Is It Labor Day?
When Wendy Hansen was due with her first child, she was hardly worried. After all, she'd been through labor and delivery at least 600 times before. An obstetrician, Dr. Hansen figured her insider knowledge would guarantee her an easier experience than that of her nervous first-time-pregnant patients.
Then labor started. Or did it? "I never got good at figuring out if I was going into preterm labor, and who should know more than an ob?" says Dr. Hansen, the mother of two sets of now-teenage twins. "But it's very difficult to tell what is a contraction."
While she feels her job skills gave her an edge -- Dr. Hansen heads the University of Kentucky's Division of Maternal Fetal Medicine -- she and other ob-gyn moms say personally experiencing childbirth gave them insights no medical school textbook or professional practice could. "I gained a greater appreciation for how different each pregnancy can be," says Linda Walsh, a San Francisco midwife. Here are some other lessons learned.
The Beginning of Labor
Hollywood would have you believe a birth begins with a gush of water, or at least a contraction savage enough to make a woman double over in pain. But many labors sneak up on moms like ocean waves creeping in with the tide.
"A lot of women think their amniotic fluid is going to come out like Niagara Falls, but it can be a trickle that might be mistaken for urination," says Robin Goodwin, a doula and mother of two in New York City. And only about 15 percent of labors begin with membrane ruptures at all. More often, labor begins with contractions so mild that moms might not recognize them. "You might just feel really tired, or like you have period cramps," says Wendy Wilcox, MD, an obstetrician at Montefiore Hospital, in New York City, and mother of two.
Contractions get stronger and more regular as labor progresses. Most obstetricians recommend heading to the hospital when they last one minute and are spaced five minutes apart for at least an hour. "It's not false labor if contractions are getting longer, stronger, and closer together. You can't chat through the real thing," says Mayri Sagady Leslie, a mother of two, midwife, and instructor at Georgetown University's School of Nursing and Health Studies' Nurse-Midwifery Program.
"If you're unsure, go for a walk, take a nap, take a shower, eat something, and then time your contractions again," says midwife Katie McCall, a mother of two who owns Birth Angels doula service in Los Angeles and The Birth Connection birth center, in Fullerton, California.
However, even if contractions are sporadic, head to the hospital if you have bleeding, haven't felt the baby move at least twice in a half hour, or notice that your amniotic fluid is yellow or green instead of clear. Any of these could indicate the baby is stressed or struggling.
And of course, feel free to call your doctor or midwife at any time. "If I could give a single message to women, it is to not feel intimidated, just to ask questions," Dr. Hansen says. "If a woman comes in and we send her home because she hasn't progressed enough, that's not a failure on her part. That to me is a good mom. It's a little bit like a 50-year-old man with chest pains -- a lot of times it's nothing, but in case it's something, wouldn't you want to be checked?"
Get This Baby Out!
Sometimes a baby will get so comfy in the womb that she doesn't seem to want to leave. Most doctors will let a woman go a week or two past her due date before suggesting induction.
"Babies don't have calendars in the womb, and many factors contribute to how long a baby needs to 'bake,'" says McCall. Induction typically involves suppositories administered vaginally and/or drugs administered intravenously.
But while many moms are relieved to have labor finally commence, induction does have its downsides. Some studies show that a first-time mother's chance of a cesarean delivery is doubled if she undergoes induction. At the very least, you may be tethered to an IV and unable to move much during labor. And many induced moms report more sudden and intense contractions.
"There are other reasons you might be induced too," warns Dr. Wilcox, like if you have low amniotic fluid, the baby isn't growing appropriately, or if you're being monitored for diabetes or high blood pressure and the baby's heartbeat is indicating stress.
Coping with the Pain
Carol Burnett once famously said that having a baby is like taking your bottom lip and pulling it over your head. Some women want to do that without drugs. "That takes an inner strength and a strong desire. It's like a marathon, and it's not for everybody," says Dr. Hansen, who needed epidurals for both her births because she endured an abruption -- when the placenta tears from the uterus -- in the first and a breech delivery of one twin in the second.
