When I was pregnant with my first baby, I read books and articles about pregnancy, labor, and delivery. I thought I was 100% ready but that was really not the case. Things can really go out of hand if you are not well in charge of different aspects of labor and delivery and I wish some of the things I am sharing with you now, would have been taught to me before I actually went to the hospital. If I and my husband were better informed we would have taken better-informed decisions, knowing the good and counter-indications of our decisions not only for me but also for my baby. In this article, I will talk about what you different things you may expect from labor and delivery, things that surprised me and a lot of women for the first time, and that i wish I knew before.
The due date
The due date is the estimated time your estimated date of delivery and that is exactly what a due date is – an estimate and is never absolutely accurate. It is usually calculated as 40 weeks from the first day of your last menstrual period. But this estimate isn't very reliable because women don't always remember exactly what day that was, and some women still have light bleeding at the start of pregnancy.
The due date can also be estimated quite accurately based on ultrasound scans in the first twelve weeks of pregnancy. But ultrasound scans aren't entirely accurate either. Due to frequent mistakes in estimating when the pregnancy started, doctors and midwives can adjust your due date accordingly. So many parents-to-be, as in my case, become anxious and feel pressured to make decisions because the due date has passed, but if there are no specific problems, the baby is very probably doing fine, and you should just wait for the last stage of development of your baby lungs and brain. Delivering your baby too soon can bring complications to baby respiratory systems, as the lungs may be still underdeveloped. The reason why a baby is overdue is usually not known and being born after the 40th week only rarely harms the child. To be on the safe side, though, the doctor or midwife will probably start doing more checks to see how the baby is doing.
The mucus plug
I waited long for my first baby and the first thing that actually happen to show me that labor was close was the release of the mucus plug. It’s a blob of mucus that has been in your cervix to block bacteria from getting in. It’s not a great sign that labor is starting because it can still take a few weeks for it to happen but it is definitely a sign that you’re time is getting close!
The bloody show
You may lose a beet of blood and mucus especially if you lose your mucus plug, and this bloody show is a better sign that labor is coming because it means that your cervix is “ripening” and getting ready for childbirth. You might even miss it if you go to the bathroom at night and are not aware of it.
Your water break may break on its own before you start having contractions but that is not often the case, and it doesn’t mean your delivery time is happening soon or even your contractions. It is just time for you to be prepared! It is ok to stay at home, talk with your health care provider, and just wait. It feels like you’re just peeing a lot, all at the same time, and with each contraction, a little more may come out. If you’re water breaks and there’s “meconium” in it, that means that your baby has pooped inside and you will probably need to have a team there to assist you, just to be certain your baby is okay after is born.
Labor can take a long time
Especially if this is your first pregnancy, you can already feel contractions, discomfort and pain, but they are irregular in time, and you will sometimes, wait for a week to really start active labor! Yes, in some situation it can come pretty fast, but in most cases, the pre-labor period really takes a long time. Being patient and just adjust and don’t fight to what is unfolding during your labor is part of the surrender every mom needs to do to have her baby in her arms. I see that today there is a lot of tendencies to control all aspects of labor, actually to control women, but labor is not about control is about surrender to the beautiful process of natural and life. So, find things to do that will help you pass your time in a relaxed and calm way, choose a good supporting time to encourage you and not stress you out, to just love you and be kind to you.
Allow yourself to express what you want in any way you want
During active labor a mother should be able to cry, or smile, to be kind or with a temper, to talk softly or scream, as I did, so many emotions can come up in your labor that you are not even expecting, so help yourself by choosing a non judgemental team, that will always love and support you unconditionally and will encourage you through the process, telling you loving and encouraging words that will allow you to come back to yourself, to your body and to your baby. You are already a great mom and labor, whatever the choices you made, will never make you a worse mother. You are the perfect mother t your baby, no one should take that way from you, especially in labor.
