What you may (or may not) know about labor and birth

I thought I'd do a mini-childbirth class here --- online! Specifically: what you may or may not know about labor and birth. Things that you may not read about in books like "What to Expect When You're Expecting". (Note: this will not be all encompassing -- every woman is different, and every birth is different!)

Labor:

Contractions can feel different for each woman. Sometimes they can be felt in the lower front part of your pelvis, your back, hips, or even down your thighs. It can feel like menstrual cramps, tightenings with little pain, stabbing, throbbing, aching, or any of the above.

Contractions usually will get stronger and closer together in labor. They might start out where they only last 30 seconds, and will usually increase in duration as labor progresses. Contractions might be anywhere from 1-2 minutes apart, to 5-10 minutes apart. Usually, the further apart they are, the earlier you are in labor. The closer you get to giving birth, the closer your contractions should come. Ironically, right before giving birth, your contractions might space out again. I consider this to be the time where your body is conserving energy for those last couple of "big" contractions that help bring your baby down and out.

Let's talk vaginal discharge in labor. It can look like mucous, like a big ball of snot. It can be pink, clear (like water), white (leukorrhea), green/yellow (meconium or a vaginal infection). Or you might have no discharge or leaking.

Speaking of leaking. When your water breaks, it will continue to leak during labor. Especially when you have a contraction, more fluid will come out. It seems like the water spout never ends for some women! This is because, in a normal pregnancy, the fetus will continue to produce amniotic fluid. Some women are surprised to learn that amniotic fluid is produced in the baby's kidneys - yes, that's right! Amniotic fluid is baby pee!

Ok, so you're leaking fluid continuously in labor (or intermittantly). What to do? Heavy menstrual pads can help. Or, if it's a lot of liquid, I say just create a big bulky "diaper" - a towel wadded up with those lovely mesh panties works great.

More vaginal discharge......bleeding in labor. It's normal to have some "bloody show" or even some light to moderate bleeding in labor. Depending on what stage/dilation, you might notice some bleeding at one point or another. As long as you do not have a huge amount of bright red blood dripping down your legs, or saturating one pad (or more) per hour, it's considered normal IN A NORMAL PREGNANCY. If you have any problems, or suspect that your bleeding is not normal - CALL YOUR PROVIDER. They know your medical/OB history and can help determine if your bleeding is normal or abnormal for you.

That being said, normal pregnancy, normal placental location, normal labor -- some bleeding is normal. You might have some spotting early in labor, and again when you hit transition or are close to having your baby. I've noticed that the last few centimeters of dilation tend to produce a good "bloody show" as the cervix dilates those last 2-3 cms. I see this quite a bit when a woman is about 7-8 cms. It's a good sign! Don't be alarmed by the bleeding. If your provider (doctor, midwife, or nurse) hasn't noticed the bleeding, just let them know. They can assess whether it's a normal amount, or if it's "too much" and cause for concern. More often than not, they will be happy to see some bleeding - this means birth isn't that far away!

Transition --- hard, hard work at this point. You might feel discouraged, want to give up, go home, get drugs if you haven't already gotten some at this point. All normal to feel this way. The end is near! Hang on momma! You can do this! You might find that you don't want to be touched, or maybe you want to have your back rubbed, or hips squeezed, or you need to move and do a "labor dance" to bring baby down. You might yell at your partner(s) to be quiet, because this is a very intense time, and you might need to put all your focus on riding it out through each contraction. No one will be upset if you say things you might not normally say at this point. No need for apologies. No need to be "lady-like". Curse, moan, groan, pace, pant, walk, breathe, whatever you need to do. Listen to what your body is telling you and go with it. Sometimes you might not know what your body is telling you. Perhaps your partner/labor support/nurse will make suggestions. If you don't like the suggestions, guess what? Your body is talking to you! Listen to it. If you need to get up and be upright, do it. If you need to pace, do it. If you need to get on all fours, do it. There is no right or wrong at this point.

As labor progresses, and you get to be completed dilated (10 cms), you will feel some rectal/vaginal pressure. It may feel just like you need to have a big bowel movement, or like you just "have to go". Let your provider know that you're feeling this. If you do not have an epidural, this pressure can get very, very intense, and you might even start involuntary bearing down. This can be scary if you've never felt this before, or even if you have felt this before. Talk to your provider or partner about your fears. (Side note: with my 3rd baby, I started to get very scared when I felt the pressure and urge to bear down a little bit. It helped me just to tell my midwife that I was scared. I realized, even though this was my 3rd birth -- no epidurals with any of them - that I was scared to push! Don't know why, but I was scared. It actually helped me to verbalize my fear, and know that my midwife was right there by my side to be emotionally supportive. My fear dissipated quickly, and poof......out came my baby girl!)

What if you have an epidural? Will you feel rectal/vaginal pressure? Hopefully yes. It's a good thing to feel pressure. This helps you know where and how to push your baby out. If you don't feel the pressure, that's ok too. Perhaps your baby is still high in your pelvis, and needs some time to "labor down" until you can feel some pressure. If you still don't feel pressure, maybe your epidural rate needs turned down, or even off, to help get some sensation to push. I have found that women with heavy epidurals tend to have a difficult time with pushing, because they cannot feel any pressure "down there" to help them in their pushing efforts. This can greatly increase pushing time, and make mom (and sometimes baby) very tired. Which can lead to the need for medical intervention (vacuum or forceps) or even a c/section birth. Ask to have your epidural reduced so you can feel pressure. And prepare yourself mentally: feeling pressure is GOOD! It's ok to be scared that the pain will come back. But know this, the epidural provides excellent pain coverage for contraction pain, even after it's shut off or decreased. It can take several hours for all sensation to come back.

Pushing: it can take a first time mom up to 3 hours to push her baby out. This is normal! Like I said above, an epidural can prolong pushing times if the epidural is very heavy and you can't feel to push. I have also seen first time moms with epidurals who push for only 10-15 minutes before birthing their babies. It's a wide range of times for pushing. Don't feel discouraged if your pushing takes longer than someone elses. It's ok! Everyone is different!

Pushing also brings a great relief to the mom. Without an epidural (or even with one), you may feel an utter sense of relief and wonder that you are DONE when the baby is born. What an amazing thing you've just done - bringing your baby into the world! The pain is almost instantly gone once the baby is born. (Isn't that a great thing to look forward to?)