Let’s talk everything leading up to the birth! You’re going to be feeling a lot of new sensations, but don’t let that scare you!

Contractions

I know when I was pregnant I was so curious as to what contractions actually would feel like. I had heard them described in different ways and I just wanted to know what was coming and what I would feel. I had pitocin induced contractions so my experience may have been different than a mom who hasn’t had pitocin but I would describe them as a very sharp period pain. However, I felt my contractions entirely in my back rather than in my abdomen like what you expect. But about 25% of mom’s will experience this “back labor.” This can be due to the baby’s position if they’re back is against your back, or just how your body is responding to the contractions.

I’m not sure what caused mine, but it stayed that way pretty much the whole time. My understanding is also that even if you don’t experience back labor, some back pain is still common throughout labor as the baby moves downwards. Something I didn’t expect was that the contraction sensation radiated out from my back down to my upper legs. I had expected it to be more acute or isolated rather than more widespread. 

When thinking about contractions, know that for the most part they’re going to be like a wave. You’ll feel them start and build, they’ll reach a peak or their highest point of discomfort and then begin to fade. For any mamas looking to go unmedicated, this is great info to have because it means that you just need to make it through that peak before things start to relax and you get a break. Which brings me to the best part of contractions- when they’re done, they’re done.

So in between contractions, the discomfort is gone. It doesn’t linger in between contractions which means you do get a break or a rest between them. This tends to not feel as true towards the end when they’re so close together, it can seem like the sensation lingers or never truly goes away before a new one starts but during early and active labor know that a break is coming!

Did you know labor has multiple stages? It typically begins with what is called early labor where your contractions will be spaced out a bit farther and not as uncomfortable. As you dilate and efface more, you’ll move into active labor where your contractions are closer together, more intense and lasting longer in duration. This is when many women start to think about heading to the hospital if they haven’t done so already.

If you are induced with pitocin, you may not experience any early labor, you may jump right into active labor. I went from having no contractions to contractions that were about 3 minutes apart almost immediately. When you get to about 8 centimeters you’ll hit what is known as transition. This is, for many women, the most intense part of labor as your body is getting you those last few centimeters of dilation. Your contractions will be very close together- about every 2-3 minutes from start of one to start of the next and will be lasting the longest- anywhere from 60-120 seconds so you will often feel like there is no real break in between.

If you have an epidural you most likely won’t be able to tell if you’re in transition unless you’re looking at the monitor and seeing those long and strong contractions go up and down. If you are unmedicated, it will most likely be the point where you wonder if you can keep going. It may be the part of your labor where you say a bunch of crazy things like telling your nurse you’re all done with this and are just going to go home and try again tomorrow (a friend of mine tried to do this- got her bag and everything!). Just remember, if you’re at this point you are ALMOST there. 

This wouldn’t be the nitty gritty details of labor if I didn’t tell you that a common symptom of transition is vomiting. This can actually happen at any point in your labor but is fairly common during transition. I tell you this one, so you can be prepared, two, so you can use it as a sign post for where you could be in your labor and three, so you can think carefully about what you eat at the beginning of labor.

A lot of hospitals don’t let you eat once you’re hooked up to an iv or have an epidural placed. This means a lot of women choose to eat something before heading to the hospital or right when they get there. This is great, you should definitely do this. Labor is a marathon and you need energy. If your hospital doesn’t restrict food I highly encourage you to continue to snack as you’re able during labor. BUT you want to choose that last meal or labor snacks wisely because you might be seeing it again later. Now is not the time for hot wings, a big juicy burger or that overstuffed spicy burrito. I recommend something mild with a lot of protein and some carbs to settle your stomach the best you can. 

Getting an Epidural

If you are not choosing to go unmedicated you are most likely opting for an epidural. I know some women have some nerves around getting the epidural, particularly if you have a fear of needles. I didn’t even see the needle myself, which I recommend if you don’t like needles, and the procedure was so smooth!

Here’s what to expect…they’ll ask you a bunch of questions beforehand which you won’t want to answer because you’re dealing with contractions. Here is where it’s helpful again, if you’re partner knows all your medical info because they can help with this part. After consent is given, the provider doing the procedure will ask you to sit with your back curled over like an angry cat. This makes your spine more visible. You can hold a pillow or lean on your partner’s forearms to help you get in this position more comfortably. You’ll feel a pinch often described as a bee sting- this is the numbing medication and is the only pain or discomfort you should feel from the procedure and it is so quick. They will ask you to sit very still and for many women this is the most challenging part- it can be tough to be still during a contraction. If possible they will wait until a contraction is over and then do the procedure during that break I mentioned earlier. If your contractions are quite close together though, one may begin before they’re finished.

