9.14 MB | 22:47 Min
Dr. Keith Eddleman is the Director of Obstetrics and a senior member of the Division of Maternal-Fetal Medicine at The Mt. Sinai Medical Center. He also co-authored the books Pregnancy for Dummies and The Pregnancy Bible with Dr. Joanne Stone.
Susan Scott Gill is a Certified Professional Midwife at Blessed Beginnings Midwifery in California. She is also certified in Neonatal Resuscitation, Adult, Child and Infant CPR and Standard First Aid and IV Therapy. She has taken advanced training in water birth.
Welcome to your Pea in the Podcast. I’m Bonnie Petrie with everything you need to know about your body, your baby and the big changes ahead in your life as you begin your journey as someone’s mom.
This week, it’s all about labor…
“I think a lot of wives’ tales that get handed down cause a lot of people to have some trepidation and fear with respect to labor. But it’s really a natural process.”
“I was in so much pain at that point that there was no walking.”
Don’t let that scare you, stick around for your Pea in the Podcast all about labor.
So, welcome! Congratulations! You’re having a baby. I know you’re thrilled. Maybe it’s a baby you’ve wanted for years. Maybe it’s a blessed surprise, I had one of those. But regardless, your little one is on its way. There is one little problem though, the baby can only get here through you. I know some of you would rather not think about that part of the process. My friend, Carmen Izzo, is 17 weeks pregnant. I see her almost every day and we talk about just about everything with regard to the baby. We talk about her shower and her registry and baby names and ultrasounds and even her plans to hire a postpartum doula to help get a good start with breastfeeding after the baby comes. But there is this one thing we really don’t talk about all that much.
“About labor? I mean, when I have to think about it, yeah it makes me nervous just because there’s so many complications and so many things can go wrong. I think, wow we’ll end up with a C-section, what will happen to me, will I rip? Not so much afraid of pain, I’m afraid of something happening to the baby; you know complications to the baby or myself.”
All pretty normal concerns, but when she thinks about labor she tends to focus on those things that can wrong.
“The cord getting wrapped around the neck, just all these things I think about and it’s just I don’t want to get that nervous.”
Dr. Keith Eddleman is a maternal-fetal medicine specialist at Mt. Sinai Medical Center in New York City. He’s the guy who wrote the “For Dummies” book on pregnancy, and he says labor should not scare you.
“It’s a natural process. The outcome is overwhelmingly positive, most times. Even when there are complications there are things that we can do to deal with them and still get a good outcome.”
This natural process can take hours, days, or even weeks to unfold.
Ariane Baer’s little girl, Gabrielle, she arrived with a flourish in February, and for her it all started with practice contractions.
“I had some Braxton Hicks contractions the whole week that my bloody show showed up.”
Bloody show, yikes, that does not sound good. Don’t worry about it, mom. Dr. Eddleman says it’s fine and it’s normal.
“As the cervix starts to dilate with labor, little tiny blood vessels on the surface of the cervix tend to break up, and those little tiny blood vessels can produce some blood, and that blood is mixed with the mucus that normally comes out of the cervix, and that’s really what a bloody show is. So I’d say it occurs probably in about a third of all women who go into labor.”
But the good doctor says the bloody show does not necessarily mean that labor is imminent.
“When people call me with the bloody show they say ‘Oh my God! Is this going to be today?’ and I say ‘Not necessarily, but it sounds like things are starting to kick up and I wouldn’t be surprised if you went into real labor in the next couple of days.’”
For Ariane, the loss of her mucus plug didn’t cause too much excitement at her doctor’s office.
“She did say ‘you know you’re starting to lose it. Could mean anything, could grow back, could be labor soon.’ She really had nothing to tell me other than that I was 1 centimeter dilated and only about 30% effaced at that point.”
Dilation is what they call it when your cervix starts to open up. Effacement means your cervix is thinning out and softening up. They’re all signs that your baby is coming, but still no guarantee that it’s coming soon.
“Some women walk around for 3 or 4 weeks dilated 2 to 3 centimeters.”
Great. So Ariane took that news in stride, and she went on about her business.
“I was at home watching television with my parents and I had really bad cramping. So I started to time it to see if they were contractions and they were pretty regular but not very regular and they were only regular the first few contractions. The first ten minutes or so I was getting a cramp every 5 minutes and then they just got further apart and I realized that it was not contractions but probably just Braxton Hicks, that’s what I told myself it was.”
Back to Braxton Hicks contractions. They’re named for the doctor who first described them back in 1872. They are your body’s way of practicing for the real thing. But sometimes it can be really difficult to tell the difference.
