Of the joys and challenges you face in life, none is more extraordinary than having your first baby. From the moment you find out that you're pregnant to the day you give birth, you'll experience many changes and learn new ways to take care of yourself and your growing baby.

Mother and baby experts from our hospitals and physician groups in the Sutter network have shared their knowledge and expertise to provide you with the best possible care. Working together, we established care recommendations based on the experiences of more than 152,000 first-time mothers across our network. This scientific evidence identified best practices for promoting a healthy pregnancy and safe delivery. The following compiled information for first-time mothers recognizes and supports this magnificent time in your life.

Early Labor

Because you've never experienced labor before, you may find it difficult to know if you're in labor. Before heading to the hospital, call your doctor or midwife to discuss your labor symptoms.

More than One Hospital Trip

It's common for first-time mothers to make more than one trip to the hospital. If you're in early labor and sent home, the following activities may be helpful:

• Walking.
• Showering.
• Resting.
• Drinking fluids.
• Listening to music, etc.

Prodromal Labor
Some first-time mothers experience a prolonged period of early labor with minimal to no change in their cervical dilation. This condition is called "Prodromal Labor". If this occurs, it's especially important to:

• Alternate rest and activity.
• Keep hydrated.
• Maintain your physical energy with light, high-energy food.

Partners and families can be very helpful in keeping the mother distracted with activities and in keeping up her spirits. Periodic contact with your healthcare provider is also helpful.

Active Labor

Literature shows, and we have found, admitting a first-time mother to the hospital when she's in active labor has a better outcome than admitting a first-time mother to the hospital when she's in early labor. Admitting a first-time mother during active labor helps her labor progress with minimal interventions and she has a higher occurrence of having a vaginal delivery. In active labor, the contractions are less than 5 minutes apart, lasting 45-60 seconds and the cervix is dilated 3 centimeters or more.

Induction

Although inducing labor may be needed for certain medical problems or prolonged pregnancies, induction for a first-time mother carries additional risk. Induction of labor for a first-time mother (especially with a cervix that is nearly closed), doubles or triples the length of labor and possibility of a cesarean birth. However, in subsequent pregnancies, the chances for a cesarean delivery after induction are lower. Inductions are not done prior to 39 weeks gestation unless there is a medical reason.

Comfort and Pain Management

Pain is a natural part of labor and every woman is unique in the level of pain she can tolerate. Women also have varying success with the kind of activities or interventions that can help decrease their labor pain and increase their comfort. Outlined below are the three types of activities and interventions: comfort measures, medication, and regional anesthesia.

Comfort Measures

There are several good approaches to pain relief that are effective throughout labor that everyone should try. Any of the following approaches with which you feel comfortable can be used during your labor:

• Walking.
• Water therapy (shower or tub).
• Sitting or leaning on a birthing ball or rocking chair.
• Keeping a restful environment in your labor room (quiet, low lighting, soothing music).
• Carefully select support people for a calm environment.
• Using various positions (all fours, sitting on toilet, kneeling, squatting, pelvic rock) and supporting with pillows if necessary.
• Massage/back rubs by support person.
• Effleurage (light massage of abdomen).
• Having your partner or a support person rub a tennis ball over your lower back.
• Applying warm or cold compresses.
• Using relaxation/breathing techniques.
• Prayers or religious ceremonies.
• Guided meditation using calming imagery.
• Utilizing several comfort techniques is an excellent way to involve first-time partners in supporting and working with you in the childbirth process.

Medication

For some women, as labor progresses and contractions become stronger or they get too tired to cope, comfort measures no longer provide enough relief. Pain medications are commonly used at that point, and your doctor or midwife will explain the benefits of each type and will help you select the appropriate medication that's safe for you and your baby. You may want to discuss medications in advance of labor with your doctor or midwife.

Medication may not totally eliminate labor pain, but can help ease it so you can better rest and cope with the discomfort. Continue to use comfort measures that help you relax as much as possible between contractions. Except in early labor, the most commonly used medications are short acting, minimizing the effect on the baby. For some women, no other medications are necessary to help cope with labor pains.