Goodwin encourages women aiming for drug-free deliveries to cope with pain by taking showers and baths, practicing deep breathing and visual relaxation learned at a childbirth class, and getting massages. But "the truth is, we give an awful lot of epidurals," says Dr. Wilcox, who had medication for her first birth and went drug-free -- unintentionally, because her daughter arrived so fast -- for her second. "I'm a big proponent of pain medication. No one's going to give you a certificate at the end saying: 'You win!'"
Regardless of how a laboring mom copes with pain, doctors and midwives agree pain management should be part of a birth plan developed while you're still pregnant. That's especially important considering most first-time labors last 20 to 24 hours -- and can drag on for two days. "Of course, you don't really know ahead of time how you're going to manage your pain, so flexibility is key," says Leslie, who went drug-free for her two births.
Some new moms try to avoid that uncertainty by planning a c-section. Convenience, control, and concerns about complications arising during vaginal delivery prompt some patients to ask for a cesarean birth, Dr. Hansen says. But remember, "postpartum is not a party after a c-section," says Walsh. "You're not only recovering from having a baby; you're recovering from major surgery."
More often, women face c-sections for medical reasons -- labor stalls or the baby experiences stress during labor. Almost 30 percent of births nationally are c-sections, according to the Centers for Disease Control and Prevention's National Center for Health Statistics.
Dr. Wilcox has seen plenty of seemingly good ideas go bad in the maternity ward, like photographing the birth. "Do you really want your vagina in pictures, with the way things end up on the Internet?" she says. And medical malpractice fears have led many hospitals to prohibit videotaping births, so check before you lug in a camcorder.
Goodwin has had to soothe many a mom who recorded her favorite music to carry her through contractions only to discover the treasured tunes frayed her nerves during labor. "And some moms like different scents; however, once they go into labor, they're like: 'Ew!!' But by then, the scent is all over the room. You become very highly sensitive," Goodwin warns.
Some laboring moms want a crowd around to share the thrill of birth and lend support. But that, too, can backfire. "It's not always a pretty picture, so we don't want to share everything with everyone," Goodwin says. Dr. Hansen agrees: "Although it's a joyous time, it's also a very intense time." Don't bring people who you'll have to soothe!
Finally, laboring moms who stubbornly cling to detailed birth plans might encounter trouble as well. "We don't know what nature has in store when it comes to birth, so we need to roll with what nature gives us, even if it's not in our birth plan," Goodwin says. "Nothing is ever written in stone."
The Big Picture
Most important, women should remember that birth is a natural and ancient process. "In our society, young women have come to think of birth as this emergency waiting to happen," Walsh says. "Certainly, we have highly trained professionals in case there are problems." But most labors and deliveries occur without complication.
"Labor is probably the only time in a healthy woman's life that she will check herself into the hospital for a normal, natural process, absent of pathology," McCall agrees. "Remember that you come from a long line of women who have birthed successfully. Your ancestors had to do so for you to even be here today."
Packing Your Hospital Bag
Ob-gyn and midwife moms have lots of advice about what to put in your birth bag. For instance:
- Pack wisely. No candles (you can't light them in a hospital) or clothes you care about (because you'll be messy). Instead, take a few changes of comfy clothes, extra socks, and a disposable camera as a backup to your regular one.
- Remember fuel. Gatorade or Recharge make fine laboring drinks, or if you think ahead, freeze them and take the cubes in plastic baggies. Tastier than ice chips!
- Have something to write in. "Delivery is like a wedding -- it goes so fast," says Robin Goodwin, a doula. Jot down labor details during recovery, while it's fresh in your mind.
Dana DiFilippo is a mother of two in Lawrenceville, New Jersey.
Originally in American Baby magazine, June 2007.