“Many times women end up coming to the hospital and it’s not really labor but there’s no way to tell unless you evaluate them, check their cervix, see how often they’re contracting, how hard the contractions are and whether or not the cervix is changing. If the cervix is not changing then they’re really not in labor.”
Susan Scott Gill is a certified professional midwife and she says one way to tell a Braxton Hicks contraction from an active labor contraction is try to talk through it.
“Sometimes I have moms who are sitting there talking to me saying ‘Oh no, this is a big one, man I feel it coming on. Wow, this is a strong one.’ Okay if they’re talking to me like that then it’s most likely not active labor.”
For Ariane, the Braxton Hicks came and went over the next day or so, so that Sunday night she decided to go to a Super Bowl party, she says she felt great and she had a good time, but she did decide to go home early before the big game was over.
“I was lying in bed watching the rest of the football game and I actually felt that I had leaked urine in my underwear and so I got up to change my underpants. The reason I thought I was leaking urine was because I had coughed and I thought that that was related. So I changed my underwear, laid back down, a few minutes later realized that my underwear was soaked again. Then I thought, maybe this isn’t urine, maybe I am leaking something else.”
Something else, like amniotic fluid.
“So I walked to the bathroom and as I stood up to take my underwear off to go to the bathroom, a big – it wasn’t a gush – but it started trickling down my leg. And at that point I realized, okay unless I’m really that incontinent because my baby is pushing so much on my bladder, this may be my amniotic fluid. This may be my water breaking.”
Dr. Eddleman says that Ariane’s experience of having her water break at home though, that’s actually somewhat unusual.
“Most women rupture membranes once they’re in labor and delivery already. But occasionally it happens before labor. In most instances when it happens people go into labor, real labor within 24 hours.”
Ariane was soon talking to her doctor’s office.
“And I’m on the telephone explaining to her that I thought I had broken my water and as I’m talking to her I experience very bad cramping and just by the sound of my voice she realized that it could be labor so she asked me to come in and just check to see if it actually had been my water that had broken.”
Ariane was in fact, in early labor.
“The first four centimeters is not really the active phase of labor, it’s sort of a prodromal phase of labor and at that point your rate of dilation varies from woman to woman, especially in women who have had a baby before. That phase can be very fast and last minutes to an hour, or it can be very slow and it tends to be slower in people if it’s their first baby, if they’re starting out with a cervix that is not very dilated.”
For Ariane, even though she was a first time mom, it was all moving very, very quickly.
“I went to the hospital, and the whole way to the hospital I had very intense contractions. It was almost as if the water broke and they just came suddenly. I was contracting, I would say every minute or two and very regular all the way to the hospital.”
Going to the hospital.
Now this is the big moment you see on TV and in the movies where Dad gets the hospital bag together, loads up the car and takes off in a rush, leaving mom behind. Well, usually dads don’t forget the laboring mom, I promise. But they do load up the hospital bag, which unless you’re me, you’ve already packed. That’s another story for another podcast, we’ll get to that, I promise. But what do you pack?
Most of you will want to bring your birth plan, insurance information, your ID, and any hospital paperwork you might have. But you’ll also want to pack things to make yourself more comfortable for what’s to come. You might want your own pillow, or some favorite CDs. Lots of moms find bringing something to focus on during contractions is helpful, like maybe an ultrasound or another picture that you love that you can tack up somewhere. Or maybe a swatch of fabric in a color that is soothing to you. Anything that you can look at as you move through contractions. You might also want something like a hot water bottle, maybe a tennis ball for massages, something to suck on like hard candy for when ice chips get old.
If you plan to spend some time managing your pain in the tub there at the hospital or birthing center, you might feel more comfortable in a tank top of your own and your birth partner might also want to have some swimwear, too, just in case they want to get in the tub with you to help you manage your pain. A watch for timing contractions might also come in handy.
After the baby comes you might be more comfortable in your own pajamas. Nursing nighties are handy because they offer good coverage yet easy access. You’re going to have lots of visitors probably, parading through and you don’t want to necessarily give them a show. If you plan on using some kind of nursing pillow, you want to bring that too. That way you don’t have to send your husband off to the baby store like I did to buy one and bring it to you immediately. You’ll want to bring some comfy clothes too and remember you’ll probably still look about 7 months pregnant when you go home so your favorite pre-pregnancy jeans, they are out. Sorry about that. Don’t forget your undies too, unless you’re a fan of that sexy mesh variety that they have at the hospital for you.
