What to expect when you're expecting (147 page)

There’s no need to take labor lying down, and in fact, lying flat on your back is probably the least efficient way to birth your baby: first because you’re not enlisting gravity’s help to get your baby out, and second because there’s the risk of compressing major blood vessels (and possibly interfering with blood flow to the fetus) when you’re on your back. Expectant mothers are encouraged to labor in any other position that feels comfortable, and to change their position as often as they can (and want to). Getting a move on during labor, as well as varying your position often, not only eases discomfort but may also yield speedier results.

You can choose from any of the following labor and delivery postures (or variations of these):

Labor Positions

Standing or walking.
Getting vertical not only helps relieve the pain of contractions but also takes advantage of gravity, which may allow your pelvis to open and your baby to move down into your birth canal. While it’s unlikely you’ll be heading for the track once contractions are coming fast and furious, walking (or just leaning against a wall or your coach) during the early stages of labor can be an effective move.

Rocking.
Sure, your baby’s not even born yet, but he or she will still enjoy a little rocking—as will you, especially when those contractions start coming. Slip into a chair or remain upright, and sway back and forth. The rocking motion may allow your pelvis to move and encourage the baby to descend. And again, staying upright allows you to use the force of gravity to help in the process.

Squatting.
You probably won’t be able to stand and deliver, but once you get closer to the pushing phase of childbirth, you might want to consider squatting. There’s a reason why women have delivered their babies in a squatting position for centuries: It works. Squatting allows the pelvis to open wide, giving your baby more room to move on down. You can use your partner for squatting support (you’ll probably be a little wobbly, so you’ll need all the support you can get), or you can use a squatting bar, which is often attached to the birthing bed (leaning on the bar will keep your legs from tiring out as you squat).

Birthing balls.
Sitting or leaning on one of these large exercise balls can help open up your pelvis—and it’s a lot easier than squatting for long periods.

Sitting.
Whether in bed (the back of the birthing bed can be raised so you’re almost sitting upright), in your partner’s arms, or on a birthing ball, sitting can ease the pain of contractions and may allow gravity to help bring your baby down into the birth canal. You might also consider a birthing chair, if one is available, which is specifically designed to support a woman in a sitting or squatting position during delivery and, theoretically, speed labor. Another plus: Moms get to see more of the birth in this position.

Kneeling.
Got back labor? Kneeling over a chair or over your spouse’s shoulders is a great position when the back of the baby’s head is pushing against your spine. It encourages the baby to move forward, taking that load off your back. Even if you don’t have back labor, kneeling can be an effective labor and delivery position. Because kneeling allows you to shift and transfer some of the pressure toward the lower spine while you push your baby out, it seems to reduce childbirth pain even more than sitting does.

Hands and knees.
Getting on all fours is another way to cope more comfortably with back labor—and to help get that puppy out faster. This position allows you to do pelvic tilts for comfort, while giving your spouse or doula access to your back for massage and counterpressure. You might even consider delivering in this position (no matter what kind of labor you’re having), since it opens up the pelvis and uses gravity to coax baby down.

Side lying.
Too tired to sit? Or squat? Just need to lie down? Lying on your side is much better than lying on your back, since it doesn’t compress the major veins in your body. It’s also a good delivery option, helping to slow a too-fast birth as well as easing the pain of some contractions.

Remember that the best labor position is the one that’s best for you. And what’s best in the early stages of labor might make you miserable when you’re in the throes of transition, so change positions as often—or as little—as you want. If you’re being continuously monitored, your positions are somewhat limited. It’ll be hard to walk, for instance—but you’ll have no problem squatting, rocking, sitting, getting on your hands and knees, or lying on your side. Even if you have an epidural, sitting, side lying, or rocking are options available to you.

“I’m concerned about stretching during delivery. Will my vagina ever be the same again?”

Mother Nature definitely had mothers in mind when she thought up vaginas. Their incredible elasticity and accordion-like folds allow this amazing organ to open up for childbirth (and the passage of that 7- or 8-pound baby) and then—over a period of weeks following delivery—return to close to original size. In other words, your vagina’s definitely designed to take it.

The perineum is also elastic but less so than the vagina. Massage during the months prior to delivery may help increase its elasticity and reduce stretching (though don’t go overboard; see
page 352
). Likewise, exercising the pelvic muscles with Kegels during this period may enhance their elasticity, strengthen them, and speed their return to normal tone.

Most women find that the slight increase in vaginal roominess typically experienced postpartum is imperceptible and doesn’t interfere at all with sexual enjoyment. For those who were previously too snug, that extra room can be a real plus—making sex more of a pleasure and in some cases, literally, less of a pain. Very occasionally, however, in a woman who was “just right” before, childbirth does stretch the vagina enough that sexual satisfaction decreases. Often, the vaginal muscles tighten up again in time. Doing Kegels faithfully and frequently helps speed that process. If six months after delivery you still find that your vagina’s too slack for comfort, talk to your doctor about other possible treatments.

