Location

The location of your placenta can change a few things:

Movement — If you have an anterior placenta you may feel your baby a little later. Some people say they feel less movement through the duration of their pregnancy – but most studies show that after about 24 weeks people feel their baby about the same as everyone else (although every pregnancy is different). This happens in about 33-50% of pregnancies (so, very normal).

I also have a youtube video on it you might find helpful:

Delivery Method – If you have a placenta previa (and you’d know it if you have it) that continues into your third trimester you’ll likely have to deliver via cesarean. A placenta previa is where the placenta covers your cervix. And, because it is keeping your baby alive, they can’t go through the cervix while it’s covering it.

MANY people have a placenta previa at early ultrasounds (even 20 weeks) but as the uterus grows, the placenta grows with it up the side walls of the uterus. A true placenta previa at delivery date only happens in about 1 in 200 pregnancies.

Want to know more cool things about pregnancy? — check out these posts:

• Pregnancy Pains That Are Actually Warning Signs
• What makes labor hurt more?
• If I had a Baby Again this is What I’d Do Different
• Charlie Horses in Pregnancy: What you can do to prevent them?
• Pregnancy, Tylenol® & Autism: What Expecting Moms Need to Know

It’s Disposible

It is meant to be thrown away — or eaten or buried if you’re an animal.

While you can 100% have your placenta from the hospital (we red bag and throw them away — don’t let anyone else tell you we’re selling them to cosmetic companies) — but eating your placenta (in anyway) does come with risks and the benefits aren’t proven. I have a post on eating your placenta here.

While we’re here, I also have a podcast episode on the placenta you might find interesting too!

Size Matters

While the placenta isn’t routinely measured, there are some new studies that are showing a correlation between extra large and extra small placentas being a risk factor for stillbirth or miscarriage.

You can ask for it to be measured (they may or may not do it) — it’s called EPV or estimated placental volume. It’s important to know that not all places have the experience to do it — but the more we ask for it, the more common it will be!

They’re just measuring the size of the placenta in comparison with the baby’s size and then if it’s too large/small then they can just watch it, and perhaps do some extra monitoring…

If you want more information on this check out Measure the Placenta.

Sometimes just KNOWING you have options is good to know – both in your placenta but also at delivery. I recommend this to know more about what options you have {and feeling prepared for them}.

That being said, my favorite way to prevent stillbirth is kick counts, and I have a cheat sheet on how to do them right here.

It’s a Filter

The placenta decides what does pass to the baby and what doesn’t. This includes medications, hormones, and more. You’ll hear it phrased — “it doesn’t cross the placenta” — meaning the placenta doesn’t pass it on to baby.

BUT, lots of things do pass to the baby, which is why you have to be super cautious about what you put in your body during pregnancy. {which often sucks}

It Has a Shelf Life

Just like your milk in the fridge, your placenta also has a shelf life.

We believe that 40 weeks is the approximate shelf life of the placenta (remember, it’s disposible). After that it has done it’s job and starts to shut down.

We’ll see calcifications on the placenta on babies who are born a while past their due date, and we believe it’s a big reason why the stillbirth rate rises after 40 weeks of pregnancy. I talk about that a bit more in this post.

Making the choice to be induced if you’re due or post dates can be tricky. I talk about induction in here because it is SO important to get the full picture before making your mind up (and there is also 3rd trimester testing we can do to see how baby is doing before you make a decision).

It Gives And it Takes

Your placenta not only gives your baby everything it needs:

• Oxygen (seriously, you are BREATHING for your baby — it’s amazing!)
• Nutrients

BUT it also takes away all the waste products from the baby (although they still pee their own amniotic fluid).

Honestly, the placenta doesn’t get it’s due. It really does a HUGE amount of work to keep that baby alive. I always took a picture of mine, because I was so grateful that it did do it’s job in there. Of course, I also let them toss it in the trash because it’s kind of gross too.

Pregnancy is just such a miracle. I want you feel prepared and confident for your delivery day, which is why I created this. It’s not a miracle to have a great birth >> preparation is the key!

Got other questions about the placenta? Let me know down below and I’ll do my best to answer!

The post 6 Things to Know About Your Placenta appeared first on The Pregnancy Nurse®.

Very first, I want to say that almost all of these pains can have normal parts of them — which is what makes this SO hard. Which is why I think it’s important to mention any new pains to your provider so they can check them out at your appointments.

I also wanted to add that some of the signs can be OK at other times and NOT ok at others (like signs of labor can be more problematic before 36 weeks) but these are pretty straightforward throughout pregnancy (unless otherwise noted).

This post may contain affiliate links where I earn a small commission your purchase at no cost to you. Feel free to check my disclosure and terms for more info!

Rib Pain

This can be tricky because baby can be kicking your ribs like it’s a soccer ball — and that’s all perfectly fine and normal (but also annoying).

BUT it can actually be a problem if it’s your liver that’s enlarging into your ribs due to preeclampisa.

So, how to tell the difference?

First off, do you feel baby kicking that spot a lot?

Which side is it? Your liver is on your right side (your right), so if it’s your left side you’re clear!

Has it been coming for a while, just annoying at first, but then a few weeks later it’s getting worse… OR did it sort of crop up in a day or so?

Pains that have come on quicker tend to be something to call your provider about vs something that slowly comes on.

Pro Tip: It is so much better, faster, cheaper to deal with these problem signs with your provider in the office. If at all possible try to call them during office hours to be seen there. That being said, if something comes on suddenly and seems problematic Labor & Delivery is open every day, every hours, just waiting for you to make sure you and baby are safe!

The good news is this is pretty easy to check for… and preeclampsia usually comes with a few other symptoms (although not always, I have had patients where the rib pain was the first main symptom). Other things to watch for include:

• Blurry Vision
• Swelling (especially swelling that suddenly showed up, vs swelling that’s been around your whole pregnancy)
• High blood pressure.

I actually think every pregnant family should have a blood pressure cuff. They’re not expensive, but can be so important.

Also, if you’re prior to 20 weeks of pregnancy, be sure to talk with your provider about if taking aspirin is right for you, as it can help prevent preeclampsia!

I actually have a whole post on rib pain with more info for you!

AND if you’re loving tips like these — come get my 5 insider tips with me:

Calf Pain

Calf pain can be a sign of a blood clot — especially if it comes with:

• Redness
• Hot to the touch
• Hurts more when you pull your toe towards your knee (flexing your calf muscle)

However, charlie horse pain can be a very normal symptom of pregnancy. Also, that calf pain can stick around for a bit even after the most intense part has happened and can feel like something is wrong. But, now you know the other symptoms to look for to see if it’s a problem.

That post I linked also has some tips for getting rid of (or lessening) charlie horse pain in pregnancy because it’s the WORST. Just as you get to sleep BOOM the devil shows up in your leg! Nothing better than waking up screaming during pregnancy to make your partner feel at ease!

Note: Blood clots are more common both in pregnancy and postpartum. There are important warning signs in both of those times that I talk about in here. So important for everyone to know about those warning signs and I include a handy paper to hang in a common area for everyone to help keep you safe!

Headache

Yet another tricky one, because most people will say that a headache was a common friend during most of pregnancy. The lack of sleep (but also being SO tired), weird fluid balances and just not feeling your best often made it a common symptom for me in pregnancy too.

Headaches can be a sign of preeclampsia.

However, a headache CAN be a VERY common thing in pregnancy. But, how do you know the difference?

Well, first off – definitely worth mentioning it to your provider at your appointments, so he can keep an eye on it — but also watch for:

• How bad is it? If it’s the “worst headache of your life” I think you need to be seen ASAP either in your provider’s office or at labor and delivery. This is often a sign of preeclampsia — but be honest with yourself.
• Is this a new symptom? — or have you had headaches throughout your pregnancy of a similar nature? (most often preeclampisa doesn’t come til’ past 20 weeks, but you can have gestational hypertension before then)
• Any other symptoms with it? – similar to the rib pain is it also coming with blurred vision, new swelling or high blood pressure?

Once again, this is an awesome time to have a blood pressure cuff at home — it can only make your headache worse to be worrying about possible preeclampsia with it, but if your blood pressure is similar to what it always is, it could be normal.

That being said — at ANY point someone says “this is the worst headache of my life” (and they’re pregnant or recently had a baby) I’d go in and be seen, even if your blood pressure measures normal.

Let me just put a push in for partners to be educated on symptoms like this as well. It’s REALLY easy for you to push off symptoms like a “horrible headache” because it’s just overwhelming to think about going to the doctor for it.

But a supportive partner can help you get the help you need, bring you the blood pressure cuff etc. It’s just good to have a second pair of eyes on you. You deserve that support.

Honestly, you deserve it in the labor room too, and far too often partners want more information on it — which is why I created this.

At the VERY least, send them this article. I think they’ll be grateful for the info!

Itchy Palms

This isn’t exactly a pain, but it is a little-known symptom that can be a pretty big problem.

Now, it’s VERY normal to feel a bit itchy during pregnancy. Your skin is being asked to stretch a lot in new places as this baby grows and your body adjusts.

But, itchy palms or itchy soles of your feet can be a sign of cholestasis. That’s a blockage of your liver that can increase your risk of stillbirth.

Now, this is JUST itchy palms and feet, it’s NOT just an itchy belly — but if you’re just feeling itchy all over then talk with your provider. It’s just a blood test if they think you fit the criteria.

