Too bad the stork's a myth
November 23, 2011 2:15 PM   Subscribe

Babyfilter: If you could get a re-do on your labor and delivery, what would you do differently?

I'm 37 weeks pregnant now, and with the delivery of my first child just around the corner, I'm starting to think about labor. My birth plan is more of a non-plan: I'm going in with a "whatever happens, happens" approach. Luckily my OB is a strong non-interventionist--I trust that he's not going to propose a c-section or the like unless they're absolutely necessary. I'm neither set on drugs or a natural birth--we'll see how I feel and how I manage the pain. I haven't taken any birth classes, and I'm not using a doula. My husband will be there with me, and family will have limited visitation access, so I don't get overwhelmed.

But you mefites have had many babies (collectively), and you hold much knowledge. Please tell me--if you could do your labor over again, what would you do differently? What are you glad you did, what would you not do again? What made your labor and delivery easier, or harder? Also--if there's a secret trick to minimizing tearing, I'd love to hear it.
posted by litnerd to Health & Fitness (46 answers total) 47 users marked this as a favorite
What I did wrong ... didn't have any music, reading materials, popsicles to pass the time (I was in labor forever with kid2).

What I did right ... deep slow focused breathing, I'd read up on the Bradley method beforehand & incorporated it into my meditation/breathing & it really worked out well for me.

Congratulations & good luck.
posted by headnsouth at 2:32 PM on November 23, 2011

Disclaimer: I'm a guy, so this is second hand or from the observation side, but my wife and I have 3 kids.

The only thing I can throw in here is be prepared ahead of times for any of the things you can be. Case in point: with the birth of our second child my wife had decided that she wanted to "wait and see" on the epidural and hence the check-in staff at the hospital did not have us complete the paperwork. I think because our first child had been a very long birth, once the labor started getting really intense, my wife decided that she did indeed want the epidural.

The nurse then handed me a 4 page (front and back) form that I was to read to my wife and then have her sign. At that point she was in NO way going to listen 8 typed pages of legal jargon and after 2 sentences I stopped reading and just had her sign it. By the time our nurse 'got around' to collecting the form, and then getting the anesthesiologist cart she was too far along to get the epidural. (I wanted to strangle that nurse for then being so cavalier about it all).

My wife and our daughter were fine of course, but man that was a terrible feeling knowing that the whole thing could have been so easily avoided. So as the first post says, bring anything you might want (reading materials, music, toothbrush, comfy pillow, etc.) and be vocal and assertive about what you want.

All that said, congratulations to you and your soon to be slightly larger family!
posted by BigHeartedGuy at 2:40 PM on November 23, 2011

A few important things to consider...

You will have to have an IV put into your hand or arm. Be sure that they do it properly, my IV entry hurt so much it was a numbing pain into the bone for months. You will know that it isn't going in right, you have had your blood taken so many times so far. Besides, if it really hurts, it is really not right! Tell them to stop and find a new place.

I had to be induced because my contractions were stopping the baby's heart beat. I was very upset to see that it punctured my baby's head to put the heart monitor on because of that. Try to do anything to prevent that from happening. the heart monitor for the baby is on your belly. Hold it there if you must to get a good heart rate reading. She healed, but it was really a big cut on her head!

Because I had to be induced, they put pitocin in my IV. The pitocin doesn't let your body recover from each contraction and it is so incredibly painful. If they need to induce your labor, don't be a hero and get the epidural done sooner than later. It will be difficult to hold still for the needle once the pitocin starts working. I have a very high pain threshold and it was hard. I was sweating so much from the pain that they had to towel me down. Once they have delivered the baby, you can back the epidural down.

People have been having babies for so many centuries without all of the medicines available to us now and I really believed in going in as natural as possible, but what is available to us now is due to the fact that you don't have to put yourself through unnecessary pains. You want to be able to have the energy to push the baby out and then enjoy the baby after! You don't want to be exhausted and suffering!

Let the doctor give you an episiotomy, don't tear! You will heal a lot better and faster. And it will minimize infection in an area that will be prone to such a thing. Do apply antibiotic and analgesic cream by putting it on the pad. Use a squeeze water bottle to clean the area and do not wipe! Blot!

Is this too long?!

Drink lots of water, it will help you produce breast milk if you are breast feeding. Eat the best everything that you can, you want to make sure the baby gets the best stuff on earth!

Most important of all...EAT before you go to the hospital! They won't let you eat once you are in!

All my best to you! Congratulations!
posted by Yellow at 2:40 PM on November 23, 2011 [3 favorites]

I've had two kids, one with a doctor I didn't like at a hospital I didn't like, and one with a doctor I think is great at a hospital that was lovely. I recommend the latter.
posted by The corpse in the library at 2:40 PM on November 23, 2011 [1 favorite]

I had a natural hospital birth, and the only thing I regret is that for an hour I was pushing "wrong." You need to envision your body like a tube of toothpaste, and squeeze from the top down, if that makes sense. Don't try to push out the bottom, squeeeeeeeze out from the top.

Also, just focus on yourself, and your breathing and your body. It WILL guide you. I was nervous, so I pushed when they told me, and pushed wrong. By an hour and a half of pushing, I just decided I would do it my own way--silently and squeeeezing down. He was out in like 3 pushes that way!

Good Luck!!

ps. also, EDUCATE YOURSELF!!! Know every drug they will offer you, and don't be steamrolled!
posted by katypickle at 2:41 PM on November 23, 2011

What made it easier: trusting my instincts - I'd thought that I would want lots of support, but as it turned out, I wanted to be ALONE. I sent everyone out of the room until it was time to push the wee one out... that was what worked for me. The most important thing for pain management was NOT TENSING UP... the more I relaxed, the easier it was to cope. Tensing up made things hurt exponentially worse.

What I would have changed: I wouldn't be as intimidated by the doctors and nurses... I would try to remember that I was a decision-maker in my/the baby's care, too.

