Day 1 - Birth Basics - Transcript

I am a pregnancy coach, a birth Doula, and childbirth educator.

I'm going to start with inductions and then talk a little bit about contractions and what to expect. Then I'll go into prodromal labor and explain what that is, and then get into what early labor is.
 

Let's start with your estimated due date, because a lot of you are in this window at the very end of pregnancy and you're at your last couple of appointments with your provider. You might start talking due dates and everybody's putting this pressure on you. Oh, the baby is almost here, it's almost your due date. And I feel like there's this pressure that moms, especially first time moms feel to have their baby by their due date. So I wanted to kind of put this out there to help you kind of put that date in perspective and to understand that it's just an estimate. So I like to use the term your estimated due date because it's not rocket science. Your due date is not precise. I wanted to make it clear that the average first time mom will give birth a week past her due date.
But it can be really discouraging to kind of see that day come and pass. So if your doctor starts bringing up induction, it just sounds like a common thing. But it may not be really necessary.

I wanted to lay out for you the guidelines from ACOG, the American College of obstetricians and gynecologists. ACOG is a highly referenced organization.

The guidelines show that you're really not even full term until you're 39 weeks pregnant. So if you're hearing your provider start talking induction at like 37, 38 weeks, even 39, it's like you're really not even full term yet. Once you hit 41 weeks, you're late term. Once you reach 42 weeks, you are post-term.

Also, only four percent of babies are born on their estimated due date. And 80 percent of babies are born during their due month, which is week 38 to 42.
 

And I've met a lot of moms that just go to 42 weeks. Their bodies need 42 weeks to grow their babies. Perfectly normal. Very common.

Labor inductions per ACOG are that any inductions done before 41 weeks pregnant should only be done if there's a medical reason. So if there is a health or medical problem that would make it safer for the baby to be outside of your body than inside.

I'll go through some of those medical reasons.

ACOG does not recommend an elective induction prior to 41 weeks because it can increase the risk of a cesarean, among other things.
 

What are the medical reasons for an induction? Medical induction reasons include gestational hypertension, diabetes, if your uterus has an infection, preeclampsia, or placental abruption. Any of those medical issues are legitimate reasons why it might be safer and medically necessary to induce.

Another medical reason for an induction is genital herpes because inducing in between your outbreaks can prevent a Cesarean. Why? Because if the baby's passing through your vagina and you have an outbreak of herpes, it's no good. So most doctors, if you have an outbreak, would do a c section immediately. So sometimes moms with herpes will induce in between an outbreak to have vaginal birth.

Another medical induction reason is post term pregnancy, beyond 42 weeks.

Another medical induction reason is if your water has broken but your labor hasn't started. So if your water broke, but there's nothing else happening, that might be something that your doctor would want to induce you for. Because there's only a certain amount of time that most providers will feel comfortable after your water breaks to kind of see some progress and that varies.

Sooner if you're group B strep positive because your providers will likely want you to be on antibiotics during labor.

And then also if your baby's not growing, right, because they'll be monitoring towards the end and if they feel like the baby isn't growing, there might be an issue.

Also, if there's an issue with the placenta affecting the baby’s growth. They might think that it's safer for the baby to come out.

Elective induction reasons are mainly convenience. If your primary support is traveling, or will be in town just for birth. Or, if a Mom wants a particular Dr to be at their birth, they might choose to be induced. It’s primarily convenience at that point.

Something you might hear about if you're considering an elective induction is your bishop score. The bishop score is basically where your provider will assess your cervix and where the baby's at, and the position and do a calculation to indicate how favorable an induction appears that it could be.

Keep in mind that your cervix is not a crystal ball. So these things are not 100 percent accurate.

