Discussing your birth plan with your spouse (or whoever will stand as your birth partner) essential as you hit your seventh month of pregnancy. If you haven't done so, the third trimester is the time to ask your doctor about the signs of labor, what to expect when it comes to pain, and the backup plan in case your desired way to deliver your child cannot happen.
SmartParenting.com.ph consulted with an ob-gyn, Mariel S. Nevado-Gammad, M.D., about the key things you need to know when you go into labor. There are three stages: the first is when you experience contractions until your cervix is fully dilated. Stage 2 is is when you push your baby out, while the last stage is when you birth your placenta.
1. How do I know if I'm already in labor?
First, distinguish true from false labor. Dr. Nevado-Gammad provides a comparison based on the book William's Obstetrics 24/E:
You're having false labor when...
You have Braxton Hicks Contractions. They're irregular contractions that do not increase in intensity or frequency. You may feel discomfort only in your lower abdomen that some pain medication should be able to address. When you go to the hospital, and your doctor checks your cervix, it's not dilating.
You're having true labor when...
You're experiencing regular contractions at intervals that gradually decreases, but the intensity continuously increases. You're feeling some discomfort on your back and abdomen that no pain medication can completely resolve. When you go to the emergency room, your cervix may already be dilated.
2. When should I rush to the emergency room?
Dr. Nevado-Gammad shares that she tells her patients to go immediately to the hospital if they experience any of the following:
- watery vaginal discharge
- bloody vaginal discharge or blood-stained mucus
- regular contractions
- if you feel that your baby isn't moving as much
Aside from these four signs, Dr. Nevado-Gammad adds that a pregnant woman should go to the hospital if she experiences any of the following during her nine months of pregnancy:
- blurring of vision
- severe headache
- severe nausea and vomiting
- severe abdominal pain
- painful urination
- swelling of hands, ankles, and face
3. When can I ask for pain meds?
"There is no fixed time when to give [anesthesia] since different women have different pain tolerance. At any point during the labor, they can ask for anesthesia," Dr. Nevado-Gammad explained. She added though that epidural anesthesia is usually administered during the active phase of labor only when the patient's cervix is approximately five to six centimeters.
Dr. Nevado-Gammad explains that if the patient is already fully dilated and with the baby almost coming out, the doctor will inject local anesthesia at the vulva as the baby passes through the birth canal. Two other anesthetic options are 1) pudendal block, another kind of local anesthesia that provides quick pain relief to the perineum, vagina, and anus, and 2) saddle block, which is administered in the spinal area that numbs the butt, inner thighs, hips, and the area between your legs.
The timing to administer pain largely depends on your doctor. That's why Dr. Nevado-Gammad suggests pregnant women make a birth plan and discuss it with your doctor.
General anesthesia, on the other hand, is usually reserved for emergency cases because "positioning of the mother will be difficult and the baby needs to be delivered as soon as possible," explained Dr. Nevado-Gammad. "Baby should be out in less than five minutes after administering general anesthesia," she stressed.
4. When should I start pushing?
Pushing the baby out only happens when you're already crowning, that is, when the head of the baby can be already seen in the perineum area. "We usually coach the mom to push during a contraction," Dr. Nevado-Gammad assures. "Contractions are very strong and may come every one to two minutes at this stage of labor."
Dr. Mariel S. Nevado-Gammad is a Fellow of the Philippine Obstetrical and Gynecological Society and the Philippine Society for the Study of Trophoblastic Diseases. She holds clinics at The Asian Hospital and Medical Center 771-0805; Medical Center Muntinlupa, Inc 861-1670; and The Premier Medical Center (865-2200 local 165).