted for about 10 seconds. Repeat 10 to 20 times in a row, two to three times a day.

Perform prenatal perineal massage. With your doctor's okay, start about six weeks before your due date. Here's how: Sit up, leaning back, in bed, or stand with a foot resting on a chair. Lubricate your fingers with vegetable oil or a water-soluble gel like K-Y Jelly. With your thumbs on the inside and other fingers on the outside, make a U-shaped movement around the bottom portion of your vagina (the part toward your back). For about five minutes, apply just enough pressure to create a stinging sensation while you focus on relaxing. Your partner could also do this massage for you, with index fingers inside and thumbs outside.

Control your pushing. During the birth, you can help by controlling your pushing according to your birth attendant's directions, by letting your knees fall far apart, and by completely relaxing your pelvic floor muscles (the opposite of a Kegel). Your doctor or midwife may apply warm compresses to help you relax, topical lubricants to ease out the baby's head, and firm hand pressure to keep the baby's chin flexed to present a smaller diameter at birth.

The Second Child

Once you've had a baby, you're more likely to avoid an episiotomy the next time. If the vaginal area has been stretched once, it should stretch more easily with less tearing for subsequent deliveries, according to Cynthia Hanna, MD, an assistant clinical professor in obstetrics and gynecology at Brown University. And even though the scar tissue from an old episiotomy isn't as elastic as normal tissue, a second-time mother can usually stretch enough to accommodate another baby without tearing badly.

Healing Hints

Whether or not you had an episiotomy or stitches from a tear, you'll feel sore or swollen for a few days to weeks after giving birth. Experts say you'll heal faster if you:

Use an ice pack for 24 hours, then take frequent warm sitz baths (you should receive one from the hospital; they're also available at your local pharmacy).

Keep the area clean and apply witch hazel or a topical anesthetic.

Do frequent Kegels to improve circulation and speed healing.

Drink lots of water to keep your urine diluted so it doesn't sting.

Don't sit on an inner tube to avoid pain -- this pulls stitches apart. Instead, choose a firm seat and do a Kegel before you sit down.

Don't baby the area; the sooner you move around, the faster your pain will decrease.

Birth Trends in America in 2001
Interesting statistics about recent birth trends in this country.

Did you know the U.S. government keeps track of every baby's birth? Here are some interesting statistics about birth trends in America in 2001.

4,025,933 babies were born in the United States in 2001, 1 percent less than the births in the year 2000.

Fifty-one percent of babies born in the U.S. were boys; 49 percent were girls.

The twin birth rate rose in 2001. For the first time, twin births exceeded 3 percent of all births in the United States.

More babies were born on Tuesdays than any other day of the week, and in August more than any other month of the year.

The average age for a woman giving birth rose to 24.8 years (up from 22.1 years in 1970).

Teen births hit a record low for the 10th consecutive year. Over the past decade, the decline was particularly significant for teens between the ages of 15 and 17 -- with the birth rate down by more than a third. For young African-American teens, the birth rate declined by nearly half.

The number of births to unmarried mothers increased to a record high of more than 1.3 million in 2001 (33.5 percent of all births). This percentage has been inching up over time as married women are having fewer children and the number of unmarried women grows.

Moms-to-be were more likely to get proper prenatal care (83 percent in 2001, up from 76 percent in 1990) and less likely to smoke during pregnancy (only 12 percent in 2001, down from 20 percent in 1989) than in years past.

The percentage of babies born prematurely (at less than 37 weeks' gestation) hit a record high -- nearly 12 percent -- and the rate of low birth weight climbed to 7.7 percent, up 13 percent from the mid 1980s. The increase in low birth weight and preterm birth can be attributed to the rise in multiple births and greater reliance on induced labor and other efforts to safely manage delivery.

The proportion of births with induced labor has more than doubled since 1989. More than one in five births were induced in 2001.