Sometimes women get induced because they think they're having a big baby. So the big baby estimate is an issue if you're nondiabetic right? So diabetic moms, there are other issues with their baby growing which larger. If you’re non diabetic, keep in mind that the size estimates at the end of pregnancy that your doctor will do based on your ultrasound and your physical exam are wrong half the time. Baby’s size estimates can be off by an average of plus or minus 15 percent. There's a great article that if you want more information on that ask me and I'm happy to post or share the article, about the problem with a big baby estimate there. Those are just a couple of the primary issues, right? And even if you have a big baby, that doesn't always mean that there's going to be a problem with delivery. And then keep in mind still that this is an issue that is a little different for moms that have gestational diabetes.

So what are the induction risks for mom?
Pain. It's painful because you're kind of forcing artificial contractions or artificial birth when your body's not doing it naturally. So it can be very painful for mom. Also a Cesarean birth because we do kind of talk about the cascade of interventions and how one thing can lead to another leads to another can lead to another and that can sometimes, you know, ultimately snowball into a Cesarean.

So inductions certainly do increase your risk of a Cesarean birth. A risk for the baby is that it's stressful, right? Because if the baby's not ready, then forcing the baby out and doing things to push a baby out when he or she isn't ready is stressful. And so sometimes also the baby can be born prematurely if they're induced early and end up needing to go to the NICU. There's a lot of development that happens with the baby in the last couple of weeks of pregnancy. So just because you've reached a certain point doesn't mean that baby is perfectly fine, I'm ready to come out. He may be a little premature because sometimes your conception dates can be a little off, little things can be off. And so, you know, it certainly increases the risk of those things happening. Right? So just some things to keep in mind.

So let's talk about induction options. I'm going to start with some of the natural induction options. Super common that you've probably heard of. The first is sex. So sex is probably the biggest one that you hear about and it's not just have sex, it's also um, sex that includes, I'm going to try to say this in a really careful way, but sex, that includes semen inside of you, right? Because semen actually contains natural prostaglandins and prostaglandins are the kind of active ingredient in one of the medical induction drugs. So we'll talk about that too. But. So the reason they say sex is because sex has semen, but also sometimes you know, if the woman, if the mom has an orgasm that encourages her uterus to contract as well. So that's part of it. Just to note if your water has broken, do not have sex to try to get things moving along because you could risk infection.

They say, three times is kind of the magic number in a shorter amount of time because that would kind of reach the amount of prostaglandins to equate as if you did the medical option that had prostaglandins to ripen your cervix.

The next one is nipple stimulation. And I don't mean just your nipples, so we're not talking about just like squeezing or pinching your nipples because one, that hurts. And two, that's not really what we we're doing here. So we're trying to recreate what a baby does when they're breastfeeding. So the baby's hands might be kind of pushing at your breast and pushing all around your nipple as well. And so we're talking about more of like a breast massage. And including more of the skin around the nipple and if you feel like that's a little bit confusing, put a breast pump on. A breast pump will have that motion and it will help you do it. Um, you know, with, without being concerned about doing it the wrong way. And why? Because it stimulates the release of oxytocin. So when you're breastfeeding, oxytocin is a hormone that's released. Oxytocin is the love hormone, the bonding hormone for you and baby. And there's a lot of things that it does in your body when you're in labor. Oxytocin will help your uterus to contract. It'll stimulate your uterus to contract. So nipple stimulation, which sounds like squeezing nipples, but just think breast pump.

So the next one, acupressure. There's several acupressure points in your body that you can use when you're trying to go into labor and also during Labor to kind of speed things up a little bit. There's points that you can press or massage, that are known to help labor progress.

Acupuncture. A lot of moms swear by acupuncture. You'd have to find somebody local to you, check your local yelp or something and find somebody who specializes in acupuncture for pregnant women. A lot of moms swear by it.

Aromatherapy also, so essential oils, maybe smelling them, maybe putting them on cotton balls, whatever you're comfortable with in the moment because you know, our senses can be a little weird during pregnancy and birth.

I'd have this woman here bouncing on a yoga ball, bouncing, opening your pelvis, things like that, staying active. Those things are really good to help progress things. Don't overdo it though, so be careful, don't, you know, if you're at like 40 weeks plus six days or something, don't go out and walk like three miles and do 50 squats and exhaust yourself.

