~*Roleplaying Pregnancy, Warning: Graphic*~

First Trimester

You Are 4 Weeks Pregnant (1st Month)

Physically, you may be experiencing any of the following symptoms: missed period, nausea, vomiting, dizziness, headaches, bloating, a feeling of fullness, light cramping, poor appetite, frequent urination, and breast tenderness. If you've had some minor spotting in the past week, it may be "implantation" bleeding, which is not a cause for concern. Some women have no symptoms at all and feel absolutely wonderful. This, too, is perfectly normal.

You Are 5 Weeks Pregnant

Your body is working overtime to produce a special new life. You may feel exhausted and unusually cranky. Of course, running to the privy every few minutes doesn't help. This is due to your increased metabolism and growing uterus. Your breasts may be particularly tender now and you may find that sleeping in a breastband helps. Don't worry; breast growth will slow within the next three weeks.

You Are 6 Weeks Pregnant

Feeling positively ill? Does the smell of salk make you want to dash for the bathroom? If so, it sounds like morning sickness. Nausea affects one third to one half of all pregnant women and usually abates by the start of the second trimester. It may be caused by a higher level of estrogen, as well as the rapid expansion of the uterus. But wait, there is some good news: Studies show that morning sickness may be related to a slightly lower risk of miscarriage.

You Are 7 Weeks Pregnant

Rapid acceleration of hormones can cause your face to break out. Wash your face twice a day with a gentle cleaner and drink plenty of water.

Your waist may already be expanding, causing your clothes to feel snug. You may experience constipation and have occasional bouts of indigestion. Some women also feel a bit dizzy or lightheaded at times.

You Are 8 Weeks Pregnant (2nd Month)

Are you feeling a bit bloated? Indigestion and bloating are common complaints of pregnancy. A slowed digestive process causes these symptoms and allows your bloodstream to better absorb nutrients that are then passed on to your baby. You may find relief from wearing loose-fitting clothes, eating small, frequent meals, chewing your food thoroughly and avoiding high fat foods.

No matter how uncomfortable these sensations are for you, rest assured that your baby is oblivious to your pain. As long as it doesn't affect your ability to eat healthy meals, your discomfort may be a nuisance, but it is harmless.

You Are 9 Weeks Pregnant

Your breasts may be feeling full and tender. This can be one of the earliest symptoms of pregnancy. The areola typically darkens and Montgomery's glands, lubricating sweat glands on the areola, may become prominent and more numerous. Especially for those with a light complexion, veins in the breast often become more pronounced.

Emotionally, you may feel like you are suffering from an ongoing bout of PMS. Even silly commercials may make you cry!

You Are 10 Weeks Pregnant

Moms-to-be should pay special attention to their oral health. Hormonal changes occur during pregnancy that can affect the gums. The gums may become swollen and inflamed in response to bacteria along the gum line. This is called "pregnancy gingivitis." It usually appears during the third to ninth month of pregnancy.

You Are 11 Weeks Pregnant

You may be suffering with more frequent headaches as a result of the change in your hormone levels. You can help prevent headaches before they start by eating regularly, drinking plenty of fluids, getting adequate sleep and keeping stress levels low.

You Are 12 Weeks Pregnant (3rd Month)

As you approach your second trimester, any nausea you may have experienced probably will begin to subside. You may also notice the linea nigra (black line), a dark line of pigmentation creeping up your abdomen -- especially if you have a dark complexion.

Your uterus has risen above your pubic bone, and your care provider will be able to feel it during an abdominal exam. It is about the size of a softball. Around this time, you may begin to "show." For first-timers, "showing" may occur a bit later, as strong abdominal muscles can help to hide your pregnancy.

You Are 13 Weeks Pregnant

The second trimester is sometimes referred to as the "honeymoon of pregnancy." This is because women often regain energy, with much of the arduous work of organ development now almost complete.

As you enter your second trimester, your nausea most likely has faded into a memory.

You may feel absolutely wonderful. You aren't yet subject to the physical discomforts that may appear in the later weeks of pregnancy and you may finally feel ready to reveal your long-held secret to the world.

You Are 14 Weeks Pregnant

You walk into the Dining Hall, only to be greeted by the nauseating smell of spiced cheromeat. But you LOVE spiced cheromeat. Or rather, you did. Now all sorts of smells seem unappealing at best and gut-wrenching at worst.

