You successfully made a baby (that was the fun part!) and by now you have this whole pregnancy thing down. Labor, though, is fast approaching—a fact you may simultaneously dread and cheer. But even if this is Baby #1, you can approach labor and delivery with a clear head.
"Giving birth is a highly emotional and largely uncontrollable event, so it's important to discuss what you're afraid of beforehand," advises Jenny Keller, M.D., director of the residency program in Obstetrics and Gynecology at George Washington University in Washington, D.C. Chatting frankly with your doctor can make you more at ease and upbeat—and approaching labor with a positive attitude can help you feel less pain, avoid C-sections, and feel satisfied with your experience, a study in BMC Pregnancy and Childbirth suggests. Read on to put your labor and delivery anxieties in perspective.
How likely it is: You've likely heard the Centers for Disease Control and Prevention stat that almost 33 percent of births are done by Caesarean, but that doesn't mean you're facing a one-in-three chance. First-time moms who aren't carrying multiples, hit full term, and go into labor spontaneously have a C-section rate of less than 15 percent, according to a study in the American Journal of Obstetrics & Gynecology.
Score better odds: You may want to hire a doula—a nonmedical labor coach—who'll be in the room along with your Ob-Gyn: Women attended by a doula were 40 percent less likely to deliver by C-section, research published in the American Journal of Public Health showed. Doulas, including those in the study, help you into positions, massage your back, and advocate for you from check-in through delivery (whereas your doctor or midwife will pop in and out; your partner will be there, but as a rookie he'll have fewer tools to help). A separate review of studies found that the difference stems partly from a doula's undivided attention and ability to help your partner help you. Some hospitals provide a free doula service (ask at the one where you'll deliver); otherwise you can get a recommendation from your physician or hire one through dona.org. Some insurers will reimburse the fee; if cost is still an issue, doulas-to-be often offer their services for free or reasonable rates.
What to do: If your doctor wants to schedule a Caesarean, ask about trying labor first. If the recommendation is a mid-labor surprise, discuss with your provider the benefits (e.g., baby's quick exit if his heart rate is falling), risks (a longer postpartum recovery) and alternatives (trying another position or simply giving yourself more time), suggests Shelley Scotka, a doula in Austin, Texas. If a C-section is your best bet, you'll probably sign a consent form and be in the O.R. within a half-hour, notes Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital in Boston. The surgery will take about 45 minutes, and your partner can almost always stay with you.
How likely it is: Labor will hurt, but you have options—and even if you decline drugs, the worst is over fast. "The pain has a purpose: It drives us into movements and positions that help labor progress," Scotka says. Most women feel able to manage the early and active stages of delivery, which are by far the longest portion; the relatively shorter period of transition (typically one to three hours) is toughest. "The good news is that pushing is usually right around the corner, and then, of course, the euphoria of the birth," Scotka says. If med-free isn't your thing, or your labor pain management plan isn't working, just say the word and relief—like an epidural— will be on its way.
Score better odds: Sign up for yoga. Prenatal yoga practitioners reported less pain during labor, a small study in Complementary Therapies in Clinical Practice found, and it's no surprise: The pairing of movement and breath builds endurance, teaches you to breathe deeply, and helps you relax into discomfort, whether that's Warrior pose or labor pains. Try visualization, too, recommends Scotka: Write down a scene that places you in a relaxing setting, like the beach where you spent your honeymoon. Fill it with sensory details (the sound of the surf, the smell of plumeria) and have your partner read it to you when a doozy of a contraction hits. Hearing it will trigger the relaxation response, making it easier for you to mentally escape mid-contraction.
What to do: Go to a birthing class— or take one online at hopkinsmedicine.org. In addition to the breathing techniques and positions you learn, there are other medication-free tactics to lower the pain—or at least make you better able to tolerate it. But if all the birthing-ball bouncing in the world can't help you get a grip on your contractions, opt for an epidural, anesthesia inserted into your lower back that numbs you from the waist down, or intravenous narcotics, which dull the pain for two to six hours. Contrary to popular belief, an epidural doesn't up your chances of needing a C-section, according to a study in The New England Journal of Medicine. But do be aware that an epidural can extend your active labor, says a new study in Obstetrics and Gynecology, so talk to your doctor. Still nervous? Ask for a consultation with an anesthesiologist, Keller recommends.
How likely it is: Your baby won't get "stuck" per se, but almost half of all unplanned Caesareans are performed because labor isn't progressing or Junior isn't fitting. The width of your hips doesn't predict the ease of your delivery, nor does Baby's size; it's just as likely his head is at an awkward angle, and there's no way to tell ahead of time.
Score better odds: Staying mobile helps the baby descend down the birth canal, so practice side-to-side motions. "Swiveling on the birthing ball, rocking while holding on to your partner, cat/cow pose, and belly-dancing-type hip circles all help open the pelvis, creating more room for the baby to make her entrance," Scotka explains.
