For centuries giving birth was strictly an affair between the pregnant woman and a midwife. Though not always present, a mid-wife would frequently aid in the birthing process. The role was often performed by an older woman who had previously experienced birth herself. She gave comfort, medical knowledge based on real experience and a second pair of hands at a critical time.

With the rise of obstetrics in the 19th century, midwifery became much less common, almost disappearing from birthing practice in the U.S., except in circumstances of deep poverty or geographic isolation. In recent decades, it has risen again in a new form in which midwives are often licensed nurses with considerable traditional medical experience.

Though midwifing was historically carried out in the home, modern practitioners carry out their work in hospitals almost entirely today. Many women want to have the services of a midwife, but still avail themselves of the advantages of modern medicine in a traditional hospital setting.

In the overwhelming majority of births, the midwife has to take little active part in the process. She provides assurance, a hand to hold and ‘insurance’ in the form of letting the woman know that, should the need arise, an expert is at hand. But their presence and practice goes far beyond or rather before labor.

Midwives are available for pre-natal visits, and they offer one-on-one advice, much as an obstetrician will do – though frequently at lower rates. They are often there for much more of the time during the entire process, too, once labor starts. Many obstetricians have more patients than any single person can care for, even working 14 hour or longer days (as many of them do). A midwife can usually devote exclusive attention to a woman during labor.

They will be there at the beginning of the birthing process, continuously up to and after the completion of birth. Having a trusted and experienced medical expert at the bedside for the entire time is a great comfort to many. That’s especially true for first time mothers, for whom the experience can be naturally a bit scary.

Midwives have the medical knowledge and the available technology to handle any situation. Breech births, preclampsia and other potential complications are nothing new to a good midwife. They can carry out needed tests – for iron levels, blood pressure and the like. And they can seek additional help, acting as an expert liaison when a woman may have other things on her mind. All midwives have an active working relationship with an obstetrician.

Midwives can be found through recommendations from friends or you can seek one by contacting the American College of Nurse Midwives in Washington, DC. The ACNM website (http://www.acnm.org/) is a good place to start your search.

Once the first stage of labor is passed, the placental sac has broken, the cervix has dilated and contractions are regular and frequent, the second stage of labor – actual delivery – begins. Of course, there’s no bright line dividing the first from the second. Where one leaves off and the other begins will vary from woman to woman and birth to birth.

There’s a wide variation among women in many aspects of the process. The length of time is different for everyone and from child to child. The amount of pain differs. And the post-birth consequences will vary for each individual person and baby. In 75% of women who carry to term, delivery is within 12 hours. Only 2% will be in labor for more than 24 hours.

During the active delivery phase contractions are frequent, though there are breaks in between. Here that training you spent so many hours to practice kicks in. Proper breathing technique differs between the resting phase and the contraction and pushing phase. Use both.

Drugs are an option but both mothers and physicians try to keep them to a minimum. Anything the mother receives still makes its way into the child. Pain medication crosses the placenta and can slow the baby’s heart rate and make breathing sluggish.

Analgesics are enough for most women, but they can produce side effects such as rapid heartbeat or nausea. A regional block may be appropriate for some women. This can offer pain relief without interfering with the ability to push, but it’s not for everyone. Hot pads, ice packs and a hand to hold can often substitute for the time needed to get through the toughest phases.

Develop a plan with your physician well in advance to cover all the possibilities.

Transition is the interval during which the cervix dilates the final two centimeters (about an inch). It produces the most intense and frequent contractions, but may last only a few minutes. Rarely is it longer than an hour. Here again, breathing techniques and a good partner are great aids to staying focused and minimizing pain.

Deep breaths are best for those resting periods, short and sharp ones for the period of active pushing. Shallow chest breathing is best for the most intense contractions. This helps keep the blood well oxygenated and the mother focused as well as possible on something other than the pain.

When the widest part of the baby’s head has moved into the birth canal, the second stage has begun in earnest. Contractions slow to four or five minutes apart. When the head is even with the lower pelvic bones, it’s said to be at ‘0′ station. It will progress through 1, 2, 3, and so on, measured by the baby’s exit.

The excitement rises as the baby becomes clearly visible. Tiring by this time is normal, but adrenaline helps keep most mothers at it during this final stage. Then, success!