As I’ve said before — new symptoms deserve a mention to your provider, so they can investigate further.

Baby Kicking Like Crazy!

It can feel like the war of the worlds in your belly.

But, being the smart mom you are, you’ve been taking note of fetal movement from those very first kicks. And you’ve been monitoring what your baby’s normal is.

Remember, it’s always YOUR baby’s “normal” — not a previous pregnancy, not compared to a friend’s pregnancy. It’s YOUR baby’s normal.

Now, super smart moms do kick counts — if you’re not sure how to do them I have a whole cheat sheet here for you:

But, sometimes you’re just like SIMMER DOWN to that baby. They’re moving like crazy. Is that a problem?

Well, if you’ve felt it before — that means it’s part of your baby’s movement pattern. They’re feeling good, and like us — if they feel good they like to get their groove on in there.

However, if baby suddenly starts moving a TON and it is very much out of their norm (reminder: it’s hard to know your baby’s “normal” pattern until you’re into your 3rd trimester) it’s worth calling your provider or going to labor and delivery to be seen.

We talk a lot about decreased fetal movement, but increased movement (especially a thrashing-type movement that is very much out of character for them) can be a problem as well.

This isn’t to scare you — it’s to inform you.

Again as you assess this:

• Are you in your third trimester where you have established your baby’s “normal” movement patterns?
• Is this something you’ve NEVER felt before – and seems VERY different from what you usually feel.

If both of those are a yes, I would encourage you to be seen. Unless your provider can seen you quickly (and most often they can’t) I’d head into labor and delivery.

I actually have a whole post on if increased movement is a sign of labor that you might find helpful as well!

And, if you’re like — Hilary, I’ve never heard this before, I get that. A lot of people don’t talk about this part of fetal movement, but I want to empower and educate you. I think education is the key.

Chest Pain

And finally — chest pain.

Once again, tricky because those boobs might feel pretty tender, sometimes even warm to the touch.

Also, the muscles around them can be sore from the changes….

But chest pain isn’t related to touching your breasts, or a certain position that you’re in.

If you have chest pain — you should be seen. Of course, “chest pain” can be subjective… things I often hear:

• Suddenly it’s like an elephant is on your chest (or a lot of pressure)
• Difficulty breathing or catching your breath (especially at rest — doesn’t count if you just walked up the stairs)
• Can also be shoulder pains (again not related to how you’re moving your body)

This can be a heart attack. You are an increased risk of heart attacks during pregnancy and you’ll want to be seen ASAP. That may mean calling 911 or heading straight to the emergency room (I know a lot of areas have pretty poor 911 service).

Even if your local hospital doesn’t have labor and delivery, I’d still go straight there in this case — they can still treat you for a heart attack (or make sure you’re stable and send you to the nearest L&D unit).

While we’re here, I should also mention you’re at an increased risk for a stroke during pregnancy. So, if you notice any stroke signs you’ll want to be seen right away too. That would be things like

• Slurred speech
• Inability to move part of your body
• Weakness on one side of your body (one side smiles when you try to smile, but the other side continues to droop)

Again, I want to remind you — this isn’t here to scare you. It’s here to remind you that pregnancy is full of weird crazy things happening to your body. It’s important to know which ones are really important to be seen, and which can wait for your next checkup.

Of course, once you get there you have to decide if it’s a pain are just wondering if it’s OK and you can live with, or if you need a fix. I have a whole post on what to do if you’re in pain in pregnancy you’ll find helpful — as many pains are brushed off as “normal” but you’re unable to do your daily activites due to the pain. And there ARE things you can try to make it better!

And finally, a high five for making it to the end of this article. It’s so important to know about these uglier parts of pregnancy. Much easier to look at onesies and car seats, but knowing that you and baby are safe is the biggest gift you can give your baby. Preparation is the key to a great birth — and if you’d love to get you both prepared in a quick and easy way I recommend this.

Which of these symptoms was a surprise to you? Tell me in the comments!

The post Pregnancy Pains That Are Actually Warning Signs appeared first on The Pregnancy Nurse®.

As a labor nurse for 20 years I definitely saw these mistakes a LOT so I’m really glad you’re here and I can help you avoid them!

Note: These are just 5 things, if you want all the things in one spot where you and your partner can easily learn them — check this out!

Also, you clearly need to be safe to stay at home and that’s something to discuss with your provider. If you are in labor before baby is due then you should 100% just head into the hospital also. This is medical information, not advice and please DO talk with your provider about when to head into the hospital at your next appointment.

I’m also going to give you a few pro tips of things TO do at the end, so keep reading for those!

1. Timing All. The Things.

Oh gosh, it’s so tempting to do! You’re wondering IS. THIS. IT? After weeks of waiting and perhaps a few false starts (btw, love this video if that’s you) you’re wanting to know if this is headed somewhere.

But, just like the boys in high school — early labor works best when ignored.

Make it want you rather than you smothering it with attention.

Ok, it may not always be that way — but I like to think of it that way.

(don’t worry, active labor is almost impossible to ignore — you won’t miss it)

Unless your contractions are clearly less than 10 minutes apart, try to ignore them and move on with your life. I’ll talk about some things TO do at the bottom, so stay tuned.

Although, one thing you don’t want to ignore is fetal movement. Keep watching for it and keep doing those kick counts.

And if you have no idea what I’m talking about get my cheat sheet here:

2. Freaking Out

This is the other thing.

Kind of a Nemo-esque “today’s the day, it’s HAPPENING” type feeling that bubbles up inside.

What to do first — pack the bag, call your doctor, do the miles circuit, or just scream that soon you’re going to be a mama!

This is the time to use the labor breathing — perhaps less for pain and more for the calm that your body desperately needs.

And, if you’re thinking “labor breathing?” I discuss it in the natural pain management bonus video in here. So helpful for you and your partner!

We believe that the main leader in labor continuing is a hormone called Oxytocin. Normally, it’s the love hormone. You feel it when you love Seth in the 7th grade, and later on when you met your partner. In small doses it’s a lovely feeling and you’ll get more of those lovely feelings with your baby soon.

Although, in labor it converts to that lovely feeling into pure pain — so sort of like a break up.

But, the thing that can stop oxytocin faster than toddler in a parking lot is worry, anxiety and frankly — freaking out.

So, the more you can stay cool as a cucumber the more Oxytocin will flow in your system.

Do things that promote feeling safe, happy, loved and bonding with that partner. I have a whole post on how to keep oxytocin flowing (and a video).

And yes — if you have no idea what to do or what to expect in early labor, it can be hard to be calm — and it can be EXTRA hard with a partner who also is freaking out inside. Which is why I have a whole chapter on early labor, what to expect and do in here.

So many classes entirely skip that part and that’s not doing either of you any favors. It is the main part you’re “alone” for if you’re planning on a hospital birth — so it can feel really scary. You need a labor bff like me to help you through it!

3. Staying in One Position

Now when I freak out I tend to just fall onto my couch or my bed and curl up (and perhaps even scoll Tiktok which is like a trifecta of things NOT to do).

This isn’t to say you can’t lay on the couch. Laying on the couch or your bed is a very important part of any third trimester.

But I am saying to continue to move.

Every 30 minutes you get up and do some movements. Things I love:

• Squats (have a wall or a sturdy couch behind you — the lower the better)
• Lunges (I know, I hate them too)
• Curb walking (yes, I have a whole post on it)
• Hands and knees (I have a pro tip in here about how to use that one best)

I once saw a midwife say that in early labor it’s like trying to wiggle a cork into the right position in a bottle (then, in active labor you get the forceful pushes to put that cork in — or pus that baby into the birth canal).

You’re trying to help baby find their right position by doing some “wiggling” type movements.

And if those seem completely impossible at least change positions in bed. Add something between your legs or cross your legs over each other — just try to get that pelvis into a different spot than it was before.

This is an awesome job for partners. First off, they’re going to love having a task, but that way you don’t have to watch the timer — they can do it and then help you to move. Then, between movements they can get you a little snack because you’re not going to want to….

4. Eating Giant Meals

It’s tempting to eat a lot because you’re not sure when you’ll eat again.

(basically, my third trimester was me thinking I should eat a lot and then just taking a few nibbles — tell me in the comments if that’s you too).

But, small snacks are better.

Now, this isn’t the time to carb-load — you’re going to want to balance protein and carbs to keep your strength up.

I have a whole bonus video in here where we go into some great labor snacks with a nutritionist (which are also just great pregnancy snacks) — but a few ideas to get you started:

• Nuts and some fruit (gotta love some fruit fiber)
• String cheese and some crackers (yes, the Lunchable of our youth)
• Peanut Butter and dates (or celery or an apple)

So, don’t eat a lot, but do eat. If you aren’t in the mood to eat at ALL, you can honor that too — your body is doing a BIG thing (and I promise you’ll be as hungry as a horse after this baby comes out).

5. Going Into The Hospital

Media, for far too long, has acted like you get a contraction and you go to the hospital.

And frankly, you totally can. We’re happy to see you in Labor and Delivery and our unit is open to make sure that you and baby are safe.

But as long as things are going OK the hospital truly is NOT the best place for you in early labor.

Now, we define early labor as 0 to 4-6 cm (the definition changes depending on who you talk to).

I want to be clear on something, you can always go to the hospital if you’re ever worried or scared something is wrong (or baby’s movement seems off). This isn’t a tip to just NOT use the hospital.

