You’ve read the pregnancy books. You’ve been to the childbirth classes. You might even have written a birth plan. And you’ve ignored everything you’ve read/heard about pooping during labor because, well, there’s nothing you can do about it anyway.
But however much preparation, deep breathing and Googling you've done over the last few months, you likely still have questions and concerns about exactly what’s going to happen on that life-altering day.
Wherever you feel most comfortable. While the vast majority of women still choose hospitals, a growing number are opting to give birth at home or in birthing centers. According to federal data, in 2012, 1.36 percent of U.S. births were outside a hospital, up from 1.26 percent in 2011.
The American Pregnancy Association says a home birth may be an option if:
If you are considering a home birth, it’s important to hire a doula, find a midwife who shares your birth philosophy and find a pediatrician who will examine your baby within 24 hours of the birth.
A home birth is definitely not recommended if you are diabetic, have chronic high blood pressure or preeclampsia, have experienced preterm labor in the past, are at risk for preterm labor now or do not have the full support of your partner in your decision to give birth at home.
That said, even if your pregnancy is healthy and low-risk, you may feel more comfortable delivering in a hospital because of the available technology and medical staff.
If you want a more natural birth experience but don't want to give birth at home, a birth center can be a great middle ground. Birth centers offer a relaxed atmosphere, a team of health care providers (which may include nurse-midwives, direct-entry midwives or nurses working with an obstetrician) and the option of returning home shortly after the birth. However, they vary greatly in terms of style and setup, so do your research.
According to Doulas of North America, a doula is "a trained professional who provides continuous physical, emotional and informational support to a mother before, during and shortly after childbirth to help her achieve the healthiest, most satisfying experience possible."
Unlike a midwife, a doula is not medically trained and doesn’t physically deliver babies. A doula’s role is to provide support to women (and their partners) at the end of their pregnancies, during labor and beyond.
Recommendations from the American College of Obstetricians and Gynecologists published in February 2017 highlight the importance of having a doula present during birth, stating, "in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor."
Evidence of the benefits of doulas from randomized trials include shortened labor, decreased need for analgesia, fewer operative deliveries and fewer reports of dissatisfaction with the experience of labor.
Every labor is different. A typical scenario includes five to eight hours of early labor (your cervix gradually opens) followed by two to eight hours of active labor (your cervix opens more rapidly and contractions are longer, stronger and more frequent). Most doctors will advise going to the hospital when contractions are five minutes apart. When you get there, you'll likely be hooked up to an IV to prevent dehydration and to an electronic monitor that measures your contractions and your baby’s heart rate. Your doctor or midwife will do an internal exam to check your progress. On average, the cervix opens about 1 centimeter per hour, but again, every woman is different.
At the end of active labor, you’re fully dilated (10 centimeters) and ready to push — and yes, it's a lottery when it comes to how long this part takes. Some women push their babies out in minutes, while others take hours and may need assistance. When you're ready to push, you'll feel intense pressure in your rectal area, as if you’re trying to pass a bowel movement (and if you do, that's totally fine). Although medical experts no longer recommend a routine episiotomy (a cut to enlarge the vaginal opening) your doctor may advise one if she feels it's truly necessary in order for the baby to be safely born.
Within 30 minutes of your baby's birth, you'll be asked to push again to deliver the placenta, which usually comes out easily. If you've torn or had an episiotomy, your doctor will then stitch you up.
When you're prepped for a C-section (whether or not it's planned) a nurse will start an IV containing saline solution and in some cases an antibiotic. Unless the C-section is an emergency, the anesthesiologist will administer an epidural so you won’t feel anything below your belly button — though you’ll be fully awake throughout the procedure. Your doctor will drape the area around your belly (you can request a clear sheet if you'd like to witness the procedure) and then cut through the skin, muscles, uterus and amniotic sac.
“You feel almost nothing — maybe a little pressure and some tugging,” says Dr. Gloria Bachmann, chief of the OB-GYN service at the Robert Wood Johnson University Hospital in New Brunswick, New Jersey. Minutes later, the doctor will lift the baby out and bring them up to your head for you to see before removing the placenta and stitching you up. The entire process typically takes 40 to 90 minutes.
According to the Centers for Disease Control and Prevention, 32 percent of all deliveries in the U.S. in 2015 were by C-section.
If you're worried about the pain of childbirth, there are several pain-relief options available to you. If you're at a hospital during early labor, you may be offered a pain reliever such as Demerol or Stadol, but you're likely to have to wait until active labor for an epidural.
If you choose an epidural, an anesthesiologist will numb your lower spine before using a long needle to inject pain-killing drugs. "An epidural is placed on a continual pump, which can be adjusted through the labor," explains board-certified obstetrician and gynecologist Renee Horowitz. "It will block a certain amount of pain associated with contractions, but it will not block the feeling of 'pushing.' Very little actually takes away the feeling of pushing."
Horowitz reminds her patients who are afraid of the pain that "all labors start, but all labors end. There is an end point. It will not go on forever."
No matter how you deliver, it's normal to wear pads for several weeks to absorb the blood-tinged fluid from your uterus as you heal.
If you still have questions and fears about giving birth, education is key, says Horowitz. "Education and being proactive is always important in health care. Anything you can learn in classes is really important, as it takes away some of the fears and anxiety of the 'unknown.' I always encourage my patients to take Lamaze and any other childbirth information classes."
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