Roundtable- Labor and Delivery

We’re focusing on labor and delivery this week and I’ll go ahead and let you know that we’re going to have a “Too Much Information” (TMI) edition of this message that will only go out to the women on this thread. There are just some things that are important to cover and you’re obviously welcome to share with your male partners, but I’ll be more comfortable writing them for a “women-only” audience.

I know most if not all of you have taken a birth class or heard from your Doctor when to call the hospital and how to know you’re in real labor. I’ve recently been re-visiting this information because with the second pregnancy, I find myself having a lot of Braxton-hicks contractions and other symptoms that had me wondering if I was going into early labor.

When contractions first start they can feel like a tightening across your whole abdomen (that may or may not hurt). They can also feel like menstrual cramping. Both types can mean the beginning of true labor or false labor. So, how do you tell which is which? The main thing is that over time false labor doesn’t get any stronger—become more regular, or increase in intensity. You’re advised to drink a lot of water and lay down or take a shower and see if the contractions lessen or stop. If they do, it’s most likely false labor. If despite your efforts at eating or drinking, changing your activity level or position, or showering you find that your contractions are becoming more regular and/or increasing in intensity, you may be in real labor.

The way to determine how regular your contractions are is to time them. This involves noting the time that a contraction first starts (i.e. 11:09 pm) and then noting how long it lasts—30 or 45 seconds. Then you would write down when the next one started (11:19 pm) and how long it lasted etc. If you find that your contractions are occurring at regular intervals for an hour or so (and you did the other things to rule out false labor) this may certainly be the real thing. Each Doctor or midwife is different so follow the guidelines you’ve been given about when to call, but I think the “general” rule is when your contractions have been 5 minutes apart for an hour.

Birth Stories
Of course you’ve heard about long labors and probably even some short ones. I’d love to hear the birth stories of the people on this list, but I’ll start with mine. Everyone in my family had very long labors and ultimately had to be induced. I was planning on natural childbirth, so I had mentally prepped myself for a 24 hour labor. My contractions started around 11 pm and I was able to just lie in bed and feel them—noting the time for about 45 minutes (they started out 7 minutes apart). I told my husband to get to bed and get some sleep because we probably had a long road ahead. I went to the guest room and could no longer lie down during contractions. I was leaning over a desk and swaying and breathing into the contractions.
I called my doula who listened to me making me way through a contraction or two and she said I sounded great and like I was in early labor (at this point they were about 5 minutes apart). About half an hour later (12:15 pm) I got JT up and got in the bathtub. At this point I lost all track of time—the contractions became very painful (intense if it makes you feel better) and it took absolutely all of my focus and energy to keep myself relaxed while my uterus was contracting like a vise. At some point I told JT to call the doula back because I needed her there (working backwards this was about 2:30/3:00 am.) By then the contractions were coming every 30-45 seconds and some after only 15 seconds. There was very little rest in between the contractions. The doula arrived about 30 minutes later—watched me during one contraction and told us that we needed to get to the hospital right then.

JT rushed around trying to get a few last minute things together and we headed over to the hospital. I think we got there around 3:45-3:50 am and Henry was born at 4:17 after I believe about 2 pushes.

So, even with a history of long labors mine went really fast. The thing about fast is that it’s over in a short amount of time, but at least for me it was really intense almost the whole time. Based on talking to other people, if you have a longer labor, it’s common for the less intense part of it to last awhile—i.e. you might actually lie down and rest during it or clean the house or something.

Even if you plan on getting an epidural as soon as possible in the hospital, you may feel contractions before they’ll admit you that you need help getting through. The best advice is to be as focused as possible on relaxing. You have to make the rest of your body as limp and relaxed as possible while your uterus gets all tight and does its own workout. If you stay relaxed, things are much more doable than if you tense up right as the contraction starts. If that happens, just get through the contraction and try to stay more relaxed with the next one. Your partner can do things like massage your back or hands or help point out that you’re grimacing or holding tension in your face or hands or shoulders.

Bouncing on one of the exercise balls can feel good as can being on all fours, laying in the bath, swaying your hips back and forth, etc. It’s not a bad idea to do a little reading on birthing positions just so you have some at your fingertips—especially if you’re going for a natural childbirth.