Re: tearing. Perineal massage, man... perineal massage.
posted by julthumbscrew at 2:41 PM on November 23, 2011

I had a great labor and delivery, but there were a few things that I would not have known to ask for unless someone told me.

- Make sure that you get a port instead of an IV. It will assure that you're not tethered to one spot. The triage nurse wanted to give me an IV and I had to talk her out of it while having heavy contractions.
- Have a code word for when you really want something. I asked for drugs a few times because it's just what was in my brain to do for that second. (I dunno, when I'm in pain I get all "Drugs! Drugs!") My husband and doula knew that I wasn't serious because I didn't say my safe word, "marshmallow", and kept the doctor from following through while I explained that I didn't mean it and still wanted to go without pain killers.
- Not all delivery rooms were the same in my hospital. I went on the tour so I knew to ask for the nice one with the tub.
- I had a squat bar that I ended up not using for squatting. However, it was a great place to rest my feet between pushes without having to resort to the stirrups. It was much less restrictive.
- I did whatever I could to be able to be able to move around freely. Unfortunately, the nurses couldn't find the portable fetal monitor so I couldn't leave the room to walk around.
- You might want to reconsider on the doula. It was nice having another person in the room who knew my wishes and could reassure and guide me when my husband was overwhelmed. I hired mine about two weeks before I gave birth.
posted by Alison at 2:42 PM on November 23, 2011 [2 favorites]

Honestly, I would have worried far less about labor & delivery and far more about newborn care and getting the house and pantry ready for two months of neglect. L&D is over quickly (though it seems long when you're at it), and in the end you have relatively little control over how things go, and no idea of how you will react. I had a whole pile of accessories (ball, massage oil, music, aromatherapy candles, lozenges), all of them carefully curated ahead of time, and all of which annoyed the utter bejesus out of me when the time came. But damn I was happy to have lansinoh cream in the house when my nipples cracked, and equally thrilled to find those frozen lasagnas four weeks in.
posted by apparently at 2:50 PM on November 23, 2011 [16 favorites]

Definitely get a port instead of an IV, and be firm about your request! I did my research ahead of time and requested a port, but in my state of heavy contractions let the nurses talk me into an IV. I should have been more persistent like Alison.
posted by sanitycheck at 2:54 PM on November 23, 2011

Thing I almost did wrong: give birth in a hospital. At 35 weeks I decided not to do a hospital birth, and I'm so glad I did, because I was in labor for 74 hours and they do not let you labor that long in a hospital (or, you would have to fight VERY HARD to avoid a c-section with a labor like that, when you're in no position to fight). Instead I had a natural labor and easy recovery. Seriously, though, what kind of c-section rates does your hospital have? It's an important thing to know, because a lot of nurses and other hospital staff in high c-section hospitals will push you in that direction, generally using scare tactics, at a time when you are very vulnerable to suggestion and not really in a position to stick to your guns.

Re tearing: I read Ina May's Guide to Childbirth, in which she mentions making out with your spouse as you push the baby out prevents tearing. Sounds kind of woo, I know, but I think it's a psychological, relaxation thing that loosens you up all over. At any rate, I did not tear. (I must also credit my midwives, who knew from experience which positions are more and less likely to tear, and got me off of the birthing stool and into a standing-with-one-leg-on-a-footstool position as my baby's head was about to pass through.)
posted by rabbitrabbit at 2:55 PM on November 23, 2011 [3 favorites]

From my mom and stepmom's experiences, via observation:
  • Do the tour. Make sure your husband knows where everything is and has a place he can go to get away from you for a while in some comfort if necessary. My dad was so stressed out when my brother was born because he really had no safe space to take care of himself for a while.
  • Definitely sign everything that needs to be signed and read everything that needs to be read in advance (they should have a packet that they're going to idiotically hand you when you arrive, like paperwork is going to be on your mind at that moment - hospitals always do this.)
  • Find out what's going to happen (the whole procedure) with your baby right after the birth. The upsetedness at being surprised by what they do lasts for hours and hours and hours afterward in my experience. The complaints continue for years. And years and years.
  • My mom says just do the drugs. I was medication free in a "gentle birth clinic," number two was medication free for a while before she gave up in a hospital (she still will wax poetic on the folly of it all if you ask her and my sister is 25 years old,) and number three was "heck yes drugs" in the hospital. She says she would have had a lot more babies if the first two had been like that one was.
  • Don't go to the county fair or a zoo or, I'm trying to remember but I think it was the mall when you're close to your due date, unless you want to speed things up. Have your stuff in the trunk regardless. Especially slippers and a robe, because it's really annoying to sit around waiting for that to be delivered.
  • Have your husband be the designated "go away family you irritate me" person. Labor is exhausting and makes some women very very cranky and that... diminishes social skills.
  • If people want to bring you meals or visit the baby or whatever, have them coordinate that through some person (mothers-in-law are good for this,) because otherwise they're just going to show up. Same with the "limited visitation" thing: nice in theory, but you need an announcement and enforcer.
  • Eat what you like before you go in because you won't get anything for a long time and then you probably won't like what you get after that. I was on Team Sneak [Stepmom] Some Food for several visits after my brother and sister were each born, and as charming a sitcom plot as this was, it was really annoying for her, especially because she'd been deprived of so many favorites for months due to nausea.
  • Bring earplugs and a face mask, because you will want to nap if it goes on a while (or if it turns out you've jumped the gun on getting to the hospital) and that's more or less impossible in a hospital setting. Also, this would be a really bad time to find out that the lights give you a headache, or that they make lots of announcements that you can hear all the time (and earplugs are tricky to find in stores when you're in a hurry.) One of the local hospitals here plays a lullaby over the loudspeakers every single time a child is born there. I would probably kill a man for earplugs if that was going on while I was a patient.
Oh, and don't think that your family's experiences will have anything to do with yours. My mom was in labor for a relatively short time with me and one sister (we were the fair and zoo babies) but twenty or so hours with the other sister, and my stepmom was in labor for about twenty hours with one and ten or so with the other. I think not having an expectation of how long it'll take would have been beneficial in each "lengthy" case - or rather, the "I can't believe this is still going on" feelings would have been much less strong.

