Baby on the Way? Here’s What You May Not Know About Labor and Delivery

When baby is on the way, it can be easy to get caught up in all the prepping and planning.

Do you have a bassinet? What kind of diapers will you use? Is the car seat installed right? Wait, is that another prenatal appointment on my calendar? What are we going to call this kid anyway?

It’s an exciting time. But there’s so much to think about that some of the details can get lost in the mix. And that can include some of the ins and outs of labor and delivery.

People might tell you that it’s important to walk into the hospital with an iron-clad birth plan in hand. How else can you know that your labor will go exactly how you want it to?

Your birth plan can be a good roadmap to start with. But there are things that go down in the delivery room that, even with the best of planning, you can’t control. And then, there are the things you might not have even expected — let alone planned for.

Chances are you’ve already done some research. Or you’re planning to take a class at your hospital to help prepare for labor and delivery. And that’s important. The more you learn, the better.

But some things about labor and delivery are discussed more than others, so we talked with Ob/Gyn Catherine Wilkins, MD, about what you really need to know about labor and delivery. What are pregnant people most surprised to learn?

The truth about contractions

Chances are you’ll experience some warm-up contractions long before labor begins. They call those Braxton Hicks contractions.

Some people will tell you that the difference is that Braxton Hicks contractions are uncomfortable, but the real ones are painful. Or they’ll tell you that Braxton Hicks don’t come with any regularity, while real contractions come like clockwork.

The truth? Labor contractions aren’t just about pain or regularity. There’s something else to it.

“By definition, labor is painful, regular contractions plus a changing cervix,” Dr. Wilkins shares. “So, you can have the first two, but if you don't have the changing cervix part of it, you’re not technically in labor.”

The trouble is, you can’t know for yourself what’s going on with your cervix. Dilation (your cervix opening) and effacement (cervical thinning) aren’t something you can feel happening.

That’s why most healthcare providers recommend the 5-1-1 rule.

Most healthcare providers will advise you to be checked when:

• 5: Your contractions are five minutes apart.
• 1: They last one minute each.
• 1: They happen for about an hour.

But here’s what can happen: Even if you meet those standards, a cervical exam may not show any progress. In that case, the team may tell you that you can go home and keep laboring for a while. That’s OK.

“Many people are very frustrated, I'm contracting every two minutes and they're painful. It's been going on like this for hours. How can I not be in labor? And it’s understandable to be disappointed or worried,” Dr. Wilkins recognizes. “It happens more often than you’d think. But if your cervix isn’t changing, it’s not time yet.”

Of course, your healthcare team may have other instructions. And they’ll probably give you some other advice about when to go to the hospital. Like if you think your water has broken, if you’re bleeding, if the baby isn’t moving as much and other situations that merit a check-in.

So, talk with your provider about when the best timing is for you.

What water breaking is really like

A developing fetus lives inside a “bag of waters” (amniotic sac) during pregnancy. Before labor, or at some point during labor, that sac can break and leak fluid from your vagina. Your water typically breaks during labor. That helps labor to progress. If it doesn’t break on its own, your healthcare provider can break it as a way to move your labor along naturally.

Some people’s water breaks a gush. For others, water breaking is more like a small trickle or a drip.

And if Hollywood has taught us anything about labor and delivery, it’s that water breaking equals baby in five minutes, right?

Probably not.

“If your water breaks, it doesn’t mean you have to rush to the hospital immediately because the baby is going to come out right away,” Dr. Wilkins clarifies. “You probably still have some time. But you do need to head to the hospital because we want to make sure everything is OK. And some people, especially those who’ve given birth before, might progress quickly.”

That’s especially important if you’re positive for group B strep. Your provider will want to start antibiotics soon after your water breaks to reduce the risk of infection.

Pain is subjective

Especially if you haven’t given birth before, it’s tough to imagine what it’s really going to feel like. Making things even more complicated, people experience pain and discomfort differently, points out Dr. Wilkins. So there’s really no way to understand it until you’re in the thick of it.

“What some people consider painful, other people, not so much. You could be 6 centimeters dilated and barely breaking a sweat, while someone else is in agony,” she elaborates. “Every individual person’s discomfort is a standalone experience. It’s theirs and theirs alone.”

When you read about other people’s birth experiences or hear stories from your friends, remember that what they describe feeling is unique to them. Your experience could be much different.

Understanding epidurals

Some people know from the get-go that they want to get an epidural during labor. Others prefer a medication-free labor. And some fall in between — taking a “wait-and-see" approach.

There’s no one “right” choice here. But it can help to understand what to expect should you have one.

Dr. Wilkins shares a few things to know ahead of time:

• It’s not a shot. Some people are under the impression that an epidural is a shot. In truth, it’s given by a catheter placed in your back — a thin, flexible tube that delivers a drip of medication throughout your labor. The epidural remains in place until after baby is born.
• You can’t walk with an epidural. You’ll hear a lot about how important it is to get some movement while in labor. Walking, swaying and otherwise getting a move on can help to move baby down the birth canal and reduce some of the discomforts of labor. But after getting an epidural, your lower half will be numb (or mostly numb), so you won’t be able to move around after getting one. And the medication can take some time to wear off after birth, so you may not be up and about for a few hours after it’s removed.
• You might feel itchy. Epidural medication can significantly lessen the pain of labor and delivery, but it can also cause some strange sensations. “Oftentimes, people will have an itchy feeling or need to scratch their legs or belly. But then, when they touch their legs, it feels weird because they’re numb,” Dr. Wilkins shares. “It’s totally normal, but it can take you by surprise.”

