What to expect when you're expecting (144 page)

12.
Don’t try to pull the placenta out. But if it emerges on its own before emergency assitance arrives, wrap it in towels or newspaper, and keep it elevated above the level of the baby, if possible. There is no need to try to cut the cord.

13.
Keep yourself and your baby warm and comfortable until help arrives.

As remote as the possibility is that this will happen to you, it’s a good idea for both you and your coach to become familiar with the basics of an emergency delivery (see boxes, above and on
page 370
). Once that’s done, relax, knowing that a sudden and quick delivery is an extremely remote possibility.

“I always hear about women who have really short labors. How common are they?”

While they make for really good labor stories, not all of the short labors you’ve heard about are as short as they seemed. Often, an expectant mom who appears to have a quickie labor has actually been having painless contractions for hours, days, even weeks, contractions that have been dilating her cervix gradually. By the time she finally feels one, she’s well into the final stage of labor.

That said, occasionally the cervix dilates very rapidly, accomplishing in a matter of minutes what the average cervix (particularly a first-time mom’s cervix) takes hours to do. And happily, even with this abrupt, or precipitous, kind of labor (one that takes three hours or less from start to finish), there is usually no risk to the baby.

If your labor seems to start with a bang—with contractions strong and close together—get to the hospital or birthing center quickly (so you and your baby can be monitored closely). Medication may be helpful in slowing contractions a bit and easing the pressure on your baby and on your own body.

“The pain in my lower back since my contractions began is so bad that I don’t see how I’ll be able to make it through labor.”

What you’re probably experiencing is known in the birthing business as “back labor.” Technically, back labor occurs when the fetus is in a posterior position, with its face up and the back of its head pressing against your sacrum, or the back of your pelvis. (Ironically, this position is nicknamed “sunny-side up” in birthing circles—though there’s nothing cheerful about back labor.) It’s possible, however, to experience back labor when the baby isn’t in this position or to continue to experience it after the baby has turned to a head-to-the-front position—possibly because the area has already become a focus of tension.

When you’re having this kind of pain—which often doesn’t let up between contractions and can become excruciating during them—the cause doesn’t matter much. How to relieve it, even slightly, does. If you’re opting to have an epidural, go for it (there’s no need to wait, especially if you’re in a lot of pain). It’s possible that you might need a higher dose than usual to get full comfort from the back labor pain, so let the anesthesiologist know about it. Other options (such as narcotics) also offer pain relief. If you’d like to stay med free, several measures may help relieve the discomfort of back labor; all are at least worth trying:

Taking the pressure off.
Try changing your position. Walk around (though this may not be possible once contractions are coming fast and furious), crouch or squat, get down on all fours, do whatever is most comfortable and least painful for you. If you feel you can’t move and would prefer to be lying down, lie on your side, with your back well rounded—in a sort of fetal position.

Heat or cold.
Have your coach (or doula or nurse) use warm compresses, a heating pad, or ice packs or cold compresses—whichever soothes best. Or alternate heat and cold.

Counterpressure and massage.
Have your coach experiment with different ways of applying pressure to the area of greatest pain, or to adjacent areas, to find one or more that seem to help. He can try his knuckles, the heel of one hand reinforced by pressure from the other hand on top of it, a tennis ball, or a back massager, using direct pressure or a firm circular motion. Pressure or a firm massage can be applied while you’re sitting or while you’re lying on your side. Cream, oil, or powder can be applied periodically to reduce possible irritation.

Reflexology.
For back labor, this therapy involves applying strong finger pressure just below the center of the ball of the foot.

Other alternative pain relievers.
Hydrotherapy can definitely ease the pain somewhat. If you’ve had some experience with meditation, visualization, or self-hypnosis for pain, try these, too. They often work, and they certainly couldn’t hurt. Acupuncture can also help, but you’ll have to arrange ahead of time to have a therapist on call when you go into labor.

“My doctor wants to induce labor. But I’m not overdue yet and I thought induction was only for overdue babies.”

Sometimes Mother Nature needs a little help making a mother out of a pregnant woman. About 20 percent of pregnancies end up needing that kick in the maternity pants, and though a lot of the time induction is necessary because a baby is overdue, there are many other reasons why your practitioner might feel that nature needs a nudge, such as:

Your membranes have ruptured and contractions have not started on their own within 24 hours (though some practitioners induce much sooner).

Tests suggest that your uterus is no longer a healthy home for your baby because the placenta is no longer functioning optimally or amniotic fluid levels are low, or for another reason.

Tests suggest that the baby isn’t thriving and is mature enough to be delivered.

You have a complication, such as preeclampsia or gestational diabetes, or a chronic or acute illness, that makes it risky to continue your pregnancy.

There’s a concern that you might not make it to the hospital or birthing center on time once labor has started, either because you live a long distance away or because you’ve had a previous very short labor.

If you’re still unsure about your doctor’s reasons for inducing labor, ask for a better explanation. To find out all you’ll need to know about the induction process, keep reading.

“How does induction work?”

Induction, like naturally triggered labor, is a process—and sometimes a pretty long process. But unlike naturally triggered labor, your body will be getting some help with the heavy lifting if you’re induced. Labor induction usually involves a number of steps (though you won’t necessarily go through all of them):

First, your cervix will need to be ripened (or softened) so that labor can begin. If you arrive with a ripe cervix, great—you’ll probably move right on to the next step. If your cervix is not dilated, not effaced, and not soft at all, your practitioner will likely administer a hormonal substance such as prostaglandin E in the form of a vaginal gel (or a vaginal suppository in tablet form) to get things started. In this painless procedure, a syringe is used to place the gel in the vagina close to your cervix. After a few hours or longer of letting the gel do its work, you’ll be checked to see if your cervix is getting softer and beginning to efface and dilate. If it isn’t, a second dose of the prostaglandin gel is administered. In many cases, the gel is enough to get contractions and labor started. If your cervix is ripe enough but contractions have not begun, the induction process continues. (Some practitioners use mechanical agents to ripen the cervix, such as a catheter with an inflatable balloon, graduated dilators to stretch the cervix, or even a botanical—called Laminaria japonicum—that, when inserted, gradually opens the cervix as it absorbs fluid around it.)

If the amniotic sac is still intact, your practitioner may strip the membranes by swiping a finger across the fine membranes that connect the amniotic sac to the uterus to release prostaglandin (this process isn’t always pain free, and while it isn’t meant to break your water, it sometimes does). Or he or she may artificially rupture your membranes (see
page 373
) to try to get labor started.