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Pregnancy And Childbirth www.PregnancyAndChildbirth.net Labor and Birth Soon, you'll experience the amazing process of childbirth! Find out how to spot the signs of labor, and get the facts on pain management, cesarean delivery, and more. Spot the Signs of Labor As you approach your due date, you will be looking for any little sign that labor is about to start. You might notice that your baby has "dropped" or moved lower into your pelvis. This is called "lightening." If you have a pelvic exam during your prenatal visit, your doctor might report changes in your cervix that you cannot feel, but that suggest your body is getting ready. For some women, a flurry of energy and the impulse to cook or clean, called "nesting," is a sign that labor is approaching. Some signs suggest that labor will begin very soon. Call your doctor or midwife if you have any of the following signs of labor. Call you doctor even if it's weeks before your due date — you might be going into preterm labor. Your doctor or midwife can decide if it's time to go to the hospital or if you should be seen at the office first. You have contractions that become stronger at regular and increasingly shorter intervals. You have lower back pain and cramping that does not go away. Your water breaks (can be a large gush or a continuous trickle). You have a bloody (brownish or red-tinged) mucus discharge. This is probably the mucus plug that blocks the cervix. Losing your mucus plug usually means your cervix is dilating (opening up) and becoming thinner and softer (effacing). Labor could start right away or may still be days away. Did my water break? It's not always easy to know. If your water breaks, it could be a gush or a slow trickle of amniotic (AM-nee-OT-ihk) fluid. Rupture of membranes is the medical term for your water breaking. Let your doctor know the time your water breaks and any color or odor. Also, call your doctor if you think your water broke, but are not sure. An easy test can tell your doctor if the leaking fluid is urine (many pregnant women leak urine) or amniotic fluid. Often a woman will go into labor soon after her water breaks. When this doesn't happen, her doctor may want to induce (bring about) labor. This is because once your water breaks, your risk of getting an infection goes up as labor is delayed. False Labor Many women, especially first-time mothers-to-be, think they are in labor when they're not. This is called false labor. "Practice" contractions called Braxton Hicks contractions are common in the last weeks of pregnancy or earlier. The tightening of your uterus might startle you. Some might even be painful or take your breath away. It's no wonder that many women mistaken Braxton Hicks contractions for the real thing. So don't feel embarrassed if you go to the hospital thinking you're in labor, only to be sent home. So, how can you tell if your contractions are true labor? Time them. Use a watch or clock to keep track of the time one contraction starts to the time the next contraction starts, as well as how long each contraction lasts. With true labor, contractions become regular, stronger, and more frequent. Braxton Hicks contractions are not in a regular pattern, and they taper off and go away. Some women find that a change in activity, such as walking or lying down, makes Braxton Hicks contractions go away. This won't happen with true labor. Even with these guidelines, it can be hard to tell if labor is real. If you ever are unsure if contractions are true labor, call your doctor. Stages of Labor Most babies' heads enter the pelvis facing to one side, and then rotate to face down. Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). How labor progresses and how long it lasts are different for every woman. But each stage features some milestones that are true for every woman. First Stage The first stage begins with the onset of labor and ends when the cervix is fully opened. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. You might want to rest, watch TV, hang out with family, or even go for a walk. Unless your doctor tells you otherwise, you can drink and eat during labor, which can provide you with needed energy later. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center. At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby's position and station (location in the birth canal). Most babies' heads enter the pelvis facing to one side, and then rotate to face down. Sometimes, a baby will be facing up, towards the mother's abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own. As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. Many of the positioning and relaxation tips you learned in childbirth class can help now. Try to find the most comfortable position during contractions and to let your muscles go limp between contractions. Let your support person know how he or she can be helpful, such as by rubbing your lower back, giving you ice chips to suck, or putting a cold washcloth on your forehead. Sometimes, medicines and other methods are used to help speed up labor that is progressing slowly. Many doctors will rupture the membranes. Although this practice is widely used, studies show that doing so during labor does not help shorten the length of labor. Your doctor might want to use an electronic fetal monitor to see if blood supply to your baby is okay. For most women, this involves putting two straps around the mother's abdomen. One strap measures the strength and frequency of your contractions. The other strap records how the baby's heartbeat reacts to the contraction. The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last, few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters. Second Stage The baby twists and turns through the birth canal. The second stage involves pushing and delivery of your baby. It usually lasts 20 minutes to two hours. You will push hard during contractions, and rest between contractions. Pushing is hard work, and a support person can really help keep you focused. A woman can give birth in many positions, such as lying on her back, squatting, or kneeling. You might find pushing to be easier or more comfortable one way. Some studies suggest that upright positions, such as squatting, may shorten this stage of labor and help keep the tissue near the birth canal intact. When the top of your baby's head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy (uh-peez-ee-OT-oh-mee), to enlarge the vaginal opening. Most women in childbirth do not need episiotomy. Sometimes, forceps (tool shaped like salad-tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After your baby is born, the umbilical cord is cut. Make sure to tell your doctor if you or your partner would like to cut the umbilical cord. Third Stage Did you know? Most baby's present head down. If a baby's feet or buttocks are in position to