Yes, you might throw up during labor, sometimes is because labor itself, and your body is just adjusting, sometimes is because of pain or even pain medication. Be prepared for it, because it can happen.
You might poop or have diarrhea
You may not even notice it. But in labor, you may poop, and is very common because you use the same muscles to poop as you do to push your baby out, so it might happen. It is totally ok!
Checking-in your birthplace
Depending on the place you have chosen for your delivery, and of course, if you are not doing it at home, it may take some time before they actually admit you in. On my second baby I had to wait until I was 4-5 cm dilated to be able to go to my own private room, before that you go in, they check on you, and if nothing has yet developed, even though you may feel contractions and some discomfort, they will just tell you to go home, that's it, and come back later the next day!
If you are in a hospital, several times throughout labor you’ll have to be checked to see how far dilated and effaced you are. It is not something you will like, specially if you are already in active labor, and you are entitle to authorize it or not, there are other ways to see if you and your baby are ok! And, if a bunch of student medicine doctor comes in the room as ask if they can to a check on you, in your private moment of labor, you can say – no, better even if you talk about this previously with your doctor! Just be ready because it does happen!
If you are in a hospital they will probably put you straight on monitoring to check on your baby heartbeat and your contractions, and you will have two big circle stripes strapped to your belly. My experience is that they move a lot and need to be adjusted. It is not a good thing to have, that is another reason why I love so much home birth if you can do it! It is uncomfortable, sometimes moms get anxious just by checking their contractions on screen, and of course, you have to lay down in bed when they are on, without being able to move freely. So, you can request to be monitored intermittently, and so you can walk around and help things progress. They can just monitor you ever 30-45 minutes and it feels so much better!
Induction is really a big topic, and in my view should only be used if there is a very strong medical/emergency reason for it. We know that is the baby that sends the signal to the mother’s body that it is time to start the rhythmic contraction for delivery and, that does not happen until the baby is fully prepared both physically and emotionally, and I think most of the times we forget that part. Induction is not a natural thing and will not help you to release the natural hormones to return to calmness and recover from each contraction. Besides that getting induced can prolong your labor, and make contractions even more painful and faster in a split of a second. Having supported women with natural hormonal labor and being induced I may say that I recommend having patience and just wait until your body goes into labor on its own, even if that means you have to fight for your right to just wait in some country systems where the due date seems to be the norm to just start an induction with no strong medical reason.
Taking an epidural
Taking and epidural in case of need can help you release pain but will also take you away from the birth process. Everybody is different and a lot of moms decide to take it, but you should know the benefits and the risks.
Besides being hard to just sit still while you are having contractions and wait for your anesthesiologist to give you the epidural, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate, because epidural can actually slow down or even stop active labor completely. Epidural may cause your blood pressure to suddenly drop and you will be routinely checked to help ensure adequate blood flow to your baby. Also, in few cases, you may have nerve damage for the rest of your life or a sensitive impression on that place of your body where you received your epidural that still last a few months after delivery.
Besides epidural you will also get a catheter, that is a tube that continuously drains your bladder and that feels really uncomfortable. It will make it impossible to move from the waist down, and as I did, you might also experience shaking and chills when you get an epidural.
But epidural will not only affect you, but it may also affect your baby, and most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, and because epidural makes pushing more difficult, additional medications or interventions may be needed, thus increasing the need for forceps, vacuum, cesarean deliveries, and episiotomies.
It would be a great idea to check with your doctor about what interventions he or she generally uses in such cases, to really make an informed decision.
If you are in a hospital, you can’t eat during labor
The reason for that is because, in the environment of a hospital, they want to be prepared for an emergency, and in case you need a c-section, they want you to be clean on your stomach because of medical procedures. So you will probably be able to have water, but because labor usually takes a long time to unfold, maybe you want to eat something before going to the hospital.
