Labor & Delivery

Going into labor is an exciting time, and you have a lot to do to prepare for the big day. One important thing you’ll need to do is pack your bags for the trip to the hospital.

Your bags should already be packed when you’re ready to go to the hospital. In fact, you should pack a few weeks before your due date. That way, you’ll be prepared if the baby comes early.

You should pack bags for yourself, your partner, and — of course — your baby.

What to pack for yourself

After your baby is born, you’ll want to keep things simple. Here’s a list of things you’ll want to bring to the hospital:

Comfortable clothes, including something loose and flowing to wear home
Robe and nightgown
Nursing bras
Sanitary pads
Toiletries (shampoo, toothbrush and toothpaste, skin care lotion, hairbrush, deodorant, etc.)
A few pairs of maternity panties
A battery-powered CD player with headphones so you can listen to relaxing music while you’re in labor
A pocket name book if you haven’t chosen a name for your baby
What to pack for your significant other/coach

Change of clothes if your significant other/coach will be staying overnight at the hospital
A camera and film and/or a video camera

What to pack for your baby

Car seat — By law, you have to have a child car seat to take your baby home. Make sure it’s installed correctly.
Receiving blanket — Bring other blankets if the weather is cold.
An outfit to wear home (including socks and booties)
Onesies — These are baby “bodysuits” that are designed for ease of dressing and changing, and add an extra layer of warmth under the baby’s outfit.
A hat — You might be able to keep the one the hospital puts on your baby.)
You might also want to bring snacks such as granola bars, crackers, dried fruit, etc. After going into labor, you will probably be hungry. You should also bring change for the vending machines in case the hospital cafeteria is closed.
It is normal for you to feel both excited and scared about labor and delivery. We hope that this handout helps answer your questions so you will know what to expect during labor.

When does labor begin?

Labor begins when the cervix begins to open (dilate) and thin (called effacement). The muscles of the uterus tighten (contract) at regular intervals. During contractions, the abdomen becomes hard. Between contractions, the uterus relaxes and the abdomen becomes soft.

How will I know if I’m in labor?

Some women experience very distinct signs of labor, while others don’t. No one knows what causes labor to start, but several hormonal and physical changes may indicate the beginning of labor. These changes include:


The process of your baby settling or lowering into your pelvis is called lightening. Lightening can happen a few weeks or a few hours before labor. Because the uterus rests on the bladder more after lightening, you may feel the need to urinate more frequently.

Mucus plug

The mucus plug accumulates at the cervix during pregnancy. When the cervix begins to open wider, the mucus is discharged into the vagina and may be clear, pink, or slightly bloody. Labor may begin soon after the mucus plug is discharged or might begin one to two weeks later.


Labor is characterized by contractions that come at regular intervals and increase in frequency (how often contractions occur), duration (how long contractions last), and intensity (how strong the contractions are) over time. As time progresses, the contractions come at closer intervals.

Labor contractions cause discomfort or a dull ache in your back and lower abdomen, along with pressure in the pelvis. Some women describe contractions as strong menstrual cramps. You might have a small amount of bleeding from your vagina. Labor contractions are not stopped by changing your position or relaxing. Although the contractions might be uncomfortable, you will be able to relax between contractions.

This part of the first stage of labor (called the latent phase) is best experienced in the comfort of your home.

Timing your contractions

Write down the time at the beginning of one contraction and again at the beginning of the next contraction. The time between contractions includes the length or duration of the contraction and the minutes between the contractions (called the interval).

Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than five minutes apart. Active labor (the time you should come into the hospital) is usually characterized by strong contractions that last 45 to 60 seconds and are three to four minutes apart.

The following suggestions may help you cope during contractions:

Try to distract yourself: take a walk, go shopping, watch a movie.
Soak in a warm tub or take a warm shower. Ask your health care provider if you should take a tub bath if your water has broken.
Try to sleep if it is in the evening. You need to store up your energy for labor.
Rupture of the amniotic membrane

The rupture of the amniotic membrane (the fluid-filled sac that surrounds the baby during pregnancy) is also referred to as your “bag of water breaking.” The rupture of the amniotic membrane may feel either like a sudden gush of fluid or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored.

