An original post from the blog, Mom Smart Not Hard. Thank you for sharing with the Bodies for Birth community!
N was born on a Monday evening in late summer. Like many mothers, getting to the amazing moment of holding her in my arms for the first time was a long process, and quite different than I had envisioned. Let’s start at the beginning…
EARLY LABOR
It being late summer, and me being very pregnant in a house without air conditioning, I was making daily trips to the quiet lake near our house to cool off and enjoy the weightless feeling of being in the water when all other movements felt awkward and uncomfortable. It was a Saturday afternoon, four days before my due date that I was swimming at the lake. It was after Labor Day so the lake was pretty empty except a few other swimmers, and while I was doing my water “walking” exercises I felt my first contraction. It felt like a mild-cramping but I instantly knew it was different than the Braxton Hicks contractions I had felt earlier in this month of pregnancy. Something in my body just knew that this was the start.
I continued swimming and after a little while felt another mild contraction. I was excited to head home and tell Patrick that things were starting to kick-off. I was relatively sure we would have a baby within the next day or two. I really can’t explain how or why, but I just knew. Sure enough, this was the start of my labor. That evening I lost my mucus plug, but my contractions were still very, very mild, sometimes 60 minutes apart, and I was able to get a mostly good night’s sleep. Well, as good as anyone is sleeping at 40 weeks pregnant.
THE MUCUS PLUG
Losing your mucus plug is a definite sign that your body is preparing for labor, but this is not a definite sign that your labor is starting or that it is even imminent. It can happen a few weeks before the baby is born, or like in my case, at the very start of your early labor. It will look just as its name indicates, like a glob of mucus. A quick google search will tell you that they are usually white and clear with pink streaks, but that there is a wide range of what they can look like. If you lose your mucus plug it is a good sign that your body is preparing for labor. You can start taking it easy, sleeping as much as you can and doing any last-minute prepping because whether it’s a few weeks, days or hours, baby is coming.
I now knew that my body was in early labor and that my experience with early labor was much longer than the average. Typically, early labor will last from 6-12 hours, but because these are averages, and because many first-time moms may not be aware of the very early contractions that get things going (like the ones I felt in the lake) it is difficult to put a length of time on how long this phase lasts. Most definitions describe early labor as your body dilating to 3cm, but some sources consider early labor up to 6cm dilated. My early labor lasted around 24 hours if I’m counting from the first contraction at the lake. Everyone is different.
After sleeping that night, Pat and I woke up and because my contractions were getting slightly more intense, but still 30 minutes apart, we knew this was the real deal and decided to get some last-minute errands done. We went out to stock up on snacks, last minute food for the fridge at home and some food to bring to the hospital. We also took our dogs to a local “wash your own dog place”. I can’t be the only mama who groomed their dog in early labor, right? In all honesty, I look back on this memory so fondly. Pat and I had a blast washing the dogs and laughing and it totally helped pass the time and get my mind off the labor. If you are unable to rest, moving around and doing activities to keep your mind busy will really help pass the time. The labor-preparedness class that we took together recommended having some activities in mind to do during this part of labor when you are not in serious pain and instead just need a distraction. Many mothers like to bake, go on a walk, watch movies, clean the house (it’s the nesting thing) or spend time with family.
WHAT TO EAT
We got home around lunchtime and I was able to eat. I made some veggie soup and ended up eating this in small portions for the rest of the day, along with a light smoothie and drank lots of water. I had no desire to eat heavily but knew my body would need fuel. Light soups with lots of vegetables, trail mix and smoothies are all great options. Most importantly though, give your body what it’s craving! Nothing has made me trust and respect the power of my body more than giving birth. It is incredible the way that it knows exactly what to do to birth a baby.
I spent the remainder of the day resting. I napped in our hammock, laid in bed dozing on and off, and did some knitting. Pat, as he literally cannot sit still, spent most of this time prepping the rest of the house by doing laundry, mowing the lawn, hiking the dogs to tire them out, and putting gas in our car.
Once dinner rolled around my contractions were starting to gain intensity and were becoming closer together, like every 15 minutes at this point. I was uninterested in eating by now, but tried to get some food in my stomach, and drank a ton of water. As the night progressed my contractions got stronger and were inching closer together. We got into bed early and watched some sitcoms. Nothing like stupid humor to distract you from labor, seriously. Around 10pm I remember telling Patrick to get some sleep because we both knew we’d be heading to the hospital by morning at the latest. By now my contractions were painful enough that sleep wasn’t happening. For a little while I was able to knit between contractions and had my hot water bottle easing the pain I was feeling in my low back, while listening to an audio book. Soon they were close enough together that it wasn’t working. I pulled out my yoga mat and stretched and laid in whatever positions felt good, and used my yoga ball to support my head and arms while I was on my knees kind of swaying back and forth.
