I also have a youtube video on the same topic:

First off, let’s go over some definitions:

Natural Tearing: This happens as the baby comes through the birth canal and most often tears the tissue between the vagina and the anus. However, it can also tear up (towards the urethra) or out to the side as the baby comes out.

Nurse Note: It’s important to know that this type of tearing happens at delivery — not during the pushing phase. A good provider helps a patient stretch (as they support) those tissues rather than push hard right at the end which can cause more tearing.

Episiotomy: This is where your provider makes a cut to help baby out — It can be either towards the rectum from the birth canal, but can also be to the sides called a mediolateral episiotomy — where the cut goes towards the thigh. They use scissors to make this cut.

Nurse Note: I am also dying as I type this. This isn’t fun to think about — but an important topic to consider, and I want to emphasize that the majority of birthing patients have some type of tear. So, I’m glad you’re here.

Let me just put a plug in for learning how to manage your care of your life and your bottom postpartum. I recommend this as I think it has a very thorough postpartum section that is missing in most.

Grades of Tears

Now, there isn’t just one type of tear — we grade them as to how close they come towards the anal sphincter and the muscles/tissues involved in it.

Sometimes patients just tear a bit, just the skin — and that is a first degree tear. If it extends further and a bit deeper, that is a second degree tear.

When the tear extends towards the anal sphincter tissues it is a 3rd or 4th degree tear depending on how close it gets to the anus. — and as you can imagine that is much more to heal from than just a first degree tear. We call these Obstetric Anal Sphincter Injuries (OASI) and that is the main thing we’re trying to prevent.

As a provider cuts an episiotomy they are most often not cutting into the anal tissues. They cut what would most often be a second degree and then often the cut extends with a tear beyond that.

If any of you are sewers reading this, I sometimes do think of it how you’ll nick a fabric with your scissors and then pull and the tear in the fabric extends easily as you’ve started it. I do see that sometimes happening. (and yes, typing this paragraph made me ).

Stats on Tears at Birth:

• About 85% of women have a tear at birth (meaning only about 15% of an intact perineum after delivery)
• First time moms are more likely to have a tear than subsequent births
• 40% of first time birth tears are 2nd degree tears
• You can also have labial tears where it it extends up towards your labia (these STING when you pee)
• Experienced midwives are less likely to have larger tears at delivery (love me a midwife)

I also want to mention that I am a survivor of a 3-4th degree tear (sort of in the middle of those) and I just want to insert some emojis of how I feel writing this. But I do want you to know I survived all of this! It is possible, even if it sounds miserable. I wish I had prepared better!

Ok, those are the basics — and I think far too many people stop there — but I think it’s important to know that an episiotomy can be necessary.

When an Episiotomy is Necessary:

These are times in which baby may need to come out quickly, or more manipulation will need to happen in the birth canal.

Shoulder Dystocia – This is where baby’s shoulder is caught behind the pubic bone. Sometimes providers have to reach up into the birth canal to help this. As there is more trauma to the tissues, most believe a cut may be necessary depending on the interventions needed. However, we can often relieve the dystocia without them having to reach up inside, in which case a cut wouldn’t help.

Fetal Heart Rate Decelerations – If baby’s heart rate is going down often they will cut an episiotomy to shorten time to delivery. It can lead to better outcomes for baby.

Forceps or Vacuum Delivery – These are assisted devices (often called an “operative vaginal delivery” to help baby to come out. I have a whole podcast episode on them if you want to learn more. I did learn in this episode that forceps do have a risk of a higher tear — and I think that’s important to know (more doctors use a vacuum lately though).

Other times I’ve seen it that seem valid:

Patient tearing towards urethra – As you can imagine a tear through the urethra is something we want to avoid — if a provider can tell that a patient is tearing up towards their urethra they may cut down to encourage the tear to go that way, rather than up. I don’t hear about this in any studies, but I’ve seen it and personally I think that’s valid!

I will say that sometimes patients get REALLY tired after a LONG pushing time (more info on pushing times here). Sometimes the doctor will ask the patient if they’d like an episiotomy to help speed-up baby’s birth. I think that’s valid. Some patients will be begging to take any more time of pushing away, while other sill prefer to continue to push. My doctor did this for me on one of my kids and I said no episiotomy, and I’m glad I did — but I didn’t mind being given the option.

You’ll notice I didn’t include things like “big baby” — while that can increase your odds for tearing, it doesn’t mean that an episiotomy will make that tear less or heal better.

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

• Epidural Myths vs. Facts: What Social Media Gets Wrong About Labor Pain Relief
• Lies I Used to Believe about Labor & Birth
• Common Choices During Labor
• How to Push During Labor (What No One Explains)
• Why People Get An Epidural Even When They’re Not Planning On It

Which brings us to:

Selective Episiotomy

So, back in the day they did a routine episiotomy — meaning they cut it on every patient. Early on in my career (remember, I started in 2001) I worked with a few older providers who cut every single patient. This isn’t considered appropriate anymore (frankly, wasn’t great in 2001, and we reported it frequently).

Now, they are encouraging selective use of episiotomy (which means “only if needed”). Obviously, that is up to expertise of your provider and would be for the reasons mentioned above. Most often due to forceps or vacuums (which happen in about 5% of births).

There is a Cochrane review where they compared selective episiotomy vs routine episiotomy. Here are the results:

• Selective Episiotomy reduced severe perineal tearing by 30% (vs routine episiotomies).
• No real difference in infection rates between the two
• Less moderate to severe reports of pain 3 days postpartum
• No changes in baby’s APGAR (shows how well baby is doing after birth) or blood loss between the two groups
• No difference in reports of pain with intercourse (reported at 6 months+ after delivery)
• No changes in reports of urinary incontinence (reported at 6 months+ after delivery)

A few other interesting things I noted in that study:

• No real difference noted between people who had their cut extend towards the anus vs to the side towards their thigh
• None of the studies in this review really dove deep into women’s pain (?) or their satisfaction with their birth {big sigh}
• Hospitals actually save money with less episiotomies (patients stay less time on postpartum when they don’t tear as much)
• The studies didn’t report on fistulas (where there is an opening between the birth canal and the rectum) or fecal incontinence (where you leak stool) — which seem important to note

(BTW, I give full citations of the studies under “sources” at the end of the article)

Benefits of an Episiotomy:

The use of an episiotomy shows less Obstetric Anal Sphincter Injuries also called OASI (meaning a tear that extends to the tissues of the rectum) during an operative vaginal delivery (forceps or vacuums). Study linked here.

Most people seem to think that if you’re doing an operative vaginal delivery you should consider an episiotomy — and that is discussed in the video linked above. You can also listen to the podcast here.

I also wanted to address something that I see a lot online:

Coached Pushing and Episiotomies

This study showed there was a higher incidence of both tearing and episiotomies when coached pushing is used.

FYI, coached pushing is when people usually hold their breath and count to ten as they push.

Nurse Opinion: I’m here to say that’s complicated. For a lot of women un-coached pushing doesn’t provide results. In order to actually get baby to descend they have to hold their breath and push a long time. I just feel like they’re two separate kinds of birth….

I agree that uncoached pushing is the best way, but often it just doesn’t work. Recently, providers have been against “laboring down” (or waiting until the patient has more of an urge to push — or baby is lower), although some studies are walking that back. It’s just complicated, and I want you to understand that with these studies.

I want you to remember that tearing happens at delivery — not the hours of pushing prior to that. To me, this means that coached pushing may be necessary to get that baby to the perineum, and then at that point we use more patient-directed pushing. Most often this happens — you’ll see providers ask for small tiny pushes as the baby’s head descends through that portion. That is very different than the types of pushing we used prior to baby coming out.

Also, that study only had 39 women in it. That may speak to the fact that most people don’t have the “fetal ejection reflex” where they just quickly bear down and baby is born.

I also have a whole post on how to PREVENT tears that dives into this all a bit more (and a few things you can do like perineal stretching and warm compresses at birth).

There are a LOT of people talking about pushing online — and many of them haven’t pushed with a variety of patients at delivery. While the studies can give us information, make sure to listen to experts about what to expect and how to make choices at your delivery.

How does this apply to you?

That’s the big question, right? How do you apply this to your own delivery. Here are a few takeaways for me.

Ask your provider how often they perform episiotomies? Honestly, it’s a good question for any provider. Gives you an idea how respectful they are of your questions. If they brush this off that it is not important, it is! A red flag in my book. If they honestly say they do it about 5% of the time but they truly try to avoid it unless entirely necessary, that’s a good answer.

Also, if a provider says “never” that’s a red flag to me too — these are sometimes necessary, and honesty is really important to me in a provider!

Ask your provider how often they use vacuums or forceps? Most of them are only trained in one or the other. Again — just allows an open conversation between your expert and you. Doesn’t need to be long, but does give an idea of what they would use if they needed to.

Be aware that sometimes a cut is necessary, and have a provider you feel confident in. I see so many people questioning their providers nonstop –but you need a provider you can trust. They could be making life or death calls for you, in addition to smaller, but substantial, calls like this.

Learn how to heal your bottom postpartum. Oh goodness, I wish I’d done better on this with my first baby. I wasn’t prepared to heal at all. I have a whole post on how to take care of your bottom after delivery, but it’s just one part of postpartum.

However that’s just one part of it. Learning to take care of yourself while taking care of someone else you love so very much is very demanding. Learning from an expert (who is honest and open about what to expect after seeing thousands of patients) is your best bet.

So yes, avoiding an episiotomy is good, but having a trained expert you trust is always the key. Plus, learning to make choices for yourself is always a good thing. I’m glad you’re here.

What did you learn or come to think after this post, tell me in the comments!

Sources:

Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017 Feb 8;2(2):CD000081. doi: 10.1002/14651858.CD000081.pub3. PMID: 28176333; PMCID: PMC5449575.