I'll dig in with my own stories. With Carys, my water broke at approx. 5 AM. Because I wanted the epidural, I did not want to wait to get to the hospital. Plus when I called my doc, she said to go the hospital. After dropping Carys off and going to the McD's drive through for a sausage biscuit (pregnant ladies have to eat), we made it to the hospital. I'll note at this point I was not feeling painful contractions so there was no feeling we needed to rush. At the hospital, I was still not having regular contractions and they tested the fluid to see if it was true that my water broke. The first nurse said the test was negative and they almost sent me home but b/c I was on bed-rest and my cervix was already thinned they decided to let me walk the halls until my doc arrived (around 11AM). While walking the halls I experienced more intense contractions which were like very bad menstrual cramps. I was thinking they were not bad at all. Once my doc checked me, she confirmed my water broke and I got hooked up for my saline. Note to ladies who are planning or not decided to get the epidural, you have to have 1 liter of saline one hour before to get the epidural. I'm not sure if this is just my hospital policy but if you are thinking you may get it, you should find out b/c once things get going, they do get intense. I never went to a birthing class but I watched so many birth stories on cable during my bed-rest, I felt like I had a pretty good idea of the things that could happen. So I learned to breath on the fly during the contractions that were more challenging before they administered my epidural. I think around 2pm, I was drugged and relaxed. And I don't remember the exact time but around 4pm, I had Carys.

With Helen, things were faster. I was on bed-rest and finishing up a project on my laptop. I remember I had timed the contractions from about 9:30 AM to 11:30 and I was telling Cullen how they were getting closer and stronger. Initially I thought it was false labor b/c there was no pain, it felt like a tightening of my belly. But after they were becoming regular (still without pain), I realized I did not want to wait. I finished off my project and told Cullen to come get me. We coordinated Tiffany to come and stay with Carys until my Mom flew in town. We got to the hospital and my doctor was on vacation so I met her stand in briefly and once he read my chart, he decided to break my water. I immediately let him know I wanted the epidural and once again, I had to wait for the saline. This time was much more intense, I think b/c it was faster. But again, by about 2pm, I had my epidural and was relaxed. I think I had Helen around 6pm, just in time to order a dinner for me from hospital cafe:). I actually got to pull Helen out this time which was surreal and cool at the same time.

I had great experiences both times, of course, the first was more anxious but beautiful too. Once Tamra shares the TMI posting, we'll get to the nitty gritty after effects of birthing and how to care for yourself.

I would just say try as best you can to be mentally prepared and be flexible for anything to happen. Hopefully your birth will be everything you imagine but sometimes you may need to change plans and go a different direction. Be focused but flexible and remember this is just one small step to your new life with baby.

Too Much Information Section
The intent of this message is not to gross you out or scare you, but to provide you with at least a basic understanding of the aftermath of birth. Of course not all of this will apply to you and if you have a c-section none of it may (I don’t have any experience with recovery from a c-section to share.)

We’ve talked some already about laboring and different ways to deal with that experience. One thing I will say is that it’s absolutely true that if you’re making your way through natural childbirth, just when you think you can’t handle it anymore, that means that it’s time to start having the baby. Things get very, very intense during this “transition” phase but for a lot of women, pushing feels a lot better because now instead of trying to stay relaxed while your uterus contracts the hell out of itself, you’re able to push with the contractions—you’re able to be active.

When you’re pushing you want to try to focus all of your energy into the push—this means trying to keep your face and other body parts somewhat relaxed and putting all the force of your efforts into your butt—it’s just like you’re trying to have a bowel movement. The doctor/nurse/midwife will tell you when you’re having a productive push and when they do you want to focus on what it felt like and repeat it. Depending on your doctor/nurse/midwife, you’ll probably be on your back with your legs up pushing. If you have an epidural this is pretty much your only option. If you don’t you might want to consider other positions like laying on your side, squatting, sitting on a birthing chair, etc because they are actually more conducive positions to getting the baby through and out of the birth canal. Lying on your back actually narrows the pelvis which makes it harder.

Pushing is really hard work and if you have any experience with exercise I think it’s helpful to think of it like an endurance workout. The contractions are still painful too and the experience is intense so lots of women feel like screaming. Making noise isn’t bad—but I think it’s more helpful to make low moaning/grunting sounds rather than high-pitched screams because the low sounds tend to help you focus while the screams coincide with just releasing and “giving up” on that contraction.

