Editing Childbirth (section)

==Signs and symptoms==
The most prominent sign of labour is strong repetitive [[uterine contractions]]. Pain in contractions has been described as feeling similar to very strong [[menstrual cramps]]. Crowning, when the baby's head becomes visible, may be experienced as an intense stretching and burning.<ref name=":11" />

[[Back labour]] is a complication that occurs during childbirth when the feet or the bottom of the baby is visible first ([[Breech birth|bottom-first presentation]]), instead of the being born head down ([[Cephalic presentation|head-first presentation]]).<ref>{{Cite web |title=What is back labor? Signs, pain relief, and more |url=https://www.babycenter.com/pregnancy/your-body/back-labor_1451580 |archive-url=https://web.archive.org/web/20200925101207/https://www.babycenter.com/pregnancy/your-body/back-labor_1451580 |url-status=usurped |archive-date=25 September 2020 |access-date=2024-03-17 |website=BabyCenter |language=en}}</ref> This leads to more intense contractions, and causes pain in the lower back that persists between contractions as the [[Occipital bone|back of the fetus’ head]] exerts pressure on the mother's [[sacrum]].<ref>{{Cite web|date=2020-04-27 |title=Back Labor |url=https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/back-labor/ |access-date=2024-03-17 |website=American Pregnancy Association |language=en-US}}</ref>

Another prominent sign of labour is the [[rupture of membranes]], commonly known as "water breaking".  During pregnancy, a baby is surrounded and cushioned by a fluid-filled sac (the [[amniotic sac]]). Usually the sac ruptures at the beginning of or during labour.  It may cause a gush of fluid or leak in an intermittent or constant flow of small amounts from a woman's vagina. The fluid is clear or pale yellow.   If the amniotic sac has not yet broken during labour the health care provider may break it in a technique called an [[amniotomy]]. In an amniotomy a thin plastic hook is used to make a small opening in the sac, causing the water to break.<ref>{{cite web |title=Labor and delivery, postpartum care |url=https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142 |website=Mayo Clinic |access-date=16 March 2023 |archive-date=2 January 2018 |archive-url=https://web.archive.org/web/20180102225815/https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142 |url-status=live }}</ref> If the sac breaks before labour starts, it's called a [[prelabor rupture of membranes|prelabour rupture of membranes]].   Contractions will typically start within 24 hours after the water breaks. If not, the care provider will generally begin [[Labor induction|labour induction]] within 24 to 48 hours.  If the baby is [[Preterm birth|preterm]] (less than 37 weeks of pregnancy), the healthcare provider may use a medication to delay delivery.<ref>{{cite web |title=Water Breaking |url=https://my.clevelandclinic.org/health/symptoms/24382-water-breaking |website=Cleveland Clinic |access-date=16 March 2023 |archive-date=17 March 2023 |archive-url=https://web.archive.org/web/20230317034514/https://my.clevelandclinic.org/health/symptoms/24382-water-breaking |url-status=live }}</ref>

=== Labour pain ===
{{See also|Pain management during childbirth}}
Labor pains have both [[Visceral pain|visceral]] and [[Somatic nervous system|somatic]] components.<ref name=":11">{{Cite journal |last1=Labor |first1=Simona |last2=Maguire |first2=Simon |date=2008-12-01 |title=The Pain of Labour |journal=Reviews in Pain |language=en |volume=2 |issue=2 |pages=15–19 |doi=10.1177/204946370800200205 |issn=2042-1249 |pmc=4589939 |pmid=26526404}}</ref> During the first and second stages of labour, uterine contractions cause [[Cervical effacement|stretching]] and [[Cervical dilation|opening of the cervix]]. This in turn triggers visceral pain in the inner [[cervix]] and lower segment of the spine.<ref>{{Cite journal |last=Lowe |first=Nancy K. |date=1996 |title=The Pain and Discomfort of Labor and Birth |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1552-6909.1996.tb02517.x |journal=Journal of Obstetric, Gynecologic, & Neonatal Nursing |language=en |volume=25 |issue=1 |pages=82–92 |doi=10.1111/j.1552-6909.1996.tb02517.x |pmid=8627407 |issn=1552-6909}}</ref> Somatic pain is triggered at the end of the first and second stages of labour by pain receptors that supply the nerves on the vaginal surface of the cervix, resulting from stretching, distention, and tearing of the vagina, [[perineum]], and [[pelvic floor]]. Compared to visceral pain, somatic pain is more resistant to [[opioid]] pain medication. [[Nitrous oxide]] may be used in hospitals and birthing centers for this reason.<ref>{{Cite journal |last=Rooks |first=Judith P. |date=2012 |title=Labor Pain Management Other Than Neuraxial: What Do We Know and Where Do We Go Next? |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12009 |journal=Birth |language=en |volume=39 |issue=4 |pages=318–322 |doi=10.1111/birt.12009 |pmid=23281953 |issn=1523-536X}}</ref> 