So medical induction options. I'm going to briefly touch on these, and then we can always go into greater detail later if you need the information.

One of the medical induction options is stripping your membranes. So what that actually is, is it's something that your doctor does and the office. They'll put on a glove and you'll lay back, put your feet up in the stirrups, and they'll go internally into your vagina and they'll actually use their finger to strip off the membranes. You might not experience anything immediately, and some women get nothing from it. Some women, it ends up accidentally breaking their water. And sometimes it takes longer for things to happen or they report that it's very uncomfortable.

The next medical induction option is the rupture of waters, which is kind of, it's like the next step further. So, and if you are familiar with like a crochet or knitting hook, that’s the tool that your doctor would use, it looks a lot like a crochet hook. So again, they go internally through your vagina and they actually break your water bag with the hook. So again, that is something that a lot of women find very uncomfortable.

Prostaglandins, that's something that I just mentioned as well in terms of having sex and having the natural prostaglandins in semen. Now there's also an artificial form, of course, the common drug that's used is cervidil. You can take it internally orally or you can insert it vaginally. It kind of looks like a Tampon suppository and you push it up inside at night and it works overnight to soften your cervix. So that's something, but again, if you're considering using cervidil, you could go have sex with your husband or your partner three times and see if that does the trick.

So the next medical induction option is pitocin. This is probably the most common induction drug. Pitocin is artificial oxytocin. So we talked about what oxytocin was, a natural hormone that your body releases during Labor, during breastfeeding, during all these things, and it has different functions depending on where you are in the process.

So pitocin is artificial oxytocin, right? And, it's administered through an IV. And then usually you'll be hooked up to fluids and all these things. So once you get started on Pitocin, you tend to be hooked up to more machines and confined to bed. So what a lot of women report when they have pitocin, they report the contractions becoming much more painful and much more challenging to cope with without pain management drugs. Why is that? That's because they’re artificial contractions. They're not real natural contractions. So when you get pitocin, what's happening is it's interfering with your body's natural ability to release oxytocin. And so when your body naturally releases oxytocin, the real hormone, it's also releasing other hormones that act as natural pain management. It’s kind of medication, but they're natural, so they're kind of all working together naturally, if they're not interfered with.

So when you start introducing things like drugs like Pitocin, you mess with that natural flow. So now not only are you not releasing the Oxytocin, but you're not releasing the other hormones that help manage the intensity of a contraction. So your contractions are probably going to feel, you know, worse or more painful. Super Common. And it makes sense, right?

The last medical induction option is a foley bulb. This is a picture of a Foley Bulb. A foley bulb is inserted vaginally into your cervix and then inflated with a solution to apply pressure to the cervix to force it open. So kind of pushing the dilation, right. Foley bulbs fall out when you reach a certain centimeter, dilation.

So we've already talked about some of this, but I want to reiterate some of the issues with elective inductions. So not medical inductions, but elective.

One issue with elective inductions is that they interfere with the natural birth process. So medical inductions will interfere with the natural hormone release.

Also, you and your baby just might not be ready for Labor.

The cascade of intervention. This is just one example, really basic, really brief of pitocin leading to epidural. So the cascade of interventions is when you start with one minor intervention and then you end up needing additional, bigger interventions. So again, my example here, as you might have started with Pitocin, maybe you're doctor suggests, hey, do you want to try induction? Inducing with pitocin can result in more painful contractions. This commonly leads to an epidural. And so what's common, once you get the epidural, the epidural will actually slow your contractions down. Because it's a pain management drug and so everything kind of slows down and so then you might need more pitocin because now your contractions have slowed down and then it becomes more painful again, so now you request more epidural. So it's like this cycle, right?

Forceps kind of look like a big kitchen appliance tool. Forceps are used to help get the baby out.

A vacuum suctions the baby out.

An episiotomy is when your doctor performs a incision with scissors and cuts your vaginal tissue to get the baby out.

They might say, okay, we need to use forceps or vacuum and get them out, or an episiotomy to open you up and get them out quickly. Not Ideal, right? Because ouch.

