What to expect when you're expecting (119 page)

A change in your vaginal discharge, particularly if it is watery or tinged or streaked pinkish or brownish with blood

An achiness or feeling of pressure in the pelvic floor, the thighs, or the groin

Leaking from your vagina (a steady trickle or a gush)

Keep in mind that you can have some or all of these symptoms and not be in labor (most pregnant women experience pelvic pressure or lower back pain at some point). In fact, the majority of women who have symptoms of preterm labor do not deliver early. But only your practitioner can tell for sure, so pick up the phone and call. After all, it’s always best to play it safe.

For information on preterm labor risk factors and prevention, see
pages 44
–47. For information on the management of preterm labor, see
page 557
.

Of course, sometimes a baby is small at birth for reasons that no one can control: the mother’s own low weight when she was born, for example, or an inadequate placenta, or a genetic disorder. A very short interval (less than nine months) between pregnancies may also be a factor. But even in these cases, excellent diet and prenatal care can often compensate and tip the scales in baby’s favor. And when a baby does turn out to be small, the top-notch medical care currently available gives even the very smallest an increasingly good chance of surviving and growing up healthy.

If you think you have real reason to worry about having a low-birthweight baby, share your concern with your practitioner. An exam and/or an ultrasound will probably reassure you that your fetus is growing at a normal pace. If it does turn out that your baby is on the very small side, steps can be taken to uncover the cause and, if possible, correct it. See
page 550
for more information.

Easing Labor Pain

Let’s face it. Those 15 or so hours it takes to birth a baby aren’t called labor because it’s a walk in the park. Labor (and delivery) is hard work—hard work that can hurt, big time. And if you actually consider what’s going on down there, it’s really no wonder that labor hurts. During childbirth, your uterus contracts over and over again to squeeze a relatively big baby through one relatively tight space (your cervix) and out through an even tighter one (your vagina, the same opening you once thought was too small for a tampon). Like they say, it’s pain with a purpose—a really cute and cuddly purpose—yet it’s pain nonetheless.

But while there may be no getting around the pain of labor altogether (unless you’re scheduled for a cesarean delivery, in which case you’ll be skipping labor and labor pain), there are plenty of ways to get through it. As a laboring mom, you can select from a wide menu of pain-relief options, both the medicinal kind and the nonmedicinal variety (and you can even opt for a combo from both columns). You can choose to go unmedicated throughout your entire labor or just through part of labor (like those easier first centimeters). You can turn to alternative medicine and nondrug approaches to manage the pain (acupuncture, hypnosis, or hydrotherapy, for instance). Or you can birth your baby with a little help—or a lot of help—from an analgesic, such as the very popular epidural (which leaves you with little or no pain during labor but allows you to remain awake during the entire process).

Which option is for you? To figure that out, look into them all. Read up on childbirth pain management (the section that follows covers the gamut). Talk to your practitioner. Get insights from friends who have recently labored. And then do some thinking. Remember that the right option for you might not be one option but a combination of several (reflexology with an epidural chaser, or a variety of relaxation techniques topped off with a round of acupuncture). Remember, too, the value of staying flexible—and not just so you can stretch yourself into some of those pushing positions you learned in childbirth class. After all, the option or options you settle on now may not sit well later, and may need to be adjusted midlabor (you were planning on an epidural but found you could handle the pain—or vice versa). Most of all, remember that (barring any obstetrical situation that would dictate how you labor and deliver), it’s completely your choice to make—your birth, your way.

When it comes to pain relief during labor, there’s a wide variety of medications to choose from, including anesthetics (substances that produce loss of sensation or put you to sleep), analgesics (pain relievers), and ataraxics (tranquilizers). In most circumstances, it’ll be up to you to select the pain medication you want to make your labor and delivery as comfortable as possible, though your choice may be limited depending on the stage of labor, whether it’s an emergency situation, or your past health history or your present condition (and
that of your baby) precludes a particular drug, and the anesthesiologist’s preference and expertise.

Something else to keep in mind as you begin to explore your options: How effective a drug is in relieving pain will depend on how it affects you (different drugs affect different people differently), the dosage, and other factors. There’s always a remote chance that a drug won’t provide you with the relief you’re looking for, or that it might not give you any at all. Most of the time, though, pain medications work exactly the way they are supposed to—offering up just what you (and your practitioner) ordered.

Here are the most commonly used labor and delivery pain medications:

Epidural.
The epidural is the pain relief of choice for two thirds of all laboring women delivering at hospitals. The major reasons for the epidural’s current surge in popularity are its relative safety (only a small amount of medication is needed to achieve the desired effect), its ease of administration, and its patient-friendly results (local pain relief in the lower part of the body that allows you to be awake during the birth and alert enough to greet your baby immediately after it). It’s also considered safer for your baby than other anesthetics because the epidural is injected directly into the spine (technically, into the epidural space, which is located between the ligament that sheathes the vertebrae and the membrane that covers the spinal cord), which means the drug barely reaches the bloodstream (unlike other anesthetics). And even better news: An epidural can be given to you as soon as you ask for one—no need to wait until you’re dilated a certain amount (3 or 4 cm, for instance). Studies show that even an early epidural doesn’t increase the chances of a C-section as was once believed, nor does it slow down labor significantly. And even if labor does slow down a bit with an epidural, your doctor can give you Pitocin (a synthetic version of oxytocin, the hormone that triggers contractions naturally) to help get your labor back up to speed again.

Here’s what you can expect if you’re having an epidural:

Before the epidural is administered, an IV of fluids is started (this is done to prevent a drop in blood pressure, a side effect some women have with an epidural; fluids will keep your blood pressure from going too low).

In some hospitals (policies vary), a catheter (tube) is inserted into the bladder just before or just after administration of the epidural and stays in place to drain urine while the epidural is in effect (since the medication may suppress the urge to urinate). In other hospitals, the bladder is just drained intermittently with a catheter as needed.

Your lower and midback are wiped with an antiseptic solution and a small area of the back is numbed with a local anesthetic. A larger needle is placed through the numbed area into the epidural space of the spine, usually while you’re lying on your side or sitting up and leaning over a table or being supported by your spouse, coach, or nurse. Some women feel a little pressure as the needle is inserted. Others feel a little tingling or a momentary shooting pain as the needle finds the correct spot. If you’re lucky (and many women are), you might not feel a thing while the epidural is being administered. Besides, compared to the pain of contractions, any discomfort from a needle poke is likely to be pretty minimal.