With their delivery day fast approaching, many moms-to-be voice new fears, especially about their upcoming labor. As obstetricians, we make sure we spend extra time with our patients during the last months of their pregnancy, not just to monitor their medical condition but also to help maintain their emotional equilibrium. We feel it's important to address a woman's hopes and worries well before the due date. On the birth day itself, you may not be able to control as much as you'd like, so being armed with information goes a long way toward making that event as stress-free as possible.
Many moms have a difficult time visualizing how their baby's head and body will make it through the narrow opening of their vagina. The concept can be frightening, but nature designed our body for this. Ideally, a woman's pelvis is shaped to allow the easy passage of the baby. The vaginal skin and muscles are incredibly elastic and can stretch open to more than 10 centimeters wide to accommodate the head. During labor, a birthing mirror can help you better understand when and where to push; if you're looking at your baby's head descending and watching the opening expand, you'll know that you're pushing correctly.
In the United States, 20 to 30 percent of babies are born by cesarean delivery. In a few cases -- such as for breech babies and multiples -- the procedure is scheduled beforehand. But especially for first-time moms, how your baby is delivered can't be determined until you are actually in labor. We hope that all moms who want a vaginal birth get their wish, but we also recognize that the other player in this game (your baby) may have a different plan. The two most common reasons why an infant is delivered by cesarean are that he doesn't fit through the birth canal or he experiences distress during labor. Whether a baby can navigate through the birth canal is not something doctors can necessarily control or predict. It depends on a number of factors: the baby's size and position, as well as the size of the mom. In the same way, we can't predict how your baby will tolerate labor. When you have a contraction, the blood flow to the placenta decreases dramatically. Because a contraction lasts for only a minute, most babies adapt to this decrease without any problem. However, some babies are not able to keep up with this for hours on end. If your baby begins to experience fetal distress, he will need to be delivered by cesarean.
Many women fear that they might have a bowel movement while they're pushing. Yes, this is possible -- and it's just fine if it happens. From a mom's point of view, it can be embarrassing, but from a doctor's point of view, it's actually a good thing, because it means that she's pushing correctly.
The umbilical cord is thin, so it can be difficult to view on an ultrasound. Still, if it's seen to be wrapped around a baby's neck (known as a nuchal cord), this can become a source of unnecessary worry for many pregnant moms. It seems scary, but in the uterus, something tight around your baby's neck won't compromise her "breathing." She gets her oxygen through blood from the placenta. In addition, the consistency and firmness of the cord make it hard for the cord to be pinched. The truth is, doctors can't do anything about the position of the cord during pregnancy; there is little risk for the baby, and it may unloop itself because the baby is still moving all the time. In a worst-case scenario, a nuchal cord can lower a baby's heart rate during labor, causing her stress to the point that a cesarean delivery is necessary. That said, a full 25 percent of infants are born with the cord around their neck -- and they have no adverse outcome.
As the date of your delivery draws near, you may become concerned about what's happening in your body and wonder, "Is it okay if I call my doctor?" For us, the bottom line is: If you aren't sure, you should call. This is even more true for first-time moms who have never experienced contractions. Contact your doctor if you aren't absolutely certain about what your body is telling you -- and if you experience any of the following, call immediately: vaginal bleeding that is like a period; contractions that occur every ten to 15 minutes if you are less than 36 weeks or every five minutes when you are more than 36 weeks; rupture of the membranes or leaking fluid; a severe headache that's not relieved with acetaminophen; severe swelling of the face, hands, and feet; decreased fetal movement; or a fever higher than 100.4?F.
Any time you call your doctor with a question or a concern -- even if it's one you've had before -- you deserve an answer. No question is foolish, and when you're on the verge of delivery, no trip to the hospital is unnecessary because a professional needs to confirm that you and your baby are okay. If you have been diligent about taking care of yourself, coming to your prenatal visits, and sharing your concerns from the beginning, your well-informed and experienced ob team will be there to guide you through any glitches or emergencies that might occur on your big day. That's what we're here for.
Originally published in the October 2011 issue of Parents magazine.
Excerpted with permission from the publisher, Da Capo Press, from The Mommy Docs' Ultimate Guide to Pregnancy and Birth. Copyright ? 2011 by Yvonne Bohn, M.D., Allison Hill, M.D., Alane Park, M.D., and Melissa Jo Peltier. Available in bookstores or at amazon.com.
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