If your “water breaks,” tell your health care provider. Tell your health care provider what time your water broke, how much fluid was released, and what the fluid looked like. Labor may or may not start soon after your water breaks.

It is also common to be in labor without your water breaking.

Effacement and dilation of the cervix

Your cervix gets shorter and thins out in order to stretch and open around your baby’s head. The shortening and thinning of the cervix is called effacement and is measured in percentages from zero percent to 100 percent. The stretching and opening of your cervix is called dilation and is measured from one to 10 centimeters.

Effacement and dilation are direct results of effective uterine contractions. Progress in labor is measured by how much the cervix has opened and thinned to allow your baby to pass through the vagina.

When should I call or go to the hospital?

-Please call during labor or when you have questions or concerns. Also call:
-If you think your water has broken (if there is a sudden gush of fluid or a trickle of fluid that leaks steadily)
-If you are bleeding (more than spotting)
-If your baby has significantly decreased movement or no movement
-When your contractions are very uncomfortable and have been coming every five minutes for an 2-3 hours

What happens when I get to the hospital?

When you get to the hospital, you will check in at the Labor and Delivery Desk. Most patients are first seen in the Triage Room for admission to the hospital or for testing. More than one patient might be in this area at the same time. Please have only one person go with you to the Triage Room.

From the Triage Room, you will be taken to the Labor, Delivery, and Recovery (LDR) room.

You will be asked to wear a hospital gown. Your pulse, blood pressure, and temperature will be checked. A monitor will be placed on your abdomen for a short time to check for uterine contractions and assess the baby’s heart rate. Your health care provider will also examine your cervix to determine how far labor has progressed.

An intravenous (IV) line might be placed into a vein in your arm to deliver fluids and medications.

Types of delivery

Vaginal delivery is the most common and safest type of birth. When necessary in certain circumstances, forceps (instruments resembling large spoons) may be used to cup your baby’s head and help guide the baby through the birth canal. Vacuum delivery is another way to assist delivery and is similar to forceps delivery. In vacuum delivery, a plastic cup is applied to the baby’s head by suction and the health care provider gently pulls the baby from the birth canal.

Although vaginal delivery is the most common and safest type of delivery, sometimes cesarean delivery is necessary for the safest outcome for you and your and baby. A cesarean delivery may be necessary if one of the following complications is present:

Your baby is not in the head-down position.
Your baby is too large to pass through the pelvis.
Most often, the need for a cesarean delivery is not determined until after labor begins.

What are the stages of labor?

The average labor lasts 12 to 24 hours for a first birth and is usually shorter for other births. Labor happens in three stages.

First stage

The first stage is the longest part of labor and can last several hours. It begins when your cervix starts to open and ends when it is completely open (fully dilated) at 10 centimeters. When the cervix dilates from zero to five centimeters, contractions get stronger as time progresses. Mild contractions begin at 15 to 20 minutes apart and last 60 to 90 seconds. The contractions become more regular until they are less than five minutes apart. This part of labor (called the latent phase) is best experienced in the comfort of your home.

When the cervix dilates from five to eight centimeters (called the active phase), contractions get stronger and are about three minutes apart, lasting about 45 seconds. You may have a backache and increased bleeding from your vagina (show). Your mood may become more serious as you focus on the hard work of dealing with the contractions. You will also depend more on your support person.

Hints to help with the active phase:

Try changing your position. You may want to try getting on your hands and knees. This helps ease the discomfort of back labor.
Soak in a warm tub or take a warm shower.
Continue practicing breathing and relaxation techniques.
If your amniotic membrane ruptures, the next contractions may be much stronger. When the cervix dilates from eight to 10 centimeters (called the transition phase), contractions are two to three minutes apart and last about one minute. You may feel pressure on your rectum and your backache may feel worse. Bleeding from your vagina will be heavier.

It may help to practice breathing and relaxation techniques such as massage or listening to soothing music. Focus on taking one contraction at a time. Remember that each contraction brings you closer to holding your baby.

