As a doula in the south, I get all kinds of unusual questions: Can I take MARTA to the hospital? Should I just wait out early labor at IKEA so I can be close to the hospital? Will my pastor/psychic/softball coach be able to visit me before I give birth? These are not the typical questions, but they are in no way “stupid.” Because believe it or not, when it comes to birth, there are actually no stupid questions. Unlike in school. But there are some questions that come up so often that I’ve on more than one occasion thought I should make a public service pamphlet to pass out to expecting parents. So, I guess this is the start of that PSA.
1. WHAT IF I PASS OUT?
You probably won’t, but if you do, it’ll be okay. Typically women do not pass out from the pain of childbirth. The pain invigorates you. I suppose it’s not totally unheard of, and if for some reason you are worried you’ll pull a Melly from Gone With the Wind, tell your birth team your fears. When you vocalize your fears you give yourself the ability to control your situation. You can make sure someone will be there to help in the case your fear is realized. But just to be clear–Fainting is not one of the ways the human body typically responds to labor. What you may be thinking of is exhaustion. Laboring women get exhausted as fuck–they often sleep between contractions, and feel utterly wiped out — but you can be given oxygen if you feel light-headed. Though still rare, it’s actually more common for the non-laboring parent to faint. Of course, this would be nice to avoid, but there’s no shame in this — some people just get lightheaded around blood or stress. Partners: If you suspect you might break into a cold sweat or worry you’ll fall apart during childbirth, a doula can help you bear the load while you make sure you eat well and stay hydrated. You can do it, but having help is never a bad idea.
2. WHAT IF I POOP WHILE I’M PUSHING?
You probably will. Real talk. But I promise you, you won’t even notice. It will be wiped away before you can even work up the embarrassment. Doctors, midwives, doulas, labor assistants, and nurses, have seen it all and won’t bat a single eyelash at this normal bodily function. Usually it’s not much — during early labor you’ll probably expel most of your pee and poop when you get up and down a million times for the bathroom. Baby is still playing with your bladder like it’s a squeeze toy, so there won’t be much left. If you don’t have an epidural, the feeling your body gives you to tell you it’s time to push feels almost exactly like the feeling you get when you are running to the bathroom after a long car ride needing to go #2. But this time you get push out a baby instead! Poop is no big deal. Trust
3. WHEN SHOULD I LEAVE FOR THE HOSPITAL/ASK MY MIDWIFE TO COME FOR THE HOME BIRTH?For first-time parents, and in the absence of any particular medical concern, it is generally recommend to head towards the hospital when the contractions are 3-4 minutes apart, one-minute long, and have been that way for an hour (4-1-1). You’ll be in touch with your doctor or midwife before that time so you won’t be doing anything irresponsible to let labor really get going at home. If you’d prefer to minimize interventions, staying home through early labor is especially beneficial. First-time labor is on average 24 hours — babies born in Ubers are rare and even more rarely those of first-time moms. So tell your partner to chill. You’ll probably make it there on time. Talk to your doctor or midwife about when to go and what to expect at home before you do so that your fears are allayed.
For home births, call your midwife and birth team as soon as you believe you are in labor. When your team is coming to you, you want to give them as much heads up as possible. Labor usually takes awhile, but you don’t want to call your labor team too late and end up delivering your own baby without being adequately prepared. Yes, to be honest, lots of babies are born unassisted—but let’s not let that be your baby unless it’s your organized and prepared plan.
4. SHOULD I HIRE A DOULA?
As you know, I am a professional doula, so on this one question I admit to being biased. A doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women and their partners have safe, memorable, and empowering birthing experiences. So in short, yes. If you have the means and desire for personalized birth help, then hire a doula.
Labor can involve 12+ hours of stress with the nurses and doctors only popping in to check on you—which is normal. They have many patients. Doulas only have ONE patient at a time, so you get their full attention and your spouse/partner/family has support as well as yourself. Hire a doula if you want continuous support. Listen, I know cost can be prohibitive. Depending on where you live and the level of your doula’s experience, doula services can cost between several hundred and a thousand dollars. (Message me if you are looking for a doula who works on a sliding scale based on income.) It’s my personal belief that every expecting woman who wants a doula should have one. Studies show that continuous labor support reduces the length of labor, the number of interventions and the likelihood of a C-section—which cuts down costs in the long run.
5. IS THERE A WINDOW FOR GETTING THE EPIDURAL?
Generally, no. But ask your doctor or midwife because different practices and hospitals have different policies and anesthesia availability. This question is often asked by my clients who want a natural birth but are terrified they may change their minds and find they are too late. I always reassure my clients that they are in safe hands when it comes to meds. Hospitals are always ready to medicate. There used to be a “window” for epidural anesthesia for pain relief in labor — it was generally between about 3-7 centimeters dilation, not too early in labor, not too close to the pushing phase. But modernly, for the most part, epidurals are available as long as the patient can sit still long enough to get one and the anesthesiologist is available. Talk to your care-provider about epidural logistics so that you feel reassured if you know you want one.
