Maternity Services

Labor

What is labor?
Toward the end of pregnancy, the uterus reaches maximum size, the placenta begins to age, and the level of the hormone progesterone begins to drop. Your body becomes more sensitive to the chemical oxytocin, which triggers labor contractions. Finally, the baby itself may release prostaglandins that trigger labor. Labor has three stages. Stage one is the dilation of the cervix (the bottom part of the uterus that leads into the vagina). Once the cervix has opened to 10 cm (about four inches), stage two begins and the baby is pushed out of the mother. Finally, the placenta is delivered during the last stage of labor.

Premature labor
Ideally, pregnancy lasts 40 weeks, during which time an embryo multiplies from two cells to literally millions of cells to form a baby who is ready to be born. Sometimes, for a number of reasons, babies are born much earlier--at 36 weeks, 32 weeks or even 28 weeks pregnancy. Obviously, the longer a woman can carry a baby, the better the outcome will usually be.

Your health care provider and Yale-New Haven Hospital work together to delay the onset of early labor as long as possible. If your baby is born prematurely, the Yale-New Haven Newborn Special Care Unit is ready to provide state-of-the-art care.

If at any point in your pregnancy you have unusual or persistent cramping, vaginal bleeding or a rush of fluids from the vagina, call your doctor or midwife right away.

When to call your health care provider

Overdue?
Even though you are not considered overdue until two weeks past your due date, 10 minutes past the date feels like a long time. Your doctor or midwife will continue to monitor you and your baby closely if your due date passes and you have not delivered. If necessary, you may be scheduled to have labor induced. That's when you come to Yale-New Haven and receive medications that begin the process of labor. Sometimes, women then go into labor on their own; other women need continued medication throughout the delivery.

Induction of labor
If you have been scheduled to have your labor induced, you will receive a phone call the night before from a nurse who will explain about coming to Yale-New Haven the next day and answer any of your questions.

The morning of the induction, you can eat a light breakfast (juice, toast, cereal or yogurt), unless your physician or midwife has asked you not to eat anything after midnight. Don't eat fatty foods because they are harder to digest.

When you arrive at Yale-New Haven, go to the Children's Hospital (West Pavilion) entrance on Howard Avenue. (Do not use the Emergency entrance). An attendant will park your car and then you can go to the Admitting Office. You will be brought up to a room in Labor and Birth. Your labor coach is welcome to be with you. You will receive medication to trigger labor.

Cesarean section
About 21% of all babies are delivered by cesarean section, a figure most obstetricians believe is still too high. Yale-New Haven is involved in a national effort to reduce the section rate to 15%.

There will always be a need for some babies to be delivered by c-section. Sometimes, c-sections are planned in advance; other times doctors or midwives decide during a delivery that a c-section is necessary.

During a c-section, a woman usually receives regional anesthetic that numbs her from the waist down. The physician makes an incision through the skin into the uterus and lifts the baby out, removes the placenta and closes the opening.

Because they are awake, women who have c-sections can still breastfeed their baby right after delivery. Because a c-section is surgery, the time spent in the hospital and recovery afterward are longer than a vaginal delivery. Depending on the reason for the c-section, you may be able to try a vaginal birth on a subsequent pregnancy. If you had a c-section, ask your physician why the section was necessary.

Some reasons why c-sections are performed:

• Premature delivery of a breech baby
• Triplets or more babies
• Concern that the fetus is not tolerating labor well (fetal distress)
• Failure of the cervix to dilate and the baby to descend through the birth canal despite good labor

When should you go to the hospital?

You should come to Yale-New Haven when you are in active labor, but CALL YOUR PHYSICIAN or MIDWIFE FIRST.

Active labor is when your contractions last one minute, come three to five minutes apart and you are three to four centimeters dilated. If you are in active labor, do not eat a large meal. Take clear liquids only.

Statistics show that women admitted to the hospital in active labor (versus early labor) are less likely to have a cesarean section.

If you will arrive at Yale-New Haven between 6 a.m. and 12 midnight, you can enter the hospital through the main entrance to the Children's Hospital. Use these driving directions. If you will arrive at Yale-New Haven between 12 midnight and 6 a.m., you will be admitted through Children's Emergency. Use these driving directions. Both entrances are only steps apart from each other should you forget.

Last revised: Oct.16, 2007 (jj)

Home page URL: http://www.ynhh.org

All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.