Crib Notes Preparing For Labor and Birth

Section I: Understanding Labor
Chapter 1: Whats Labor Like?

Most common questions: - What will labor be like? - Will it be the worst pain Ive ever felt? - Can I really do this? No way to predict how itll be for you Labor is different for every woman Meeting your baby at the end makes it all worthwhile
Chapter 1: Whats Labor Like? Chapter 2: Stages of Labor Chapter 3: Signs of Labor Chapter 4: Birth Stories Chapter 5: Banishing Labor Myths
Med-Speak
epidural = pain relief procedure that blocks pain in your lower body cesarean section (c-section) = surgical procedure used to deliver a baby through the abdomen
What are the main types of labor?

Labor and birth can happen in three basic ways:
Vaginal birth with pain medication C-section (always involves pain medication) Vaginal birth without pain medication
How long does labor last?

A 2006 survey of U.S. women showed:
Never given birth before - Median length of labor: 11 hours Given birth before - Median length of labor: 6 hours
Where do women give birth?
What type of caregiver do women choose?
How many women use pain medication?
What do contractions feel like?
How some women have described them:

Strong menstrual cramps A charley horse Pressure, tightness, achy throbbing Gas pains Backache that wraps around to abdomen
Chapter 2: Stages of Labor
Stage 1: From early contractions until its time to push Stage 2: Pushing and delivery Stage 3: Delivering the placenta
What happens to my body during labor?

Your body does two main things:
Pushes your baby down and out with contractions of the uterus Opens the cervix to give your baby a way out
Med-Speak
dilation = opening effacement = thinning
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First stage of labor

Lasts from early contractions until its time to push Longest stage (average of 10 to 14 hours for first-time moms) Three parts:
Early labor Active labor Transition
First stage: Early labor

Contractions get longer, stronger, and closer together Might be painful or just slightly uncomfortable Eventually contractions last 40 to 60 seconds each and come every 5 minutes Early labor may take 6 to 12 hours Once your cervix is 4 cm dilated (the size of a Ritz cracker), you move into active labor
Contractions get longer, stronger, and more frequent Your cervix opens all the way up
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The 5-1-1 Rule
To help you remember when its time to call your caregiver, use the 5-1-1 rule. That stands for contractions coming about 5 minutes apart, lasting about 1 minute each, and patterned this way for about 1 hour.
First stage: Active labor

Youll stop being able to talk through contractions After an hour or two, call your doctor or midwife Active labor lasts 4 to 8 hours, on average Medication and natural pain management can help Epidurals are typically given at this stage
First stage: Transition

Usually the most painful part of labor Cervix opens from about 8 cm to 10 cm (about the size of a bagel) Very strong contractions that last a minute or more If you have an epidural, you should be numb If you dont, you may feel shaky, nauseated Transition can take minutes or hours
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Once your cervix is 8 cm dilated (a little larger than a soda can), you enter transition
Second stage: Pushing

Begins when youre fully dilated Contractions do a lot of the work for you Can last from a few minutes to several hours Bear down with your abdominal muscles You might be coached to push during each contraction You might wait until you feel a spontaneous urge to push Epidural can reduce the urge to push Different positions can help
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Second stage: Crowning & birth

Your babys head will become visible and push against your perineum May feel the ring of fire Crowning is when the widest part of your babys head becomes visible Most painful part is over Baby is turned sideways and slips all the way out
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Third stage: Delivery of placenta

Uterus contracts again, causing placenta to detach Gently push to deliver placenta Can take 5 to 10 minutes and usually doesnt hurt Youre done with labor!
What happens to my baby after delivery?

Baby is dried and handed to you Skin contact helps him stay warm and is good for bonding May want to breastfeed Umbilical cord is clamped, then cut
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Chapter 3: Signs of Labor

Your body starts preparing for labor up to a month before your baby is born In labor: contractions are getting longer, stronger, and closer together Know the key signs of labor
Fast Fact
Only 1 in 20 women deliver on their due date. Youre more likely to go into labor within a week or two before or after.
What happens to me after delivery?

