Labor and Delivery

Normal Labor
When it is time for your baby to be born, your body will go through a series of changes to prepare for and complete the birthing process. Like pregnancy, your labor and delivery will be different from any other women's. In fact, each time you give birth, your labor and delivery will probably be different.

Early Labor
Labor is divided into two phases: early, or latent, labor and active labor. Early labor may last as many as twenty hours, especially during your first pregnancy. There are several hormonal and physical changes that indicate you are in early labor.

• Lightening

• Passing of the mucus plug

• Irregular contractions

• Breaking of water

• Effacement and dilation of the cervix.

Lightening
The process of your baby settling or lowering into your pelvis is called lightening. Lightening can occur a few weeks or a few hours before labor begins.

Passing of The Mucus Plug
During your pregnancy, a mucus plug accumulates at the cervix to seal off the cervix and protect your baby from infection. When your cervix begins to open wider to prepare for the birth of your baby, the mucus is discharged into your vagina. The mucus will be clear, pink, or slightly bloody.

Irregular Contractions
During early labor, you will most likely experience irregular contractions that are mild enough that they do not interfere with your normal activities. These early, unpredictable contractions begin the process of opening (dilating) your cervix so that your baby can be born.

No one knows what causes labor to start or can predict when labor will start or how long it will last.

Breaking of Water
As your body prepares for childbirth, the amniotic sac that has surrounded your baby during pregnancy usually breaks, releasing the amniotic fluid it contains. When this happens, you may feel either a sudden gush or a trickle of fluid that leaks steadily. The fluid is usually odorless and may look clear or straw-colored.

If your "water breaks," write down the time, approximately how much fluid is released, and what the fluid looks like. Call you doctor with this information.

Not all women have their water break during labor. Many times, your doctor will rupture the amniotic membrane in the hospital.

Effacement and Dilation of The Cervix
During early labor, your cervix will gradually thin and stretch (called effacement) and open (called dilation) to prepare for the passage of your baby through the birth canal. How fast your cervix opens and thins varies from woman to woman and cannot be predicted with any certainty until active labor begins. In some women, this process may occur over a period of weeks.

Cervical effacement is described as a percentage, with 100% being completely thinned. Dilation is expressed in centimeters from 0 to 10, with 10 being completely dilated or open.

How Do I Know When I'm In Labor?
Many women experience what is known as "false" labor pains or Braxton Hicks contractions. These irregular uterine contractions are perfectly normal and generally start during your third trimester of pregnancy.

To determine if you are in true labor, ask yourself the following questions:

True Labor False Labor

Q. How often do the contactions occur?
A. Contractions come at regular intervals and last about 30-70 seconds. As time goes on, they get closer together. Contractions are often irregular and do not get closer together.

Q. Do the contractions change with movement?
A. Contractions continue even when you move or change positions. Contractions may stop when you walk, rest, or change positions.

Q. How strong are the contractions?
A. Contractions generally increase in strength as time goes by. Contractions are usually weak and do not get much stronger. Or they may be strong at first and then get weaker.

Q. Where do you feel the pain?
A. Contractions usually start in the lower back and move to the front of the abdomen. Contractions are usually only felt in the front of the abdomen or pelvic region.

Q. When Do I Go To The Hospital?
A. If you think you are in true labor, you should begin timing your contractions. Write down the time each contraction starts and stops. The time between contractions, called the interval, includes the length or duration of the contraction and the minutes in between the contractions.

Mild contractions generally begin 15 to 20 minutes apart and last 60 to 90 seconds. You should go to the hospital once you reach active labor. For most women, active labor is characterized by strong contractions that last 45 to 60 seconds and occur 3 to 4 minutes apart. Talk with your doctor about the best time for you to go to the hospital.

Call your doctor if:

• You think your water has broken

• You are bleeding

• Your contractions are very uncomfortable and have been coming every five minutes for an hour.

Staying Comfortable During Early Labor

For most women, the early stages of labor -- before active labor begins - are best experienced in the comfort of their own home. While you are at home, there are several things you can do to help cope with any discomfort you feel:

• Try to distract yourself; take a walk, read a book, watch a movie.

• Soak in a warm tub or take a hot shower.

• Try to sleep if it is in the evening.

Labor
Labor has three stages

• 1st: Strong, frequent, and regular contractions (latent phase until 4cm, active phase to 10 cm)

• 2nd: The birth of your baby

• 3rd: The delivery of the placenta.

