The Waiting Game
There comes a time in every pregnancy when all that's left to do is...wait. The books have been read, the nursery decorated, the car seat installed. "Once you get to 37 weeks of pregnancy, your baby could be born at any time," says Susan Cooter, RN, director of Prepared Childbirth Educators, an organization based in Hatboro, Pennsylvania.
But even though most women give birth between 37 and 42 weeks -- a fairly broad span -- there's no way to pinpoint when labor will begin. "Not knowing makes some women very anxious," says Cooter, who is also a certified doula, an individual who is trained to provide emotional and physical support to women in labor.
If you're a first-time mom, you may not even realize when you're officially in labor. "Plenty of women head to the hospital only to be told to go back home," notes Cooter. It can be hard to distinguish Braxton Hicks contractions, also known as false contractions, from the real thing. But if your contractions gradually become stronger, last longer, and are getting closer together, chances are that labor has begun.
Even if you're in true labor, it may take a while before you're sure. "I was past 39 weeks pregnant with my first baby, but I was in denial that labor was imminent," says Sarah Kearney, a mom of three who lives in Portland, Oregon.
On the day before her daughter Phoebe, now 5, was born, Kearney left her house in the late afternoon to run errands and noticed some fleeting back pains. "I thought I was just sore from my morning swim," she says. It wasn't until that night that she realized she was in labor. "I'd been having minor twinges all day, but at about 10 p.m., the contractions really started to hurt."
When they were about 8 minutes apart, at around 2 a.m., she and her husband headed to the hospital. Upon arriving there, Kearney's cervix was already 7 centimeters dilated (a baby is ready to be born when the cervix is dilated to 10 centimeters). Phoebe was born around noon, after more than six hours of pushing.
In the early stages of labor, you're better off at home where you'll be more comfortable. After all, a first-time mom can expect to be in labor for 12 to 14 hours, according to the American College of Obstetricians and Gynecologists. "Labor with subsequent pregnancies usually goes faster," Cooter says.
When it does come time to check in to the hospital or birthing center, keep in mind that things don't always (or more accurately, don't usually) go exactly as planned. You may not be able to get the epidural you wanted, or you may end up needing a cesarean. "It's fine to have an idea of how you'd like the birth to go, but you need to be flexible," says Cooter.
Keeping in mind that labor is different for every woman, and for each of her pregnancies, here's what you might expect.
Stage 1: Labor
Your physician will likely have told you when to call her or go to the hospital, but it's typically when contractions happen at regular intervals, such as every 8 or 10 minutes, and get closer together. Other indications that you're in labor include the "rupture of membranes" (when your water breaks), losing the mucus plug, and passing bloody discharge, called "show." Remember that not all women experience all of these signs of labor, so if you're unsure, call your caregiver.
- Signs: During this phase, contractions usually last between 30 and 60 seconds; they generally start 20 minutes apart and move to about 5 minutes apart. Look for contractions that continue even if you move around, that get stronger, and that start in your back and move around to the front.
- How long it lasts: 6 to 8 hours for a first-time mom; 2 to 5 hours for subsequent pregnancies.
- What you can do to make it more comfortable: Anything that helps you relax, says Cooter. "Rest, shower, eat a small meal, take a walk, and practice slow-paced breathing," she says.
- Signs: Contractions are increasingly more intense, last for 45 to 60 seconds, and are 3 to 5 minutes apart. Some women feel discomfort in their back and hips and cramping in their feet and legs; this is the point when many women ask for an epidural. However, even with pain relief, active labor can unhinge some women's tempers. "I think this was about when I started to yell at my husband," says Kearney. "It hurt, and I had to take it out on someone."
- How long it lasts: 3 to 6 hours for a first-time mom; 1 to 3 hours for subsequent labors. If you've taken Pitocin, a drug that induces contractions, this phase may go more quickly, but if you've had an epidural, things can slow down.
- What you can do to make it more comfortable: By this point in labor, you have been admitted to the hospital or ensconced at your birthing center. If you have your epidural in place, you may not be able to get out of bed, but it's still a good idea to change position every half hour or so. If you can get out of bed, try walking up and down stairs for a few minutes at a time (if hospital policy allows it) or marching in place. "This movement encourages the cervix to open and helps the baby rotate into the birth position," says Cooter. This is also a good time to use the relaxation techniques you learned in childbirth education class and to enlist your partner for emotional support. Your hospital may also want to monitor the baby's heartbeat with a stethoscope, a handheld Doppler device, or an electronic monitoring device.