You’ll need toiletries, toothpaste — that kind of thing — makeup, your glasses or contacts and everything that goes with them. Some lotion might be nice. Also for the baby you might want some onesies and socks, maybe a hat or two and some other clothes, and for pictures and for coming home you might want to buy a preemie outfit. Most newborns, swim in newborn clothes, really. And you’ll of course want weather appropriate outer wear for your little one. Your carseat, mom, should already be installed when you go to the hospital. Don’t forget your phones and phone cards for long distance calls, your phonebook so you have numbers of people you want to call, your camera, extra batteries, memory cards, film, whatever your particular camera uses or maybe disposable cameras. Clothes for dad, geez, I think you’re going to need at least two bags and maybe a spare one, too, that is empty for the haul you get at the hospital or birthing center. They have a lot of stuff for you there.
Now let’s get back to Ariane and her trip to the hospital, she spent the entire ride contracting and harassing her husband.
“He has a standard car so every time he shifted gears I felt more contractions more intensely so I kept joking with him, like I said can you just drive in one gear please. It was crazy.”
Yeah, Pregnancy for Dummies Doc Keith Eddleman says this is active labor.
“Once you get to 4 centimeters, the rate of cervical dilation in a normal situation starts to pick up and it’s usually about a centimeter an hour. In a patient who’s never had a baby before it might be a little bit less than that and in a patient who’s had a baby before it’s a little more than that, about 1 and a half centimeters an hour. And that usually goes pretty quickly from that point on and the contractions usually get stronger.”
Which is why Ariane was ready to start managing her pain.
“So I looked at my husband, said please get the IV set up for the epidural because I am in so much pain right now, I can’t even imagine when the baby comes out what it’s going to feel like. So they got me hooked up.”
Not everyone chooses to manage their pain with drugs. That’s okay. We’ll talk about other pain management options in future editions of Pea in the Podcast. But Ariane did. She knew she wanted an epidural, which, like a spinal block, is safe for the baby.
“They work locally; they work to decrease the sensation of pain at the spinal level. So you don’t get appreciable drug levels to the baby at all, so the drugs themselves don’t have any affect on the baby.”
Dr. Eddleman says they do try not to give epidurals too early in labor.
“There’s some data that shows if you put the epidural in too early that you can prolong the course of labor and increase the chances that the baby’s head will come down in a position that’s difficult to deliver.”
Earlier in labor, if pain meds are your thing, you’re not going to have to do it on your own. There are other medical pain management options. There are narcotics that you’ll want to avoid later on.
“Nubain, Stadol, and things like that, they are respiratory depressants and that’s why you don’t like to give them right around the time of delivery.”
A mom with an epidural is not as free to move around during labor as an unmedicated mom.
“You do have to be monitored more carefully because an epidural, in some instances, can cause the mother’s blood pressure to drop a little. It’s usually a transient thing but you have to watch that closely after the epidural, especially right after the epidural is put in.”
Now, this can slow labor down, but for Ariane, the epidural was just what the doctor ordered.
“I could feel all of it. It didn’t feel painful, but I could feel it. So whoever gave me the epidural did a really great job.”
She got it in plenty of time for the phase of labor that’s called transition.
“You reach a phase of about 9 centimeters to what we call a rim, where there’s just a little bit of cervix left, and that’s considered the transitional phase.”
This is the part of labor some of your mommy friends will tell you horror stories about.
“Many women, when they reach that period — and it’s unclear why — will have nausea and even vomit sometimes. That’s sometimes one of the signs you’re almost fully dilated, is that you have nausea and vomiting. That can make it a little uncomfortable but it’s not unusual at all.”
Dr. Eddleman says transition doesn’t usually live up to its bad press, but he does admit that some moms do become overwhelmed.
“At that point when women realize how close it actually is, I think there’s a lot of emotional component, very excited. Also sometimes if the active phase of labor has been long then they’re tired, they’re exhausted.”
Dr. Eddleman says it is normal for a mom or a dad to get emotional during labor and he says it’s part of his job to reassure them.
“They’re not alone, they’re not the first person to go through this, that their concerns are real and that they’re not unreasonable. Again you reassure them that in the overwhelming majority of times things go well.”
And then when you’re 10 centimeters dilated, it is time to push. For many moms pushing doesn’t really feel like it’s optional.
“To compare it, not to be too graphic, like I had to pass a bowel movement. I mean I really felt like I have to push. So I’m telling everybody around, ‘I have to push, I have to push, like if I don’t push….’ It was the strangest feeling because I never felt that before really.”
Dr. Eddleman says you can blame the baby for that.
