Our Bodies, Ourselves (86 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
We got a room. I took a shower and curled into the yoga “child's position,” letting hot water run down my back, relatively comfortable. Lucy finally arrived, saw I was completely dilated, and said, “Impressive! Good show!”
LOWERING YOUR CHANCE OF A CESAREAN BIRTH
In the United States today, about one in three women gives birth by cesarean section. While most mothers and babies who have cesarean births do fine, cesarean sections involve more risks than spontaneous vaginal births (births that do not involve the use of forceps, vacuum extraction, or a cesarean). The following tips can help lower your chances of having a cesarean section:
⢠Choose a care provider who follows the midwifery model of care. (See
“Choosing a Provider.”
)
⢠If you're healthy and haven't had complications in your pregnancy, consider giving birth at home or in a birth center (see
“Birth Places,”
).
⢠Ask what the C-section rate is for your provider and birth setting. If the C-section rate is above 15 percent, the provider or setting probably uses C-sections in women who could safely birth vaginally.
⢠Be proactive in your health habits. Eating well and exercising regularly may reduce the risk for complications such as gestational diabetes that often lead to cesareans.
⢠Don't induce labor unless there is a clear medical need. Concern that the baby is big is not a medical reason to induce, nor is being up to a week beyond your estimated due date.
⢠Don't go to the hospital until you are in active labor. If you go to the hospital and have not yet dilated to 4 centimeters, return home or go for a walk nearby.
⢠Have continuous labor support from a companion who trusts your ability to give birth. This can be a friend, a volunteer doula, or a doula you hire. (For more information, see
“Doulas.”
)
⢠Avoid routine medical interventions during labor, especially continuous electronic fetal monitoring, unless clearly needed.
⢠Resist any pressure to have a cesarean if there is no good rationale. (For more, see “If Your Care Provider Recommends Induction of Labor or Cesarean Section,” page 393.)
I pushed for two hours. I never doubted that I could do it, but it took so long, I was exhausted. Finally, Rosa crowned. Margaret caught her; I remember she put her on my belly. Since she didn't cry, they worried, took her to another room, but Marg said, “That's ridiculous: Bring her back!” And so they did. We stayed two nights. It was an amazing moment finally to bring her home
.
Labor continues the process begun at conception. The finely tuned biological system that nurtures developing babies guides labor as well. Just before labor begins, your body and your baby get ready for birth. The joints in your hips and pelvis further relax and open, ligaments increasingly
soften, and the baby may drop deeper in your pelvis. Toward the end of pregnancyâfor some women, even earlierâyou may occasionally feel a painless tightening of your uterus, the Braxton Hicks contractions. You may also feel increased pressure in your pelvis and on your bladder as the baby settles deeper into your pelvis.
WHEN WILL LABOR BEGIN, AND WHAT MAKES IT START?
No one can predict or determine exactly when labor will start. The baby's size and maturity, as well as multiple hormonal and placental changes, affect the onset of labor, but the biological mechanisms that cause labor to begin are not well understood.
You may notice that your emotions are nearer the surface and that your interest in anything unrelated to the birth of your baby wanes. Your baby is getting ready, too, removing fluid from the lungs, wriggling into position, and responding to the shifting hormones that increase resilience for the work ahead. Other signs of approaching labor may include loose stools, more mucus discharge, or cramping. Most of these signs are not specific enough to be obvious, and some women don't experience them at all, but in retrospect, you may recognize signals that your body and mind were gearing up for labor.
WHEN TO CALL YOUR HEALTH CARE PROVIDER
You and your care provider should discuss when you should call. Specific recommendations will be based on your health, how far along you are in your pregnancy, and whether or not this is your first baby. In general, you should call your provider if:
⢠Your bag of waters breaks (membranes rupture).
⢠You experience strong, painful contractions that are difficult to talk through and are steadily getting more painful and closer together.
⢠You are experiencing severe pain.
⢠You think that your labor has started and you are less than thirty-seven weeks pregnant.
⢠You experience bleeding that is as heavy as a period or bright red.
⢠You have any questions or concerns.
If you are planning to give birth in a hospital, talk with your provider about when you should go in. In general it is best to wait until you are in active labor (see
“The Stages of Labor”
). This can help you avoid a cascade of unnecessary interventions that can lead to avoidable cesarean surgery and other undesirable outcomes.
One woman describes how her focus shifted as labor approached:
During my pregnancies, I always tried to take a walk during lunch. The bigger I got, the shorter my walks became, and in retrospect, they also became more focused. In the days leading up to my daughter's birth, I went like a homing
pigeon to a local bookstore that always seemed to have some must-have cookbook on sale
. The Food and Cooking of Thailand; The Complete Spanish Cookbook; One-pot, Slow-pot, and Clay-pot Cooking; Slow Cooker;
and
Russian, German & Polish Food & Cookingâ
I simply had to have them all. These books are now fondly known as my “nesting collection.”
