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INTRODUCTION

I want labor to begin on its own

I had really hoped for a natural labor, but when I went to the doctor for my 39wk visit, he told me that he induced all of his patients if they hadn’t gone into labor by three days after their due date. Unfortunately, my labor did not start on it’s own and so I went to the hospital for my induction. My cervix was only dilated one centimeter, so they first had to soften it. They put a pill in my vagina every few hours and then, once I was dilated enough, they broke my water and started pitocin. The contractions were really intense and so I ended up asking for the epidural after about eighteen hours into the induction. After twenty-four hours, I hadn’t dilated past six centimeters and my doctor said it had been going on too long and my baby was in danger of an infection, so they took me back for a cesarean. I often wonder what would have happened if we had just waited.

—P. S., new mother

SPONTANEOUS LABOR PROCESS

Spontaneous labor is best described as the gradual process by which the cervix goes from being a strongly contracted structure that holds the baby within the uterus to a completely relaxed structure that lets the baby out. It is helpful to think of the circular smooth muscles and collagen of the cervix as a tightly bound spool of ribbon, forming a thick, firm base for the uterus. As the longitudinal muscles of the body of the uterus contract, the structure of the cervix relaxes, causing the cervix to slowly thin and open, just as a spool of ribbon unwinds (Figure 5-1).

The melting away of the firm structure of the cervix, until it is flush against the baby’s head, is referred to as effacement and as the cervix both opens and effaces, the baby is able to descend lower and lower into the pelvis. Once the cervix has completely relaxed and retracted behind the baby’s head, the woman uses her abdominal muscles to push the baby down through the lower bony structure of the pelvis and out through the soft tissues of the vagina.

For most women, the first signs of labor are subtle. The baby engages in the pelvis, with increasing sensations of pressure along the pubic bone and lower pelvis. The mother may feel cramping sensations in the upper thighs and lower back pain and shooting vaginal discomfort. The cervix will begin to soften and open, frequently indicated by more significant amounts of vaginal discharge and the passage of the mucus plug, a thick collection of cervical mucus that is yellow or brown in color, occasionally containing small streaks ...

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