In her new column for the Town Crier’s Your Health section, midwife Tracy Donegan addresses common questions and issues related to natural labor and delivery.
Q: How will I know labor has started and when it’s time to go to the hospital?
A: Unlike what we tend to see on “Grey’s Anatomy,” moms rarely experience sudden intense contractions that require deep breathing right from the beginning. Many moms experience some backache and a crampy feeling like their period is starting before contractions start to settle into a pattern.
One of the most common fears for first-time moms is that strong, painful contractions will come out of nowhere, and they will race off to the hospital only to be told that it’s just Braxton Hicks – or, just as worrying, that the hospital has no rooms available and they will send you home.
Braxton Hicks contractions are usually irregular and don’t settle into any kind of pattern. In true labor, these sensations get closer together and stronger, taking up all of your focus. When you can’t talk between contractions – never mind during – then you know it’s the real thing.
Other signs that labor has started may include a blood-stained, mucousy show or your bag of waters release.
Most care providers will give the same advice: Unless you are not coping well, home is the best place for a healthy mom and baby for early labor. You’re more likely to progress, and you have privacy and access to all of your home comforts, including your favorite foods, the bath and your own bed.
As a childbirth educator and midwife, I recommend using the “4-1-1 Rule”: Stay home until you’re having contractions every 4 minutes, lasting at least 1 minute for 1 full hour. Consider engaging a doula to help you stay comfortable at home for longer, especially if you are planning not to use medication.
Don’t hesitate to call Labor and Delivery if you have any concerns or questions about what you’re experiencing.
Q: What is the best way to prevent or reduce tearing?
A: This is a question that has every expectant mom crossing her legs. Tearing is not uncommon, and most moms heal without any ongoing problems. The good news is that there’s a lot you can do to reduce your risk of tearing, including the following.
• Practice perineal massage in the third trimester, especially if you’re a first-time mom. It doesn’t train your muscles, but it gets you used to that stretching sensation so that when you feel it, that’s your signal to stop pushing and allow your body to nudge the baby down without any extra effort on your behalf.
• Avoid the epidural – you’re more likely to have an instrumental birth, and you can’t feel the stretching. With an epidural, ask not to have vaginal stretching by your care provider when you’re pushing, as it can cause micro tears in the perineum by trying to make room for the baby.
• Birthing on your back makes tearing more likely.
• Avoid coached pushing (cheerleading counting by staff and holding your breath for long periods). It puts unnecessary pressure on the perineum and turns off oxygen to your baby and pelvic floor.
• Labor in the bath or a pool, if your hospital has one, as it reduces tearing.
• Ask your partner or your doula to apply a warm compress to your perineum when your baby’s head is almost visible. This simple intervention is shown to reduce serious perineal injury – and if feels amazing.
In the event you do have a tear, sometimes it’s just down to genes or the baby’s position – all you can do is stack the odds in favor of your not experiencing a tear.