You’re pregnant and overwhelmed with information overload. You’re not exactly sure what to expect in labor and delivery. Every person who stops you at the supermarket asks you if you’re pregnant with twins and tells you their childbirth horror story.
First of all, ignore them. You’re powerful and growing a human that could save the world. Also, their experience does not dictate yours.
I’m a Certified Nurse-Midwife with more than a decade of experience in birth. I’m also a mother who birthed four babies in very different ways. I encourage you to find a birth provider who shares your views. It’s the best way to ensure you feel empowered, listened to, and supported. According to the research, nurse-midwives produce extraordinary outcomes and fantastic care.
What should you expect in labor & delivery?
Now it’s time to get acquainted with the real story and try to alleviate those pre-birth jitters. Let’s look at the different birthing choices and what to expect in labor and delivery.
- Natural childbirth
- Pain medication in childbirth
- Epidural anesthesia
- Cesarean delivery (C-section)
- Vaginal Birth After Cesarean (VBAC)
Natural Child Birth
Natural childbirth is giving birth without pain medication. Often, people wish to avoid invasive medical interventions and maintain autonomy (control) during labor. Most of the time, labor and delivery are perfectly healthy periods. Eating and drinking during labor are perfectly acceptable if you’re low-risk and your baby is doing well. You also should be able to give birth in the position you want.
How can you best prepare for childbirth?
- Find a supportive provider who will try to avoid unnecessary induction of labor and pain medication and one who is open to different positions and movements for laboring and birth.
- Find a supportive birthplace. There are prospects like birth centers, home births, and hospitals. Do your homework on the safety of each of these. If you choose a hospital and want an unmedicated birth, ask about natural childbirth accommodations and c-section rates. Likewise, if you choose a home birth or birth center, find out what the process looks like if you become high-risk or experience preterm birth.
- Exercise throughout pregnancy. The more mental and physical stamina and flexibility you have mentally and physically, the better your chances of having an unmedicated birth. You don’t have to run marathons to reap the benefits of exercise, either. Yoga, swimming, and walking are excellent alternatives.
- Get a doula! Doulas reduce the likelihood of medical interventions in labor and increase your chance of having an unmedicated childbirth. A skilled doula can help find natural pain relief methods and often knows where to touch you to improve your pain!
What are the best ways to have a natural birth?
- Learn coping techniques beginning earlier in pregnancy. Some complementary therapies include music, aromatherapy, birthing balls, positioning, warm water, meditation, deep breathing, and progressive relaxation.
- Water, water, water. If you notice a theme with hydrotherapy, hydrating, and warm water immersion- it’s because water is fabulous for labor and birth. Some facilities encourage water birthing- if that’s something you want, go for it! Water is so crucial for relaxation and the processes of labor and birth.
- Eat! If your hospital doesn’t allow eating, eat on your way! Drink lots of water. Make sure that you stay nice and hydrated. Labor and birth are hard work! If you get dehydrated, your contractions may become ineffective and affect your baby and your heart rate. Drink up!
- It’s normal to feel like you want to give up. When that happens, you are usually in the labor transition phase and ready to begin pushing.
- Trust your body! It instinctively knows what to do.
- Let it go. If you don’t have the birth of your dreams, look at the positive outcomes. Focus on your strengths, and snuggle that sweet baby!
What method did you use for childbirth?
I polled the readers of this article for the method they used during labor between 2016 and 2019. I am pretty shocked that only 24% had an epidural.
- 50% Natural childbirth
- 12% Opiate pain meds (Nubain, Stadol, Morphine)
- 24% Epidural Anesthesia
- 15% C-section
Thirty-four people have voted in this poll.
What is epidural anesthesia?
Epidural anesthesia is currently the most popular anesthesia method during labor. An anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) inserts a thin catheter into the epidural space in the spine and then infuses medication.
Epidural anesthesia is regional anesthesia that blocks pain receptors in only a specific region of your body. It reduces discomfort by blocking pain receptors involved in labor and childbirth.
Epidural anesthesia gives pain relief and decreased sensation in the portion of your body (lower abdomen) that works so hard during labor!
Because it decreases the sensation in your legs, you can’t get out of bed after the epidural is placed. Usually, a nurse will empty your bladder with a catheter. Because your baby is navigating the passageway, it’s essential to continue with your position changes so that baby can get into a good place!
Epidural medications usually combine local anesthesia, typically your “numbing” medications: bupivacaine or lidocaine. They may be given concurrently with narcotics like fentanyl.
What do I need to know before I get an epidural?
In order to have an epidural, you will get an intravenous (IV) catheter inserted and IV fluids. You will need to have your recent blood count checked to ensure your platelets are at an adequate level (typically above 100,000 per microliter of blood). Checking that your platelets are normal will help ensure there are no issues with clotting or bleeding.
