What to expect when you're expecting (157 page)

Speaking of bowel movements, since you’re bearing down on the whole perineal area, anything that’s in your rectum may be pushed out, too; trying to avoid this while you’re pushing can slow your progress. Don’t let inhibition or embarrassment break the pushing rhythm. A little involuntary pooping (or passage of urine) is experienced by nearly everyone during delivery. No one else in the room will think twice about it, and neither should you. Pads will immediately whisk away anything that comes out.

Take a few deep breaths while the contraction is building so you can gear up for pushing. As the contraction peaks, take a deep breath and then push with all your might—holding your breath if you want or exhaling as you push, whatever feels right to you. If you’d like the nurses or your coach to guide you by counting to 10 while you push, that’s fine. But if you find it breaks your rhythm or isn’t helpful, ask them not to. There is no magic formula when it comes to how long each push should last or how many times you should push with each contraction—the most important thing is to do what comes naturally. You may feel as many as five urges to bear down, with each push lasting just seconds—or you may feel the urge to bear down just twice, but with each push lasting longer. Follow those urges, and you’ll deliver your baby. Actually, you’ll deliver your baby even if you don’t follow your urges or if you find you don’t have any urges at all. Pushing doesn’t come naturally for every woman, and if it doesn’t for you, your practitioner, nurse, or doula can help direct your efforts, and redirect them if you lose your concentration.

Don’t become frustrated if you see the baby’s head crown and then disappear again. Birthing is a two-steps-forward, one-step-backward proposition. Just remember, you are moving in the right direction.

Rest between contractions. If you’re really exhausted, especially when the pushing stage drags on, your practitioner may suggest that you not push for several contractions so you can rebuild your strength.

Stop pushing when you’re instructed to (as you may be, to keep the baby’s head from being born too rapidly). If you’re feeling the urge to push, pant or blow instead.

Remember to keep an eye on the mirror (if one is available) once there’s something to look at. Seeing your baby’s head crown (and reaching down and touching it) may give you the inspiration to push when the pushing gets tough. Besides, unless your coach is videotaping, there won’t be any replays to watch.

While you’re pushing, the nurses and/or your practitioner will give you support and direction; continue to monitor your baby’s heartbeat, with either a Doppler or fetal monitor; and prepare for delivery by spreading sterile drapes and arranging instruments, donning surgical garments and gloves, and sponging your perineal area with antiseptic (though midwives generally just don gloves and do no draping). They’ll also perform an episiotomy if necessary, or use vacuum extraction or, less likely, forceps if necessary.

A First Look at Baby

Those who expect their babies to arrive as round and smooth as a Botticelli cherub may be in for a shock. Nine months of soaking in an amniotic bath and a dozen or so hours of compression in a contracting uterus and cramped birth canal take their toll on a newborn’s appearance. Those babies who arrived via cesarean delivery have a temporary edge as far as appearance goes.

Fortunately, most of the less-than-lovely newborn characteristics that follow are temporary. One morning, a couple of weeks after you’ve brought your wrinkled, slightly scrawny, puffy-eyed bundle home from the hospital, you’ll wake to find that a beautiful cherub has taken its place in the crib.

Oddly shaped head.
At birth, the infant’s head is, proportionately, the largest part of the body, with a circumference as large as his or her chest. As your baby grows, the rest of the body will catch up. Often, the head has molded to fit through Mom’s pelvis, giving it an odd, possibly pointed “cone” shape. Pressing against an inadequately dilated cervix can further distort the head by raising a lump. The lump will disappear in a day or two, the molding within two weeks, at which point your baby’s head will begin to take on that cherubic roundness.

Newborn hair.
The hair that covers the baby’s head at birth may have little resemblance to the hair the baby will have later. Some newborns are virtually bald, some have thick manes, but most have a light cap of soft hair. All eventually lose their newborn hair (though this may happen so gradually that you don’t notice), and it will be replaced by new growth, possibly of a different color and texture.

Vernix caseosa coating.
The cheesy substance that coats the fetus in the uterus is believed to protect the skin from the long exposure to the amniotic fluid. Premature babies have quite a bit of this coating at birth; on-time babies just a little; postmature babies have almost none, except possibly in the folds of their skin and under their fingernails.

Swelling of the genitals.
This can occur in both male and female newborns. The breasts of newborns, male and female, may also be swollen (occasionally even engorged, secreting a white or pink substance nicknamed “witch’s milk”) due to stimulation by maternal hormones. The hormones may also stimulate a milky-white, even blood-tinged, vaginal secretion in girls. These effects are normal and disappear in a week to 10 days.

Puffy eyes.
Swelling around the newborn’s eyes, normal for someone who’s been soaking in amniotic fluid for nine months and then squeezed through a narrow birth canal, may be exacerbated by the ointment used to protect the eyes from infection. It disappears within a few days. Caucasian babies’ eyes are often, but not always, a slate blue, no matter what color they will be later on. In babies of color, the eyes are usually brown at birth.

Skin.
Your baby’s skin will appear pink, white, or even grayish at birth (even if it will eventually turn brown or black). That’s because pigmentation doesn’t show up until a few hours after birth. A variety of rashes, tiny “pimples,” and whiteheads may also mar your baby’s skin thanks to maternal hormones, but all are temporary. You may also notice skin dryness and cracking, due to first-time exposure to air; these, too, will pass.

Lanugo.
Fine downy hair, called lanugo, may cover the shoulders, back, forehead, and temples of full-term babies. This will usually be shed by the end of the first week. Such hair can be more abundant, and will last longer, in a premature baby and may be gone in a postmature one.

Birthmarks.
A reddish blotch at the base of the skull, on the eyelid, or on the forehead, called a salmon patch, is very common, especially in Caucasian newborns. Mongolian spots—bluish-gray pigmentation of the deep skin layer that can appear on the back, buttocks, and sometimes the arms and thighs—are more common in Asians, southern Europeans, and blacks. These markings eventually disappear, usually by the time a child is 4 years old. Hemangiomas, elevated strawberry-colored birthmarks, vary from tiny to about quarter size or even larger. They eventually fade to a mottled pearly gray, then often disappear entirely. Coffee-with-cream colored (café-au-lait) spots can appear anywhere on the body; they are usually inconspicuous and don’t fade.

Once your baby’s head emerges, your practitioner will suction your baby’s nose and mouth to remove excess mucus, then assist the shoulders and torso out. You usually only have to give one more small push to help with that—the head was the hard part, and the rest slides out pretty easily. The umbilical cord will be clamped (usually after it stops pulsating) and cut—either by the practitioner or by your coach—and your baby will be handed to you or placed on your belly. (If you’ve arranged for cord blood collection, it will be done now.) This is a great time for some caressing and skin-to-skin contact, so lift up your gown and bring baby close. In case you need a reason to do that, studies show that infants who have skin-to-skin contact with their mothers just after delivery sleep longer and are calmer hours later.

What’s next for your baby? The nurses and/or a pediatrician will evaluate his or her condition, and rate it on the Apgar scale at one minute and five minutes after birth (see box,
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); give a brisk, stimulating, and drying rubdown; possibly take the baby’s footprints for a keepsake; attach an identifying band to your wrist and to your baby’s ankle; administer nonirritating eye ointment to your newborn to prevent infection (you can ask that the ointment be administered after you’ve had time to cuddle with your newborn); weigh, then wrap the baby to prevent heat loss. (In some hospitals and birthing centers, some of these procedures may be omitted; in others, many will be attended to later, so you can have more time to bond with your newborn.)