Thursday, February 26, 2015

Expectations of a normal vaginal birth

Today, I am sharing with you what you can expect during a normal vaginal birth. We will mostly go over different terms the nurses and docs will throw around as well as some other terms that only some "seasoned" mothers will be familiar with.

First things fist, what are common signs that your body is preparing for labor soon 

  • the baby will drop which just means that the baby will move into "go-time" position by dropping deeper into your pelvis *hopefully* head first.  Some women notice, others not so much. I couldn't really feel a difference because by that time, I was feeling just a little smaller than a beluga whale. However, I had at least a dozen people (mostly my coworkers who were also nurses or providers) tell me that I had "dropped."
  • more regular Braxton-Hicks contractions.  These "practice contractions" occur throughout the pregnancy though, so don't count on these too much. If they aren't regular and increasing in strength or frequency, then it's just your uterus doing some exercising.
  • Mucous plug. I just remember being disgusted each time I discovered my mucous plug had come out. It's basically a "cork" in your uterus opening and the release of it generally means labor is soon.  Now, each body is different and soon might be tomorrow or perhaps a week.
  • Dilation and effacement- your cervix may be ripening (or softening if ripening sounds too much like fruit) and prepping for baby to make its debut.  Dilation is the cervical opening widening and effacement is the cervix getting shorter/thinner. I will cover more on this in the next section below. Take a look at this video clip to visualize it better:

Signs that labor is about to begin or very near:
  • Your water bag breaks.  The amniotic sac is the thin membrane that lines the uterus, is attached to the placenta, and holds the baby and all the amniotic fluid.  This can rupture on its own before any contractions are ever felt (less common) and it could be a trickle of fluid or gush depending where the baby's head/body is.  Providers sometimes rupture the sac by assistance or they will let it break on its own, depending on their practice methods.  Call your provider as soon as this happens as each one will have a specific protocol they follow.
  • Contractions, the rhythmic movement of the uterine muscles that move the baby down, will be more frequent, about 3-5 minutes apart, and will increase in strength over the duration of time. This is key.  It can be confusing to any mom when contractions are felt and they feel strong but then go away.  The usual pattern is increased strength and frequency. For me, contractions felt like menstrual cramps that radiated upwards through my whole abdomen and, later in labor, to my low back as well.  Depending on the birthing method you choose, your contractions could feel different (pain vs pressure).
Let's take a moment to discuss dilation and effacement again.  You will hear these terms throughout your pregnancy and on Facebook statuses of laboring moms.  Right? "______ is at 6 cm now and 80%!!! Baby will be here soon!!" Dilation/effacement can occur weeks before labor actually begins though! For example, I had been having irregular contractions around 35 or 36 weeks and my doctor thought she'd just check and I was already 3 cm.  By two days before I went into labor at 38 weeks, I was 5 cm dilated- just walking around and working, halfway done with labor (ha! If only labor could be something we multitasked). To deliver, you must be dilated completely and go from 0 cm to 10 cm and be 100% (or close) effaced (paper thin).

One more term you will hear during labor is +/- station. This refers to where the baby's head is at in your pelvis.  Generally, you will here a range from -3 to +3. -3 is at the very top of your pelvis and +3 is when the baby is "crowning." Crowning is the visibility of the top of the baby's head beginning to peak out.  Here is another visual aid for fetal stations: 

We are so close to the actual birth now! Just to refresh you from previous pregnancy readings, labor comes in three stages (four if you're in nursing school).  The first is when productive contractions begin and you are awaiting complete dilation and effacement.  The second stage is actively pushing the baby out resulting with the delivery, and the third is the delivery of the placenta.  You will likely hear all about the ring of fire if you are researching med-free births- it is the reported burning sensation a woman feels as she is crowning and the skin is stretched to capacity.  Note that I say "reported" because I personally did not feel it during my med-free birth experience.  Some providers consider recovery as the fourth stage, but you probably won't hear this that often.  