Cesarean deliveries increased for the fifth consecutive year in 2001 to nearly one-quarter of all births -- the highest level reported since at least 1989. The primary cesearean rate jumped 5 percent and the rate of vaginal birth after previous cesarean delivery fell 20 percent.

The Whys and Hows of Cesareans
Answers to your most pressing questions about cesareans.

Why Are They Performed?

A cesarean section is delivery of the fetus through incisions in the abdominal and uterine walls. In the United States the rate of cesarean sections is about 25 percent of all births.

Few women go into a pregnancy expecting a cesarean section -- also called a c-section -- but it could become necessary if there are complications during delivery. Read the answers to these commonly asked questions and you'll be prepared in the event that you need one.

The following are the most common reasons a doctor has to perform a c-section:

Failure to progress in labor and cephalopelvic disproportion (meaning the baby's head is too big to fit through the pelvic cavity): These factors account for about 30 percent of c-sections.

Repeat c-sections: A patient who has already had a c-section may elect to have another one. This accounts for 30 percent of all c-sections. In fact, 60 to 80 percent of patients who have had nonemergency c-sections may safely undergo vaginal birth after cesarean (VBAC). You and your physician will make this decision based on the reason for your previous c-section.

Breech presentation: When the baby is breech, or positioned feet first, a c-section may be necessary. Cesareans due to breech presentation are especially prevalent in preterm fetuses.

Fetal distress: A c-section is required to hasten a safe delivery if the baby's health is jeopardized from decreased oxygen flow caused by factors such as maternal illness, cord compression, prolonged labor, or infection.

Placenta previa or premature separation of the placenta: A c-section is clearly the safest way to protect mother and baby when these conditions are present.

How Are They Performed?

Once it's determined that a c-section is absolutely necessary, you'll be given anesthesia, which is typically an epidural or a spinal block through a needle in your lower spine. In an emergency delivery, general anesthesia is given because it's faster to administer.

When you and the medical staff are certain that you're numb, a horizontal cut is made through your lower abdomen, followed by an incision in the lower uterine segment to ease out the baby (you may feel pulling). The time from the uterine incision to delivery should be less than three minutes. Since your baby does not have the advantage of being in the birth canal, which aids in squeezing the excess fluid lodged in the respiratory tract, suctioning the baby's nose and mouth to clear secretions is necessary. After that you should be able to hear that first wonderful cry!

At this time, the doctor will stitch you back up, while your baby is being given his first physical. After this, with assistance, you'll be able to hold and nurse your newborn.

What's Recovery Like?

What is the recovery period like? Will I be in pain? What will my scar be like? These are some of the many questions you probably have about c-section recovery.

Recovery is only uncomfortable when you use your abdominal muscles too strenuously. You need to position yourself carefully when nursing and not do any lifting -- including baby -- for the first week. You'll be given pain medications to take if you're feeling very uncomfortable. If your physician knows that you're planning on nursing, she'll only give you pain medication that's completely safe for your nursing baby.

The area around your scar will be tender for a few weeks. If it becomes very red or inflamed, call your physician as the incision may be infected. Sometimes wearing a big bandage over the area will protect it from getting irritated and facilitate healing. Typically, the area around the scar is numb from the cutting of the nerves. Over the next several months the numbness should diminish.

The appearance of your scar will continue to improve throughout your first year after delivery. Try to stay calm through the purple and pink stages of healing, and know that the scar will indeed continue to fade. C-section incisions are usually made very low, below the navel, so it's easy to hide.

Will It Affect Sex?

If you had a c-section, your vagina didn't experience the stretching and trauma of a vaginal birth. When you resume sexual activity you'll probably find sexual intercourse more comfortable than you would if you had delivered vaginally. However, you do need to wait until your incision is healing well and until your cervix returns to normal. This is usually about four weeks after delivery, but ask your doctor when it's safe to resume sexual activity -- each case is different. Other than having to wait until you're healed, having a c-section should not impact your sex drive, enjoyment of sex, or ability to have sex.

Can I Lower My Risk?