But if things are going ok at home, baby is moving well and you’re feeling alright — stay at home. Use your natural pain management techniques (think: breathing, massage and maybe a brownie or two — along with some nuts) to help you stay there.

Your home lets Oxytocin flow. It allows you to let your body do what it was made to do. Move, and cling that partner who is so very important in this process.

Then, when the pains are getting overwhelming, you can’t talk through them and you’re to the point your provider recommended head on in.

Of course, for everyone this time is going to be different. I just heard of a rural labor unit closing just south of me that will add an hour to people’s labor and delivery experience. This is happening far too often in the US (shaking my fist at the world).

You may have a far drive, you may have some crazy traffic, and you might be GBS positive (which changes things a bit). So, talk with your provider to see what they recommend.

Also, ask them if they have someone on for them 24/7 — can you call someone, even if it’s in the middle of the night — to talk to them about laboring at home. Talk through things and make a plan that’s best for you.

Most do, and it’s important to know how they handle those situations. They can be a great lifeline when you’re feeling a little too alone at home.

I was thinking that many of you will experience early labor in the hospital with an induction — and honestly, these rules can still be followed for the most part — you can always ask your nurse to help you make the most of them, and be SURE to get EXTRA prepare for an induction — I have a whole chapter on it in here.

Ok, now…

What SHOULD you be doing?

Like I said before keep having small snacks if you’re a bit hungry.

Pack that hospital bag — I just did a video on a few things to do right before you go into the hospital but even the best packed hospital bag is likely going to have a few things you need to add at the end (and grabbing those things is good movement for your body).

And, if you’re not sure what to put in it I do have a no-fluff packing list:

And, the big one is to sleep. If you can actually get some rest (note: you’re going to have to put freaking out behind you in order to get it) it will be SO good later on.

This is truly the time to ignore the fact that you could be having a baby in a few hours and focus on what you need — and rest not only fills up your gas tank with some energy, but the relaxation can also help your baby find their right spot — just as well as curb walking.

The key is actually sleeping, so if you’re just “resting” — be sure to keep moving every 30 minutes. This is great for a partner to keep checking on you to see if you’re actually asleep.

I just want to say that this can feel really scary. I felt prepared, but my husband did NOT (I mean, he was married to The Pregnancy Nurse®, who can blame him?). He just wanted to leave, he didn’t want to deliver this baby on his own and his pressure often took me into the hospital too early.

I wish I’d done a better job at preparing him for what to expect. Maybe I should have taught him chapter 3 in here.

I don’t want you to be scared or anxious (I don’t want that for your partner either). There is a better way, and feeling prepared is at the root of it. People aren’t just “lucky” they got to the hospital at the right time — they prepared and made the right choices (and hopefully had an awesome provider on speed dial while at home).

Early labor is just one of those scary parts, so be sure to get prepared for all of it. I can’t wait for you to have this exciting journey, best of luck to you!

The post Things to Avoid in Early Labor appeared first on The Pregnancy Nurse®.

NOTE: This is clearly if you’re going in for labor — if you’re going in for other things like decreased fetal movement, issues with your blood pressure, etc — just high tail it on in. With labor you have a bit more wiggle room and some important priorities before that event! Also, if you’re planning for a caesarean birth these might not apply there either. Be sure to talk with your provider about what to do if that’s your plan.

Drink Water

Drinking water brings two things to the table:

1. It will make sure that you’re not just contracting because you’re dehydrated
2. Being hydrated makes putting in your IV easier in the hospital

(btw, if you’re like IV — no thanks, check out this article)

I recommend two big glasses initially, and then a big glass every hour thereafter.

Sleep

This one might not feel normal — but honestly, if you can rest — DO IT.

As a labor nurse for 20 years, I saw far too many couples who either started obsessing over labor and timing every. little. thing. OR, just headed into the hospital too early.

IF you can rest (and often you can’t) it would be AMAZING to get a nap in. Honestly, even if it’s just like 10-20 minutes, it’s still going to fill that gas tank — plus your body will relax and baby might even find their best way out.

Now, if you’re thinking, HILARY — this is going to be so wildly stressful there’s no way I can sleep — I hear you. This part of labor where you’re at home and you’re sort of “doing it on your own” can feel like a lot.

It’s why I recommend taking a birth class that covers that early labor at home time. The one I recommend covers:

• What to be eating
• How to move your body to keep things going
• How to get rest
• What your PARTNER can be doing << This is SO important as they’re your big help during this stage!

This doesn’t come naturally to most people — you need a bit of training, and that class does it quickly for both of you!

Grab Last Minute Bag Items

You may have your hospital bag packed for a while (or, you’re like me and you felt like it might give you bad ju-ju — in that case, actually pack the bag). Either way, grab those last minute items. Beyond the regular packing list items (don’t worry I’ll link my list below), this usually includes:

• Bra for labor
• Going home outfit (think something that fit well a couple of months ago — your body won’t be back to “normal” but it also won’t be as pregnant as you are now)
• Shoes for labor

But, obviously, anything you didn’t have duplicates for, that you knew would have to go in at the end.

Grab my packing list here:

Want to know more about your bag — check out these posts:

• When to Pack Your Hospital Bag
• What to pack in Your Hospital Bag: Your Labor & Delivery Checklist
• What to Pack in a C-Section Hospital Bag: 4 things you’ll want from an L&D RN.
• What to Pack in Hospital Bag for Baby
• Hospital Bag for Dad
• What to pack in your bag for after baby

Eat

Ok, like I talked about above eating can be a good thing to do while you’re in early labor.

While some hospitals will let you eat in labor, some may not be able to provide you food (great question to ask your provider about in advance as they’re the ones that give the order as to if they can feed you or not).

The other thing is that hospital food often just sucks, particularly in labor and delivery where they don’t feed a lot of people.

So, eating something you love in advance can be a big win.

I recommend eating something that balances carbs and protein. We talk more about in the nutrition bonus video in here, but some ideas:

• Sandwich — deli meat, or PB&J
• String cheese and some fruit
• Nuts & some fruit

If you’re hungry, you could also eat a complete meal, but I’d make it small, you aren’t going to want to labor on a full stomach.

And of course, keep staying hydrated.

Call Your Provider

Now, this isn’t a requirement — your nurse will call your provider once you show-up to the hospital.

However, most providers have someone who answers their phones 24/7. It may be a phone service, but if you think you’re in labor, they normally will have someone you can talk to, or will call you back.

That person can be a great resource as to when you should go into labor and delivery.

As an experienced L&D RN I was able to tell pretty well over the phone if it was time to HURRY in, or they could probably stay at home for a bit. It’s not foolproof, but your provider knows you, your history (I hope), where you live and when it would be good to head into the hospital.

Challenge: At your next appointment, ask your provider how you can get hold of them after office hours if you think something is up. That will help you know what to do in this type of situation.

And if talking with your provider makes you nervous, I have a bonus video in here that talks about provider communication.

Move

I know, I know — I just said sleep. But, a lot of people aren’t able to sleep — and when you’re NOT sleeping, you should move.

Maybe that’s walking through your house packing the hospital bag, maybe it’s doing the Miles Circuit to keep things going….

One of my favorites is to get down on hands and knees and clean something.

And just as I said that you thought — I hate you Hilary, which is valid. But, hands and knees is a GREAT position to be in to help baby find their best position in your pelvis, and when you combine that in getting some tasks done — be it cleaning your bathroom, your floor or cleaning out a cupboard is a double win for me.

Sometimes resting your upper body on a stool with your elbows, and putting a pillow or something soft under your knees on it can make it easier. But swaying and moving on hands and knees is a great way to move.

I actually have labor movement cards in here to give you ideas of how you can move.

It’s really easy to feel like a deer caught in the headlights in labor — suddenly, you’ve forgotten everything you’ve learned. That’s why those cards can be so handy! The bundle class also has key point videos which is like cliff notes for labor — the best review for your big day!

Throw a Pad On

A lot of people wonder if there are signs as to when their water might break, and the biggest one is that you’re in labor.

In addition to that, discharge just gets to be a lot in labor, so having a pad on would be handy.

Honestly, I’d always keep my bum on a puppy pad if I was really in labor — just to protect anything. Plus, once you’ve had the baby you can always use those pads for countless things. I’m a big fan.

{No idea what puppy pads are? Check out this affiliate link to see them}

BTW, love pro tips like this — check out my insider tips series:

Ok, I’ve given you a few things TO do — but there are a few things I would NOT do…

Things not to do:

Call your family — so often your mom just gets into a tizzy about all of this, and sometimes shows up to the hospital FAR too early. Unless you want your mom with your ASAP I’d wait to call her after you go into the hospital and see if they’re keeping you.

And if you’re like… KEEP ME? Check out my video on choices at admission:

Eat too much — while eating is smart, having a GIANT meal you’ll likely see it again once you’re in rip-roaring labor, and that’s not fun at all.

Freak Out — It’s really easy to think it’s HAPPENING and just want to run around like a chicken with your head cut off.

But, freaking out can shut off oxytocin which may make labor stop. In addition you’re pumping stress hormones to both you and baby, which isn’t awesome.

The best, calmest families have prepared for this ahead of time. And they have better births. Studies prove it.

Check out the reviews on this one — 5,000+ have taken it and absolutely love it. You can be calm when that big time comes too.