Apgar Score

The Apgar score is your baby’s first test, and it’s a way to quickly evaluate your newborn’s condition. At one minute and again at five minutes after birth, a nurse, midwife, or doctor check the infant’s Appearance (color), Pulse (heartbeat), Grimace (reflex), Activity (muscle tone), and Respiration. Babies who score above 6, which most babies do, are fine. Those who score between 4 and 6 often need resuscitation, which generally includes suctioning their airways and administering oxygen. Those who score under 4 require more dramatic lifesaving techniques.

“The sight of blood makes me feel faint. I’m not sure if I’ll be able to handle watching my delivery.”

Here’s some good news for the squeamish. First of all, there isn’t all that much blood during childbirth—not much more than you see when you’ve got your period. Second, you’re not really a spectator at your delivery; you’ll be a very active participant, putting every ounce of your concentration and energy into pushing your baby those last few inches. Caught up in the excitement and anticipation (and, let’s face it, the pain and fatigue), you’re unlikely to notice, much less be unsettled by, any bleeding. If you ask friends who are new mothers, few will be able to tell you just how much blood, if any, there was at their deliveries.

If you still feel strongly that you don’t want to see any blood, simply keep your eyes off the mirror at the moment of birth (and look away, too, if an episiotomy is performed). Instead, just look down past your belly for a good view of your baby as he or she emerges. From this vantage point, virtually no blood will be visible. But before you decide to opt out of watching your own delivery, watch someone else’s by viewing a childbirth DVD. You’ll probably be much more amazed than horrified.

Some fathers, too, worry about how they’ll handle viewing the birth. If your spouse is anxious about this aspect of delivery, have him read
page 483
.

Childbirth

Delivering a baby is the challenge of a lifetime, but it’s also an emotional and physical rush like no other. It’s an experience that you may be looking ahead to with trepidation (and maybe a little dread), but that you’ll likely look back on—once it’s all said, done, and delivered—with nothing but the purest joy (and maybe a little relief).

Fortunately, you won’t be going it alone. In addition to the support of your coach, you’ll have plenty of medical professionals on the scene, too. But even with all that expertise in your camp, it’ll help to have some know-how of your own.

Stages and Phases of Childbirth

Childbirth progresses in three stages: labor, delivery of the baby, and delivery of the placenta. Unless labor is cut short (or eliminated) by a C-section, all women go through the labor stage, which includes early labor, active labor, and transitional labor. The timing and intensity of the contractions can help pinpoint which phase of labor you’re in at any particular time, and so can some of the symptoms you’re experiencing along the way. Periodic internal exams will confirm the progress.

Stage One:
Labor

Phase 1: Early (Latent)
—thinning (effacement) and opening (dilation) of the cervix to 3 cm; contractions are 30 to 45 seconds long, 20 minutes apart or less.

Phase 2: Active
—dilation of cervix to 7 cm; contractions are 40 to 60 seconds long, coming 3 to 4 minutes apart.

Phase 3: Transitional
—dilation of cervix to 10 cm (fully dilated); contractions are 60 to 90 seconds long, about 2 to 3 minutes apart.

Stage Two:
Delivery of the baby

Stage Three:
Delivery of the placenta

After nine months at it—graduating from queasiness and bloating to heartburn and backache—you almost certainly know what to expect when you’re expecting by now. But what should you expect when you’re laboring and delivering?

That’s actually hard to predict (make that impossible). Like every pregnancy before it, every labor and delivery is different. But just as it was comforting to know what you might expect during those months of growing your baby, it’ll be comforting to have a general idea of what you might have in store for you during those hours of childbirth. Even if it turns out to be nothing like you expected (with the exception of that very happy and cuddly ending).

This phase is usually the longest and, fortunately, the least intense phase of labor. Over a period of hours, days, or weeks (often without noticeable or bothersome contractions), or over a period of two to six hours of no-doubt-about-it contractions, your cervix will efface (thin out) and dilate (open) to 3 cm.

Contractions in this phase usually last 30 to 45 seconds, though they can be shorter. They are mild to moderately strong, may be regular or irregular (around 20 minutes apart, more or less), and become progressively closer together, but not necessarily in a consistent pattern.

For the Record

Instead of grabbing the nearest piece of scrap paper to write down the timing of your contractions, flip open to the childbirth journal in
The What to Expect Pregnancy Journal and Organizer
to record all the info about your contractions and your labor experience (or better yet, have your spouse jot it down). This way you’ll have a keepsake to help you remember the event—not that you’d ever forget.

During early labor, you might experience any or all of the following:

Backache (either constant or with each contraction)