Strong, Frequent Contractions
Compared with early labor, the contractions that occur once you enter active labor are more intense and more frequent (every 2 to 3 minutes) and longer lasting (50 to 70 seconds). As your contractions intensify, you may:

• Feel restless and excited

• Find it difficult to stand

• Have food and fluid restrictions

• Want to start using any breathing techniques or other calming measures you've chosen to manage pain and anxiety

• Feel the need to shift positions

• Want pain medication, such as epidural anesthesia

• Be given intravenous (IV) fluids.

Contractions feel different for each woman and may feel different from one pregnancy to the next. They move in a wave-like motion from the top of the uterus to the bottom.

The Birth of Your Baby
The strong contractions you experience during active labor are your body's way of pushing your baby through the birth canal. During the birth process, your contractions may slow down to every 2 to 5 minutes, lasting 60 to 90 seconds.

Other things you may feel as your baby passes through the birth canal include:

• You may have a strong urge to push or bear down with each contraction. The baby's head is likely to create great pressure on your rectum.

• You may need to change positions several times to find the position in which you feel most comfortable.

• When you baby's head passes through your vagina (crowns), you may feel a burning pain. The head is the largest part of the baby and the hardest part to deliver.

The pushing stage of your labor can be as short as a few minutes or can last for several hours, especially for your first birth. The doctors and nurses will be there to make you feel as comfortable as possible and to offer support, guidance, and pain relief.

The Delivery of the Placenta
After you deliver your baby, your mind and your body may have different agendas. You will want to be getting to know your baby; however, your uterus will be busy contracting as the placenta detaches and passes through the birth canal. Your contractions will continue until after the placenta is delivered. Your doctor will make sure the entire placenta has been detached and delivered.

Pain Management
Each woman's labor is unique. The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby and the strength of contractions.

Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications. The decision to use medical pain relief is entirely yours and there is no "right" or "wrong" decision. Your doctor can give you guidance and answer any questions you have about your pain relief options.

There are two types of pain-relieving drugs - analgesics and anesthesia - that can be used during labor and delivery. Analgesics relieve pain without total loss of feeling or muscle movement. They do not always stop pain completely, but they do lessen it dramatically. Anesthesia blocks all feeling, including pain. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness.

Easing Discomfort

Some natural ways to relieve discomfort during labor:

Some women need little or no pain relief, and others find that pain relief gives them better control over their labor and delivery. Talk with your doctor about your options.

• Do relaxation and breathing techniques taught in childbirth class.

• Have your partner massage or firmly press on your lower back.

• Change positions often.

• Take a shower or bath, if permitted.

• Place an ice pack on your back.

• Use tennis balls for massage.

Regional anesthesia tends to be the most effective method of pain relief during labor and causes few side effects. Epidural anesthesia, spinal blocks, and combined spinal-epidural blocks are all types of regional anesthesia that are used to decrease labor pain.

Epidural anesthesia, sometimes called an epidural block, causes some loss of feeling in the lower areas of your body, yet you remain awake and alert. An epidural block may be given soon after your contractions start, or later as your labor progresses. Your doctor will work with you to determine the proper time to give the epidural. Pain relief will begin within 10-20 minutes after the medication has been injected.

During your prenatal visits, talk with your doctor about your labor and delivery options.

A spinal block, like an epidural block, is an injection in the lower back. While you sit or lie on your side in bed, a small amount of medication is injected into the spinal fluid to numb the lower half of the body. A spinal block brings good relief from pain and starts working fast, but it lasts only an hour or two. A spinal block usually is given only once during labor, so it is best suited for pain relief during delivery.

A combined spinal-epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor.

Labor and delivery are unpredictable so it is best to be flexible about the pain medication decisions you make.

Unlike analgesics or regional anesthesia, general anesthetics are medications that put you to sleep (make you lose consciousness). If you have general anesthesia, you are not awake and you feel no pain. General anesthesia often is used when a regional block anesthetic is not possible or is not the best choice for medical or other reasons. It can be started quickly and causes a rapid loss of consciousness; therefore, it is often used when an urgent cesarean delivery is needed.