Youll probably be emotional or in a bit of shock You may be shaky or have chills Uterus becomes firm Any tear or incision is stitched up Epidural removed After-birth pains may continue
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Med-Speak
ripen = soften, thin, and open
Signs that labors coming

Your baby drops You feel more Braxton Hicks contractions Your cervix starts to ripen You pass your mucus plug Your water breaks call your doctor or midwife!
When to call your doctor or midwife

You spend an hour feeling regular, painful contractions that last about a minute each and come every five minutes If you think you might be in labor and have concerns about whether you need care yet
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Chapter 4: Birth Stories

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Call your caregiver immediately if

Your water has broken, especially if the liquid is discolored Your baby seems less active You have heavy vaginal bleeding, severe abdominal pain, or fever You have contractions or signs of labor before 37 weeks You have severe headaches, changes in your vision, unusual swelling, or tenderness in your upper abdomen Trust your instincts
Jackie: Stalled labor leads to a c-section Purvi: Giving birth before the baby shower Colleen: An epidural offers major relief Melylah: Drug-free birth and a surprise daughter Leslie: Induced labor and a long recovery Breanna: Hoping to avoid an epidural Scott: A dad's view of a c-section Shino: A big baby and a painful tear Kelly: Speedy birth in the family car
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Chapter 5: Banishing Labor Myths
Myth #1: Labor pain Myth: It will be the worst pain Ive ever felt. Fact: Maybe or maybe not. Be prepared for anything.
Myth #2: Coping with pain

Myth: Medication is the only way to ease labor pain. Fact: Medication is the easiest way to dramatically reduce pain, but natural techniques help too.
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Myth #3: Pain medication

Myth: Theres no downside to using pain drugs. Fact: Pain drugs are safe, but they can have side effects for you, your labor, and your baby.
Myth #4: Laboring in bed

Myth: The best way to labor is lying in bed. Fact: Laboring in bed isnt your only option. Staying upright and moving around can help labor along. In some cases, youll need to stay in bed.
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Myth #5: Eating and drinking

Myth: I shouldnt eat or drink during labor. Fact: Drinking clear liquids is fine. Eating in early labor is okay, but talk to your caregiver about eating in active labor.
Myth #6: Baths

Myth: I shouldnt soak in a tub after my water breaks. Fact: Its safe to soak in a tub during the first stage of labor. Make sure you dont overheat or slip.
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Section II: Key Decisions to Make

Chapter 6:
Where to Labor and With Whom
Myth #7: Doctors and nurses

Myth: My primary caregiver will coach me through labor. Fact: Some caregivers will, some wont. Its wise to have your own support person: a loved one, midwife, or doula.
Chapter 7:
Pain Management
Chapter 8:
Medical Interventions
Chapter 9:
After Your Newborn Arrives
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Chapter 6: Where to Labor and With Whom
Where can I deliver my baby? Hospital Birth center Home
At the hospital
Equipped to handle everything Most options for pain management, including epidurals Less personalized care More routine interventions Ask about the things that are important to you
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At a birth center
An option for low-risk pregnancies Can move freely Minimal interventions No epidural Personal attention and support for drug-free birth if you want one Doctor and hospital available in case of complications
At home
An option for low-risk pregnancies Safe with a skilled caregiver Need backup plan for getting to hospital No pain medication Greatest control over your experience
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Who will help me? Obstetrician Family physician Midwife Doula (labor coach)
Doctor
Most U.S. births are attended by a doctor: an obstetrician or family physician High-risk pregnancies usually require an obstetrician Doctors most available type of caregiver in hospital Covered by health insurance May be busy, not with you until youre pushing
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Midwife
More personal and holistic approach Can spend more time with you Focus on providing emotional support Good coach if you want to avoid pain medication Different types of midwives: Most common is certified nurse-midwife, or CNM (can deliver babies in any setting) If your pregnancy is low risk, just as likely to have an excellent outcome with a midwife as a doctor
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Doula
Serves as a labor coach Provides personalized, one-on-one attention and support Costs extra Can be main coach or work with your partner Helps before labor Can assist in hospital, at birth center, or at home Doulas shown to improve labor experience
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Chapter 7: Pain Management
Family and friends