Sometimes it can be super helpful and there may be a legitimate reason to get them out.

Alright, let's talk about contractions because this is something that a lot of people will ask me about or message me and ask for more information. I think it's kind of confusing because first time moms have never had contractions before and don't know what to expect. You've had period cramps maybe.

So what is a contraction? Basically your pituitary gland releases oxytocin, which stimulates the uterus to contract. So the uterus is started out rather small, but has grown to accommodate your baby, right? So it's now like the house for your baby and it's made up of all these muscles. So at the top of your uterus, that's where the contractions are happening. The muscles at the top of your uterus are contracting, the bottom part of your uterus and your cervix at the bottom are relaxing and stretching.

Contractions are periodic tightening and relaxing of the uterine muscles. And contractions come in a wave. So they build up, they hit a peak and then they fade down. And then you'll have a space of time in between. So when you're timing them, your timing contraction starts at the beginning of one and ends at the beginning of the next one. This may be a little bit hard to remember in the moment because if you are in labor and you're having contractions that you're going to be like, how am I supposed to time these? Again, my best tip for this, is to download a free contraction timing app.

What do contractions feel like? Well, it depends on who you ask. Our experiences with pain are very different. So someone who will tell you it's super painful, it's this, it's that you won't be able to handle it, or someone really say that they didn't hurt or they didn't feel a thing, which is normal because we all experienced pain or discomfort or pressure or everything a little bit differently. Right? So think about tattoos. If you ask everybody who has a tattoo, did it hurt? Some people will say not at all, like they didn't feel a thing. I mean, I know it's not the same pain, it's not the same experience, but just in concept, in theory, think about people's varied response. A lot of people say it's discomfort, it's uncomfortable, right? Or some people think it really hurts depending on where you got it done. But for some people, you know, tattoos don’t hurt at all, so it's very subjective.

Contractions can be felt from the back all the way around to the front of your abdomen. Your stomach actually hardens during a contraction. You can physically see it really tightened because the muscles of your uterus are tightening. So you can see that from the outside,

Braxton Hicks, this is a huge one and this keeps coming up, you know, in conversations that I have with moms in the group. How can I tell if it's Braxton Hicks or real contractions? So braxton Hicks are real contractions. Braxton hicks are practice contractions, but they are real. They are real contraction that are happening. The thing is they're not the type of contraction that's leading you to a start of labor. So it's a practice. It is happening, you're having contractions, but it might not mean that you're starting labor.

Braxton hicks contractions are intermittent, so they're inconsistent. There's no schedule to them. There might be an hour in between one and the other 20 minutes or you know, they're very inconsistent. And the biggest thing is if you take rest, lay down, have something to drink, get some hydration, do they go away? So if resting and drinking some fluids help them to go away, then they're probably racks and Hicks.

What is the purpose of contractions? We already talked about this a little bit, but I really like this visual. So there's a few things that the contractions are actually doing. One, contractions are dilating the cervix, so I know a lot of us hear that term and it's hard to visualize or understand what's really going on. Dilating or dilation is expressed in centimeters. So you go from zero to 10, typically during Labor, right? So in this image here, if you can see this picture, this cervix right here, it's close together. It's completely closed. It's not dilated at all. You move over here where she's one centimeter dilated and see how there's like a little gap right there. So it starts to open and then as you continue to dilate, your cervix opens to 10 centimeters. When I want to show you too, this is kind of a helpful visual and I hope you can see this because I know the thing is kind of small.

So this Cheerio is about one centimeter dilated so it's not very wide. It's very small. Here's a Bagel. Think about a good sized Bagel that's 10 centimeters dilation, and those little tiny babies they can squeeze through there and the way that they're turning in, rotating, they can fit through this, right? So that's just kind of helps to visualize and see what zero is completely close to a Bagel size. That's what your body does and labor, that's what your cervix is doing. It's dilating. The cervix is also effacing. So you might hear your doctor say something like you're 10 percent effaced or your zero percent effaced when they do a vaginal exam.