During this late-night session of my labor ramping up, our black lab was the sweetest companion. He laid with me, let me hug him, and was a presence I needed. By 2am my contractions were lasting a full minute about 4 minutes apart. I was using an app to track contractions. At this point I took a bath and then a shower, which felt really good. After about an hour, at 3am, things were feeling intense. My labor pains were suddenly wrapping around my back and I woke Patrick up. Based on an hour of contractions at 4 minutes apart, and the intensity I was feeling, I knew I wanted to call the midwives and see if they thought I should head in. Patrick called the midwife on duty and she asked to speak with me. We explained what was going on and she encouraged us to come in.
KNOWING WHEN TO HEAD TO THE HOSPITAL
The general rule of thumb is that you should at least call and think about heading in when your contractions reach 4-1-1. That means, contractions happening every 4 minutes, lasting for 1 minute, for 1 hour. Now this is just a place to start, and like all things birth, there is a wide range of normal. Additionally, I want to add that you should call and go in whenever it feels right to you. They will examine you and you can always leave. If you feel safe and more comfortable laboring in a hospital then that’s what you should do! When visualizing my birth plan, I thought for sure I would want to labor at home for as long as possible, but when push came to shove (literally) I really wanted to head there as soon as contractions were close together for my own peace of mind. I felt much more comfortable knowing that we were in the hands of the midwives and hospital staff.
ACTIVE LABOR
My birth plan didn’t rule out any possible interventions in their entirety, but instead I hoped to use coping mechanisms that didn’t involve having to stay in bed or heavy medication – spoiler alert – I ended up getting an epidural and have zero regrets about it. But let’s get back to the timeline to see how it progressed for me.
Once we got into our labor room, I felt much safer and secure. Now that I have had my first baby, I do think that I will aim to labor at home much longer, but for my first delivery being in the hospital made me feel better. Follow your instincts. The more comfortable and relaxed you feel mentally, the more positive your labor and delivery will seem. Upon arrival they had me put on a hospital dressing gown and a thick, spandex-like band that went around my stomach. This is so monitoring can easily be conducted with devices against your stomach and you don’t have to hold them there. Once I was situated, the midwife came in and checked my dilation, I was 3 cm and remember this feeling very defeating. She and the nurses did an amazing job at congratulating my hard work and making me feel good about my decision to come when I did. The midwife helped me devise a strategy of what to try first. I felt my labor almost completely in my low back and it was excruciating.
WHAT IS BACK LABOR?
I had never heard of or read about back labor before my birth, and I think it’s important for expectant mamas to know what this is in case this ends up being their labor experience. Many women who experience back labor with one birth and ‘regular’ labor with a second birth will say the experiences are completely different. Many resources will tell you that back labor is more painful, but some mothers say the opposite. Whatever it may be, each labor and birth are unique and comparison is probably not helpful. What is helpful is knowing strategies about how to cope. Back labor more often results in pain interventions that the same mother might not have needed with more common labor pain and that’s okay. Back labor is often caused by the position of the baby. If your baby is “sunny side up” or occiput posterior, then you may experience this. This is not always the case, N was not positioned this way, and I still felt my labor all in my back. Some other causes might be a shorter torso (which is probably what was the case for me), previous back pain, weak ligaments/muscles, and pelvic shape.
Many of the same coping strategies are effective as with regular labor but heat applied to your low back in the form of a heating pad, hot water bottle, shower jet, or warm bath can feel especially good. Light, low-back massage was also extremely helpful for me. I remember laying over the yoga ball on my knees in the shower at the hospital while Patrick rubbed my low-back for a very long time. This really helped me progress longer in my labor without interventions. Be sure to speak up about what feels good and coach your partner to get what you need, i.e. rub harder, lower, softer, to the right, etc. They are probably feeling just as nervous and helpless and just want to do whatever they can to help.
On that note, when Patrick and I wrote our birth plan and had discussions about our birth, it was important to me that he understand my intervention plans and the coping strategies I thought would work. I knew that I would need him to have a level head and be ready to suggest things to try when I was in the moment, and I was right. Patrick did a great job of suggesting new things to try to put off pain interventions longer, and when he didn’t know what to do he was assertive towards getting a nurse or midwife in the room to help. I was so happy with my decision to birth at a smaller local hospital rather than traveling a bit further to a larger hospital. They average only six births per day, and this meant that I got a lot of one-on-one attention from my nurses and midwives. My nurses cheered for me during labor, brought us water, massaged my back and helped show Patrick what he could do to help. They were an amazing part of my birthing team and I couldn’t have done it without them.