Time for delivery
Labor is unpredictable no matter what they tell you and gynecologist is not a precise science, and it really can take a long time to actually push your baby out. Usually, hospitals have a 12-14hours to wait for you before starting to ask you to make decisions about your state and how things are developing. Yes, some moms stay 30 hours in the hospital to deliver, but that is not often the case, so you and your partner should be aware of what kind of procedures you are comfortable or not comfortable with before going to the hospital and have a wishing plan handy to give them before labor or when you check-in, in case you feel pressure to make decisions.
If you are at home or in a birth center, things tend to go smoother, but the hospital is a system with regulations and you should be aware of them, so don’t be afraid to ask or make uncomfortable questions about different scenarios.
Your nursing team
In hospital usually, nurses or midwives have 12 hours shift. So you can start with a team and end up with another, be prepared for that and I recommend the partners to serve as a shield for moms, and instruct each new team member about the situation instead of making it a mother task. Be kind and respectful, they are there to help you and make it easier for you and not to be one more pressure.
Have a wishing plan prepared
Some people like to call it a labor plan but I always felt it was much nicer to address it as a whishing plan, because not always things go according to plan and I wanted to inform my health care providers of my wishing but also reassuring them that their opinion was also important for me to take my own decisions about labor and delivery.
So I had a formal, written whishing plan that I brought first to talk with my midwife and later with my doctor. Of course, we all wish for a natural, free emergency labor, a healthy mom and a happy baby but we may end up with an epidural and a c-section, and if that happens it is okay, you are still a great mom, and the first priority should be the safety of both of you. Prepare yourself the best you can, feel connected and bonded with your baby even before birth so your baby can also be one more of your team members to help you make your decisions.
There can be lots of people in the room
When the delivery time comes, and again in a hospital scene, you might expect to have lots of people for your delivery time. You may have their the doctor, nurses or midwife, and also medical students, and it gets crowded very quickly, so this is also something you should think about if, besides your partner, what are the people you would like to have there to welcome your baby, and you are always allowed to request no students in the room if you really care.
Stand up for yourself
This is your life, your body, and your baby. Lots of moms that I help and already had a baby before, often tell me their moms wish they had stood up for themselves during labor, that is why I think it is so important for you to be well prepared, and look for the benefits and risks of your own decisions. In my first labor my wonderful doctor suggested me that, in case there was a major decision to make, he would ask me the same question 3 times, because from his own experience, in the time of labor, he knew how fragile a mother could feel and how suggestible they can be, and just say yes to a procedure without even thinking what they were doing to them or to their babies. You might have an amazing team as I had, but you may also feel you are not being well treated and if that happens don’t be afraid to say it or even ask a different nurse. This is yours and your baby time to meet and you this to be a positive experience for both. Talk with your partner about this so you are both on the same team.
One more thing that can that its time, so don’t expect to just push through two or three contractions and suddenly you have your baby in your arms as you see in movies, most women have to push for a long time before their babies are born. In pushing you are using the same muscles as when you are pooping, and most women just do it naturally, but if you feel concerned about it you may request to be instructed as to when you should push or not.
The ring of fire
When you reach 10centimeters in diameter, of your cervical opening, your muscles and skin reach the maximum stretch as your baby enters the vagina. The labia and perineum (the area between the vagina and the rectum) eventually reach a point of maximum stretching. At this point, moms may feel that the skin is burning, and this is called the ring of fire because of the burning sensation felt as the mother’s tissues stretch around the baby’s head.
Delivering the placenta
After your baby is born, you still have a little more work to do and you will have to push again to deliver the placenta. It might be easy and smooth, it might be hard and painful in case your placenta brakes, but in most cases this will be just one more natural thing that your body is totally able to take care of, some moms even prefer to have their baby in their partners arms to be focused on the last moment of the delivery.
