In the United States, if the birth process is taking too long, physicians may administer the drug Pitocin to speed up labor. In Bolivia, however, certain groups of people believe that nipple stimulation helps the birth move quicker. So if a birth is moving too slowly, a woman’s nipples may be massaged. Biologically, nipple stimulation leads to a release of oxytocin, which is a natural form of pitocin. This is why many midwives in the U. S. also practice nipple stimulation during childbirth.

In some Guatemalan societies, long and difficult labors are believed to be due to a woman’s sins, and so she is asked to confess her sins. If this does not help speed up labor, her husband is asked to confess. If neither of these confessions helps, the father’s loin­cloth is wrapped around the woman’s stomach to assure her that he will not leave her once the baby is born (Dunham et al., 1992).

The first stage of labor can last anywhere from 20 minutes to 24 hours and is longer in first births. When true labor begins, the Braxton-Hicks contractions increase. The cervix begins dilation (opening up) and effacement (thinning out) to allow for fetal passage (this phase is called early labor). Throughout the first stage of labor the en­trance to the cervix (the os) increases from 0 to 10 centimeters to allow for the passage of the fetus.

Toward the end of this stage, the amniotic sac usually ruptures (however, this may happen earlier in some women). Contractions may last for about 30 to 60 seconds with intervals of between 5 and 20 minutes, and the cervix usually dilates to 4 to 5 centime­ters. Couples are advised to time the contractions and the interval between contractions and report these to their healthcare provider. When they are about 5 minutes apart, the healthcare provider will advise the couple to come to the hospital.

Подпись:Подпись:The contractions will eventually begin to last longer (1 minute or more), become more intense, and increase in frequency (every 1 to 3 minutes). Dilation of the cervix

Подпись: I transition The last period in labor, in which contractions are strongest and the periods in between con-tractions are the shortest. Подпись:Подпись:Stage OneПодпись:continues from 4 to 8 centimeters (this phase is called active labor). The contractions that open the os can be very painful, and nurses will usually monitor the progress of cer­vical dilation.

The last phase in stage one is called transition, which for most women is the most difficult part of the birth process. Contractions are very intense and long and have shorter periods in between, and the cervix dilates from 8 to 10 centimeters. The fetus moves into the base of the pelvis, creating an urge to push; however, the woman is ad­vised not to push until her cervix is fully dilated. Many women feel exhausted by this point.

The woman’s body produces pain-reducing hormones called endorphins, which may dull the intensity of the contractions. Should a woman feel the need for more pain re­lief, she can also be given various pain medications. However, she may become drowsy or nauseated and/or the drugs may affect the fetus. In the past several years, there has been a movement away from the use of drugs during delivery. Women are being encour­aged to incorporate methods of relaxation, breathing, hypnosis, and acupuncture.

The fetus is monitored for signs of fetal distress, such as slowed heart rate or lack of oxygen. This is done either through the woman’s abdomen by a sensor or by accessing the fetus’s scalp through the cervix. Fetal monitoring can determine whether or not the fetus is in any danger that would require a quicker delivery or a cesarean section.

Question: Is it safe to use drugs to lessen the pain of labor and birth?

Although some women believe in a "natural" childbirth (one without pain medications), other women want to use them. The search for a perfect drug to relieve pain, one that is safe for both the mother and her child, has been a long one. Every year, more and more progress is made. Medication is often recommended when labor is long and complicated, the pain is more than the mother can tolerate or interferes with her ability to push, forceps are re­quired during the delivery, or when a mother is so restless and agitated that it inhibits labor progress. In all cases, the risks of drug use must be weighed against the benefits.

The most commonly used pain medications include analgesics (pain relievers) and anes­thetics (which produce a loss of sensation). Which drug is used depends on the mother’s preference, past health history, present condition, and the baby’s condition. An epidural block (an anesthetic) is increasingly popular for the relief of severe labor pain. However, how well a pain medication works depends on the mother, the dosage, and other factors. We do know that the use of some drugs, including epidurals, can increase labor time and may be associated with other risk factors. However, newer lower dosage epidurals have been found to produce fewer side effects and are better tolerated by women (Neruda, 2005).