I'm also completely sure something is going to go weird or be not in accordance with your ideal scenario. It's like having a wedding in that way, except the money isn't going to a caterer. Hold onto that "it's okay if it goes how it goes" thing. I have spent most of my life hearing about all the things that went not-so-great at the births of five different people, including myself, and it's really quite tiresome.
posted by SMPA at 3:16 PM on November 23, 2011

Nothing cuts "getting ready for the labor/baby" worries down to the essentials like an emergency c-section.

At my routine 35 week checkup, I was diagnosed by my obstetrician with severe pre-eclampsia and sent directly to the hospital. I was told I'd be monitored overnight and if my blood pressure didn't go down, I would have a c-section in the morning. It being a month ahead of time, and me being an enormous procrastinator, I didn't have a hospital bag packed, or the baby's room painted, or the house clean, or a freezerful of casseroles made and packed away like I'd planned. I hadn't done any perineal massage and my breathing skills were...sketchy. As it turned out, the things that I really wished I had taken care of were:

-eating lunch. I skipped lunch before going to the doctor and by evening I was starving, but couldn't eat anything before the operation. So...don't skip any meals from here on out.

-having a bag packed with at least a few essentials: pajama pants, hard candies, a camera, a book to read, chapstick. Chapstick and Hand Lotion. I can't stress THOSE enough. Pack it and leave it in the car.

-if you haven't done the tour, do the tour of the hospital.

-learning what items were really, really essential for the baby. As it turned out, he was in the NICU for two weeks, which (while depressing and stressful) gave us time to figure out that we needed tons and tons of burp cloths, not so much any more clothes or playsets.

-oh! and, I really, REALLY wish I had known the symptoms of pre-eclampsia (achiness, especially in your upper right quadrant; exceeding puffiness; any sort of unusual cramps, including if your Braxton Hicks contractions suddenly are much worse; if your eyes suddenly won't focus or are differently dilated; and hyper-reflexes) because it can sneak up on you at any time - I was riding my bike around town the week before.

You're probably way more on top of things than we were. I don't have much labor advice; I can't say I'm sorry to have missed out on the pushing and pain; having a c-section is a good way to minimize tearing (in a sense), but it takes several weeks before you feel like yourself again. I guess my advice is to keep in mind that things could be completely not the way you expect; therefore always have chapstick with you. Get a lot of rest, take care of yourself, and most of the other stuff will work itself out.
posted by daisystomper at 3:42 PM on November 23, 2011 [3 favorites]

Two things: I would have authorized (in case I wanted it) an epidural in advance In order for me to sign the paperwork, I had to be put on a monitor and wait until I wasn't having a contraction. Which only took a few minutes but felt like forever.

The second thing I would have done differently was to ask them to dial back the epidural before I began pushing. I had a long pushing stage (a little over three hours) and didn't feel the urgency to push until about 10 minutes before Toddler theBRKP was born. As it turns out, I felt the urgency because the epidural had run out and what had been in my system was beginning to wear off.

And yes, definitely make sure you get a port instead of an IV. It will allow for a lot more movement.
posted by theBigRedKittyPurrs at 4:05 PM on November 23, 2011

I had a natural hospital birth, and the only thing I regret is that for an hour I was pushing "wrong." You need to envision your body like a tube of toothpaste, and squeeze from the top down, if that makes sense. Don't try to push out the bottom, squeeeeeeeze out from the top.

I had a natural birth, same experience, but opposite pushing. I was pushing from the top for a long time and getting nowhere. At the end of another fruitless contraction, exhausted and desperate, I brought my lower abdomen in as well and got immediate cheers. A few more of those, and babygirl popped right out. I once heard having a baby described as "shitting a watermelon." Sums it up pretty well.

The other thing I'd have done differently is not have had a doula I wasn't familiar with brought in. Since you're not using one, that won't be your issue, but I'd definitely not feel bad about keeping it private or kicking people out.

Oh, one last thing: I'd stand my ground better on what I wanted.

Dunno if you'll be hooked up or what your facility offers, but OH MY GOD the hot shower was wonderful.
posted by moira at 4:26 PM on November 23, 2011 [1 favorite]

Hospitals are awful places to rest in. And after you have a baby, you will want to rest! But there will always be someone coming in and poking at or checking on you and the baby. I was required to stay in the hospital for two days after having my first child (standard procedure for insurance purposes, I was told) and it was miserable - even with my husband there, even in a private room. I had a long, long labor and some trouble starting breastfeeding, and I just wanted to SLEEP PLEASE, but I couldn't because of the constant interruptions by the various staff, until I broke down crying to my mother on the phone. She came to the hospital and literally guarded the door to my room so I could finally sleep - for three hours. It was brutal. Every birth I've had since, I go in, have the baby, recover from the epidural, and leave either that day or the next morning (thank goodness Ontario hospitals don't require you to stay). Sleep. So important. The hospital staff have their own routines they want to stick to - understandably - and that just isn't very accommodating of personal needs. Have your husband, or someone, willing to play the heavy for your sake.

The other thing is - I don't know if you're planning to breastfeed, but if you are - breastfeeding doesn't always come naturally. And in my experience, no matter how accommodating the hospital staff says they are of breastfeeding, or how experienced they say they are in lactation consultancy, I have found doctors and nurses more often incorrect than correct in their notions of breastfeeding, how it should go, how to deal with issues, etc. Having someone you trust (who is experienced) available to consult would be a godsend with your first child. I wish I had such a person that first time! I spent the next two weeks undoing - blindly, by instinct - all the trouble caused by the first two days, with nurses insisting they had to wake my son up, and that they had to feed him formula, etc. Just - be cautious and have your radar up, which is hard, I know, when you are so exhausted and it's all new to you.