Is an episiotomy always necessary during an operative vaginal delivery with vacuum? A longitudinal study — The Journal of Maternal-Fetal & Neonatal Medicine Antonio Ragusa,Fernando Ficarola, Alessandro Svelato, Caterina De Luca, Sara D’Avino, Alis Carabaneanu, Amerigo Ferrari, Gianna Barbara Cundari, Roberto Angioli &Paolo Manella Article: 2244627 | Received 26 May 2022, Accepted 31 Jul 2023, Published online: 08 Aug 2023

Sampselle CM, Hines S. Spontaneous pushing during birth. Relationship to perineal outcomes. J Nurse Midwifery. 1999 Jan-Feb;44(1):36-9. doi: 10.1016/s0091-2182(98)00070-6. PMID: 10063223.

The post Episiotomy vs a Natural Tear: Which Is Better? appeared first on The Pregnancy Nurse®.

BTW, if you love some labor tips — check out my insider tips for a great birth:

I should also mention that with ANY choice you should discuss your options with your healthcare team. Some of these might really not be appropriate for you and sometimes emergencies happen (that’s why you’re in a hospital after all) — I just wanted to remind you of that before we get going!

What to Wear

This is a big one. As a nurse I have a gown laid out for every patient I see — and most take that option. You have to realize it’s important we do this. Many patients come to the hospital unprepared to be there. They won’t have their own gown or are prepared for this visit.

But, this does NOT mean you need to wear it.

Pro gown tip: It opens in the back. This allows our monitor cords to come through with some privacy for you. Plus, if you’re bleeding it doesn’t get on the gown if you leave it open on a pad on the bed.

We’ll often say bra and undies off when we tell you to get in the gown. Does this mean you HAVE to take that all off? No.

Some options here:

• Commando — go fully naked. It happens. Most people don’t start this way — but many end-up this way and we don’t mind at all.
• Wear a bra — if your bra doesn’t have metal, the risk of wearing it is pretty low. You just need to know there is always a chance we will have to cut it off, so I don’t recommend wearing your favorite bra.
• Wear your own gown — many people bring their own gown. That’s AOK with me — I just want you to know that labor is a messy process. Many will choose to throw the gown away (even if it’s washable) just because of ALL the things that get on it.
• Wear something else — I love a shelf bra tank top. Keeps your top covered, and we cover your bottom half with a sheet anyway (if that’s important to you).

I actually have a few posts on what to wear during labor:

• What to Wear For a Cesarean Section
• Do You Wear a Bra During Labor?
• Your Guide on What to Wear in Labor & Delivery and Your Hospital Stay
• How to Wear a Pregnancy Belly Band

Hopefully this is getting you started realizing you’ve got options! BUT we don’t often offer all of them because most patients are grateful for the hospital gown.

Ok, let’s keep going….

Where to Be

Well, you’re in the hospital — but you have options as to where your body will be (or what position you’re in).

I will admit that often, because we want to make sure that you and baby are safe, we love to have you lay down and quickly find baby on the monitor. However, after that — I think you’re good to move about the room (just like the stewardess always says).

That’s right, you can find the position that works for you.

Now, does that mean your baby will let us monitor them in that position? Not always. However, at that point you then decide what type of monitoring you want.

I have a few posts on that:

• What You Need to Know About Wired vs Wireless Monitors in Labor (this gives a lot of tips even if your hospital does not have wireless monitoring — or it doesn’t work — which happens a lot)
• Intermittent Auscultation: Who it’s for (and why it’s better) — this is getting a lot of play in the news lately, but the reporting is poor so get the full story from that article.

A few facts you need to know:

1. If baby isn’t on the monitor there are things we can NOT do — which include running an induction or an epidural. If you decline monitoring with those, we will have to stop those things. Nurses could lose their license without them.
2. Even with wireless monitoring, there are some positions the baby just can’t be monitored in, and it varies baby to baby.
3. Your nurse may need to frequently adjust the monitor — we hate it, you hate it. You can always ask if there’s anything you can do to help. Sometimes just you resting a hand on it keeps us away a bit longer. And — sometimes your belly ends-up looking like arts and crafts with tape, and other things helping us keep baby on.

I always say that fetal monitoring (especially obtaining it– is an art, not a science) — and sometimes we have to get very creative.

There is a monitor called a fetal scalp electrode that goes into the very tip of the baby’s scalp to monitor their heart beat — and this normally allows more positions as we’re attached to baby. However, it does require your water broken, and can be a bit more invasive (and a bit more risky if you have GBS).

I also want to add that I am a HUGE fan of movement in labor — you just have to know that sometimes it requires some creativity. Which can still be done, even if you need wired monitoring. Positions can be tricky. There’s labor movement cards in here to give you ideas of positions to choose between.

Letting Them Break Your Water

I wish providers were better at giving a choice on this. Often I hear “I’m going to break your water” vs — “Would you like me to break your water”? But remember, it is ALWAYS your choice.

Honestly, if you’re in the hospital an your provider is going to check you — ask if they’re going to break your water. Some do it without asking. It’s wrong, but at least you have that conversation ahead of time.

I have a couple of posts that dive into this more:

• Should You Let Your Provider Break Your Water?
• Should You Get the Labor Epidural Before They Break Your Water?

Here’s the Cliff Notes of what you need to know:

• Breaking water is almost always a choice (there are a few times we sometimes have to do it urgently — but you’ll sense it’s different).

• Studies show that breaking it in early labor isn’t particularly helpful at making labor progress faster. However, if you’re early in labor and not progressing, they may think it might help. It’s worth a try if they do. I go more into the the studies in this post.

• Often your contractions feel more painful once your water is broken. Think of it as squeezing a full water balloon vs a mostly-empty one — you can just squeeze harder, that’s what your uterus is doing.

• Some babies don’t love having the water broken and it can (although rarely) lead to a c-section — so, you want to be sure of your choice — that the pro’s outweigh the cons.

• It is true that as you progress into active labor (so, this is past 6 cm normally) sometimes breaking water is necessary to let labor progress. Sometimes the bag of water is bulging and just can’t push on the cervix enough to open it up and let baby descend.

So often I’ll hear doulas say on social media “don’t let them break your water” — but as I hope you’ve seen, this is a nuanced discussion that requires knowing what’s going on at THAT moment. This is why you have experts in the room — doctors, nurses and YOU (you’re an expert in your own needs).

Let me just say that far too often people make these choices simple when they can have a lot of complicating factors. I really recommend learning more about all your options in labor — I recommend this.

Want to know more about hospital routines — check out these posts:

• How to Push During Labor (What No One Explains)
• How to Feel Confident Making Choices During Labor
• What To Do If Labor Isn’t Progressing?
• Secret Keys to Labor that No One Talks About
• The Three Biggest Mistakes Labor Patients Make—And How to Prevent Them

Eating

This one gets a lot of talk online — and honestly, for good reason.

For a long time we just haven’t given anything more than clear liquids (think: liquids you can see through) to people in labor. BUT the studies are showing this isn’t necessary for most people.

Clearly the choices are:

• Eat real food (either brought in from home/restaurant or what the hospital provides)
• Just drink clear liquids
• Don’t eat at all

And all of those choices are right for some people.

Decent chance of a cesarean section (think twins, or a baby that has been having issues for a while in labor) — not eating is probably your best bet so you don’t have issues with anesthesia.

Real food makes you want to die, but could use a little sugar boost — maybe ask for a popcicle?

Starving? Eating some real food might be awesome for you! More and more we’re seeing that a little food can help your body get the energy it needs to help labor progress — especially if it’s been a long time.

Hospital Pro Tip: Your nurse can actually only do what your doctor orders. SO, if they say you can’t eat she can’t provide you with food. That doesn’t mean you can’t eat — it’s just part of how the hospital works. But always understand the risks and the benefits, even before you do simple things like eating.

Why is this a big deal? Mostly anesthesia worries that if you were to have a cesarean section and need general anesthesia you can vomit and that can go into your lungs. It’s less problematic if you haven’t eaten, but clearly we don’t want food in our lungs — which is why anesthesia is adamant about this.

However, there really aren’t many patients who go to general anesthesia…. so…. there’s that.

Again, talk about your options, and make the choice that is right for YOU!

Other Choices….

Now, labor is full of choices — and I think it’s awesome to think of them ahead of time. Which is why I have a free birth plan series where I walk you through it and how to use it:

But, a birth plan is not a plan for your birth. It’s just you thinking through your options about what you’d like. It’s honestly like looking a menu over in advance — knowing, sometimes the restaurant is out of things and you’ll have to choose something else. But, you know what “mood” you’re in.

You then have to know how to apply those choices to the circumstances (and knowing some of your options). Having a foundation of knowledge for your birth is a key to this one. I recommend this.

So, what other choices are you thinking about for YOUR labor? I’m actively working on making content around choices in labor — so I’d love to know what you’d like to know more about. Tell me down in the comments!

The post Common Choices During Labor appeared first on The Pregnancy Nurse®.

Now, I think this post will be MOST helpful with a video — don’t worry it’s in the works. Stay tuned (and subscribe right here).

Really quick as a reminder labor is split into 4 stages:

1 – Early Labor: Up to about 4-6 cm

2 – Active Labor: from 4-6 cm to 10 cm

3 – Pushing: Once you’re 10 cm until baby is delivered ** That’s what we’re talking about today!

4 – Delivery of the placenta: This is the easiest phase, most people find

We’re going to go back to our elementary school report days and go over the important stuff — when to push, where to push, and HOW to push?

Want to know more about the phases or stages of labor — check out these posts:

• Stages of Labor Duration: How long does labor last?
• How Long Does it Take to Push Out A Baby?: The 3rd stage of labor
• 4 Things You Can Do to Prepare Your Cervix for Labor
• How to Prepare for Childbirth

I also have a video on this same topic:

When?

So, as you can see on my chart above — once you hit 10 cm it’s time to push. BUT, like most things in pregnancy, it’s not always that cut and dry.

For a long time it’s been thought to delay pushing for a bit — especially if baby is still high. And then you start to push with your body once baby is a bit lower. The idea here is to save mom’s strength, let her uterus do the work for a bit and then once baby is engaged, mom will push.

However, new studies are showing that delayed pushing can increase infection rates, and postpartum hemorrhage rates.

