Topic Overview

Is this topic for you?

This topic provides basic information about normal labor and delivery and about the postpartum period. If you need information on pregnancy or other types of childbirth, see the following topics:

• Pregnancy
• Preterm Labor
• Cesarean Section
• Breech Position and Breech Birth
• Vaginal Birth After Cesarean (VBAC)

What is labor and delivery?

At the end of the third trimester of pregnancy, your body will begin to show signs that it is time for your baby to be born. The process that leads to the birth of your baby is called labor and delivery. Every labor and delivery includes certain stages, but each birth is unique. Even if you have had a baby before, the next time will be different.

Giving birth to a baby is hard work. That’s why it’s called labor. It can also be scary, thrilling, and unpredictable. Learning all you can ahead of time will help you be ready when your time comes.

What are the stages of labor?

There are three stages of labor. The first stage of labor includes early labor and active labor. The second stage continues the active labor and lasts through the birth, with the baby traveling down and out of the birth canal. The third stage is after the birth, when the placenta is delivered.

During early labor, the muscles of the uterus start to tighten (contract) and then relax. These contractions help to thin (efface) and open (dilate) the cervix so the baby can pass through the birth canal. (See a picture of cervical effacement.) Early contractions are usually irregular, spaced from 5 to 20 minutes apart, and they usually last less than a minute.

Early labor can be uncomfortable and long, sometimes lasting 2 to 3 days. Walking, watching TV, listening to music, or taking a warm shower may help you manage the discomfort.

During the first part of active labor, contractions become strong and regular. They happen every 2 or 3 minutes and last longer than a minute. This is the time to go to the hospital or birthing center.

The pain of contractions may be moderate or intense. Having a support person, trying different positions, or using breathing exercises may help you cope. Many women ask for pain medicine during this time. Even if you plan on natural childbirth, it can be comforting to know that you can get pain relief if you want it.

After the cervix is fully effaced and dilated, your body changes to "push" mode. During this second stage of active labor, the baby is born. Pushing to deliver the baby may take from a few minutes to several hours. It is likely to be faster if you have had a baby before.

The third stage is after the baby is born, when you have contractions until the placenta is delivered.

How can you prepare for labor and delivery?

Getting regular exercise during pregnancy will help you handle the physical demands of labor and delivery. Try adding Kegel exercises to your daily routine. They strengthen your pelvic floor muscles. This helps prevent a long period of pushing during labor.

In your sixth or seventh month of pregnancy, consider taking a childbirth education class with your husband, partner, or support person. A class can reduce your stress both before and during labor and delivery by preparing you to deal with what might happen. It can teach you ways to relax and the best ways for your support person to help you.

There are many decisions to make about labor and delivery. Before your last weeks of pregnancy, be sure to talk to your doctor or nurse-midwife about your birthing options and what you prefer. Things to talk about include:

• Where you want to have your baby. Most women choose to work with a doctor and have their baby delivered in a hospital. Hospitals offer experienced staff in case problems arise and also a wide range of pain relief options. Women at low risk for problems may choose to work with a midwife or have their baby at a birth center.
• Who you want to be with you. You may want to have family and friends around you or only the baby’s other parent or another support person.
• What comfort measures you want to try. Breathing techniques, laboring in water, trying different positions, and having one-on-one support may help you manage pain.
• Your preferences for medical treatments. Consider what type of pain medicine you would prefer, even if you do not think you will need it. It is a good idea to learn about the medical options ahead of time. Just keep in mind that you may not always get to choose.
• How your baby will be cared for after delivery. This might include having your baby stay in the room with you rather than going to the nursery, delaying some tests and procedures, and getting help with starting to breast-feed.

You can write down all of your preferences as a birth plan. This gives you a chance to state how you would most like things to be handled. Just keep in mind that it is not possible to predict exactly what will happen during labor and delivery. Sometimes there are quick decisions that only your doctor or nurse-midwife can make.

What can you expect after childbirth?

Now you get to hold and look at your baby for the first time. It is common to feel excited, tired, and amazed all at the same time.