deliver first, the baby is said to be breech. Breech deliveries increase the risk that the baby will suffer health problems or die. If your baby is breech, your doctor may try to turn the baby a few weeks before your due date simply by pushing your abdomen or suggest a cesarean delivery. A recent large study found that if one or both parents were born breech, their children are twice as likely to be born the same way. The third stage involves delivery of the placenta (afterbirth). It is the shortest stage, lasting 5 to 30 minutes. Contractions will begin 5 to 30 minutes after birth, signaling that it's time to deliver the placenta. You might have chills or shakiness. Labor is over once the placenta is delivered. Your doctor will repair the episiotomy and any tears you might have. Now, you can rest and enjoy your newborn! Managing Labor Pain Virtually all women worry about how they will cope with the pain of labor and delivery. Childbirth is different for everyone. So no one can predict how you will feel. The amount of pain a woman feels during labor depends partly on the size and position of her baby, the size of her pelvis, her emotions, the strength of the contractions, and her outlook. Some women do fine with natural methods of pain relief alone. Many women blend natural methods with medications that relieve pain. Building a positive outlook on childbirth and managing fear may also help some women cope with the pain. It is important to realize that labor pain is not like pain due to illness or injury. Instead, it is caused by contractions of the uterus that are pushing your baby down and out of the birth canal. In other words, labor pain has a purpose. Try the following to help you feel positive about childbirth: Take a childbirth class. Call the doctor, midwife, hospital, or birthing center for class information. Get information from your doctor or midwife. Write down your questions and talk about them at your regular visits. Share your fears and emotions with friends, family, and your partner. Natural Methods of Pain Relief Many natural methods help women to relax and make pain more manageable. Things women do to ease the pain include: Trying breathing and relaxation techniques Taking warm showers or baths Getting massages Using heat and cold, such as heat on lower back and cold washcloth on forehead Having the supportive care of a loved one, nurse, or doula Finding comfortable positions while in labor (stand, crouch, sit, walk, etc.) Using a labor ball Listening to music Water and childbirth More and more women in the United States are using water to find comfort during labor. This is called hydrotherapy. Laboring in a tub of warm water helps women feel physically supported, and keeps them warm and relaxed. Plus, it is easier for laboring women to move and find comfortable positions in the water. In waterbirthing, a woman remains in the water for delivery. The American Academy of Pediatrics has expressed concerns about delivering in water because of a lack of studies showing its safety and because of the rare but reported chance of complications. Ask your doctor or midwife if you want to know more about waterbirthing. Medical Methods of Pain Relief While you're in labor, your doctor, midwife, or nurse should ask if you need pain relief. It is her job to help you decide what option is best for you. Nowadays women in labor have many pain relief options that work well and pose small risks when given by a trained and experienced doctor. Doctors also can use different methods for pain relief at different stages of labor. Still, not all options are available at every hospital and birthing center. Plus your health history, allergies, and any problems with your pregnancy will make some methods better than others. Methods of relieving pain commonly used for labor are described in the chart below. Keep in mind that rare, but serious complications sometimes occur. Also, most medicines used to manage pain during labor pass freely into the placenta. Ask your doctor how pain relief methods might affect your baby or your ability to breastfeed after delivery. Medical Methods of Pain Relief Method How it Can Help Some Disadvantages Opioids (OH-pee-oids) – also called narcotics, are medicines given through a tube inserted in a vein or by injecting the medicine into a muscle. Sometimes, opioids also are given with epidural or spinal blocks. Opioids can make the pain bearable, and don't affect your ability to push. After getting this kind of pain relief, you can still get an epidural or spinal block later. Opioids don't get rid of all the pain, and they are short-acting. They can make you feel sleepy and drowsy. They can cause nausea and vomiting. They can make you feel very itchy. Opioids cannot be given right before delivery because they may slow the baby's breathing and heart rate at birth. Epidural and spinal blocks – An epidural involves placing a tube (catheter) into the lower back, into a small space below the spinal cord. Small doses of medicine can be given through the tube as needed throughout labor. With a spinal block, a small dose of medicine is given as a shot into the spinal fluid in the lower back. Spinal blocks usually are given only once during labor. Epidural and spinal blocks allow most women to be awake and alert with very little pain during labor and childbirth. With epidural, pain relief starts 10 to 20 minutes after the medicine has been given. The degree of numbness you feel can be adjusted throughout your labor. With spinal block, good pain relief starts right away, but it only lasts 1 to 2 hours. Although you can move, you might not be able to walk if the medicine used affects motor function. It can lower your blood pressure, which can slow your baby's heartbeat. Fluids given through IV are given to lower this risk. Fluids can make you shiver. But women in labor often shiver with or without epidural. If the covering of the spinal chord is punctured, you can get a bad headache. Treatment can help the headache. Backache for a few days after labor. Epidural can prolong the first and second stages of labor. If given late in labor or if too much medicine is used, it might be hard to push when the time comes. Studies show that epidural increases risk of assisted vaginal delivery. Pudendal block – A doctor injects numbing medicine into the vagina and the nearby pudendal nerve. This nerve carries sensation to the lower part of your vagina and vulva. This is only used late in labor, usually right before the baby's head comes out. With a pudendal block, you have some pain relief but remain awake, alert, and able to push the baby out. The baby is not affected by this medicine and it has very few disadvantages. Inducing Labor Sometimes, a doctor or midwife might need to induce (bring about) labor. The decision to induce labor often is made when a woman is past her due date but labor has not yet begun or when there is concern about the baby or mother's health. Some specific reasons why labor might be induced include: A woman's water has broken (ruptured membranes), but labor has not begun on its own Infection inside the uterus Baby is growing too slowly Complications that arise when the mother's Rh factor is negative and her unborn baby's is positive Not enough amniotic fluid Complications, such as high blood pressure or preeclampsia Health problems in the mother, such as kidney disease or diabetes The doctor or midwife can use medicines and other methods to open a pregnant woman's cervix, stimulate contractions, and prepare for vaginal birth. Inducing labor increases a woman's chance of cesarean delivery. So you will want to make sure with your doctor that the benefits of inducing labor outweigh the risks of continuing the pregnancy. Cesarean Birth Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth. Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995. Public heath experts think that many c-sections are unnecessary. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery. Reasons for C-sections Your doctor might recommend a c-section if she thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when: the mother is carrying more than one baby (twins, triplets, etc.) the mother has health problems including HIV infection, herpes infection, and heart disease the mother has dangerously high blood pressure the mother has problems with the shape of her pelvis there are problems with the placenta there are problems with the umbilical cord there are problems with the position of the baby, such as breech the baby shows signs of distress, such as a slowed heart rate the mother has had a previous c-section Patient-requested C-section: Can a Woman Choose? A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems. But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits. Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger. Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery. The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need. The C-section Experience Most c-sections are unplanned. So, learning about c-sections is important for all women who are pregnant. Whether a c-section is planned or comes up during labor, it can be a positive birth experience for many women. The overview that follows will help you to know what to expect during a nonemergency c-section and what questions to ask. Before surgery Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask: Can I have a support person with me during the operation? What are my options for blocking pain? Can I have music played during the surgery? Will I be able to watch the surgery if I want? During surgery The doctor will make 2 incisions. The first is about 6 inches long and goes through the skin, fat, and muscle. Most incisions are made side to side and low on the abdomen, called a bikini incision. Next, the doctor will make an incision to open the uterus. The opening is made just wide enough for the baby to fit through. One doctor will use a hand to support the baby while another doctor pushes the uterus to help push that baby out. Fluid will be suctioned out of your baby's mouth and nose. The doctor will hold up your baby for you to see. Once your baby is delivered, the umbilical cord is cut, and the placenta is removed. Then, the doctor cleans and stitches up the uterus and abdomen. The repair takes up most of the surgery time. Questions to ask: Can my partner cut the umbilical cord? What happens to my baby right after delivery? Can I hold and touch my baby during the surgery repair? When is it okay for me to try to breastfeed? When can my partner take pictures or video? After surgery You will be moved to a recovery room and monitored for a few hours. You might feel shaky, nauseated, and very sleepy. Later, you will be brought to a hospital room. When you and your baby are ready, you can hold, snuggle, and nurse your baby. Many people will be excited to see you. But don't accept too many visitors. Use your time in the hospital, usually about 4 days, to rest and bond with your baby. C-section is major surgery, and recovery takes about 6 weeks (not counting the fatigue of new motherhood). In the weeks ahead, you will need to focus on healing, getting as much rest as possible, and bonding with your baby — nothing else. Be careful about taking on too much and accept help as needed. Questions to ask: Can my baby be brought to me in the recovery room? What are the best positions for me to breastfeed? Vaginal Birth After C-section (VBAC)? Some women who have delivered previous babies by c-section would like to have their next baby vaginally. This is called vaginal delivery after c-section or VBAC. Women give many reasons for wanting a VBAC. Some want to avoid the risks and long recovery of surgery. Others want to experience vaginal delivery. Of women who try VBAC, 60 percent to 80 percent are able to deliver vaginally. But VBAC isn't the right choice for everyone. Some women have health or pregnancy complications that make VBAC unsafe. For other women, the risks of c-section are more acceptable than the risks of VBAC. Still, others don't live near a hospital where VBAC is possible. Your doctor can tell you if you are a good candidate for VBAC. VBAC might be an option for you if: You had 1 previous planned c-section done with a low, horizontal incision ("bikini" incision). You have no other uterine scars (aside from the prior c-section) or problems. You have no known problems with your pelvis. A doctor will be present during all of labor and delivery and can perform an emergency c-section if needed. A surgical team is immediately available in case an emergency c-section is needed. Your doctor can explain the risks of both repeat cesarean delivery and VBAC. With VBAC, the most serious danger is the chance that the c-section scar on the uterus will open up during labor and delivery. This is called uterine rupture. While very rare, uterine rupture is very dangerous for the mother and baby. Less than 1 percent of VBACs lead to uterine rupture. But doctors cannot predict if uterine rupture is likely to occur in a woman. This risk, albeit very small, is unacceptable to some women. The percent of VBACs is dropping in the United States for many reasons. Some doctors, hospitals, and patients have concerns about the safety of VBAC. Some hospitals and doctors are unwilling to do VBACs because of fear of lawsuits and insurance or staffing expenses. Many doctors, however, question if this trend is in the best interest of women's health. Choosing to try a VBAC is complex. If you are interested in a VBAC, talk to your doctor and read up on the subject. Only you and your doctor can decide what is best for you. VBACs and planned c-sections both have their benefits and risks. Learn the pros and cons and be aware of possible problems before you make your choice.