You sound like you are prepared to be flexible with labor and delivery, which is an excellent attitude in my opinion. I would only say - have someone else as a backup while laboring (a doula, your mother, your best friend) besides your husband - not only to spell him if he gets tired or overwhelmed, but for your sake as well. I love my husband very much, but when I'm in labor, I don't find him nearly as calming to me as my midwife or even her student (which is entirely not his fault). I wish he were - he is great at letting me squeeze his hands so hard, he is super supportive! But I am just not as responsive to him when he tries to talk me down as I am to other people, so I would never want to do it all with only him there.
posted by flex at 5:03 PM on November 23, 2011

Two things: I wish I had asked for a different nurse when the one we had was annoying us. Our second nurse (next shift) was so awesome, it was a major factor in our comfort. I didn't think about kicking her out - didn't occur to me that I could.

Another thing on nurses. When you are at the hospital they are there to help you. That's why you have the little button at your bed. You need help in the middle of the night and hubby is getting much needed rest or is away? Hit the buzzer.

One more thing: if you end up with a "c" make it a personal goal to poo before you leave the hospital. The pain meds will back you up and while nothing will seem less pleasant than taking a poo, trust me on this. Have some Miralax ready for home and ask your doc about this.

Good luck and congrats!! No matter what, this will all be a blur in a month. ;)
posted by amanda at 5:19 PM on November 23, 2011

Keep any photos of you right after the birth- when making up photo books for my little sister's wedding, my sibs and I noticed my mom is perfectly made up in most family photos except for the ones taken holding us right after we were born- she looks exhausted/ecstatic, no makeup, sweaty hair, gown askew, etc. We all loved that- as if we got to see what really went on, not a posed photo where the focus was on appearances.

Apparently she tried to throw them out (this was the seventies) but my dad made her keep them because "If I'm going to buy film and pay for developing we're keeping every photo if you like it or not!". :)
posted by variella at 5:33 PM on November 23, 2011 [2 favorites]

I had a wait and see approach too, and ended up going without drugs because by the time it got bad I was in transition and it was too late for drugs. Make sure that your nursing team knows what your plan is. If your plan is to go without drugs and see what happens, make sure they know that. Make sure whomever is with you there (doula, friend, husband, whomever) knows the plan and is willing to argue for what you want if that is necessary. Hopefully it won't be necessary, my nurses were fantastic and never pushed anything I didn't want.

Things I did right, spending time in the jacuzzi tub at the hospital. Things I wish I had did more, got in the tub sooner. It was really blissful in there and made the pain less. Also, if you want food, make them give it to you. My hospital was perfectly fine with it, but I ended up not being able to.
posted by katers890 at 5:38 PM on November 23, 2011

- Gatorade and/or popsicles
- Hot shower and/or bath for contractions
- When it comes time to push (and if you're doing it naturally especially) growl low instead of screaming in a high-pitched way
- Ask for perineal massage to reduce tearing
- Just go with what works rather than what you had planned. Small example - with baby #2 I didn't listen to any carefully-prepared music mix; rather, NPR was on and I think I gave birth to Science Friday
- If you're in the hospital and haven't taken any classes, you might consider a doula
posted by kirst27 at 5:39 PM on November 23, 2011 [2 favorites]

The #1 best thing I did, hands-down: hire a doula. We found our doula through our doctor so that I knew they would work well together, and she was fabulous. I interviewed several and most were far too ... spiritual for what I wanted, but the one we found was amazing, and given that I spent 60 hours at the hospital from first attempt at induction to birth (via c-section), it was nice to have someone to talk to, especially since my husband was sleeping much of the time (he had shingles!). Also, she was there to take pictures during the delivery and then to sit with me while the baby and the husband went off together and I was getting sewn up. If you happen to be in the Boulder area (despite your profile info), I'm happy to provide a reference to our doula.

Oh, and heed amanda's advice and get a new nurse if you don't like yours.
posted by freezer cake at 5:40 PM on November 23, 2011

Would've agreed to hire a doula (father here) - because it would've been nice to have more support than nurses who wandered in & out every hour or so, and it's pretty emotionally & physically exhausting for us too, you know.

I realise it's taboo to even hint that birthing is hard on guys, when the woman bears the lion's (lioness'?) share of the physical exertion, but if your boss, for example, demanded that you stay awake for 36 hours & work on one single thing, without a break & mostly without leaving the room, you'd rightly consider it a freaking marathon too.

Plus, the doula can take the blame for anything not to plan, or explain that sometimes babies just spontaneously decide to spin 180 degrees to face the wrong direction the day before the birth.
posted by UbuRoivas at 5:49 PM on November 23, 2011 [3 favorites]

Don't worry about a C-section being some god-awful experience. They're not. They're quick, painless, and -- if the doctors want it to happen -- much safer for you and the baby. You don't want to insist, stand your ground, etc., and end up with an oxygen-deprived infant or a ruptured uterus requiring a long hospital stay while your baby isn't with you. The most important thing is not the way the baby is born, but that the baby is born and you and baby are both healthy.
posted by Capri at 6:00 PM on November 23, 2011 [4 favorites]

Could someone explain what they mean by insisting on a port? I am a physician and I am unsure what you are talking about. To my mind, a port is the semi-permanent IV access device that gets installed in cancer patients for their frequent blood draws and chemotherapy. I don't believe any such devices are getting put into women during labor and delivery.

The word "port" can also be used to refer to the little circular pieces that come off the IV tubing that medications are administered through, i.e. "This IV has 2 ports". I don't think either one of these is what you mean. Do you mean a saline lock (a locked IV that is not connected to any bag of fluid)? I thought saline lock IV would be standard for most laboring women. Anyway maybe on an L&D ward they have a different understanding of what "port" means, but if you came into my ER and said "I want a port, not an IV", I would be clueless as to what you meant.
posted by treehorn+bunny at 6:01 PM on November 23, 2011 [5 favorites]

This is weird, but bring some tums or something. By the time I was pushing, I hadn't eaten for so long that the pushing seemed to be squeezing my stomach acid up into my throat. It was an awful sensation and while the nurses did eventually get me something for it, it would have been much easier and faster if my husband had just had an antacid on hand.