There is really nothing a woman can do to decrease her chances of having a c-section once she's developed a complication affecting the delivery of the baby. But in certain cases, there is a trial period of labor to see if it might be avoidable. This would only be allowed if it's safe for both the mother and the baby.

The best thing is to try to emotionally prepare yourself for this possibility. Speak with your physician, take a childbirth class, and make sure your partner is prepared to support you in any eventuality during childbirth. Remember that a good physician will not consider doing a cesarean unless absolutely necessary for you and/or your baby.

If you have to have a c-section, remember that you haven't done anything to cause it, so don't feel guilty. You might experience feelings of being cheated out of the experience of childbirth, and that's natural. But do your best to focus on the positive and keep your eye on the end result -- a beautiful, healthy baby along with a healthy mother to care for him!

The Lowdown on Labor
Find out what really happens when you're in labor!

Introduction

According to movies and television, "labor" is the time when expectant fathers race out of important business meetings, crazy cab drivers run red lights, and George Clooney comforts the mother-to-be as she yells in crescendos that rival those of an opera diva. But what really happens when the time comes? Here's a quick lowdown on the facts of labor.

Signs of Labor

There are three distinctive signs that you're in labor -- or will be soon. Most women experience one or more of them:

1. Regular uterine contractions: These generally occur every five minutes, and last from 45 seconds to a minute each. Sometimes you can feel contractions that are "false labor" toward the end of pregnancy, but these cease after you rest, walk, or change position. But during true labor, these contractions continue and do not go away no matter what you do. The contractions usually feel like a lower backache or strong menstrual cramps. Uncomfortable but not necessarily debilitating, these contractions are accompanied by a definite hardening of the uterus, which you can feel by placing your hand on your abdomen.

2. Show, or bloody show: This is the passage of a small amount of bloodstained mucus or brownish blood that you may find on your underwear or toilet tissue. It's the mucus plug, which formed early in pregnancy to close off the cervix and prevent infection. If you discharge any fresh red blood or have a heavy, period-like flow, report it to your doctor immediately.

3. Rupture of the membranes, or bag of waters: In the uterus, your baby is surrounded by amniotic fluid, which is held by the amniotic sac, or bag of waters. Rupture of the membranes is most likely to occur during a later stage of labor, but it sometimes happens early. If the membranes rupture before you go to the hospital, call your doctor. The longer the period between the rupture of the membranes and delivery, the greater the likelihood
of infection.

Stages of Labor

Once one or more of the signs of labor occur, it's time for the onset of labor. The process of labor and delivery is usually divided into three separate stages:

Stage I:
Extending from the start of labor to the time when the cervix -- the opening of the uterus -- is fully dilated, Stage I labor consists of three phases: early labor, active labor, and transition. The entire first stage of labor can last anywhere from 12 to 14 hours for a first-time mother, and from five to six hours for a second-time mother. The force of uterine contractions dilates the cervix. Dilation, or dilatation, is normally measured in centimeters. During the pelvic exam, your doctor uses one or two fingers to feel the size of the opening and estimate how much your cervix has dilated. Full dilation is 10 centimeters, or five finger widths.

Once labor is really underway, contractions become stronger and closer together. You can time them and note when each contraction begins and ends to mark progression through Stage I into Stage II.

Stage II:
Also known as delivery, Stage II begins at full dilation and ends with the birth of the baby. As the baby moves down the birth canal, your body will temporarily mold his skull. But don't worry -- there are soft spots on the baby's skull called fontanels for the very purpose of allowing the skull bones to overlap, thereby allowing the baby to fit more easily through the birth canal.

Stage III:
This stage lasts from the completion of delivery of the baby until the completion of the delivery of the afterbirth, or placenta.

What Labor Is Really Like
Hear what these new moms have to say about childbirth.

Not What I Expected

When we asked new moms to describe what labor felt like, we received almost 500 responses. In the course of describing labor pain, your answers hit on many similar themes -- how the experience compared with your expectations, what pushing was like, and whether you'd recommend an epidural. We culled through the responses to pick some of the most common themes.