“The head is coming down into the pelvis and it’s pressing on the rectum and it causes a lot of pelvic pressure and rectal pressure because the head is compressing it and that’s what they feel. Then the muscles that form the floor of the pelvis are also dilating because of the fetal head. It’s not just the cervix, it’s the muscles in the pelvis, too, and that pressure on those muscles can be translated into the sensation of pelvic and rectal pressure for the mother.”
When the doctor gives you the go ahead to start pushing.
“That generally takes anywhere from 2 to 3 hours, depending upon whether or not you’ve had a baby before and whether or not you have an epidural in place, a little bit longer if you have an epidural in place and it’s a little bit longer if it’s your first baby.”
So mom, you may be wondering what’s going on with your baby during this time anyway?
“Well the baby is descending very slowly and gradually in the birth canal, and as that happens, the head — the bones in the skull — are made to mold to the birth canal. In other words they’re not like your skull and my skull, which is very — especially mine — I’m very hard headed. It’s not like that, but it’s very soft and so the skull bones can mold so that the head can be pushed through the birth canal safely and it doesn’t injure the baby at all. So that’s what is happening during that labor process.”
For Ariane, the pushing phase lasted less than an hour.
“I started pushing, they got the doctor in and at 1:58AM my little baby girl showed her face to the world.”
We’ll try not to hate her too much for that. Ariane’s pushing phase was unusually fast.
“She came out so fast that she slipped right through the doctor’s hands. Good thing there was that extra portion of the bed because she sort of slipped through her hands. The first thing the doctor said was ‘you little stinker.’”
There was no time for an episiotomy, which is the cut doctors make to the muscle between the vagina and the rectum to widen the vaginal opening for delivery.
“I did have a tear, and they told me it was a small tear and they sewed me up right away.”
Dr. Eddleman says getting that cut, that episiotomy, it’s no longer actually a given.
“What we do is we watch and if the tissues are stretching out then we just let it proceed normally.”
Eddleman says very often a mom will stretch enough to accommodate her arriving baby, really. But there is no way to tell who will need that little extra help.
“You really can’t tell until the very last second if you’re going to need an episiotomy. What you do is you watch those tissues and as the head starts to pass through the very last layers of skin toward the outside of the vagina, if they look like they’re going to tear, then at that point you cut the episiotomy to prevent the tissues from tearing themselves. If they don’t, then you let them deliver without an episiotomy.”
Your baby is here.
Now some dads participate during this portion of labor by having their hands there to catch the baby, but you heard Ariane say they’re pretty slippery. Dr. Eddleman says that’s why they don’t do it at his hospital.
“We don’t let dads physically catch the baby because first of all it’s pretty tough, and they’re pretty slippery and easy to drop. I mean even with a medical student or an intern, we never let them be the sole person there. Our hands are always underneath ready to catch.”
Dads can cut the cord.
“We have a separate set of scissors on our delivery table that’s sterile that we hand to them, we let them do that.”
But guess what? Your labor isn’t over; you do have to deliver that placenta. It’s the third and final stage of labor, it can take from 5 minutes to an hour for the placenta to detach from the uterine wall and be expelled. You may have to push some more to complete this stage, which for Ariane it was also quick.
“They showed me the placenta which I thought was pretty interesting. By the time they were done with that they brought Gabrielle back and put her on me and I got a chance to really see her for the first time, her little face. She was very small; she was 5 pounds, 6 ounces.”
Small, but perfect. Ariane and Gabrielle had a nearly textbook labor and delivery. Dr. Eddleman says that should really ease your mind. Ariane’s experience is the rule not the exception.
“Even when there are complications, things still end up well. Doctors sometimes have to perform a cesarean section for a fetal heart rate tracing that’s not reassuring, but even then the outcome is good. It’s just that they didn’t have a vaginal delivery. But still that’s considered a good outcome because at the end of day they have a normal healthy baby to take home with them.”
What advice does our new mom have for you?
“Be flexible, be open, never say never and learn as much as you possibly can because even if yours is going to be completely different from what the textbook says, the more knowledgeable you are, the less scary labor actually is.”
Truer words were never spoken. Thanks, mom!
We hope you’ve enjoyed this Pea in the Podcast all about labor. Please visit our website, peainthepodcast.com, for more information about our experts, to find links and transcripts, and to register to receive tailored week-by-week shows for each week and stage of your pregnancy. It’s everything you need to know about your body, your baby and the big changes ahead in your life in your journey to becoming a mommy. For Pea in the Podcast, I’m Bonnie Petrie, thanks for listening.
A Special Thank You To…
Ariane, who graciously shared her story of labor and delivery with us for this podcast.