Recovering After Childbirth

Right now, you are focused on caring for your new baby. But new mothers must take special care of their bodies after giving birth and while breastfeeding, too. Doing so will help you to regain your energy and strength. When you take care of yourself, you are able to best care for and enjoy your baby.

Getting Rest

The first few days at home after having your baby are a time for rest and recovery — physically and emotionally. You need to focus your energy on yourself and on getting to know your new baby. Even though you may be very excited and have requests for lots of visits from family and friends, try to limit visitors and get as much rest as possible. Don't expect to keep your house perfect. You may find that all you can do is eat, sleep, and care for your baby. And that is perfectly okay. Learn to pace yourself from the first day that you arrive back home. Try to lie down or nap while the baby naps. Don't try to do too much around the house. Allow others to help you and don't be afraid to ask for help with cleaning, laundry, meals, or with caring for the baby.

Physical Changes

After the birth of your baby, your doctor will talk with you about things you will experience as your body starts to recover.

• You will have vaginal discharge called lochia (LOH-kee-uh). It is the tissue and blood that lined your uterus during pregnancy. It is heavy and bright red at first, becoming lighter in flow and color until it goes aware after a few weeks.

• You might also have swelling in your legs and feet. You can reduce swelling by keeping your feet elevated when possible.

• You might feel constipated. Try to drink plenty of water and eat fresh fruits and vegetables.

• Menstrual-like cramping is common, especially if you are breastfeeding. Your breast milk will come in within three to six days after your delivery. Even if you are not breastfeeding, you can have milk leaking from your nipples, and your breasts might feel full, tender, or uncomfortable.

• Follow your doctor's instructions on how much activity, like climbing stairs or walking, you can do for the next few weeks.

Your doctor will check your recovery at your postpartum visit, about 6 weeks after birth. Ask about resuming normal activities, as well as eating and fitness plans to help you return to a healthy weight. Also ask our doctor about having sex and birth control. Your period could return in 6 to 8 weeks, or sooner if you do not breastfeed. If you breastfeed, your period might not resume for many months. Still, using reliable birth control is the best way to prevent pregnancy until you want to have another baby.

Regaining a Healthy Weight and Shape

Both pregnancy and labor can affect a woman's body. After giving birth you will lose about 10 pounds right away and a little more as body fluid levels decrease. Don't expect or try to lose additional pregnancy weight right away. Gradual weight loss over several months is the safest way, especially if you are breastfeeding. A healthy eating plan along with regular physical fitness might be all you need to return to a healthy weight. But talk to your doctor before you start any type of diet or exercise plan.

If you want to diet and are breastfeeding, it is best to wait until your baby is at least two months old. During those first two months, your body needs to recover from childbirth and establish a good milk supply. Then when you start to lose weight, try not to lose too much too quickly. This can be harmful to the baby because environmental toxins that are stored in your body fat can be released into your breast milk. Losing about one pound per week (no more than four pounds per month) has been found to be a safe amount and will not affect your milk supply or the baby's growth.

You can safely lose weight by consuming at least 1800 calories per day with well-balanced, healthy food choices that include foods rich in calcium, zinc, magnesium, vitamin B₆, and folate. Eating less than 1500 calories per day is not recommended at any point during breastfeeding. This can put you at risk for a nutritional deficiency, lower your energy level, and lower your resistance to illness.