In fact, nearly 85 percent of pregnant women have at least one food aversion. One explanation, according to researchers, is that food aversions peak when hormones are fluctuating. As you progress through the second trimester, and hormones stabilize, your aversions may disappear.

And while aversions to salk or alcohol may be your body's way of preventing you from consuming anything harmful to the baby, aversions to healthy foods should be treated differently. No, you don't have to force-feed yourself the detested item. Instead, find a palatable alternative that offers similar nutritional value.

You Are 15 Weeks Pregnant

When will you "show"? At 15 weeks of pregnancy your uterus is just popping up above the pubic bone. You are at a very in-between stage right now. You may not yet look pregnant to the world -- or you may have already popped out. There is a great variation in the time your pregnancy becomes visible. This usually occurs between 14 and 20 weeks. If this is your second or third pregnancy, you are probably "showing" sooner than a first-time mom because the muscles of your abdomen are a bit more lax, and the uterus tends to fall forward more easily because of the relaxation of the supporting ligaments.

Second Trimester


You Are 16 Weeks Pregnant (4th Month)

For some women, nasal congestion and nosebleeds are an annoying side effect of pregnancy. This is due to altered levels of hormones, which may cause the mucous membranes in your nose to swell. Increased blood volume and softening of the tissues also contributes to this. Unfortunately, it may continue throughout your pregnancy. A vitamin C deficiency may cause nosebleeds, so an increase in your consumption of vitamin-C-rich foods may help. Do not use nose drops, other than saline, unless recommended by your care provider.

You Are 17 Weeks Pregnant

Halfway between your navel and pubic bone, your uterus is rising up to greet the world. Increased secretions -- from nasal to vaginal -- are common as your blood volume increases.

You may be noticing tan-colored spots on your face or chloasma may occur on the forehead, nose, upper lip and cheeks. Don't worry, it's not permanent, and it will fade soon after birth. Use sun block to prevent spots from darkening due to sun exposure.

You Are 18 Weeks Pregnant

You may be waiting anxiously for your baby's first movement, known as "quickening." You want to know that your baby, who's been quietly maneuvering around since seven weeks, is big enough and strong enough to send you a message. Many women find this barometer of their baby's well-being very reassuring.

Typically, you will feel the first small rumblings of fetal movement between 18 and 22 weeks (or later, in some cases). If you have very strong abdominal muscles, you're very overweight or your fetus is "hiding," you may fall on the late end of the scale. If this is your first pregnancy, you may not feel fetal movement as early as you will in successive pregnancies. Most likely, though, junior will make his or her presence known within this next, exciting month. Early fetal movements may feel like soft tapping, or "butterflies," just above the pubic bone.

You Are 19 Weeks Pregnant

To your dismay, you may find that heartburn is more likely to occur as your uterus pushes up against your stomach. Because the movement of food through the digestive tract has slowed, nutrients reach the fetus more efficiently -- generally within one or two hours after meals. Hang in there. When your baby "drops," (first-time moms only), usually in the final month of pregnancy, there will be considerably less pressure on your stomach. Eating several smaller meals throughout the day can work well if you are troubled by heartburn. Try not to eat right before bed. Sleep with your upper body slightly elevated.

You Are 20 Weeks Pregnant (5th Month)

Congratulations -- you are halfway through your pregnancy! You're probably feeling wonderful now that you've regained your energy. Finally people are beginning to notice that you are indeed pregnant, as your uterus pushes your abdomen out at the belly button. The uterus now reaches the level of the umbilicus (plus or minus a fingerbreadth). Your care provider has probably been measuring the level of your fundus, or top of the uterus, with a tape measure. It should now be approximately 18 to 22 cm. if you are having one baby and your dates are accurate. Your abdomen may start to itch a bit as stretching occurs. Let your care provider know about this even if though it's probably perfectly normal.

It is now possible to hear your baby's heartbeat with a special stethoscope, called a Delee stethoscope. Some providers begin to use this type of listening device instead of a doppler. It may now be possible for your partner to hear your baby's heartbeat by placing his or her ear against your bare lower abdomen. If you can't hear it right away, try the other side. Listen every day and you will be rewarded with a tiny, fast, rhythmic beat.