So, those are some tips on what to do right before going into the hospital. Of course, if you have other kids, you’ll be figuring out who’s watching them, etc. And everyone might have additional things they need to do. Tell us what was important to you down in the comments!

Thanks for being here, and making it to the end. I wish you the VERY best at your upcoming hospital birth!

The post To Do Right Before Going to the Hospital appeared first on The Pregnancy Nurse®.

This (or any article on The Pregnancy Nurse) should be taken as medical advice, this purely educational. Please talk with your provider about your specific needs and circumstances.

Increased Risks of Advanced Maternal Age: What the studies show

Because a lot of people are getting pregnant after 35, I feel like we’ve started to act as though there isn’t an increased risk to making that choice. Just because something has been normalized, doesn’t mean that it still can’t be risky.

The fact is that the older you are, the more risky pregnancy gets. But you’ll find that maybe just being 35 isn’t the same as being 40+… so let’s review the studies

TRIGGER WARNING: We are discussing stillbirth a LOT here. If that’s an issue or if you’re like TOO MUCH DATA HILARY — just give me the skinny skip to here.

Ok, jumping into the studies:

This one stratified the data according to age:

• 0.6% among teenage mothers (these girls tend to get poor prenatal care – I believe that’s the issue here)
• 0.5% in mothers between 20 and 39 years (notice the ages here)
• 0.9% among mothers 40 and 49 years
• 1.0% among 50 years and over

Now, that’s your total stillbirth risk — but that is a good sized jump between the 20-39 age vs the 40-49 years old.

Dongarwar D, Aggarwal A, Barning K, Salihu HM. Stillbirths among Advanced Maternal Age Women in the United States: 2003-2017. Int J MCH AIDS. 2020;9(1):153-156. doi: 10.21106/ijma.346. Epub 2020 Feb 10. PMID: 32123639; PMCID: PMC7031887.

I know those percentages do look very small, but for the few that could have been prevented it is a devastating loss to all involved.

This one reviewed a few different studies (my favorite way to do it) — and it talks more about the relative risk vs the actual risk — meaning that in the study above the relative risk was 80% higher between 20-39 years and 40-49 years — but that doesn’t meant that 80% had stillbirths… just that it was a much higher risk (even though the risk was still small).

It said:

We found that greater maternal age was significantly associated with an increased risk of stillbirth; relative risks varied from 1.20 to 4.53 for older versus younger women…. Women with advanced maternal age have an increased risk of stillbirth. However, the magnitude and mechanisms of the increased risk are not clear, and prospective studies are warranted.

Greater maternal age was significantly associated with an increased risk of stillbirth

It talked about some of the reasons this risk might be higher:

• Lower blood flow to the placenta due to decreased blood flow everywhere due to age (called vasculature in literature)
• Increased incidence of chronic disease or obstetric complications
• Higher incidences of blood pressure or diabetes in older women
• Increased numbers of twins, triplets (or more) in older women – older women are 1.5 to 2 times more likely than younger women to have this (although some is due to reproductive help like IVF)

It did call-out that Between 50% and 70% of mothers of stillborn infants had medical or pregnancy complications during their pregnancies — meaning a good number do have a complication (but also, a good number do not)

It also mentioned that not enough of the studies showed information about moms who’s previously had children (called parity in the study). Although, the incidence in general of stillbirth is less if you’ve already had a successful pregnancy.

Some of you may just be FREAKING OUT right now — which isn’t unusual — I did appreciate this paragraph:

Women should understand that the risks associated with pregnancy increase as they get older. In this systematic review, we have demonstrated that risk of stillbirth is one of the risks that increases with advanced maternal age. However, since the absolute stillbirth rate among older women is less than 10 per 1000 births in most industrialized countries, a live birth can be expected in most cases if appropriate medical care is provided. Thus, increased maternal age should not be considered an absolute barrier to the decision to have a child, at least in terms of the risk of stillbirth.

Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C. Maternal age and risk of stillbirth: a systematic review. CMAJ. 2008 Jan 15;178(2):165-72. doi: 10.1503/cmaj.070150. PMID: 18195290; PMCID: PMC2175002.

I can’t see this entire study — but the basics were:

The rate of antepartum stillbirth in women <35 years was 3.5 per 1000 live births and in women ≥35 years was 4.0 per 1000 live births

Showing there is an increased risk (but I’m not seeing the data stratified by age). It did talk a lot about fetal anomalies overall, which definitely increases your risk (but would likely be seen on ultrasound prior to delivery)

Kate F. Walker, Lucy Bradshaw, George J. Bugg, Jim G. Thornton,
Causes of antepartum stillbirth in women of advanced maternal age,
European Journal of Obstetrics & Gynecology and Reproductive Biology,
Volume 197,
2016,
Pages 86-90,

This one had some good data with it much more stratified out by ages. It’s important to know because the risk is very different at 35 than it is at 40+. It ALSO shows the risk based on DAD’s age as well. They have a great chart on page 4 of that study…

Here’s the risk of stillbirth in 1000 live births based on age:

• 28 — 1.0 (this was considered their baseline)
• 30 — 1.08
• 32 — 1.17
• 36 — 1.54
• 40 — 2.16
• 44 — 3.04
• 48 — 4.28
• 50 — 5.07

So, as you can see there is a decent sized jump at 36 (even though relative risk is still pretty small when you’re thinking PER 1,000 babies).

Parental age and stillbirth: a population-based cohort of nearly 10 million California deliveries from 1991 to 2011
Jonathan A. Mayo, MPH a, *, Ying Lu, PhD b, David K. Stevenson, MD a, Gary M. Shaw, DrPH a, 1, Michael L. Eisenberg, MD c,

As I look at these studies it is pretty frustrating that all of them are from the 2010’s — it’s important to note that these have to be LONG TERM studies as we have to include hundreds of thousands of births to see trends like this. But also, research dollars are drying up lately — it we want this data, we have to continue to fund good research. Hopefully we get some new studies soon!

ACOG (the American College of Gynecologists — they’re the ones who make the guidelines for OB’s in the US) has a great page that outlines some of the reasons for these increased rates — they include:

• Increased incidence of IVF
• Increased Diabetes
• Increased preeclampisa or hypertension
• Increased risk of genetic conditions (like down syndrome — although that’s not the only one)

Those are called comorbidities. You might also have some that are distinct to just you — like decreased flow to the placenta or baby’s size measuring big or small.

A few recommendations I pulled out…

• They recommend encouraging an induction for those over 40 (even though “advanced maternal age” starts at 35) due to increased stillbirth risks
• They still recommend trying for vaginal delivery in general (although if baby is breech or extra large that may change)

I also want to call out that there is an increased risk for problems with mom as well. Mostly including heart issues like cardiomyopathy as pregnancy continues — especially in older moms. So this isn’t entirely about stillbirths.

Hilary’s Thoughts on This Data

I appreciate the data — but I did want to pull out a few things I personally thought during this:

• Risk at 35 isn’t the same as the risk 40+ (although it is increased from people under 35 overall)
• You want good data on any comorbidities — meaning
  • Getting all your ultrasounds at the right time
  • Doing any testing recommended
  • Attending prenatal appointments (all of them)
• IVF does play a role in this. It’s difficult to tell how much, but a “natural” pregnancy will be different than one via reproductive help.

As always, it is important to apply what you’re learning and seeing in the data, to what YOU want for your pregnancy and what the situation is for YOU. We’re going to talk more about that coming up!

Figuring out what YOU want starts with a birth plan — grab my free Birth Plan Template to start getting clear on your preferences before those provider conversations get real.

Want to know more about inductions? — check out these posts:

• Lies I Used to Believe about Labor & Birth
• Pumping To Induce Labor? Will it work?
• 5 Things NOT to do Before Your Induction
• Pitocin to Induce Labor
• Inducing Labor at 39 Weeks: Pros and Cons

Why They Recommend It

So, as noted above — ACOG recommends an induction of labor in people over 40.

Now, I’m also hearing a LOT of people 35-39 also being recommended to have it… and that could be based on all the data above.

But, ultimately they are recommending it because they want to prevent stillbirth (and possibly poorer outcomes to moms).

And, honestly, the risks to an induction are pretty low.

This study showed there wasn’t an increased risk of cesarean delivery during a 39 week advanced maternal age induction vs someone who was expectantly managed (aka, just watched and went into labor on their own, or needed to be induced). It also showed no adverse short-term effects on maternal or neonatal outcomes.

What I’m not seeing in that study is actually less stillbirths. They did study it — but you need a REALLY LARGE study to check that out as the incidence of stillbirths is so small in both populations.

Randomized Trial of Labor Induction in Women 35 Years of Age or Older Kate F. Walker, M.R.C.O.G., George J. Bugg, M.D., Marion Macpherson, M.D., Carol McCormick, M.Sc., Nicky Grace, M.A., Chris Wildsmith, B.A., Lucy Bradshaw, M.Sc., Gordon C.S. Smith, D.Sc., and James G. Thornton, M.D.

You’re always weighing the risks to the baby, and the mom to the risk of being born early and possibly induction complications. That’s your doctor’s job.

Your job is to weigh all of that against what you want for your birth. And that’s OK too.

Induction Before 39 Weeks?

Now, some of you out there are wishing your baby could be induced before 39 weeks of pregnancy.

It’s very heavily regulated who is offered an induction before 39 weeks pregnancy — and no, advanced maternal age isn’t one of those reasons.