The Bradley Method
Practice Statement Regarding: The Bradley Method

The Bradley Method of Childbirth (also known as “Husband-Coached Childbirth”) was first developed and promoted by Dr. Robert A. Bradley over 40 years ago. Dr. Bradley developed his method in the era of what he referred to as “knock-em-out, drag-em-out obstetrics,” when “twilight sleep” and general anesthesia were common in hospital deliveries and husbands were relegated to pacing the waiting room. Dr. Bradley had grown up on a farm in Kansas and believed that women, like the animals he had witnessed on the farm, could give birth without drugs. It was based on his observations of other mammals during labor and delivery that he developed a childbirth method to teach women to do the things that other animal mothers do instinctively. As he gained experience with his method he also came to believe that the presence of the father during labor and birth was important to the mother’s success at achieving a natural childbirth. He became a pioneer in including the father in the birth process and ultimately expanded his childbirth method to include instruction of the father as the labor coach.

Dr. Bradley should be praised for the way he recognized and addressed several issues that existed with the practice of obstetrics in the 1950’s. The routine use of pain medications and anesthesia at or just prior to delivery frequently necessitated use of forceps or a vacuum- assisted delivery since the mother could not push effectively and these assisted deliveries carried a greater risk of trauma to the babies and to the mother. Moreover, the use of these medications would increase the risk for excessive bleeding for the mother and difficulties with breathing in the infant. The primary goal of the Bradley Method was and is healthy mothers and healthy babies and in the 1950’s a natural (drug-free) childbirth was the best way to achieve that goal.

Medicine has come a long way in the last 50 years and the advances that have been made particularly in respect to pain management during labor and delivery have made childbirth safer for both mother and child. Specifically we recognize that any medicine given intravenously to the mother is rapidly transported through the placenta to the baby. Because of this the use of such medications for management of pain in labor is very limited and generally confined to only the earliest stages of labor so that they are out of both the mother’s and the baby’s system by the time of delivery. The development of the epidural is clearly the biggest change. With an epidural pain medication and anesthesia are delivered directly to the area where the nerves that are responsible for the pain associated with labor and delivery are located. By delivering these medicines directly to the site of action, only a very small amount of medication is needed and this means that there is virtually no effect on the mother’s state of awareness or alertness and no significant transfer of these medicines to the baby. Unfortunately, natural childbirth proponents regularly produce studies that show that epidural anesthesia can prolong labor or increase the risk of a cesarean section, but this is not the case with appropriate and judicious use. In fact, when an epidural is placed in the active phase of labor, when the cervix is already dilating, the relaxation of the pelvic muscles can actually lead to more rapid progression of labor. Moreover, studies have shown that with an epidural tears and episiotomies may be reduced because there is a more gradual progression of the final stages of labor allowing the vaginal tissues to stretch.

So we would like to thank Dr. Bradley for bringing fathers into the delivery room and we thank him for reminding everyone that it is possible to give birth without drugs, but we are also confident that modern pain management techniques are not only safe for mothers and babies, but in some cases may be even safer than a drug-free natural delivery.

Are we pushing epidurals? No, we’re pushing choices. It seems an inordinate number of patients in our practice who are considering the Bradley Method are having their first baby. The Method is an intensive program that teaches one to “tune in” to their body and use relaxation and natural breathing as pain management techniques. The stages of labor are reviewed and management options for each stage are rehearsed and finally each couple formulates a personalized birth plan. Here’s where the problem comes in: When you make a plan, you are automatically limiting your choices and in fact setting yourself up for disappointment. Every labor is different; some are fast, some slow, sometimes the water breaks and labor doesn’t come at all. Every baby reacts to labor differently; some babies act like nothing is happening, some show signs of mild stress with each contraction and occasionally a baby will not tolerated contractions at all necessitating an emergent cesarean section. Finally, everybody perceives labor differently; for some patients the pain of contractions may be quite tolerable while for others the pain can be overwhelming despite endless preparation with breathing and relaxation techniques. It is simply impossible to have a labor plan that addresses all these variables.

So what now? Don’t give up on natural childbirth. The breathing and relaxation techniques taught by Bradley, Lamaze and most other childbirth class will be useful to some degree. You may find that that is all you need to get through labor and delivery and if that’s the case, congratulations. At the very least, these techniques will hopefully get you through the early stages of labor and delay the need for an epidural or other pain medication. Be flexible. If it is too early in the labor to get an epidural, we’ll encourage you to tough it out a little while longer or take some intravenous medication to take the edge off. If the labor is progressing slowly or you need pitocin to help the labor progress, we may encourage you to get the epidural so that you can rest and be ready for the pushing stage. If the baby is showing signs of stress we may suggest you get the epidural so that a cesarean section could be performed more quickly if it is necessary.