You Are 21 Weeks Pregnant

At your prenatal appointment your provider has probably been measuring the height of your uterus (fundal height) since it appeared above your pubic bone. After about 20 week, this measurement generally correlates with your dates. Fundal height measurements assess growth from visit to visit. If the measurement is consistently "small" or "large," the first thing to look at is the accuracy of dating. More than one baby is a possibility if your uterus measures "large for dates." If the fundal height is "small for dates," this might be an indication that your baby is smaller than expected. A dolphin visit would be suggested for any inconsistency in fundal height. After about 36 weeks the measurement for fundal height becomes less accurate as your baby settles into your pelvis.

You Are 22 Weeks Pregnant

Sex may be very fulfilling for you at this stage of your pregnancy, due in part to the increase in blood flow to your clitoris and an increase in vaginal lubrication. On the other hand, some women don't want to be touched at all -- period! Whatever works for you and your partner is best. Just be assured that sex during a healthy pregnancy is safe for both you and your baby.

(If you have a history of preterm labor, recurrent pregnancy loss, ruptured membranes, placenta previa or placental abruption, intercourse and/or orgasm are not recommended. Discuss your concerns with your care provider.)

You Are 23 Weeks Pregnant

What exactly are Braxton Hicks contractions? Your uterus undergoes periods of contraction and relaxation from the moment of conception. Even in the non-pregnant state, the uterine muscle rhythmically contracts and relaxes. These cycles become more noticeable as your pregnancy advances. Commonly known as Braxton Hicks contractions, they may be felt as tightenings in your lower abdomen. They are never (very) painful and are erratic in frequency. You might be more likely to experience them after a busy day, following exercise, after making love, or even when you are a bit dehydrated. Drinking fluids may help quiet the uterus. These contractions may last from 15 seconds to one minute. The good news? While annoying at times, Braxton Hicks contractions begin the process of ripening your cervix (softening and effacement), which just might mean an easier labor for you!

You Are 24 Weeks Pregnant (6th Month)

It is very normal to experience anxiety about your pregnancy weight gain. The prospect of putting on 25 to 30 pounds in less than a year is one that many women fear or dread. As your appetite increases, with your feeling of well-being, during the second trimester -- and due to changes in your metabolism -- you may find it extremely easy to gain weight. Your body is doing what it is supposed to! Just keep in mind that while you might be able to indulge in an occasional chocolate bar or piece of baklava when not pregnant, it might turn into fat now. Make every calorie count by eating a varied diet of healthy foods. Select snacks from foods such as cheese, plain yogurt, hard-boiled eggs, fruits and veggies.

Much of the weight gained during pregnancy goes to your baby and the products of conception:

Fetus: 7.5 to 8.5 pounds
Amniotic fluid: 1 to 2 pounds
Placenta: 1 to 2 pounds
Increase of blood and fluid volume: 4 to 8 pounds
Uterine muscles: 2 to 3 pounds
Breasts: 2 to 3 pounds
Fat deposits around internal organs: 2 to 10 pounds

You Are 25 Weeks Pregnant

Itch, itch, itch. Your abdominal skin, which is being drawn taut, may be driving you crazy. Try massaging your skin with olive oil or cocoa butter, if not allergic. If persistent itching continues, be sure to mention to your care provider. It could be "PUPP" (pruritic urticarial papules and placques of pregnancy), the most common of all pregnancy skin conditions, or rarely, associated with a serious liver condition.

You Are 26 Weeks Pregnant

As your belly gets bigger and your baby's movements increase, you are probably beginning to think more and more of your upcoming birth. And you may find that birth plans you were comfortable with early in your pregnancy no longer work for you. Many women begin to seriously rethink their plans for birth around this time. Remember, hardly any decisions you have made are set in stone.

You Are 27 Weeks Pregnant

Perhaps right in the middle of a ... a ... achoo ... excuse me, a sneeze, an embarrassing thing can happen -- a bit of urine leaks out. "Stress incontinence" is very common in pregnancy; Urine can leak when coughing, laughing, exercising, changing positions, running to catch a bus or to catch up to your children. Due to the influence of hormones, and also to the compression of the bladder by the growing baby, you may develop this new symptom anytime during your pregnancy, but most commonly in your third trimester. Women who have already given birth may find that they have this troublesome symptom more often than those having their first baby. The good news is that muscles which support the pelvic floor and surround the vagina and urethra can be strengthened, minimizing the occurrence of stress incontinence.