Continuous support can help you feel more satisfied with your birth experience Think about whether a loved one can be there for you If you dont have support, ask about volunteers at hospital Consider who you dont want in the room
Fast Fact
How your body can help you

Feel-good hormones
Among women who had support during labor, 82% got support from their partner and 38% got support from another loved one. (Some women got support from more than one person.)
endorphins
High levels reduce pain Boost your levels by staying calm and condent
Expert FAQ
adrenaline
Stress hormone High levels slow labor, increase pain Reduce your levels by avoiding fear and panic, having a support person close by
Name Credential
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Pain isnt constant

Contractions are intermittent Take them one at a time The most intense contractions last 60 to 90 seconds Relax between each one
Pain comes in waves
Little things can help

Create an environment that helps you through labor Think about the details youd like to set the stage Setting things up to your taste can help you feel more in control and positive
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Smart Tip
If youre planning an unmedicated birth, your nurses will ask you about your pain levels throughout labor not because theyre nudging you to take pain medicine, but because its a requirement of hospital accreditation and has to be documented. If youd rather not be asked to report on your pain levels, you can request that your nurse ask instead, How are you coping with your contractions?
Natural methods Can help any woman Four basic techniques
Breathing
Many breathing techniques can help One type: slow, deep breaths
Can calm and relax you May help distract you You can do them alone or with your partner Sends more oxygen to your baby and uterus
Another type: patterned breathing

Your caregiver can help you try it Helps to distract you
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Movement
You may feel the urge to move Eases discomfort Can get your baby in a good position Movements and positions to try:
Walk, stand, sway, lean, kneel, rock, lie on your side, straddle
Massage
Physical touch can comfort Strong, sustained pressure against lower back (low back squeeze) or hips (double hip squeeze) can lessen pain Massage on your face or head can help with all-over relaxation
Some can be tried in or near bed Certain positions can also help when pushing Your support person can suggest options during labor, or you might intuitively find what works for you Practice during pregnancy
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Water
Water can help (hydrotherapy) Shower or tub Can work like a massage, ease pressure, relax muscles Stay hydrated Water shouldnt be too hot Tub is safe in first stage of labor, even after your water breaks
Alternative techniques
These include:
Visualization Self-hypnosis Acupuncture
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Limits on natural pain relief

With an epidural or certain interventions, you may not be free to move around or get in the water Will help you cope with pain, but wont eliminate it
Pain medication
Most U.S. women opt for pain medication Usually need to decide during first stage of labor whether you want drugs Some medications dull pain, others block it Four main options
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Chapter 7: Pain Management Systemic medication

Dulls your pain Affects your whole body Usually delivered through IV or injection Doesnt require an anesthesiologist Many birth centers can offer it Commonly used in U.S.: Demerol (meperidine), Stadol (butorphanol), Nubain (nalbuphine), Sublimaze (fentanyl) Can make you sleepy, dizzy Can reach your baby May have to stay in bed at first Unlike epidural, doesnt make other medical interventions more likely later or interfere with ability to push Many women start with systemic drugs then use an epidural later 1 in 5 women who use drugs during labor use systemic narcotics
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Epidural
Most common form of pain relief during labor Delivers continuous pain medication throughout labor Blocks pain in lower body How it works: numb your back, insert tiny tube, deliver medication through tube Can take about 15 to 40 minutes to feel full relief
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Epidural
Pros Effective, long-lasting relief Can help you rest Stay alert Dose can be adjusted Little medicine reaches baby Cons Lose sensation and strength in legs May need to stay in bed Will need IV and monitoring Can make pushing stage longer, make pushing more difficult, lead to assisted delivery May feel spotty pain relief, itchiness Rarely, leads to bad headache
Spinal block
Blocks pain in lower body Takes effect within a few minutes Lasts only a few hours Only tiny amount of medication reaches baby Easier to administer than epidural Good option if youre short on time Recommended if youre having a planned c-section Will need IV and continuous monitoring Cant get out of bed Can make pushing more difficult and lead to other interventions
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Combined spinal/epidural
Blocks pain in lower body Swift relief of a spinal Long-lasting relief of an epidural Has drawbacks of both spinals and epidurals Not done at all hospitals; check with yours
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What pain medication is right for me?

