What to expect when you're expecting (143 page)

Also call your practitioner immediately if contractions are increasingly strong but your due date is still weeks away, if your water breaks but labor hasn’t begun, if your water breaks and it has a greenish-brown tint, if you notice bright red blood, or if you feel the umbilical cord slip into your cervix or vagina.

Ready or Not

To make sure you’re ready for your baby’s arrival when he or she is ready to arrive, start reading up now about labor and delivery in the next chapter.

A
RE YOU COUNTING DOWN THE
days? Eager to see your feet again? Desperate to sleep on your stomach—or just plain desperate to sleep? Don’t worry—the end (of pregnancy) is near. And as you contemplate that happy moment—when your baby will finally be in your arms instead of inside your belly—you’re probably also giving a lot of thought to (and coming up with a lot of questions about) the process that will make that moment possible: labor and delivery. When will labor start, you’re likely wondering? More important, when will it end? Will I be able to handle the pain? Will I need an epidural (and when can I have one)? A fetal monitor? An episiotomy? What if I want to labor—and deliver—while squatting? Without any meds? What if I don’t make any progress? What if I progress so quickly that I don’t make it to the hospital or birthing center in time?

Armed with answers to these (and other) questions—plus the support of your partner and your birth attendants (doctors, midwives, nurses, doulas, and others)—you’ll be prepared for just about anything that labor and delivery might bring your way. Just remember the most important thing that labor and delivery will bring your way (even if nothing else goes according to plan): that beautiful new baby of yours.

“I think I lost my mucous plug. Should I call my doctor?”

Don’t send out for the champagne just yet. The mucous plug—the clear, globby, gelatinous blob-like barrier that has corked your cervix throughout your pregnancy—occasionally becomes dislodged as dilation and effacement begin. Some women notice the passage of the mucous plug (what exactly
is
that in the toilet?); others don’t (especially if you’re the flush-and-rush type). Though the passage of the plug is a sign that your body’s preparing for the big day, it’s not a reliable signal the big day has arrived—or even that it’s around the corner. At this point, labor could be one or two days, or even weeks, away, with your cervix continuing to open gradually over that time. In other words, there’s no need to call your practitioner or frantically pack your bags just yet.

No plug in your pants or your toilet? Not to worry. Many women don’t lose it ahead of time (and others overlook it), and that doesn’t predict anything about the eventual progress of labor.

“I have a pink mucousy discharge. Does it mean labor’s about to start?”

Sounds like it’s bloody show time—and happily, this particular production is a preview of labor, not of a gory horror movie. Passing that bloody show, a mucous discharge tinged pink or brown with blood, is usually a sign that the blood vessels in the cervix are rupturing as it dilates and effaces and the process that leads to delivery is well under way (and that’s something to applaud!). Once the bloody show has made its debut in your underwear or on the toilet paper, chances are your baby’s arrival is just a day or two away. But since labor is a process with an erratic timetable, you’ll be kept in suspense until the first true contractions strike.

If your discharge should suddenly become bright red, contact your practitioner right away.

“I woke up in the middle of the night with a wet bed. Did I lose control of my bladder, or did my water break?”

Asniff of your sheets will probably clue you in. If the wet spot smells sort of sweet (not like urine, which has the harsher odor of ammonia), it’s likely to be amniotic fluid. Another clue that the membranes surrounding your baby and containing the amniotic fluid he or she’s been living in for nine months have probably ruptured: You continue leaking the pale, straw-colored fluid (which won’t run dry because it continues to be produced until delivery, replacing itself every few hours). Another test: You can try to stem the flow of the fluid by squeezing your pelvic muscles (Kegel exercises). If the flow stops, it’s urine. If it doesn’t, it’s amniotic fluid.

You are more likely to notice the leaking while you are lying down; it usually stops, or at least slows, when you stand up or sit down, since the baby’s head acts as a cork, blocking the flow temporarily. The leakage is heavier—whether you’re sitting or standing—if the break in the membranes is down near the cervix than if it is higher up.

Your practitioner has probably given you a set of instructions to follow if your water breaks. If you don’t remember the instructions or have any doubts about how to proceed—call, night or day.

“My water just broke, but I haven’t had any contractions. When is labor going to start, and what should I do in the meantime?”

It’s likely that labor’s on the way—and soon. Most women whose membranes rupture before labor begins can expect to feel the first contraction within 12 hours of that first trickle; most others can expect to feel it within 24 hours.

About 1 in 10, however, find that labor takes a little longer to get going. To prevent infection through the ruptured amniotic sac (the longer it takes for labor to get going, the greater the risk), most practitioners induce labor within 24 hours of a rupture, if a mom-to-be is at or near her due date, though a few induce as early as six hours after. Many women who have experienced a rupture actually welcome a sooner-than-later induction, preferring it to 24 hours of wet waiting.

The first thing to do if you experience a trickle or flow of fluid from your vagina—besides grab a towel and a box of maxipads—is call your practitioner (unless he or she has instructed otherwise). In the meantime, keep the vaginal area as clean as possible to avoid infection. Don’t have sex (not that there’s much chance you’d want to right now), use a pad (not a tampon) to absorb the flow, don’t try to do your own internal exam, and, as always, wipe from front to back when you use the toilet.

Rarely, when the membranes rupture prematurely and the baby’s presenting part is not yet engaged in the pelvis (more likely when the baby is breech or preterm), the umbilical cord can become “prolapsed”—it is swept into the cervix, or even down into the vagina, with the gush of amniotic fluid. If you can see a loop of umbilical cord at your vaginal opening, or think you feel something inside your vagina, call 911. For more on what to do if the cord is prolapsed, see
page 565
.