Third Trimester

You Are 28 Weeks Pregnant (7th Month)

Though it's something no mom-to-be wants to think about, it is important to be aware of the signs and symptoms of preterm labor.

If you have back pain or menstrual-type cramping that seems to come and go, or if your uterus seems to be contracting four to five times an hour, drink two glasses of water and call your care provider immediately.

Call your care provider if you experience any of these signs -- not all related to preterm labor:
• Leaking of fluid
• Discharge that seems to be abnormal in color, consistency or odor. Call your care provider if you have any loss of your mucus plug or any bleeding at all.
• If you are feeling lots of pelvic pressure. If your baby feels like he or she is pushing down quite heavily, you should let your provider know.
• Burning or pain when you urinate
• Fever and/or headaches that don't go away
• Pain in your upper abdomen
• Swelling in your face and upper extremities

You Are 29 Weeks Pregnant

Welcome to your third trimester. Aches and pains may become bothersome as your uterus grows and the joints of the pelvis begin to loosen in preparation for delivery. It's easy to acquire back problems if you allow yourself to slump when sitting or standing. Don't stop exercising. Walking (or swimming) is important and can make you feel more energetic. Exercises designed for strengthening the abdominal muscles, which support the back, can help.

You Are 30 Weeks Pregnant

You may be noticing some swelling of your ankles and legs. Between 40 and 75 percent of pregnant women will develop mild edema. It's most common in late pregnancy, particularly on hot days, or if you've been on your feet a lot. While mild swelling is normal, it's important to call your practitioner if your hands or face begin to swell, if swelling lasts more than 24 hours or if it's accompanied by a rapid weight gain or a rise in your blood pressure -- possible signs of preeclampsia. Your midwife will check your blood pressure, note the degree of swelling present and will probably decide to run a quick test to see if there is protein in your urine. Preeclampsia affects approximately 5 to 10 percent of pregnant women. Some studies indicate that proper nutrition can reduce your chances of developing this condition.

You Are 31 Weeks Pregnant

At this point you may be quite eager for your pregnancy to end and your baby to be born. Aches and pains, along with feelings of anxiety, may increase at this time. Some women may become frightened by their own lack of maternal feelings. This is a common and natural emotion that many pregnant women experience. For some women, bonding won't occur until birth -- or even later. The final weeks may begin to drag.

You Are 32 Weeks Pregnant (8th Month)

Are you beginning to waddle? The pregnancy hormone, relaxin, is responsible for the softening hip joints that cause you to move differently. Your graceful gait is not helped by your large uterus, which can throw your posture off and cause you to have a swayback appearance. And if you'd like to sidestep back pain, it's important to heed Mother's advice: Stand up straight!

By now, you may long for a good night's rest, and finding a comfortable position may have become an ongoing challenge. If you feel like sleeping on your back -- or even on your belly -- go right ahead. Pregnant women should sleep in whatever position they find the most comfortable!

You Are 33 Weeks Pregnant

At long last, you finally fall asleep, only to wake with leg cramps. Ouch! But there's no need to suffer night after night. Try these tips to help eliminate cramps:
• Exercise helps! Get out and walk during your lunch hour.
• Do not stand in the same position for a long period.
• Increase your calcium intake through diet or supplements.
• When lying down, keep your legs a bit elevated.
• When a cramp comes on, flex your toes upward to relieve the spasm and use your hands to apply pressure to the affected muscle.

You Are 34 Weeks Pregnant

With labor looming, you may be getting just a bit nervous -- especially if this is your first baby. Will you have a safe birth? Will the pain be more than you can handle? Will your labor drag on for hours, or will you even make it to the Infirmary in time?

Studies indicate that pain and length of labor may be related to the level of maternal anxiety about the process of giving birth. Physical stress can translate into uterine muscle tension which can make contractions more painful. Stress and anxiety also increase a substance in the blood called catecholamines, which work against your body's natural production of oxytocin. As a result, labor does not progress as quickly as it might otherwise.

