Most women will have their baby in the hospital, although some women opt to have the baby delivered at home. As a woman’s due date approaches, she should contact her obstetrician (OB) and/or go to the hospital if any of the following occur:

• The amniotic sac (which holds the fluid that surrounds and protects the fetus) ruptures. More commonly referred to as a woman’s water “breaking,” this occurs when there is a leak or break in the sac holding the amniotic fluid that surrounds the baby. Women may notice a leakage of fluid that can range from a trickle to a gush. When a woman’s water breaks, she should call the hospital or a physician immediately. A broken amniotic sac is vulnerable to infection.
  
  
• Bleeding from the vagina. Bleeding that is more substantial than mere spotting may be a sign that labor is beginning.
  
  
• Contractions arrive five minutes apart or less for at least one hour.
  
  
• Constant, severe pain ensues.
  
  
• There is a marked decrease in fetal movement.

After the woman is admitted to the hospital, she will be given an initial physical evaluation, which will include measuring her blood pressure, heart and respiratory rates, temperature and weight. The physician will also review the patient’s prenatal records. This is done to look for signs of potential complications and to review other valuable information. The physician also will monitor the fetus’ heart rate and may palpate (examine through touch) the fetus through the abdomen using a technique known as Leopold maneuvers. This can help the physician determine whether or not the fetus is lying in the proper position for safe delivery, with the head emerging before the rest of the body.

Once labor actually begins, it often lasts between 12 and 14 hours – or longer – for first-time mothers. Labor is usually shorter in subsequent births. Throughout labor, the heart rate of the fetus will be monitored either through listening (auscultation) or an ultrasound device. The heart rate is usually checked after each contraction.

In addition, women may receive various medications to numb discomfort during labor, or may use natural techniques to help block pain. Relaxation techniques such as breathing exercises also may help reduce discomfort.

Labor is divided into three distinct stages. Each stage has different phases:

• Stage one. Begins after the cervix dilates and effaces (thins out), and ends when the uterus is fully dilated. It is the longest stage of labor, and is divided into three separate phases:
  
  
• • Early labor. The cervix dilates from 0 centimeters to 3 centimeters, and mild to moderately strong contractions last 30 to 60 seconds, arriving every five to 20 minutes. If a woman has not previously experienced bloody show (blood that appears as the cervix dilates and capillaries rupture), it is likely to occur at this point. Many women also report symptoms such as backache, upset stomach, warmth in the abdomen and diarrhea.
    
    Early labor can last from several hours to several days. It is likely to be longer for first-time mothers.
    
    
  • Active labor. The cervix dilates to nearly 7 centimeters, and contractions become stronger and longer, lasting as long as 45 seconds to a minute or longer. Contractions are often two to four minutes apart. Many women report increasing pressure in their back during active labor. If a woman has not reported to the hospital by this point, she should now do so.
    
    Active labor usually lasts between three and eight hours, but may be shorter for women who have had a previous delivery.
    
    
  • Transition. The cervix dilates from 7 centimeters to 10 centimeters. This is usually the shortest stage of labor, but is often the most unpleasant. Contractions increase in strength and frequency, with time for only hurried breaths between contractions. Contractions quickly reach peak intensity and last up to 90 seconds.
    
    Many women feel increased pressure in the lower back and rectum, and may feel hot and sweaty for a minute, then cold and chilled. Transition can last between 15 minutes and three hours. Women who have had a previous vaginal delivery are likely to experience shorter transitions.
    
    
• Stage two. This is the phase in which the baby is actually born. Once the cervix is fully dilated, the baby must move down into the vagina. To facilitate this process, women are encouraged to push each time they have a contraction. Some women may find this to be more comfortable from a lying position, while others prefer squatting, sitting or getting on their hands and knees (or kneeling).
  
  As the baby moves deeper into the pelvis, the body and head will turn to make delivery as easy as possible. It can take from a few minutes up to several hours or more until the baby is born. Generally, it takes longer for first-time mothers and women who have received an epidural, an injection of anesthesia into the epidural space of the spine.
  

  

  In some cases, the physician may need to help the baby’s delivery. There are two ways to achieve this:
  
  
• • Forceps. An instrument that resembles two large spoons. These are gently placed on either side of the baby’s head, and the baby is pulled out of the womb.
    
    
  • Vacuum cups. A plastic cup is attached to the baby’s head using a vacuum pump, and the baby is gently delivered.
    
    
  Once the baby’s head has been delivered, the baby’s airway will be cleared. The physician or other healthcare provider will make sure the umbilical cord is free, and the rest of the baby’s body will follow.
  
  Infant nutrition experts recommend that physicians wait at least two minutes before clamping a newborn’s umbilical cord. Delaying cord clamping can boost iron reserves and prevent anemia for several months in babies, according to a new study. The umbilical-cord clamping procedure stops blood flow from the placenta to the baby in preparation for cutting the umbilical cord. Typically, the procedure is done within 10 seconds after a baby’s shoulders are delivered.
  
  After the baby is finally delivered, the umbilical cord is cut and the baby is washed off, weighed and measured. The physician also performs an APGAR test. This includes several measures that are taken at one minute and again at five minutes after birth. A score of 7 to 10 is considered normal, while a score of 4 to 7 might require resuscitative measures. Measures below 3 require immediate resuscitation. APGAR measures include:

• Stage three. After the baby is delivered, the uterus continues to contract. The placenta is typically delivered about five to 10 minutes after the baby has been delivered. In some cases, it may take up to 30 minutes. When the placenta is expelled, it usually comes out in a small gush of blood. If necessary, medications to help contract the uterus and decrease the amount of bleeding may be administered at this time. Mild contractions may continue for a while after the placenta has been delivered.
  
  The placenta will be examined to make sure it is intact and that there are no remaining fragments in the uterus that could cause bleeding and infection. The mother will also be examined to see if there is any need for stitches or other repair work. If stitches are required, a local anesthetic may be injected into the area.

Perineal pads are applied to soak up excess blood from the genital area. The physician will measure the amount of blood on these pads and will monitor blood pressure for several hours to ensure that the mother is not losing excessive amounts of blood.

The first hour after delivery is the time of greatest risk for postpartum complications. Postpartum uterine hemorrhage occurs in 1 percent of patients, and is more likely to occur after rapid or protracted labor, or uterine enlargement. It is a potentially life-threatening condition.