Second stage

The second stage of labor begins when your cervix is fully dilated at 10 centimeters. This stage continues until your baby passes through the birth canal or vagina and is born. This stage may last two hours or longer.

Contractions may feel different — they will slow to two to five minutes apart and last from about 60 to 90 seconds. You will feel a strong urge to push with your contractions. Try to rest as much as possible between intervals of pushing.

Here are some helpful hints for pushing:

Try several positions (squatting or getting on your hands and knees).
Take deep breaths in and out before and after each contraction.
Curl into the push as much as possible. This allows all of your muscles to work.
You may receive anesthetics (pain-relieving medications) or have an episiotomy if necessary. An episiotomy is a procedure in which a small incision is made between the anus and vagina to enlarge the vaginal opening. An episiotomy may be necessary to assist the baby out quicker or to prevent large, irregular tears.

The location of your baby’s head as it moves through the pelvis (called descent) is reported in a number called a station. If the baby’s head has not started its descent, the station is described at minus three (-3). When your baby’s head is at the zero station, it is at the middle of the birth canal and is engaged in the pelvis. The station of your baby helps indicate the progress of the second stage of labor.

When your baby is born, your health care provider will hold the baby with his or her head lowered to prevent amniotic fluid, mucus and blood from getting into the baby’s lungs. The baby’s mouth and nose may be suctioned with a small bulb syringe to remove any additional fluid. Your health care provider will place the baby on your stomach and shortly after, the umbilical cord will be cut.

Third stage

The third stage of labor begins after the baby is born and ends when the placenta separates from the wall of the uterus and is passed through the vagina. This stage is often called delivery of the “afterbirth” and is the shortest stage of labor. It may last from a few minutes to 20 minutes. You will feel contractions but they will be less painful. If you had an episiotomy or small tear, it will be stitched during this stage of labor.
What pain-relief options are available during childbirth?

It is important for you to learn what pain relief options are available during childbirth. Please discuss your options with your health care provider well before your “birth day.” Getting pain relief should not cause you to feel guilty! You are the only one who knows how you feel, so decisions regarding control of your labor pain must be made specifically by you.

Remember, however, that your pain relief choices may be governed by certain circumstances of your labor and delivery. Throughout your labor, your health care provider will assess your progress and comfort to help you choose a pain relief technique.

Analgesic medications can be injected into a vein or a muscle to dull labor discomfort. Analgesic medications do not completely stop pain, but they do lessen it. Because analgesic medications affect your entire body and may make both you and your baby sleepy, they are mainly used during early labor to help you rest and conserve your energy. We prefer an epidural to IV medications.
Local anesthesia may be used by your health care provider during delivery to numb a painful area or after delivery when stitches are necessary. Local anesthetic medications do not reduce discomfort during labor.
Regional anesthesia (also called epidural, spinal or systemic anesthesia) is administered by an anesthesiologist during labor to reduce discomfort. In both epidural and spinal anesthesia, medications are placed near the nerves in your lower back to “block” pain in a wide region of your body while you stay awake. Regional anesthesia greatly reduces or eliminates pain throughout the birthing process. It can also be used if a cesarean birth becomes necessary.
General anesthesia is used for emergencies during the birthing process. General anesthesia induces sleep and must be given by an anesthesiologist. While safe, general anesthesia prevents you from seeing your child immediately after birth.

How is regional anesthesia given?

Your anesthesiologist will inject medications near the nerves in your lower back to block the discomfort of contractions. The medication will be injected while you are either sitting up or lying on your side.

After reviewing your medical history and asking you some questions, your anesthesiologist will numb an area on your lower back with a local anesthetic. A special needle is inserted into this numb area to find the exact location to inject the anesthetic medication. After injecting the medication, your anesthesiologist removes the needle. In most cases, a tiny plastic tube called an epidural catheter stays in place after the needle is removed to deliver medications as needed throughout labor.

When is regional anesthesia given?

The best time to administer regional anesthesia varies depending on you and your baby’s response to labor. If you request regional anesthesia, your health care provider will contact your anesthesiologist and together they will discuss with you the risks, benefits and timing of regional anesthesia.

Will a regional block affect my baby?

Considerable research has shown that regional anesthesia is safe for you and your baby.