Cahill AG, Srinivas SK, Tita ATN, et al. Effect of Immediate vs Delayed Pushing on Rates of Spontaneous Vaginal Delivery Among Nulliparous Women Receiving Neuraxial Analgesia: A Randomized Clinical Trial. JAMA. 2018;320(14):1444–1454. doi:10.1001/jama.2018.13986

That doesn’t mean that delayed pushing isn’t right for some people. People who may want to consider it:

• You’re already exhausted, maybe you got a late epidural and you just need a nap
• People who have NO urge to push (maybe we turn down the epidural and give you 30 minutes to feel that pressure)
• The baby is still VERY high — maybe try some movements to help baby descend before you start pushing.

As a reminder it is always up to you when you start pushing. If they say you’re complete and it’s time to push, and you feel ready — then you make the choice to push.

If you’re complete and they say it’s time to push and you have NO energy you have a conversation about how things look like for you.

Honestly, I think some labor nurses have used “laboring down” as a way to get the next shift to deliver their patient. I’ve seen people laboring down for hours — and that’s never been good care. Yes, in certain circumstances maybe 30 minutes with good position changes, and maybe rest for mom can be a game-changer and leave her less tired.

But, sometimes it’s a lazy way to do nothing.

But, you didn’t hear that from me.

Love how I pull back the curtain a bit on labor and delivery. I think tips like this can be REALLY helpful. We’re all just human and understanding how the “system” works can be a big win. I recommend this to help out!

Where?

Well, if you’re here — it’s likely going to be in the hospital that you’re pushing — but I’m talking more about the position you push in.

And frankly — this one is up to you.

I hear a lot of people saying that it hurts your pelvic floor to be in a specific position during pushing.

The reality is that all types of pushing does put a lot of pressure on your pelvic floor — and it’s different for every patient.

Pushing needs to sort of be put into 2 different categories (or periods of time):

Pushing before baby starts to stretch the perineum — this is most often done with your nurse (or sometimes midwife) at the bedside. This tends to be the longest part of things (especially on your first baby).

Pushing once the perineum is really stretching (often called crowning) — This is most often when the doctor is called for delivery.

While both types of pushing can cause issues with your pelvic floor, I think it’s important to remember that birth in general can cause issues with the pelvic floor. I recommend patients try a few positions (even more if they don’t have an epidural). If you find a position that is working for you, I say use it.

During labor there aren’t any studies that show one position is better than another for all patients. Every study I have read notes a lot of it is based off patient preference in how they are feeling best pushing. Often called shared decision making.

Also, patients with an epidural are limited in how they push. We can sometimes get you onto all 4’s to push, but within 15-20 minutes your hips hurt enough you want to try something else. You can still use a peanut ball and change sides or sit up and use a squat bar. There are options, just not things off of the bed as your legs won’t be able to hold you up. I have a whole post on using movement during labor with an epidural.

I hear a LOT about pushing from physical therapists on social media. I think it gets a lot of views, but they really haven’t read the studies OR actually pushed with patients — so, be mindful of that one. I’ve done both.

It’s important to know that protecting your perineum from a tear is different than pushing prior to crowning. How you push prior to baby crowning isn’t going to make a big difference in how you tear (although I recommend a few things including a cold compress in my post on how to prevent tearing).

Here are a few studies with links and the main conclusions:

This study showed that not being on your back reduced tearing and episiotomies.

Familiari A, Neri C, Passananti E, Marco GD, Felici F, Ranieri E, Flacco ME, Lanzone A. Maternal position during the second stage of labor and maternal-neonatal outcomes in nulliparous women: a retrospective cohort study. AJOG Glob Rep. 2023 Jan 17;3(1):100160. doi: 10.1016/j.xagr.2023.100160. PMID: 36825260; PMCID: PMC9941360.

This one showed that at delivery all 4’s and or kneeling was the best to prevent tearing (and I’d agree). It also showed that squatting made tearing worse.

Fay Lodge Melanie, Haith-Cooper. The effect of maternal position at birth on perineal trauma: A systematic review British Journal of Midwifery. 02 March 2016

This one showed that pushing more upright or laterally (on your side) was more helpful. It strongly recommended against laying on your back with feet in stirrups.

Huang J, Zang Y, Ren LH, Li FJ, Lu H. A review and comparison of common maternal positions during the second-stage of labor. Int J Nurs Sci. 2019 Jun 20;6(4):460-467. doi: 10.1016/j.ijnss.2019.06.007. PMID: 31728401; PMCID: PMC6839002.

Now is the part that I pull back the curtain and tell you this: Most doctors are really trained best to deliver you in a supine position. It makes it easy for them, they’re used to it and they do their best work in preventing tears at delivery at this point.

Your delivering provider does do a lot in preventing tears at delivery. Both in helping the perineum stretch and talking you through how to push right there at the very end to prevent you from tearing. It’s important to know that.

Many doctors scoff at the idea of not delivering patients on their back — but this is something you can bring up at prenatal appointments. Ask your provider if they’re comfortable delivering in other positions than with you on your back with your feet up in the stirrups. See what they say.

There’s lots of things you might want to ask your provider about for your delivery — doing a birth plan can be really helpful to start these conversation. I have a free series I give you a printable and walk you through it (there is a spot for delivery position preferences on my sheet):

As a note — how a provider delivers does say something to their routines of birth, and how open they are to letting the patient make the choices. As you have these discussions you may realize this isn’t the provider for you. While you may not be able to switch, it might be worth it to at least look around and see what your options are.

As a note: After delivery almost all patients will end up on their back with feet in stirrups so the doctor can clearly see if you have torn and if a repair will be needed. It’s important they do that as if a tear goes undetected (because you’re squatting) it could be really bad — we want them to be able to visualize the space well. But it does not mean you have to deliver that way — just that we’ll move you like that after delivery.

In summary on “where”:

• Try a few different positions as you start to push, see what feels good and helps baby descend well.
• Your DELIVERY position may be different than your pushing position (but trying to be side-laying or on all 4’s has been show to reduce perineal trauma)
• Talk with your provider about how they prefer to deliver

And, if you’re thinking you’d like to know more about labor & pushing positions I have some labor movement cards in here that can get the ball rolling on using movement to your benefit during labor.

How?

There are two types of pushing. And honestly, they’re pretty similar to how you poop when you’re constipated — so you can try them out now and see which works best for you.

Here’s a couple of studies that talk about it:

Closed- or open-glottis pushing for vaginal delivery: a planned secondary analysis of the TRAnexamic Acid for Preventing postpartum hemorrhage after vaginal delivery studyFroeliger, AlizéeSentilhes, Loïc et al.American Journal of Obstetrics & Gynecology, Volume 230, Issue 3, S879 – S889.e4

Chloé Barasinski, Anne Debost-Legrand, Denis Savary, Pamela Bouchet, Sandra Curinier, Françoise Vendittelli Does the type of pushing at delivery influence pelvic floor function at 2 months postpartum? A pragmatic randomized trial—The EOLE study AOGS 09 November 2022

Again, neither one really showed a huge benefit overall in the population. Some people really hate one or the other — so, decide which is right for you when you’re having your baby.

That second one did show some benefit to open glottis pushing on subsequent babies (vs your first) which makes sense. Often you’re only giving a few pushes and it makes sense to make it a bit less forceful on those deliveries.

To boil the act of pushing down — there is:

Open-Glottal Pushing: This is where you do a deep moan as you push. You’re not holding the air in — you’re more moaning and pushing down towards your bottom with your diaphragm.

Closed-Glottis Pushing: This is more like when you take a deep breath in to jump in the pool as a kid. You’re pulling that air in, and then pushing down with the air in your lungs on your diaphragm to push on the baby.

Pro Tip: I see some people saying “forceful pushing” can cause tears — and I want to be REALLY CLEAR that this is just at delivery time. During the other hours of pushing (especially on your first) you WANT to be forceful, you NEED to be forceful to get that baby to move. At delivery your provider will coach you with small pushes when your perineum needs time to stretch.

As for the two types — I think it’s smart to try both and see which you like better. You can even switch during your pushing time if you feel like one is getting less-effective. All of that is fine. You don’t have to stick to one type or position of pushing and go with it — you can adjust as you’d like!

I see a TON of stuff about pushing online. Most of it is from physical therapists who have not seen a lot of patients push (they’re going more on theory and possibly their own birth rather than a wide swath of people). The reality is that pushing is VERY personal — it’s just kind of how you get it done. Try a few things, see what works, ask for ideas from your team if you’re stuck and remember it can take quiet a while — even if you’re a GREAT pusher (especially on your first baby).

You know, I keep saying first baby, but my second baby was quite a bit bigger than my first baby — and it still took some time with him as those tissues needed to stretch more. So, you can’t always COUNT on it being fast — that being said, my 3rd was very quick (and smaller). So, you never know!

I love that you’re here learning about pushing — but I bet you’d love a teammate for this, not just someone over there scrolling Tiktok saying — go Kylie go! I recommend this to get them engaged in this process as well. I think you’ll find it so helpful!

So, what are you plans for pushing? Tell us down in the comments. And, tell me if you’d like me to include anything else in the video (or in future videos). I am here to help you guys out!

The post How to Push During Labor (What No One Explains) appeared first on The Pregnancy Nurse®.

Before we start, I want to explain something really important:

Data gives us wide swaths of information across a full population (at least good ones do).

However, you really need experts to apply it to YOUR situation with a lot of experience — and that’s where your doctor comes in. Like I always say in my disclosure:

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.

The hope is to take the data, apply your current and past medical situations and make a plan together moving forward. But, how do you do that? I’ve got tips!

A Foundation of Information

Ok, the first thing you need to know is just a foundation of how birth happens, what to expect in the hospital and how to get the most out of your stay.

Now, I know you’re thinking — where do I get that, because my birth class just covered pain management?

And that’s awesome — but a good birth class covers so much more…

And, as a note I think a good birth class should also engage your partner and getting them prepared as well — which is why I recommend this one.

When you’re tallying if a class is helpful, you want to watch for:

• Understanding 3rd trimester testing (because FAR too many births are going off the rails at this point)
• How to labor at home in early labor (safely)
• What to expect from admission at the hospital (this part already leaves far too many families freaked out)
• Common interventions & supplies (these can be really scary if you don’t know how routine they are in L&D)
• Pain management options including natural pain management techniques (you deserve to know your options in advance)
• What to expect at an induction (even if you’re not planning on one, you just never know)
• What happens at a cesarean birth (again, even if you’re not planning on one)
• What happens at delivery
• How to manage your postpartum stay (and get the most out of it)
• What to expect when you get home, how to stay safe and even thrive as a new parent!