Beyond physical pain, there are also well-documented [[Biocultural diversity|biocultural]] and [[psychosocial]] aspects of labour pain and pain management.<ref>{{Cite journal |last1=Alehagen |first1=Siw |last2=Wijma |first2=Klaas |last3=Wijma |first3=Barbro |date=2001 |title=Fear during labor |url=https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0412.2001.080004315.x |journal=Acta Obstetricia et Gynecologica Scandinavica |language=en |volume=80 |issue=4 |pages=315–320 |doi=10.1034/j.1600-0412.2001.080004315.x |pmid=11264605 |issn=1600-0412}}</ref><ref>{{Cite journal |last=Rooks |first=Judith P. |date=2012 |title=Labor Pain Management Other Than Neuraxial: What Do We Know and Where Do We Go Next? |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12009 |journal=Birth |language=en |volume=39 |issue=4 |pages=318–322 |doi=10.1111/birt.12009 |pmid=23281953 |issn=1523-536X}}</ref><ref>{{Cite journal |last=Lowe |first=Nancy K. |date=1996 |title=The Pain and Discomfort of Labor and Birth |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1552-6909.1996.tb02517.x |journal=Journal of Obstetric, Gynecologic, & Neonatal Nursing |language=en |volume=25 |issue=1 |pages=82–92 |doi=10.1111/j.1552-6909.1996.tb02517.x |pmid=8627407 |issn=1552-6909}}</ref> Pain is experienced distinctly by different cultures and there are various culturally-relevant interventions than can lessen labour pain, such as having extended female family members present during childbirth.<ref>{{Cite journal |last1=Callister |first1=Lynn Clark |last2=Khalaf |first2=Inaam |last3=Semenic |first3=Sonia |last4=Kartchner |first4=Robin |last5=Vehvilainen-Julkunen |first5=Katri |date=2003-12-01 |title=The pain of childbirth: perceptions of culturally diverse women |url=https://www.sciencedirect.com/science/article/abs/pii/S1524904203000286 |journal=Pain Management Nursing |volume=4 |issue=4 |pages=145–154 |doi=10.1016/S1524-9042(03)00028-6 |pmid=14663792 |issn=1524-9042}}</ref> Labour might be less painful in subsequent births, and this has been associated with lessened fear.<ref>{{Cite journal |last=Lowe |first=N. K. |date=1992-01-01 |title=Differences in first and second stage labor pain between nulliparous and multiparous women |url=https://www.tandfonline.com/doi/abs/10.3109/01674829209009197 |journal=Journal of Psychosomatic Obstetrics & Gynecology |volume=13 |issue=4 |pages=243–253 |doi=10.3109/01674829209009197 |issn=0167-482X}}</ref><ref>{{Cite journal |last1=Huang |first1=Yue |last2=Zhong |first2=Yuehua |last3=Chen |first3=Qiaozhu |last4=Zhou |first4=Jun |last5=Fu |first5=Bailing |last6=Deng |first6=Yongfang |last7=Tu |first7=Xianfang |last8=Wu |first8=Yingfang |date=2024-05-31 |title=A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study |journal=BMC Pregnancy and Childbirth |language=en |volume=24 |issue=1 |page=400 |doi=10.1186/s12884-024-06571-3 |doi-access=free |issn=1471-2393 |pmc=11143632 |pmid=38822235}}</ref>