The anesthesiologist or nurse anesthetist is the professional who inserts your epidural. You can sit or sometimes lay on your side during the placement. A nurse will monitor your vital signs during the process.
You will push your back out like an angry cat. Cleaning your back with a cold antiseptic solution reduces your chances of infection. After that, you may feel a pinch or a bee sting as they inject local anesthesia (a numbing solution).
The anesthesiologist or CRNA waits until your back is numb and then inserts a needle through the skin of your back into the epidural space. They place a small catheter, which remains in place while you receive the medication. The needle is taken out, but the catheter constantly provides medication.
All done! The anesthesia team will tape the catheter down very well. While removing it may feel like back waxing, many patients would gladly endure a little tape ripping for pain relief.
I’m a midwife and talk to pregnant people every day. While the process sounds scary, contractions usually distract you during the placement. Sometimes the medication can cause your blood pressure or the baby’s heart rate to drop. You will know this occurs if you feel dizzy or lightheaded. This is temporary because medication called ephedrine can reverse the effects.
What are the options for pain medications?
Pain medication in childbirth includes opiate pain medication. Opioids are generally given through an intravenous (IV) port or an injection into your muscle. Nitrous oxide is another example of pain medication used in labor.
- Opiates: An opiate is an analgesic or medication administered to relieve pain after trying traditional measures like deep breathing, massage, and movement. These medications are given in small doses and early in labor to avoid side effects to the infant at birth. They may reduce the overall pain level but will not affect a patient’s ability to push. Side effects include nausea, vomiting, itching, dizziness, and respiratory depression.
- Nitrous Oxide: Patients who use nitrous may still be aware of labor pain. However, it can help you relax, reduce anxiety, and decrease the perception of pain’s strength. It is self-administered, so you can choose how much medication (dose) to use. The effects of nitrous oxide disappear within five minutes after stopping. Nitrous generally has fewer side effects than opiates.
Cesarean Section: Operative Delivery
Cesarean delivery (C-section) is a surgical procedure to birth a baby through an incision in the uterus and abdomen. There are many medical and elective reasons for performing a cesarean. There are several types of c-sections:
- Scheduled (planned)
Scheduled: If you have had a c-section in the past, you may schedule a repeat cesarean. Depending on your medical history and why you had the surgery, you may also have the option of vaginal birth after cesarean (VBAC). VBAC candidates may have to meet specific criteria, like a provider who performs VBACs and 24-hour anesthesia. Other requirements include a healthy BMI, adequate spacing between children, and the type of incision from your first surgery. If you have certain pregnancy complications, you and your provider may decide to give birth by c-section.
These scheduled complications include:
- Placenta previa occurs when the placenta is near or over the cervix.
- Vasa previa is when the blood vessels that the placenta and umbilical cord should protect are left open and vulnerable and cross the cervix.
- Herpes simplex virus (HSV) outbreaks occur immediately before or during labor. (Outbreaks earlier during pregnancy do not require a cesarean section unless they occur close to labor and birth.)
Urgent: A timely cesarean delivery is performed due to the deteriorating status of the pregnant person or baby but not an impending risk of maternal or fetal harm.
Emergent: The obstetrics team will perform a cesarean delivery as soon as possible due to imminent fetal or maternal demise. Your team will try to expedite the time between the decision for surgery and the cesarean birth.
What is malpresentation at birth?
Finally, if you have a breech (bottom first baby) presenting baby, you may have no idea what to expect in labor and delivery! The following options also apply to those expecting a transverse or shoulder presentation.
- An external cephalic version (ECV) is where they try to turn the baby from outside of your abdomen. First, the doctor will use an ultrasound to look at the baby’s position and see if the baby remains malpositioned. Next, you may get an epidural to be more comfortable. Finally, the doctor will use their hands to try to move your baby. If the ECV fails or you opt not to have one, you may schedule a c-section or the next option.
- You may choose to have a breech birth with a skilled provider. However, it increases the risk of head entrapment. Finding a qualified provider for vaginal breech birth is challenging if the baby is in a specific position (frank breech). Frank breech is when the legs are both up towards the baby’s head, and the butt is the presenting part.
I hope you understand your birthing options and what to expect in labor and delivery. In my personal experience, the essential part was feeling empowered and supported in my choices.
Birth and motherhood don’t always go according to plan. Sometimes babies have a strategy all of their own.
Did your experience go according to plan? Let me know in the comments!
If you’re looking for a nurse consultant or a content creator, let’s talk!
I am Caitlin Goodwin, DNP, CNM, RN. As a certified nurse-midwife with more than a decade of experience in obstetrics, I am an expert in low-risk pregnancy care.
This content is accurate to the best of my knowledge and does not substitute for treatment from a licensed health professional. If pregnant or nursing, consult with a qualified provider individually. Seek immediate help if you are experiencing a medical emergency.