What to do: Sometimes labor will "fail to progress" despite everyone's efforts. Your uterus might tire, or the baby could be in a difficult position or, in rare instances, too big to fit through the birth canal. If that's the case and he is close to crowning, your OB might suggest forceps or a vacuum extractor to ease him out. (Which one she uses depends mostly on her training, but this kind of assistance is used in less than 3 percent of births.) If the baby is stuck farther up, your doctor will recommend a C-section. "Discuss your options— laboring longer, using forceps or vacuum extractor or opting for surgery—with your provider in advance, so you'll know your preferences going in," Riley says.
How likely it is: Once routine, episiotomies—cutting the perineum, or tissue between the vagina and rectum to make more room for the baby or prevent a more severe tear—are now done in roughly 12 percent of births, usually to speed things along if Baby's not handling labor well. Tearing happens when your skin won't stretch enough to accommodate your cutie and is quite common: Doctors repair a laceration in almost half of hospital births. Your OB may give you a shorter snip, requiring just a couple of stitches, to prevent rupture.
Score better odds: "Side-lying and upright positions are great for protecting the perineum," says Angi Gunther, L.C.C.E., a childbirth educator in Portland, Ore. Even women who get an epidural may be able to use a squat bar when it's time to push, which could keep the bottom bits intact. In addition, ask a nurse to hold a warm compress over your perineum, which increases blood flow and elasticity. Your nurse can also give you a perineal massage as you push, helping you stretch as Baby's head comes out, says Sarah McMoyler, R.N., CEO of thebestbirth.com.
What to do: If you do have a snip, you'll be so distracted by the birth that you won't register the sting of anesthesia your doctor injects before stitching you up with sutures that dissolve in a few weeks. The tissue may itch or feel tight as it heals; sitting in a bath daily can ease soreness (and normal swelling from delivery) and a topical estrogen cream may be prescribed if the incision isn't healing, Keller says. The tear will likely mend by your six-week checkup.
How likely it is: Very. "If there is anything inside you ahead of the baby, it's going to get pushed out," McMoyler says. As your baby's head moves through the birth canal, it flattens your rectum like a tube of toothpaste. Most women wind up pushing out a little poo along with their baby, so don't be embarrassed!
Score better odds: There's no way to make sure your colon is empty before labor because you don't know when it will start. But you may naturally have looser and more frequent bowel movements before contractions begin.
What to do: As you push, a nurse is at your feet ready to clean up. Your partner probably won't see any of this from the head of the bed. And if he does? "You're so far into it, social graces are long gone," says McMoyler, who has assisted with more than 5,000 deliveries and found this to be a total non-issue.
It's unlikely your baby will be born in your Honda. "Most first labors are fairly long, with lots of time to get to the maternity ward," Keller explains. In fact, it's much more common for a first-time mom to arrive during early labor (when the cervix is dilated less than 4 centimeters), which can last hours to a few days, and be sent home. To avoid a U-turn, call your provider when your water breaks or when contractions fit the 5-1-1 rule: every five minutes and lasting one minute, continuing for an hour. The stress of the hospital can stall labor if you arrive prematurely, McMoyler says; it's best to spend early labor on a walk or at home tidying up.
And in the unlikely case of a backseat delivery, if you were to cut the cord, clear the baby's nostrils and mouth, and swaddle him, the baby would likely be perfectly okay, says James Woods, Jr., M.D., chair of the department of obstetrics and gynecology at the University of Rochester Medical Center. "But there aren't many people who have labors that are only 20 minutes long," he says, laughing. "A lot of women would love to have that."
"I had heard that Gwyneth Paltrow was in labor for 70 hours before Apple was born," says Mary Heller, of Kansas City, Missouri. "I imagined being in labor for days."
Early labor, when your cervix begins to dilate and thin out, varies wildly. It can last a few hours or go on for days. But for many women, this stage, which starts with mild contractions, isn't particularly uncomfortable. Active labor, when the cervix dilates to 10 centimeters and contractions are longer and more intense, typically lasts about eight hours. And most doctors won't let you go longer than 24 hours once your water has broken.
"Needles were my worst phobia," says Margot Kast, of Naples, Florida. Indeed, Jennifer Krupp, M.D., maternal fetal medicine fellow at the University of Wisconsin in Madison, sees lots of needle squeamishness. However, "the only part of an epidural that hurts is when they numb the area first with a tiny needle," she reassures. "It feels like a little bee sting, which is not actually the needle but the numbing medicine." Once that's in, the patient won't even feel the epidural needle – rather, she'll experience pressure. And "most anesthesiologists work behind you, so you won't see it," Dr. Krupp says. The hardest part of getting an epidural in active labor is that you have to sit still through contractions.