There is a lot to get up to speed with when it comes to Labor and Delivery and child birth. We enlisted L&D Nurse Liesel Teen to help us answer some of the most frequently asked questions about Labor and delivery. As always, this isn’t intended to replace the advice of your provider.

 

What are Early Labor Signs?: 

There are many signs that your body is getting ready for labor. Here are a few that consistently show up.

  1. Mucus Plug / Bloody Show – Throughout your pregnancy your cervix issealed shut with a plug of sticky mucus. When your cervix starts to dilate, this mucus starts to release. It can come out all in one piece, or little by little. This can be clear, or be tinged with brownish reddish blood. 
  2. Increase in vaginal discharge.
  3. Increase in Back Pain
  4. Plateau in weight gain
  5. Baby drops – this might happen in your final few weeks of pregnancy. The baby starts to descend moving their head into the pelvis in preparation for birth. 

 

What are Signs of Labor? Stage 1

  1. Contractions – you’ve probably experienced Braxton Hicks contractions throughout your second and third trimesters. But these contractions are no longer painless. These contractions are stronger and longer and are more consistent.  
  2. Water Breaks – This is the most obvious sign of labor, but only ~15% of women will experience this prior to being in active labor. Despite what hollywood would have you believe, it’s not as dramatic as it may seem. Sometimes it’s just a trickle of fluid. It’s rarely a huge gush.

 

What does a contraction feel like?

This is one of the harder questions to answer because it’s different for everyone. For some women it starts in their back and slowly moves up and around. Others will describe it as starting everywhere. When labor is just beginning, they start out pretty mild like menstrual cramps, as your labor progresses the intensity will increase. When you are in active labor, a contraction can be all encompassing. Having a strong foundation or pain management, breathing techniques and comfort care measures is so important. The Juna Birth Prep course has an entire section on different things you can do to help manage labor pains. 

 

Is Diarrhea a sign of labor?

Throughout your pregnancy you may have experienced bouts of loose stools. But if you are nearing your due date, looser stools may be a sign that labor is near. Some women have reported bouts of diarrhea right before they started active labor, while others report having diarrhea throughout the whole first stage of labor. Contractions are putting pressure on your entire abdomen so it’s very common for the contractions to irritate your bowels as well. But look on the bright side, the more that comes out during labor, means the less comes out on the table when you are pushing. Which leads us to our next popular questions.

 

Will I poop during labor & delivery?

This is the number one question Liesel gets from first-time moms, and yes, most women do poop during labor. But the good news is, it’s a sign you’re pushing correctly. 

“If you poop while you’re pushing, you’re actually pushing effectively. You’re just taking a really big poop, you know, that’s what it feels like. The thing I tell people is if you’re pooping, then you’re doing the right thing, you’re pushing in the right spot.

“If you think about the mechanics of having a baby, your baby has such a large head and it’s coming through your vagina. And your vagina is right next to your rectum where your poop sits.

“So as your baby is coming down and dilating your cervix, it’s putting a lot of pressure on your rectum, so it feels like you have to poop. It’s creating a lot of pressure, so anything that’s in there is going to come out because it doesn’t really have anywhere else to go.

“I try to tell people, ‘don’t be concerned about it.’ If you poop on the table, they clear it away so fast, you don’t even notice.”

How Painful is child birth?

Giving birth is physically painful, but how bad it hurts depends on the person and their methods of pain management.

“What I tell people realistically about labor is, it usually starts out with very, very painful period cramps coming and going every few minutes. Then it [progresses to] the worst period-type cramps that you’ve ever had in your entire life, along with pressure.  You might be vomiting and have nausea, it’s just not fun. I don’t want to sugar coat anything.”

Educating yourself about the physiology of birth and your pain management options will help you work through any pain-related fears and anxieties.

Will I tear during birth?

The majority of first-time births will involve some form of tearing of the perineum, i.e. the skin between your vagina and rectum. 

“If you’re going to tear, you’re probably either going to have a first or a second degree,”Liesel says. “The biggest risk for tearing is just being a first-time mom and never doing it before.”

  • First-degree tears involve the skin and tissue of the perineum. These may heal with or without stitches.
  • Second-degree tears involve the perineum and some of the tissue inside the vagina. This tear requires stitches and a few weeks of recovery.
  • Third-degree tears involve the perineum and the muscle surrounding the anus. This tear often requires surgery and may take a bit longer than a few weeks to heal.
  • Fourth-degree tears involve the perineum, anal sphincter, and the mucous membrane that lines the rectum. Like third-degree tears, this tear requires surgery and a longer recovery time.

 

Source: American Pregnancy Association

How can I minimize tearing?

Labor & delivery

One of the scariest-sounding things about birth is the perineal tear. Perineal tears are when the perineum, i.e. the skin between your vagina and rectum, naturally tears to make room for the baby’s head as it’s coming out. 