Feeling Blue

After childbirth you may feel sad, weepy, and overwhelmed for a few days. Many new mothers have the "baby blues" after giving birth. Changing hormones, anxiety about caring for the baby, and lack of sleep all affect your emotions.

Be patient with yourself. These feelings are normal and usually go away quickly. But if sadness lasts more than 2 weeks, go see your doctor. Don't wait until you postpartum visit to do so. You might have a serious but treatable condition called postpartum depression. Postpartum depression can happen any time within the first year after birth.

Signs of postpartum depression include:

• Feeling restless or irritable

• Feeling sad, depressed, or crying a lot

• Having no energy

• Having headaches, chest pains, heart palpitations (the heart being fast and feeling like it is skipping beats), numbness, or hyperventilation (fast and shallow breathing)

• Not being able to sleep, being very tired, or both

• Not being able to eat and weight loss

• Overeating and weight gain

• Trouble focusing, remembering, or making decisions

• Being overly worried about the baby

• Not having any interest in the baby

• Feeling worthless and guilty

• Having no interest or getting no pleasure from activities like sex and socializing

• Thoughts of harming your baby or yourself

Some women don't tell anyone about their symptoms because they feel embarrassed or guilty about having these feelings at a time when they think they should be happy. Don't let this happen to you! Postpartum depression can make it hard to take care of your baby. Infants with mothers with postpartum depression can have delays in learning how to talk. They can have problems with emotional bonding. Your doctor can help you feel better and get back to enjoying your new baby. Therapy and/or medicine can treat postpartum depression.

Your Baby's First Hours of Life

After months of waiting, finally, your new baby has arrived! Mothers-to-be often spend so much time in anticipation of labor, they don't think about or even know what to expect during the first hours after delivery. Read on so you will be ready to bond with your new bundle of joy.

What Newborns Look Like

You might be surprised by how your newborn looks at birth. If you had a vaginal delivery, your baby entered this world through a narrow and boney passage. It's not uncommon for newborns to be born bluish, bruised, and with a misshapen head. An ear might be folded over. Your baby may have a complete head of hair or be bald. Your baby also will have a thick, pasty, whitish coating, which protected the skin in the womb. This will wash away during the first bathing.

Once your baby is placed into your arms, your gaze will go right to his or her eyes. Most newborns open their eyes soon after birth. Eyes will be brown or bluish-gray at first. Looking over your baby, you might notice that the face is a little puffy. You might notice small white bumps inside your baby's mouth or on his or her tongue. Your baby might be very wrinkly. Some babies, especially those born early, are covered in soft, fine hair, which will come off in a couple of weeks. Your baby's skin might have various colored marks, blotches, or rashes, and fingernails could be long. You might also notice that your baby's breasts or vulva are a bit swollen.

How your baby looks will change from day to day, and many of the early marks of childbirth go away with time. If you have any concerns about something you see, talk to your doctor. After a few weeks, your newborn will look more and more like the baby you pictured in your dreams.

Bonding With Your Baby

Spending time with your baby in those first hours of life is very special. Although you might be tired, your newborn could be quite alert after birth. Cuddle your baby skin-to-skin. Let your baby get to know your voice and study your face. Your baby can see up to about 2 feet away. You might notice that your baby throws his or her arms out if someone turns on a light or makes a sudden noise. This is called the startle response. Babies also are born with grasp and sucking reflexes. Put your finger in your baby's palm and watch how she or he knows to squeeze it. Feed your baby when she or he shows signs of hunger. You can visit our section on breastfeeding for tips to make these first feedings go well.

Medical Care for Your Newborn

Right after birth babies need many important tests and procedures to ensure their health. Some of these are even required by law. But as long as the baby is healthy, everything but the Apgar test can wait for at least an hour. Delaying further medical care will preserve the precious first moments of life for you, your partner, and the baby. A baby who has not been poked and prodded may be more willing to nurse and cuddle. So before delivery, talk to your doctor or midwife about delaying shots, medicine, and tests.

The following tests and procedures are recommended or required in most hospitals in the United States:

Apgar Evaluation

The Apgar test is a quick way for doctors to figure out if the baby is healthy or needs extra medical care. Apgar tests are usually done twice: one minute after birth and again five minutes after birth. Doctors and nurses measure 5 signs of the baby's condition. These are:

• heart rate

• breathing

• activity and muscle tone

• reflexes

• skin color

Apgar scores range from 0 to 10. A baby who scores 7 or more is considered very healthy. But a lower score doesn't always mean there is something wrong. Perfectly healthy babies often have low Apgar scores in the first minute of life.

In more than 98 percent of cases, the Apgar score reaches 7 after 5 minutes of life. When it does not, the baby needs medical care and close monitoring.

Eye Care

Your baby may receive eye drops or ointment to prevent eye infections they can get during delivery. Sexually transmitted diseases (STDs) including gonorrhea and chlamydia are a main cause of newborn eye infections. These infections can cause blindness if not treated.