By 9 or 10am the shower just wasn’t cutting it anymore, neither was walking around, the yoga ball or anything. This span of time from 3 to 9am is an absolute blur. I cannot remember many details, but just flashes of feelings and scenes. I remember hugging Patrick and almost “slow dancing” for a while, I spent a lot of time in the shower and some time sitting backwards on the toilet. This can be an extremely effective laboring position because it is a place where our bodies are naturally conditioned to ‘release’. I remember being on hands and knees on the floor and using the birthing ball that was in the room. Towards daylight, I remember being back in the shower for a long time and when I got out of the shower, I was freezing. Everything I read told me about how hot I would be and not to bother packing anything warm, the opposite was the case for me. I just couldn’t warm up! The nurses helped get me into a flannel hospital gown and luckily I had brought fuzzy slipper socks and this helped a lot. Just remember, that you never know how you are going to feel, and in my opinion, having a variety of options is better. At this point I was SO ready for the epidural. I was howling in pain and asking for it.
Patrick and the midwife knew that my goal was to deliver without an epidural and despite my pleas they convinced me that I should try using nitrous oxide first
WHAT IS NITROUS OXIDE AND HOW CAN IT HELP IN LABOR?
Nitrous oxide is a coping intervention used widely across Europe during birth and is starting to become more prevalent in the United States as well. The hospital where I delivered started offering nitrous as an intervention about 6 months before my birth, and I was glad to have it as an option. Nitrous oxide is a helpful medical intervention during labor because it is known to have anti-anxiety and pain reducing effects. It is given in a blend of 50% oxygen and 50% nitrous oxide and is self-administered under the supervision of a nurse. Because it is taken by inhaling, the effects of the nitrous oxide can leave the system within 5 minutes of an inhale if you are unhappy with the way it feels. And for the same reasons, as soon as you are set up with a tank and breathing mask, it takes effect immediately.
Women have different thoughts and experiences with nitrous oxide, but I highly recommend at least considering it in your birth plans because if you decide it is not for you, that’s it, it can be over. And if it does wind up being successful, then it might be the less invasive pain intervention you need to make it through your birth without an epidural, if that is your goal.
Prior to my birth, I read about nitrous oxide and spoke to my midwife about it as an option and knew it was something that I was interested in trying. In the moment of my labor, nothing in my brain could have convinced me that it would actually work, at that moment all I wanted was the epidural. Patrick and the midwife encouraged me to give it a try and told me we could immediately call for the epidural if I didn’t respond or think it was enough. To my surprise the nitrous made a HUGE difference and helped me go another 3 hours and get to 7 cm without the epidural. I am so grateful for their “pushiness” because it really worked and made the timing of my epidural perfect for it to last through my delivery.
For me, nitrous mostly helped me to feel calm and breathe through my contractions in a more rhythmic way. It allowed me to lay on the bed on my side with my legs opened with a stack of pillows and rest. At this point I was beyond exhausted from so much intense laboring (11 hours at this point of painful contractions). I think I was even dozing for a few minutes of time between some of my contractions- that’s how relaxed it help me feel. I liked being in control of the medication and think that it did help with my perception of the pain. For a little while I was feeling so much better with this intervention at my disposal that I was actually chatting with the nurse and Patrick and laughing! They don’t call it laughing gas for nothing (although the proportions are much weaker than you get at the dentist). The nurse was asking if it was our first, and about our families. Pat eagerly told her about his 7 siblings and how he doesn’t want a big family, probably just four…what a time to mention this!
After about two and half hours of laboring with the nitrous, the positive effects just weren’t cutting it. As I was dilating, my contractions were becoming more and more intense and closer together. I was beyond exhausted, in a lot of pain that the nitrous was no longer masking the pain. I was scared and knew that it was time for the epidural.
GETTING AN EPIDURAL
As I mentioned, going into my birth I was hoping to deliver without this medical intervention but hadn’t ruled it out completely. I mostly wanted to let my body and mind experience delivery naturally, but I was also terrified of have a needle injected into my back. That’s how I knew that I needed it. That fear went completely out the window and all I wanted was relief.
An Epidural is a regional aesthesia that will provide pain relief in a specific area, in this case most of your lower body. I think it is important to learn that the goal of an epidural is not complete numbness from the waist down, but rather to ‘block the nerve impulses from the lower spinal segments. This results in decreased sensation in the lower half of the body.’ (see sources at the end of this article). This is exactly how I would describe my experience. I was still able to feel the ‘wave’ of my contractions but without any pain. This was important because when it came time to push I could feel the roll of each contraction to optimize my pushing.