To avoid this problem altogether, don't listen to them when they tell you that you can't eat. Stick to something liquid like a smoothie, but don't allow yourself to be starved.
posted by kitcat at 6:12 PM on November 23, 2011 [1 favorite]

Treehorn, I think they mean a heplock - where access is available, but you're not hooked up to the pole, so you can move more freely.
posted by chiababe at 6:16 PM on November 23, 2011 [2 favorites]

New-ish dad here.

My experience is that I hadn't thought enough about those first couple of days in hospital. Birth is the beginning of a marathon for both of you. I didn't get sleep when I had the opportunity. Too much adrenalin. As a result, I was too fried to be as helpful as I wanted to be.

Ms. Show agrees with the point above about asking for the epidural before you need it. Asking when you need it is too late.

We didn't want to be overwhelmed by family, but a couple of key family members were super-helpful in those first couple of days at the hospital. Think about who that might be for you and welcome their help.

If driving home, get to know your carseat before the baby arrives. We spent quite some time on the way out the door of the hospital trying to sort out the straps. It's much easier to take 15 minutes during the calm before the storm.

Your flexible, open attitude will serve you well. Good luck!
posted by thenormshow at 6:55 PM on November 23, 2011

treehorn+bunny: Do you mean a saline lock (a locked IV that is not connected to any bag of fluid)?

I gave birth three weeks ago. This is what I had. It was referred to as "the IV," and required no discussion on my part.
posted by purpleclover at 7:52 PM on November 23, 2011

Regarding Yellow's recommendation of an episiotomy rather than risk a tear: it's not true that it's always better to be cut. See Mayo Clinic, PubMed, Rathfisch G et al. "Effects of perineal trauma on postpartum sexual function." J Adv Nurs. 2010 Aug 23, etc.

And more advice on preventing a tear: according to this article, delivery between contractions reduces the chance of tearing.
posted by rabbitrabbit at 8:31 PM on November 23, 2011 [10 favorites]

I would have done Bradley method classes, and I would have had a water birth. My water didn't break, I couldn't get comfortable, and in spite of having educated myself over the course of over a decade, being friends with Bradley instructors, and having attended two births, I didn't have what I needed in order to have the labor and delivery I wanted. It's like if I tried to run a marathon after having read about it and watched from the sidelines. Not that a series of classes is the same as going through it, but it's muchmuch better preparation than what I went in with. I still had an unmedicated birth, but it was 26 hours and very uncomfortable, resulted in some explosive tearing, and I was focused on the other people in the room. It could have been better.

My most urgent advice is this, though: Do not, under any circumstances, no matter how curious you are about your tear/s, your perineum, your general crotchal area - I repeat, DO NOT - squat over a magnifying mirror to check it out.
posted by magdalenstreetladies at 9:08 PM on November 23, 2011

Make sure you haven't parked in a tow zone the night before.
posted by stargell at 9:13 PM on November 23, 2011 [2 favorites]

Expect the unexpected. Do not assign high importance,in terms of your maternal, feminist, or anti- or pro-anything identity, ideology or priorities, to any element of your birthing Plan 'cause that can be the one that vanishes in the first five minutes, or last five minutes.

Also, any sentiment or recommendation that begins "women have been giving birth for thousands of years" is to be ignored with great prejudice unless it is followed by "and very often dying along with their new- or never- or still-born child or surviving with agonizing debilities but with child still dead, which we intend to avoid today by doing thus..."
posted by MattD at 9:28 PM on November 23, 2011 [14 favorites]

I was overprepared going in for baby #2: I had been using my yoga ball so I wanted it in hospital with me, plus my own pillow, a CD player, my bag, snacks, whatever else I thought I needed at the time...and then my husband couldn't get a carpark outside the maternity hospital and had to park miles away, so I was trying to lug my yoga ball and pillow and CD player and bag on my own (by my own irrational choosing) while trying to get to the 6th floor during contractions.

So pack light and know where you'll be parking. :-)
posted by tracicle at 9:56 PM on November 23, 2011

I would have waited another hour before OK'ing the C-section, also would have asked for epidural to make waiting easier to deal with. My doula and husband were useless here.
posted by crazycanuck at 10:28 PM on November 23, 2011


- Prepare yourself for a long labour. My mother and aunts and cousins all had labours that were 4 hours or less. I assumed I would, too. My midwives encouraged me to think more along the lines of 12 hours, so I adjusted a little. I ended up in labour for 40 hours, and the additional 28 hours seemed unfair, rather than just part of what could happen.

- SLEEP in early labour. My water broke at 2 am, after 2 hours sleep, and I was so excited I didn't go back to sleep. (Plus, I thought it'd be all wrapped up by sunrise.) After 16 hours of labour, and 2 hours sleep in the previous 36 hours, I was totally exhausted.

- EAT in early labour. I was also too excited to eat. Later, though, when contractions were tougher, I couldn't stand the sensation of food in my mouth when I had a contraction (which was every 3-4 minutes) so eating was really difficult. I ended up chugging maple syrup from the bottle to keep up my energy, which in retrospect seems completely insane.

- Don't get too attached to any one idea about the birth. It sounds like you are already taking a wait-and-see attitude, which is great. I really had a script in my head, that involved a short labour and a peaceful birth at home. After 18 hours and virtually no progress, I transferred to the hospital for drugs and sleep, and it felt like a HUGE defeat. (On preview, what MattD said, times a thousand.)

- Pack a bag for the hospital. Probably you are smart enough to have already done this. It really sucked to have people running all over the house trying to find what I needed to take to the hospital, 18 hours into labour. BRING YOUR OWN PILLOW and slippers. My feet and legs were so swollen after the birth that I couldn't put my shoes on. A friend had to bring me her 2-sizes-bigger slippers so I didn't have to go home in my sock feet. I also wish I had brought a Walkman (this was pre iPod!), a sleep mask and ear plugs. We went to the hospital so I could sleep, but the nurse coming in and out of the room, checking me and leaving the light on, which made that impossible. I went two full nights with only 2 hours sleep.

