Labour most commonly happens 37-41 weeks gestation, that is, within a 4 week window around your due date. True labour involves rhythmic contractions that lead to change of your cervix.

Labour can begin spontaneously or require induction. Your water may break before contractions start.

If you think you may be in labour, go to 4D at Grand River Hospital, Labour and Delivery triage. You will be initially assessed by a nurse, who will then notify your physician. You can usually expect a vaginal exam to determine if your cervix is changing. Sometimes a speculum exam may be done to help determine if your water has broken.

Oxytocin

Oxytocin or Pitocin is the hormone involved in normal labour. It is used for induction of labour but also sometimes used augment labour (ie increase the strength or frequency of contractions that are already happening). Oxytocin is adminsitered intravenously. You will be asked to sign a consent prior to administration. Although oxytocin can be tremendously beneficial to the progress of labour, it carries the risk of over-stimulation of the uterus. This occurence ("tachysystole") can lead to fetal distress or rarely rupture of the uterus. If you are being administered oxytocin, you can expect continuous monitoring of your baby's heart rate.

Episiotomy

Episiotomy is a procedure where your physician cuts the perineal and vaginal tissue deliberately. This procedure is not done routinely but rather on an individual basis. Episiotomy is performed to allow more space for baby's head and to avoid tearing directly downward into the rectum.

Operative delivery

Operative or assisted delivery refers to the use of a vacuum or a pair of forceps (metal tongs) to assist with vaginal delivery. Most commonly operative delivery is performed when baby's head is very low (ie close to delivery) but baby is showing signs of stress or mom's energy is nearly depleted. If baby is showing signs of distress, time is of the essence – a baby in distress will eventually be compromised in their ability to deliver oxygen to their brain. Vacuum deliveries can be complicated by a cephalohematoma or a blood collection on baby's head; rarely there can be severe bleeding in the brain. Most cephalohematomas resolve within a few weeks with no intervention. Mothers are generally unaffected by vacuums. Forceps deliveries can be complicated by facial deliveries and bleeding as well. Forceps deliveries often require an episiotomy and increase the risk and severity of vaginal injury. Both vacuums and forceps are only offered if the conditions permit their safe usage.

Caesarean section

At times, it becomes apparent that a vaginal delivery cannot happen in a manner safe for both mother and child. Sometimes this happens early in pregnancy, for example, if the placenta is growing over the opening of the cervix ("placenta previa"). Sometimes this happens suddenly late in pregnancy, for example, if there is sudden pain, vaginal bleeding and fetal distress (suspected "placental abruption"). In these cases and other scenarios, your physician will discuss your options and will seek consultation with an obstetrician. They will further discuss the risks and benefits of proceeding with caesarean delivery.



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