Now, you’re thinking — “This is a full college class, Hilary” — and I’m here to tell you that you’re really getting surface information. You don’t need to know the chemical make-up of oxytocin, but you do want to know how it affects your birth and how to promote it.

I think a good birth class can be done in just a few hours.

I think it’s also smart to make sure you “vibe” with the teacher. The class I recommend actually has a secret free chapter right here that gets you understanding 3rd trimester testing.

Do a vibe check. Like what you see — jump in and get it done!

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

• Do Birth Classes Improve Birth Outcomes? What do the studies show?
• Do You Need a Birth Class if You Plan to Get an Epidural
• Alternatives to Hospital Birth Classes
• How Much Do Birth Classes Cost?
• Are Childbirth Classes Covered by Health Insurance? 

Remember What Your Job Is

Ok, here is where I remind you that your job is to give that baby a safe, happy place to grow and thrive in your womb.

It’s not your job to understand fetal monitoring.

It’s not your job to read all the studies about everything you’ll confront at birth.

That’s why you’re hiring an expert.

For instance, I know nothing about tree trimming, but we have a few really close to our house and we get wild winds here in Phoenix. So — I hire an expert to trim it right and keep our home safe. I just know to call him before monsoon season hits.

You really need to look at your doctor as nothing different. They’re just an expert in the room that does know all those things and you call them in when you need help.

They are not, under almost ALL circumstances, making choices for you.

Somehow doctors decided that since they sometimes (and I mean RARELY) make life-saving choices in situations they get to make all the choices. Honestly, I think most of those doctors are retiring, but they are still out there.

Sometimes you’ll hear them say dumb things like :

• We’ll schedule your induction at 37 weeks (vs — let’s consider an induction at 37 weeks)
• We’ll section at 8 if I don’t see progress (vs, I’m concerned about how baby’s descending, let’s review it at 8)
• We’re going to break your water (vs, what do you think about me breaking your water?)

Honestly, not sure who the “royal we” is in this situation, but I’m not a fan. And you don’t have to be a fan either (and feel free to correct them — nicely, that’s honestly the only way they will learn).

So, to boil this section down:

• It’s your job to get a foundation of knowledge (like we talked about above)
• It’s your job to ultimately make the choices

Oh, I also think it’s smart to think about what you’d like in a perfect world with a lot of these things — building a birth plan can do that. I can also help with that right here:

This doesn’t mean things go according to that “plan”…. and you’ll still have to make choices the day of. So let’s keep talking!

Informed Consent Isn’t EVERYTHING

Before “big” choices your provider should provide informed consent.

And honestly, even before smaller ones, they should at least provide some balanced info that should include:

• Risks — things that could go wrong with their recommendation (they often forget this part)
• Benefits — why they are recommending it
• Alternatives — what else could we do (often, this is to wait)

The thing is, this should be very medically-minded. For an induction it might look like:

I think we should perhaps induce you. The baby seems to not have enough fluid around her and that can be a problem as they stay in the womb including possibly stillbirth from the cord getting squished. You’ve said that fetal movement seems less lately and that has me concerned. However, there is a risk to an induction of labor including increased pain, longer being in the hospital and possibly postpartum hemorrhage. We could also wait if you would prefer. I could order an ultrasound in a couple of days to check again. Either way, I want to be sure that you’re doing your kick counts.

Now, that is a very simple statement. But what’s important to you?

They said you might be in the hospital longer, but some people think that means a few extra hours, when it really could be a few extra days.

Keeping in mind that while your provider has a guess they don’t really know how long your induction will take (please let me know if you find a good crystal ball out there).

So — how do you find out what’s important to you? You ask questions.

If my provider gave me that informed consent, I’d ask:

• I was hoping to avoid an epidural — do you think this increases the chance I’ll need one?
• I hate being in the hospital, how long would you guess I’ll be there? What should I prepare for?
• How low is that fluid number, how concerned are you about that? How often do they measure wrong, could we get an NST to see how baby is looking?

As you can see in those questions I asked, I use my foundation of info to know about 3rd trimester testing, I knew that I preferred not to have an epidural in my perfect birth “birth plan”, and I also knew enough about inductions to know that sometimes they’re pretty long — I’d done my part to get to this point.

I think far too many people get that informed consent and then feel like it’s a multiple choice test where they then have to choose option A or option B.

When in reality this an essay test, and you should now ask questions to get more information.

You also don’t have to make a choice right then.

You could ask the doctor to see their next patient while you discuss it with those you love (even making a phone call is fine), or even go home to make the choice in a few hours as you sit on it (again — making sure your provider doesn’t see any big issues with a few hours wait – this low fluid scenario could be mild, or really problematic).

So, keep asking questions until you get clear on:

• What your risks are
• What is going to happen moving forward
• Any complications you need to keep an eye on

Bytheway, far too many people go in for an induction and just don’t ask the questions to get the full picture of what the plan is. I made an induction checklist to do just that:

Changing Minds & Hearts

Here’s the one. The one my husband hates.

You can always change your mind.

Ok, not always. Once they start a cesarean you can’t really walk that back, and once they break your water it’s broken — but in MOST cases you can say, this isn’t working for me I want to stop.

That may mean taking a breather to talk about things a bit more.

It may mean going home.

BTW, going home is one of my favorite keys that people just don’t talk about enough.

But you can change your mind.

Once again — I think far too many patients get stuck on “I made this choice” and forget that they can change their mind once they really see what they’re facing. Often providers don’t bring it up — but it is an option.

Now, is it always a safe option? I don’t know. That’s up to you to decide with your expert team. The good news is once you’re admitted to the hospital you also have a labor nurse you can include in this conversation.

As a note, it is NOT your nurse’s job to give you informed consent, that is you doctor or midwife’s job. BUT they can educate you, talk over options and help you navigate the “system” — be sure to use them!

Ok, it’s honestly a lot more simple then this article made it seem:

1. Get that foundation on information. I recommend this.
2. Remember, your job isn’t to be the expert, but it is to make the choices (with their expert advice)
3. Once you get informed consent, be sure to ask questions about what’s important to you (because it’s different for everyone)
4. Remember you can most often change your mind — very few choices are final.

That last one always gives me a lot of comfort as a human.

Honestly, I think you’re going to do so great because you’re getting prepared already. I’m so glad you’re here. Please subscribe so we can continue to hang out for the rest of your pregnancy!

Also, check out my YouTube vide for more on this topic:

The post How to Feel Confident Making Choices During Labor appeared first on The Pregnancy Nurse®.

Just wanted to say that I LOVE that you’re here. If you’re wishing your partner was getting as prepared as you are — I recommend this. It’s quick & easy, couples love it!

What to Do if You Stop Progressing in Early Labor

Go home: Now, you might not be in the hospital but often I see people coming in with consistent contractions, but then suddenly things just peter out. My best tip is to go home. Remember, at home:

• You can move however you want (no worries about keeping baby on the monitor)
• You can EAT whatever you want — even if we have orders to feed you our 3-day old ham sandwiches might not be the thing for you!
• You’re comfortable, and it just lets that Oxytocin flow.

The hospital may be willing to augment your labor to keep you going — but I think far too many couples just bypass the fact that they could go home and maybe let things go on their own without Pitocin…

Remember this is normal: It’s also really annoying, and I get that. Prodromal labor can feel like false start after false start. It happened to me, even on my last baby when I had been a labor nurse for eight years. You have to PLAN on the false starts early in labor — it makes it less annoying.

It’s really important your PARTNER also understand there will be false starts. Often their hopes get so high that “it’s happening” and they pressure you to go to the hospital when staying home for a bit would be smarter. I recommend getting them on the same page as you in here.

Nipple Stim — of all of the studies I’ve read this is the one thing that you can do. Definitely check with your provider before doing it… but I’ve heard plenty of anecdotal as well as actual studies that show while it might not get you into rip-roaring labor in minutes, it may work within a couple of days.

Check out my full post on if pumping will put you into labor.

Want to know more about things that might put you into labor — check out these posts:

• What is Stripping Membranes? (Membrane Sweep)
• Best Sex Position to Induce Labor?
• When Should I Start Drinking Raspberry Leaf Tea?
• Can Curb Walking Induce Labor?
• When to start Eating Dates During Pregnancy?

Honestly, early labor is just something most people aren’t great at. Anxiety plays a big role in that. We talk a lot about what to do in here, I also have some tips on my post on prodromal labor.

If you’re still about 36 weeks there ARE a few evidence-based things you can do to help prepare your cervix for labor.

What to do if you stop progressing in active labor?

This one is trickier, because you’re most likely at the hospital at this point — and you may feel a bit more powerless here.

Change Position

We labor nurses often say that motion is lotion — it really just helps baby find their best spot in the pelvis to come out. In order to do that, we use gravity and different positions to pull down the baby into the pelvis.

Honestly, this can be something as simple as turning sides if you have an epidural. I have a whole post on how to use movement during your labor if you have an epidural. It’s always a little bit trickier when you have an epidural (and you’ll likely need some help to change positions) — but it CAN be done.

You being willing (bonus points if your partner is also willing to help out) is a HUGE way that nurses can help you do it. If you aren’t very helpful it’s less likely your nurse is going to work on rotating you — we really can’t move you on our own, and sometimes other nurses just aren’t available. PLUS, you performing the action to try to move on your own can help sometimes too!

If you DON’T have an epidural there are lots more positions for you. Even if you have to stay on a wired monitor << that post has some awesome tips if that’s the case. I also have labor movement cards included in the bundle in here that are GREAT for partners wanting to help you switch it up.

But, my 4 favorite are:

• Lunges by the bed (using the bed to keep you steady) or down the hallway (using the sides of the hallway to keep you steady)
• Squatting by the bed (use the side rails on the bed to help) — you can also lower the doctor’s stool and sit on it instead of an actual squat — since that’s hard to keep hold of for a while.
• Captain Morgan pose — lower the bed to the lowest position, put your foot up on the bed — it’s sort of like a lunge but less painful and really stretches out your hip flexors.
• Sitting backwards on the toilet (if you have monitoring that allows it). Straddle the toilet facing the wall. You can rest on the back of the toilet and it somehow just feels good to have the bowl opening with so much going on downtown.