In days past it would often take weeks to get the results of a pregnancy test, after a visit to your doctor. Today, you can have the answer in minutes.

Home pregnancy tests work much the same way as those carried out by professional labs. Both test for the presence and level of a hormone called hCG (Human Chorionic Gonadotropin) in blood or urine. Blood samples are considered more reliable, but certainly less pleasant, particularly for home tests. Most of them test urine.

Two criteria chiefly determine the worth of a home pregnancy test: readability and sensitivity.

Readability is partly a subjective issue, though some tests are definitely easier to interpret than others. Some show you a number, others match a color strip against a stated result. Many these days just say ‘Pregnant’ or ‘Not Pregnant’ in some form. Which you choose depends largely on personal taste.

The time to get a result is no longer a factor. In fact, if you wait too long to read the results the indicator becomes unreliable. Also, contemporary over-the-counter products from any major manufacturer are reliable. False negatives and false positives aren’t completely absent, but they affect fewer than 5% of cases.

One major component of that reliability score lies as much in the two criteria as in the quality of the test. As tests have become more and more sensitive, the level of false positives has a tendency to go up. For example, women who have recently given birth or miscarried may have elevated levels of hCG present even when they are not pregnant. Certain medications can increase the level as well.

As a result, tests which measure low levels can give a misleading result. Keep in mind that no HPT (Home Pregnancy Test) measures pregnancy directly. The only way to do that is to actually examine the implantation of the fertilized egg into the womb, a procedure that (so far) can’t be carried out at home. So, an indicator is measured as a proxy and that indicator can be high for other reasons, such as those above.

Some HPTs can measure hCG levels as low as 25 mIU/ml (milli International Units per milliliter). The abbreviated unit after the number is complicated, but not important to the home consumer. Just look at the sensitivity rating of the test and compare. In order to reduce false positives, tests can be designed not to give a ‘Pregnant’ indication until higher levels are reached. Many measure levels at 50 mIU/ml or even at or above 100 mIU/ml.

But raising those levels to be less sensitive means introducing two potential problems.

One, if the test detects hCG only at higher levels, you have to be pregnant longer before the body builds up to that level. That reduces the value of a home test, many of which are labeled EPT (EARLY Pregnancy Test) for a reason. The other potential problem is closely related. It can introduce false negatives, you really are pregnant, but the test tells you that you’re not.

For most women, these issues are not major. A home pregnancy test is a great convenience, but once you get a positive result it should be followed up with another from your physician. Also, many HPTs come with multiple strips. Test once, then test again a week later. If you get the same result, the odds are much higher that the test is valid.

Follow the instructions carefully and you can be confident that the test is telling you the truth, in 95% or more of cases. Those are pretty good odds, all things considered.

There are a variety of tests that an expectant mother can have performed to gain information about the health of her growing fetus. Some, like amniocentesis, have been around for over 100 years. Ultrasound was introduced in the 1960s, though early tests had limited value. Modern tests are much clearer, some even in 3-D, many showing motion.

Today, ultrasound is clear, simple, and (as medical tests go) relatively inexpensive. Most are covered by standard insurance plans that cover pregnancy.

Also called sonography or just ‘a scan’, the woman’s abdominal area is exposed to harmless ultra-high frequency sound waves. The echoes are then recorded and interpreted by a computer program – then projected onto a screen. The basic principle is similar to that used in fishing boats, submarines and other applications.

Unlike X-rays they produce no ionizing radiation, though the sound waves still carry energy. Nevertheless, the procedure is safe and painless. It has the added advantage that it can examine soft tissues that don’t show up as clearly in x-rays, and the images are displayed in real-time. Since there are no ill-effects produced by the test, it can be repeated as often as desired as the fetus develops.

The technician (often your physician) uses a small, hand-held wand that travels over the surface of the skin. A clear gel is applied to the skin beforehand to eliminate air between the wand and the surface, producing improved results. Unlike amniocentesis and other tests, it’s non-invasive and the preliminary results are available immediately. It takes no more than half an hour.

More extensive analysis of the results can be performed by a trained specialist, if desired. A report is typically sent to your physician. From the results, doctors can detect physical abnormalities, tissue rupture, bleeding or simply whether problem implantation has occurred.