So, you’re pushing and pushing and finally you’re bringing the baby down and their head has come out (if they were head-down to begin with). Frequently your Dr. will tell you to wait while they suction the baby out or unwrap the cord from their neck. Then they’ll give you the all-clear and you’ll be able to push the baby the rest of the way out.

What happens next depends on your hospital, your Dr. and your preferences. The baby can be immediately placed on your stomach and will probably be crying while the nurses are rubbing the baby all over—stimulating their lungs and getting them cleaned up. Someone (and it might be your partner) will cut the umbilical cord. Generally after all this happens in the first few minutes, the baby will be taken by a nurse to be weighed, measured, footprinted, and possibly bathed and dressed. The other thing that generally happens is they put eye drops on the baby’s eyes (I can’t remember for sure what this is and what it’s for, anyone?). You can request they delay doing some of this stuff so that you have more time to bond with your baby right away if you like. I let them move along with their schedule and had a few minutes to be totally overwhelmed and close with JT. Then Henry was brought to me and started to nurse.

During this time you’ll be working on delivering the placenta. I believe mine came out quickly after Henry was born and I don’t remember much about it—clearly the birth of the baby kind of overshadows this.

What I do remember is that I tore while Henry was being born and my Dr. spent quite awhile stitching me up. Actually the stitching was most unpleasant and seemed to take forever! It helped to have Henry there and focusing on him but i’m not going to say that I didn’t even notice because I was holding my new sweet baby.

In many hospitals now, you labor and deliver in one room and are then transferred to another room for your recovery, i.e. your hospital stay. Old school was to labor in one room, deliver in another, and recover in a third which I guess could still apply, so you might want to ask about that during your hospital tour.

One thing I was surprised at was when it came time to move to our recovery room (3 hours after Henry was born) I had to get off the bed/table and get into a wheelchair. I’m sure that’s standard practice, but I was shocked that they expected me to STAND UP after I had just given birth. The nurse and my doula were really helpful but it hurt and I just kept thinking--can’t they just wheel this bed into my new room?

When you get to your room that’s when you’ll hopefully have a chance to get some rest. It’s also when you need to make sure to get all the supplies you need from the nurses. Here’s a rundown of the basics.

They will supply you with pads to use while you’re at the hospital. At first they gave me combo pads/ice packs which were amazing. They seemed to be in short supply though and after the first 4 or so I wasn’t able to get anymore. Next time I’ll be more aggressive about asking for these (and to be honest I ordered a case of them for my use at home from a medical supply business!)

The hospital also provides this mesh super stretch “underwear” to use. I’ve heard some people say that they didn’t like it but it was honestly all I wore for probably a week. It was WAY more stretchy and accommodating than any underwear I had (even old stretched out stuff). You need to wear something so that you have something to attach the pad to, but especially with a tear, you want it to be as loose as possible. I just got one pair but this time I’m definitely asking for a few more to take home.

They also give you this stuff called epi foam which has a numbing agent in it and can be sprayed on the pad. If you had a tear at all, it’s a lifesaver. It’s a really small bottle and again it’s something you should tell the nurses up front you’ll need another one for while you’re in the hospital and one to take home as well.

They also supply you with something called “chux” or “chucks” pads. These are basically plastic/paper sheets about the size of a small baby blanket that you can put under you to catch any overflow while you’re laying down. They’re helpful in the hospital and you can take quite a few with you when you leave at home to protect your sheets.

At some point after you get to recovery you’ll either have to go to the bathroom or the nurse will make you. At least for me they helped me to the bathroom the first time and explained how to use the little squirt bottle they give you. Basically you fill this plastic bottle with a squirt top with warm (not hot) water and spray that on yourself while you pee. It helps allay any stinging from the urine on you delicate parts and it can help relax you enough to let you go.

Make sure you drink as much water as humanly possible after delivery so that when it comes time for a bowel-movement things are regular.

At many hospitals the baby will be “rooming in” with you meaning that they will stay in your room while you’re in the hospital. If your baby had any complications after birth they might need to be in the NICU. Some hospitals give you the option of keeping the baby in the nursery while you get some sleep.