So when the baby is coming out, your provider will try to as gently as possible guide the head out first.  Babies have flexible skulls that mold to the shape of your birth canal as they exit, hence some babies have coneheads when born.  Also, our coccyx bone (tailbone) is flexible, albeit somewhat limited, but can generally accommodate a baby.  After the head is out, your provider will untangle the umbilical cord that is sometimes wrapped around the baby, and guide one shoulder out at a time.  After the shoulders, the baby will come out more quickly.  Keep in mind, you are pushing during this time, often with your provider saying "push now, hang on, ok push again, wait," etc.  You may have a little more control with an epidural but without any medication, you may feel little control as your body goes into autopilot mode.  Time to visualize the birth with the following clip (don't you love the classical music accompanying the videos?):

The placenta will deliver on its own between 15-30 minutes postpartum (after birth). Sometimes the provider will tug on it gently to help it come out.  So that's what a normal delivery looks like! Complications, often minor, can arise at any point and interventions will be necessary.  Some common interventions during the second stage (pushing):

  • forceps: if baby is posterior, gravity is working against you, or perhaps just  "stuck," your provider may suggest forceps use.  They look like giant metal salad tongs.
  • vacuum: it is what it says and looks like- a baby head vacuum.  The suction may be just enough to help pull the head out, the widest part of the baby. 
    *just my personal input- I would try to avoid forceps at all costs if I could do my first delivery all over.  It is very invasive and will cause more tearing deeper inside, which makes recovery worse.  Nonetheless, if it can't be avoided due to safety, then take the forceps.
  • episiotomy: this is an assisted cut to your perineum, the skin that is between the vagina and anus.  This will stretch thinly during the second stage and sometimes tear on its own (see this site more on the degrees of tearing) but if the provider feels that the natural tearing may be worse than an assisted cut, they will perform an episiotomy.
  • amniotomy (or artificial rupture of membranes): this is when the provider ruptures your membranes/water bag.  The tool used looks a lot like a large crochet hook.
Common pain medications and other meds used during or to induce labor:
  • epidural/spinal block
  • IV or IM (muscle injection) narcotics- a common one is Nubain but I have also heard of morphine being used
  • pitocin- also nicknamed "pit." Many women either have labor induced with this or if their labor is not progressing fast enough, they will be started on it.  It increases the strength and frequency of contractions. Sometimes a shot after delivery will be given just as protocol for postpartum bleeding or if there is a little excessive bleeding, an IV infusion will be started postpartum.
  • prostaglandins- medication inserted into the vagina to induce labor. Cervidil is the most common one I know of.  Prostaglandins are naturally occurring hormones that when stimulated help soften the cervix and kickstart dilation/effacement.  A common protocol with this one is being admitted just before bedtime to induce labor overnight.  If labor doesn't start, than other induction methods will be used.
    • other induction methods I know of: is the use of a Foley catheter.  A Foley catheter is typically used to drain the bladder.  It has a balloon near the tip and instead of inserting it into the urethra, it is inserted into the vagina and the balloon is inflated in the opening of the cervix, applying pressure to it to hopefully start the natural release of prostaglandins. Membrane sweep- or also called "stripping the membranes.  This is done in the office, often when the provider suspects labor is nearing and only if you are term and dilated to 1 cm or more.  The provider will use their finger and sweep along the inside of the cervix to manually pull the membranes away from the cervix.  This can also stimulate the release of prostaglandins
Before I end this post, I want to share a little about the, *ahem*, less glamorous aspects of a vaginal childbirth:
  • you're often naked or really exposed.  Your va-jay-jay is everyone's business and really, you probably won't care after a couple of hours and a little fatigue.
  • there can be poop involved.  It happens. But don't worry, your nurse will be really professional and probably not even make a comment cleaning you up because it happens to many women. And it'll be so fast, you may not even know it ever happened. Seriously, you're pushing like you're about to have the largest bowel movement of your life.
  • you may say crazy things or get angry at loved ones
  • you may get nauseous and need to expel some contents out of your stomach
  • Feel free to comment below about other less glamorous things
Hoping this is another helpful post, let me know if you have any questions and I will do my best to answer you or find the correct answer!

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