Cervical effacement is softening. So you start at zero effacement, you can't see this so much in the image, but a little demo that I think it's pretty easy to try. Take your finger and just put it on your nose and like push a little bit on the tip of your nose and feel kind of the hardness or the softness of that, of that area, you know, that part of your body, right? So that's kind of like if you're not effaced, it's not soft. Now take your finger and touch your lip, like right inside your lip, and see how soft the skin is. You see how when you push up against this it’s a lot softer. So that's just like kind of an example of how you know, effacement feels, you know, you're going from something that's a little bit harder to something that's much softer.

Contractions also help the baby moved down and descend and engage in your pelvis. Even though it probably feels at the end of pregnancy like the baby is right there, she's not, she has a little bit of moving to do. She is right there, but she still has movement to do, to get further down. So the contractions are helping her move down.

Also, your cervix actually moves forward during labor, so contractions or helping your cervix to move.

Contractions help the baby to rotate and position. Sometimes babies are not in the optimal fetal position, but as you get closer to labor, you might experience contractions that will help the baby to move.

So rotating, descending, getting in the right position.

In terms of descending, there's a station that you might hear your doctor refer to. What station is the baby at? I've got my little pelvis and I'm going to try to show you. So this is your pelvis and this is the front view right? So you're looking straight on at your pelvis. Now during pregnancy, your baby is kind of floating around up here, right? Not really engaged in your pelvis, but as you get closer to labor, baby is engaging. So when you talk about station being negative three, we're talking about being further. Set that aside for a minute further up, and as the baby moves down your pelvis, he goes from negative three to negative two to negative one and zero is right at the back of these little pelvic bones back here. And then one, two, three. As they start to come out of your head comes out of your pelvis.

Prodromal labor is commonly referred to as false labor, but it is not false labor. Prodromal Labor is labor contractions that can be irregular so they might not be coming at consistent times and they might not be increasing in frequency or intensity. So, and they might actually slow down for a while. Some moms have no prodromal labor and some moms do. It really varies. So it's hard to tell if you, you know, whether or not you will experience this, but I wanted you to be prepared for it. The biggest thing I want you to know is that prodromal labor is not a labor complication in and of itself. It's common, it happens. It can be really difficult for moms because it can last for hours or even days.

Sometimes your mucus plug can come out or loosen and a lot of women will like text their doula pictures of their mucus plugs and be like, is this my mucus plug? So yeah, I mean that's common, but that doesn't mean necessarily that baby's coming immediately.

Why do some women have prodromal labor? It could be because the baby's trying to get into the best position for birth. So your baby is really smart, your body is really smart and the reason you might be having all these contractions is trying to move the baby to get him into the perfect position to make labor and birth easier. So that's one reason why it could be happening. Prodromal labor can be really uncomfortable for moms so rest.

You won't necessarily experience all of these signs of labor. So don't feel like you have to experience all of these labor signs to know that you're in labor, but you may experience some of them. One, your baby drops, so you can actually kind of see your stomach looks like it dropped and your pelvic joints may feel more relaxed, perfectly normal. That's what you want. You want your pelvis, pelvic area to be relaxed and to be stretching and all of those things to allow the baby to easily get through.

Cervical changes as a sign of labor. Oftentimes women will feel like that twinge lightening sharp pains in their vagina. That's common when your cervix is going through changes to get ready for Labor.

You may lose your mucus plug and have a little bit of a bloody show, which is a common labor sign.

A lot of women experience some back pains or backache, maybe some diarrhea at the onset of labor. Your bowels are emptying themselves to make it easier for the baby to get through because everything is crammed and pushed and squeezed down there, including whatever is sitting in your bowels. So if your body can push all that out, it's just gonna create more space and make it easier for you to birth.

Another labor sign is that your contractions are getting stronger, longer and closer together. This is actually a good sign that labor is happening because things are intensifying.

Water breaking is a sign of labor. If your water has broken, you were in labor.