If you plan to breast-feed, you may start to put your baby to your breast soon after birth. Don't be surprised if you have some trouble at first. Breast-feeding is something you and your baby have to learn together. You will get better with practice. If you need help getting started, ask a nurse or breast-feeding specialist (lactation consultant).

In the hours after delivery, you may feel sore and need help going to the bathroom. You may have sharp, painful contractions called afterpains for several days as your uterus shrinks in size.

During the first weeks after giving birth (called the postpartum period), your body begins to heal and adjust to not being pregnant. It's easy to get overtired and overwhelmed. Take good care of yourself. Make sure you get as much rest and help as you can.

• Try to sleep when your baby does.
• Let family and friends bring you meals or do chores.
• Eat healthy meals to build up your strength.
• Drink extra fluids if you are breast-feeding.

It is common to feel very emotional during the postpartum period. But if you have "baby blues" that last more than a few days or you have thoughts of hurting yourself or your baby, call your doctor right away. Postpartum depression needs to be treated right away.

Your doctor or midwife will want to see you for a checkup 2 to 6 weeks after delivery. This is a good time to discuss any concerns, such as birth control. If you do not want to get pregnant, be sure to use birth control, even if you are breast-feeding. Talk to your doctor about which type of birth control is best for you.

Frequently Asked Questions

Labor and Delivery: Your Birthing Options

During your prenatal visits, talk with your doctor about your labor and delivery options. As you identify your preferences, you may want to write them down as a birth plan. A birth plan is not so much a "plan" as it is an ideal picture of what you would like to happen. Since no labor and delivery can be predicted or planned in advance, be flexible. As you think about how you'd handle possible complications, give yourself permission to change your mind at any time. And be prepared for your childbirth to be different from what you planned.

A birth plan isn't a contract for your doctor to follow. If an emergency situation arises, he or she has a responsibility to ensure both your safety and your baby's safety. You may still be allowed to share in some decisions, but your choices may be limited.

When you are writing your birth plan, first think about the location of your delivery, who will deliver your baby, and whether you want continuous labor support from a designated health professional or a doula, a friend, or family members. If you haven't already, this is also a good time to decide whether you'll attend a childbirth education class, starting in your 6th or 7th month of pregnancy. After you've set the stage, think through your preferences for comfort measures, pain relief, and medical procedures and fetal monitoring. Also think about how you'd like to handle your first hours with your newborn.

Comfort measures

There are many ways to reduce the stresses of labor and delivery. Consider:

• Continuous labor support from early labor until after childbirth, which has a proven, positive effect on childbirth. Women who have continuous one-on-one support (for example, from a mother's support person, or doula; nurse; midwife; or childbirth educator) are more likely to give birth without pain medicine and are less likely to describe their birthing experience negatively.¹ Although there is not a proven direct connection between continuous support and less labor pain, having a support person does help you feel more control and less fear, which are strong elements of mental pain control.
• Walking during labor, including whether you prefer continuous electronic fetal heart monitoring or occasional monitoring. Most women prefer the freedom to walk and move around, but a high-risk delivery would require constant monitoring.
• Nonmedication pain management ("natural" childbirth), such as continuous labor support, focused breathing, distraction, massage, and imagery, which can reduce pain and help you feel a sense of control during labor.
• Early laboring in water, which helps with pain, stress, and sometimes slow, difficult labor (dystocia).^{3, 4} Giving birth in water needs more study to show how safe or risky it is for mother and baby.³
• Issues about eating and drinking during labor. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted because the stomach digests food more slowly during labor. An empty stomach is also best in the rare event that you may need general anesthesia.
• Playing music during labor.
• Acupuncture and hypnosis, which are low-risk ways of managing pain that work for some women.⁶

Pain relief with medicine

Your options for pain relief with medicine may include:

• Opioids (narcotics), which are used to reduce anxiety and partially relieve pain. An opioid is less likely than epidural anesthesia to lead to an assisted (forceps or vacuum) delivery.² But they are usually used well before delivery, because an opioid can affect a newborn's breathing.
• Epidural anesthesia, which is an ongoing injection of pain medicine into the epidural space around the spinal cord. This partially or fully numbs the lower body. A "light" epidural allows you to feel enough that you can push, which reduces full-dose epidural risks of stalled labor and assisted (forceps or vacuum) delivery.⁸
• Pudendal and paracervical blocks, which are injections of pain medicine into the pelvic area to reduce labor pain. Pudendal is one of the safest forms of anesthesia for numbing the area where the baby will come out. It can be helpful with fast labor when a little pain medicine is needed close to delivery. It does not affect the baby. Paracervical has been generally replaced by epidural, which is more effective.