Medicines used can sting and/or blur the baby's vision. So you may want to postpone this treatment for a little while.

Some parents question whether this treatment is really necessary. Many women at low risk for STIs do not want their newborns to receive eye medicine. But there is no evidence to suggest that this medicine harms the baby.

It is important to note that even pregnant women who test negative for STDs may get an infection by the time of delivery. Plus, most women with gonorrhea and/or chlamydia don't know it because they have no symptoms.

Vitamin K Shot

The American Academy of Pediatrics recommends that all newborns receive a shot of vitamin K in the upper leg. Newborns usually have low levels of vitamin K in their bodies. This vitamin is needed for the blood to clot. Low levels of vitamin K can cause a rare but serious bleeding problem. Research shows that vitamin K shots prevent dangerous bleeding in newborns.

Newborns probably feel pain when the shot is given. But afterwards babies don't seem to have any discomfort. Since it may be uncomfortable for the baby, you may want to postpone this shot for a little while.

Newborn Metabolic Screening

Doctors or nurses prick your baby's heel to take a tiny sample of blood. They use this blood to test for many diseases. All babies should be tested because a few babies may look healthy but have a rare health problem. A blood test is the only way to find out about these problems. If found right away, serious problems like developmental disabilities, organ damage, blindness, and even death might be prevented.

All 50 states and U.S. territories screen newborns for phenylketonuria (fee-nuhl-kee-toh-NUR-ee-uh) (PKU), hypothyroidism, galactosemia (guh-LAK-tuh-SEE-mee-uh), and sickle cell disease. But many states routinely test for up to 30 different diseases. The March of Dimes recommends that all newborns be tested for at least 29 diseases.

You can find out what tests are offered in your state by contacting your state's health department or newborn screening program. 

Hearing Test

Most babies have a hearing screening soon after birth, usually before they leave the hospital. Tiny earphones or microphones are used to see how the baby reacts to sounds. All newborns need a hearing screening because hearing defects are not uncommon and hearing loss can be hard to detect in babies and young children. When problems are found early, children can get the services they need at an early age. This might prevent delays in speech, language, and thinking. Ask your hospital or your baby's doctor about newborn hearing screening.

Hepatitis B Vaccine

All newborns should get a vaccine to protect against the hepatitis B virus (HBV) before leaving the hospital. HBV can cause a lifelong infection, serious liver damage, and even death.

The hepatitis B vaccine (HepB) is a series of three different shots. The American Academy of Pediatrics and the Centers for Disease Control (CDC) recommend that all newborns get the first HepB shot before leaving the hospital. If the mother has HBV, her baby should also get a HBIG shot within 12 hours of birth. The second HepB shot should be given 1 to 2 months after birth. The third HepB shot should be given no earlier than 24 weeks of age, but before 18 months of age.

Complete Check-up

Soon after delivery most doctors or nurses also:

• Measure the newborn's weight, length, and head.

• Take the baby's temperature.

• Measure that baby's breathing and heart rate.

• Give the baby a bath and clean the umbilical cord stump.

What is Colporrhaphy? 

Colporrhaphy is the surgical repair of the vaginal wall. This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "Pelvic Organ Prolapse," "vaginal prolapse," "Vaginal Vault Prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele. A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the Colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina. The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed. 


Who performs the Colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.


What is a Pelvic Prolapse?

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse."  Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, prolapsed uterus, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse, vaginal relaxation, or vaginal vault prolapse.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, prolapsed uterus, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse, vaginal relaxation, or vaginal vault prolapse.

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

What is the Vaginal Vault?

What is Vaginal Vault Suspension?

Vaginal Vault Suspension is a surgical procedure that provides support for the apex/vault of the vagina to various pelvic structures.

What is Vaginal Dryness?

Vaginal dryness is one of the most distressing, and painful problems a woman faces.  Vaginal dryness occurs when the natural vagina secretions decreases within the vagina. The amount of vaginal moisture varies throughout a woman's monthly menstrual cycle. Vaginal dryness is particularly problematical as a woman enters and becomes menopausal.

What is a "Vaginal Moisturizer"?

Vaginal moisturizers, provided by numerous companies, and a variety of brand names, are products designed to relieve the pain and discomfort of vaginal dryness. These products are applied or inserted, into the vagina, one or more times per day, depending on the amount of vaginal dryness she may be experiencing.

A vaginal moisturizer may or may not be a vaginal lubricant.  Vaginal lubricants are normally used as an aid for intercourse and used on a short-term basis to help a woman that is not able to produce enough vaginal moisture to permit her to comfortably (and painlessly) engage in intercourse.  

A menstruating woman's vaginal moisture changes from day to day, and varies depending upon her hormones that control the production of vaginal moisture.  A woman can experience vaginal dryness even during times of menstrual bleeding, especially when using tampons, as tampons can remove the natural moisture her vagina produces which can cause irritation and pain.