While we’re here — telling your staff that you want to use movement opens the door to them offering more and a birth plan is a GREAT way to do it — get the easy way to do it here:

Ask Your Nurse

This is a great one, because sometimes it depends on how the baby is facing in the womb. What’s your nurse feel on a vaginal exam, or while looking at your tummy — is there a way that would be best for baby to turn?

She may also have other ideas, like emptying your bladder, or other props you can use (stay tuned for more on this).

I think sometimes patients are afraid to ask their nurse, feeing they’ll seem foolish but I think it’s SMART to do. Use all the team members to their potential.

Nurses may also be reticent to tell you to move because some patients don’t like it when we do that — so just ask!

Eat Something

Ok, this one might be against doctor’s orders, but if labor is going on, and you have no glucose in your system it can sometimes be a problem.

Even if you’re not allowed to have any food, you can usually have clear liquids — so I’d try a some juice as a nurse if it was my only option.

Or, if you REALLY can’t have anything by mouth I’d ask for some D5 IV fluid (it has a little dextrose — or, sugar) in it from your doctor to see if some glucose would give your uterus some energy to get that baby out!

BUT if you can eat, have something small. Some people think that tums have helped labor progress, something about the calcium helps the muscles contract. I’ve seen studies that contradict that, but honestly — worth a try to have a little cheese (or tums).

Chill Out/Nap

A watched pot doesn’t boil, and sometimes a watched pregnant lady doesn’t progress.

You and your partner may be so upset that things aren’t going how you’d planned it just doesn’t help.

If you have an epidural, see if you can get in a great position (I love this one), lower the lights, put on some quiet music and try to get some rest.

For heaven’s sake, don’t keep checking it every hour — that might not be helping the oxytocin flow either!

If you don’t have an epidural, and you aren’t too far along, it might be a good time for some IV pain medication. It can allow you to rest between contractions and maybe relax to let that baby descend.

Or, the reality is that epidurals often help baby to descend — ultimately by helping you to relax, so you might want to consider one if you don’t already have one.

The reality is that if you’re tensed up with a lot of pain and anxiety it does the same thing to your pelvis which puts the red light into baby descending into the birth canal — try to chill out as much as you can. AND if you’re anxious about labor in general — I recommend this.

Try to get your partner or support person to nap too — it will be good for BOTH of you. Even just a tiny power nap will both of you fresh eyes on the situation.

New Prop?

No, this isn’t like your Jr High play where you held a newspaper — I’m talking about things like peanut or birth balls, etc.

If you DON’T have a peanut ball between your legs, maybe add one. Or if you DO have a peanut ball — is there something else you could try?

I’ve been a nurse so long we didn’t have peanut balls back in the day. I’d use all the things in the room for my patient instead. Nurses love to McGuyver!

The props in labor can both allow you to rest, but also help baby to come down.

Pro Tip: If you’re not actually ASLEEP you want to try to move every 30 minutes. Let your nurse know this is the hope, and if she comes in the room open at least one eye to let her know you’re not actually asleep, and if it’s time to move you’re a willing participant. It doesn’t need to be huge, it just needs to use gravity on the baby in a new way!

What if my Doctor is Wanting to Do a Cesarean?

This is called “failure to progress” and is one of my least favorite diagnoses in labor.

Ultimately, it says that both mom & baby are tolerating labor pretty well, but baby just couldn’t come down — and we weren’t in the mood to be patient.

Now, you may be ready for a Cesarean, and that’s up to you. Again, make sure you understand the risks and the benefits and then move forward how it seems good to you.

But, you may wanting to be more patient and try some new things.

Keep trying the things I mentioned, you might also consider something like having your water broken, or even going home if you’re early in labor? I’ve definitely seen doctors want to do a cesarean when the patient hasn’t really even gotten into a good labor pattern and could have gone home.

It is ALWAYS your choice if you have a caesarean or not, but if you and baby are both doing fine, I think it’s fine to ask for more time.

Now, if you have other things like baby’s heart rate is going down, or you’re getting a fever, than that’s more than just failure to progress. And that needs to be considered as well.

This deserves a lengthy talk with your provider before for you make your mind up, and the good news is that most often (unless they’ve already started the surgery) you can change your mind.

Don’t feel PRESSURED into something you don’t understand. It’s important that you get the information you need.

Honestly, the hospital can be a pretty “high pressure” situation… it’s important to know how to handle it before you’re in it. And remember, if you’re anxious the natural oxytocin shuts off. I recommend every couple take this << it’s WELL worth your time to prepare both of you!

Were any of these helpful for you? Tell us in the comments!

I also have a YouTube video on this same topic:

The post What To Do If Labor Isn’t Progressing? appeared first on The Pregnancy Nurse®.

Of course, these are just some tips you can use — always talk about your situation with your provider so that you can make the best choice for yourself in the situation. As always, this isn’t medical advice, just some general tips for y’all.

You can go home.

I think there’s a song out there that says you can never go home — but it doesn’t apply to labor.

This one MAINLY applies to when an induction (or going in thinking you’re in labor only to find out that you’re not) just isn’t going anywhere.

And honestly, when I bring it up to patients you’d think that I was insane to even bring it up.

Let me just say that I know you left your house thinking — next time we come home, we’ll have a baby… but it may be better to wait a bit and then maybe something will happen or try again with an induction.

Now, this doesn’t always work if you have a real medical reason to need to induced or have your baby — but if you’re just WANTING to be induced, or if things just aren’t looking the best — it may be an option.

Mostly, I don’t want you to pull it off the table as an option.

When I went in for my own induction I very much left going home on the table, as I’d seen it used many times in a power move when things weren’t progressing.

Now, once your water is broken, you’re sort of set to stay there and have the baby…. BUT often right up until that point it can be an option.

Don’t be afraid to bring it up with your providers, and don’t immediately think it’s crazy-town if they bring it up.

Honestly, because most patients absolutely HATE it when we bring it up, we often don’t — but if it’s something you’re considering feel free to mention it.

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

• What You Need to Know About Wired vs Wireless Monitors in Labor
• The Three Biggest Mistakes Labor Patients Make—And How to Prevent Them
• Your Complete Guide to Epidurals in Labor: Everything You Need to Know
• 3 Tips to Using Movement During Labor WITH an Epidural
• 3 Proven Labor Secrets You Don’t Want to Labor Without!

You Can Ask For a New Nurse

Every single person in the hospital knows that not every patient will mesh with every nurse. Nurses know this extra because we hate it when it’s just not a relationship that’s not working — but we have no choice in that matter.

You, on the other hand, do have the opportunity to ask for someone else.

BUT, it’s not as simple as everyone seem to make it out online.

The FIRST things you need to know about asking for a new nurse, is that it is most often not going to happen right away.

Meaning, you’re still going to have some time with the current nurse.

Fun facts:

• You HAVE to have a nurse (and a doctor/midwife) assigned to you if you’re a patient in the hospital. You can’t just be there without a nurse.
• There most likely isn’t a bunch of nurses at the nursing station just waiting to jump in if a relationship isn’t working — many units have very tight staffing.
• It isn’t fair to switch up a nurse/patient relationship that is working to fix yours. In fact, most mistakes happen when we do switch nurses, so we try to do it as little as possible.

However, things happen and we’re used to juggling staffing, it just takes some time.

If my nurse just wasn’t giving me the support that I needed I would:

1. Check in with my partner. What does he think of the relationship? You may be at a point where NO one would be good enough, even the Mary Poppins of nursing because you’re in so much pain. If they too think someone else would be good…
2. Ask to speak with the charge nurse. Say it’s not a big deal but you’d just like to check in with her. This is awesome if you can ask someone in the hallway (great job for partners) rather than directly asking your nurse.
3. Just say that you know your nurse is trying but that relationships is making labor more difficult for you, and you wonder if it’s possible to switch as soon as they can (making it clear you understand there isn’t a pile of nurses just waiting to jump in).
4. Should your current nurse come in and address the situation, be as honest as possible about what your issues were/are and thank them for their time. This may be a time for that nurse to improve, but at least they know rather than stewing about something they did wrong.

If you have a specific COMPLAINT (vs just not meshing) about a nurse — maybe a poor practice or something she did that made you feel unsafe be sure to be specific about that with the charge nurse. We can only fix unsafe practices if patients are honest about their own experience.

Hopefully within the hour you’ll have a new nurse (but it may be longer – which no one seems to mention online).

Now, I also online see often that you can kick your doctor out and I honestly don’t know how that works. If they’re not the hospitalist then you may have options but in smaller hospitals you may have to have that doctor — again, because every patient has to have a provider assigned to them.

BTW, want more keys to a good birth — check this out:

Labor at Home as Long as You Can (and that it can feel scary)

I do see people say to stay home as long as you can — but I don’t think they talk about the fact that it can feel REALLY scary to be doing your own thing at home.

I mean, you’re paying for a hospital birth, shouldn’t they be the ones managing this part?

I get it, I get it so much. My husband HATED me laboring at home. He’d get so antsy and want to go to the hospital right away. But I knew this truth:

The hospital is the best (and safest) place for ACTIVE labor (which is most often defined as being 4-6cm where your cervix is actively dilating — meaning, we check you now and again in an hour and your cervix has changed).

Early labor is best managed at home.

But why? It’s similar to the “watched pot” theory. When we’re constantly watching you to see if labor is progressing, how you & baby are doing — there’s just more time for us to find something wrong and want to act — meaning you get interventions you may not need.

Plus, at home you’re comfortable — and comfort allows oxytocin to flow in our veins unencumbered by stress or anxiety of driving to the hospital (ugh, never a fan of that) or the whole, get the gown on, get checked, wait around of it all. You have your people, your things, your food. It’s good times at home.

And yes, I basically said it’s not good times at the hospital. I am aware that we do stuff that isn’t the fun-est or greatest when you’re in pain. In fact, I hate the hospital so much I stayed home with an appendicitis until it ruptured. When I ultimately went in and asked them to kill me if they couldn’t fix it.