Pregnancy: Should I have an epidural during childbirth?

Some pain relief medicines are not the type that you would request during labor. Rather, they are used as part of another procedure or for an emergency delivery. But it's a good idea to know about them.

• Local anesthesia is the injection of numbing pain medicine into the skin. This is done before inserting an epidural or before making an incision (episiotomy) that widens the vaginal opening for the birth.
• Spinal block is an injection of pain medicine into the spinal fluid, which rapidly and fully numbs the pelvic area for assisted births, such as a forceps or cesarean delivery (no pushing is possible).
• General anesthesia is the use of inhaled or intravenous (IV) medicine, which makes you unconscious. It has more risks, yet it takes effect much faster than epidural or spinal anesthesia. So general anesthesia is only used for some emergencies that require a rapid delivery, such as when an epidural line (catheter) has not been installed in advance.

Birthing positions

Birthing positions for pushing include sitting, squatting, reclining, leaning on a ball, or using a birthing chair, stool, or bed. See pictures of various birthing positions:

• Walking
• Leaning
• Sitting
• Squatting
• Kneeling
• Kneeling on all fours
• Downward from knees
• Side-lying

Medical procedures for labor and delivery

Fetal heart monitoring is a standard practice during labor, but other procedures are used as needed.

• Labor induction and augmentation includes a simple "sweeping of the membranes" just inside of the cervix, rupturing the amniotic sac, using medicine to soften (ripen) the cervix, and using medicine to stimulate contractions. This is not always, but can be, a medically necessary decision—such as when a mother is about 2 weeks past her due date or when the mother or her baby has a condition that requires immediate delivery.
• Antibiotics if you tested positive for group B strep during your pregnancy.
• Electronic fetal heart monitoring may be either continuous for a high-risk delivery or periodic to check for signs that the baby might be in distress.
• Episiotomy widens the perineum with an incision. This is sometimes used to deliver the baby's head more quickly, when there are signs of distress. (Perineal massage and controlled pushing can also prevent or reduce tearing.¹¹)
• Forceps delivery or vacuum extraction is used to assist a vaginal delivery, such as when labor is stalled at the pushing stage or when the baby shows signs of distress at the pushing stage and needs to be delivered quickly.
• The need for a cesarean birth during a labor in progress is primarily based on the baby's and mother's conditions. (For more information, see the topic Cesarean Section.)

If you have had a cesarean delivery before, you may have a choice between a vaginal trial of labor and a planned cesarean birth. For more information, see the topic Vaginal Birth After Cesarean (VBAC).

Newborn care decisions

Before your baby is born, plan ahead about:

• Keeping your baby with you for at least 1 hour after birth, for bonding. (Many hospitals allow rooming-in, with no mother-baby separation during the entire hospital stay. A rooming-in policy also allows you to request time alone for rest, if you need it.)
• Preventing breast-feeding problems. You can plan ahead for breast-feeding support in case you need it. Check around for a lactation consultant. Some hospitals have them in-house. You can also make sure that hospital staff knows not to give your baby supplemental formula, unless there is a medical need.
• Delaying certain procedures, such as a vitamin K injection, a heel prick for a blood test, and the use of eye medicine, so that your newborn has a more calm transition after delivery.
• Whether and when you'd like visitors, including children in your family.
• Whether to bank your baby's umbilical cord blood after the birth for possible use as a stem cell treatment. (This requires advance planning early in your pregnancy.)

Breast-feeding: Should I breast-feed my baby?

Pregnancy: Should I bank my baby's umbilical cord blood?

Consider taking a childbirth education class, and tour the labor and delivery area of your hospital or birthing center. This will help you feel more comfortable when the time for delivery comes.

