Labor and Delivery

Labor is a series of progressive and continuous contractions of the uterus that help the cervix to open and thin, allowing the baby to travel through the birth canal. Labor usually starts within two weeks before or after your estimated delivery date. However, this can vary widely.

Labor and delivery are hard work and involve some discomfort. The level of discomfort experienced during childbirth varies from woman to woman and from pregnancy to pregnancy. Each woman chooses a different way to experience her birth — some prefer to go through it without medication, while others choose to have medication or anesthesia. Many decide to "see how it goes" and make choices as their labor unfolds.

We offer a spectrum of options for managing your pain during labor and delivery. You will be assigned to your own nurse during your stay in the birthing suite. He or she will help keep you comfortable and guide you through non-drug approaches to pain management, such as whirlpool soaks and position changes.

Pain Management

Non-Medical Approaches for Labor and Vaginal Birth

The Birth Center rooms provide a number of options for comfort during labor including space to move around, tubs for soaking, rocking chairs and beds that convert into different positions.

Relaxation and breathing techniques ease the discomfort for many, as does the presence of family and friends and the support of health care providers. Comfort measures can be learned from classes, books or videos available through UCSF's Great Expectations Pregnancy Program.

Medical Approaches for Labor and Vaginal Birth

  • Narcotic — Injections of a narcotic can be given intravenously (through an IV) during labor. The narcotic works quickly and can be given every hour during labor. However, it is not given immediately before delivery to ensure that the effects will have worn off before the baby is born. For some women, this medication takes the edge off and allows them to rest and relax between contractions.
  • Nitrous oxide gas — This is the same gas that is used at the dentist, and can be inhaled during contractions through a mask you hold. The gas can lessen but not eliminate the pain of labor. The effect occurs only while the gas is being inhaled and disappears rapidly when the mask is removed. It can be used through delivery.
  • Epidural anesthesia — An epidural offers the most complete pain relief during labor and birth. A tiny tube or catheter is placed through a needle into a space (the "epidural space") outside the spinal cord sac in the lower back. The needle is removed and the tubing is taped in place. Similar to an IV, medication is given continuously through the tube during labor and birth. The medication blocks the pain of contractions.

    Because of the numbness produced by the epidural, a woman with an epidural cannot get out of bed. Most women take the opportunity to get some rest. A "walking epidural" — also called a "combined spinal-epidural" — is a technique that allows a woman to continue to move around while receiving a lighter form of medication.

Our anesthesiologists are available to the Birth Center 24 hours a day. The anesthesiologist on-call meets every woman who is admitted in labor regardless of whether she is planning anesthesia for her birth. The purpose of this visit is two-fold: To learn of any medical problems you may have in the unlikely event of an emergency, and to answer any questions you may have about the pros and cons of medical approaches to pain relief during labor.

Caesarean Birth

When a Caesarean is Needed

While most women will have a vaginal delivery, some may need abdominal surgery referred to as Caesarean section. Most often women have a Caesarean birth when labor does not progress — the cervix does not completely dilate or the baby cannot be pushed out — over a long period of time. It is a decision made by the woman and her doctor when both feel everything else has been tried and this is the only alternative.

Sometimes a Caesarean birth is planned. Situations that might require a scheduled Caesarean include:

  • Breech position
  • Previous Caesarean section
  • Placenta previa, when the placenta is covering the cervix

Rarely, Caesarean birth is due to an emergency situation that endangers the woman's or her baby's health. In these situations, there is no time to wait for the regular process of labor and the decision to perform a Caesarean section must be made very quickly. Indications for an emergency Caesarean may include:

  • Maternal bleeding
  • The baby being in distress

Anesthesia for Caesarean Section

For a planned or non-emergency Caesarean, an epidural or spinal anesthesia is the anesthesia of choice. This allows the woman to be awake and able to see her baby immediately after birth. In an emergency situation, the woman would be put to sleep using general anesthesia. This is the fastest anesthesia to administer when time is of the essence.

If the woman is awake, a support person can be with her for the birth. If general anesthesia is used and the woman is asleep, support people need to wait in the labor room or waiting room until the surgery is completed.

Caesarean Procedure and Recovery

Most often, the doctor will make a low transverse incision — a "bikini cut" — both on the skin, just above the pubic hair, and on the uterus itself. This is a preferable cut for both comfort and recovery. Occasionally an "up and down" or vertical incision is made on the skin, uterus, or both. This is a faster cut and may be used in an emergency. The size and position of your baby also may determine the need for this kind of incision.

Recovery from surgery takes longer than recovery from a vaginal birth. Usually it requires an extra night or two in the hospital, for a total of three to four nights, and more help at home in the first few weeks.

Many women choose to attempt a vaginal birth after Caesarean, called VBAC, and many will succeed. Every woman who has had a Caesarean will need to discuss the subject of VBAC with her provider. Many factors — including the reason for the Caesarean, the type of incision and the number of prior Caesareans — will influence the safety of VBAC.

Birth Plans

You will be provided with a Birth Plan, a form asking about your preferences for delivery. This promotes communication with your health care provider and helps them meet your individual needs. You will complete your Birth Plan and discuss it with your health care provider at your 34 to 36 week visit.

Make photocopies of your Birth Plan. Give one to your health care provider to put in your medical record, and bring one with you when you come to the hospital in labor.

Reviewed by health care specialists at UCSF Medical Center.