Know how long it could take

At the first hint of labor coming on, you’ll probably be on high alert. It’s timmmmmme!

But like any highly anticipated party guest, babies can take their sweet time making their appearance.

The average labor lasts 12 to 24 hours for a first birth. But that’s just an average. Some go faster. And some can take much longer.

“If you have a scheduled labor induction, especially for a first birth, and your cervix hasn’t effaced or dilated, it can take well over 24 hours, 36 hours or longer,” Dr. Wilkins states.

In other words, your baby’s birthday could be a day or two (even more) after labor induction starts. Pace yourself.

Pushing

During the first stage of labor, baby is getting into position. In the second stage, you’re ready to push. And pushing is considered its own stage for a reason — because it can take some time, too.

“A couple of hours of pushing is completely normal,” Dr. Wilkins notes. “Two hours of pushing is perfectly common.”

And up to four hours of pushing (maybe more) isn’t always a cause for concern.

Know that when it comes to pushing, lying on your back with your legs in the stirrups (common movie fodder) isn’t the only way to do it.

“There are different positions for pushing. And they’re not just options for your comfort. Moving into different birthing positions can be important for positioning your pelvis in different ways to help with labor progression,” Dr. Wilkins explains. “Your team will likely encourage you to move around and try out different birthing positions. And even if you have an epidural, they can help you get into different positions.”

C-section birth

Some people know long before they head to the delivery room that they’ll be having a cesarean birth (C-section). For others, it can be a necessary change to their original birth plan.

Whether you plan for a C-section or not, it can be helpful to know a bit of what to expect and how it works. Dr. Wilkins shares these lesser-known truths about C-sections.

• You’ll probably be awake. Typically, unless it’s an emergency situation, you won’t be under general anesthesia for a C-section. Just your bottom half will be numb.
• You might still feel some sensations. Dr. Wilkins points out that you shouldn’t feel pain during a C-section. But you may still feel touch and pressure. “It’s not that you won’t feel anything. It’s just that you shouldn’t feel anything sharp,” he adds.
• You may get skin-to-skin time when baby is born. If you and baby are both doing well, your healthcare team will likely encourage you to hold them skin-to-skin (kangaroo care) after birth.
• You can have a support person, as long as you’re awake. Typically, you don’t get to bring a buddy into surgery. But hospitals will allow a support person in the operating room during a C-section in most situations.
• You may have some restrictions after a C-section. Some people believe that after a C-section birth, you can’t walk up and down stairs when you get home. Dr. Wilkins says that’s not the case. But you will be encouraged to keep the heavy lifting to a minimum. “For the first six weeks, we don’t want anyone to do any heavy lifting greater than 10 pounds, other than the baby,” he advises. “That’s to help reduce the risk of developing a hernia while that abdominal wall is healing.”

First impressions

If you’ve never seen a baby straight out of the womb, you could be in for some surprises. Because those beautiful baby pictures you see on social media don’t necessarily reflect the reality of a freshly born baby.

To be blunt, a brand-new baby can be a shock.

• They could have some body hair. (Perfectly normal and it usually sheds within about a week of birth.)
• Their head could be elongated from squeezing through your pelvis. (Totally OK and it’ll round out soon.)
• If they were breech and delivered by C-section, they may have a flat spot on the top of their head from pushing up against your diaphragm. (Again, it’ll go away.)
• They could look bruised, even blueish, from the pressure of the birth canal. (No biggie. It’ll fade. And it doesn’t hurt them.)

But go on! Snap those pictures! Because even if they’re not quite what you expect, your baby is beautiful. (And will only get cuter as time goes on!)

Connecting

When you picture yourself holding your baby for the first time, you probably imagine being flooded with joy. Full of pride. Soaring right over the moon in love.

The reality may not be quite so awe-inspiring.

“Birthing a baby can be challenging and exhausting. It’s normal to feel physically and emotionally overwhelmed. Some people even feel not entirely ready to receive the baby immediately,” Dr. Wilkins reassures. “If you don’t feel an immediate connection, it’s not only OK, it’s also very common and understandable.”

Once things settle down, you’ll be more likely to get those loving feelings that you’re craving. But it could take a bit.

“More than 80% of people will get baby blues,” Dr. Wilkins cautions. “That typically lasts the first week or two after birth when you’re dealing with sleep deprivation and still trying to process everything that happened with the birth.”

If you continue to feel disconnected from your baby or have strong emotional reactions, like uncontrolled weepiness or are unable to care for yourself or your baby, it’s time to get some help. It might be postpartum depression.

You’re not alone

What you experience as part of your labor, delivery and postpartum journey is in many ways unique to you.

But that doesn’t mean that others can’t relate.

“After having a baby, it’s easy to feel like no one else can understand it — like you’re alone on some island or that you’re the only one it’s not working easily for,” Dr. Wilkins empathizes. “But that’s not at all true. There’s so much support and so much help. It’ll be OK.”

It’s almost like being in middle school again. You might feel awkward. Out of place. Like no one understands you. But in hindsight, you realize that others around you are feeling the exact same way.

You can find community and connect with other new parents online and in person. Look for local community support groups. Join discussion boards. Talk with your healthcare team about what’s going on. And be open to advice.

“You’re never alone. There’s always help,” Dr. Wilkins reinforces. “There are people who understand. People have been giving birth for millennia. And you can thrive, too.”