During her pregnancy, a woman (and, ideally, her spouse or partner) may want to attend a childbirth education class, which will help her know what to expect before, during and after delivery. It is a good idea to take these classes during the 6^th to 7^th month of pregnancy.

The obstetrician (OB) is also an invaluable aid in understanding labor and delivery, and women should try to have all their questions answered during their prenatal visits.

Expectant mothers and their partners should establish a birth plan prior to delivery. During this process, a woman can develop a written plan of her labor and delivery preferences. The plan should be flexible, because labor and delivery is often unpredictable.

Preparation steps that can be taken include planning the hospital route, properly installing a baby seat in the car and planning for childcare, if necessary.

Prior to labor, pregnant women should decide whether they want to relieve pain through use of medication, or whether they prefer natural methods of pain relief. Pain relief through medication includes analgesia (which masks pain) and anesthesia (which eliminates pain).

The type of pain relief chosen depends on a number of factors, including the stage of labor or delivery. It is important that women try to get to the hospital promptly after labor begins, as pain medications may no longer be an option if labor moves too far along.

Methods of administering pain medication include the following:

• Epidural block. Delivery of regional anesthesia (through needle or catheter) into the epidural space around the spinal cord that partially or fully numbs the lower body. This method allows a physician to administer additional anesthesia as needed throughout labor. A lighter epidural allows the mother to feel enough that she is still able to push, which reduces the risk of stalled labor. It may also be used during Caesarean section (C-section) or post-birth procedures (such as tubal ligation).
  
  
• Spinal block. Also called spinal block, a method of pain relief that can be given to a woman during childbirth by injection into the spinal fluid. It provides immediate pain relief, but its effects last only up to a couple of hours. Longer deliveries may require additional injections. Although not as commonly used as epidurals, spinal blocks are sometimes used for C-sections and during difficult deliveries in which forceps are required.
  
  
• Combined spinal-epidural block (CSE). Also referred as a “walking” epidural, this method has the advantages of both epidural and spinal anesthesia. This type of pain relief is injected into the spinal fluid and into the space below the spinal cord. A CSE provides instant pain relief and additional medication can be administered – via a catheter – as needed throughout labor. The advantage of this procedure that has recently become more popular is that because it only numbs a woman’s abdominal nerves, it allows her to move around without discomfort for an extended period prior to delivery. Due to the combined technique in CSE there is rapid pain relief provided by the spinal part in addition to long-lasting, continuous relief through the epidural portion. However, a woman should assume that if she is going to get an epidural, she will not be able to ambulate until after the delivery, when the epidural is discontinued. In addition, a CSE requires a special technique and may not be available at all birthing centers or hospitals.
  
  
• Pudendal blocks. These drugs block pain between the vagina and anus (perineum) in cases when delivery of the baby needs to be assisted by vacuum extraction or the use of forceps. In this treatment, a local anesthetic (e.g., lidocaine) is injected into the pudendal nerve, through the vaginal wall shortly before delivery. Pudendal blocks can be used to relieve pain experienced after an episiotomy or a tear during delivery. Pain relief is localized and usually lasts for several minutes up to an hour. Pudendal blocks do not provide pain relief from contractions and they may slightly decrease a woman’s urge to push.
  
  
• Intravenous pain medication. Pain medication can be administered into the mother’s bloodstream through an intravenous catheter. This method is frequently used to relieve pain in early labor since the medication does get into the baby’s bloodstream and, ideally, it is out of the baby’s system before delivery. 

Some women may choose non-medicinal pain-relief techniques, which include acupuncture, hypnosis, relaxation and positive visualization techniques. It is important to discuss all these options with an OB. In addition, a woman will meet with an anesthesiologist after she is admitted to the hospital.

Prior to normal labor, a woman’s body usually will offer several cues that the process is about to begin. These differ from woman to woman, and may be more subtle for some women than for others.

Changes that may signal impending labor include:

• Lightening. As a woman’s pregnancy enters its final stage, the baby may begin to settle deeper into the pelvis. This process is known as lightening. During lightening, a woman may notice a change in the shape of her abdomen and a feeling that the baby has become less heavy. The baby’s new, lower position often makes it easier for the mother to breathe as there is less pressure on the diaphragm. However, this benefit to the lungs is somewhat offset by the fact that the baby is now exerting increased pressure on the bladder, which can make the mother need to urinate more frequently
  
  In an initial pregnancy, lightening usually takes place weeks or days before labor begins. In subsequent pregnancies, it may not occur much in advance of actual labor.
  
  
• Effacement. Prior to birth, the cervix begins to soften and thin, a process known as effacement. The only way to detect effacement is for a physician to examine the cervix during a vaginal exam. The degree of effacement is expressed as a percentage from 0 to 100, and the cervix must be completely thinned out prior to vaginal delivery.
  
  
• Dilation. The closer a woman gets to delivery, the more her cervix opens, a process known as dilation. A physician measures the degree of dilation in centimeters from 0 to 10. Many women dilate very slowly until labor begins, when dilation quickly increases.
  
  
• Bloody show. Throughout a woman’s pregnancy, a thick plug of mucus develops that walls off the cervical opening from the outside. This helps prevent bacteria from entering the uterus. As the cervix thins during effacement, the plug is sometimes lost. A woman may notice this as stringy mucus or a thick, brownish mucus that sometimes contains blood. The loss of the mucus plug is often – although not always – a sign of impending labor.
  
  
• Nesting. Women sometimes feel a burst of energy to make preparations for their new baby, such as cleaning or arranging baby clothes. This feeling is often strongest just prior to labor.
  
  
• Contractions. Initially, a woman may experience irregular bouts of rhythmic tightening and relaxation of the uterus. These are known as Braxton Hicks contractions and they do not indicate impending labor.
  
  However, eventually a woman will experience contractions that do indicate labor is about to begin. There are several characteristics to contractions that signal impending labor:

Once a woman experiences these types of contractions, she should call her physician. Ultimately, the only way to determine whether or not contractions indicate true labor is to check for the telltale signs of cervical dilation and effacement.