Labour & Delivery
Labour is long and typically lasts 14-20 hours for first-timers. A lot can happen in that time!
Please know that doctors and nurses want to support you to have the best possible and safest birthing experience.
We will keep you updated about your progress and continue open conversations about your desires, worries, excitement.
In Canada, about 75% of moms deliver babies vaginally, 25% by C-section.
About 80% of those having a first-time vaginal delivery with have a vaginal tear that will be repaired.
60-80% of moms choose to have an epidural for pain relief.
Making sure you have accurate information to make informed choices is key.
Keeping realistic and flexible expectations is really important!
Use this birth preferences form to visualize your experience. Bring it with you to hospital.
When should I go to the hospital?
First-time moms should go to the hospital when huffing and puffing, “can’t walk or talk” every 5 minutes, your water breaks, or you have abnormal bleeding or pain.
Call triage if you are unsure. An OBGYN is in hospital 24/7 to assess you and listen for your baby’s heartrate for 20 minutes.
Labouring patients who have had babies before should go when contractions are every 10 minutes or as directed by your OBGYN. Give yourself extra time!
If you are scheduled for a C-section, go to hospital if you have any contractions/cramps or any of the above concerns.
Be aware of your baby’s movements and if you have any of the above concerns, or can’t feel at least 10 movements in 2 hours, go to Triage/Labour & Delivery.
Reliable fact-based Birthing Info from Society of Obstetricians and Gynaecologists’ pregnancyinfo.ca.
Excellent pregnancy, labour, and delivery info from TheMotHERS program
Dr. Kirkham answers your most common pregnancy questions on the Marilyn Denis show
5 strategies for dealing with a long labour in Today’s Parent
What happens in a C-section and what are the reasons I might end up with one? TVASurg
Drs Gunter, Kirkham, and Thornhill discuss birth in this TV episode of Jensplaining
Learn more about epidurals, the most popular and effective local pain relief during labour.
Epidurals are much lighter than they were in the 1970s. The majority of women in hospital choose to have one, as do many who plan otherwise and end up transferring to hospital for epidural. .
Most moms are able to push amazingly and have a vaginal delivery.
The epidural lasts as long as your need, including for sleeping(!) through the rest of your labour while your uterus continues to contract every 2 minutes for hours, for comfortable vaginal checks for dilation, pushing, vaginal tear repair (80-90% have a tear from vaginal delivery without or without epidural), or for C-section.
Complications are extremely rare and will be explained to you by your anaesthesiologist.
Laughing gas (nitrous oxide) is currently not available due to COVID-19, but is usually only helpful in the last stages of labour and in someone who will delivery very quickly (someone who has had a baby before).
What is an Induction of Labour?
Your care provider (whether doctor or midwife) may discuss your need for an induction (starting the labour process). They are needed for
maternal reasons (past your due date, gestational diabetes, high blood pressure, over 40 years old (max 39 weeks), previous stillbirth, cholestasis of pregnancy, parental choice),
fetal reasons (very large baby, growth-restricted baby, low amniotic fluid, excess amniotic fluid, water broke and no labour yet to decrease risk of infection, decreased movements),
placental reasons (poor blood flow to/from baby, placenta dysfunction which usually occur as placentas age).
Inductions may occur at term (37+ weeks) or pre-term (<37 weeks) depending on the severity of the above situations.
Recent research shows that inductions do NOT increase the risk of C-section. The above reasons for having an induction may increase the risk for C-section, regardless of induction or not.
Expect your length of labour to be longer than the usual 14-20 hours of active labour because of the added time on top to get things started (latent early labour). Having this frame of mind helps.
At our hospital, we usually use the most natural way to induce labour, a foley catheter (tube with a balloon inflated on the end) to increase your own prostaglandin hormone at the cervix to ripen it. This is done the night before with the use of a speculum (like the one used for pap smears) and you go home with the catheter. A nonstress test (listening to your baby’s heart rate for 20 minutes) will be done before and after the procedure. Wearing a dress home helps. You may have mild cramps overnight, just as one would with labour that starts on its own. You can eat a good breakfast before returning to Labour & Delivery the next morning. The next steps may include starting and carefully titrating iv oxytocin (the same hormone your body makes in order to have contractions strong enough to squeeze the baby down to open the cervix) or breaking your water (feels like a vaginal exam, usually uncomfortable but not painful) both of which continue to help the uterus contract. The only way a vaginal delivery can occur is with adequate strength and timing of contractions. Imagine contractions as squeezing a balloon.
Induction can also be done with the use of prostaglandin vaginal ribbon or gel. This hormone insert helps to soften and ripen the cervix. It leads to mild cramps and contractions and the start of labour in the next 6 to 12 to 24 hours.
Oral or vaginal misoprostol is another option. This medication is given on a specific schedule in hospital to help with ripening the cervix and starting labour.
For those who are already 2-3cm (usually someone who has had a baby before), simply breaking the water during a vaginal exam is also a form of induction as it recruits natural hormones to get labour started.
Inductions do not necessarily increase the pain. Effective contractions are painful, regardless of your own body’s oxytocin or via augmentation. Oxytocin is an important hormone from your brain that helps with uterus contractions, milk production, contractions that stop excess bleeding after delivery (postpartum hemorrhage), and bonding with your baby.
What happens during labour?
