During the childbirth prep classes I teach in NYC I get all manner of unusual questions: Can we bring a vibrator to the hospital? Can I take the subway to the hospital? But there are some questions that come up in pretty much every class.
Some are obvious: A big concern for first time parents is figuring out when labor is for real happening and then getting the hospital in time. I had a very funny student in class recently who asked, “But like when do we go?” over and over. She needed to talk it through several times to assuage giving-birth-in-the-foyer fears.
Other common questions might surprise you — they pertain to the vagina, pain-relief and pooping. (These ones usually come up in the last class, when people feel more comfortable.)
Though many students start with, “This is such a dumb question, but … ” none of these are dumb questions. All of them are absolutely legit and worth thinking about. In fact, the more questions the better. And on that note:
1. WHAT IF I PASS OUT?
As a general rule, women don’t pass out from the pain of childbirth. It’s not totally unheard of and I suppose it could happen, but for some reason, passing out is just not one of the ways the human body responds to labor. Maybe medications could make you faint, or get you into a very difficult position, but even if you are the fainting type, it’s rare that labor alone would cause it. Women get exhausted, sleep between contractions, and feel utterly wiped out — you’ll be given oxygen if you feel light-headed or other signs point to the necessity for such a thing. Though still rare, it’s actually more common for dads to faint. Though it would be nice to avoid, there’s no shame in this — some people just get lightheaded around blood or even the thought of it. Partners: If you suspect you might break into a cold sweat during childbirth or the placement of an epidural, eat well and stay hydrated and remember you can give great support by focusing on mom’s face and holding her hand.
2. WHAT IF I POOP WHILE I’M PUSHING?
It will be whisked away before you even know it! Doctors, midwives and labor assistants have seen it all and won’t bat an eye. When you’re pushing a baby out there is a decent chance other things will come out at the same time. Usually it’s not much — women can have loose bowels at the end of pregnancy and tend to make several trips to the bathroom throughout early labor. If you don’t have an epidural the feeling at the onset of pushing highly resembles the feeling of really having to go to the bathroom. Like *really* having to go. Some women don’t feel this urge to bear down (which is fine) but if you do, go for it, what you’re mostly feeling is the need to push out … a baby.
3. HOW WILL WE KNOW WHEN TO GO TO THE HOSPITAL?
For first-time parents, and in the absence of any particular medical concern, I generally recommend going in 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. Doctors and hospital staff will actually send you home if you come in too soon. Many couples — especially dads! — have completely understandable concerns about making it to the hospital in time. First-time labor is on average 24 hours — babies born in cabs are rarely those of first-time moms. 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. And use your common sense: If there’s a snow storm during rush hour… go sooner.
If this is not your first baby, talk to your care-provider about the timing — the odds are your labor will progress faster this time.
4. WHAT IS A DOULA AND SHOULD I GET ONE?
A labor support doula is a woman who has been trained to help women/couples in labor with pain coping, understanding what’s going on and navigating the hospital. Doulas are a relatively new phenomenon and I think they came about when the hospital system made is such that women are mostly alone during labor until the end, when pushing starts. This can involve 12+ hours or many more with nurses and doctors check-in on you but not giving continuous support. The cost can be prohibitive. Depending on where you are and the level of experience doulas charge between several hundred and a couple thousand, but many women swear it’s worth it. Studies show that continuous labor support reduces the length of labor, the number of interventions and the likelihood of a C-section.
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. 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 for the most part, especially in NYC where I teach childbirth classes, epidurals are available as long as mom 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 IF THE WATER BREAKS?
If your water breaks (spontaneous rupture of membranes) at night you may sleep through it and wake up to find a wet spot. 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 pee pretty quickly. It feels different and 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 then 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.
In the movies, a woman’s water breaks and she rushes to the hospital. This is not typical in real life. Mostly 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 labor starts (contractions), be reassured that most women will go into labor on their own within 24 hours.
7. HOW WILL I KNOW LABOR HAS STARTED?
There are signs that labor is imminent, such as the loss of the mucous plug, the baby lowering or “dropping” and a crampy, fluish feeling; but mostly you’re looking for contractions that become longer, stronger and closer together. A contraction is the tightening of the uterine muscle — now the largest muscle in your body — 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. They don’t hurt at first but get very intense as labor progresses.
Many women get warm-up or 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. Women are given ample cues to help them realize they are in labor. Talk to your midwife or doctor about signs of labor and under what circumstances you should call or go into the birthing facility.
8. HOW CAN I PREVENT TEARING?
Tearing is common 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 likelihood of tearing can be influenced by genetics, size of the baby or baby’s head, positioning for pushing, speed of second stage labor and 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 for a low dose epidural and have it turned off for pushing so that you can get into optimal gravity-friendly positions and control of your muscles. I am personally neither a fan of the perineum stretching advice women sometimes get nor a fan of doctors manually stretching the perineum of women who have epidurals. I think generally our bodies were made to do this so to pull and pull and pull on this part of your body in preparation for stretching it just seems added strain on that area — there’s no good evidence that stretching the perineum helps reduce tearing though it is done frequently. Staying active, fit, eating well and doing kegel exercises throughout pregnancy may help, too.
9. DO I SHARE A ROOM DURING LABOR?
No! I don’t know of any hospital that puts laboring women in together. For recovery, yes, often the standard is a shared room with a curtain between the two moms. But you definitely get your own room during labor!
10. CAN I EAT DURING LABOR?
Many hospitals have a no eating, no drinking rule for laboring women. 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. I think it’s definitely changing and most doctors and nurses will say something along the lines of “what I don’t see, I don’t know.” They know this rule doesn’t make sense for most women — labor is hard and nourishment gives you strength. I wouldn’t go into the hospital with a steaming chicken parm b/c the nurses will have to tell you to put it away. 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.