I have a whole post on why you might get induced early — but basic indications include:

• Preeclampsia or gestational hypertension
• Type 1 or Type 2 pre-existing diabetes
• Placental issues or fetal growth restriction (IUGR)
• Premature rupture of membranes

I should say no matter WHEN you’re considering an induction you want to make sure you understand what will happen — I have a whole induction questionnaire that can help you do just that:

Studies vs Your Situation

When you have all that data, you can also ask yourself these questions:

• Was this baby naturally conceived, or did you use IVF?
• Do you have comorbidities — like blood pressure, diabetes or other health issues?
• Multiples (twins, etc — although those are general induced or go into labor early)
• How old ARE you — are you just a few weeks over 35 or 40+
• Any circulatory issues? As blood flow to the placenta is a big concern — how’s your blood flow overall otherwise? (cholesterol, etc)

Those are just some ideas — I think it’s smart to go over with your provider your unique situation.

Making the Choice for YOU

Honestly, many women 35+ are begging for an early induction because they’re miserable. And that’s fine too — this article is just here to give you the facts. But if you ARE getting induced, I extra recommend something like this.

The reality is many doctors recommend an elective induction to everyone at 39 weeks of pregnancy, as stillbirth risks do rise the longer you’re pregnant and the ARRIVE Trial supported that.

It is a controversial trial, and there are some that have come out since then that both support what they learned, and some that show an increased incidence in cesareans with elective 39 week inductions. However, the ARRIVE trial is pretty solid research, and it is worth considering as you make your choice. I actually do a deep dive in the Arrive trial in the bundle in here.

When you make the choice for yourself you’re going to balance all the things I talked about above about if you have comorbities, etc along with your own desires for your birth.

I would also have them check my cervix. I think this is a missing piece a lot of people don’t really consider. I have a whole post on if your body is ready for induction that will help explain that more.

For instance, I was 12 days over my due date with my last one, I had prodromal labor every night, my pelvis had separated and I was miserable. My cervix was also 5 cm and I was very ready for an induction. That’s very different than it being closed, thick and high. But I waited and cried and cried when I was actually induced. Needlessly — the induction was actually really easy!

If you want a more “natural” birth that is valid. There is some middle ground:

• Get NST’s weekly, possibly also a BPP to check on baby (I talk more about 3rd trimester testing in lesson 2 in here)
• Setting an appointment in a couple of days to consider it again (and re-look at the current situation — things can change rapidly in those last few days)
• There ARE things you can do to prep your cervix in advance (best done starting at 36’ish weeks, but you can try at any point after talking with your provider.
• Doing your kick counts — SO IMPORTANT to do these correctly and it can prevent stillbirth — I have a kick count cheat sheet here:

It feels like people think birth is very black and white, and while your provider may encourage an induction, it doesn’t mean you have to take one if you really don’t want to (there is a lot of grey area) — but it is important to talk about your risks and then some of the middle ground I mentioned above. And remember you can always change your mind. If an induction starts to feel more right, don’t be afraid to call them!

So, what do you think you’ll do? Tell us in the comments. I think it’s good to learn from others — see how they made THEIR choice and figure out how to manage things for yourself. I also found this very helpful handout made by a clinic in Canada to talk more about your risks if you want more info!

Evidence based birth also has an article on this that you might find helpful too!

The post Advanced Maternal Age – Do you have to be induced at 39 weeks? appeared first on The Pregnancy Nurse®.

Anxiety

Being nervous ads a whole new layer of anxiety into labor.

Now, here’s the hard truth. Everyone’s going to walk in with some anxiety. It’s a big day. You’re not sure what will happen, or how your life will change after today (even if you’ve already had a baby).

But, a lot of couples walk in completely blind, very unprepared (and possibly even worse than unprepared if they’ve seen some social media clips that made things worse).

Be prepared makes birth better, because it removes anxiety.

And because it’s normal to feel some anxiety, learning some breathing techniques can help this as well!

Want to know more about feeling less anxious? — check out these posts:

• The 3 Worst Ways People Prepare for Birth
• Labor Anxiety? These 3 Things Help You Feel in Control
• Why Labor Pain Can Feel So Different For Each Person
• Mistakes You’re Making That Makes Labor Longer

No Sleep

Being tired is the true arch nemesis of labor.

So many people run around freaking out in early labor when they could actually be sleeping. I totally get it, you’re like IT’S HAPPENING (insert meme here ). But, the more you can sleep in early labor, it’s going to be SO helpful as you get further into labor.

I also have some other pro tips like asking for a sleeping pill from your provider (like, literally one — and maybe only take half of it) if you’re in early labor and need to sleep. It can be tricky to calm your mind. This can be especially helpful with an induction. We all know third trimester sleep can feel hard to come by…

Someone reading about sleep in late pregnancy is clearly close to the end and starting to think “okay I need to get my act together.” A birth plan is a very natural “next step” feeling – it’s on every third trimester checklist and it triggers that same “I don’t want to go in blind” instinct.

Baby’s Position

How baby is facing in the womb can make a difference in how you feel labor.

While there are lots of positions baby can be in, the most commonly painful one is if baby is OP (occipit posterior — meaning baby is facing out rather than towards your spine). This puts that baby’s very hard head right into your tender back (that has already had a LOT of work to do this whole pregnancy).

Many people call this “back labor” — and there are techniques like being on all fours and swaying, along with counter pressure from a partner that can help with this.

The good news is that most babies turn after being in labor for a bit — and then you’ll feel the pain differently…

Want to know more about baby’s position? — check out these posts:

• 3 Ways To Get Baby to Flip Head Down
• How to Tell if Your Baby is Head Down
• Once Baby is Head Down Can They Turn Again?
• 32 Weeks Pregnant Ultrasound: What will the scan be?

Being at the Hospital

Hospitals suck. There, I said it.

No one at the hospital is under the delusion that they are a fantastic place to be — and so much better than home. We know they’re loud, they often have alarms going off, and the freaking staff is coming in at all hours to bother you.

Some of you may have some trauma associated with hospitals (I sure do!).

Some of you may just feel like things are far too real (this is when that sleeping pill might help if sleep is even close to an option).

Hospitals just don’t promote sleep, they promote safety — and while we know how important sleep is, sometimes it’s just not our highest priority. Unfortunately.

Just understanding how the hospital runs is key here. It’s a different land with different customs, practices and language. It’s possible!

Previous Surgeries

If you’ve had abdominal surgery you might just feel labor pains differently.

Now, this isn’t just for my VBAC patients — it’s for anyone who’s had any type of uterine or cervical surgery. It can just create scar tissue that may have to “break” in order for baby to move into the pelvis.

If you’ve had surgery in the past I’d ask your provider what to expect from that as you head into this labor.

Past Trauma

Lots of feelings can be swept up when baby is headed towards an area where past trauma has happened. I’m so sorry you’ve had that, and it’s just not fair — but it’s important to know.

Honestly, getting some therapy before birth can help. Definitely knowing what could happen… both of those can be really helpful.

But, mostly just knowing it might happen can help a lot. Using tools you’ve got to help you deal with those emotions and feelings can help so much. I’m a big fan of those tools and they’ve helped me a lot in the past too.

Everyone feels labor pain differently — but hopefully knowing these 5 things will help you feel a bit more prepared.

OH, one more:

Pro Tip: Never compare your labor pain to anyone else’s. It just isn’t helpful. It can’t actually be done and it ultimately just makes you feel worse about it. Take your labor as it comes.

Ready to feel truly prepared? My Online Prenatal Class for Couples covers everything you need to walk into that hospital feeling confident.

The post What makes labor hurt more? appeared first on The Pregnancy Nurse®.

One of the hardest parts about the epidural is how tricky it can feel to get correct information about it in advance. In most places, you’re unable to speak with an anesthesiologist until you ask for it in the hospital. At that point you’re miserable and you just want it to take away the pain. This means you don’t listen very well and any info you DO get isn’t absorbed. Many people rely on social media rumor mills to fill in the gaps.

I hate that system. Quality information on epidurals is important. While this article will give you some good info, it’s important to get prepared for what an epidural might look like. I recommend this.

I also think it’s important to think about what you’d like for your birth ahead of time. I walk you through an easy way to do that right here:

Before we get into the effects, it’s important to know….

What happens to the Epidural After Baby is Born?

So, once we make sure baby is out and you’ve had any tearing repaired, we turn the epidural off.

Epidural Pro Tip: The epidural is normally put on a pump that injects medication very slowly during the duration of your labor. This allows you to have a good amount of pain relief as your labor progresses. If you want more info on epidurals in general << check out that post. Tons of good info here, but this article will focus on what happens AFTER baby is born.

At this point, the epidural is no longer infusing and the effects of the drugs start to wear-off.

At some point after baby is born when it’s convenient for you, we often take the epidural tubing out of your back. This is a lot of tape and it can feel a bit like a back wax. We make sure that the whole tube is intact and you’re good to go.

This doesn’t mean the drugs are out of your system though. They are still being processed in the epidural space for 1-3 hours after birth.

Ok, onto those side effects you might experience THEN:

Postpartum Epidural Side Effects

Hard to Move Legs

I think most people just think pain is taken away, but in order to do that, we also weaken those muscles while the drugs are taking effect.

This means you’ve got less movement while you’re in labor, but also as the drugs wear off after birth.

You should NOT be getting up to walk during labor (unless you have a walking epidural which I talk about here << but those are rare). You should also not get up to walk after baby is born for 1-2 hours.

