Pregnancy – labor

Pregnancy and Labor in Grand Rapids, Michigan

Labor is the process your body goes through to give birth. It is divided into three stages:

1. First stage – your cervix thins (effaces) and opens (dilates) to about 10 cm
2. Second stage – the birth of your baby
3. Third stage – delivery of the placenta

For first-time mothers, labor often takes around 12–14 hours. If you’ve given birth before, labor may be closer to 7 hours, although every birth is different.

In Grand Rapids, your labor and delivery care may take place at local hospitals such as Corewell Health (formerly Spectrum Health) Butterworth Hospital, Trinity Health Grand Rapids, University of Michigan Health–West (University of Michigan Health-West (formerly Metro Health)), or other regional birth centers. Your obstetrician or midwife will help you choose the safest setting for you and your baby.

Braxton-Hicks vs True Labor

Many West Michigan parents notice Braxton-Hicks contractions (often called “practice contractions”) during the second half of pregnancy. These can:

• Make your belly feel tight or hard
• Lift or visibly change the shape of your pregnant belly
• Be irregular and usually not very painful
• Often ease with rest, hydration, or changing position

These are not true labor. The exact trigger for true labor isn’t fully known, but the hormone oxytocin plays a key role in causing regular uterine contractions that gradually open the cervix.

Signs You May Be Going Into Labor

As your body prepares for birth, you may notice:

• A small bloodstained discharge as your cervix thins (effaces)
• Loss of the mucus plug (often called a “show”)
• Period-like cramps
• Low backache, which can be common in colder Grand Rapids winters
• Diarrhea or loose stools
• A gush or trickle of fluid if your waters (amniotic sac) break
• Contractions that become regular, stronger, and closer together

If you’re unsure whether you’re in labor, you can call your hospital’s labor and delivery unit (e.g., at Corewell Health, Trinity Health Grand Rapids, or University of Michigan Health-West) or your midwife for advice.

First Stage of Labor

The first stage of labor is when your cervix thins and opens to about 10 cm. This stage is usually the longest and is divided into three phases:

Latent Phase (Early Labor)

• Cervix dilates from 0 to about 3 cm
• Contractions may be:
  • Mild
  • Irregular or far apart
  • Sometimes barely noticeable
• This phase can last hours, days, or even weeks

During this time in Grand Rapids, many women choose to:

• Stay at home if everything is low-risk
• Rest, hydrate, and eat light foods
• Use warm showers, warm packs, or gentle movement to cope with discomfort

Cold Michigan weather, especially in winter, can make getting to the hospital slower. Plan ahead for winter driving conditions and consider leaving a bit earlier if roads are icy or snowy.

Active Phase

• Cervix dilates from about 3 to 7–8 cm
• Contractions become:
  • Stronger and more painful
  • 3–4 minutes apart
  • Lasting 30–60 seconds

Most women will be in their intended place of birth (hospital or birth center) by this time. Your midwife or doctor will:

• Monitor your contractions
• Check your cervix periodically
• Assess your wellbeing and your baby’s heart rate

Transition Phase

• Cervix dilates from 8 to 10 cm (fully dilated)
• Contractions are often:
  • Very intense
  • Very close together
  • Sometimes feel like they are “running into each other”

You may:

• Feel out of control, shaky, or overwhelmed
• Have a strong urge to use the toilet as the baby’s head moves down and presses on the rectum
• Feel pressure very low in your pelvis

Throughout the first stage, your care team at a Grand Rapids hospital or birth center will closely monitor:

• Your vital signs (blood pressure, pulse, temperature)
• Your baby’s heart rate
• The progress of your labor

This helps detect any problems early and allows timely intervention if needed.

Second Stage of Labor: Birth of Your Baby

The second stage of labor begins when your cervix is fully dilated (10 cm) and ends with the birth of your baby.

During this stage:

• Contractions are regular and strong
• You may feel a powerful urge to bear down and push as each contraction peaks
• You’ll feel stretching or burning as your baby’s head moves down and crowns (appears at the vaginal opening)

Your doctor or midwife will:

• Guide your pushing to support a gentle, controlled birth of your baby’s head
• Check for the umbilical cord around your baby’s neck
  • If present, they may loosen it, lift it over the baby’s head, or clamp and cut it so your baby can be born safely
• Support your baby’s shoulders and body as they follow the head

For first-time mothers, the second stage can last 1–2 hours, especially if you have an epidural. If you’ve had a baby before, this stage is often shorter.

Monitoring of you and your baby is usually more frequent during the second stage to ensure both of you remain safe.