But, laboring at home can feel really scary — for both you and your partner. That’s right, I said partner.

They’re your main support system when you’re at home and you really need to get them prepared to be just that. For most people, it doesn’t come naturally. That’s why I recommend a birth class that prepares BOTH of you. If that sounds interesting — the one I recommend is right here << check it out.

Let me give you a few tips to early laboring at home:

1. Sleep — far too many people sit up timing these contractions and don’t get rest. Sleep as much as you can. Ignore it as much as you can. Partners can keep an eye on them, and if they’re getting closer than 5 minutes apart, you can start to make further plans. But SLEEP for now (if at possible).
2. Move — when you’re not actually asleep (even if you’re “resting”) change positions every 30 minutes to help baby get their groove down into the birth canal. Again, partners can be awesome at this — and I even have labor movement cards in here to help them be awesome at this.
3. Eat — I’m not talking a giant burrito. I’m talking about some snacks that balance carbs and proteins nicely to keep your body fueled. Again — another great thing partners can do is have that snack nearby and encourage you to take a bite now and then (if you’re actively feeling nauseous though, might want to skip this step for a bit). Food can be tricky which is why I have a nutrition bonus video in here.

I sort of made the mistake of thinking my husband could just stay at work as long as I wasn’t going to the hospital but I felt alone and unsupported — and those few hours of work he would’ve missed might helped me feel better from the start of labor. Early labor is a team sport, you deserve a teammate, not just a cheerleader!

I actually have a whole chapter on contractions, counting them, and other things you can do in early labor in here. I think it’s not talked about enough and can be a very tricky part that often leads to needless interventions.

Ok — there’s three tips that are going to start getting prepared for birth. I’m so glad you’re here even just thinking about what to do and what you’ll want at birth. I know it’s going to pay off BIG time!

And, if you’re wishing your partner was doing the same — let’s hang out in here. It’s guaranteed to having you both feeling more confident in just a few hours!

The post Secret Keys to Labor that No One Talks About appeared first on The Pregnancy Nurse®.

I actually recommend talking about your monitoring options in advance — it’s a part of my printable birth plan — grab it here:

Fetal Monitoring

First off, let’s talk about fetal monitoring.

There’s two parts to fetal monitoring:

Fetal Heart Rate Monitoring

The idea here is to catch any issues with baby as labor progresses by watching their heart rate. This is pretty complicated, as we watch how baby is doing. Labor nurses spend HOURS learning how to read the fetal heart monitor (honestly, probably more than doctors) and knowing how to respond.

I hear sometimes that people feel like THEY should know how to read the monitor, but I’m here to say that it’s complicated enough it likely isn’t worth it. You definitely want to get prepared for birth, but learning fetal monitoring is not the best use of your time. I think this is a better use of your time.

I also want to say the interpreting the fetal monitor is a science, but obtaining continuous monitoring is an art. Sometimes it involves extra parts, washcloths, extra tape – it is tricky and it’s a skill that labor nurses learn….

The odd fact is that studies really haven’t proven that this is as effective as we’d hoped in low-risk births — I’ll talk about that more in a minute — keep reading!

The fetal heart rate can be monitored using an ultrasound monitor, and also a fetal scalp electrode (FSE) in case we need to follow the baby closer, or the ultrasound isn’t picking up well and we need to see baby.

Wondering how an FSE works? We talk about it in here.

Contraction Monitoring

Beyond the fact that it is nice to know if you’re contracting and how long they are, Fetal HEART monitoring needs to be followed in association with contractions. If baby’s heart rate is dropping we need to know if it’s with a contraction or after it.

This can be monitored using a toco (long name: tocodynamometer) which measures the pressure of the uterus pushing on the monitor, or an IUPC (intrauterine pressure catheter) that is an internal monitor and is much more precise in how hard the uterus is contracting.

It can be temping to think that contractions measured using the TOCO can tell you how strong they are, but it really depends on where we place it, where baby is and your body dynamics. It really just shows us they’re happening, not how hard they are (I HATE it when a partner tells them — oh man, this is a HUGE ONE)….

Intermittent Auscultation

First off, this isn’t an option in a lot of hospitals.

Many hospitals boil this down to continuous fetal monitoring (often called intermittent monitoring) for about 20 minutes out of every hours, but intermittent auscultation is different.

I have a full post on it, which I would entirely recommend if you’re thinking this sounds like a nice option:

Here are the cliff notes:

• Your provider will listen to the baby (using a doppler) every 60-5 minutes (depending on your labor) before, during and after a contraction.
• It is ONLY for low-risk births, any higher risk things (including induction or epidurals) hospitals will require continuous monitoring
• 2/3 hospitals I worked for had no policy or even a way to chart for this — it’s an entirely different skill to learn than continuous monitoring
• This has been shown to reduce caesarean sections for lower risk births (again, tons more info and studies in that full article on it).

I am ALL FOR hospitals using this monitoring more, but as I discuss it in pregnancy groups/online I get a lot of moms who really enjoy seeing how their baby is doing all the time.

Until more pregnant patients are requesting it, it won’t be an option in many hospitals (because it requires more nurses, and more training to do it this way).

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

• The Three Biggest Mistakes Labor Patients Make—And How to Prevent Them
• Your Complete Guide to Epidurals in Labor: Everything You Need to Know
• 3 Proven Labor Secrets You Don’t Want to Labor Without!
• YOUR Birth Priorities: How to make them clear
• How To Have A Natural Hospital Birth

Ok, let’s talk about wireless monitors!

Wireless Monitors

These are monitors that can move with you. There are some monitors that still plug into a “transmission station” that I normally hung on an IV pole near you. They still had wires, but you could move about the unit freely.

As a note wireless and waterproof monitors are two different things (although some can be used both ways). Some wired monitors can be used like above in the bath — so ask your hospital their options (a great option when you go on a hospital tour).

However, there’s newer ones that are direct transmitters. The most often used one is called the Novii (also called the Monica).

It is used with the same heart monitor system we always have at the bedside but it transmits directly to those (we plug extra things into the monitor to pick it up).

Problems With Them?

Just like all the technology at your house — it sometimes doesn’t work.

There is a process of roughing up your skin to apply it (because it’s not an ultrasound, it’s catching electrical signals) and sometimes, no matter how much we try, it just doesn’t work.

I am in a very large labor nurse group on Facebook and a few times a week people are screaming how frustrated they are.

In fact, they just came out with a new generation — and I’m not hearing those work any/much better.

Who Can’t Use Them?

There are a few patients that we have the hardest time using them on, and that tends to be overweight patients.

Now, I’m an overweight girl myself (hello, Semaglutide) but the reality is that you have more fat over your uterus — which can make monitoring difficult.

Also, sometimes when you get up to walk your thighs rub against your belly, which can sometimes REALLY mess-up monitoring.

Yeah, I’ll be out there walking with you to try to fix it but it is sometimes impossible…

We can’t just magically make them work if we’re trying all the things and it won’t work.

I know a lot of people show these as magical cure that can help people move wherever in labor, but I am here to say it doesn’t always work that way.

SOMETIMES it does, and I love it — SO MUCH! It’s really frustrating that fetal monitoring hasn’t changed much since I started in 2001.

But, it isn’t always that magical cure….

Refuse Monitoring?

So, you get to the hospital and these things aren’t working and you’re miserable, can you refuse monitoring?

Absolutely.

Will that be really hard for your nurses & your provider?

Absolutely.

We’re very much trained to watch the monitor and act accordingly.

You need to realize that you’re refusing one of the main tools in our toolbox to see how your labor is progressing.

If you plan to refuse monitoring in labor, that is a conversation I’d have very early with your provider. It’s part of my birth plan series here:

Honestly, at the very least I’d want intermittent auscultation. Labor is a time that a lot can go wrong for the baby (and for you) — watching the baby once an hour should be your bare minimum. Again, you’ll want to find a hospital that truly does it and deliver there (and find a provider who also delivers there).

Tips for Wired Monitor Use

I think that a lot of people (and nurses) think that if you use wired monitors you have to stay in bed, and I’m here to testify that isn’t the case at all.

The wires on those monitors are pretty long, which is awesome — it gives us some great options!

Some of my favorite things to do with wired monitors:

Sit on a Yoga Ball or the Doctor’s Stool (personally, I think the doctor’s stool is one of the most under-used tools in the labor room, but I digress). This is a great way to stretch out your back, and legs while still feeling very supported.

Squats & lunges at the Bedside. I love to use those side rails as a ballet bar to allow us to move your hips in lots of ways to both open your pelvis but also stretch out your hip muscles as labor makes them awfully tight. I know walking gets a lot of love during labor, but I an a HUGE lunge fan….

Even if you’re not up for lunges, we often have a step stool in the room you could put one foot on and slowly sway or do circles with your hips — it just gives your pelvis a new spot to be in.

Dancing at the Bedside — you may not be up to drop it like it’s hot, but maybe some bear hug swaying with the one you love will get the juices going. BTW, music is something awesome to put on your birth plan — sometimes it remind your nurse to ask how you want to play it!

Let’s not discount awesome positions in the bed either. I love a Left Sims (I talk about that in this post), or even hands and knees on the bed (love the cushion of the bed vs the floor). All of these can be done while the monitors are plugged in!

Many hospitals also have peanut balls that can be used in the bed as well (with an epidural also).

This isn’t to say that these positions will always work either. In order to monitor you, we have to find & keep baby on the monitor, and while fetal monitoring is an art — sometimes it’s just not possible.

No matter the type of monitoring you have, I still recommend moving every 30 minutes that you’re not asleep. I talk about that a LOT in here (and give tips for partners to help — because this is a GREAT way for them to be a teammate).

The Nurse Monitoring Bugs You

I’ve seen a few posts on social about how much people hate the nurse moving the monitor.

I’ve even seen people saying they hit their nurse because they kept adjusting it.

First off, I 100% understand being annoying (we’re also annoyed) but hitting a nurse is absolutely NEVER OK.

You have two choices, you can be monitored, or you refuse the monitoring.