The majority of first-time births will involve some form of tearing, the most common being first and second-degree tears, which are stitched up and healed by four to six weeks. Third and fourth degree tears are much less common, occurring in roughly 6% of first-time births and 2% in consecutive births. Source: [RCOG](https://www.rcog.org.uk/en/patients/tears/third-fourth/) 

While there’s no way to completely prevent tears during a vaginal birth, there are ways to try and minimize them. 

  1. Take a Birthing Class – Educating yourself is key. Take a birthing class to learn techniques for slow and controlled pushing, then practice breathing and connecting with those muscles.
  2. If you’re planning an unmedicated birth, you’ll be able to physically feel how you’re progressing. If you’re going for an epidural, communicate your technique to your provider so they can support and guide you while you push. Some providers offer mirrors to help keep your eye on the prize.
  3. Strengthen Your Pelvic Floor – A strong pelvic floor won’t necessarily prevent or minimize tearing, however it will likely help with recovery.
  4. Be sure to do your kegels and choose workouts that engage your pelvic floor, like squats, bridges and bird dogs. Juna has a whole library of workouts designed to engage that specific area.
  5. Perineal Massage – This is definitely not comfortable but there is evidence to suggest that it can be helpful in minimizing your tear.  After 35 weeks, your provider might recommend starting perineal massage at home, which involves washing your hands, then placing two lubricated fingers at the opening of your vagina, and applying pressure as you sweep from side to side. Your partner can help with this as well, and your provider might perform perineal massage during labor. Check out this blog post on how to perform perineal massage.
  6. Keep Your Perineum Warm – Placing a warm cloth on the perineum during the second stage of labor may also help soften the skin around the vagina.
  7. Change Positions Switching up your birthing position may aid in your pushing. The most common birthing positions include:
  • Reclining
  • Squatting
  • Kneeling
  • A birthing bar or stool
  • There is some evidence to suggest that delivering in the side lying position can reduce the risk of tearing.

Contrary to popular belief, you can change birth positions with an epidural. Talk to your provider about your options.

 

Know How to Manage a Tear in Postpartum recovery

If you do end up with a tear, knowing how to manage your recovery will go a long way. Here are our tried and true tips:

  • Ice the area ASAP with ice diapers or padsicles.
  • Spray the area with Dermoplast, a cooling and numbing agent.
  • Use a peri bottle when you pee to dilute the acidity of your urine and minimize stinging.
  • During bowel movements, wrap your hand in toilet paper and apply pressure to the perineum to support and ease pain.
  • Take Motrin or a preferred prescription painkiller.
  • Rest as much as possible for the first two weeks postpartum. The first two weeks are critical for proper tissue healing.
  • Air out the area, wear breathable clothing and avoid tight underwear.
  • Sit down while coughing and sneezing if those instances are painful.

 

What is an episiotomy and will I need one? 

An episiotomy is when your doctor makes an incision in your perineum during birth.

“Episiotomies are much less common than they used to be back in the day. I think the current U.S. statistic is like 2 percent of deliveries,” Liesel says. “So it’s pretty low. There are still some old-school doctors that kind of do them routinely, but for most deliveries, we are getting away from that practice because we’re seeing that tearing naturally is actually better for you.”

Episiotomies are usually only used in emergencies, such as the baby being stuck due to shoulder dystocia, or if there’s a risk of damage to your urethra during delivery. 

Physical recovery from an episiotomy is similar to a tear, which will require stitches, recovery management and follow-ups with your provider.

 

When to go to the hospital for labor & delivery?

The simple answer is: you’ll know. 

But if you’re a first time mom, it’s impossible to grasp what it’s like the moment you know you need to head to the hospital. 

“If you are, number one, no longer questioning that you’re in labor, and you’re having other signs that you’re in labor, whether you’re vomiting or sweating, then it’s time to go to the hospital,” Leisel says.

Many women follow the 4-1-1 rule: contractions that are 4 minutes apart, 1 minute long and last for 1 hour. We recommend you download one of those apps to keep track. It will make it much easier when trying to track your trends. This is something your partner can take charge of!

Note that many medical groups and hospitals won’t admit you until you’re at least four centimeters dilated —so that’s another great question to ask your provider if you don’t want to just be sent home. 

How do I know if my water breaks?

The dramatic gush in the middle of the grocery store most commonly happens in movies and not in real life. It’s often a form of leakage, from a trickle to unusually damp underwear. 

If you feel your water has broken, Liesel says to first check with your provider before heading to the hospital. Depending on your situation, they might advise you to lie down and wear a pad, especially if contractions haven’t gotten intense yet.

“If you come up to the hospital and your water has broken already, then we’re not going to send you back home. You’re going to stay until you have your baby.” So if laboring at home is something you want to do, we recommend you do that until your contractions are regularly 4-1-1.