How soon does regional anesthesia take affect and how long does it last?

Epidural anesthesia starts working 10 to 20 minutes after the medication has been injected. Pain relief from epidural anesthesia lasts as long as your labor, since more medication can always be given through the catheter.

Spinal anesthesia starts working immediately after the medication has been injected. Pain relief lasts about two and one-half hours. If your labor is expected to last beyond this time, an epidural catheter will be inserted to deliver medications to continue your pain relief as long as needed.

How numb will regional anesthesia make me feel?

Although you will feel significant pain relief, you may still be aware of mild pressure from your contractions. You may also feel pressure when your health care provider examines you.

Do I have to stay in bed after regional anesthesia?

Yes, “walking epidurals” are not done in the Savannah area currently.

Will a regional block slow my labor?

In some women, contractions may slow after regional anesthesia for a short period of time. Most women find that regional anesthesia helps them to relax and actually improves their contraction pattern while allowing them to rest. Pitocin is normally given with an epidural to ensure adequate contractions.

If I have regional anesthesia, will I be able to push?

Yes. Regional anesthesia allows you to rest comfortably while your cervix dilates. When your cervix is completely dilated and it is time to push, you will have energy in reserve. Regional anesthesia should not affect your ability to push — it will make pushing more comfortable for you.

Are there any side effects of regional anesthesia?

Your anesthesiologist takes special precautions to prevent complications. Although complications are rare, some side effects may include:

Decreased blood pressure. You will receive intravenous fluids and your blood pressure will be carefully monitored and treated to prevent this from happening.
Mild itching during labor. If itching becomes bothersome, your anesthesiologist can treat it.
Headache. Drinking fluids and taking pain tablets can help relieve headaches after regional anesthesia. If the headache persists, tell your anesthesiologist and additional medication can be ordered for you.
Local anesthetic reaction. While local anesthetic reactions are rare, they can be serious. Be sure to tell your anesthesiologist if you become dizzy or develop ringing in your ears so that he or she can quickly treat the problem.

What is an episiotomy?

An episiotomy is a procedure during which a small incision is made between the anus and vagina to enlarge the vaginal opening. The procedure is intended to prevent vaginal tears during delivery.

How is an episiotomy performed?

To perform an episiotomy, local anesthesia (numbing just the immediate area) is usually used. Just before the baby is born, the obstetrician makes an incision at the bottom of the vaginal opening. This enlarges the vaginal opening. The incision is closed after the baby and placenta have delivered.

When is an episiotomy necessary?

An episiotomy might be needed if one of the following circumstances applies:

The baby is large and the doctor needs extra room to manipulate the baby.
The doctor needs extra room when using forceps to help deliver the baby.
The vaginal perineal tissue looks fragile as the baby’s head begins to crown. A fragile-looking perineum might begin to bleed or might not stretch well.

How is an episiotomy performed?

Before the episiotomy is performed, your doctor will numb the area with an injection if needed. The doctor then will use surgical scissors to make a small cut in the perineum. Another dose of local anesthesia might be given to ensure that the perineum is completely numb before the cut is stitched up.

Is any special care required after an episiotomy?

The perineal area will need time to heal. Ice packs might numb the area and help reduce swelling. Other techniques that can speed healing and ease soreness include:

Taking sitz baths—A sitz bath is a warm water bath, taken in a seated position, that only covers the hips and buttocks.
Allowing exposure to air—Expose the area to as much air as possible.
Keeping the area dry— After showering, hold a blow dryer set on warm 10 to 12 inches away from the area until it is dry.
Doing Kegel exercises—To do a Kegel exercise, contract the pelvic floor muscles (the ones that stop the flow of urine).
Limiting the amount of time you spend in a sitting position immediately after delivery
Using a numbing spray from the hospital or a drug store
Drinking lots of water and eating fiber so that no strain is required for bowel movements

Resuming sexual activity after an episiotomy

The perineum should be completely healed about four to six weeks after delivery. You may resume sexual activity after this healing period. There might be some initial tenderness and tightness. You will want to be relaxed as possible. The use of a lubricant might help to ease discomfort.