Labour takes almost an entire day, especially if it’s your first baby. Each labour and the pushing (second stage) becomes shorter. Your contractions may start first or your water may break first. Contractions that feel like painful period cramps need to happen in order to squeeze your baby down the the birth canal for a vaginal birth to occur. Walking or moving around, bouncing on a ball, dancing in early labour when contractions begin can be helpful. Many people need support in active (more intense labour when your cervix if dilated more than 3 cm and you can hardly walk or talk) and it may be in the form of your doctor or midwife breaking your water, offering oxytocin through a vein in your hand or arm, placing a peanut ball between your legs to open your pelvis, or offering an epidural for pain relief and to relax the pelvic floor. Try to rest and sleep as much as possible during labour (this is possible with an epidural that removes the pain sensations) so that you will have energy to push and care for your baby after birth.
What should I bring to the hospital?
You DO NOT need to pre-register at the hospital. You will labour and deliver in your own room.
After delivery, OHIP covers fees for shared rooms. You can upgrade to a private room, if available. Bring any extended health benefits insurance coverage info.
Where do i go if i think I’m in labour or have other concerns?
Vitamin K is highly recommended. Vitamin K is a vital and life-saving vitamin for your newborn baby.
What is vitamin K?
Vitamin K is an important vitamin that is used by the body to form clots to stop active bleeding. It stops us from continuing to bleed. All humans need this vitamin. It is available in certain fruits and vegetables.
Why does a newborn baby need vitamin K?
Without vitamin K, baby can have internal bleeding. Babies have a long journey to birth whether it is labour (~10-24 hours of contractions and squeezing), with or without vacuum or forceps intervention, C-section, and are handled after birth. In other words, there are many opportunities for pressure to their body, and bleeding that can lead to jaundice (bruising of blood vessels that become yellow) and bleeding from any organs. Bleeding from the brain is a stroke, for example.
Newborns have low levels of vitamin K and thus need it from another source for bone and blood health. Vitamin K does not pass through the placenta from mom, so even taking prenatal vitamins will not increase baby’s vitamin K. Breastmilk has low levels of vitamin K.
Why is it given by injection instead of orally?
Vitamin K injection is not a vaccine.
It is given by injection to the muscle because it takes 5-7 days for the body to make the clotting (coagulation) factors. Baby’s low levels of vitamin K continue to fall after birth and cannot be replaced by vitamin K from breastmilk. An injection is a quick way to give medicine. Vitamin K injections have been given to babies for over 60 years. Oral doses would require repeated doses over several weeks and months. Oral doses are too slow to make the clotting factors.
Why can’t I wait to see if my baby needs it?
Waiting to have a vitamin K shot may be too late because the bleeding is internal into the intestines or brain. Waiting leads to emergency medical intervention such as blood transfusion, resuscitation, surgery, hospitalization, or death. The amount in the injection replaces baby’s very low levels at birth, then is stored in the liver and continues to help make the clotting factors over the next few months. The ideal time for injection is within 6 hours of birth.
What is hemorrhagic disease of the newborn?
Hemorrhagic disease of the newborn is vitamin K deficiency bleeding (VKDB). It leads to internal bleeding from any organs that can occur in the first couple days of life or can also happen later. This bleeding risk remains for 6 months and is life-threatening or can cause 1 in 5 babies with VKDB to die. Internal bleeding leads to an emergency need for injections, blood and plasma transfusion and resuscitation for baby to stay alive.
What is in the vitamin K injection?
Vitamin K1 (Phytonadione) comes in a clear yellow preservative-free solution and includes propylene glycol and polyethylene glycol (PEG-15) and water. Those common nontoxic chemicals help to dissolve the vitamin K into water. They are used in many food products. There is no known toxicity or side effects from vitamin K1 (vs vitamin K3 was given in the past).
What is the potential harm of not giving vitamin K?
Newborns who do not get vitamin K injections are 81 times more likely to have severe bleeding.
They have high risks for long term problems (organ or brain damage) or death.
Are some babies at higher risk for VKDB?
All newborns are at risk.
Baby boys, breastfed babies, and those born preterm (<37 weeks) or by vaginal birth are at slightly higher risk.
Babies born to moms on anti-seizure, anti-tuberculosis, and cephalosporin antibiotic medications also have lower vitamin K.
What is the risk of death from VKDB if not giving vitamin K?
20% or 1 in 5 babies with VKDB dies. 50% of babies with late VKDB have bleeding into the brain or other organs like intestines, with possibility for permanent brain damage and disability. Bleeding then leads to blood transfusions and surgeries.
If we decline vitamin K injection for our baby, what should we be watching for?
Bruising, oozing (from nose, belly button cord stump, or circumcision site), inactive baby, difficulty breathing (baby working hard to breathe where you can see their ribs and abdomen drawing in), belly getting big and distended, abnormal yellow eyes or skin or pale colour of baby, extra sleepiness or irritability, vomiting, black stool (old blood) or bloody stool. These are emergencies that need immediate medical attention.
This seems to be a hot topic on social media. What is the reality?
As with all social media, please be vigilant that you do not end up in a rabbit hole. In a 2020 study in the US, only 0-3.2% of parents refused vitamin K injections in hospital, while 14.5% of parents who choose home births and 31% of those in birthing centres (no MDs or nurses in these facilities) refused.
How can I help my baby with their injection?
Feeding your baby while they get their injection can be very soothing. Or cuddling your baby as skin to skin within the first hour after birth is recommended and supported in hospitals.
Vitamin K1 injection is
a life-saving intervention for your baby
an easy way to prevent internal bleeding and early and late VKBD
is preservative-free
not a vaccine
non-toxic
safe
a no-brainer