One last thought about the Bradley Method: It is said that Bradley empowers patients to take responsibility for their births, rather than hand all of that responsibility over to a physician. Let me just say I have three children and I did not deliver any one of them. I have 19 years of experience in labor and delivery and am comfortable that I can deal with any situation that might arise, but knew I could not provide objective thoughtful care where the lives of my wife and children were involved. I didn’t want responsibility because I knew if something bad happened I could never live with myself, so I gave that responsibility to a trusted colleague. I was comfortable that he had our best interests in hand. We hope that as your pregnancy progresses you be able to develop the same level of comfort with our physicians.

Dr. Bradley was a pioneer in his time, but The Bradley method is now antiquated and as its name implies, it is too focused on the method and does not place appropriate importance on the endpoint. All we want is a healthy baby and a healthy mother who can remember this wonderful day without regrets about an unrealized plan that was probably not realistic in the first place.

Sincerely,
Walter J. Hodges, Jr., M.D.

If after reading this you decide that our approach is incongruous with your needs, we would respectfully ask that you consider another physician or midwifery practice that is more “Bradley-oriented.”

Normal Delivery
Most women give birth between 37 to 42 weeks of pregnancy. To help you prepare for the birth of your baby, you may want to do the following prior to going into labor:

• Talk with your doctor about exactly what to expect.

• Consider taking a childbirth class.

• Choose a support person to be with you during labor and delivery.

• Consider writing a "birth plan" that outlines how you would ideally like the birth of your baby to occur.

The Birthing Process
At Inova Fair Oaks Hospital, once it is determined that you are in labor you will be moved to a specialized room called an “LDR” for labor, delivery and recovery.

Once you reach active labor, it is just a matter of time until your baby is born. Of course, no one knows exactly how much time. First babies generally take longer to be born than subsequent babies.

Your doctor and the hospital nurses will be there to make you feel as comfortable as possible and to assist with the delivery of your baby. Your support person will also be there to offer assistance and to comfort you.

The doctors at Fair Ridge Ob/Gyn make it our mission to provide you with a safe and pleasurable birthing experience.

Once the cervix is completely dilated (10cm), you can play a much more active role in helping your baby be born. The nursing staff and your support person may hold your legs in a comfortable position to help you push. Your doctor will instruct you when to push and how hard to push.

The first view you see of your child will most likely be the tip of his or her head seen with the help of a mirror. When your baby's head is first seen at the opening of your vagina, it is called "crowning." Once your baby has crowned, the doctor may ask you to push more slowly.

The average length of time for a first baby (and the placenta) to be born once you are in active labor is about 12 hours.

Depending on what you have requested and your doctor's recommendation, your doctor may massage your perineum (the area between the bottom of the vagina and the top of the rectum) and gently try to stretch it in order to fit your baby's head through without tearing this area. If necessary, you may be given an episiotomy so that your baby can be delivered without tearing your perineum. With an episiotomy, your doctor makes a surgical incision into the perineum to widen the vaginal opening for delivery.

Once your baby's head is out (the most difficult part of the delivery), you will be asked to stop pushing while your baby's nose and mouth are suctioned clean of all fluids. The doctor will then instruct you to push so that you can deliver the rest of your baby. After another, more thorough suctioning of your baby's nose and mouth, your baby will be handed to you to hold. The umbilical cord will be clamped and cut - a process that is totally painless for your baby and can often be performed by your support person.

The pushing stage of your labor can be as short as a few minutes or can last for several hours, especially for your first birth.

Even after your baby is born, you will continue to experience contractions. This is your body's way to deliver the placenta - the tissue that has protected and nourished your baby throughout your pregnancy. Within about 20 minutes of birth, the placenta will detach and pass through the birth canal. Your doctor will make sure that the entire placenta has been detached and delivered.

What You May Feel
While every birth is unique, there are some physical sensations that most women report feeling during the birth process. Remember that your doctor will provide you with pain relief if requested.

• You may have a strong urge to push or bear down with each contraction.

• The baby's head is likely to create great pressure on your rectum.