As a first-time mom, I had a difficult time deciding if I was in labor or if I was having Braxton Hicks contractions. My symptoms did not fit into either category. I had a lot of cramping under my belly, not radiating from the top down or in my back like the books said. When I finally went in to the hospital to be checked, sure I would be sent home, I was told that I was actually in labor.

With both my babies I didn't experience normal contractions. Instead I felt like I was having one long contraction that felt like the worst menstrual cramps I had ever had.

I was told it would feel like very bad menstrual cramps but that's not what it felt like to me. It was much more intense and it was almost all in my lower back. Every time a contraction would come, my lower back would slowly begin to seize up. It was kind of like the muscles inside were slowly twisting harder and harder until it became almost unbearable, and then it would slowly subside. It was still much more painful than I had imagined it would be.

A Tug of War

Over and over again, many of our respondents used similar images to describe labor pain: intense menstrual cramps combined with internal twisting.

To me, labor felt like the worst menstrual cramp or gas pain that you've ever had, combined with someone stabbing you in the stomach! It would subside and come back until the beautiful epidural lady came to save me.

The pain is like having your insides twisted, pulled, and squeezed. If I fought it, the pain became worse. Once I surrendered to and accepted the pain, it was more bearable. It is like getting caught in the undertow of a wave. Being trapped under water is scary -- you can fight it and get more scared or you can just let go and wait until the wave releases you. Also, there was an intense searing pain in my lower back, which was helped when my husband applied pressure to it.

I would consider labor pains as menstrual cramps multiplied by a million. It feels like your abdomen is trying to squeeze out all its contents, not just the baby. They come in waves and varying intensity throughout the laboring process. I would go from a pretty tolerable one to an extremely intense one the next time. I have a pretty high tolerance for pain and it is definitely the hardest thing I have ever done.

The best description I can offer of how the pain actually felt was like a deep internal "pulling" -- like someone kept reaching up deep inside me, grabbing hold of whatever internal organs they could, and trying to tug them out.

My labor pain felt like my hips were being pulled apart!

It's Not That Bad

While the vast majority of our respondents found labor extremely painful, some women were pleasantly surprised to find it easier than they had imagined.

My labor was wonderful. I went in for my 36th week visit and the midwife was checking to see if I was dilated. She got a funny look on her face and told me I was five centimeters dilated and 90 percent effaced! I went to the hospital, got an epidural, and four hours later had a baby girl virtually pain free.

Labor wasn't as scary as I thought it would be. I was in labor for 16 hours, and it seemed to fly by. And it all got much easier once the epidural kicked in.

There is pain and labor does hurt, but it was not as bad as television shows or family and friends made it out to be. To me, it felt like a menstrual pain that was more painful than normal but not excruciating. Actually, the worst part was how a contraction would kick in whenever the nurse put the baby monitor on my stomach!

Labor pain was not that bad. It feels like cramping when you get your period, just a little more intense. And the pushing is a relief. Once you hold the baby you forget all about the pain you were in.

Once My Water Broke...

A handful of women mentioned that that the pain didn't escalate until their water broke.

After my water broke is when the real pain started. It was more of a tightening that got worse and worse until it peaked, then dropped off. If I could have had this particular pain once an hour or even once every 15 minutes, I'd have been able to tolerate it. But the fact that just as soon as you get through one contraction another is coming, that's what wears you down.

I didn't have much pain until my water broke. The pain was so bad that in the middle of one contraction I imagined that I walked away from my body. I tried to picture myself walking on the beach. Of course, that didn't work and my next thought was of the epidural.

At first it was not so bad but after my water broke, the contractions were horrible. It felt like someone had taken hold of my insides and were wringing them out like a wet dishrag.

Thank God for Epidurals!

It appears that the majority of moms who participated in our survey opted for an epidural -- and were happy they did.