You Are 35 Weeks Pregnant

The time is rapidly approaching when months of waiting (years, for some
parents!) is rewarded with your newborn son or daughter. Just as real, are the fears you may be experiencing. If this is your first baby, you may wonder how you will cope with labor. Will it be "easy" or "hard," long or short? We all have visions of the perfect labor, just as surely as we have visions of the "perfect baby." You are probably wondering if you will be a good mother or father, if you will be prepared to meet the demands of parenting. You and your partner have already made some very important decisions, but many more lie ahead.

This last month of pregnancy is often an introspective time. Of course it is also a busy time, a time for packing your bag if you will be giving birth in the Infirmary.

You Are 36 Weeks Pregnant (9th Month)

Welcome to the last month of your pregnancy. You may find it very hard to get in a comfortable position! Sleeping on your side with one or two pillows between your legs and one at your back may be comforting. If you have difficulty sleeping, try drinking warm milk, chicken broth or "sleepy time tea." And then, just as you get to sleep, you might need to get up again ... to use the privy.

Many couples enjoy making love, right up to the end of pregnancy. Feel free to enjoy, as long as you have not experienced third trimester bleeding, your placenta is high, and your membranes are intact. Research actually has shown that the prostaglandin in semen may help to ripen your cervix and may start contractions -- when your baby is ready. And of course, sharing intimacy with your partner is a great way to stay connected as you both prepare for this incredible event!

You Are 37 Weeks Pregnant

Congratulations! Even though you are about three weeks from your due date, if your baby weighs over five and one half pounds and you finish the 37th week, your baby is considered "full term." In most cases, nothing will be done to stop your labor once it starts.

You may be counting the days until your baby's official due date.

If you are having your first baby your baby may have "dropped" into your pelvis. The process of engagement or "lightening" in a woman who has already given birth is a phenomenon usually reserved for labor. True engagement is the fixing of the fetal presenting part -- usually the head -- at the level of the mid pelvis, or at the level of the ischial spines.

You Are 38 Weeks Pregnant

Your baby is truly "full term" and could really arrive at any time!

Around this time, you may "lose" your mucus plug. It can look like thick, slippery brown discharge or an actual "plug." Some women never experience this. For others, it may occur just before labor, or any time in the last month of pregnancy.

You Are 39 Weeks Pregnant

Are you cleaning house for the first time in months? This may be your "nesting instinct" at work.

Some women begin to "turn inward" at this time of their pregnancy, thinking about the work ahead. They may seek the support of other women who have given birth, talk to their mothers, read voraciously or may just want to be alone.

Heartburn and constipation are two of the most common physical complaints at this time. Psyllium and water can relieve constipation. Try keeping a little something in your stomach at all times to avoid heartburn. Avoid large meals and don't eat just before heading to bed. You may also find it helpful to sleep with your head elevated.

You are continuing to make amniotic fluid but the rate of absorption may outpace the amount you make, so levels may start to decrease a bit. Be sure to alert your care provider if you have any leaking of fluid. It can be difficult to tell the difference between leaking of urine and amniotic fluid. A good way to check is to recline in bed for an hour after emptying your bladder. If upon arising, fluid trickles out, it is most likely amniotic fluid. Regardless, it is always best to have this checked out.

You are probably feeling very large -- and very uncomfortable -- at this point of your pregnancy. If possible, don't just stay at home. Go out!

You Are 40 Weeks Pregnant

You've made it to your due date. Congratulations!

Oh, no ... You've passed your due date! In just one week, you've probably experienced a host of emotions. It is natural for you to feel let down if your due date goes by with nary a contraction. But stay optimistic. Soon you'll be holding your new baby in your arms!

Remember that 95 percent of babies are born either in the two week period before or after their due date.


LABOR AND DELIVERY

FIRST STAGE

Dilation and Effacement of Cervix
Early Labor
to 3-4 cm (7 - 8 hours)*

You May...
• be excited, anxious, energetic, confident, nervous or fearful.
• be receptive to suggestions.
• be more comfortable at home until labor becomes active.
• eat nutritious and light food, (i.e. fruit, soups, yogurt, and toast).
• wonder if this is it.
• continue with or begin to engage in calming, but not tiring, activities in
the daytime.
• go back to sleep if it’s nighttime.
Your Contractions...
• usually result in cervical dilation to 3 - 4 cm and in partial effacement.
• are wave-like, build to a peak and recede.
• are usually mildly to moderately painful and begin in lower back or feel
like menstrual cramps.
• may be such that normal breathing is all that is necessary.
• may eventually be strong enough to require that you pay attention to your
breathing and/or initiate relaxation exercises, such as visualization, self hypnosis or whatever else you have practiced.
• may be 5 - 20 minutes apart and will become more intense, longer and
closer together.
• may be 30 - 45 seconds long, but not more than 60 seconds long.
• result in baby beginning to bring chin to chest to later enable smallest
diameter of head to pass through the pelvis.