If you’re making the choice to be monitored, your nurses is likely going to need to adjust it a lot. She may not ask every time she has to adjust (because it is sometimes like every 5 minutes). Should she? Yes — but she has a lot on her plate and she figures you want the monitor, so she needs to fix it.

If you don’t want her to adjust the monitor then that is refusing monitoring. It’s not fair to put that on the nurse.

I know some people say “don’t touch it when I’m having a contraction” — but the problem is that often the problem time to get baby on is during a contraction (as the moves the baby). If you want monitoring, it may come with her adjusting it during a contraction.

That’s just how it is.

Intermittent monitoring is amazing, but can’t be used with every birth. Also, you have to realize that even with that type of monitoring the nurse will be listening to the baby at every point and may need you to move to be able to access your belly whenever they need to listen.

I just think a lot of people aren’t aware of how annoying monitoring can be during labor, so I hope this article was helpful and helps you understand your options!

I think there’s a LOT that people don’t understand about labor ahead of time — this is why I recommend an expert, unbiased birth class. I recommend this one. It is:

• Affordable — not the $400 ones a lot of doulas like to offer
• Quick — in just 3 hours you can be prepared with the basics for birth
• Created to help your partner be a teammate, not just a cheerleader

Thousands of couples have taken it, be sure to read the reviews, they’re definitely what convinced me that class rocks.

So, what type of monitoring are you planning for during your birth? Did this open your eyes to how wired & wireless monitoring works? Let me know in the comments!

The post What You Need to Know About Wired vs Wireless Monitors in Labor appeared first on The Pregnancy Nurse®.

Before we get started though, grab birth plans made easy right here:

Let’s break down these common pitfalls, why they happen, and concrete steps to avoid them.

Mistake #1: Relying on Social Media for Birth Preparation

In today’s digital age, social media serves as the go-to for everything—including childbirth prep for some people. While Instagram, TikTok, and other platforms are packed with birth stories and advice… not all of it is created equal (or honestly, helpful).

The Problem: Mismatched Advice

Social media is full of helpful hints, but not everyone online is offering information relevant to your situation. In fact, many of the most popular birth influencers delvier mostly at home, even though the vast majority of people deliver at the hospital. The advice just doesn’t translate well.

How to Vet Your Sources

There are three important questions to ask before trusting any online expert:

1. Do they specialize in your chosen setting?
   If you’re delivering at a hospital, take advice from those with hospital experience — and if you’re delivering at home, I actually still recommend some hospital learning as many patients do end up having to go to the hospital.
2. What are their qualifications?
   Look for credentials. Nurses, doctors, and certified midwives have specialized training. For example, I am a registered nurse (RN, BSN), I have advanced fetal monitoring training, and am certified in emergency procedures for mothers and newborns.
3. What’s their depth of experience?
   More time in the delivery room means broader experience across lots of different scenarios and patient backgrounds. Value comes from both knowledge and hands-on experience.

The Takeaway

While social media can offer real-world perspectives and comfort, make sure your birth preparation is rooted in reputable, experienced voices—ideally from professionals trained to handle the specific circumstances of your planned birth location.

Remember it’s also important to get prepared for all of birth — something that is TOUGH to do on whatever the algorithm feeds you. I 100% recommend a full birth class.

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

• Labor Anxiety? These 3 Things Help You Feel in Control
• Prodromal Labor: What is it and how to avoid it?
• How To Build Confidence For Your Birth Experience
• Why Labor Pain Can Feel So Different For Each Person
• Avoid Tearing at Delivery: 3 things you can do.

Mistake #2: Staying Quiet When You Have Questions

One of the biggest pitfalls in the labor room is failing to speak up when you’re unsure or need more information. Medical decisions—like whether to induce labor, move forward with a C-section, or perform a cervical exam—should not feel like mandates. But, too many patients nod along, later feeling forced into doing something or even traumatized by their birth experience.

The Problem: Passive Agreement

It’s distressingly common for patients to simply agree with a provider’s recommendation without fully understanding it. This can stem from fear, feeling overwhelmed, or not wanting to “bother” busy healthcare staff. But birth is personal, and you deserve (and honestly, requested) to be part of every decision.

How to Advocate for Yourself

• Ask Questions:
  The moment your provider makes a suggestion—no matter how big (“I recommend a C-section”) or small (“Let’s do a cervical exam”)—is the right moment to ask what’s being seen, the risks and benefits, and if there are alternatives.
• Informed Consent Goes Both Ways:
  While it’s a provider’s responsibility to ensure you understand your options, remember that you play a vital role by voicing your concerns and seeking clarification. Only by doing so can you make informed choices that leave you feeling empowered.
• More Gray Than Black-and-White:
  Most situations are not emergencies and allow for discussion. True emergencies are unmistakable—marked by urgency and a crowded room—so in less-critical moments, don’t hesitate to slow things down and get the information you need.

The Takeaway

Active participation in your care is essential for a positive birth experience. When in doubt, speak up. It’s your body, your baby, and your experience.

Mistake #3: Not Preparing with Your Partner

All too often, the mother-to-be is the only one delving into prenatal education while partners remain in the dark. This disconnect shows up in the delivery room where partners, feeling lost, may retreat to their phones or a nap instead of providing valuable support.

The Problem: Solo Preparation

Traditional in-person classes can be inconvenient, and many online classes focus solely on the pregnant person, neglecting the partner’s needs entirely. Yet, your birth partner—whether spouse, parent, friend, or sibling—has a major role to play both at birth and once the baby is home. When partners aren’t prepared, confusion, misunderstandings, and a lack of support often follow.

How to Get Ready—Together

• Take a Class Designed for Couples:
  Choose online courses that cater to both of you. This ensures you’re on the same page and your partner feels prepared (not helpless).
• Communicate Expectations Early:
  Discuss big decisions—like sleep arrangements for the baby—or who will be present at birth well before labor. This avoids conflict and surprises when the time comes.
• Engage Your Partner:
  Encourage your partner to ask questions and be involved in the education process. Prepared partners feel more confident, supportive, and connected during labor.

The Takeaway

Don’t go it alone. When both you and your partner are prepared, you’ll have a more united and less stressful labor experience. You can even get started today right here.

Final Thoughts: Prepared, Not Scared

Labor is unpredictable, but by steering clear of these common mistakes, you set yourself up for a more confident, informed, and empowered birth.

• Vet your sources to ensure you’re getting advice tailored to your situation.
• Speak up and actively participate in medical decisions.
• Prepare with your partner so you’re both ready for what’s to come.

Which of these mistakes are you most concerned about? Share your thoughts in the comments, and remember: You deserve a birth experience that’s both safe and supported.

The post The Three Biggest Mistakes Labor Patients Make—And How to Prevent Them appeared first on The Pregnancy Nurse®.

As a labor nurse for 20 years I definitely saw epidurals used right, and WRONG. I think some people think they just sleep til’ baby comes out, and while that is sometimes true there’s more to it than that. So, let’s get started on your complete guide to labor epidurals.

While we’re here, a reminder that while in the US the epidural is definitely the most popular form of pain management — but there are other options — happy to share those with you as well. This also talks about IV pain medicine and that is VERY much mis-understood so I’m here to clarify that too:

We’re gonna start at the very beginning. First off, a man and a woman love each other very much… Ok, maybe we’ll fast forward to when you’re actually in labor.

When can you get the epidural?

First off — to get an epidural you definitely have to actually be in labor (although, you can get an epidural prior to a version — but that’s a very different case). I will admit when I was a pregnant labor nurse, I was jealous of the epidurals. That sounded pretty darn nice. BUT you gotta be in labor to get one.

I really do recommend getting the epidural once you’re in pain, although some people do request the epidural before their induction starts. AND if they’re just going to break your water, a lot of people recommend getting the epidural before they break your water.

Frankly, I am still a fan of you having some pain (and promoting movement) until you feel like you’re ready for it — vs just getting the epidural in advance of the pain.

But, How Many CM Do You Need to Be to Get An Epidural? — is a question a lot of people ask. I will say that when I started in L&D it was very normal for providers to say that patients couldn’t get the epidural until 4 cm or something along those lines, but that isn’t really the case anymore.

Studies have shown that the epidural is best given when the patient wants it. If you’re really wanting to pick the best time for you, I’d recommend this post: The Best Time to Get an Epidural During Labor

While we’re here, talking about your hospital stay — have you thought about packing your bag? Grab my packing list right here:

Is it ever “too late” to get the epidural?

In a word, yes. But it’s complicated. I go into more in this post

What you really need to know is that on your first baby there is a very wide span of when you can get an epidural. Mostly because you likely have 1-2 hours of pushing ahead of you, and that is still a safe time to get an epidural.

However, on your second baby those last few centimeters can go much quicker and pushing time is very reduced. Often we say that about 7-8 centimeters is when you really need to decide on a 2+ baby.

Note: That would be a 2+ VAGINAL delivery — if you are having a VBAC with no prior vaginal deliveries it would be the same as first delivery.

Really quick — have you started your birth class? If not, there’s still time — I recommend this one!

How Is the Epidural Put In?

Ok, so I bet a LOT of you wonder how the epidural is put in. Totally normal. I actually go through the whole process with a doll, using common (less scary) household supplies to show you how in here:

But, I bet one of the questions most of you wonder is — How Bad Does the Epidural Hurt? << that post has tons of info, but most people think it’s actually less painful than the IV stick.

Pro Tip: You WILL need an IV to get an epidural (although it can be run as a saline lock until you request an epidural as long as you’re low-risk).

You may also wonder — who Administers an Epidural? Most often it’s an anesthesiologist, but it may be a CRNA (sort of like a nurse practitioner for anesthesiology). It’s important to know that it is NOT your OB — that isn’t their specialty, so it is given by another provider.

And, as a ANOTHER pro tip — you’re welcome to ask to speak with the anesthesiologist well before you want the epidural if you have questions to ask them. Many of them love to come in and have a conversation about risks and benefits with you before the pains get too much — so that’s something to consider as well.

There are a couple of types of epidurals — Epidural vs Spinal: Which is best for you? The reality is that it’s best to get whatever kind the provider giving you the epidural is good at. I just think it’s good info to have.