My daughter's birth was very traumatic. There are a few things that I think could have prevented some of the trauma:

- I had never felt comfortable with the mid-wife who was on duty the day I went into labour. I wish I had asked sooner to have the other mid-wife step in. As it was, there were patients of the midwife practice delivering at the same time, and my favourite mid-wife arrived in the final hours of my labour. She saved my daughter's life, so it was a stroke of good luck she was there. But, I think the whole thing would have gone better if she'd been there all along.

- I wish I'd had a doula. I had my best friend and my mother at the labour, but when thing got scary, they both kind of shut down. At the very worst part, my friend had to leave the room because she was so freaked out. I don't blame her or think she was terrible or anything, but it would have been great to have someone with more experience in the room who was there for me, since my midwife and the emergency doctors and nurses were all focused on my baby.

- I wish I had consented to a C-section when the OB consulting (whom I had decided I hated) (which, to be fair to me, he was a condescending ass) suggested it. I'd been in labour for 38 hours and pushing for 2, and making virtually no progress. When he suggested it, I just kind of lost it and cried for a long time. This was 100% about things not going the way I thought they were supposed to, and having come to the hospital, then taken Demerol, then having an epidural, then agreeing to pitocin, all of which I had been adamantly opposed to all through the pregnancy, it felt like the C-section was my last stand. My mid-wife and the LD nurse both encouraged me to keep trying (he did say I could keep trying a while longer, but that he didn't think I'd be able to do it), which is what I wanted to hear. As it turned out, my daughter wasn't descending properly because she was positioned badly, and the labour ended with a shoulder dystocia (i.e. she got stuck). There was no way to know that was going to happen until it happened, so that wasn't why the OB suggested it, so that's not the issue. The issue for me is that I refused the C-section based on some weird macho thing of NO WAY I'M HAVING HER THE HARD WAY.

- After she was born, the did all kinds of stuff to my daughter (gave her shots, took blood, started IV anti-biotics, I forget what all else) without asking me. Hours later, they presented me with a consent form to sign. There were a couple things they did, that were in no way related to her birth trauma (the eye goop, maybe? I honestly don't remember) that I had previously said I did not want done. So when they gave me the consent form, I was angry, but thought, Oh, well, too late, might as well sign it. It took almost a year for me to realize I should not have signed it. I hadn't consented, and they had done things I wouldn't have consented to, but I felt too shaken up and insecure to make a fuss, especially since the procedures had already been done.

Regarding the episiotomy, my midwives weren't sold on perineal massage during pregnancy. They said I could do it if I wanted to, and that it certainly wouldn't hurt, but they hadn't seen enough evidence to suggest that it helped a great deal. The midwife did perineal massage during delivery, however, and used hot compresses and counter pressure. I had no tearing right through birthing my daughter's head. On the other hand, when they were doing the manoeuvers to release my daughter's shoulder from behind my pubic bone, they performed an episiotomy specifically so that I would tear and provide enough room to fit a hand in to turn her around.

So, yeah, again, don't rule anything out, and don't idealize any one way of giving birth. You really have absolutely no idea how it's going to go, and, as you already seem aware, the best approach is to stay connected with what is going on in any given moment.

(We're both fine, and there were no lingering effects of the delivery, by the way.)
posted by looli at 10:54 PM on November 23, 2011 [2 favorites]

Be prepared to forgive and forget everything that goes wrong. You'll be exhausted and stressed out with a new baby afterwards, and second-guessing your labour decisions isn't worth the energy.

Be super-nice to nurses and hospital staff. They'll still help you if you're a jerk, but you'll get slightly faster and better care if you've been a pleasant patient. Yelling at them doesn't work as much as very firm polite repetition. Unless you get a vile person, in which case you can often request a replacement from their senior.

I had an early emergency c-section, after a very difficult pregnancy. I would change just about everything that happened if I could, but I tried to believe in the best intentions of everyone involved and focused on a happy healthy baby, not a single experience. She's happy and getting healthier now, in the NICU.

Ask for pain medication if you need it. They will give you a 1-10 pain scale and contractions will be around 8-10. The pain after the c-section for me was easily the same, and I had to ask for more medication. Ask and ask - they want to limit the amount of meds you take for your health, and they can't tell how much pain you're in without you asking. Don't feel weak or needy about it at all. Everyone has a different pain threshold, and some women really do have fairly painless deliveries. Maybe you'll be one of those lucky women, but it's not a moral failure if your body is wired differently.

Buy a Belly Binder if your hospital/midwife doesn't supply one. These are elastic wraps around your abdomen that just hold everything in gently. Fantastic after a c-section, and pretty good for vaginal birth - you can get up and move about faster with one.

And nursing is all over the place with techniques. I bought several books and ended up with what works for me from two different nurses and a friend's help. Your supply is minute the first day or two, because the baby's stomach is so tiny, and you will catch up in a week. They are meant to lose weight the first week, it's normal.

If you want to nurse, and other people are pushing you not to, feel free to imagine their heads bursting into flames. Ditto if you want to go by the bottle. It's the start of everyone telling you what to do, and you gotta learn to decide your own parenting choices.

Lipbalm was good too.

And oh, if you are in any way a high risk pregnancy and might need a c-section, then don't eat or drink after labor starts. The risk for needing anesthesia later on is real, and they're not just being cruel about limiting food and fluids.

Laughing gas is AWESOME. I got to use it when I wanted, and felt far more in control. I was all chained up with monitors and couldn't move, but the laughing gas helped hugely in managing pain so I could talk and make decisions.
posted by viggorlijah at 11:13 PM on November 23, 2011 [2 favorites]

I would not have changed anything about either of my births.