When the Second Stage Is Long

A prolonged second stage can increase risks for you and your baby, such as:

• Maternal exhaustion
• Increased chance of assisted vaginal birth (forceps or vacuum)
• Distress for the baby

If your labor is not progressing, your care team will:

• Assess the reasons (baby’s position, strength of contractions, pelvic anatomy, etc.)
• Discuss options to help labor move along, which may include:
  • Changing positions
  • Adjusting pain relief
  • Using medications to strengthen contractions
  • Assisted vaginal birth if needed

Third Stage of Labor: Delivering the Placenta

After your baby is born, your uterus continues to contract to:

• Loosen and push out the placenta
• Reduce bleeding by clamping down on blood vessels

The placenta is usually delivered within 5–30 minutes after birth. You may not feel these contractions as strongly as during the second stage.

A moderate amount of bleeding (up to about 500 ml) is normal. Because of the risk of heavier bleeding (postpartum hemorrhage), the third stage is carefully supervised in Grand Rapids hospitals and birth centers.

Managing the Third Stage of Labor

There are two main approaches:

1. Active Management (Common in U.S. Hospitals)

This is the standard practice in most Grand Rapids maternity units:

• With your consent, you are given an injection of oxytocin after your baby is born
• The umbilical cord is clamped and cut
• The midwife or doctor gently pulls on the cord while supporting your uterus to help deliver the placenta more quickly

Active management has been shown to:

• Reduce the risk of excessive bleeding (postpartum hemorrhage)
• Reduce other serious complications

2. Expectant (Physiological) Management

In this approach:

• The placenta is allowed to deliver on its own, with help from:
  • Gravity
  • Your own contractions
  • Nipple stimulation (which increases natural oxytocin)
• The umbilical cord remains attached to the baby until it stops pulsating

Not every hospital routinely offers expectant management, especially if you have risk factors for heavy bleeding. Your options can be discussed with your provider during prenatal visits at clinics in Grand Rapids.

Monitoring Your Baby During Labor

Throughout labor, your baby’s heart rate is checked regularly to ensure they are coping well.

Intermittent Monitoring

If your pregnancy has been low risk and labor is progressing normally, your baby’s heart rate may be checked:

• Every 15–30 minutes during active labor
• Using:
  • A hand-held Doppler ultrasound device
  • A Pinard fetal stethoscope

This can usually be done in any position—standing, sitting, on a birth ball, or lying down.

Continuous Monitoring (CTG)

If you had problems during pregnancy or if concerns arise in labor, your baby may be monitored continuously using a cardiotocograph (CTG):

• Two plastic disks (receivers) are strapped to your abdomen with belts
• The machine records your baby’s heart rate and your contractions
• In some hospitals, CTG may limit your movement, though some units in Grand Rapids have telemetry machines that allow you to move around more freely while being monitored

Care of the Perineum and Episiotomy

The perineum is the area between the vagina and the anus. As your baby’s head crowns, this area stretches significantly. If it cannot stretch enough, it may tear.

• Most tears are small and heal well with stitches
• In about 3–4% of cases, a more severe tear can extend from the vagina to the anus

An episiotomy is a planned cut in the perineum using scissors. It:

• Is easier to repair than some natural tears
• Often heals more predictably
• May be less traumatic to the muscles and tissues in some situations

An episiotomy may be recommended if:

• You are at high risk of a severe tear
• Your baby needs to be born quickly because of signs of distress
• You are having an assisted vaginal birth (forceps or vacuum)

Episiotomies Should Not Be Routine

Current medical guidance is that episiotomies should be done only when clearly needed. Routine use does not:

• Reduce the risk of severe perineal injury
• Prevent urinary stress incontinence
• Protect the baby from trauma

Preventing Perineal Tears

To help reduce your risk of significant tearing:

• Perineal massage in the last few weeks of pregnancy (at home) may help if this is your first baby
• Perineal massage during the second stage of labor has not been shown to prevent injury
• Your midwife or doctor may:
  • Support the perineum with warm compresses
  • Guide your pushing to allow a slower, more controlled birth of the head

Preparing for Labor in Grand Rapids, MI

Being prepared can help you feel more confident and calm when labor starts. Helpful steps include:

Choose Your Support Person

Select someone who:

• Makes you feel safe and supported
• Can stay focused on helping you, not distracting you
• Is comfortable being in the birth space

Take Childbirth Education Classes

Look for classes offered by:

• Corewell Health / Corewell Health
• Trinity Health Grand Rapids
• University of Michigan Health-West–West
• Local doulas and birth educators
• Community resources through the Kent County Health Department or Grand Rapids Public Health

Classes may cover:

• Stages of labor
• Pain relief options
• Breathing and relaxation techniques
• Breastfeeding and newborn care
• Partner/support person roles

Consider Comfort and Coping Strategies

Some women find the following helpful:

• Prenatal yoga (in-person or online, with many options in Grand Rapids)
• Relaxation exercises or meditation
• Hypnobirthing or hypnotherapy techniques
• Practicing breathing techniques with your support person

Early Labor at Home

When early labor starts, general suggestions include:

• Rest whenever you can
• Relax at home where you feel comfortable
• Eat light, easy-to-digest foods
• Drink plenty of fluids (water, herbal tea, clear fluids)

You usually do not need to go to the hospital until contractions are regular and painful.