Labor pains were worse than anything my imagination could have drummed up! After eight hours of labor pains I opted for the epidural. I had immediate relief.

Labor pain for me was like really bad menstrual cramps. The breathing I learned in class helped, but it was hard to concentrate because of the pain. Thank God for the epidural -- from someone who was not sure if she was going to get it when she first went to the hospital!

It's definitely one of the worst pains I have ever felt! The best way I can think to describe it is to say that it felt like my stomach was getting an extremely bad cramp -- like a charley horse, but in my stomach! The pain was really bad, but I'm not afraid to go through labor again.

Epidural-Free Delivery

Some moms went with unmedicated childbirth and managed their pain in other ways.

I have three kids and each experience was different, as it is from woman to woman. I've had IV drugs, an epidural, and nothing. I honestly preferred nothing.

My first child was born while I was under the influence of a walking epidural. I did not find that this really relieved my pain but rather made my labor feel like a nasty stomach virus. I swore I would never have anesthesia again because of how awful I felt afterwards. My second baby was born naturally. I found this labor to be much easier to cope with. The pain was very intense, but it was a clean pain almost like a sports injury. Pushing was more difficult. It felt like my whole pelvis was made of breaking glass, but this passed very quickly and I felt terrific almost immediately after delivery.

Labor pain was the most excruciating pain I ever felt. The good news is that in between contractions there is no pain, and the contractions only last about a minute. I had four children with no pain medication.

I didn't use an epidural or any pain medication. I kept my eyes closed and concentrated on my husband's voice and hummed through the contractions. It was the most empowering thing I've ever done. I would do labor over again in a heartbeat; the nine months preceding it is the hard part.

Oh, the Pushing

Most moms said that by the time they got to the pushing stage the worst was over. Some though, really didn't like to push, and initially had a hard time figuring out how to push effectively.

The pain was intense and horrible for two hours while I pushed. It was mostly vaginal pressure that was so painful.
Cristina, Atlanta, GA

Labor was by far the hardest physical activity I have ever participated in. But once you get to the pushing stage and have that feeling that is similar to having a bowel movement, you are almost done. And you know that if you can just make it through the last little part, you will meet this wonderful little person you have dreamed about for so long!
Kari, Onalaska, WI

Of the pushing contractions, all I can say is that I knew I had to push. And it felt good to push! The only real pain I remember was when my son's head crowned. That burned!
Rachel, Avon, IN

Pushing was really easy, not painful at all.
Eileen, Glendale, CA

When I started active labor, I struggled to push correctly. I didn't understand what to do until my nurse told me to push like I was pooping. I thought she was crazy but once I recognized the right push, and where it felt like it was coming from, I delivered my daughter within a few minutes!
Tracy Fives, Lake Worth, FL

I hate to be so graphic, but it felt like I had to have a bowel movement in the worst way! That's the only way I can describe it! It also felt as if something was going to burst through my back; I had excruciating back pain. I think I felt everything in my back rather than in my pelvis.

I'd Do It All Again

Even though most of the moms felt that giving birth was the hardest they'd ever done, they'd still do it all over again. That's what keeps the human race going!

Pushing was the worst. I could feel every stretch, pull, and tear. The burning was like no other. I remember feeling there was no way I could push the baby out, it won't fit. But once all was done, I was so happy to hold our precious baby. It was all worth it.
Sharon, Danbury, CT

The pain of my labor came in waves, where I could feel it begin, crest, and subside. During the crests, it was hard to remember to breathe as it felt like my body was one big leg cramp, kind of like I was a towel being twisted and curled in half. But when it's all said and done and you're looking at your little joy, you know you'd go through it all again.
Kathy, Appleton, WI

Whenever I hear Johnny Cash's booming drawl singing "Burning Ring of Fire," I remember labor and delivery. The miracle of what it means to be a woman is that all that agony is worth the 8 pounds, 1 ounce of pure beauty and joy that you hold in your arms for the first moment.