• You may need to change positions several times to find the position in which you feel most comfortable.

• When you baby's head passes through your vagina (crowns), you may feel a burning pain.

Your Baby's Appearance
When the doctor hands you your baby, do not be surprised to see a white cheesy substance called vernix covering your baby. This protective coating is produced toward the end of pregnancy by the sebaceous (oil-producing) glands in your baby's skin. Your baby will also be wet with amniotic fluid from the uterus. Your baby's skin, especially on the face, may be quite wrinkled from the wetness and pressure of birth. Your baby's skin color may be a little blue at first, but will gradually turn pink as breathing becomes regular. In addition, your baby's head may be slightly cone-shaped from passing through the birth canal.

Your baby won't need to be slapped or spanked to begin breathing. Nor will your baby necessarily cry; many newborns take their first breath quietly.

You may also notice that your newborn's breathing is irregular and very rapid. While adults normally take 12 to 14 breaths per minute, your newborn may take as many as 60. An occasional deep breath may alternate with bursts of short, shallow breaths followed by pauses. Don't be alarmed - this is normal for the initial days after birth.

After The Birth
After your baby is born, the following may be done before you are moved to your room:

If there were no complications, you will most likely stay in the hospital one or two nights.

• If your perineum has torn or if you had an episiotomy, the incision or wound will be closed with stitches.

• A nurse may massage your abdomen to help your uterus clamp down and decrease bleeding.

• Your vaginal area, perineum, and rectum will be washed to remove all of the birth fluids and blood.

• You may be given an ice pack to apply to your perineum to reduce pain and decrease swelling.

• You may require a shot of Pitocin to help decrease bleeding.

• You may be given pain medications by mouth, injection, or IV.

Operative Delivery
Sometimes, a baby's head doesn't move as expected through the birth canal. If this happens or your doctor feels that your baby needs to be born more quickly, a forceps or vacuum extraction delivery may be performed. This type of delivery is known as an operative vaginal delivery.

In a forceps delivery, the doctor slips the rounded forceps instrument around either side of your baby's head and uses light traction to deliver the baby. The procedure is usually performed during a contraction while you are pushing. Once your baby's head is crowned, the forceps are usually removed and the rest of the delivery proceeds normally. You will most likely require an episiotomy if you have a forceps delivery.

Like a forceps delivery, a vacuum extraction is a procedure in which you are assisted with the delivery of your baby. Your doctor places a soft, flexible cap around your baby's head and then applies slight traction to help extricate your baby from the birth canal.

Your doctor may decide to use an operative delivery if:

• Your baby is in fetal distress

• You are in distress

• Lack of progress in late labor

• To aid in the delivery of your baby's head in a breech delivery.

An operative vaginal delivery is performed if a spontaneous birth is judged to pose a greater risk to mother or child than an assisted one.

There is a slight risk of complications with both types of operative deliveries. Your doctor will explain these to you prior to the procedure so that you feel comfortable about the type of delivery assistance being used.

• A perineal tear may cause damage to the vagina or rectum, bleeding, or reflex retention of urine

• Bruising and swelling of your baby's scalp; this will disappear in a few days.

Shoulder Dystocia
Though it is a very rare occurrence, shoulder dystocia can lead to complications for both you and your baby. This condition occurs when one, or less frequently both, of your baby's shoulders do not pass under the pubic bone during birth.

While this potentially dangerous condition has been the focus of many studies, there is no one factor that can predict who will have a shoulder dystocia. The best predictor of this condition may be a combination of factors such as a very large baby, a small-framed mother, complications during pregnancy, and previous babies with shoulder dystocia.

If you and your doctor think that you may be at risk for should dystocia, you can use birthing positions known to pose less of a threat of this condition, such as kneeling on all fours. There are also several maneuvers your doctor can use to help your baby move through the lower birth canal.

After the birth, your doctor will be on the lookout for:

• A baby who is slow to breathe, requiring prompt assistance with breathing

• Fractures of the baby's collarbone or humerus

• Fetal brachical plexus injury

• Maternal hemorrhage

• Uterine rupture.

Shoulder dystocia occurs in less than 1% of all births.

While a shoulder dystocia isn't a very common occurrence, knowing what potential risk factors are for you and your baby can help you make wise choices for your labor and birth.