When to Call a Doctor

You or someone else should call 911 or other emergency services immediately if you think you may need emergency care. For example, call if you:

• Have a seizure.
• Passed out (lost consciousness).
• Have severe vaginal bleeding.
• Have severe pain in your belly or pelvis.
• Have had fluid gushing or leaking from your vagina (the amniotic sac has ruptured) AND you know or think the umbilical cord is bulging into your vagina (cord prolapse). This is quite rare, but if it happens, immediately get down on your knees and drop your head and upper body lower than your buttocks to decrease pressure on the cord until help arrives. Cord prolapse can cut off the baby's blood supply.

Call your doctor now or go to your hospital's labor and delivery unit immediately if you:

• Have any vaginal bleeding.
• Have signs of preeclampsia, such as:
  • Severe headache that does not go away with acetaminophen (such as Tylenol).
  • New visual problems (such as dimness or blurring).
  • Sudden swelling of your face, hands, or feet.
• Have belly pain or cramping.
• Have a fever of 100.4°F (38°C) or higher.
• Have had regular contractions for an hour. This means about 4 or more in 20 minutes, or about 8 or more in 1 hour, even after you have had a glass of water and are resting.
• Have a sudden release of fluid from your vagina. It is possible to mistake a leak of amniotic fluid for a problem with bladder control.
• Have low back pain or pelvic pressure that does not go away.
• Have noticed that your baby has stopped moving or is moving much less than normal.

If you are between 20 and 37 weeks pregnant, call your doctor immediately or go to the hospital now if you have:

• Concern that the baby has stopped moving or is moving much less than normal. See kick counts for information on how to check your baby's activity.
• Any vaginal bleeding.
• Uterine tenderness, unexplained fever, or weakness (possible symptoms of infection).
• Loss of a large amount of fluid from your vagina [1 cup (240 mL) or more].

Some of these symptoms could mean you are having preterm labor.

Call your doctor right away if you have:

• Regular contractions for an hour. This means about 4 or more in 20 minutes, or about 8 or more in 1 hour, even after you have had a glass of water and are resting.
• Unexplained low back pain or pelvic pressure.
• Intestinal cramping with or without diarrhea.

For more information, see the topic Preterm Labor.

After 37 weeks of pregnancy, call your doctor immediately or go the hospital if you have:

• Concern that the baby has stopped moving or is moving much less than normal. See kick counts for information on how to check your baby's activity.
• Any vaginal bleeding.
• Regular contractions (about 4 or more in 20 minutes, or about 8 or more in 1 hour).
• A sudden release of fluid from the vagina.

At any time during pregnancy, call your doctor if you have new steady or heavy discharge from the vagina along with symptoms of itching, burning, or odor.

After delivery

After you have delivered, call 911 if:

• You have sudden, severe pain in your belly.
• You passed out (lost consciousness).

After you have delivered, call your doctor now or seek medical care right away if:

• You have severe vaginal bleeding. You are passing blood clots and soaking through a new sanitary pad each hour for 2 or more hours.
• Your vaginal bleeding seems to be getting heavier or is still bright red 4 days after delivery or you pass blood clots larger than the size of a golf ball.
• You feel dizzy or lightheaded, or you feel as if you may faint.
• You are vomiting or you cannot keep fluids down.
• You have a fever.
• You have new or more belly pain.
• You pass tissue (not just blood).
• You have a severe headache, visual problems, or sudden swelling of your face, hands, or feet.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You are not getting better after 2 to 3 days.
• You have vaginal discharge that smells bad.
• You have signs of postpartum depression, such as:
  • Feelings of despair or hopelessness for more than a few days.
  • Troubling or dangerous thoughts or hallucinations.
• Your breasts are painful or red and you have a fever, which are symptoms of both breast engorgement and mastitis. For more information, see the topics Breast Engorgement and Mastitis While Breast-Feeding.

Early Labor

The birthing process is known as labor and delivery. No one can predict when labor will start. One woman can have all the signs that her body is ready to deliver, yet she may not have the baby for weeks. Another woman may have no advance signs before she goes into active labor. First-time deliveries are more difficult to predict.

