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How do you know when labor begins?

It can be difficult to know when actual labor begins, however most experts would suggest calling your provider when you are experiencing contractions that are three to five minutes apart for about an hour. Contractions should be of a moderate intensity and it should be difficult to carry on a normal conversation through a contraction. Other reasons to call your provider are if you believe your water has broken or if you have significant vaginal bleeding. False labor or “Braxton Hicks” contractions are irregular contractions, which may be painful. Typically true labor contractions come at regular intervals and will get closer together over time. The proper way to time contractions is from the start of one contraction to the start of the next one.

What are the options for pain control during labor and delivery?

There are several options for pain control. In early labor, simply staying mobile is enough to give you the relief you need. This may include walking around, sitting on a birthing ball or bathing/showering.  Another option for pain relief is receiving medication through your IV line or an intramuscular injection known as systemic analgesia. This form of pain medication may cause drowsiness, nausea or difficulty concentrating. It is most often used in the early phases of labor. The most common form of pain relief used during labor and delivery in the U.S. is an epidural block. In most communities this is performed by an anesthesiologist and typically results in some loss of feeling in the lower half of the body, but you remain awake and alert. In an epidural block, medication is given through a tube placed in your lower back.  It is a continuous infusion, providing ongoing pain relief throughout labor.

What is a doula and what is their role in labor and delivery?

A doula is a woman who is a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth. Studies have shown that when a doula is present during a birth there tends to be fewer complications and shorter labors. The American College of Obstetrics and Gynecology has supported the use of doulas to help lower Cesarean section rates. 

What is induction of labor?

Induction of labor is the use of medications or other methods to bring on labor. Labor can be induced in a variety of ways, and your provider will help you choose the proper method for you following your cervical exam. One of the most common methods to induce labor is using oxytocin, which is a medication that causes contractions of the uterus. Other methods include performing an amniotomy (breaking the water) or using special devices to help the cervix dilate or expand. Labor induction may be recommended if the health of the mother or baby is at risk. In some cases, labor induction can be performed electively.

Are there certain labor positions that can be beneficial?

There are many different positions that can help not only decrease pain in labor, but also facilitate labor. Being able to walk around is extremely helpful in allowing you to freely change positions. Some of the popular labor positions include standing, sitting or kneeling on a birthing ball, leaning, rocking, swaying and squatting. If you are unable to ambulate (if you have an epidural) there are still many options for different labor positions. These include hands and knees and lying on your side with your legs propped up. These positions are not only good for laboring, but for delivering your baby as well. 

Dr. Kirifides, a Delaware native, graduated from the Philadelphia College of Osteopathic Medicine in 2000. He completed his residency at Christiana Hospital in 2005, where he was chief resident his senior year. He has been practicing in the Newark, Del. area since 2005 and is board-certified in Obstetrics and Gynecology. Dr. Kirifides is trained in all the newest surgical techniques including laparoscopic gynecologic surgery. He serves on the Rules and Guidelines Committee as well as the Credentialing Committee for the Christiana Care Health System.

First State Women’s Care
875 AAA Blvd., Suite B
Newark, Del., 19713


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