When we do get you up to walk, your nurse will “test” your legs with you at the bedside for a bit.

For many people their legs will still not be as strong as feels safe, so we’ll use a device to wheel you into the restroom to help you pee and clean you up after baby is born.

For some people that numb feeling can last for quite a while. On my last baby I had one numb leg that remained pretty numb for about 12 hours after I had her. Honestly, I don’t think I process numbing agents very well. It’s similar when I have stitches — it takes a while to numb me, but once it is numb it takes a VERY long time for it to wear off.

Everyone’s different in how that process works. Just know that lack of movement and strength in your legs can be very normal and isn’t a sign that something went wrong with the procedure.

As a note, other effects of the epidural like shaking and itching can still also continue for a bit even after we turn it off. Check out my post about some of the weirder side effects of the epidural.

Want to know more about epidurals? — check out these posts:

• The Benefits of an Epidural No One Talks About
• Epidural Myths vs. Facts: What Social Media Gets Wrong About Labor Pain Relief
• Why People Get An Epidural Even When They’re Not Planning On It
• 3 Tips to Using Movement During Labor WITH an Epidural
• Do You Need a Birth Class if You Plan to Get an Epidural

Pro tip: To give you the cliff notes to that article I linked just above — Yes, I think every pregnant patient needs good information on both an epidural and natural pain management options. This class goes over both << it’s a winner!

Hard to Pee

So, after you have an epidural it can be difficult to pee.

It’s important to know that most patients will get a urinary catheter when they have an epidural.

Just having a catheter in can sometimes make peeing tricky after it is pulled out.

But, when you also add in the numbing of that area due to the meds (similar to how your legs can’t move) and it can sometimes be really tricky to pee after you have an epidural.

Now, it’s easy to think — well, if you can’t pee — just move on with your life. And I agree with that in most scenarios — but, after you have a baby it is really important that you not let your bladder fill up. It can prevent your uterus from properly cramping down to stop bleeding from where the placenta was attached to it.

So, postpartum peeing is important. If we note your bladder is filling, and you’re unable to pee we may use a quick catheter again just to get the urine out, and then give your body some time to let the medications wear off and you can try again in a bit.

As a note, the whole postpartum peeing thing is much more complicated than most people imagine. Just getting up and walking, in addition to taking care of a sore bottom is a lot. Honestly, most of postpartum is this way — again, preparation is key in that area as well. This class also includes 2 full chapters on life after baby (when most birth classes just stop).

Bruising/Pain at the Epidural Site

As with any time a needle punctures your skin, there can be bruising and pain at the site of insertion.

You’ll likely also notice this on your IV site (btw, you’ll NEED an IV to get an epidural — just FYI).

I noticed it most when I was in the shower and water would hit my epidural site or my IV site. It just feels bruised.

One of the biggest myths out there is that the epidural causes long-term back pain. And while I am sure there there are people who have had a complication, the studies show that those who had an epidural-free birth have just as much postpartum back pain as those who did get an epidural.

I have a whole post on if an epidural causes long term back pain that you might find helpful. It dives more into the studies.

The reality is that pregnancy, labor, birth, and postpartum is HARD on a woman’s back.

I believe the standard of care should be a visit to physical therapy for every woman postpartum. Currently, it is not — but you can always ask your provider for a referral.

AND, if you’re pregnant, and in a lot of pain I’d ask to start a relationship with a physical therapist now, so you’ll already have that after baby is born.

Want more postpartum tips? — check out these posts:

• First Poop After Delivery: Make it less-hard (literally)
• Your Guide to Your Postpartum Plan with Free Template
• Self Care During Postpartum & Pregnancy
• C-Section Recovery: Tips You’ll Need
• Postpartum Essentials for a Great Recovery

Breastfeeding

I’ve been hearing this a LOT lately — that the epidural effects breastfeeding after birth.

I actually hope to do a full post on what the studies say, but in my research, most studies show that it does not have an effect on it.

Here a few facts and the links to where you can learn more:

This article reviewed several studies. Showed there was no difference in fentanyl epidurals on breastfeeding (I hear that one a LOT), there may be some correlation in some other drugs they use, but they don’t demonstrate causation.

It’s really important to know that when we use pain management drugs in labor (like fentanyl) it is not going directly into your blood stream. It’s going into the epidural (or spinal in the case of a spinal) space. This makes it’s effects only happen on the nerves in those spaces vs systemic like I were to put it in your IV. While a very small amount does get into the blood stream it is NOT anything like when we give it as an IV pain medication. I can testify to this after seeing thousands of epidural and seeing hundreds of patients get the same drug IV — the effects are very different.

Evidence Based Birth has an article on breastfeeding and epidurals. They said that they encouraged lactation support especially in patients who’ve had an epidural. They also had some outdated guidance like no pacifiers or formula in the room (I’m a big believer in patient choice rather than just restricting things). Personally, I believe every patient deserves a lot of lactation support after birth.

This article showed that people who had an epidural had lower milk supply. Honestly guys — I don’t get this one at all. It really makes no sense. It also studied synthetic oxytocin (Pitocin)…. which is beyond just an epidural. I dunno on this one, didn’t give me the vibes that I would trust this one. I also asked several qualified lactation consultants to see if they saw supply issues more in those with an epidural, and they did not. So, take that all for what it’s worth.

As we often see in these studies the data is mixed. I think it’s important to know this type of data to make the best choice for you when the time is right. And, also know that if breastfeeding is important to you, that you should have some lactation help postpartum. I always think a post hospital discharge appointment with a lactation consultant (usually an IBCLC) is best (and often covered by insurance).

This site reviews a study in which they compared different medications and dosages of fentanyl to breastfeeding rates (they did women who’d previously breastfed and hoped to breastfeed again). They did see a small decrease in breastfeeding with larger doses of fentanyl in the epidural, but otherwise didn’t see a difference in rates. They also concluded that fentanyl in the epidural did NOT make baby extra sleepy and unable to feed in the first hours after birth.

This study showed there was no effect from epidurals on breastfeeding.

A few thoughts I had in reviewing these:

1. Try to use the lowest dose of epidural that gives you the pain relief you need. I talk more about this in my post on the walking epidural or my video on customizing your epidural.
2. Plan to ask for lactation help as soon as you can after birth. Their support can help your breastfeeding journey. Plan to also make an appointment after you leave the hospital too to make sure things are going well.
3. Breastfeeding is wildly complicated to study (and often people’s own thoughts and values enter these studies too much).

People who get an epidural (as most aren’t planned) often have:

• More complications
• An induction due to those complications
• Longer births

And all of that may decrease breastfeeding rates in general. There’s just a lot of confounding factors.

As I said at the beginning. Epidurals are complicated, not a lot of education is given in advance because your OB or Midwife does not do the epidural, and anesthesiologists won’t do consults ahead of time (annoyig).

So, getting prepared for what an epidural really does, how it can work for you and how to make the best choice in advance is key to making your labor the best it can be.

I recommend this to do just that. I think you’ll love it (in fact, it’s guaranteed).

What did you learn about epidurals? Tell us in the comments!

The post Epidural Side Effects After Birth appeared first on The Pregnancy Nurse®.

The best way to prepare for birth isn’t more random tips — it’s a clear, step-by-step understanding of what to expect, what your options are, and how to navigate it all as a team. That’s where real confidence comes from.

Social Media

We do it, we ALL do it — I was just on social media looking at my son’s chances of getting a job he’d had a final interview for. Why? I have no idea — I’m just saying we all look to social media bout what to expect from life.

But, just like videos on social media have nothing to do with my own son’s chances of getting a job — it also can have some issues in preparing for birth.

But why?

You Don’t Get the Full Story

The videos that do the best on social media are often short (at least under 90 seconds — but often closer to 30 seconds) and include a hook that draws you in that often peaks your interest on a topic you’re interested in (but doesn’t fulfill on that promise).

Ultimately, you often get a small nibble of information which leaves you with more questions. Then, you head into the comment section to learn more only to find so many more questions and often a LOT of people with a LOT of opinions (not facts).

This can leave you feeling overwhelmed and like you can NEVER learn what’s important for your upcoming birth.

Social media can be:

• An OK way to supplement your already prepared and confident brain (I recommend this)
• A great way to share how you’re feeling and not feel so alone
• A nice way to find people you trust to help you learn MORE — you may have even found me there (find me @pregnancynurse on all the platforms).

But it really, really can’t be your main way to get prepared.

At the very least try to get videos on Youtube vs the short reels. You’ll at least get more of the full picture on a topic. You can find my channel (with a TON of videos) here. But I want more than even that for you!

Clips give you pieces. Preparation comes from seeing the whole picture.

It Can’t be Trusted.

When I first started really working as a content creator in 2014 (I’m old, I know) I learned that “if you are willing to write on a topic, that means you’re an expert”.

And I was like…. what?

Sure, that might be true on things like what diapers are best, or what hair product works best in curly hair… but when it’s something as important as your baby…? Or, possibly even your life?

Here we are in 2026 and this is honestly just a standard. There are so many people out there saying acting as experts who’ve….

• Doula’d in a few births
• Maybe just had a few kids of their own (or honestly, just one)

And these might be fine people to have a chat with at your local mom’s group, but when you’re looking for actual foundational advice for your pregnancy, labor & birth and managing postpartum — they’re not who you give that trust to.