But apart from detecting potential problems, the test is used to provide useful information. It can reveal sex and age and record at the development process. It can also show the physical location of the baby within the womb. That helps determine if a breech birth is likely and other potential positioning issues. With that advanced look, delivery can be better planned.

The procedure has limitations, however. Ultrasound waves, unlike regular sound waves, don’t travel as efficiently through air. As a result, any areas where air pockets exist – such as the stomach itself – won’t yield as much information. Also, they don’t penetrate bone as well as x-rays and the waves are dampened as they pass through fatty tissue. The results may be less useful for obese women.

Those limitations can be overcome by supplementing ultrasound with other tests, such as amniocentesis and others that use chemical indicators to give useful data about the baby’s health.

It can be difficult to know exactly when labor begins in earnest. But some signs are unmistakable. One such occurs when your new baby’s head exerts pressure on the amniotic sac and it breaks. When your ‘water breaks’ (the liquid isn’t just water, but amniotic fluid), labor is imminent.

Unfortunately, ‘imminent’ doesn’t mean ‘will occur within 10.5 hours’ or any exact amount of time. The time to the beginning of regular contractions and actual delivery, can vary enormously from woman to woman and even child to child.

Nevertheless, when you feel that trickle or gush of colorless fluid flow down your leg, it’s time to get ready. On average, labor will begin within 12 to 24 hours later. For some, the time is much sooner.

Note the time, wipe away the fluid and clean the vagina to minimize the risk of infection. Don’t bathe. Look for any green or brownish fluid, the meconium, which is from your baby’s bowel movement. That’s an indicator of fetal stress and should be reported to your physician immediately.

Contractions will follow shortly.

The uterus is a muscle and one of its roles is to force the baby out into the world through the birth canal. The contractions you feel are that muscle tensing. They will usually be preceded by dull cramps in the lower back or pelvis. When they happen regularly for an hour, lasting at least 30 seconds each, gaining in intensity, actual labor has started.

Since they can vary from woman to woman, try to verify that the contractions are labor by varying your position. Move around and sit. See if they still occur. Remember to keep a close eye on the clock or your watch. Timing the events is important.

First pregnancies will often take a little longer, so try to avoid any sense of panic. When contractions are coming five minutes apart for an hour, it’s time to head to the hospital. Err on the side of caution, though. The number is just an average and it’s best to avoid complications by being too early, rather than too late.

Severe pain, rather than regular (even if uncomfortable) contractions can be a sign of placenta previa. This is a condition in which the placenta can block the exit from the uterus. Or, the pain can be the result of placental abruption, where the placenta separates but limits the baby’s oxygen supply. Call your doctor.

Almost all labors proceed without incident. Stay calm, execute your plan and get ready for a healthy baby.

Some women understandably wish from time to time that a baby could be delivered by Fed Ex. After nine months of hormonal changes, carrying extra weight and reduced movement many will want to just get it over. But the race is won at the final leg and Lamaze, Bradley or other options can help carry you over the finish line in optimal shape.

Women, obviously, have been giving birth for hundreds of thousands of years. The basic process has changed little over that time. But medical knowledge has grown by leaps and bounds.

During the mid-19th century that knowledge consisted of a growing set of tools and drugs to minimize pain. By the mid-20th century, though, birth was almost something that happened to a woman and her baby, rather than something they did. Contemporary knowledge can help the expectant mother take more active control of her birth and deliver with the highest chances for her baby’s health.

The Bradley method was devised by Dr. Robert Bradley in the 1940s. The emphasis was, and is, on a set of techniques to deliver without the use of drugs. There are pros and cons to the approach, since anything a mother receives will affect the baby. With the drugs designed today, and the dosages low enough, the odds of harm are very low. Completely drug-free births are not entirely without risks either.

The uncontroversial aspect of the Bradley method is its use of breathing techniques that aid the woman during periods of non-contraction. Relaxation techniques are helpful at those moments to prepare for more active moments. The deep breathing taught in Bradley classes is a positive benefit.

Lamaze has its own proponents and detractors, and more similar reasons. Developed by a French physician and popularized in the 1960s, it too emphasizes ‘natural’ childbirth. It discourages use of pain control drugs, in favor of hot and cold packs, positioning and breath control.