With you sitting hunched over and very still they will thread the epidural line in- you won’t even know it’s happening because of the numbing shot and then voila you’re all set! They’ll hook it up to your IV and you should feel the effects within 10 minutes- for me it was almost immediate. Know that with an epidural you will have to stay in bed as it does limit the use of your legs. Also, some women experience a shaky feeling afterwards, as if you’re shivering from cold, this isn’t anything to worry about although it can be a bit annoying. I definitely experienced this symptom and it was so weird because I knew I wasn’t cold…I had actually been sweating before my epidural was placed but I could not stop shivering for a while afterwards. Some women also experience either a one-sided epidural or a hot spot where it seems the medicine just isn’t reaching. If this is the case, let your nurse know! Often this can be fixed with some repositioning or they can redo the epidural for a better placement. 

Too late for an epidural? A lot of women worry about getting to the hospital too late for an epidural. Well what is too late really? A lot of people think there is a number. For example, you can’t get an epidural once you hit 8 cms. But, the labor and delivery nurses I know will tell you as long as you can sit still and the baby isn’t coming out at that moment you can get one. It’s worth asking your provider the guidelines for this before your labor if you plan to get an epidural and are curious but keep that little tidbit in your back pocket if you need it. 

Catheter

So because you can’t get up with an epidural and because you don’t have much sensation throughout your lower body, a catheter needs to be placed. This can make many moms nervous, worried it’s going to hurt or be uncomfortable. I know it was one reason I didn’t want an epidural initially because the idea of a catheter was so unpleasant to me. But most likely if you’re getting a catheter placed during birth it’s because you have an epidural (or are having a C-section)!

This means having it placed, which they do AFTER the epidural, won’t be painful. You most likely won’t even be able to tell. In my hospital they remove the catheter when you start pushing so I also couldn’t tell it was being removed. There are some women who do not have an epidural but still may need a catheter because they’re struggling to empty their bladder, in many cases they wouldn’t give you a catheter that would stay in but would rather just use one to help you empty your bladder then remove it. If you’re nervous about this, let your nurse know! 

Modesty? 

I consider myself a pretty modest person, and I’m guessing there’s many of you out there that would fall in that same category. When in labor this goes out the window. Perhaps not for everybody but for me absolutely. During labor, before my epidural was placed, I became very warm and pulled off my hospital gown with gusto. I couldn’t have cared less who was in the room, I’m actually not even able to remember who was there at the moment but I know keeping myself covered up was the last thing on my mind. Same thing when I was pushing. I remember thinking I would be maybe uncomfortable having so many people (hospital staff) around while pushing and in such a vulnerable position. But again, at the moment, all I cared about was getting my baby boy out and into my arms.

I appreciated having two nurses and my doctor up close and personal, helping me. When we needed some additional staff later in the delivery, I wasn’t worried about how many people were seeing me naked…I think the answer to this question might be around 9 or 10. All I cared about was that there were people there who were helping me and were going to make sure my baby was safe and healthy. So if you’re worried you’ll be embarrassed or uncomfortable, I am here to reassure you this most likely won’t be the case. And if it is, you can always request less people be in the room, or ask your nurses for privacy during times you don’t need them in there. Also, a comfy sports bra is probably your friend so if you, like me, throw off your hospital gown mid-contraction, you’ll still have some coverage to keep you comfortable. 

Pushing

I think this part may scare people the most. However, I actually found it to be a welcome stage of labor, and I think many women feel this way when looking back at their labors. Laboring unmedicated is hard work mentally and it’s a challenge to just let your body do the work of contractions. But once you’re at the pushing stage YOU get to do some of the work with your body which is often a welcome change.

If you have an epidural, the laboring part of your birth can feel long and make you antsy waiting to get to 10 cm. But again, once you’re at the pushing stage it means your baby is almost here which is exciting! That doesn’t mean this part of labor is easy, it’s hard work! But don’t be afraid of it, welcome it and face it with the excitement of someone about to meet their baby! 