Regional Anesthesia (Epidural, Spinal or Intrathecal Medication)

If you reach a point in active labor that comfort measures and/or medication are no longer giving you adequate pain relief, your physician or midwife may order regional anesthesia to provide stronger pain relief. The anesthesiologist inserts a needle in your lower back to administer regional anesthesia. The goal of regional anesthesia, especially after your cervix is completely dilated, is to reach a balance between easing your feeling of pain and still feeling the urge to bear down to actively participate in delivering your baby. Talk to your doctor or midwife in advance of labor about regional anesthesia, and tour the hospital to find out what types of regional anesthesia are available.

Episiotomy

There is a national trend to avoid routine episiotomies (a cut in the perineum to enlarge the vaginal opening). Recent studies show that routine episiotomies have little or no medical benefit. What used to be a national episiotomy rate of 60 to 80 percent for first-time mothers has decreased to less than 13 percent.

The main concern is that the episiotomy can increase the risk for extended tears to the rectum, especially for first-time mothers. This may lead to greater short and/or long term problems with bowel control (loss of gas or stool) later in life. Twenty years ago, it was thought that episiotomy might prevent these problems. We now know that this is not the case and that midline episiotomy actually appears to increase the rate of these problems.

For your first delivery, you're encouraged to discuss episiotomy with your obstetrician or midwife (and their partners if they are part of a group practice) at one of your last prenatal appointments or when you're in early labor.

Close to 70 percent of women will have a natural tear with the birth of their first baby. Such tears usually involve less tissue and trauma than an episiotomy.

Pushing

Also known as the second stage of labor, pushing starts sometime after the cervix is completely dilated (10 centimeters).

The Importance of Waiting

It's important to wait for the natural urge to bear down before starting active pushing. You're often encouraged to push by "holding your breath and push as hard and as long as you can." Research has suggested that a woman's spontaneous urge to push occurs three to five times during a contraction while the woman is exhaling and bearing down.

Pushing with an Epidural

If you use an epidural, you may be encouraged to rest until you have the sensation to push. Women who receive epidural anesthesia for labor may have difficulty pushing, especially if the strength of the anesthetic numbs the sensation to bear down. The practice of delayed pushing (waiting for the baby to passively come through birth canal) is an alternative to routine pushing at 10 centimeters in women using epidurals.

There may be circumstances, such as having a strong regional anesthetic, or an arrest of labor, where you may not feel the urge to push. If so, you will be assisted with pushing.

Other Information and Tips

• Upright positioning (sitting, squatting, standing) allows gravity to help you push.
• Allowing the baby's head to gradually stretch the tissue at the outlet of the vagina (perineum) will reduce the risk of a significant tear. Lying on your side is associated with fewer significant tears.
• During second stage labor, your uterus pushes the baby down the birth canal (passive descent).
• Perineal massage (gradual stretching of the vaginal and perineal tissues) from 36 weeks on has been associated with fewer perineal tears. Ask your doctor or midwife for information about perineal massage.
• If your obstetrician or midwife is concerned about your or your baby's health, they may opt to shorten the second stage of labor by using a vacuum or forceps on the baby's head (performed by the obstetrician).
• The breathing techniques used for pushing vary and depend upon what works best for you.

Recovery

Life outside the womb is a special period of adjustment for your baby. Your body is also adjusting to great physical changes. The first hour after birth is a time for you to make these adjustments and, with your partner, enjoy these magical moments as a new family.

During the approximately 90-minute recovery period, your temperature, pulse, blood pressure, respirations, condition of your uterus and vaginal discharge (lochis) will be checked frequently. Throughout this time period, your baby will become acquainted with you through sight, touch, and smell. Baby will probably self-attach for breastfeeding, as babies are in a very alert state and ready to nurse and bond with their parents at this time.

After the recovery period, you and your baby will be taken to the postpartum room.

Breastfeeding

• It's important to hold your baby skin to skin in the first hour following birth. This closeness will assist with your first breastfeeding experience.
• Your baby is most interested in nursing within the first hour of life.
• Your baby is eager to meet you and needs the colostrum (initial fluid from your breast) for energy and protection against infection.
• After the first 1 to 2 hours, your baby may become sleepy and less interested in nursing.

Baby

• Purchase and learn how to use an approved car seat. California State law requires the use of a federally approved car seat.
• Your baby must always be placed in the car seat, beginning with the ride home from the hospital.