Best person to help you is your caregiver Ask what your options are Talk through the pros and cons Get personalized advice
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Chapter 8: Medical Interventions
Fetal monitoring
What it is:
Tracks your babys heart rate Most hospitals do continuous monitoring Transducers strapped to your belly with wide, stretchy bands Internal monitor used for more accurate reading Intermittent monitoring uses transducers on belly or handheld device Intermittent monitoring done at birth centers and some hospitals
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Fetal monitoring
What to know about it:
Wires limit your movement Wireless or waterproof monitors may be available Transducers can be bothersome Reduces seizures but not mortality or long-term problems Continuous monitoring required with epidural, induction, complications Continuous monitoring can create false alarms Intermittent monitoring can be just as effective
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Inducing labor
What it is:
Inducing labor
How it works: Several ways to do it Ripen cervix with medication or other technique Contractions may start on their own If not, start contractions with Pitocin (synthetic form of oxytocin) Induction methods include:
Medication inserted into your vagina Small, water-filled balloon against cervix Stripping or sweeping the membranes Breaking your amniotic sac (bag of waters) Pitocin
Your caregiver uses medication or other techniques to kick-start your labor Getting more and more common More than 1 in 5 U.S. women induced You might be induced if:
Youve gone 1 to 2 weeks past your due date Its been 12 to 24 hours since your water broke You have preeclampsia Your placenta isnt working properly You have low amniotic fluid Your babys health or yours is at risk
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Many women experience more than one of these

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Inducing labor
Youll need continuous fetal monitoring Some induction methods can make contractions come on too strong and fast Rarely, can cause more serious complications Induction recommended only when necessary If induction doesnt work in timely manner, youll need a c-section
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C-section
What it is:
Surgical procedure; baby delivered through abdomen rather than vagina Quickest way to deliver when vaginal birth isnt progressing well Can be a planned procedure 1 in 3 U.S. babies delivered by c-section Major abdominal surgery Usually awake, with anesthesia Procedure: Small incision, usually horizontal Cut through skin, uterus, amniotic sac Remove baby and placenta
Fast Fact
What are your chances of ending up with a c-section? Not too high unless your doctor tells you during pregnancy that you'll need one. Less than 2 out of 10 women who go into labor planning to deliver vaginally end up with a c-section, according to Yale University researchers.
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C-section
What to know about it: Riskier than vaginal delivery Higher risk of: Infection Excessive bleeding Blood clots More severe postpartum pain Longer hospital stay and recovery Partner can be with you
C-section
Planned c-section: If you shouldnt labor or deliver vaginally Previous uterine surgery Twins or multiples Placenta previa Baby is breech or transverse Baby is ill or has abnormality Unplanned c-section: When problems arise during labor Labor stalls Babys heart rate worrisome Umbilical cord slips Placenta separates Herpes outbreak
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Fast Fact
Some moms choose to have a c-section without any medical reason. These controversial elective c-sections get attention, but they aren't too common Yale University researchers estimate that they're less than 2% of all c-sections and less than 0.5% of all births.
You or your baby is in distress
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Episiotomy
What it is: Surgical cut in the perineum to enlarge the vaginal opening Helpful if:
Your baby needs to be born quickly. Your doctor or midwife needs more room to pull your baby out.
Episiotomy
Was thought to help reduce risk of tearing or incontinence May actually cause problems Can make recovery longer and more painful Most experts say episiotomies should be done only when necessary, not routinely Best protection against episiotomies is a caregiver who tries to avoid them
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Fast Fact
About 35% of women who give birth vaginally get an episiotomy but studies show that only about 7% truly need one.
Youll be numbed before the procedure and before you get stitched up Becoming less common
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Assisted delivery
What it is:
Happens when your baby is almost out Caregiver uses a vacuum or forceps to help pull your baby out Happens in about 1 in 20 U.S. births Done because baby needs quick delivery or mom cant keep pushing Vacuum: Flexible, curved cup stuck to babys head Forceps: Curved surgical tongs grasp babys head
Assisted delivery
Can leave bruising or blisters on your babys head You might need an episiotomy Higher risk of tearing If it doesnt work, youll need a c-section
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How can I avoid unnecessary interventions?
Interventions carry some risk and lead to more interventions To avoid unnecessary interventions:
- Choose a caregiver you trust and whose views ring true to you - Have a dedicated advocate - Practice natural pain management techniques - Ask questions
Chapter 9: After Your Newborn Arrives
Newborn screening tests