The Lamaze breathing techniques, like Bradley, are helpful – more so during the more active parts of delivery. The rapid, in-out-in intake of air helps fully oxygenate tissues and control pain. The focus required to maintain that breathing, while also focusing on the need to push in the proper way helps keep the mother’s mind off the pain and onto the process.

Both Bradley and Lamaze classes emphasize the importance of having a birth partner to assist in delivery. That can be a friend, spouse or even a midwife. Having that person there is an emotional comfort. Either professionally, or thanks to the classes, they’ll have an (at least theoretical) understanding of delivery. They help maintain focus, provide physical assistance in positioning and offer a friendly face in what might be an emotionally cold environment.

Mothers should consider carefully all their options. There’s no need to rule out modern medical technology. Being aware of the risks and benefits of anesthetic and some of the common potential problems can help you prepare. The more information you have, the better you can rationally examine options ahead of time. That helps you make better decisions at a time when you have other things on your mind.

The most common symptom you’ll hear about and may experience during the first trimester is morning sickness. Your body is undergoing so many changes, it’s really quite impossible not to have any symptoms. Not all women will experience morning sickness, while others have a hard time with it. Everyone’s different, and you won’t know what your symptoms will be like until you experience them yourself.

Also, expect to feel tired and fatigued a lot of the time. Again, your body is reacting to the many changes going on. Don’t fight these changes. If you get tired, rest and go easy on yourself. You’re not pregnant the rest of your life, just for nine months or so! One way to help with the fatigue is to make sure to drink a lot of water. This will also help with any constipation you might have to deal with. And yes, you most likely will experience that and other unpleasant symptoms!

Your breasts might become extra sensitive or even swollen. This is normal. It’s a natural progression for your breasts to develop more fully and prepare for breastfeeding after the baby is born. Whether you decide to breastfeed or not, your body will prepare for it.
After your first trimester, that tiny being growing inside of you will now have developed their main organs. It’s truly amazing to realize the phenomenal growth process that’s going on. Just wait until you get to have your first ultrasound, and actually SEE inside the womb!

Some women understandably wish from time to time that a baby could be delivered by Fed Ex. After nine months of hormonal changes, carrying extra weight and reduced movement many will want to just get it over. But the race is won at the final leg and Lamaze, Bradley or other options can help carry you over the finish line in optimal shape.

Women, obviously, have been giving birth for hundreds of thousands of years. The basic process has changed little over that time. But medical knowledge has grown by leaps and bounds.

During the mid-19th century that knowledge consisted of a growing set of tools and drugs to minimize pain. By the mid-20th century, though, birth was almost something that happened to a woman and her baby, rather than something they did. Contemporary knowledge can help the expectant mother take more active control of her birth and deliver with the highest chances for her baby’s health.

The Bradley method was devised by Dr. Robert Bradley in the 1940s. The emphasis was, and is, on a set of techniques to deliver without the use of drugs. There are pros and cons to the approach, since anything a mother receives will affect the baby. With the drugs designed today, and the dosages low enough, the odds of harm are very low. Completely drug-free births are not entirely without risks either.

The uncontroversial aspect of the Bradley method is its use of breathing techniques that aid the woman during periods of non-contraction. Relaxation techniques are helpful at those moments to prepare for more active moments. The deep breathing taught in Bradley classes is a positive benefit.

Lamaze has its own proponents and detractors, and more similar reasons. Developed by a French physician and popularized in the 1960s, it too emphasizes ‘natural’ childbirth. It discourages use of pain control drugs, in favor of hot and cold packs, positioning and breath control.

The Lamaze breathing techniques, like Bradley, are helpful – more so during the more active parts of delivery. The rapid, in-out-in intake of air helps fully oxygenate tissues and control pain. The focus required to maintain that breathing, while also focusing on the need to push in the proper way helps keep the mother’s mind off the pain and onto the process.

Both Bradley and Lamaze classes emphasize the importance of having a birth partner to assist in delivery. That can be a friend, spouse or even a midwife. Having that person there is an emotional comfort. Either professionally, or thanks to the classes, they’ll have an (at least theoretical) understanding of delivery. They help maintain focus, provide physical assistance in positioning and offer a friendly face in what might be an emotionally cold environment.