Signs of approaching early labor

Signs that early labor is not far off include the following:

• The baby settles into your pelvis. Although this is called dropping, or lightening, you may not feel it.
• Your cervix begins to thin and open (cervical effacement and dilatation). Your doctor checks for this during your prenatal exams.
• Braxton Hicks contractions become more frequent and stronger, perhaps a little painful. You may also feel cramping in the groin or rectum or a persistent ache low in your back.
• Your amniotic sac may break (rupture of the membranes). In most cases, rupture of the membranes occurs after labor has already started. In some women, this happens before labor starts. Call your doctor immediately or go to the hospital if you think your membranes have ruptured.

Early labor (latent phase of labor)

Early labor is often the longest part of the birthing process, sometimes lasting 2 to 3 days. Uterine contractions:

• Are mild to moderate (you can talk while they are happening) and last about 30 to 45 seconds.
• May be irregular (5 to 20 minutes apart) and may even stop for a while.
• Open (dilate) the cervix to about 3 cm (1 in.). First-time mothers can experience many hours of early labor without the cervix dilating.

It's common for women to go to the hospital during early labor and be sent home again until they progress to active labor or until their "water" breaks (rupture of the membranes). This phase of labor can be long and uncomfortable. Walking, watching TV, listening to music, or taking a warm shower may help you through early labor.

Early labor that is progressing

If you arrive at the hospital or birthing center in early labor that is dilating and effacing the cervix or is progressing quickly, you can expect some or all of the following:

• In the birthing room, you will change into a hospital gown.
• Your blood pressure, pulse, and temperature will be checked.
• Your previous health, pregnancy, and labor history will be reviewed.
• You will be asked about the timing and strength of your contractions and whether your membranes have ruptured.
• Electronic fetal heart monitoring will be used to record the fetal heart rate in response to your uterine contractions. Fetal heart rate shows whether the baby is doing well or is in trouble.
• You will have sterile vaginal exams to check whether your cervix is thinning and opening (effacing and dilating).
• Depending on your own physical needs and your doctor's preference, you may have an intravenous (IV) needle inserted in case you need extra fluids or medicine later on.

Most hospitals and birthing centers have birthing rooms where women can labor, deliver, and recover. Providing that you have an uncomplicated birth, you can probably be in the same birthing room for your entire stay. If your delivery becomes complicated, you can be quickly moved to a delivery room equipped to handle the problem.

After you have been admitted to the hospital and you have had your initial exam, you will be:

• Encouraged to walk. Walking helps many women feel more comfortable during early labor. Walking is thought to help labor progress, but recent research suggests that walking doesn't actually speed or slow labor.⁹
• Briefly monitored every hour or so (at the least) to check your contractions and the baby's heart rate. You may be monitored throughout your labor.
• Allowed visitors. As your labor progresses and you become more uncomfortable, you may want to limit visitors to your partner or labor coach.

Active Labor, First Stage

The first stage of active labor starts when the cervix is about 3 cm (1 in.) to 4 cm (2 in.) dilated. This stage is complete when the cervix is fully dilated and effaced and the baby is ready to be pushed out. See a picture of cervical effacement. During the last part of this stage (transition), labor becomes particularly intense.

Compared with early labor, the contractions during the first stage of active labor are more intense and more frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is the time to be at or go to the hospital or birthing center. If your amniotic sac hasn't broken before this, it may now.

As your contractions intensify, you may:

• Feel restless or excited.
• Find it difficult to stand.
• Have food and fluid restrictions. Some hospitals allow you to drink clear liquids. Others may only allow you to suck on ice chips or hard candy. Solid food is often restricted, because the stomach digests food more slowly during labor. An empty stomach is also best in the rare event that you may need general anesthesia.
• Want to start using breathing techniques, laboring in water, acupuncture, hypnosis, or other calming measures that you've chosen to manage pain and anxiety.
• Feel the need to shift positions often. This is good for you, because it improves your circulation. You may not know which birthing position is right for you for a while.
• Want pain medicine, such as epidural anesthesia.
• Be given intravenous (IV) fluids.