Timing Contractions

Once your contractions are about 7–10 minutes apart, begin timing them:

• Time from the start of one contraction to the start of the next
• Note how long each contraction lasts
• Track whether they are becoming stronger and closer together

When to Call or Go In (Grand Rapids Context)

Call your hospital’s labor and delivery unit, your midwife, or your obstetrician if:

• You’re unsure whether to stay home or come in
• Contractions are regular and getting stronger
• You have concerns about your baby’s movements

In general, you should go to your intended place of birth when:

• Contractions are about 5 minutes apart, lasting about a minute, for at least an hour
• You live a long distance from your hospital or road conditions (snow, ice, heavy rain) may slow travel
• You no longer feel comfortable being at home

Go to the hospital immediately if:

• Your waters break, especially if the fluid is green, brown, or has a bad smell
• You have vaginal bleeding that is more than a light “show”
• You notice a sudden decrease in your baby’s movements
• You develop severe pain, fever, or feel very unwell

During Labor at the Hospital or Birth Center

Once you arrive at your chosen Grand Rapids hospital or birth center, helpful strategies include:

• Drink plenty of fluids (water, clear juices, ice chips)
• Suck on sweets or ice to keep up your energy if allowed
• Vary your position:
  • Standing or walking
  • Kneeling or leaning forward
  • Sitting on a birth ball or straddling a chair
  • On all fours
• Use water:
  • Take a warm shower
  • Soak in a bath if available and safe
• Ask your support person for a:
  • Back rub or massage
  • Heat pack for your back
  • Cool cloth for your face or neck

Pain Relief Options

Discuss pain relief options with your doctor or midwife, which may include:

• Breathing and relaxation techniques
• Warm water (shower or bath)
• Nitrous oxide (“laughing gas”)
• Intravenous medications
• Epidural anesthesia

Your care team at Corewell Health, Trinity Health Grand Rapids, or University of Michigan Health-West will explain the benefits and risks of each option.

Using Gravity and Listening to Your Body

• Try to stay upright and mobile as much as possible if you and your baby are stable
• Walk, stand, or sit upright to help your baby move down
• Wait to push until your cervix is fully dilated—your midwife or doctor will guide you

Do not worry about:

• How you look or sound—midwives and labor nurses have seen and heard it all
• Grunting, yelling, or swearing—this is common
• Passing a bowel motion during labor—this is normal and expected

The Role of a Support Person

Having a support person with you can make a big difference in how you experience labor. Your support person can:

• Encourage and reassure you
• Help you change positions and stay comfortable
• Remind you of breathing and relaxation techniques
• Offer massage, a heat pack, or cool cloths
• Provide ice chips or sips of water if allowed
• Communicate your preferences to the care team
• Celebrate the birth of your baby with you

Many families in Grand Rapids also choose to work with a doula—a trained birth support person—alongside their medical team.

Local Resources in Grand Rapids, MI

If you’re pregnant in Grand Rapids, you can access:

• Corewell Health (Corewell Health) maternity services
• Trinity Health Grand Rapids obstetric and midwifery care
• University of Michigan Health–West (University of Michigan Health-West) women’s health clinics
• Trinity Health Grand Rapids affiliated providers in the region
• The Kent County Health Department and Grand Rapids Public Health for:
  • Prenatal education
  • WIC program support
  • Immunizations and postpartum resources

Your primary care doctor (primary care doctor), obstetrician, or midwife can help coordinate your care and refer you to local classes and support groups.

Key Points About Labor

• Labor has three stages: cervical dilation, birth of the baby, and delivery of the placenta
• A long second stage can increase risks for you and your baby; if labor is not progressing, your team will work to find the cause and support safe delivery
• The third stage can be managed actively or expectantly; active management is common in U.S. hospitals and helps reduce heavy bleeding
• Episiotomies should be performed only when needed, not routinely
• Staying informed, having a trusted support person, and using local Grand Rapids maternity resources can help you feel more prepared for labor and birth