The first question that is asked to me by most patients even before they plan pregnancy is: ‘Doctor, will I deliver normally?’. So, here I am writing this to answer few questions and most commonly asked doubts.
A pregnant woman goes through lot of physical as well as physiological changes which can create lot of confusion, affect the sleep and food intake as well as mental well-being also can be affected.
In pregnancy, the progesterone hormones maintain quiescence of the uterus until the body is prepared for labour at term. As you approach term, there are certain internal changes in the body that can signify its preparation for labour.
LIGHTENING
After 37 week’s gestation, the fetal head enters into the pelvis and you may suddenly feel that the upper part of the abdomen is light and there is more pressure in the pelvis. You will have frequent urge to pass urine due to the same reason.
LABOUR SIGNS AND SYMPTOMS
- SHOW

It’s a discharge of mucus along with blood which is shed at the beginning of labour. The mucus usually occludes the cervix till term preventing any infection.
LEAKING OF AMNIOTIC FLUID
You may feel sudden gush of fluid (watery) coming out from the vagina, over which you won’t have any control. It would stain the clothes and may continue to wet the bedsheets. At times, the leaking of amniotic fluid maybe of very minimal quantity happening slowly over a period of time causing slow reduction in the amniotic fluid without your knowledge. It would be better to get yourself examined when your underwear is repeatedly getting wet.
LABOUR PAIN
It starts as a tightening of the uterus on and off lasting for few seconds with relaxation in between, along with pain occurring at the lower belly, thighs and the lower back. The intensity of pain can gradually increase, as well as the duration.
Tightening of the uterus without pain is called Braxton hicks contractions which happen throughout pregnancy.
LOW BACK PAIN
Some women may experience only low back ache along with the contractions on and off and may not be able to appreciate the abdomen pain well.
BLEEDING PV
Cervical dilatation during labour causes some amount of bleeding or even passage of small clots or mucus. However, if there is excess bleeding with frequent changing of pads, it could be abruption (early separation of placenta) or because of placenta praevia (low lying placenta) where immediate care is required.

WHEN AND HOW EARLY SHOPULD I REACH HOSPITAL?
If you are a primigravida (first pregnancy), labour pain can last for 8-12 hours or even longer.
However, if you are in second or third pregnancy or prior history of cervical incompetence, labour can progress faster.
If there is a leak PV it is better to reach the hospital at the earliest.
MILLION DOLLAR QUESTION? WILL I DELIVER NORMALLY?
Normal labour requires certain pre-requisites. We examine our patients at term (37-38 weeks).
- Assess the baby weight and position
- Pelvic examination to understand the cervix changes
- Pelvic examination to assess the space if it is adequate for the baby head to pass through.
A woman with low risk pregnancy, with normal baby weight (<4kg), with good space in the pelvis and if the baby is positioned cephalic (head down), will be able to deliver normally.
During labour, a woman is assessed internally to check for progress of labour, fetal heart rate is assessed by CTG test. If there is halt in progress, if there is fetal distress, or if baby passes meconium, such conditions may require emergency caesarean section.
CONDITIONS WHERE NORMAL DELIVERY IS NOT POSSIBLE.
1 Placenta covering cervical os
2. Breech or transverse position
3.Severe IUGR or very low amniotic fluid
4.Fetal distress
5.Cord prolapse
6. CPD/ when the pelvis space is inadequate compared to the fetal head etc.
It is important to discuss the delivery process with the doctor in detail.
If a woman doesn’t develop pain till delivery date, we induce labour with certain tablets or gels containing prostaglandins. Ultimately our goal as obstetricians is to have a healthy mother as well as the healthy baby.