6. WILL I KNOW WHEN MY WATER BREAKS?
Not necessarily. If your water breaks (spontaneous rupture of membranes) at night you may sleep through it and wake up to find you’ve made yourself a nice water bed. If it breaks during the day you might think you’re peeing — a little urinary incontinence at the end of pregnancy is common (the baby’s head is literally sitting on your bladder) but most women realize that it’s not urine pretty quickly. For one, it feels different and definitely doesn’t smell like urine. Often there’s a bit of a gush (you have to change your clothes) right when the membranes rupture as there’s a pocket of fluid under the baby’s head that comes out first, but then the baby’s head blocks the opening of the uterus so fluid tends to come out only when you change position. Sometimes it doesn’t gush but comes out in a slow leak. Both are completely normal. In the movies, a woman’s water breaks and she rushes to the hospital. This is NOT what happens in reality. Most of the time, the water breaks during labor, not at the onset and often it doesn’t mean you need to rush to the hospital. It does mean you should call your care-provider and that you’ll be having the baby at some point in the next day or so. If your water breaks before you have any contractions be reassured that labor is on its way.
7. HOW WILL I KNOW LABOR HAS STARTED?
There are signs that labor is imminent, such as the loss of the mucus plug, the baby lowering or “dropping” and a crampy, shitty feeling; but mostly you’re looking for contractions that become longer, stronger and closer together. A contraction is the tightening of the uterine muscle and can last anywhere from about 45-90 seconds at the very end of labor. Your belly becomes very hard during a contraction and then softens again. Most say they don’t hurt at first but get very intense as labor progresses. Many women get Braxton Hicks contractions during pregnancy which are technically contractions (tightening of the muscle), but they are not opening the cervix and making you go into labor. The difference between Braxton Hicks contractions and labor contractions is that the latter don’t go away when you change position or drink water and they become longer, stronger and closer together. Often women start to realize it’s actually labor when they’re about 5 or 6 minutes apart and feel intense enough that you have to stop what you’re doing to cope with them. If you can’t talk or stay aware of what’s going on around you during your contractions, they are the real deal. If you have a doula, they should be able to help you decide when it’s time to get on the road. Talk to your midwife or doctor about signs of labor and under what circumstances they would like you to call or go into the birthing facility.
8. HOW CAN I PREVENT TEARING?
Tearing is common (but not a certainty) in first-time vaginal births but most women get superficial tears, not the kind that tear through muscle. Stitches are sometimes required and will fall out on their own. The things you can do to help prevent tearing is massaging the perineum throughout pregnancy with approved lubrication, choosing a care provider who will allow you to change positions during birth (and who also isn’t scissor happy), and lastly giving up the idea that births happen on your back. The likelihood of tearing can be influenced by the positioning for pushing, speed of second stage labor and mostly by the skills of the practitioner and whether or not an epidural was used. To minimize tearing, go with a doctor or midwife who is comfortable with you pushing in an upright position, which may help reduce pressure on the perineum, and who has a low episiotomy rate. An episiotomy is an incision on the vaginal opening that is supposed to prevent tears but can actually make them more likely. You can try forgoing medications or demanding only a low dose epidural that can be turned off for pushing so that you can get into optimal gravity-friendly positions. Being in control of your muscles will take you farther than any other technique.
9. DO I SHARE A ROOM DURING LABOR?
No. The episode of F.R.I.E.N.D.S where Rachel gives birth has lied to you. Personally, I don’t know of any hospital that puts laboring women in together. Maybe in the 1950s when maternity care moved from primarily in home to in hospital only, women were put together to Labor, but not in the US today. For recovery, yes, often the standard is a shared room with a curtain between the two moms. But while in labor you get and deserve your own room for privacy.
10. CAN I EAT DURING LABOR?
Physically you can, and you should. Many hospitals have a no eating, no drinking rule for laboring women. Which is RIDICULOUS. It started years ago when women would get general anesthesia for C-sections — the fear was that mom could aspirate on vomit under anesthesia. But these days moms almost always get a local anesthesia for a C-section. Still, the rule is in place in too many hospitals. Protocols are definitely changing and most doctors and nurses will say something along the lines of “what I don’t see, I don’t know.” But, if eating and drinking is important to you, research your area’s hospital protocols and what care providers are most lenient. They know this rule doesn’t make sense for most women — labor is hard and nourishment gives you strength.
There is nothing wrong with fighting the system but be careful with what you choose. I wouldn’t bring into the hospital a crock pot of ginger chicken. It will smell down the hall and cause dissension with the staff. High protein snacks and water with electrolytes (Vitamin water or Gatorade) can be a great idea however. Also eat very well and often during early labor before you go to the hospital. Most women aren’t that hungry once active (hard) labor starts and will be just fine with the ice-chips the hospital provides.
So, what did I miss? Do you have any questions you’d like me to cover? Message me at firstname.lastname@example.org or find us on Facebook at Belly Blossom Doulas. We want to hear from you!