What if? Those words precede many thoughts throughout a woman’s pregnancy. What if I’m pregnant? What if I need a C-section? What if our baby looks like Uncle Harry? You get the point.
But for many women, the most pressing “what if” question is this: What if I don’t make it to the hospital and have to deliver my baby at home?
Although it is extremely rare for that to happen, especially with a first baby, many women worry about getting to the hospital in time during those last weeks of pregnancy. Rest assured, the length of labor for a first-time mom can be anywhere from eight to 24 hours … so you really do have plenty of time. (For second-time moms, the labor may be half as long as it is for first-timers, but keep in mind that these times are averages, and there are women who defy the statistics and give birth much faster or slower!)
In the unlikely event that you do find yourself stuck in a cabin during a snowstorm, locked in bumper to bumper traffic, or alone at home when contractions hit, don’t panic! We’ve mapped out what you need to know to deliver your own baby.
Is This Really IT?
Figuring out if you’re in real labor or false labor is essential. Before your 35th week of pregnancy, your doctor or midwife will most likely review with you the symptoms of real and preterm labor. (They are used to getting a lot of calls from moms, so don’t be afraid to call and check in if you think this might really be it!)
If you’ve experienced the following, chances are you’re in real labor:
- Loss of mucus plug (this plug has been tucked inside the cervix, protecting the opening)
- Rupturing of your bag of waters
- Low back pain or cramping (it can start intermittently and may become regular)
- Tightening of your abdomen (contractions)
If the time from the beginning of one contraction to the beginning of the next lasts between 30 to 75 seconds, and there are about five minutes between contractions, this may indeed be real labor. You’ll find that the pain with real labor contractions will build, and your belly will harden and then soften. And you won’t be able to make these contractions go away by lying down, emptying your bladder, or drinking fluids.
Assessing Your Stage of Labor
The progression of labor is divided into three stages:
Stage One: This stage is divided into two parts and brings you from the first contraction all the way to being fully dilated (10 centimeters).
- Early Labor: This part covers the time during which a normal, thick cervix begins to thin and soften (four centimeters dilated).
- Active labor: During this time contractions become stronger, and you’ll be between four and 10 centimeters dilated.
The time between seven and 10 centimeters is often referred to as transition. The transition phase of active labor is when contractions become quite strong and you may begin to feel more pressure in your bottom.
Stage Two: This is when pushing begins, and it ends with the delivery of your baby (generally after one to two hours).
Stage Three: This stage begins right after your baby is born and ends with the delivery of the placenta.
Here Comes Baby!
OK, so what if you are one of the statistics-defying women who suddenly feel the urge to push shortly after experiencing what they thought were just cramps and a sore back? What if you have a sitcom moment and find yourself telling your partner in no uncertain terms, “It’s time! We are not going to make it!”
According to Dr. Robert Goldberg, MD, of Westport, Connecticut, calling 911 right away is the most important first step. “Most people do not live in such a remote area that they are beyond the reach of emergency help. So call 911 if you think delivery is imminent,” he says. He recommends that women pay attention to their symptoms and try to call their doctor or midwife early so that he or she can help decide when it is time to go to the hospital (and avoid the panic or fear of a home delivery).
All this being said, if you are feeling increased pressure in your rectum and perineum, feeling the urge to push, and experiencing frequent and intense contractions, here’s everything you need to know to ensure that you and your baby are safe.
Your Step-by-Step Guide to Birthing a Baby
Step One: Call 911 and Get Ready
If you’re in your car, carefully pull over and get in the back seat or find a safe spot nearby. If you’re at home, station yourself in a warm, clean area. If there is someone with you, have him or her place towels or blankets on the floor or ground to create a soft “nest” for you and to help with any leaking amniotic fluid and blood that will accompany your baby’s birth. If you don’t have towels or blankets handy, try clothing, a soft rug, or anything absorbent and relatively soft.
Step Two: Position Yourself
Lie down on your left side or on your back with a pillow wedged under your left hip to avoid being completely flat (you can drape a blanket over your naked bottom half if that helps you feel more comfortable). Taking this position is important so that you don’t compress the vena cava. Your baby’s weight and your uterus pressing on this vein will decrease blood flow, making both of you feel ill.
While you’re getting settled, your support person should gather more blankets and towels for drying the baby and swaddling her after birth. One major complication with an emergency home birth can be hypothermia for a baby, so once she is born, it will be very important to keep her warm and dry.
Step Three: Slow Down, Focus, and Breathe
Don’t worry if Baby comes much faster than you expected. In the case of a rapid (precipitous) delivery, most babies will do fine making their way into the world.
If you feel the urge to push, Dr. Goldberg recommends using panting breaths to concentrate on your contractions and try to hold off the arrival of Baby until help arrives. However, do not try to keep your legs closed or try to hold the baby’s head in to keep her from delivering as this could result in injury. As you wait for help, you can massage your perineum, the space between your vagina and your anus, to help improve its elasticity (and decrease your chance of tearing during birth).
Step Four: Use Your Hands
As Baby’s head emerges, check to make sure the cord is not caught around Baby’s neck. If it is, gently slip it over her head. Be sure to not pull or tug on the cord. Next, you (if you are alone) or your support person should place hands on the baby’s head to slow down the delivery and help guide the baby. (Going slowly may help you from experiencing tears in your perineum.) Baby will be really slippery from the amniotic fluid, blood, and mucous involved in delivery (all of this is normal!). Having a towel in hand may help you “catch” Baby better.
NOTE: In the event that the cord is visible in the vagina before the baby’s head (you or your support person can see it or feel it) get on your hands and knees and use your fingers to keep the baby’s head from compressing the cord. This is a cord prolapse and is considered an emergency. Be sure to mention it to the EMS crews as soon as they arrive.
Step Five: Make Sure Baby and You Are OK
Once the baby has emerged, it is important to use a towel or blanket to vigorously dry Baby to prevent her from getting too cold or stressed. This drying will usually get the baby crying, which is important immediately after birth—it helps your baby clear her lungs. So don’t be afraid of a good lusty cry!
Don’t worry if Baby’s hands and feet are bluish; this is normal for a brand new baby. However, if she is purple or gray all over, she may be experiencing breathing difficulties. You can try blowing on her face to startle her into breathing. But if that doesn’t work, seal your mouth over her nose and mouth and give a gentle puff of air.
If you think of it, ask your partner to note the time of the birth.
Once Baby is dried off, put away the wet towel and put her, naked, on your belly or chest. Both of you should be kept warm with a blanket or coat. Do not cut the cord. You should continue to recline on your left side. Trying to breastfeed immediately after birth is a great way to help both you and Baby recover quickly. Breastfeeding will cause the release of oxytocin and help to contract your uterus (which will help the placenta deliver more quickly and help prevent heavy bleeding).
The placenta may take anywhere from a few minutes to an hour after the baby has been born to be delivered. Again, do not tug or pull on the cord! If it does deliver before the EMS arrives, you can place it in a bag.
Don’t worry about Baby’s umbilical cord. Do not attempt to cut the cord; however, if you have a string handy, such as a clean shoelace, Dr. Goldberg says you can tie the cord, but no closer than four inches from the baby’s belly.
While you await the arrival of EMS, be sure to stay warm—this is important for both you and Baby. If you’re alone, you’ll need to concentrate on staying alert and awake as well.
Now you know how to deliver a baby! Pregnancy and labor can be full of the unexpected. That’s why in the very unlikely event that you don’t make it to the delivery room, knowing in advance what to do will help minimize your fears. Remember to stay in touch with your healthcare provider and always be aware of symptoms and changes in how you are feeling.