GETTING STARTED WITH LABOR
As much as two weeks before labor gets underway, you may pass bloodtinged mucous, called show, which can be white, brownish, or pink. And while you wait for baby, you may experience mild cramping and Braxton-Hicks contractions. Contractions are just what the word sounds like—tightening and releasing of the muscles of your uterus with a rest in between.
Braxton-Hicks contractions occur when your uterus hardens. They don’t occur regularly, and moving around or drinking water may make them subside. Then, at some point, these contractions will shift into prodromal labor: They may occur more regularly, usually in a pattern of less than 30 seconds long and more than 5 minutes apart.
After what could be (sorry to say) as long as a day or a week, early contractions will begin to get stronger, closer together, and more regular. And, for most women, sometime around the day before labor gets serious, your colon will (ahem) cleanse itself in the form of diarrhea.
When the contractions are regular and 5 minutes apart or less, or when your health-care provider recommends that important call, then make it. Depending on how you sound, he or she may advise that you stay put for a while, time your contractions, and call back in a little while, or you may be told to proceed to the hospital or birthing center.
First-time moms average as many as 300 contractions to birth their babies, while moms who have previously given birth need about 100 fewer contractions to perform the same task. First-time moms average about 12 to 14 hours of labor from start to finish. But, in some cases, labor stretches on for 24 hours or longer. So eat and rest as much as you can before you go to the hospital, and tell your driver to obey the speed limit.
Making the call
Most likely, your health-care provider will begin to make preparations for your admission after your contractions reach about 30 to 60 seconds long and are 5 minutes apart, or less. (You should also call if your water breaks, whether your contractions have begun or not. That happens before labor in only about one in ten women.)
How to Tell When It’s REAL
Labor is really happening and not a false start if you have the following symptoms:
Changed contractions. Contractions are definitely occurring regularly and getting longer, stronger, and closer together.
Moving doesn’t help. Moving around does not ease the contraction, or even make them stronger. (Moving around or drinking water during a Braxton-Hicks contraction can often make it go away, but doing the same thing during true labor makes no difference and can even make contractions stronger and more frequent.)
Different kind of pain. If you experience pain that is not confined to your lower back or belly. Labor contractions usually start in your lower back and move around to your front like a tightening band, rather than staying in one place.
You may be really eager to hit the road, but if you want to avoid extra labor interventions in the hospital, current medical research suggests that staying home until your labor gets well-established could be protective.
Most hospitals have protocols about how quickly a woman’s labor is expected to proceed, and when it appears to be slower than the “standard,” nurses, your doctor, or midwife may recommend a drip of intravenous (IV) medication to strengthen your contractions. This is known as augmentation of labor. Sometimes it can lead to very strong, rapid, and painful contractions, which might increase the risk of injury to both you and the baby. If your care provider wants to augment your labor, ask him or her about the risks versus the potential benefits, and don’t let yourself be rushed just because the hospital is having a busy night.
If you’re quite sure you’ll be heading off to the hospital in the next half hour, call your doula or labor assistant, and also call the labor and delivery department of your hospital to let the nurses know you’re on the way—especially if you have special needs or a specific room request (like a suite with a birthing tub). A labor-and-delivery nurse can help you decide when to leave or be helpful if you’re not getting a timely callback from your doctor or midwife.
Tip
Whether you have to share your room with another mom and then get whisked off to a labor and delivery area for birth or get the posh all-in-one birthing suite may depend upon how many other women are giving birth at the same time and what your insurance will pay for. Some policies will pay only for a shared room. Do your homework in advance!
Quick notes about labor
Labor and birth is a book unto itself, but here’s what’s worth remembering about that amazing 12-to-24-hour period:
• It’s natural. Birth is a natural, healthy process, not a medical emergency, and it is extremely safe.
• You can DO it. Yes, childbirth hurts, and quite a lot—but you will be able to handle it, even with no pain relief, thanks to natural endorphins. Just remember, though, that first-time babies may take quite a while to work their way down. Meanwhile, prepare yourself by talking to your care provider about the risks and benefits of pain relief options before you go into labor, and enlist the labor support of a midwife or doula to be there for you if you choose a nonmedicated birth.
• Labor doesn’t go on forever. Even though contractions hurt, they’re cyclical, and you know they’re going to end. They’ll bring you your baby, and they won’t kill you—so the pain is still better than an injury or food poisoning.
• It can be unpredictable. If birth doesn’t go the way you pictured it, you’re not alone. Every birth story is its own epic of circumstances, surprises, and curveballs (which is why it makes such good reality-TV material). It helps to think of each contraction as a strong body wave that each time brings you closer to the shore (birth).
• Positive images help. Visualize giving birth to a healthy, vigorous baby. Have faith that if something was wrong with the baby, chances are extremely good that your doctor would have detected the problem by now. Trust that if the worst possible scenario happens and something is wrong with the baby, you’ll have the clarity and strength to figure out what to do.
THE FIRST HOUR AFTER BIRTH
Is it a boy? Is it a girl? Is the baby going to cry? Is there hair on that head? Five fingers on each hand? Two eyes? Twenty digits total?
Tip
Being in a rush to cut the baby’s cord before it stops pulsing could affect your baby’s oxygen supply, putting a sudden strain on his body. If you’ve decided to collect your baby’s cord blood, someone will need to give the kit to the labor-and-delivery nurse or the doctor or midwife delivering your baby. The hospital may dispatch the kit to the company, or you may have to make the arrangements yourself.
Congratulations, you’ve produced the most perfect little human being ever created!
The baby’s time of birth will be noted by the delivering doctor or midwife and be officially recorded.
It usually takes about 20 minutes or so after the baby’s born for your body to deliver the afterbirth, the placenta, and the membranes. This delivery is known as the third stage of labor. After a few strong contractions, the soft, gooey mass will painlessly slide out with a gushing sensation.
Following the placenta, if you haven’t had painkillers or an epidural, you may feel genuine discomfort if your doctor, midwife, or a nurse massages your uterus to help it contract. You may get a shot of ergometrine in your thigh, and some will be put in your IV to help your uterus contract if your doctor is concerned about a postpartum hemorrhage.
Even if you wrote on your birth plan that you’d like to have all procedures on the baby performed in front of you, your wish may not be granted. Most hospitals routinely take the baby to the observation nursery soon after birth for bathing and watching, because many health problems become apparent in the first hours of life. Fewer problems occur when a newborn is kept skin-to-skin during the first 90 minutes after birth. The best plan is to request that your baby be placed on your belly and stay next to your skin until he spontaneously moves up, and starts the first breastfeeding. Then, you can let the baby go for tagging and weighing.