Cesarean Section Delivery
Sometimes it isn't possible for a baby to be born through the birth canal. In such cases, a cesarean delivery is performed. With this type of delivery, your baby is born through surgical incisions made in your abdomen and uterus.

There are many reasons why a cesarean birth may be used to deliver your baby. These include:

• Having two or more babies

• Your labor does not progress normally

• Your baby having trouble during labor

• Problems with the placenta that can cause heavy bleeding, such as placenta previa and placental abruption

• Previous cesarean deliveries and your doctor feels there is a threat of your uterus rupturing during a vaginal delivery

• Your baby is too large to be born vaginally

• Baby in the breech or feet first position

• Maternal infections such as human immunodeficiency virus or herpes that may be passed to your baby.

Whether or not your cesarean delivery is planned in advance or decided upon during labor, your doctor will explain why this type of delivery is best for you and your baby and discuss how the birth will be performed.

Sometimes a woman requests a cesarean delivery. This is a complex decision that the doctors at Fair Ridge Ob/Gyn can help with.

The Cesarean Delivery
Before your cesarean birth, a nurse will prepare you for the delivery. Your abdomen will be washed and may be shaved. A catheter (tube) will be placed in your bladder. Keeping the bladder empty lowers the chance of injuring it during surgery. An intravenous (IV) line will be put in a vein in your arm or hand to allow you to receive fluids and medications during the delivery.

You will receive anesthesia so that you do not feel pain during the delivery. You will be given either general anesthesia, an epidural block, or a spinal block. If general anesthesia is used, you will not be awake during the delivery. With both the epidural and spinal blocks, the lower half of your body will be numb but you will be awake.

The type of anesthesia used depends on many factors, including your well-being and that of your baby. Prior to your delivery, your doctor will talk with you about the types of anesthesia and will take your wishes into account if at all possible.

The doctor will make an incision through your skin and the wall of the abdomen. The skin incision may be horizontal or vertical, just above the pubic hairline. The muscles in your abdomen are moved and, in most cases, do not need to be cut.

Another incision will be made in the wall of the uterus. The incision in the wall of the uterus also will be either transverse or vertical. When possible, a transverse incision in the uterus is preferred because it is done in the lower, thinner part of the uterus and results in less bleeding and better healing.

Your baby will be delivered through the incisions, the umbilical cord will be clamped and cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body. Stitches or staples are used to close your abdominal skin.

After The Delivery
If you are awake for your cesarean delivery, you can most likely hold your baby right away. You should also be able to begin breastfeeding right away if you choose.

You will be taken to a recovery room or directly to your room. Your blood pressure, pulse rate, breathing rate, and abdomen will be checked regularly. Soon after surgery, the catheter will be removed from your bladder. You will receive IV fluids after your delivery until you are able to eat and drink.

In most cases, your birth partner will be with you during your cesarean delivery.

You may need to stay in bed for a while. The first few times you get out of bed, a nurse or other adult should help you. Your abdominal incision will be sore for the first few days after your delivery. Your doctor can prescribe pain medication to alleviate as much of the pain and discomfort as possible.

A hospital stay after a cesarean birth is usually two to four days. The length of your stay depends on the reason for the cesarean birth and on how long it takes for your body to recover.

Recovery
When you go home, you may need to take special care of yourself and limit your activities. It will take a few weeks for your abdomen to heal.

While you recover, you may have:

• Mild cramping, especially if you are breastfeeding

• Bleeding or discharge for about four to six weeks

• Bleeding with clots and cramps

• Pain in the incision.

Many maternity centers have classes for couples who may need cesarean birth. If you have questions or concerns about cesarean birth, talk to your doctor.

To prevent infection, for a few weeks after your cesarean birth, you should not place anything in your vagina or have sex. Allow time to heal before doing any strenuous activity. Call your doctor if you have a fever, heavy bleeding, or the pain gets worse.

Possible Complications
Like any major surgery, cesarean birth involves risks, most of which can be managed and treated. Your doctor will discuss all risks with you prior to your cesarean delivery.

Complications from cesarean delivery occur in a small number of women and usually are easily treated.

• The uterus, nearby pelvic organs, or skin incision can get infected.

• Loss of blood, sometimes enough to require a blood transfusion.

• Blood clots in the legs, pelvic organs, or lungs.

• Your bowel or bladder can be injured.

• A reaction to the medications or types of anesthesia that are used.