States require various screening tests 1 in 1,000 babies has something amiss Catching conditions early allows treatment before lasting harm is done Tests cause little discomfort
Consider asking:
- For a clear explanation of what your caregiver wants to do - Why its necessary - About the risks and benefits - Whether it could lead to further interventions - If there are alternatives - If it can wait
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Newborn treatments
Antibiotics in eyes Vitamin K injection Hepatitis B vaccine
Feeding your baby

Think about whether you want to breastfeed Recommended by many experts If you cant or dont want to breastfeed, your baby will drink formula Pros and cons to every approach Decide whats right for you and your family
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Reasons to breastfeed
Strongly recommended by experts Provides all vitamins and nutrients Helps protect babies from disease Can be good for you, too Much cheaper than formula
What if I have trouble breastfeeding?

Almost three quarters of U.S. moms plan to breastfeed Some women and babies have trouble Many sources of help Can use a breast pump and a bottle Worth trying right after birth Youll be producing colostrum Breastfeeding doesnt have to be all or nothing
Med Speak
lactation consultant = breastfeeding specialist colostrum = first milk, with powerful immune properties
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Reasons to formula feed

Formula is specially prepared to meet babies needs Can ask pediatrician for help choosing one Reasons to formula-feed include:
Poor sucking reflex Excessive pain during breastfeeding Returning to work Baby not getting enough milk Being away for a long time Medication that shouldnt be passed through your breast milk Desire to involve other loved ones
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Rooming in
Having your baby stay with you instead of in the nursery Nice way to bond and get to know your babys signals Can have your baby with you as much as possible or just when youre awake You might want your baby in the nursery so you can rest
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Cord blood banking

Saving your babys cord blood to later treat disease Cord blood is different than regular blood: a rich source of stem cells Can treat dozens of diseases Collecting cord blood doesnt cause any pain or discomfort
Cord blood banking

Private banking: Pay for your own familys use Public banking: Donate to a public bank
Private banking: - Expensive - Many families dont end up needing the cord blood - When baby has a condition, cord blood likely to be affected (and useless) Public banking: - Not available at all hospitals
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Fast Facts
About 5 percent of families bank cord blood 80 percent of collected cord blood is banked privately; 20 percent publicly Researchers estimate that anywhere from 1 in 2,500 to 1 in 200,000 families end up using their privately stored cord blood
Circumcision
Surgical removal of the foreskin at the end of the penis Practice is controversial AAP says parents should decide
Circumcision
Potential benefits
Fast Fact
U.S. circumcision rates Northeast: 64% Midwest: 78% South: 55% West: 34% Across all regions: 56% These percentages reflect the number of baby boys circumcised in a hospital. Some boys are circumcised in doctor's offices and other nonhospital settings, so the actual numbers are higher than what you see here.
Slightly lower risk of UTIs, cancer of the penis, and HIV May help prevent infection Religious beliefs, cultural reasons, personal preference
Potential risks
Complications like bleeding, infection, injury, improper healing May reduce sexual pleasure
If youre planning to breastfeed and circumcise, consider delaying circumcision until breastfeeding is going well
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Section III: Things to Do Before Youre Due

Chapter 10:
Your To-Do List
Chapter 10: Your To-Do List
Consider your options
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Create a birth plan

Helps you focus your thoughts about what you want Spells out your preferences so everyones on the same page No guarantee things will go according to plan!
Create a birth plan