Birth number one was long and hard. I labored at home and arrived at the hospital already dilated to 8. I labored for 6 more hours and pushed for an additional 4. I refused all drugs and screamed through the whole thing, to - I'm sure - the hospital staff's chagrin. She ended up being a vacuum extraction due to fetal distress and was born blue and not breathing and a team of people whisked her away without telling me what was happening. She was fine, it was terrifying, and I had no control over the pieces of that story that I wish had been different. I look back on that experience with a "Damn. Look what I did. I'm fucking *awesome*".

Birth number 2 was fast and easy. I had back labor and spent the day at home miserable without knowing why. My water broke and contractions started immediately and we went immediately to the hospital. The birthing rooms were full so I had to wait in the hallway in unbelievable pain with amniotic fluid dripping into my shoes while one was cleaned and prepared. I was, again, already dilated to 8. The rapid onset of labor did not give me time to adjust or transition or maybe I was just tired and scared with the pacing of it all but I got an epidural and was able to talk and laugh and really enjoy the birthing experience. She was born 3 hours after arrival at the hospital. I had no control over the pieces of that story that I wish had been different. I look back on that experience with a "Damn. Look what I did. I'm fucking *awesome*".
posted by lilnublet at 11:47 PM on November 23, 2011 [4 favorites]

If your care practitioner tells you to spend the next two weeks in bed (after a vaginal delivery), listen. That is the thing I wish I had done differently. That, and not kicking out the horrible CNA who berated my partner.

The thing is, there's a lot about giving birth that we evolved to do. With the addition of sanitation and modern medicine, the chances of positive outcomes are fantastic. But it's still a fussy biological process, and every person's experience is different. For every "I'm glad I was at home," there's an "I'm glad I went to the hospital."

Giving birth to my son was not the magical home birth experience I'd hoped for (maybe next time), and it was the hardest thing I've ever done, but i'd do it again.
posted by linettasky at 12:05 AM on November 24, 2011 [1 favorite]

treehorn+bunny: When I said port I did indeed mean a saline lock (since other people in this thread were using the term "port" I just went along with it... whoops).

You would think it would make sense to use a saline lock for women in labour, but when I asked for one in the hospital the nurses talked me out of it and gave me a regular IV instead. Why would they do that? Is it more work for the nurses to use a saline lock?
posted by sanitycheck at 12:14 AM on November 24, 2011

I had one hospital birth and one home birth, many years ago. What I remember about the first is that they didn't offer drugs until the point where, in retrospect, I didn't need them. The drugs made it almost impossible to push. Maybe they do things differently these days. The second was easy, I had a midwife, family and friends, and a short labor.

Do you have any nearby close friends or family members who have given birth? Having a trusted woman with you is very helpful when you reach that point where you want to tell your loving supportive husband to shut the fuck up because he has no real idea of what you're going through. In contrast, when a trusted woman who has been through it reassures you that you're doing fine, that it's almost over, that you can do it, etc., you're more apt to believe her.
posted by mareli at 5:14 AM on November 24, 2011

The information that was most helpful in labour was that it will feel like needing to poop and you push the baby out just the same way. Push 3 times per contraction and keep your chin to your chest when pushing as it gives you more power.

Finally, listen to yourself. The nurses, doctor and your family will all tell you things but I found the experience very primal and solitary. I didn't want to be touched, I just wanted to push and I remember feeling almost out of body. Yes my body is in pain, but I'm not there. I am too busy making this baby happen.

I recommend skin-to-skin right after birth and delayed cord cutting. The benefits of both are easy to google.

Good luck!
posted by saradarlin at 12:11 PM on November 24, 2011 [2 favorites]

I wish I had consented to a C-section when the OB consulting [...] suggested it. I'd been in labour for 38 hours and pushing for 2, and making virtually no progress. [...] The issue for me is that I refused the C-section based on some weird macho thing of NO WAY I'M HAVING HER THE HARD WAY.

Ms. Ubu has also said the same thing, that not agreeing to the C-section when it was first suggested only caused an extra 12 hours of pointless effort, with the same final result. That's with the benefit of hindsight, though. If we had agreed right away, perhaps there would have been some kind of lingering guilt later over "not having tried hard enough"?

Impossible to know, but as long as you trust that your medical team aren't just trying to churn the births through as quickly as possible for their own benefit, then if they start suggesting C-sections, consider that maybe they know what they're talking about & that they've been through all of this more often than you have.
posted by UbuRoivas at 12:44 PM on November 24, 2011

I haven't read all the responses yet so forgive me if this is repeated, but I wanted to share a few things about my experience before I have to go nurse my little boy who I expect to wake up any minute.

I had a Pitocin induction (due to obstetric cholestasis) and did it without an epidural or pain meds. It was painful and the hardest thing I've ever done but I did it and I would do it again in a heart beat with my next child. It IS possible to be induced without an epidural. The benefits of going without pain meds for the baby and myself are worth it to me. Educate yourself so you know the risks and benefits of each drug they may offer you because it is going to be hard to think clearly about these things when you're deep in it. If you are at all considering going natural (I know you said you aren't commited to drugs or natural at this point, and that's fine, but if you think there is a chance you might want this...) educate yourself now on pain management techniques you and your partner can do to help you.

For me the things that worked were:

-Hiring a doula. She got me through it and I would never, ever give birth again without one. It is possible to hire one at the last minute if you are rethinking this. The amount of support I had from her during labor was priceless.

- Asking for a room with a tub. That was my "big guns" pain management weapon. If I hadn't done that (and been lucky enough to get one), I'm not sure I could have avoided the epidural.

- Lots of healthy snacks and water throughout the day. Eat a good meal before you go in.

- Breathing deeply and relaxing through every contraction. Hip squeezes and counter pressure on my low back from my partner.

- I had minimal tearing, and it was higher up, not my perineum. The key to this is to resist all urges to push that baby out quickly when he starts to crown. It's going to be hard, if you are really feeling the pushing urge (not sure how it feels with an epidural), but if you can slowwww down and give your tissues time to stretch it is going to help more than you know. I remember someone telling me "a lot of pain now makes for a lot less pain later" when I was in the middle of pushing and insisting I couldn't hold back. But I did, and it was worth it. Warm conpresses during the pushing can help too, and perineal massage now. Also I would NOT recommend an episiotomy unless absolutely necessary. Your tissues will heal better with less scar tissue if you tear, rather than if they cut you in a straight line.