Am I in Premature Labor?
Are your early contractions something to worry about?

Am I Really in Labor?

The threat of premature labor shouldn't cause panic. The majority of preterm babies are delivered between 34 and 36 weeks, and most of them are healthy and need little or no special care after birth. If a baby is born before 32 weeks, however, the prognosis is less optimistic.

After about 30 weeks of pregnancy, many women notice occasional uterine contractions. Called Braxton Hicks contractions, they're normal and usually painless. They tend to occur when you're tired or have just had physical activity, and they usually stop when you rest. True labor contractions come at regular intervals or progressively become more frequent or more painful; Braxton Hicks contractions don't.

You are considered to be in preterm labor when you have uterine contractions every ten minutes (or more often) as well as cervical changes (dilation, thinning, softening) prior to 37 weeks gestation.

In some cases it can be difficult for even a doctor to determine if a woman truly is in labor. Your doctor will probably tell you to go to the hospital (if you're not already there), where you can be monitored carefully. Some women at high risk for preterm labor are given a belt with electronic sensors. This is strapped around the abdomen to detect early contractions. Once or twice a day, the monitor is hooked up to a telephone so it can relay graphs of uterine activity to a nurse. The goal of home monitoring is to detect preterm labor early, when it's most treatable.

Two tests, one that measures hormones in the saliva and another that measures vaginal secretions, can also aid in diagnosing preterm labor. A vaginal ultrasound, which can accurately assess cervical dilation and other cervical changes, may help too.

If your doctor determines that you are truly in labor, she will probably attempt to halt it, unless for some medical reason it's not advisable. (For instance, if you have very high blood pressure or uterine bleeding due to a problem with the placenta, or if there's fetal distress such as a slowed heart rate that could indicate a lack of oxygen.)

How Can They Stop the Contractions?

To try to halt your contractions, your doctor will ask you to rest on your left side (this position increases blood flow to the uterus), and if you seem dehydrated, she will give you intravenous fluids. These steps help stop contractions in about 50 percent of women. If your contractions stop and your cervix doesn't dilate during several hours of observation, you will probably be able to go home.

If your cervix is dilating, however, your contractions are unlikely to stop on their own. If you are between 34 and 37 weeks and the baby already is at least 5 pounds, 8 ounces, the doctor may decide not to delay labor. These babies are very likely to do well even if they're born early.

Your obstetrician may decide that postponing the birth through medication is the appropriate course of action. While there is no established "right" time to start treatment with medication, many doctors recommend beginning once your cervix becomes two to three centimeters dilated. While drugs usually don't postpone labor for long (often not more than a couple of days), sometimes even a short delay can make a lifesaving difference to your baby.

For example, it gives your doctor time to begin treatment with corticosteroid drugs aimed at preventing or lessening complications in preterm newborns. Corticosteroids speed maturation of fetal organs, reducing infant deaths by about 30 percent and cutting the incidence of the two most serious complications of preterm birth: respiratory distress syndrome and bleeding in the brain. They are given by injection and are most effective when administered at least 24 hours before delivery.

All About Induced Labor
Learn about the risks -- and the reasons -- for inducing labor.

Why Is Labor Induced?

Labor induction is the stimulation of uterine contractions before they occur spontaneously. Induction is on the rise -- in fact, the rate of induced labor doubled between 1989 and 1997, according to the National Center for Health Statistics. A 1999 report by the American College of Obstetricians and Gynecologists (ACOG) says that up to 15 percent of all deliveries are induced. However, ACOG advises that the benefits of inducing labor should be carefully weighed against the possible risks for mother and child before undertaking the procedure.

According to ACOG, some of the most common reasons for labor induction include:

Post-term pregnancy (two weeks or more past your due date)

Placental abruption

Chorioamnionitis (infection of the membranes enclosing the amniotic fluid)

Premature rupture of membranes

Preeclampsia

Other reasons for induction of labor are more logistical. For instance, if you live very far from your hospital or if you're at risk of rapid delivery, your doctor might decide to induce your labor after carefully weighing the risks versus the benefits. There is also an increase in women wishing to schedule labor for convenience. For instance, scheduling delivery around a move, a trip, or work. But in general, most doctors will not induce a woman as a matter of convenience.