Healer May...
• suggest coming to Infirmary if membranes rupture (water breaks) or
contractions are 5 minutes apart.


Active Labor. Continued Dilation
to 4-7 cm (3 - 5 hours)*

You May...
• wake up in active labor if you slept through the early stage.
• focus on work of labor and not be receptive to small talk.
• go through periods of feeling frightened or trapped.
• become frustrated if progress is slow.
• find walking helps maintain or quicken progress of labor.
• find it helpful to continue eating lightly if still at home (once in
Infirmary you generally receive only clear fluids).
• need to concentrate on relaxation and breathing to continue working
effectively with labor. (Begin with slow, deep breathing.)
• start or continue to use hypnosis, visualization and other mental
exercises previously practiced.
• find massage and other kinds of relaxing touch calming.
• find bath (sponge bath if membranes ruptured) soothing.
• be helped by frequent position changes; use of extra pillows (i.e. in
between knees and behind back when side-lying). Positions that work with gravity (i.e. standing or kneeling), supported by partner, are beneficial.
• experience lower back pain with contractions or, if baby is posterior,
(back of baby’s head facing mother’s spine) continuously. You will be more comfortable with your weight off your back - especially hands and knees position.

In Your Body...
• contractions may occur every 2 to 4 minutes and last up to 60 seconds.
They may be moderately to very painful, although they are experienced very uniquely by each woman.
• cervix will dilate from 3 - 4 cm to 7 - 8 cm, and continue to efface.
• membranes may rupture spontaneously with a gush or trickle.

Healer/ Midwife May...
• want to check your temperature, urine, blood pressure, cervical dilation
(by a vaginal examination) and baby’s heart beat upon arrival at Infirmary. The last three are regularly checked during labor.
• help make mother comfortable.
• inquire about your expectations, hopes and plans for this labor.
• reinforce or help you initiate breathing and/or relaxation exercises.
• be invaluable in offering reassurance that all is proceeding normally, and
in offering support.
• offer explanations if a problem arises.
• offer pain medication.
• encourage urination about once per hour.


Transition
(1/2 - 1 1/2 hours)*

You May...
• be exhausted, confused, irritable, unaware, frustrated, panicky.
• have no sense of time.
• shake (legs especially).
• sweat, hiccup, vomit.
• get the chills on and off and have cold feet.
• have a dry mouth and dry lips.
• not want to be touched, or may want only firm touch; may prefer to be
held.
• hyperventilate.
• moan, cry or scream.
• have urge to push or have rectal pressure.
• be resistant to changing position.
• sleep in between contractions.
In Your Body...
• contractions are at their most intense. They may occur as often as every
30 seconds (but are erratic), last up to 90 seconds and may have double peaks.
• cervix completes its dilation process to 10 cm, and fully effaces.
• bloody show may increase.

Healing Staff or Midwife May...
• do vaginal exam.
• be helpful in offering reassurance that intensity is normal.
• stay with you.
• be alert for imminent delivery.
• ready the room for delivery (if in labor room/birthing room).
• take blood pressure and fetal heart rate.
• continue to help you manage the discomfort.