Pain management techniques during labour can include pain relief with medication (such as an [[Epidural administration|epidural injection]]) or coping techniques (such as the [[Lamaze technique|Lamaze breathing]]).<ref>{{Cite journal |last1=Smith |first1=Caroline A |last2=Levett |first2=Kate M |last3=Collins |first3=Carmel T |last4=Armour |first4=Mike |last5=Dahlen |first5=Hannah G |last6=Suganuma |first6=Machiko |date=2018-03-28 |title=Relaxation techniques for pain management in labour |journal=Cochrane Database of Systematic Reviews |language=en |volume=2018 |issue=3 |pages=CD009514 |doi=10.1002/14651858.CD009514.pub2 |pmc=6494625 |pmid=29589650}}</ref><ref name="Cochrane Database of Systematic Reviews" /><ref>{{Cite journal |last1=Thomson |first1=Gill |last2=Feeley |first2=Claire |last3=Moran |first3=Victoria Hall |last4=Downe |first4=Soo |last5=Oladapo |first5=Olufemi T. |date=30 May 2019 |title=Women's experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review |journal=Reproductive Health |language=en |volume=16 |issue=1 |page=71 |doi=10.1186/s12978-019-0735-4 |doi-access=free |issn=1742-4755 |pmc=6543627 |pmid=31146759}}</ref>

=== Psychological ===

During the later stages of [[gestation]], there is an increase in abundance of [[oxytocin]], a hormone that is known to evoke feelings of contentment, reductions in anxiety, and feelings of calmness.<ref>{{Cite journal |last1=Uvnäs-Moberg |first1=Kerstin |last2=Ekström-Bergström |first2=Anette |last3=Berg |first3=Marie |last4=Buckley |first4=Sarah |last5=Pajalic |first5=Zada |last6=Hadjigeorgiou |first6=Eleni |last7=Kotłowska |first7=Alicja |last8=Lengler |first8=Luise |last9=Kielbratowska |first9=Bogumila |last10=Leon-Larios |first10=Fatima |last11=Magistretti |first11=Claudia Meier |last12=Downe |first12=Soo |last13=Lindström |first13=Bengt |last14=Dencker |first14=Anna |date=9 August 2019 |title=Maternal plasma levels of oxytocin during physiological childbirth – a systematic review with implications for uterine contractions and central actions of oxytocin |journal=BMC Pregnancy and Childbirth |language=en |volume=19 |issue=1 |page=285 |doi=10.1186/s12884-019-2365-9 |doi-access=free |issn=1471-2393 |pmc=6688382 |pmid=31399062}}</ref> Oxytocin is further released during labour when the fetus stimulates the cervix and vagina, and it is believed that it plays a major role in the [[Maternal bond|bonding of a mother to her infant]] and in the establishment of maternal behaviour. The father of the child also has an increase in oxytocin levels following contact with the infant and parents with higher oxytocin levels show being more responsivene and "[[Behavioural synchrony|in synch]]" in their interactions with their infant.  The act of [[breastfeeding|nursing]] a child also causes a release of oxytocin to help the baby get [[Breast milk|milk]] more easily from the nipple.<ref>{{cite web |url= http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/oxytocin.html |title= Oxytocin | vauthors = Bowen R |date= 12 July 2010 |work= Hypertexts for Biomedical Sciences |access-date= 18 August 2013 |url-status= live |archive-url= https://web.archive.org/web/20140829220747/http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/hypopit/oxytocin.html |archive-date= 29 August 2014 }}</ref><ref>{{cite journal |title=Oxytocin and early parent-infant interactions: A systematic review |journal=International Journal of Nursing Sciences |year=2019 |pmid=31728399 |last1=Scatliffe |first1=N. |last2=Casavant |first2=S. |last3=Vittner |first3=D. |last4=Cong |first4=X. |volume=6 |issue=4 |pages=445–453 |doi=10.1016/j.ijnss.2019.09.009 |pmc=6838998 }}</ref>