Labor and Delivery

If you experience any of the warning signs listed below or have other symptoms you feel aren’t normal, call your doctor immediately.

Preterm labor (three weeks or more before your due date)

• Contractions – more than four in an hour
• Menstrual-like cramps – may come and go or be constant
• Abdominal cramps – may occur with or without diarrhea
• Pelvic pressure – feels like the baby is pushing down
• Change in vaginal discharge – a sudden increase in the amount, or it may become more mucous-like, watery or tinged with blood
• Low backache – comes and goes or may be constant

Vaginal bleeding
Bright red vaginal bleeding isn’t normal. Call your doctor, and note the following details:

• Amount
• If clots are present

Abdominal pain

• Severe nausea and vomiting
• Severe abdominal pain, especially if you are also experiencing bleeding, nausea or vomiting

Swelling

• Sudden and severe swelling of hands, face or eyes, especially if accompanied by headache or blurred vision
• Sudden weight gain of more than two pounds accompanied by swelling of hands and face

Decreased Fetal Movement
You may choose to use a fetal activity chart during the last weeks of pregnancy to track movement. Seek medical attention if you notice the following:

• Absence of movement for 24 hours after the sixth month
• Significant lessening of movement

Fever

• A fever of more than 100.4° F can be dangerous. Call your doctor immediately.

Headache

The UT Center for Women's and Children's Health offers the only full service obstetric center including High Risk Obstetrics and High Risk Nurseries in East Tennessee.

For information about the Labor and Delivery and the Postpartum areas, to arrange a tour or to simply ask questions, please call us at 865.305.9300.

How to tell the difference between true and false labor

It can be hard to tell the difference between true and false labor, especially for first-time mothers. If you’re not sure, call your healthcare provider – and here are some general guidelines to help:

• True labor
• Contractions occur at regular intervals
• Intensity of contractions increases
• Intervals between contractions shorten
• Pain in abdomen and lower back
• Walking doesn’t help relieve pain
• Cervix dilates
• Thick pink discharge often present (“show”)
• Bag of water may rupture
• False labor
• Contractions occur at irregular intervals
• Intensity doesn’t change much
• Interval between contractions doesn’t shorten
• Pain primarily in lower abdomen
• Walking helps relieve pain
• Cervix doesn’t dilate
• No vaginal show
• Bag of water remains intact

The Stages of Labor
There are three basic stages of labor:

The First Stage of Labor begins with the start of true labor and ends when the cervix has dilated to 10 centimeters. It’s usually the longest stage, generally lasting from 12-16 hours for first-time moms and 6-7 hours for women who already have one or more children. There are three phases within the first stage of labor:

• The early phase generally lasts about eight hours, from the start of labor until your cervix has dilated to three centimeters. Many women are excited and social during this phase – but remember, it’s important to conserve your energy.
• The active phase averages four to five hours and dilates your cervix to seven centimeters. Contractions become longer and stronger, and you’ll focus more and more on the process.
• The transition phase is the shortest phase of the first stage – which is a good thing, because it’s often the hardest phase. During this phase, contractions will grow so strong that your cervix will dilate to ten centimeters.

The Second Stage of Labor starts when the cervix is fully dilated and concludes when the baby is born. The length of this phase can vary from one contraction to about two hours. You’ll feel a strong urge to push – but pushing too early can cause your cervix to swell, which will delay delivery even more. Your doctor or nurse will tell you when it’s time – and then, you’ll push your baby through the birth canal until it’s born.

The Third Stage of Labor lasts just five to 15 minutes. It begins after the baby is born and ends with the delivery of the placenta.

Cesarean birth
In a Cesarean birth or Cesarean section, the baby is delivered through an incision in the mother’s abdominal wall. This procedure is only performed when there’s a concern about your health or the health of your baby.

Some women who’ve experienced a Cesarean birth have feelings of disappointment afterward, especially if they were hoping to have a vaginal birth. If this happens to you, don’t blame yourself or feel inadequate because a vaginal birth wasn’t possible – the health of you and your baby is all that matters. After all, you will have given birth!

Here are some of the most common reasons Cesarean sections are performed:

• Celphalopelvic disproportion (CPD)
  As its name implies, this condition occurs when the mother’s pelvis and the baby’s head are disproportionate – that is, the baby’s head or body is too big for the mother’s pelvis.
• Fetal distress
  When fetal monitoring suggests that the baby isn’t tolerating labor well, your physician may order an emergency cesarean.
• Abnormal presentation
  Usually, the back of the head is delivered first – but sometimes, the baby comes out of the birth canal with face or forehead first. This is called abnormal presentation and can cause a problem – your doctor will recommend the safest way for you to deliver your baby.
• Breech presentation
  A breech presentation is when the baby is positioned so that its feet or buttocks will be born first, rather than its head. If your baby isn’t in the right position, your doctor may manipulate your abdomen to try and turn the baby before labor begins. However, this generally isn’t an option if you’re in active labor – a Cesarean may be recommended.
• Transverse lie
  Transverse lie babies are in a horizontal position in the mother’s uterus. If your baby is in this unusual position, your doctor will probably order a Cesarean.
• Placenta problems
  There are a variety of problems with the placenta, the organ that nourishes the baby in utero, which can make a Cesarean delivery a good option. The placenta can detach from the wall of the uterus prematurely, for example.
• Cord problems
  Problems with the umbilical cord, the cord that connects the baby to the uterus, can also cause a Cesarean delivery. Examples of cord problems include when the cord is looped around the baby’s neck or another part of the baby.
• Ineffective contractions and/or progress of labor
  Occasionally, labor gets “stuck” –little progress is made because contractions aren’t effectively dilating the cervix. Your doctor may decide to perform a Cesarean if the bag of waters burst over 24 hours ago and labor isn’t progressing.

Would you like to see our Labor and Delivery Unit?

Would you like to tour the unit. Please call 865.305.9300?

• Severe headache
• Seeing spots or flashing lights
• Other neurological symptoms, including:
• Numbness
• Loss of vision
• Weakness
• Loss of balance
• Speech difficulty
• Fainting or dizziness

Urinary discomfort

• Frequent urination with small amounts of urine
• Painful urination, especially when accompanied by fever, chills and backache
• Blood-tinged urine
• A sudden increase in thirst, accompanied with no desire to empty your bladder