Mothers should consider carefully all their options. There’s no need to rule out modern medical technology. Being aware of the risks and benefits of anesthetic and some of the common potential problems can help you prepare. The more information you have, the better you can rationally examine options ahead of time. That helps you make better decisions at a time when you have other things on your mind.

For centuries giving birth was strictly an affair between the pregnant woman and a midwife. Though not always present, a mid-wife would frequently aid in the birthing process. The role was often performed by an older woman who had previously experienced birth herself. She gave comfort, medical knowledge based on real experience and a second pair of hands at a critical time.

With the rise of obstetrics in the 19th century, midwifery became much less common, almost disappearing from birthing practice in the U.S., except in circumstances of deep poverty or geographic isolation. In recent decades, it has risen again in a new form in which midwives are often licensed nurses with considerable traditional medical experience.

Though midwifing was historically carried out in the home, modern practitioners carry out their work in hospitals almost entirely today. Many women want to have the services of a midwife, but still avail themselves of the advantages of modern medicine in a traditional hospital setting.

In the overwhelming majority of births, the midwife has to take little active part in the process. She provides assurance, a hand to hold and ‘insurance’ in the form of letting the woman know that, should the need arise, an expert is at hand. But their presence and practice goes far beyond or rather before labor.

Midwives are available for pre-natal visits, and they offer one-on-one advice, much as an obstetrician will do – though frequently at lower rates. They are often there for much more of the time during the entire process, too, once labor starts. Many obstetricians have more patients than any single person can care for, even working 14 hour or longer days (as many of them do). A midwife can usually devote exclusive attention to a woman during labor.

They will be there at the beginning of the birthing process, continuously up to and after the completion of birth. Having a trusted and experienced medical expert at the bedside for the entire time is a great comfort to many. That’s especially true for first time mothers, for whom the experience can be naturally a bit scary.

Midwives have the medical knowledge and the available technology to handle any situation. Breech births, preclampsia and other potential complications are nothing new to a good midwife. They can carry out needed tests – for iron levels, blood pressure and the like. And they can seek additional help, acting as an expert liaison when a woman may have other things on her mind. All midwives have an active working relationship with an obstetrician.

Midwives can be found through recommendations from friends or you can seek one by contacting the American College of Nurse Midwives in Washington, DC. The ACNM website (http://www.acnm.org/) is a good place to start your search.

It can be difficult to know exactly when labor begins in earnest. But some signs are unmistakable. One such occurs when your new baby’s head exerts pressure on the amniotic sac and it breaks. When your ‘water breaks’ (the liquid isn’t just water, but amniotic fluid), labor is imminent.

Unfortunately, ‘imminent’ doesn’t mean ‘will occur within 10.5 hours’ or any exact amount of time. The time to the beginning of regular contractions and actual delivery, can vary enormously from woman to woman and even child to child.

Nevertheless, when you feel that trickle or gush of colorless fluid flow down your leg, it’s time to get ready. On average, labor will begin within 12 to 24 hours later. For some, the time is much sooner.

Note the time, wipe away the fluid and clean the vagina to minimize the risk of infection. Don’t bathe. Look for any green or brownish fluid, the meconium, which is from your baby’s bowel movement. That’s an indicator of fetal stress and should be reported to your physician immediately.

Contractions will follow shortly.

The uterus is a muscle and one of its roles is to force the baby out into the world through the birth canal. The contractions you feel are that muscle tensing. They will usually be preceded by dull cramps in the lower back or pelvis. When they happen regularly for an hour, lasting at least 30 seconds each, gaining in intensity, actual labor has started.

Since they can vary from woman to woman, try to verify that the contractions are labor by varying your position. Move around and sit. See if they still occur. Remember to keep a close eye on the clock or your watch. Timing the events is important.

First pregnancies will often take a little longer, so try to avoid any sense of panic. When contractions are coming five minutes apart for an hour, it’s time to head to the hospital. Err on the side of caution, though. The number is just an average and it’s best to avoid complications by being too early, rather than too late.

Severe pain, rather than regular (even if uncomfortable) contractions can be a sign of placenta previa. This is a condition in which the placenta can block the exit from the uterus. Or, the pain can be the result of placental abruption, where the placenta separates but limits the baby’s oxygen supply. Call your doctor.

Almost all labors proceed without incident. Stay calm, execute your plan and get ready for a healthy baby.