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JAMA Patient Page
May 4, 2005


JAMA. 2005;293(17):2180. doi:10.1001/jama.293.17.2180

A typical pregnancy lasts about 40 weeks (9 months) from a woman's last menstrual period. During this time, the fetus develops inside the mother's uterus (womb). As the pregnancy approaches term, the uterus changes and begins to have contractions in the process of labor leading to childbirth. Obstetricians are doctors trained in the health care of pregnant women, including methods of delivery. Nurse midwives are registered nurses who specialize in the care of pregnant women, including labor and nonoperative methods of delivery. The May 4, 2005, issue of JAMA includes an article about episiotomy (an incision to widen the opening of the vagina) during the childbirth process.

Types of childbirth

  • Spontaneous vaginal birth—the baby is born through the vagina, usually with only guidance and assistance by the doctor or midwife.

  • Vacuum-assisted vaginal birth—a suction (vacuum) device is placed on the baby's head to help the baby's body transit the birth canal.

  • Forceps-assisted vaginal birth—instruments called forceps are placed around the presenting part (usually the baby's head), allowing the doctor to complete a difficult delivery.

  • Cesarean birth (abdominal delivery)—a major surgical procedure requiring anesthesia and a recovery period. About 20% of births in the United States are accomplished using cesarean birth. The cesarean rate in other parts of the world varies greatly.

Pain relief during childbirth

Because labor and childbirth can cause significant pain, it is important to know your options about pain relief. Relaxation techniques and methods of breathing are popular and useful ways to ease the pain of labor. Other ways of managing labor pain are pain medications given through an intravenous line, nerve blocks, and medications given through a catheter (tube) placed in the epidural space around the covering of the spinal cord or as spinal anesthesia (injection into the spinal fluid). Epidural catheters placed to relieve labor pain may also be used for epidural anesthesia if a cesarean birth becomes necessary. Other types of anesthesia used for cesarean births include spinal anesthesia and general anesthesia (being put to sleep), which is usually used only for emergency cesarean deliveries or when medical problems do not allow for spinal or epidural placement.

Preparing for labor and delivery

  • Seek early prenatal care if you suspect you are pregnant.

  • Maintain a healthful diet and exercise plan approved by your doctor.

  • Do not use tobacco, alcohol, or any illegal drugs.

  • Use the educational resources available through your doctor to learn as much as possible about the process of pregnancy, labor, and the methods of delivery.

  • Get plenty of rest as your due date approaches. Labor and delivery may be lengthy and tiring.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. A Patient Page on birth labor was published in the September 18, 2002, issue; and one on cesarean delivery was published in the May 22/29, 2002, issue.

Sources: National Institute of Child Health and Human Development, American Society of Anesthesiologists, March of Dimes, National Women's Health Information Center

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.