SECOND STAGE

Full Dilation to Birth of Baby
(1/2 - 2+ hours)*

You May...
• experience renewed sense of energy and excitement.
• need to collect yourself after intensity of transition.
• not feel urge to push right away.
• hold breath when pushing or allow some breath to release, letting out a
sound as you push. As long as your baby’s heartbeat is stable, there is no rush to push your baby out. It may take a while before you feel you’ve ‘got the hang of it’, but eventually you’ll gain confidence.
• be surprised by overwhelming urge to push (bear down) with contractions.
• enjoy bearing down, or may find it painful.
• be tired, especially as stage progresses, and may sleep in between
contractions.
• be frightened by intense rectal pressure of fullness and may resist
bearing down.
• continue to have lower back pain.
• be embarrassed about passing some stool.
• find the following positions comfortable and effective:
~ semi-sitting - at a 45 degree angle or more.
~ side-lying - useful for severe hemorrhoids or unusually fast delivery; allows you to watch the birth. ~ hands and knees - excellent for back pain. May help posterior baby turn. ~ squatting - increases diameter of pelvis. Especially good for minimal, or lack of, progress. ~ sitting on toilet - useful because of association with ‘letting go’. In Your Body...
• baby’s head slips out of the fully dilated cervix, leaving some room at
the top of the uterus. It may take few minutes for the uterus to become taut again around the rest of baby’s body. This accounts for occasional lack of urge to push upon full dilation.
• baby’s oxygen level affected if you hold your breath during pushing. Safe
level is maintained when a new breath is taken at least every 6 - 8 seconds. Contractions... ~ are generally much less painful. ~ may occur every 2 - 5 minutes and last about 60 seconds. ~ may come in waves. ~ push baby downward through open cervix. ~ help baby finish turning to face mother’s back (starts in first stage). Shape of the pelvis is such that baby can leave it more easily with head in front-back position.
• eventually nearly-born head causes perineum to bulge and vaginal lips to
part when the mother pushes. When the head is low enough, it becomes visible.
• head recedes out of sight in between pushing efforts.
• baby’s head fully opens vaginal lips and does not recede at some point.
This ‘crowning’ is characterized by an intense stretching and burning sensation known as 'rim of fire'.
• perineal tissue is vulnerable to tearing at crowning. 'Rim of fire'
sensation can be seen as nature’s way of discouraging mother from pushing at this time, thus, decreasing the likelihood of tearing.
• baby’s shoulders follow and the rest of the body is born. Some mothers
enjoy reaching down after the shoulders are out and delivering their own baby! Medical/Nursing Staff or Midwife May...
• now stay with you until after delivery.
• put hand on your abdomen so as to feel when contractions occur.
May encourage you to push during contractions and offer guidance and/or instructions.
• examine you vaginally while pushing to feel baby’s head.
• stretch the perineal tissue with U-shaped massaging motions and warm
compresses.
This helps avoid tearing and sometimes is done as an alternative to episiotomy.
• do episiotomy instead of above. Regional anaesthetic given if needed
• check fetal heart rate more frequently.


THIRD STAGE
Birth of Placenta
(5 - 30 minutes)*

You May...
• need a few minutes to collect yourself before focusing on baby.
• be surprised by baby’s appearance - irregularly-shaped head, covered with
white substance (vernix), bloody, greyish/purple color.
be engrossed with baby. Be emotional, overwhelmed and cry.
• not notice birth of placenta.
In Your Body...
• uterus contracts to enable placenta to come away from uterine wall.
Contractions may be mildly painful.
• placenta usually slips out with 1 - 2 pushes.
• uterus contracts against exposed blood vessels from placental site to
control bleeding.

Healing Staff or Midwife May...
• check baby’s condition immediately and evaluate it at one and five minutes
and give baby an Apgar score.
• dry and wrap baby to keep warm.
• invite partner to cut cord. Some believe cord should be cut immediately,
others prefer to wait until it stops pulsating.
• ask you to push for placenta, at appropriate time.
• examine placenta and umbilical cord to make sure they appear normal.
• take routine blood samples from umbilical cord.
• repair episiotomy if one was done; repair tears if necessary - small ones
are left alone.


FOURTH STAGE

First Hours After Birth

You May...
• be very hungry, tired, elated and satisfied.
• be a little uncomfortable if episiotomy has been performed. Your Baby
May...
• open eyes and be very alert and attentive to parents (known as 'first
period of reactivity').
Healing Staff or Midwife May...
• encourage baby to breast feed. This helps control uterine bleeding. Also,
if baby is breast fed within the first two hours after birth, it is more likely that baby will succeed at breast feeding in the coming weeks.
• check height and tightness of uterus, vaginal bleeding and blood pressure.
• put antibiotic ointment in baby’s eyes. This can be delayed for an hour so
as not to interfere with baby’s first glimpse of parents.
• leave new family alone for most of first hour together.

* All labors are different and yours may not proceed exactly like the above, especially with regard to the timing of each stage. Your partner also will play an important role. No matter what kind of labor you have, it is hoped you will congratulate yourself at the end for your hard work...and the miraculous result.