Pregnancy: Should I have an epidural during childbirth? (For more information about pain medicine options, see the Labor and Delivery: Your Birthing Options section of this topic.)

Transition phase

The end of the first stage of active labor is called the transition phase. As the baby moves down, your contractions become more intense and longer and come even closer together than before. When you reach transition, your delivery is not far off. During transition, you will be self-absorbed, concentrating on what your body is doing. You may be annoyed or distracted by others' attempts to help you but still feel you need them nearby as a support. You may feel increasingly anxious, nauseated, exhausted, irritable, or frightened.

A mother in first-time labor will take up to 3 hours in transition, and a mother who has vaginally delivered before will usually take no more than an hour. Some women have a very short, if intense, transition phase.

Active Labor, Second Stage

The second stage of active labor is the actual birth, when the baby is pushed out by the tightening uterine muscles (contractions). During the second stage:

• Uterine contractions will feel different. Though they are usually regular, they may slow down to every 2 to 5 minutes, lasting 60 to 90 seconds. If your labor stalls, changing positions may help. If not, your doctor may recommend using medicine to stimulate (augment) uterine contractions.
• You may have a strong urge to push or bear down with each contraction.
• The baby's head is likely to create great pressure on your rectum.
• You may need to change position several times to find the right birthing position for you.
• You can have a mirror positioned so you can watch your baby crown and emerge from the birth canal.
• When the baby's head passes through the vagina (crowns), you will feel a burning pain. The head is the largest part of the baby and the hardest part to deliver. If this is happening quickly, your doctor may advise you not to push every time, which may give the perineum, or area between the vulva and the anus, a chance to stretch without tearing. Or he or she may make an incision in the perineum (episiotomy). This is not recommended unless there is a medical need.
• Your medical staff will be ready to handle anything unexpected. If an urgent problem comes up, people will move quickly. You may suddenly have more people and equipment in the room than before. This is a time when your doctor or nurse-midwife will be deciding what is best for you and your baby.

This pushing stage can be as short as a few minutes or as long as several hours. You are more likely to have a fast labor if you have given birth before.

Third Stage, After the Baby is Born

After your baby is born, your body still has some work to do. This is the third stage of labor, when the placenta is delivered. You will still have contractions. These contractions make the placenta separate from the inside of the uterus, and they push the placenta out. Your medical staff will help you with this. They will also watch for any problems, such as heavy bleeding, especially if you have had it before.

Your doctor's or nurse-midwife's goal is for the third stage to proceed normally, and for all of the placenta to leave the uterus. This is what keeps your bleeding down. At the least, you can expect to have a nurse press down on your belly to help the uterus release the placenta.

You may be given some medicine to help the uterus contract firmly. Oxytocin (such as Pitocin) may be given as a shot or in a vein (intravenously) after the placenta is delivered. Oxytocin is given to make your uterus shrink and bleed less. (This is the same medicine that is sometimes used to make contractions more regular and frequent during labor.) Breast-feeding right away can also help the uterus shrink up and bleed less.

The third stage can be as quick as 5 minutes. With a preterm birth, it tends to take longer. But in most cases, the placenta is delivered within 30 minutes. If the placenta does not fully detach, your doctor or nurse-midwife will probably reach inside the uterus to remove by hand what is left inside. Your contractions will continue until after the placenta is delivered, so you may have to concentrate and breathe until this uncomfortable process is complete.

Post-Term Pregnancy

Full-term babies are delivered sometime between 37 and 42 weeks of pregnancy. (Those weeks are counted from the first day of your last menstrual period, or LMP.) A pregnancy that has reached 42 or more weeks is called a "post-term" or "post-date pregnancy." You might also call it "overdue." Pregnancy that lasts beyond the due date is fairly common.

Some post-term pregnancies are not truly post-term. A common "cause" is an incorrect due date. (Your due date is 40 completed weeks after your LMP. If you ovulated late in your cycle, your pregnancy didn't start as early as this due date says.) An ultrasound measurement of your fetus during the first trimester can give the most accurate due date. But even that due date is an estimate of when you might deliver.

In most cases, there is no obvious cause of a post-term pregnancy.

What concerns are linked to post-term pregnancy?