What is Female Sexual Arousal Disorder?

Female Sexual Arousal Disorder or simply "FSAD" occurs when a woman is unable to attain and maintain a full and complete erection of her clitoris along with sufficient vaginal lubrication during intercourse to be able to reach an orgasm.  

Female Sexual Arousal Disorder may also be diagnosed when the woman has no desire for sexual intercourse. 

Female Sexual Arousal Disorder affects up to 43 percent of all women, or an estimated 90 million women. Most women (more than 1/2) with FSAD are postmenopausal. Some women with Female Sexual Arousal Disorder describe the condition as being "unable to get turned on," or being continually disinterested in sex. Female Sexual Arousal Disorder has  also been called "frigidity." Other symptoms of Female Sexual Arousal Disorder may include dyspareunia and vaginismus, both of which involve pain during intercourse.

The woman and her husband/partner should both be seen as this is a "couple's problem" that is typically best resolved with both partners in treatment.  Their doctor will also insure that this  is not the result of another psychological disorder which could be a primary problem. 

If the husband/ partner of a patient with suspected Female Sexual Arousal Disorder feels that this is a problem within the relationship, that concern should be sufficient for the individual to seek psychological consultation.

What is Female Erectile Dysfunction?

Female Erectile Dysfunction occurs when a woman is unable to attain, and maintain a complete erection of her clitoris through orgasm.

If the husband/partner of a patient with suspected Female Erectile Dysfunction feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation. 

What Are Female Sexual Problems?

Female Sexual Problems are also referred to as "Female Sexual Dysfunction."  A woman may have one or more Female Sexual Problems that we are just now learning that may be related to a number of factors.  

Typically, Female Sexual Problems are labeled generically as "Female Sexual Dysfunction" until such time as her doctor or therapist may be able to make a proper diagnosis.  

Female Sexual Problems may be a cause of significant distress to both her and her husband. 

If the husband/partner of a patient with suspected Female Sexual Problems feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation. 

What is Female Orgasmic Disorder?

Female Orgasmic Disorder is defined as a sexual dysfunction that is characterized by a persistent or recurrent delay or absence of orgasm following the excitement phase of the female sexual response cycle, causing significant distress or interpersonal problems, and not being attributable to a drug or a general medical condition. 

Female Orgasmic Disorder is directly related with the woman's inability to attain and maintain a fully-erect clitoris.  

Without a full erection of the clitoris, a woman cannot reach an orgasm. 

What is Hypoactive Sexual Desire Disorder?

Hypoactive Sexual Desire Disorder or "HSDD" has been defined as a deficiency or absence of sexual fantasies and desire for sexual activity. Hypoactive Sexual Desire Disorder is considered a disorder if it causes distress for the woman or husband.  The woman and her husband should both be seen as this is a "couple's problem" that is typically best resolved with both partners in treatment.  Their doctor will also insure that this  is not the result of another psychological disorder which could be a primary problem. 

If the husband/partner of a patient with suspected Hypoactive Sexual Desire Disorder feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation.

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What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband/partner.

Vaginal Relaxation?

Ladies, is your loose vagina causing you embarrassment or have you lost the joy of intimacy?  

If one or more vaginal childbirths have caused your vagina to become loose, and "not tight", he has probably noticed as well. You can once again, have the "tight vagina" of your youth! 

What you, and he are experiencing, is something called "Vaginal Relaxation," the medical jargon for "loose vagina."

Did you know that over 35 - 40 million American women and their husbands are suffering loss of joy and intimacy due to "Vaginal Relaxation?" 

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Some women, as another symptom of Vaginal Relaxation, have problems controlling their urine in certain situations or notice changes in their bowel habits. These symptoms of Vaginal Relaxation are typically related to one or more problems that occur as a result of vaginal childbirth, other vaginal trauma, aging or a combination of the above.  

There is hope!  Women, and their husbands/partners, no longer need to suffer from Vaginal Relaxation.  More and more doctors are treating women and couples suffering from Vaginal Relaxation with treatments – sometimes including surgery – that will help them return to a life without the embarrassment, disappointments and heartache of the symptoms and discomforts associated with Vaginal Relaxation.

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What Dads & Husbands Must Know About Vulvovaginal Health 

Especially For Dads who are 
"Raising Girls Without Women"

Let's face it, more and more dads, are being awarded primary and sometimes, sole-custody of their daughter(s). And, it's about time the courts recognize that dad's are just as capable, just as loving, just as nurturing, as a parent, than their ex-wives.  Many times, Dad's are even better at parenting. 

Dads with daughters need to be able to communicate with their daughters when it comes to their daughter's vulvovaginal health and feminine hygiene needs. 