Most providers advise going to the hospital within 24 hours of your water breaking to avoid infection. 

When should I get an epidural? 

The timing of your epidural is a personal choice, and in most cases, you can get one any time until the baby starts crowning. However, there are a few things to consider before paging the anesthesiologist. 

If it’s a busy day in your hospital’s maternity ward, the anesthesiologist may take some time to get to you. The process takes about 15 minutes, and it kicks in within 20. 

After the anesthesiologist administers your epidural you will:

  • Receive a catheter
  • Be hooked up to an IV
  • Not be able to eat
  • Be bedridden for the duration of your birth

So the earlier you get your epidural, the longer you’ll be in that position. 

While hooked up to your epidural, your L&D nurse will help you change positions to help the baby come down. 

Talk to your provider about what they recommend for timing your epidural.

How do I prepare for birth?

“My number one piece of advice is to just continue to educate yourself, and that goes for if you’re having a vaginal delivery or you’re having a c-section,” Liesel says.  

Think about how you envision your birth. Do you want an epidural or a natural birth? Do you want to deliver at a birth center or hospital? 

Make sure your provider is on the same page and ask as many questions as you want. 

“Another tip I would give going along with [educating yourself] is listen to birth stories. Talk to your family members about their births, whether they’re traumatic or beautiful birth stories, it’s good to hear a mix of everything.

“Just continue to [have] goals for yourself in birth. It’s going to make it a lot less scary and a lot less anxiety-provoking if you go into it educated.”

Juna has a Birth prep video course available in the Juna App.

What should I know about recovery?

Giving birth is a monumental event for your body, so giving yourself the time to heal is key. Take all the help you can get —not only will you need it, you’ll deserve it.

For both vaginal and c-section births:

  • The Shakes: After delivering your baby, you might experience uncontrollable shaking for a few minutes to an hour. The combination of adrenaline, hormones and painkillers (if applicable) creates a shaking response in your body. While startling, it is normal. If you experience shaking in the days following birth, contact your provider.
    • Uterine contractions: Your uterus will start contracting down to its normal size, which can be painful. Breastfeeding speeds up this process, and can also intensify the pain. Your provider can prescribe a painkiller for this.
    • Breastfeeding: While breastfeeding is natural, it rarely comes naturally. It can take weeks to get in the breastfeeding groove, so if you’re planning to breastfeed, educate yourself and give yourself grace.

 

  • Bleeding: Bleeding for two weeks postpartum is completely normal. If you feel your bleeding has suddenly gotten heavier, take some time to rest. If it hasn’t subsided, call your provider.

 

  • Postpartum preeclampsia: Although rare, postpartum preeclampsia can be dangerous if undetected. It can occur within 48 hours after birth, and more rarely, 6 weeks after birth. Contact your provider immediately if you experience any of the following symptoms:
    • High blood pressure (hypertension) — 140/90 millimeters of mercury (mm Hg) or greater
    • Excess protein in your urine (proteinuria)
    • Severe headaches
    • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
    • Upper abdominal pain, usually under the ribs on the right side
    • Decreased urination

Source: Mayo Clinic

For vaginal births:

  • Ice the area on and off for 24 to 48 hours with “ice diapers” or “padsicles.”
  • Wear breathable mesh underwear.
  • Take prescribed Motrin. 
  • Use Dermoplast spray to cool and numb the area.
  • Use a peri bottle to rinse the area while urinating (it will reduce stinging).
  • Use Tucks pads to soothe hemorrhoids.

 

For c-section births:

  • Since a c-section is a major surgery, expect to stay in the hospital for three to four days post-birth. 
  • It takes roughly 8 weeks to physically heal from a c-section.
  • Apply padsicles to your c-section incision by sticking them to the inside of your high-waisted mesh underwear.
  • Stay on top of your incision care to avoid infection.
  • Avoid lifting anything heavier than your baby in the first few weeks, and get clearance from your doctor to start exercising.

 

What About Postpartum Sex?

Your provider will give you the physical all-clear for sex at about 6 weeks postpartum, but that doesn’t necessarily mean you’ll be ready. Honor your mind and body wherever it’s at —whether you’re raring to go or need more time before any action happens down there. But when you do feel ready, it shouldn’t be painful. If you do experience pain, we recommend seeing a pelvic floor therapist. 

 

“One thing I tell people to do is if it’s been past your 6-week visit and you’re still in a lot of pain, or even in those first three or four months, you’re still really having a lot of pain with intercourse, seeing a pelvic floor therapist can be very, very beneficial,” Liesel says.

We recommend you listen to our podcast episodes with Marcy Crouch – The Postpartum Vagina Part 1 & Part 2. These episodes give great insight into everything that is happening, what’s normal vs what is common.