Review your options Think about your goals Ask your partner for input Plan for the unexpected Write it down Review and revise, then finalize
Fast Fact
In a BabyCenter poll, 42% of moms say labor and birth didn't go at all as they planned but only 12% were really disappointed by the experience.
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Smart Tip
If you plan ahead, you can get a great tax break on the money you'll spend on medical care for yourself and your baby. Healthcare flexible spending accounts allow you to set aside money ahead of time, tax-free, for certain medical expenses. Be careful to put aside only what you're sure you'll spend, because if you don't use the money by the end of the year, you lose it. Talk to your tax professional or human resources representative for details.
Review insurance coverage

Understand whats covered and what isnt Find out how and when to add your baby to your plan Ask about coverage for your babys stay in the nursery
Arrange maternity leave

Find out what youre eligible for Fill out all the paperwork you can Understand your options in case of complications
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Take a tour
Smart Tip
Take a tour
You may be able to preregister at the hospital when youre visiting. (Who wants to fill out paperwork while having contractions?)
On your tour, youll: Find out where to park, enter, and check in See the rooms Visit the nursery Ask questions
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Photo courtesy of: Scripps Memorial Hospital, La Jolla
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Plan your trip

Map most direct route to hospital or birth center, as well as alternates just in case Have plenty of gas in the tank
Install car seat

You cant drive your baby home without one
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Pack your bag

Make sure to include: Drivers license or ID Insurance card Hospital paperwork Birth plan, if you have one Cell phone and charger Glasses Toiletries Camera Nursing bra Comfortable clothing for trip home
Line up help
Ask for help with food and housekeeping Many women ask for this as a baby shower gift Try to spread out the help over the first few months
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Practice natural pain management

If you practice, more likely to come easily Practice with your partner Can ease pregnancy discomfort
Enjoy some quality time
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Crib Notes Preparing For Labor and Birth

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Section I: Understanding Labor

Chapter 1: Whats Labor Like?

Chapter 1: Whats Labor Like?

Chapter 1: Whats Labor Like?

What are the main types of labor?

How long does labor last?

Chapter 1: Whats Labor Like?

Chapter 1: Whats Labor Like?

Where do women give birth?

What type of caregiver do women choose?

Chapter 1: Whats Labor Like?

Chapter 1: Whats Labor Like?

How many women use pain medication?

What do contractions feel like?

How some women have described them:

Chapter 2: Stages of Labor

Chapter 2: Stages of Labor

What happens to my body during labor?

Chapter 2: Stages of Labor

Chapter 2: Stages of Labor

First stage of labor

First stage: Early labor

Chapter 2: Stages of Labor

Chapter 2: Stages of Labor

First stage: Active labor

First stage: Transition

Chapter 2: Stages of Labor

Chapter 2: Stages of Labor

Second stage: Pushing

Second stage: Crowning & birth

Chapter 2: Stages of Labor

Chapter 2: Stages of Labor

Third stage: Delivery of placenta

What happens to my baby after delivery?

Chapter 2: Stages of Labor

Chapter 3: Signs of Labor

What happens to me after delivery?

Chapter 3: Signs of Labor

Chapter 3: Signs of Labor

Signs that labors coming

When to call your doctor or midwife

Chapter 3: Signs of Labor

Chapter 4: Birth Stories

Call your caregiver immediately if

Chapter 5: Banishing Labor Myths

Chapter 5: Banishing Labor Myths

Myth #2: Coping with pain

Chapter 5: Banishing Labor Myths

Chapter 5: Banishing Labor Myths

Myth #3: Pain medication

Myth #4: Laboring in bed

Chapter 5: Banishing Labor Myths

Chapter 5: Banishing Labor Myths

Myth #5: Eating and drinking

Myth #6: Baths

Chapter 5: Banishing Labor Myths

Section II: Key Decisions to Make

Myth #7: Doctors and nurses

Chapter 6: Where to Labor and With Whom

Chapter 6: Where to Labor and With Whom

Where can I deliver my baby? Hospital Birth center Home

Chapter 6: Where to Labor and With Whom

Chapter 6: Where to Labor and With Whom