While most young ladies do not have problems with vaginal dryness, vaginal odor, or feminine itching, changes in their hormones as they approach their first menstrual period, and after, can sometimes cause these problems.  

And when you are the only parent, you need to know how to help your daughter(s) with these health issues. By being informed, honest, and straight forward, you can be the trusted resource your daughter needs. And just as important, if you don't know the answer to her vulvovaginal health or feminine hygiene questions, tell her that you don't know and will find out and let her know.  

What is Vaginal Dryness?

Vaginal dryness is one of the most distressing, and painful problems a woman faces.  Vaginal dryness occurs when the natural vagina secretions decreases within the vagina. The amount of vaginal moisture varies throughout a woman's monthly menstrual cycle. Vaginal dryness is particularly problematical as a woman enters and becomes menopausal.

What is a "Vaginal Moisturizer"?

Vaginal moisturizers, provided by numerous companies, and a variety of brand names, are products designed to relieve the pain and discomfort of vaginal dryness. These products are applied or inserted, into the vagina, one or more times per day, depending on the amount of vaginal dryness she may be experiencing.

A vaginal moisturizer may or may not be a vaginal lubricant.  Vaginal lubricants are normally used as an aid for intercourse and used on a short-term basis to help a woman that is not able to produce enough vaginal moisture to permit her to comfortably (and painlessly) engage in intercourse.  

A menstruating woman's vaginal moisture changes from day to day, and varies depending upon her hormones that control the production of vaginal moisture.  A woman can experience vaginal dryness even during times of menstrual bleeding.  

What is menopause?

Menopause is a normal change in a woman's life when her period stops. That's why some people call menopause "the change of life" or "the change." During menopause a woman's body slowly produces less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row.

What is hormone therapy for menopause?

Hormone therapy for menopause has also been called hormone replacement therapy (HRT). Lower hormone levels in menopause may lead to hot flashes, vaginal dryness and thin bones. To help with these problems, women are often given estrogen or estrogen with progestin (another hormone). Like all medicines, hormone therapy has risks and benefits. Talk to your doctor, nurse, or pharmacist about hormones. If you decide to use hormones, use them at the lowest dose that helps. Also use them for the shortest time that you need them.

What are the symptoms of menopause?

Every woman's period will stop at menopause. Some women may not have any other symptoms at all. 

As women begin reaching the age of 40, their bodies are preparing for menopause, or the stopping of their monthly menstrual periods.  Menopause never happens all at once.  As young ladies approach their first period and monthly menstruation, her body's hormones are "transitioning" to producing hormones levels that will support monthly menstruation for about the the next 35 years. Similarly, as women reach their 40's, their bodies' hormone levels begin to change, and in preparation of menopause. 

Women will know they are approaching menopause, as they will notice the following symptoms:

• Changes in your period - time between periods or flow may be different.

• Hot flashes ("hot flushes") - getting warm in the face, neck and chest.

• Night sweats and sleeping problems that lead to feeling tired, stressed or tense.

• Vaginal changes - the vagina may become dry and thin, and sex may be painful.

• Thinning of your bones, which may lead to loss of height and bone breaks (osteoporosis).

Who needs treatment for symptoms of menopause?

• For some women, many of these changes will go away over time without treatment.

• Some women will choose treatment for their symptoms and to prevent bone loss. If you choose treatment, estrogen alone or estrogen with progestin (for a woman who still has her uterus or womb) can be used.

What are the benefits from using hormones for menopause?

Hormone therapy is the most effective FDA approved medicine for relief of hot flashes, night sweats or vaginal dryness.

Hormones may reduce your chances of getting thin, weak bones (osteoporosis) which break easily.

What are the risks of using hormones?

For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen increases her chance of getting endometrial cancer (cancer of the uterine lining). Adding progestin lowers this risk.

Should I use estrogen just to prevent thin bones?

You can, but there are also other medicines and things you can do to help your bones.

Should I use hormone therapy to protect the heart or prevent strokes?

No, do not use hormone therapy to prevent heart attacks or strokes.

Should I use hormone therapy to prevent memory loss or Alzheimer's disease?

No, do not use hormone therapy to prevent memory loss or Alzheimer's disease.

Do hormones protect against aging and wrinkles or increase my sex drive?

Studies have not shown that hormone therapy prevents aging and wrinkles or increases sex drive.

How long should I use hormones for menopause?

You should talk to your doctor, nurse or pharmacist. Again, hormones should be used at the lowest dose that helps and for the shortest time. (For example, check if you still need them every 3-6 months.)

Does it make a difference what form of hormones I use for menopause?

The risks and benefits may be the same for all hormone products for menopause, such as pills, patches, vaginal creams, gels and rings.

Are herbs and other "natural" products useful in treating symptoms of menopause?

At this time, we do not know if herbs or other "natural" products are helpful or safe. Studies are being done to learn about the benefits and risks.

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