Inserting the epidural is a lengthy process. It takes some time for the anesthesia team to get to your room and you have to be sitting up straight on the edge of your bed. Luckily, the doctor administering mine had excellent bedside manner and was sensitive to my needs in labor and was careful to time his insertion between contractions. I was so scared. I was crying hysterically and finally announced how scared I was to the whole room and the entire tone of the room changed for the better. Everyone became a lot more vocal in their support towards me and the midwife recommended I use the nitrous while having the needle inserted because it had helped me with the fear and anxiety previously. I felt a lot better after I told everyone how I was feeling and was ready to do it. The anesthesiologist prepared to do the injection and immediately the most intense rush of pain shot up my back and down to the tips of my toes and I let out a holler that alarmed the entire team (and believe me, I was a very vocal laborer up until now). It turned out that when they went to insert the needle he accidently hit a nerve in my back which caused that sharp and intense pain to shoot through every fiber of my body. There were no adverse effects, and truly I was not upset or angry at the man, but it took me completely by surprise and didn’t help with my fear of the whole situation.
We took a 15-minute breather and attempted again, that’s how badly I wanted this, and this time had no issues. Within 30 minutes I was literally on cloud nine. A calmness took over my body and the entire room. I could still move my legs slightly and wiggle my toes but no longer felt any pain. My body was so relieved to be able to rest and I was sure that I had made the right decision. We put nature sounds on the hospital TV and Patrick and I both dozed for a while. At some point in the afternoon while I was lightly sleeping in the hospital bed I felt my water break, and it became clear very quickly that there was meconium, the name for a newborn’s first poop, in my amniotic fluid.
In the end, I did feel that getting the epidural was the right decision for me, but I have now learned so much more about ways I could have prepared more to attain my goal of a natural birth and even after this experience it will be my goal to deliver without pain interventions for my next birth. I have since learned about hypnobirthing. It is a program designed to change your entire mindset about birth to be more positive, equip you with tools for natural pain management through breath and meditation, and educate you on your body’s functions to help you feel prepared and ready to trust that your body can do this immense job that it was built to do. To learn more about this incredible program check out Hypnobubs Online Hypnobirthing Class.
This meant that N had pooped in utero and that it would be important to monitor her closely when she was born because it can be very dangerous if baby inhales the poop when they take their first breath because it can block their airways or cause meconium aspiration syndrome (MAS) which is similar to pneumonia. Now, I don’t want you to be alarmed if this happens to you. It happens in about 13% of labors and is most often not a cause for alarm. As long as there are no other indications of problems with baby or that baby is under stress your labor will progress normally like mine will. They will suction the baby’s nose and mouth upon birth and as long as baby’s APGAR score is sufficient at birth, that’s all there is to it. I feel fortunate that we did not experience further complications and that N did not have any breathing issues or complications due to the meconium. My midwife told me in a very low-key way which did not cause any concerns or alarm to arise. She answered all of our questions about what this would mean and even described a worst-case scenario at my request, which essentially was that baby would need to be moved immediately to the neonatal ICU if her airways were blocked or MAS was in play. Fortunately, N’s APGAR score was fine, and there were no complications.
The nurses did an excellent job of positioning me in different ways on the bed to help promote dilation and by 6pm I had full dilated. The midwife came in to do a check and no one had anticipated it to be time yet, but there she was saying, “Who’s ready to have a baby?!” Patrick and I had a playlist that we loved and had been listening to for most of the summer, it was an easy choice for delivery music. While I hadn’t been interested in music during my labor and we just had it on for background noise, I am so glad that we put this playlist on during pushing and delivery. The midwife, pediatrician (who needed to be in the room because of the meconium) and nurses were all tapping their toes and enjoy the music as well between pushes. It is a sweet, and dare I say, fun memory I have of N’s birth. They even all commented on how our delivery room was the place to be with the music and fun energy in the room. We still listen to this playlist today and tell N that she was born to it.
Pushing was a quick process for me and my perception of it was a lot worse than what it was. All women are different and I can only describe my experience. I think I had this built up in my head as being the worst part, but because my labor wound up being so exhausting and painful and with the epidural in place, I found pushing to be really manageable. I even said to the midwife during it, well this isn’t so bad, and everyone laughed. Like I mentioned earlier, because I wasn’t totally numb and I could feel the waves of my contractions, the midwife helped me learn how to time my pushing with the peak of each contraction, making my pushes more productive. She told me to literally think of it as the pushing you do when you need to go to the bathroom, and that’s exactly what I did. After only about 30 minutes or so baby N came out, it felt like a slipping motion and was the most intense relief of pressure I have ever felt. Patrick and I were both in tears.
N was placed on my chest for immediate skin-to-skin, and Patrick cut the umbilical cord, per our delayed cord clamping wishes. N was wide eyed on my chest in the delivery room and grasping onto Patrick’s finger. Within 20 minutes of being born she was rooting on my chest and the nurse helped me latch her for her first feeding. What a sweet and magical moment that I will never forget. It is so raw and amazing the way your body can provide exactly what your newborn needs and the way that she biologically and instinctually knew how to get what she needed, truly a miracle.