My best tips:

• Look for experience — as a labor nurse you really don’t become competent until about 8 years into your practice — so, you should be looking for real experience in the labor room (not a physical therapist, or an RN who has not worked L&D).
• Combine that with initials — I’m an RN-BSN which means I am licensed and I have a bachelor’s degree. I have met minimum requirements a few times, which means I meet a standard.
• No Outliers — their advice should be fairly standard, and should empower you to make choices for yourself. Not pushing you into one specific way to birth.

Social media often shares opinions — not context. Learning from an expert helps you understand the “why” behind what’s happening, so you can make informed decisions that feel right for you.

Focus Just on Planned Stuff

This one catches a lot of people off-guard because the planned stuff is actually the foundation for a lot of classes. Things like:

• Stages of labor
• How baby progresses down the birth canal
• How to manage the planned pain of labor.

These are things that happen in almost all births.

We know they’ll happen — so it is smart to prepare for them. But they should only be a small section of your class!

There was a recent study that showed that out of 65 birth classes they looked at — NONE covered the unplanned events. And I’m not talking about crazy rare things — I’m talking cesareans, inductions, episiotomies. I outline that in this article.

Now, clearly a sample size of 65 isn’t big — but it’s something. AND they clearly didn’t look at the class I recommend as it has a chapter on caesareans and inductions.

The reality is that a lot of pregnancy, labor, birth and postpartum is unplanned. You need a class that is going to talk about the unplanned things that might happen. And yes — I did say postpartum. Just as important to know what to do if that’s going wrong too!

It’s not the unexpected that makes labor feel overwhelming — it’s not being prepared for it. When you understand what situations like induction or cesarean actually look like, you can approach them with less anxiety and more confidence instead of trying to process everything in the moment.

Want to know more about those unplanned events? — check out these posts:

• Episiotomy vs a Natural Tear: Which Is Better?
• What To Do If Labor Isn’t Progressing?
• What You Need to Know About Wired vs Wireless Monitors in Labor
• Your Complete Guide to Epidurals in Labor: Everything You Need to Know
• 3 Tips to Using Movement During Labor WITH an Epidural

Alone

This final one is easy to do.

Schedules are crazy, partners may not be super jazzed to learn about this — or think learning about this is up to you.

But I’m here to say that you can be as prepared as you can be — but if 5 nurses run in your room (see unplanned events above) and that partner starts to freak out, that freak out will start to pass-on to you too.

And I don’t want that for you. I want BOTH of you to feel cool, calm, collected.

Of course, this dives right into the fac that most people are “preparing” on social media and may send a few important topics to their partner, but the partner is left with those bits and pieces, and questions that overwhelm them.

That’s why a class, you can take together, and get all the important stuff is so important. I recommend this one (it’s specifically there to do with a partner — even if it’s your mom or a friend). It only takes a few hours, and if time together is at an absolute premium in the bundle there are key point videos where it’s like getting the cliff notes of labor!

One of the biggest shifts couples notice isn’t just what they learn — it’s how much more connected and prepared they feel together. When you’ve talked through what to expect, your options, and how to support each other, you’re not trying to figure things out in labor — you’re working as a team.

I just wanted to say how glad I am that you’re here. That you’re even thinking about getting prepared.

I know you’re going to pick the right path for you, and have a wonderful journey into parenthood.

What other crappy ways have you seen people prepare — tell me in the comments!

The post The 3 Worst Ways People Prepare for Birth appeared first on The Pregnancy Nurse®.

Now, before you go saying that I hate “natural birth” >> let me remind you that I also have a post on reasons to avoid the epidural as well. I want patients to have a well-rounded knowledge of what an epidural CAN and can NOT do for them at their birth…. and then make the choice on their own.

Ok, let’s jump into those benefits!

Rest

This is a HUGE thing that a lot of people don’t talk about — the fact that you’ve labored for hours, without good rest and you’re just dying for a nap but those contractions are relentless.

Many people get the epidural because they’re just tired and they need to sleep.

They also know that it’s not like they’ll be able to sleep for weeks after this baby is born, and it might be good to fill up their gas tank a bit with some rest before baby is born.

Honestly, all of that is valid.

If you’re aiming for an epidural-free birth I always encourage people to rest as much as possible in the beginning (perhaps gaslighting themselves into believing they’re not in labor). That is often easier said than done though.

BTW, a recent study showed that hardly any birth classes talk about the unplanned things of birth — unplanned cesareans, inductions and yes — epidurals. That’s why I recommend this. I think you’ll love it (in fact, it’s guaranteed).

Being Able to Pee Afterwards

Now, this isn’t true for everyone — sometimes that epidural lays claim to the muscles that help your bladder relax. BUT I will say the worst cases I’ve seen of patients being unable to pee after birth come from people who get local anesthesia on their perineum at birth (this is often given if you’re tearing or they need to do an episiotomy).

SO, you may have an easier time to pee after baby is born. It’s not guaranteed.

BUT if you’ve heard this as a “risk” it can be better than other options.

Not being able to pee after birth is actually not all that uncommon. Your nurse will have a few tricks she can try to help you (if you don’t pee, there’s a chance you’ll bleed more, so we like to minimize that).

Want to know more about birth? — check out these posts:

• Common Choices During Labor
• How to Push During Labor (What No One Explains)
• What To Do If Labor Isn’t Progressing?
• Secret Keys to Labor that No One Talks About
• What You Need to Know About Wired vs Wireless Monitors in Labor

Decreased Blood Pressure

Some of you may be experienced increased blood pressure, especially as you head towards your due date.

And, as you can imagine the pain of labor can also make that blood pressure drive upwards.

One of the big benefits of the epidural is it can help manage that blood pressure as well.

Yes, there are medications that we can give to lower your blood pressure in labor, but sometimes they work or don’t work depending on how you’re experiencing pain.

I’m just here to say that if your blood pressure is trending upwards, it may be something you want to consider. If your blood pressure gets too high it can have serious consequences including heart issues, and possibly a stroke (although super rare). SO, we want to avoid that for sure!

And be sure to check out my article about 5 things you need to know about preeclampsia that goes along with this one!

Not Having to Pee

Clearly, pee is a big deal when a person is pregnant or postpartum.

But a LOT of people really LOVE that we put a catheter in you to drain out the urine once you’re numb from the epidural (or they may put one in every couple of hours depending on your hospital and your requests).

This means uninterrupted sleep! I will admit that when I was pregnant and a nurse, I’d get jealous of my patients who had an indwelling catheter (learn more about catheters here) in — knowing I’d be up a few times in the night to pee!

Some of you might be thinking that’s a big NO THANKS to an epidural — because a catheter doesn’t sound fun. I have a whole post on if you can refuse a catheter — because you DO have options!

I’m just here to say a lot of people are big fans of it!

Everyone is so different — this is why having a birth plan can be so helpful to know what’s important to you:

Helps Your Body Relax!

This is the big one, my friends.

Imagine the last time you were in a lot of pain — maybe it was a kidney stone, or a bad bout of tummy troubles? Did you find yourself wanting to relax into that pain — or did you tense up like a ball of tinfoil around your body?

Most people don’t find relaxation easy in labor.

If you’re unable to help relax that pelvic floor you’re not going to let baby descend into the birth canal, or let that cervix dilate.

Which is super tricky. Honestly, learning to relax is important in all parts of labor, even early labor or ligament pains. That’s why I recommend a birth class that covers natural pain management (this one does).

However, sometimes all the breathing and relaxation in the world just doesn’t help that pelvic floor relax and an epidural can be a great option to help with that.

Often, in patients who aren’t progressing we will recommend an epidural to see if it can help them relax, and help baby move down into the birth canal. Often I’d check that patient an hour later and baby will have moved into the pelvis nicely — they just needed some help relaxing.

This is the part where I remind you that you can’t tell yourself that “Sally down the road was able to relax — why can’t I?”

We don’t know what Sally was doing, or how her baby was positioned, or how big it was. All you can do is make the right choice for you, and also know that both natural pain management and an epidural have proven to be effective and safe for labor pains. Anyone who says otherwise is misinformed.

That’s honestly all an epidural is – it’s a little help. It often ends up being the villian or the hero in labor stories but it is just a little help!

Want to know more about epidurals? — check out these posts:

• Epidural Myths vs. Facts: What Social Media Gets Wrong About Labor Pain Relief
• Why People Get An Epidural Even When They’re Not Planning On It
• Why Labor Pain Can Feel So Different For Each Person
• 5 Simple Tips for a “Natural” Labor & Delivery
• Is an Induction More Painful than “Regular Labor”

So, as you can see there are benefits to an epidural that we don’t talk about. I’m not saying that any of these are a reason to get the epidural — and honestly, I don’t think you have to make up your mind on your plan right now either way. I have a whole post on What to Do If You Can’t Decide if You Want an Epidural or Not? << and the spoiler alert is, that’s fine….

Get educated on what it will be like, when you might want it or not want it, and look forward to a great labor day.

Most of labor is like that. Education is key, and learning to make choices in the moment will be a huge skill both in labor and postpartum to help you thrive as a new family.

So, did you learn anything new about the epidural in this one? Tell me in the comments!

The post The Benefits of an Epidural No One Talks About appeared first on The Pregnancy Nurse®.

And yes — this is from both my own 3 births, plus watching thousands give birth in the hospital and talking to millions online. It’s something I think about a lot.