How do I know that this is really labor? If two out of three of these are yes, then yes, you're in labor. So one - are your contractions are getting longer, are they getting stronger and are they getting closer together? If you're using your app, just kind of keep an eye on things, rest, hydrate, do those things and see if it goes away, does it come back?

You can call the doctor and stay in touch with your provider too. They'll be able to walk through some of those things to give you some peace of mind to know if you're in labor or not. And they may want to see you too.

When is it considered early labor? So what happens officially during early labor is that your cervix begins effacing, your cervix will begin to dilate. When your cervix dilates from from zero to six, that is usually the benchmark for what's considered early labor.

In early labor, your contractions will get longer. They might start at about 30 to 45 seconds and during the course of early labor or they reach a minute and a half to two minutes. In early labor, the length of time in between contractions could be 15 to 20 minutes.

If you're still able to talk through your contractions, if you're still having a conversation, if you're able to pick up the phone and call your doctor with no pauses to take breaths during contractions, if you're really able to communicate, if you're kind of joking around or watching a movie, it's likely still early labor. And don't worry if you're not dilating. That doesn't mean anything. Moms can go from zero dilation to 10 cm dilated in a very short amount of time.

There are a lot of things that you can do if things appear to be slowing down. There are a lot of things that your support person can help you do to kind of make things or help things progress along. But if you're not dilating that’s not an indication that your labor is going to be a problem or that you're going to run into problems.

Prolonged early labor. Another one of those things happens and is totally normal and not a labor complication if there are no other issues present. Of course, you want to stay in touch with your provider because they'll want to know these things. Prolonged early labor can be really exhausting for mom, period. It's exhausting. Keep in mind that prolonged early doesn't mean that your entire birth will be slow. Early Labor as commonly the longest part of labor. So you know, if it feels like that early part is taking forever, that doesn't mean that the rest of your labor, the rest of your birth is going to take a long time to keep that in mind.

Why do women have prolonged early labor? Again, your cervix probably still changing. Your cervix is still effacing and moving forward, if you have scarring on your cervix from any prior procedures, that can affect the amount of time you're in early labor and still, if your baby's trying to get in that right position for birth, and if you're stressed out, tense, anxious, or tired. Some doctors will even tell you to go home and take a bath, go home and relax, go home and take a nap because you just need to calm down, rest, relax. And that can usually help things progress and move along.

What do you do during early labor? Most hospitals won't admit you until you're in active labor for a reason. Once you're admitted, you can't eat or drink. So they might send you home. Not a bad thing, but what do you do when you get home? You might be uncomfortable, you're not quite sure what to do.

Here are a couple of ideas of what to do when laboring at home. I think the biggest overall theme and thing to keep in mind is that you want to try to maintain or resume normal activity for that time of day. So if it's like 11:00 at night, I wouldn't suggest going out and walking right? If it's, if it's nighttime, try to sleep. If it's morning time and you usually would be doing this, this and this, try to do those things and eat something that's easy on your stomach to digest. Maybe take a nap. If you can take a rest. Early labor can last a while, especially for first time moms, right? Six to 12 hours is the average early labor for first time moms. Listen to music or journal, write something, meditate, watch a movie, take a shower. Or get your hospital stuff together. If you're up for it and it's daytime and you have some energy, go for a little walk. Just don't overdo it because you are in labor. So you're going to need your strength and you're going to need your energy. So think of things that you can be doing to kind of find a balance between resting and maintaining your strength.

When do you call your doctor in labor? Anytime you're not sure of something, have any questions, call them. I always would say to call your provider. You should be having this discussion with your doctor at your last couple of prenatal visits because they're looking at your pregnancy as a whole. They're looking at everything involved and there may be other things to consider, like if it's not your first birth, you might want to go in a little bit sooner because you might have a shorter labor. So those are things to consider if you have other medical issues that they are aware of that they might say it's safer or we would feel much more comfortable knowing that you were here sooner.

Otherwise, if your water breaks, call your provider. If you're having any bleeding, absolutely call your provider. If you’ve reached the 4-1-1 or 5-1-1 rule, call your provider. Don't ever hesitate to call your doctor.