Your Labor Day

What to expect before, during and after your baby arrives.

The weeks prior to your due date can be exciting and anxiety-provoking. Most women will go into labor between 39 and 41 weeks, but not knowing the exact date or time can be challenging and make the wait feel like an eternity.

Before the big day, you may experience some signs that your body is getting ready. Losing your mucus plug a few weeks or days before labor is not uncommon. Irregular contractions are also typical. You might experience a sensation known as lightening as your baby drops into your pelvis. However, none of these symptoms is a prerequisite for the onset of labor. Even if you never experience any of them, labor may be imminent!

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Not All Contractions Are Created Equal
Throughout your pregnancy you may notice your belly periodically getting hard and tight. Typically painless, such episodes can happen whether you are active or at rest. These Braxton Hicks contractions are most often benign and can indicate fatigue, dehydration or just your body getting ready for labor. Usually they will not change your cervix. When painful, menstrual-like cramps deep and low in your abdomen accompany the tightening of your belly, you may be experiencing contractions more likely to change your cervix, especially when they are regular and uncomfortable.

Stages of Labor
There are three stages of labor. The first, starting at the onset of labor and ending when you are fully dilated, is divided into two phases: early and active.

In early labor you may experience irregular contractions that vary from mild to strong. In most low-risk pregnancies, home is the best place to be during this phase. Most women feel more comfortable in their own space, resting between contractions in a familiar bed or bathtub.

In addition, early hospital admissions are not without risk, including higher rates of infection and the potential to slow labor down. Check with your healthcare provider if you think you’re in labor. This will allow you to make a plan specific to your needs and those of your baby.

Active labor is more challenging since contractions in this phase are more regular in frequency and intensity. You may need more physical and emotional support. Employing breathing techniques that you have practiced can be beneficial, and it’s not uncommon to desire something to ease your pain. This is an appropriate time to be evaluated and potentially admitted to the hospital. You may experience bloody show or your water breaking during the first stage of labor.

The second stage of labor starts with full cervical dilation (10 cm) and ends with the birth of your baby. Most of this stage will be spent pushing. A labor nurse will be with you the entire time, and your provider may be in the room as well. Even if you have an epidural, you may feel vaginal or rectal pressure during this stage that can help make your pushes more effective. This stage can last from 15 minutes to 3 or more hours and, during that time, you may be in multiple positions (side-lying, hands and knees, squatting) to help facilitate the descent of your baby.

The third stage of labor includes the delivery of placenta, which can take up to 30 minutes. During this time you may bond with your baby who is lying on your chest.

Skin-to-skin contact helps with regulating your baby’s temperature and encourages healthy colonization of bacteria on your baby. Your provider and your nurse will be monitoring vital signs and nay bleeding you may experience throughout the process. Any lacerations created during birth will be repaired. You may even initiate breastfeeding.

To Eat or Not to Eat
Every hospital has a different protocol regarding eating in labor but, generally speaking, if you are hungry and don’t have an epidural, it’s safe to eat. In early labor, when things can feel more manageable, women often enjoy light snacks such as toast, fruit or yogurt. This can keep energy up and might even help ease any pain. In more active labor, women are typically not as hungry and may even feel nauseous, so they avoid food.

Once an epidural is placed, the general recommendation is to avoid solid foods. Clear liquids — water, ice, juice, Jell-O or chicken broth — are often allowed.

If you plan to have your baby in a hospital, there will typically be a provider in the room along with a labor and delivery nurse for much of your labor. There may be a student or resident as well if you are at a teaching hospital. If you decide to have an epidural placed, an anesthesiologist will be present. An anesthesiologist also can address issues such as low blood pressure. If there is concern about the baby’s heart rate, a few neonatologists may be at the delivery.

Studies show that women who have continuous labor support are happier with their birth experience. Some laboring women wish to be surrounded by multiple family members, while some prefer a more intimate, quiet environment. Make sure you select those you trust who understand your labor goals. Talk to them while you’re pregnant so they have a clear understanding of how best to support you during a challenging, vulnerable time.

Sarah Kleinman, CNM, is a Certified Nurse Midwife in Boston who delivers babies at Beth Israel Deaconess Medical Center.

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Written by Sarah Kleinman, CNM

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