- Signs: Contractions are increasingly intense and last between 60 to 90 seconds, and they're 1 1/2 to 2 minutes apart. You may feel pelvic and rectal pressure, have hot flashes and/or chills, have cold feet, and feel nauseous or even vomit. You may feel overwhelmed, and it's also normal to feel discouraged, as though labor will never end.
- How long it lasts: This is the shortest but most intense phase, typically lasting from 10 minutes to 2 hours.
- What you can do to make it more comfortable: Imagine you're in a place that makes you feel safe and relaxed -- lying on the beach, resting against a tree, or sitting in a rocking chair in your baby's nursery. Breathe deeply and develop the scene, filling in the details. What do you see? What do you smell? What do you hear? If you're in more pain than you expected, it's usually not too late to ask for pain relief at this point. However, whether you get any will depend on whether an anesthesiologist is available.
Stage 2: Delivery of Baby
While some lucky moms-to-be push just a few times, Sonia Millsom's experience is more typical: "I pushed for about two hours and then had Veronica," says the mother of two, from East Greenwich, Rhode Island.
- What's going on: Your baby is moving down the birth canal. Contractions continue to be strong, lasting for about 60 seconds and coming 3 to 5 minutes apart. You will likely feel a strong urge to push.
- How long it lasts: 1 to 2 hours for a first labor; 15 to 30 minutes for subsequent labors. If your baby is in distress at this point, or if she doesn't seem to be making her way through the birth canal, your doctor may decide to deliver her by c-section or use forceps to help her out.
- What you can do to make it more comfortable: Take solace in knowing that you're almost there! Concentrate on pushing your baby down and out. Your partner can help by encouraging you to push and to rest in between pushes. Don't be afraid to try different positions -- for instance, get on your hands and knees or kneel while your partner supports your upper body.
Stage 3: Delivery of Placenta
"When my daughter was delivered, I remember thinking, Okay. I'm done. I did it," says Dimity Davis, a mother of two, in Colorado Springs. "Then about three minutes later, I was having contractions again and the doctor told me to start pushing, because the placenta had to come out." Davis admits that even though she had taken childbirth classes, she hadn't remembered this part of the birth experience. "I had to push for 10 seconds, just like I did with the baby, and it was unexpectedly painful," says Davis, who couldn't have the epidural she had planned on since the only anesthesiologist on call was needed at a c-section delivery. "At least it was quick," she says. "One push and that was it."
- What's going on: Minutes after your baby is born, you feel contractions again. This usually causes the placenta to separate from the uterine wall. When your doctor sees signs of separation, she will ask you to push again to expel the placenta. In some cases, she may need to reach inside and help pull out the placenta.
- How long it lasts: 1 to 20 minutes for first and subsequent pregnancies.
- What you can do to make it more comfortable: Be patient. As Davis notes, "I had a new baby, so it was pretty easy to deal with this last, relatively quick bit of discomfort."
The Right Support
"It's been the trend for many years to have Dad be the labor support person, but that's not the only option," says Susan Cooter, RN, a nurse and childbirth education expert based in Hatboro, Pennsylvania. "Sometimes men are tense about the whole process," she says, "and may not make the best labor aid." Have a conversation with your spouse well before the big day arrives, she says. He might be relieved to share the day with a professional doula who is trained to provide support to women in labor, or with your sister or a friend. "The last thing you want is to have someone who is stressed or scared in the room with you," notes Cooter. To find a certified birth doula in your area, visitdona.org.
Real Mom Delivery Stories
"I was about a week past my due date when I woke to labor pains at 1 a.m. I refused to go to the hospital with dirty hair, so first I jumped into the shower, moaning all the while. Then my husband got lost on the way to the hospital!" -- Heide Balaban, Baldwin, New York
"With my first baby, I was two weeks late, so I had to be induced. They gave me Pitocin to get things started, but once labor kicked in, it kicked in fast. After maybe 3 hours, my daughter was born!" -- Kara Casten, Downers Grove, Illinois
"I had to deliver via c-section. I entered the operating room at 8 a.m., and my daughter was delivered at 8:17. I still can't believe it was so quick!" -- Pam Hansell, Levittown, Pennsylvania
Originally published in the September 2007 issue of American Baby magazine.
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