How Is Labor Induced?

Before you can be induced, your cervix must be "ripe," or ready for labor. If the cervix isn't ripe, mechanical dilators and synthetic prostaglandins can help. Other methods include continuous intravenous oxytocin drip, and administration of the hormone relaxin. However, the safety and effectiveness of these two methods are unclear, according to ACOG.

Once your cervix is ready, labor can be induced by a doctor administering oxytocin, misprostol, or mifespristone. Oxytocin is the most commonly used labor-stimulating agent. Other methods of stimulating labor include nipple stimulation, stripping the amniotic membranes (amniotomy), or rupturing the amniotic membranes manually with a sterile hooked instrument (also called artificial rupture of membranes, AROM, or "breaking the water").

Artificial rupture of membranes is generally painless. It's usually very effective at triggering spontaneous labor, but in some cases spontaneous labor doesn't begin for a long while, or at all. That's why oxytocin is often given to help with the induction when your membranes are ruptured artificially.

Stripping of membranes is a bit different. In this case, your bag of waters is manually separated from your cervix. According to ACOG, this procedure results in more reported instances of spontaneous labor and fewer inductions in women who are post-term.

Nipple stimulation is also not a certain method of inducing labor, but it appears to work in some instances because it can trigger the release of naturally occurring oxytocin in your body.

How Is Labor Induced?

Before you can be induced, your cervix must be "ripe," or ready for labor. If the cervix isn't ripe, mechanical dilators and synthetic prostaglandins can help. Other methods include continuous intravenous oxytocin drip, and administration of the hormone relaxin. However, the safety and effectiveness of these two methods are unclear, according to ACOG.

Nipple stimulation is also not a certain method of inducing labor, but it appears to work in some instances because it can trigger the release of naturally occurring oxytocin in your body.

Benefits and Risks

If you're having medical problems, or your baby's health is at risk, induction can begin labor at a crucial time. If done properly, and by a qualified physician who has carefully considered your situation, it can lead to the safe delivery of a healthy baby or allow timely treatment of a baby who needs medical assistance.

According to the American Academy of Family Physicians (AAFP), one risk that must be considered for labor induction is that the medication might make your contractions too strong. This can put stress on your uterus and on your baby. If this happens, your doctor might stop the medication and wait to see if the contractions lessen. Or he may decide to do a cesarean if he feels it's too risky to wait.

According to a June 2000 study in Obstetrics and Gynecology, for women with prolonged pregnancies, labor induction alone does not lead to a higher rate of cesarean delivery. The results of the study showed that risk factors, such as whether the woman had given birth previously or had an undilated cervix, rather than the labor induction alone, caused the generally higher number of cesarean deliveries noted in women with prolonged pregnancies.

But generally speaking, there's no sure way to know whether you'll need to have a cesarean in the event that you're induced. Discuss your concerns with your doctor, who can help identify any risk factors that could make a cesarean delivery more likely.

What Is the Procedure Like?

Labor induction itself is not painful. But once you're induced you may experience very strong contractions that can be painful. Your experience of pain is related to your tolerance for pain, your physical condition, your emotional and psychological condition. You can use nonmedical methods of coping with pain during labor, such as Lamaze or the Bradley Method. If you're still having trouble, talk with your doctor about medical methods of managing pain.

According to the AAFP, labor-inducing medications might upset your stomach. As a result, if you're going to be induced with medications, your doctor will likely advise you not to eat much before coming in for the induction.

How long it takes to be induced varies depending on the individual. How far along you are in your pregnancy, whether this is your first baby, and your general health are a few of the factors that will influence how quickly your labor will be induced.

Your should know:

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.