Most often, a post-term baby is born in good health. But a very small number of post-term pregnancies are linked to stillbirth and infant death. This risk increases with each week, up to 10 out of 1,000 post-term pregnancies after 43 weeks.⁵ This is why your doctor or nurse-midwife will monitor your baby after 40 to 41 weeks.

Many doctors and nurse-midwives want to lower risks for the post-term baby by delivering by or before 42 weeks. In most cases, watching and waiting is also fine. It is often hard to know which choice is best during the 2 weeks after the due date:⁵

• Any time after the due date that a fetal problem shows up in testing, it is time to deliver.
• For a cervix that is "favorable" for delivery—is softening, thinning, or opening—many doctors speed up the process by inducing labor. This may start in the doctor's office with a simple sweeping of the membranes. Watching and waiting until 42 weeks is also a reasonable choice, as long as there are no signs of problems. (There is no research that shows one choice to be better than the other for mothers and babies.⁵ Discuss this with your doctor or nurse-midwife.)
• For a cervix that has not started to soften, thin, or open, watching and waiting is a reasonable choice. But giving medicine to soften the cervix and induce labor does seem to have some advantages. A review of studies has shown that softening and inducing labor after 41 completed weeks lowers the rate of stillbirths and infant deaths (though, either way, deaths are very rare).⁷ And the rate of cesarean delivery, pain medicine use, and forceps or vacuum delivery does not increase.⁵

For safety reasons, most health professionals will plan to deliver a baby by 42 weeks, inducing labor if necessary. In general, the risks of waiting for natural labor beyond 42 weeks are thought to outweigh the benefits.

After Childbirth

It is normal to feel excited, tired, and amazed all at the same time after delivery. You may feel a great sense of calm, peace, and relief as you hold, look at, and talk to your baby. During the first hour after the birth, you can also expect to introduce your baby to feeding by breast, if you plan to breast-feed.

Breast-feeding

Breast-feeding provides significant health benefits to both you and your baby and is strongly encouraged by the American Academy of Pediatrics.¹⁰ If you breast-feed, don't be surprised if you and your baby have some difficulty at first. Breast-feeding is a learned technique, so you will get better at it with practice. Almost all difficulties that can develop with breast-feeding can be remedied with home treatments and by talking to your health professional or a breast-feeding specialist (lactation consultant). Most hospitals have at least one lactation consultant available to help new mothers breast-feed. Don't hesitate to ask for help.

During the first days of breast-feeding, your nipples will probably become tender or sore and may even develop painful cracks in the skin. But as breast-feeding becomes more established, the soreness usually goes away. For more information, see the topic Breast-Feeding.

For helpful information about getting a good start with breast-feeding and preventing complications, see:

Breast-feeding: Learning how to nurse.

Your first hours of recovery

You may experience shaking chills right after delivery. This is a common reaction in the hours after delivery. A warm blanket may help you feel more comfortable.

During the first hours after the birth, your health professional or a nurse will:

• Massage your uterus by rubbing your lower abdomen about every 15 minutes. Later, you will be taught to massage your own uterus. This helps it tighten (contract) and stop bleeding. If your uterus does not contract (boggy uterus), it may bleed too much, or hemorrhage. (When hemorrhage occurs, medicine is used to slow the bleeding, and the uterus is checked for placenta that hasn't detached, a common cause of heavy bleeding. You'll also be checked for tears in the cervix and vagina, which can lead to hemorrhage. In severe cases, surgery is used to stop bleeding, and fluid and blood transfusions are used to prevent shock and blood loss.)
• Check your bladder to make sure it isn't full. A full bladder puts pressure on your uterus, which interferes with contractions. You will be asked to try to urinate, which may be hard because of pain and swelling. If you cannot urinate, a tube (catheter) can be used to empty your bladder. Difficulty urinating usually passes quickly.
• Check your blood pressure frequently for several hours.
• Repair the area between your vagina and anus (perineum) if it tore or if you had an incision (episiotomy).
• Remove the small tube in your back (epidural catheter) if you had epidural anesthesia. If you plan to have a tubal ligation surgery to prevent future pregnancy, the catheter will be left in.