I’m confident I used muscles I didn’t even know I had to get my baby out. Hopefully your baby isn’t as stubborn as mine but just know, they may not pop out after only a few pushes. It isn’t unusual for a first time mom to push anywhere from 30 minutes all the way up to 3 hours as an average. This number can vary greatly depending on the position of the baby, whether or not you’ve had an epidural and other factors. The nurses will often give you guidance on pushing but it can take several pushes to really figure out what you’re doing, especially if you have an epidural and aren’t getting that physical feedback from your body to help you.

Often women are told to push like they’re having a bowel movement. But there are several ways to push- open glottis or closed glottis pushing (also known as chin to chest or purple pushing). Go with what feels right for you. I tried some of the open glottis pushing which is more along the lines of breathing your baby out and found that he was being too stubborn and needed more oomph so I moved to closed glottis pushing and had better success. 

Pushing positions can also affect this stage of labor. If you’ve had an epidural you might be under the impression that you must push on your back. But many women have enough sensation to try some other options with the support of their nurse and partner like a side lying pushing position, a supported squat or even hands and knees. If one position isn’t working for you, ask to try something else.

If you haven’t had an epidural, chances are your body will put you in the position that works best for you and you’ll intuitively adjust as needed based on what you’re feeling. Some hospitals may have “policies” on how you can deliver, but just remember it’s your baby and you’re the one giving birth so don’t be afraid to advocate for yourself or say no if you’re asked or told to get into a position that isn’t what you want or isn’t working effectively. In birth, gravity is your friend so finding a way to incorporate an upright position into your pushing can help tremendously. 

It happens. Sometimes women poop during the pushing stage of labor. I’m here to tell you two things about this. One- it means you’re doing your best to get that baby out and pushing effectively. I have a friend whose nurse told her “If you ain’t poopin’ you ain’t pushin’”. Two- you won’t care or likely even notice. You’ll be much too focused on pushing to care if that’s happening or not. And because of the vast amount of sensations you’ll be experiencing and the variety of bodily fluid labor comes with chances are even if you do poop you won’t notice. Your nurse will handle it and won’t make a fuss about it at all. I have no idea if I did or not. If I did I certainly couldn’t tell and my hubby and nurse had the kindness not to point it out. So if you’re fretting about this, take a breath and let it go!

Tearing

I know. It’s scary. It was 100% the thing I was most nervous about before I gave birth. People like to tell you their horror stories or you just hear the word tearing in regards to your own body and you cringe and think hm, maybe the baby could just stay in…I could be pregnant forever right? But the truth is, the baby has to come out and there is a chance you’ll tear. For first time moms that chance is a bit higher, some estimates put it at about 80-90%%. I actually found that high percentage comforting- is that weird? Let me explain. I figured if up to 90%% of moms were experiencing this and recovering then I could handle it. I mean, we don’t live in a world full of only children right? Which means even after a tear many women choose to have more kiddos and go through labor and birth again. 

But to give you a brief overview and a few more numbers.- tears from birth are classified by degree with a first degree tear being the most minor and a fourth degree being the most severe. To help put you at ease only about 3% of tears are third or fourth degree with the majority being first or second. A first degree tear only affects skin and often doesn’t even need stitching. A second degree (most common among first time moms) does go a bit deeper and affects the muscle so will require some stitches to repair.

The most common place for tears is along your perineum but you can tear in other areas around there as well. I myself had a second degree tear- I did not feel it happening as I had an epidural and the healing was definitely manageable. I do have friends who have had unmedicated births where a tear occurred and can share that they reported they couldn’t identify when the tear happened. There are so many sensations going on you won’t necessarily be able to pick out that one over the other feelings of pushing that are occurring. 

Some women receive what is called an episiotomy which is when the doctor makes a cut along your perineum rather than it tearing naturally. ACOG no longer recommends these be done routinely but rather only done for more emergent situations. For example, if your baby was in distress and needed to come out immediately, one may be done to expedite the birth or they are sometimes needed if forceps or a vacuum are required for delivery, though not always.

If you do tear and require stitches, your doctor will repair the tear after your baby and placenta have been delivered while you are snuggling your newest love. If you didn’t get an epidural or if it has worn off they will give you a topical anesthetic for the stitching process. If tearing is something that is of particular concern to you, I encourage you to bring this up with your doctor before delivery.

Talk about how they can support you during the birth to prevent tears, or at least prevent a more severe tear. This might include things like the position you choose to push in or having a nurse or your partner use a warm compress on the area during the pushing stage. There is also something called perineal massage that can be done by you, before labor, that has been shown to decrease the instances of tearing.

Still with me? Part three will cover delivery and what happens after, check back soon!