Congratulations! You can do this. Just be open to things happening in ways you might not expect. Things can change in an instant, but if you are flexible with your plan, and it sounds like you are, and just keep one thing in mind - healthy mom and baby is all that matters - you will make the right decisions. Best of luck to you for an amazing birth experience!
posted by katy song at 2:17 PM on November 24, 2011

I just gave birth two weeks ago. Like you, I didn't really have a defined birth plan. I ended up being induced (which sucked because they didn't call me in until 11:30pm when we'd been waiting since 7am). Unfortunately I hadn't been able to sleep because I was anxious, and I definitely should have ate more because I was damn hungry during labour.

After labouring with pitocin for 4 hours, the nurse said I was still only 2cm dilated and because I was super sleepy, so I asked for the epidural so I could get some rest (thinking that I was in for a long haul). But by the time the anesthesiologist got it in, I was checked by my OB and was all of a sudden fully dilated...wha? So I'm not really sure what happened - either they should have checked again right before the epidural got put in, or maybe getting the drugs caused the baby to move down all at once? Anyway, I wish I'd asked for the laughing gas or something first, because the epidural made it pretty hard to push. I couldn't feel any pressure at all, so it was hard to know if I was doing it right. Baby was born after about an hour and a half of pushing, with an episiotomy and vacuum assistance, because her hand was up around her neck and her heart rate was occasionally dropping.

Fortunately she was fine and we were able to do skin-to-skin contact and delayed cord clamping, which I really recommend. Delivering the placenta and getting stitched up took a lot longer than I thought.

I wish I'd brought ipod speakers - I'd made a playlist, but I didn't feel like having earphones on, so no music for me. My partner wished he'd brought a pillow for himself - there was a couch but no pillows or blankets. I thought I'd pass the time by playing Angry Birds or playing cards, but they put the IV in my right hand which made it rather difficult to maneuver. I should have asked for it somewhere else.

Right now I'm wishing I'd done some more meal planning - sure, there's a bunch of stuff in the freezer, but casseroles are becoming much less appealing. Also, my appetite is not reliable - it would be handy to have a variety of snacks at hand other than granola bars and other sugary things.
posted by raxast at 2:55 PM on November 24, 2011

The two things I feel like I did "wrong" with regard to labor and delivery were:

1. I didn't hire a doula.
Almost 20 months out, I still feel like this was the biggest "bad" decision I made. My husband was supportive, and we took a birthing class, but neither of us had any idea what labor would actually be like. I think a doula would have really helped me get a better feel for what stage of the game I was in and would have suggested alternate laboring positions, breathing, etc. when I was too out of it to think of them myself. If we have another baby, I will insist on hiring a doula.

2. I got in the tub too early.
I wanted to try to avoid pain medication, and I think I should have used the tub as a very last resort instead of the first one. My labor kept progressing even though I was in the tub, but once it stopped working to help ease the pain of contractions, I didn't feel like I had anywhere else to go but the epidural. And since I didn't have a doula to suggest I walk around, or do X or Y, I got the epi and was stuck in bed from there on out.

Some stuff I did right:

- Insisted on sleeping with my baby instead of leaving him in the plastic tub bassinet thing. The hospital really encouraged skin-to-skin despite them not wanting you to sleep with your baby, so I learned very quickly to wake up as the nurse was entering the room and pretend I had been awake the whole time. I'm sure she saw right through me, but it worked. I ended up with a c-section and couldn't get up to fetch him from the tub if he cried so keeping him close to me helped both of us sleep better.

- Got help with breastfeeding right away. I saw two or three lactation consultants while I was in the hospital because my baby didn't want to open his mouth very wide to latch. I was determined to breastfeed so I wanted to make sure we got the help we needed to succeed.

- Really, really rested once we were home. I set the bar super low and my only goals were to keep the baby happy, fed, and changed. My husband handled meals/household stuff and I basically laid in bed and breastfed the baby. Highly recommend this if you can swing it - you don't want to overdo things right away.

Best of luck to you! You'll do great.
posted by meggan at 12:53 PM on November 25, 2011 [2 favorites]

You would think it would make sense to use a saline lock for women in labour, but when I asked for one in the hospital the nurses talked me out of it and gave me a regular IV instead. Why would they do that? Is it more work for the nurses to use a saline lock?

L&D nurse here. Running IV fluid versus having a saline lock makes no difference to me either way. It'll make a huge difference for you, though, if you begin your labor dehydrated like 75% of my patients do[1]. IV fluid hydration helps turn frequent, sub-powered uterine irritability into functional uterine contractions in early labor.

Is it so hard to believe that a nurse might have your best interests in mind? It baffles me that so many laboring women see their nurse as an enemy to be outsmarted or bested, when in fact we're on your side, and we're trying to use what we've learned watching thousands of women give birth in order to help you have the birth you want.

[1] You really need to drink a lot more water than you think is necessary to be a well-hydrated pregnant woman. I've had patient after patient come to me declining IV fluid and saying, "I can't be dehydrated, I drank a bazillion glasses of water today," and then their urine sample looks like they've been lost in the desert for a week.
posted by jesourie at 12:43 PM on December 4, 2011 [3 favorites]

I know this is a million years after the original question now, but what jesourie said ('IV fluid hydration helps turn frequent, sub-powered uterine irritability into functional uterine contractions in early labor.') reminded me - I had asked for IV fluids fairly early on, and it took them hours to get around to it (not sure if they ever did, now I think of it) - and I'm sure this contributed to my labour being longer and less effective than strictly necessary. So IV fluids would also be high on my do-over wishlist.
posted by magdalenstreetladies at 5:41 PM on December 16, 2011

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