Ahh sleep—you’re exhausted, your partner is worn-out and (hopefully) the baby is sleeping already. Do your best to get some rest, but know that hospitals are about the least conducive places to sleep possible. The nurses will come in every 30 minutes and then every 45-1 hour to check your pulse, your uterus (to make sure it’s shrinking), take your temp, etc. They’ll also ask you about the baby and if s/he’s nursing, how often, and how many dirty/wet diapers you’ve changed. I found it really helpful to have a journal or at least a piece of paper to jot this stuff down on so that when they came in to check on me at least I could just read them what happened.

In addition to all the checks by the nurses, you have people delivering your food, picking up your garbage, picking up your soiled linens, giving you information about the hospital photos you can have taken, helping you fill out the forms you need to get the baby a SS card, etc. Also, your Dr. and a Pediatrician will have to come by at some point before you can leave the hospital to check both you and the baby out.

Bring ear plugs! Also, if you have a twin air mattress you might want to bring that for our partner. Hospitals generally have one of those fold-out chair beds and they’re not particularly comfortable. I’m a light sleeper so I wanted to get home as soon as we could so that I could be in my own home and get some rest there. If you are hoping to leave sooner rather than later, make sure to let the nurses know so that they can start lining things up for your discharge, it takes awhile.

Questions to ask your Doctor or Midwife
This last message touches on those things that are a good idea to discuss with your Doctor or midwife before the birth—even if you’re not planning on having this stuff happen to *you*, it’s still a good idea to know the Doctor of midwife’s policy.

What is their policy on induction. If you go later than your due-date, will they automatically induce you, refuse to induce you, etc. Some people are very ready to not be pregnant anymore, and demand to be induced if they go late. Others want to avoid induction—often if they’re hoping for a natural labor. Find out what their policy is, and also how inductions are generally handled. For instance, do you have to come in the night before and get the gel applied to your cervix and spend the night in the hospital or do you get to go home and come back in the morning to start the pitocin? If you don’t want to be induced can they recommend natural labor inducers that you could try first? How long will they let you try to “get your labor started” before they move on to something else, i.e. a c-section?
What generally causes your practitioner to either schedule or recommend an emergency c-section? What is their c-section rate, i.e. how many of their patients wind up getting c-sections? How would a c-section work, both scheduled and emergency? Even if you don’t plan on having one, it’s not a bad idea to understand how a c-section would happen, what to expect, who can be with you, etc. in case you wind up needing one.

Fetal Monitoring
What is your practitioner or the hospital’s policy on fetal monitoring? Do you have to be monitored continuously (i.e. you have to stay in bed) or can you be monitored intermittently so you can get up and walk around? Or do they have portable monitors so that you can walk and be monitored continuously. How do they use the fetal monitors to make decisions? What could happen that would make them intervene in your labor, i.e. baby’s heart-rate speeding up or slowing down, etc.

Eating and Drinking
What is the policy on eating and drinking during labor? Most hospitals only allow you ice chips, is that the case, if you want to be able to eat can your practitioner make an exception for you, etc.

What is your practitioner’s policy/approach to episiotomy? I don’t think many Doctor’s do them routinely anymore, but there are probably specific cases under which they would recommend them. What are those situations? If it’s important to you to avoid one, how much control will you have over the decision?

Family and Visitors
Depending on your wishes, you may want to find out who is allowed in the labor room with you. Also, what is the policy on photos and videos? If you have family or friends that will want to see you in the hospital, are there specific visiting hours, limits on the numbers of visitors, etc. Can you use cell phones in the facility? If not where can you go to make calls?

Does your facility have a well-baby nursery? If so what are the policies around where the baby stays while they’re in the hospital. One extreme would be the baby being in the nursery most of the time and only being brought to you periodically and the other is not having a well-baby nursery at all—the baby is in your room at all times. Many women, especially if you’re planning to breastfeed, like to have the baby “room-in” with them so that you can feed when the baby is hungry. Others (breastfeeding or not) want to take advantage of the nursing staff and get some sleep while they’re baby is taken care of.

What tests, evaluations, and hoops do you have to go through before you’re allowed to leave the hospital? How long do you have to stay, how long CAN you stay? Are there certain tests or exams the baby has to have before being allowed to leave? What about for you—what are the types of things that could prolong either you or the baby’s stay in the hospital?

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