IF YOUR WATER BREAKS BEFORE LABOR
The sac containing the amniotic fluid that surrounds your baby (the membranes, or “bag of waters”) usually breaks shortly before contractions start or during labor or birth. In a small percentage of women, though, the waters can break many hours or days before labor starts. This causes the fluid to leak out before contractions begin. You may experience a large gush of fluid, followed by continuous leaking.
If the sac breaks on its upper side, the fluid may trickle out slowly. A slow leak may be confused with urine leaking or with discharge of mucus.
Call your midwife or doctor to make a plan when your bag of waters breaks or if you think you are leaking amniotic fluid. Your provider will probably want to see you to confirm that the bag has broken and to check the baby's position and heartbeat. At this time, there will likely be a discussion of the pros and cons of waiting for labor versus inducing labor.
Health care providers have different opinions about how long to wait for labor to start after the bag of waters has broken. The American College of Nurse-Midwives (ACNM) says that waiting for labor to begin on its own is a safe option unless there are signs of or risk factors for infection, and as long as the woman and baby are otherwise healthy.
2
With this approach, eight out of ten women will begin labor naturally within twenty-four hours. In contrast, the American Congress of Obstetricians and Gynecologists (ACOG) advises immediate induction of labor after water breaks, which is a reversal of its previous recommendation. ACOG made this change without citing any new evidence that induction is safer than waiting for labor to begin on its own.
3
If you wait for labor contractions to start spontaneously, you should avoid having intercourse or putting anything into your vagina and decline vaginal exams unless there is a clear medical need, to reduce the risk of infection. It may be best to avoid taking a bath until active labor has begun.
4
Another woman was surprised by how little warning she had before labor began in earnest:
It was July 4, and while eating breakfast I said to my husband, “I guess we're not going to have a Fourth of July baby.” I just felt so normal. I'd had Braxton Hicks contractions for a few weeks and some mild indigestion the night before, but everything seemed to be status quo, and I figured that even if I began having the early signs of labor, I'd still have a long road ahead. Little did I know that my “independence baby” would be in my arms by four o'clock that afternoon!
One woman describes the beginning of her labor:
I went into spontaneous labor in the wee morning hours during a rainstorm. My contractions started waking me up at two
A.M
., so I got out of bed and started cleaning. . . . I did some organization around the apartment for a bit and then took a wonderful bath in our Jacuzzi tub. I deep conditioned my hair and carefully shaved my legs, knowing that I might not have the luxury to do these things in the busy weeks to come
.
I told my partner, Brian, at around four a.m. that I was starting labor. We snuggled in bed, and he put on one of my favorite movies. I held on to him tightly through my contractions, which were not that close together yet. I called Melissa, my nearest and dearest friend, who lives three hours away. She was one of my labor support team. She would head down right away to help me through this
.
The latent phase of labor may feel much the same to you as prelabor, but during this time your cervix will open up (dilate) to 4 to 5 centimeters and will usually completely thin out (efface). Labor contractions will be short and spaced relatively far apart (from five to twenty minutes apart). During the latent phase, your contractions will become longer, more painful, and more regular. This is not yet the time to go to a hospital or birthing center. However, most
women at this stage want some kind of care, such as the reassuring presence of a partner or close friend or a care provider or other guide familiar with birth. Some women say that this phase of labor is the hardest psychologically. One midwife explains:
It's like starting a hike and no one is telling you how long it is. The trail has lots of meandering switchbacks and hills, and you don't know where you're headed or how long it will take to get there, but you just keep going. Later, it may get physically more difficult, but at least then you can see the end in sight, the peak of the mountain, and you can push on
.
Sometimes contractions build up gradually, starting with any of the signs mentioned above, with menstrual-like cramps evolving into stronger contractions that grow closer together over a long period of time, sometimes even over a period of days. At the other extreme, labor can begin abruptly, with strong regular contractions no more than five minutes apart, causing you to stop everything you are doing and concentrate.
Everyone responds differently to early labor. Walking, showering, taking long baths, or cuddling with loved ones can relax you and help labor progress. These early hours may be sweet as you lie with your partner or sit alone, the baby still within you in the quiet of your home. It is important that you continue to eat nourishing foods to prepare you for the work ahead. And sleep is critical for much the same reason, particularly with a first baby, for which labor may be longer. Some women feel too excited or apprehensive to sleep. Try to save your energy for active labor. Don't worry if contractions slow down when you lie down to rest; it's still early. If you truly don't feel up for rest, spending time with friends and family can be a nice distraction, but check in with yourself frequently and consider whether you would rather be resting. If you begin to feel like a “watched pot,” ask for some time alone.