“My membranes ruptured, and the fluid isn’t clear—it’s greenish brown. What does this mean?”

Your amniotic fluid is probably stained with meconium, a greenish-brown substance that is actually your baby’s first bowel movement. Ordinarily, meconium is passed after birth as the baby’s first stool. But sometimes—such as when the fetus has been under stress in the womb, and more often when it is past its due date—the meconium is passed before birth into the amniotic fluid.

Meconium staining alone is not a sure sign of fetal distress, but because it suggests the possibility of distress, notify your practitioner right away. He or she will likely want to get labor started (if contractions aren’t already in full swing) and will monitor your baby very closely throughout labor.

“My doctor said that my amniotic fluid is low and she needs to supplement it. Should I be concerned?”

Usually, nature keeps the uterus well stocked with a self-replenishing supply of amniotic fluid. Fortunately, even when levels do run low during labor, medical science can step in and supplement that natural source with a saline solution pumped directly into the amniotic sac through a catheter inserted through the cervix into the uterus. This procedure, called amnioinfusion, can significantly reduce the possibility that a surgical delivery will become necessary due to fetal distress.

“In childbirth class we were told not to go to the hospital until the contractions were regular and five minutes apart. Mine are less than five minutes apart, but they aren’t at all regular. I don’t know what to do.”

Just as no two women have exactly the same pregnancies, no two women have exactly the same labors. The labor often described in books, in childbirth education classes, and by practitioners is what is typical—close to what many women can expect. But far from every labor is true-to-textbook, with contractions regularly spaced and predictably progressive.

If you’re having strong, long (20 to 60 seconds), frequent (mostly 5 to 7 minutes apart or less) contractions, even if they vary considerably in length and time elapsed between them, don’t wait for them to become regular before calling your practitioner or heading for the hospital or birthing center—no matter what you’ve heard or read. It’s possible your contractions are about as regular as they’re going to get and you’re well into the active phase of your labor.

“I just started getting contractions and they’re coming every three or four minutes. I feel silly calling my doctor, who said we should spend the first several hours of labor at home.”

Better silly than sorry. It’s true that most first-time mothers-to-be (whose labors are generally slow-going at first, with a gradual buildup of contractions) can safely count on spending the first several hours at home, leisurely finishing up their packing and their baby prep. But it doesn’t sound like your labor’s fitting that typical first-timer pattern. If your contractions have started off strong—lasting at least 45 seconds and coming more frequently than every 5 minutes—your first several hours of labor may very well be your last (and if you’re not a first-timer, your labor may be on an even faster track). Chances are that much of the first stage of labor has passed painlessly and your cervix has dilated significantly during that time. This means that not calling your practitioner, chancing a dramatic dash to the hospital or birthing center at the last minute—or not getting there in time—might be considerably sillier than picking up the phone now.

So by all means call. When you do, be clear and specific about the frequency, duration, and strength of your contractions. Since your practitioner is used to judging the phase of labor in part by the sound of a woman’s voice as she talks through a contraction, don’t try to downplay your discomfort, put on a brave front, or keep a calm tone when you describe what you’re experiencing. Let the contractions speak for themselves, as loudly as they need to.

If you feel you’re ready but your practitioner doesn’t seem to think so, ask if you can go to the hospital/birthing center or to your practitioner’s office and have your progress checked. Take your bag along just in case, but be ready to turn around and go home if you’ve only just begun to dilate—or if nothing’s going on at all.

“I’m afraid that I won’t get to the hospital in time.”

Fortunately, most of those sudden deliveries you’ve heard about take place in the movies and on TV. In real life, deliveries, especially those of first-time mothers, rarely occur without ample warning. But once in a great while, a woman who has had no labor pains, or just erratic ones, suddenly feels an overwhelming urge to bear down; often she mistakes it for a need to go to the bathroom.

Emergency Delivery if You’re Alone

You’ll almost certainly never need the following instructions—but just in case, keep them handy.

1.
Try to remain calm. You can do this.

2.
Call 911 (or your local emergency number) for the emergency medical service. Ask them to call your practitioner.

3.
Find a neighbor or someone else to help, if possible.

4.
Start panting to keep yourself from pushing.

5.
Wash your hands and the vaginal area, if you can.

6.
Spread some clean towels, newspapers, or sheets on a bed, sofa, or the floor, and lie down to await help (unlock the door so help can get in easily).

7.
If despite your panting the baby starts to arrive before help does, gently ease him or her out by pushing each time you feel the urge.

8.
As the top of the baby’s head begins to appear, pant or blow (do not push), and apply very gentle counterpressure to your perineum to keep the head from popping out suddenly. Let the head emerge gradually—don’t pull it out. If there is a loop of umbilical cord around the baby’s neck, hook a finger under it and gently work it over the baby’s head.

9.
Next, take the head gently in two hands and press it very slightly downward (do not pull), pushing the baby out at the same time, to deliver the front shoulder. As the upper arm appears, lift the head carefully, feeling for the rear shoulder to deliver. Once the shoulders are free, the rest of your baby should slip out easily.

10.
Place the baby on your abdomen or, if the cord is long enough (don’t tug at it), on your chest. Quickly wrap the baby in blankets, towels, or anything else that’s clean.

11.
Wipe baby’s mouth and nose with a clean cloth. If help hasn’t arrived and the baby isn’t breathing or crying, rub his or her back, keeping the head lower than the feet. If breathing still hasn’t started, clear out the mouth some more with a clean finger and give two quick and extremely gentle puffs of air into his or her nose and mouth.