I even did a video on it:

Low Pressure

This is the first thing that came to mind. I felt FAR too much pressure to:

• Clean my house (my husband should step it up more — I’m not saying I’m cool living with it dirty)
• Still attend all the functions
• Put myself into labor
• Manage full life postpartum

Those are just the few that came off the top of my head.

But the reality is you’re going a full on human inside of you, let that be your main goal. Allow the rest of your team to come in and do the other things.

And stop thinking you control so much (like labor) it’s just putting too much on you, and you don’t need that. You control a lot less than the world makes you think you do.

Now, this doesn’t mean you lay on the couch all day. Still use movement to your advantage. I was actually really good at doing stretching and some working out, plus my job was pretty movement-filled. But I wish I’d allowed myself more naps without feeling like I needed to do more….

Want to know more pregnancy tips — check out these posts:

• The Three Biggest Mistakes Labor Patients Make—And How to Prevent Them
• Mistakes You’re Making That Makes Labor Longer
• 5 Mistakes People Make Preparing to go to the Hospital to Have Their Baby
• 5 Mistakes People Make in Their Third Trimester

Live in a State with Maternity Leave

Clearly, you can’t really control this — but gosh, living in California with paid maternity leave was a world different in Utah where I had very few maternity leave benefits.

I had enough sick days to spread out and pay for my health insurance while I was off.

Lucky me.

I’m just saying when you’re considering where to live, especially if you want a family, this should be part of the discussion. That is all.

But, once you’re pregnant it sort of is what it is…. (and I get that).

Check out my full post on maternity leave.

Taken an Out of Hospital Birth Class

My hospital birth class just sucked.

It really made me a great patient, rather than preparing me for birth or to make choices on possible intervention.

Now, not all birth classes are like that. I taught for my hospital and I really tried to prepare them for both what to expect, and how to manage the hospital chaos. But, I think those types of classes are rare. Most nurses don’t re-design the curriculum (or have mangers who let them)…

I recommend this class. Plus, it prepares your partner too, which is a big win.

Want to know more about birth class benefits? — check out these posts:

• Do You Need a Birth Class if You Plan to Get an Epidural
• Alternatives to Hospital Birth Classes
• How a Birth Class Changes Pregnancy, Labor, Birth & Life With Baby
• 6 Lies You Hear About Birth Class
• Why are Birth Classes So Expensive?
• Do Birth Classes Improve Birth Outcomes? What do the studies show?

Kick Counts

I wasn’t the best kick counter — even though Kaiser gave me a laminated book to do them in (let’s remember smart phone apps weren’t really a thing when I was having babies).

I wish I did them better. I tried.

And honestly, that’s all we can do — but the data makes me realize the outcome could’ve been worse because I didn’t pay as close attention to fetal movement as I should have.

I may have been too busy with the dumb things in #1….

Again, your main job is to grow a healthy baby and monitoring fetal movement is one of the best ways to do that in your third trimester. AND Kick counts is an evidence-based way to do them. Grab my cheat sheet on how to do them here:

As a note, I also wasn’t great about SIDS precautions either. I think we can always look back at our parenting journey and wish we’d been a little safer. I definitely tried though, but I should’ve taken the bumpers off. I knew better.

Use a Midwife

I’m talking a Certified Nurse Midwife.

I just think they’re the bomb. There are SO many benefits to them. Most of all they tend to use less interventions and still have really great outcomes with birth.

I’d love one that is tied in well to an OBGYN office as well. More and more practices are allowing midwives to handle care, and consult an OBGYN or a perinatologist when necessary. But, you can still see them, they can help with your delivery, etc.

It works well for overworked OBGYN’s, and allows us to get better care.

I wish I’d used one, but they weren’t available where we had to have our baby — so, such is life.

If you’re not in love with your doctor, and you’re not past 30 weeks yet — check out a midwife in your area.

Again, a certified nurse midwife — abbreviated CNM — they can deliver in the hospitals and provide REALLY great care!

Check out this video with more info:

Get Induced if Needed

If you know anything about my birth story, I resisted an induction even at 12 days overdue and even when I decided on one I cried and cried.

Wasted life.

I had prodromal labor for weeks, my cervix was 5 cm — I honestly just needed my water broken to have that baby but instead I insisted that nature was the way.

I tried all the things to put myself into labor… but why on earth didn’t I just consent to an induction?

I don’t know — but studies really have proven that they’re safe after 39 weeks. I was 100% miserable being pregnant and thought I was going into labor every night. Plus, my cervix was ripe and ready.

I was dumb, I wanted control over things. Like an angry toddler I thought “I do it mySELF” — but ultimately I needed them to break my water. But oh no, there are more dumb Hilary stories ahead — keep reading!

Want to know more about preparing your body? — check out these posts:

• 4 Things You Can Do to Prepare Your Cervix for Labor
• Best Sex Position to Induce Labor?
• Pumping To Induce Labor? Will it work?
• Does Evening Primrose Oil Induce Labor?

Done Perineal Massage

I tore a lot with my first, although he was a forceps delivery, so it’s hard to know if that could’ve been avoided, but perineal massage has been proven to prevent the larger tears. I think it’s worth the effort.

Although the pre-labor-nurse-me might have felt icky about it.

The labor nurse me would’ve been fine with it.

Go Through a Birth Plan with Partner

I wish I’d thought through what I wanted for birth with my partner.

Honestly, I kept him pretty out of the loop — and he maybe could’ve talked some sense into me about the whole not being induced situation as I sat crying to him that my body wasn’t going to go into labor.

That’s what a partner is for — they’re there to talk thinks over. I wish I’d used mine more, but hey — I’m The Pregnancy Nurse — I’ve got this (spoiler alert: I did not).

We all need a partner, and I have a handy birth plan series for both of you right here:

Checked my Vitamins Better

I honestly just took whatever prenatal vitamin Kaiser sold in their pharmacy — but I wish I’d checked the levels better. The more research I’m finding out about Choline and other vitamins — I just think prenatal vitamins are something I could’ve done better on.

I like this guide from my friend Mckenzie who is a Dietician. She gives you the levels you should be striving for, and some good options to take (even if you can’t keep down those giant pills).

Want to know more about prenatal care? — check out these posts:

• Charlie Horses in Pregnancy: What you can do to prevent them?
• Pregnancy, Tylenol® & Autism: What Expecting Moms Need to Know
• Allergies During Pregnancy: What’s Safe and What’s Not
• 7 Habits of Happy Pregnant Women
• Month-by-Month Pregnancy Timeline & To Do List

Prepare Partner More

I WISH (especially on my first) I’d prepared my partner more about what he could do to help me both during pregnancy and birth.

I wish I’d taken a class that talked to him at all.

They were sort of an afterthought in my birth class. Honestly, it wasn’t all that helpful:

A birth class is a GREAT way to do this (even though so many are bad at it). I recommend this one.

Let them Break my Water Earlier

So, as I said above I was resisting that induction and boy oh BOY did I resist them breaking my water.

I knew as soon as my water was broken I couldn’t just go home — I had to have that baby.

So I didn’t let them do it, even though they asked a few times — I said no.

But, as soon as I let them do it — boom. Baby.

As soon as I let go my own control I had my baby.

Honestly, a life lesson. I’m a controller and maybe they did know best.

My bad. I’d do it differently next time.

Prepare for Postpartum

I’m always horrible at this. With my second baby I moved 10 days after he was born, and a few days before birth my mom said — “You know you can’t lift anything when you guys move” — and I was like — I’d honestly never considered my own safety in that scenario…

And yes, I was a labor nurse.

I just thought I could be superhuman. I wouldn’t bleed. Not me, I’ve got stuff to do.

Buying myself pads is always an afterthought.

BTW, if supplies are on your list of things to get — grab my checklist here:

Want to know more postpartum tips — check out these posts:

• First Poop After Delivery: Make it less-hard (literally)
• Your Guide to Your Postpartum Plan with Free Template
• Self Care During Postpartum & Pregnancy
• C-Section Recovery: Tips You’ll Need
• Postpartum Essentials for a Great Recovery

I just wish I’d prepare better for postpartum because I’m really bad at….

Give Myself Grace / Be Kinder to Myself

I know I went over this a bit at the beginning but these are words I type to new moms countless times during the day.

Please be kind to yourself.

Give yourself grace, this is really hard.

They were words I never said to myself.

You’re 5 days out, you should be driving the kids to school, why are you crying so much?

That’s what I said to myself.

I also wish I’d gone on anti-anxiety meds after my last baby. I was having panic attacks almost daily, but I knew it wasn’t postpartum depression so I thought I should just power through. That was a mistake. It’s not right for everyone, but it would’ve made my transition easier.

But, I’m here to say — let other people help. It makes them feel good, and you deserve it. You’re re-populating the earth single-handedly.

And I’m also hear to say that give you a few months and you can be that village that other people so desperately need. We have to be kinder, and more willing to help each other out. Give others grace.

It makes a better world for all of us. I love helping out new moms, it’s one of my greatest joys as a human. Please let me (or someone like me) do it for you.

Be sure to take a birth class that prepares you for realistic expectations postpartum. Far too many of us believe life will be like the photos we see on Instagram. It’s likely not. I recommend this class.

So, those are what I wish I’d done differently. What did I miss? Tell me in the comments!

The post If I had a Baby Again this is What I’d Do Different appeared first on The Pregnancy Nurse®.