Postpartum Recovery and Coping

Physical changes after childbirth

After childbirth (postpartum period), your body goes through numerous changes, some of which continue for several weeks during your postpartum period. Like pregnancy, postpartum changes are different for every woman.

• Shrinking of the uterus to its prepregnancy size (uterine involution) starts when the placenta is delivered and continues for about 2 months. Within 24 hours, the uterus is about the size it was at 20 weeks of pregnancy, and after 1 week, it is half the size it was when you went into labor. By 6 weeks after delivery, the uterus is nearly as small as it was before pregnancy.¹²
• Contractions called afterpains shrink the uterus for several days after childbirth. These sharp pains are usually not as problematic after a first childbirth as they are after later deliveries. Afterpains typically improve during the third day.
• Sore muscles (especially in the arms, neck, or jaw) are common after childbirth. This is a result of the hard work of labor and should go away in a few days. You may also have bloodshot eyes or facial bruising from vigorous pushing.
• Difficulty with urination and bowel movements (elimination problems) can occur for several days after childbirth. Drink plenty of fluids and use stool softeners, if needed.
• Postpartum bleeding (lochia) may last for 2 to 4 weeks and can come and go for about 2 months.
• Recovery from an episiotomy or perineal tear in the area between the vagina and anus can take several weeks. You can ease the pain with home treatment, including ice, pain medicine, and sitz baths. Pain, discomfort, and numbness around the vagina are common after any vaginal birth.
• Breast engorgement is common between the third and fourth days after delivery, when the breasts begin to fill with milk. This can cause breast discomfort and swelling. Placing ice packs on your breasts, taking a hot shower, or using warm compresses may relieve the discomfort of engorgement. For more information, see the topic Breast Engorgement.
• Recovery from pelvic bone problems, such as separated pubic bones (pubic symphysis) or a fractured tailbone (coccyx), can take several months. Treatment includes ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and sometimes physical therapy.

Call your doctor if you are concerned about any of your postpartum symptoms. For more information, see the When to Call a Doctor section of this topic.

Coping during the postpartum period

When you have returned home, you may find it a challenge to meet the increased demands on your limited energy and time. Take it easy on yourself. Pause for a moment, and think of what you need. Tips for coping during the postpartum period include accepting help from others, eating well and drinking plenty of fluids, getting rest whenever you can, limiting visitors, getting some time to yourself, and seeking the company of other women who have new babies.

Fitness: Staying active when you have young children

Postpartum depression

If you are having trouble with postpartum blues that last more than a few days or you think you may have signs of postpartum depression, call your doctor right away. For more information, see the topic Postpartum Depression. For tips on how to cope with postpartum depression, see:

Depression: Managing postpartum depression.

Even if you have no significant postpartum problems, your doctor will want to see you for a checkup 2 to 6 weeks after delivery. This is a good time to discuss any concerns, including birth control.

Sexuality, fertility, and birth control

Avoid sexual intercourse and putting anything in the vagina (including tampons) until you have stopped bleeding. After you have stopped bleeding, avoid having sexual intercourse if it is still painful or uncomfortable. Your body needs at least 4 to 6 weeks to heal after the trauma of childbirth.

It is common to have little interest in sex for a while after childbirth. During the time when your body is recovering from childbirth and your baby has many needs, you and your partner will need to be patient with one another. Talking together is a good way to deal with the changes in your sexuality after childbirth.

Your menstrual cycle, and thus your ability to become pregnant again, will return at your body's own pace. Remember that you can ovulate and get pregnant during the month before your first menstrual period, as soon as 2 to 3 weeks after childbirth. If you do not want to become pregnant right away, use birth control even if you are breast-feeding.

• If you do not breast-feed, your menstrual periods may begin within a month or two after delivery.
• If you breast-feed full-time, your periods will probably not resume for a few months. The average among women who breast-feed exclusively is 8 months. But breast-feeding is not a dependable method of birth control. For more information, see Breast-feeding as birth control.

Most methods of birth control are safe and effective for breast-feeding mothers. Talk to your doctor about which type is best for you. For more information, see the topic Birth Control.