For years, an episiotomy (a surgical incision of the perineum and the posterior vaginal wall generally done by a doctor) was thought to help prevent more extensive vaginal tears during childbirth, it would heal better than a natural tear, and would help preserve the muscular and connective tissue support of the pelvic floor. This could not be more wrong! Today, research suggests that routine episiotomies don't prevent these problems after all and episiotomies are no longer recommended unless there is a strong medical reason for it. In case you need one and haven't had any type of anesthesia, you'll likely receive an injection to numb the tissue. You shouldn't feel your doctor making the incision or repairing the episiotomy, but recovery can be very uncomfortable.
Also, an episiotomy has its own risks because sometimes the surgical incision is more extensive than a natural tear. Infection is possible and midline episiotomy puts you at risk of fourth-degree vaginal tearing, which extends through the anal sphincter and into the mucous membrane that lines the rectum. Fecal incontinence is a possible complication and some women report pain during sex in the months after delivery.
If you had a natural or if you had an episiotomy you’ll have to get a few stitches. The doctor will do it right after your baby and placenta are delivered, and usually, stitches are usually absorbed on their own. Depending on if you get an epidural or not, you might feel it or not.
Delayed cord clamping
Delaying the time between the delivery of a newborn and the clamping of the umbilical cord has great benefits for the baby, and more and more hospitals now are using this practice that was naturally done in ancient cultures and at home births. It is usually performed 30 seconds to 5 minutes after giving birth and it allows more blood to transfer from the placenta to the baby, sometimes increasing the child’s blood volume by up to a third! The iron in the blood of your baby also increases the newborn’s iron storage, which is vital for healthy brain development.
Meeting your baby for the first time
Tell your health care provider that you want to hold your baby in your harms immediately and do skin-to-skin. You may also delay cleaning or medical examinations, or choose to have the medical examinations to be performed with your baby in your arms. Skin-to-skin works like magic for both you and your baby, both physically and emotionally, it is the natural place for your baby and is what your baby is expecting. So let them know what you want and, if that was not possible somehow, don’t be too hard on yourself and remember you will soon be together.
The first thing you are going to give your baby is the colostrum, and that is like a boost of nutrients to your baby to help your baby survive and recover from labor. Your baby can sleep for hours after that! I never woke up my babies to feed them, let's be honest here, who would like to wake up to just eat and go back to sleep? Babies have their own personal rhythms and if everything is ok with your baby, as it usually is, there is nothing to worry about and just let nature take its course. The first 10 to 15 days of breastfeeding are the most challenging and you should know this. Have a supportive team around you or someone to call that will help and encourage you. Your breasts may hurt for a few days as you adjust to lash your baby in your breast and your nipples get used to it.
Breastfeeding can be demanding but is so beneficial, again is what your baby is expecting and is the natural norm. Formulas are there, they save lives, but will always be artificial and everything that you have shared with your baby through your blood flow you are now sharing trough your «white blood» your milk! Breastfeeding is going to be a whole new chapter of your life and you should feel as prepared for it as you were for labor, so start collecting all the information, the benefits and possible challenges you may face and how to overcome them.
Squishy belly and stripes
Your body has just produced a totally new human being, in all its complexity, body, mind, emotions and energy and now you have a squishy belly and some stripes around your body. Yes, it happens, and you should love yourself and your body, even more, you are a mother, and as the same earth does not stay the same when a new flower is born, so will not stay your body. It is all about your transformation as a woman. Media is always showing us, women, the perfect body, but in this life, nothing stays the same and moons, we have different phases in life, and this should be one of the most positive ones for you and your baby.
I hope you have enjoyed this article and this has put some perspective on your future decisions because your baby needs you to be his voice too in time of delivery and birth!
About the Author
Susana Lopes is a prenatal educator, prenatal and post-natal yoga teacher, author of the book “Yoga e Maternidade” and President of the Norwegian Association of Prenatal Education. She is also a speaker and advocate for pregnant moms and their conscious babies. Her present work includes guiding women to effectively release stress and anxiety from their body and improve their overall health and connection with their baby.