Now, if you’re really worried about the needle or the pain of the epidural I have a good podcast episode for you:

Tailoring Your Epidural to YOU

This is a real pro tip that not a lot of people talk about. You may have heard of the walking epidural…

but I gotta say that while MOST hospitals don’t provide a “walking epidural” there is actually a lot that we can learn from walking epidurals.

Mostly that the epidural can be tailored to what you need.

Most often the anesthesiologist will just ask us to set the epidural pump to a “rate” and then they leave (that rate being the same for everyone). However, if you’re feeling too numb or you’re feeling TOO MUCH you can ask just to change that rate. I like to think of that as a “starting” rate — and then we can adjust as needed (especially after you get a nap in for some energy).

The good news is that pump can go up and it can go down. Depending on your hospital you may need to speak with the anesthesiologist to change the rate — but that’s your right.

The real sweet spot of an epidural is when you’re still able to move, but only feeling about 20% of the pain. And you can really tailor that epidural to YOU!

If you, right now — are thinking, huh — I never knew that? I’m right there with you. I either had epidurals that left me in a lot of pain, or so numb I had no idea I even had legs — I couldn’t move them at ALL.

But, pro tips like tailoring your epidural to YOU are what can truly make your labor extra good. I learned so much in here — I think you will too! Tons more pro tips like this one in there!

Does Labor Still Hurt with an Epidural?

The thing is, as you tailor an epidural to what you need — there is likely going to be some pain.

And honestly, they really want you to be able to feel SOMETHING. That allows you to be able to move some in bed, and also get some feedback that baby is moving down the birth canal and when it’s time to push.

I do have a whole article on this:

However, labor has several stages, so it’s good to know what to expect as you advance through them (especially right at delivery) — I think you’ll find these articles helpful.

• Can You Feel the Baby Coming Out With the Epidural?
• Do You Feel the Ring of Fire With an Epidural

That being said, I always sort of wondered — What Does Having an Epidural Feel Like? << that post has tons of info, but it is very similar to how your leg feels when it’s fallen “asleep” — you just don’t get that pins and needles feeling as it “wakes” back up — it just stays asleep. Sort of numb.

It think it’s important to remember that the epidural isn’t designed to completely take the pain away. Because, this is the case — it’s important to remember that breathing is an important tool to have, to learn to relax even when it’s hurting. This is true both before the epidural and afterwards (and frankly, as you raise that sweet babe).

I think any good birth class should include breathing. This one has a whole natural pain management bonus video to help you learn both breathing and some other awesome techniques to help. I recommend everyone watch it — planning on an epidural or not.

That being said — I often see a LOT of gas-lighting from anesthesia that it’s “just pressure” that people are feeling — not pain. This is them, not really wanting to do their job….

What to do if your epidural doesn’t work?

If you’re feeling more pain then you’d prefer I’d 100% ask to see them (you may have to be insistant). I have a whole post on what to do if this is the case:

Ok, let’s get into the nitty gritty of the epidural:

How long will the epidural last?

A LOT of people wonder if they get the epidural too early, will it “run-out” before the baby is born? I answer that thoughly in this post:

The good news is that the epidural continuously pumps in similar to an IV pump. We just change the bag if it’s out of medication, and it keeps infusing.

They used to give epidurals with like large bunches of medication that would slowly wear-off — and that isn’t the case anymore (but you might hear those stories from your mom).

Now, the longer the epidural is in the more likely it is to have issues that cause it to not work — so, that is something to consider, but that’s up to your anesthesia team to help you troubleshoot if there is an issue (scroll up to that post on what to do if the epidural doesn’t work for more info on that).

Thinking that you’d prefer to wait as long as you can is a great thing to consider as you make your birth plan. I have a free printable here that gets you started on yours:

Epidural Side Effects

You might be wondering what the side effects might be. The most common side effects I have seen are:

• Shaking
• Itching
• Blood pressure dropping

I think it’s really important to know that these aren’t unusual at all (and for the blood pressure dropping one we attempt to stop it by giving you extra IV fluids in advance).

But, there are a few other ones that I talk about in this post:

As you can imagine some of these side effects can be upsetting when they just happen — but if you KNOW you may shake uncontrollably for a bit after the epidural you’re not freaking out when it happens, and you can even just nap through them (which often makes them disappear).

Pro Tip For Shaking In Labor: Stick out your tongue. I have no idea how this works but it often stops the shaking. The hard fact is that trying to “stop” the shaking often makes it worse so just “going with it” is sometimes your best bet if the tongue thing doesn’t work.

Honestly, labor is a lot like this — a LOT of it can be upsetting — but it doesn’t have to be when you’re prepared.

What to do WHEN You have the Epidural?

Most often the first action is to nap. You’ve been in pain and likely haven’t slept well for a while. A nap is also a great way to let your body relax and let baby to descend into your pelvis.

BUT once that nap is done (or at any point you wake-up) you want to MOVE.

Now, movement with the epidural does look different than the movement you might imagine if you didn’t have the epidural. There’s no lunging or slow-dancing with your husband to the pain.

This looks more like rotating in bed, and using supplies to help open your pelvis while you’re safely in bed. I have a whole post that gives tips to using movement with the epidural:

That post has some very important tips that help incorporate movement into your labor.

I can testify that this really DOES make a difference in helping baby to descend and you to progress towards a vaginal delivery (instead of a c-section).

The thing is, if you don’t know tips like this, often your nurse will take the easy road out and just let you sleep or stay in one position. However, just asking her to help you move ever 30 minutes while awake will awaken her to the fact that you want to move and help out — and I bet she’ll become the MacGyver of getting that baby to descend.

It’s also an awesome job for partners to help out with. They finally feel like they can do something and be really helpful to the process. Tips for both you AND your partner is what this class is full of. I think you’ll absolutely have your best labor if you take that class!

Post Delivery With the Epidural?

We turn the epidural off once they’re finished with the delivery and any repair that is necessary. It normally takes 1-2 hours for that to wear off, but I think it’s important to know that some people it takes a while longer (and some a bit shorter). But, I go into more detail into it with this post: How Long Does It Take for the Labor Epidural Anesthesia to Wear Off?

Back Pain After The Epidural?

Now, a lot of you may have heard that an epidural can cause long-term back problems:

That post reveals the fact that studies do not show an increase in back pain between those who got the epidural vs those who did not, long-term.

There is some short term bruising that you’d expect with a needle going in your back.

The reality is that pregnancy, labor and birth really cause our bodies a LOT of stress and I am 100% on board with making sure to get some physical therapy after birth to help our bodies adjust afterwards.

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

What if you need a C-Section?

Ok, so you get the epidural, and then it turns out you need a cesarean section.

Most often they can just add new drugs to your existing epidural and make it work for a cesarean section.

Honestly, it’s one of the big perks of having an epidural in — if there’s an emergency, they can just dose it up extra, rather than having to put you to sleep.

And while that might sound better — I have a whole post on Cesarean Section Anesthesia that you’ll find helpful as to why we normally pick a spinal vs general anesthesia.

Avoiding the Epidural

Maybe you’re one of the ones who wants some info about the epidural, but you really don’t want to get one if you can avoid it.

Honestly, I think that’s smart. Any time you can avoid medical intervention, there are less risks overall. I have a few articles that might help you out on that:

• How To Have A Natural Hospital Birth
• Why Not to Get an Epidural: 10 Reasons to consider other pain management in labor
• What to Do If You Can’t Decide if You Want an Epidural or Not?

That last one is where most people are. I think they come-in thinking they would prefer not to, but aren’t sure how they’re going to move forward.

The good news, you really don’t have to decide all the things in advance. I think it’s smart to learn about them and know your options, but then take labor as it comes.

AND in case you’d like some reasons people DO get the epidural I have a post on that too.

Like I said — you want to know your options, and be prepared for what you might face, but also be flexible knowing you really don’t have all that much control over what will happen that day.

There are studies that show that most birth classes really only cover very normal things, but most don’t cover things that might go wrong, or how to navigate the pitfalls of birth.

In my experience, that’s true. My own birth class that I took with my first sort of painted labor in sunshine and rainbows, that were only brighter once you went home.

The reality is that you will maybe face things like:

• 3rd trimester testing that may have results that are different than you’d hoped
• Needing/wanting an induction
• Possibly needing a cesarean

The BEST news is that you have time to learn about these things — and I’m not saying that you need that 22 hour Saturday birth class marathon (ew, no). In The Online Prenatal Class for Couples you can learn in just a few hours what you need to know about navigating your own birth. And the best part is that your partner will also be on the same page with you (rather than you having to explain all of it to them as you’re making choices on your own).

In just three hours you can feel prepared and confident about your birth. Sounds pretty great, right? Come join me!

Oh, and as a bonus for joining while we already know so much about the epidural — use coupon code EPIDURAL to save 10% on the class!

The post Your Complete Guide to Epidurals in Labor: Everything You Need to Know appeared first on The Pregnancy Nurse®.

What is a Catheter?

The word catheter means tube in the hospital. So, we have lots of catheters. Other ways we use it:

• IV catheter
• Epidural catheter

And neither of those has anything to do with urine.

The FOLEY part of the catheter is the bag that the urine drains into. More precisely we’d call this a urinary catheter.

What are Catheters Used for In L&D?

Draining Urine

This is likely the most common reason. Urinary catheters can be done a couple of different ways:

Indwelling — means we put it in once and remove it and then are (hopefully) done with it.

Intermittent — this means we place the tube into your bladder every couple of hours to drain out the urine and then remove it.

The type that the hospital uses is based on policy (and hopefully infection rates associated with it).

Which type is better?

Honestly, the evidence seems really mixed as to which one is better. I really think it can be up to the patient:

If the idea of something “sitting” in your bladder freaks you out, and you’d rather have a catheter inserted every hour or so to drain it, that should be OK.

If the idea of being re-cath’ed every hour or so really creeps you out, then ask for an indwelling one.

This is something you CAN ask for, and it’s a way to tailor your birth to your own needs.

Most often they’re used with epidurals — want to know more about epidurals, check out these posts:

• 3 Tips to Using Movement During Labor WITH an Epidural
• Epidurals During Pregnancy & Labor
• Weird Side Effects from The Epidural That No One Talks About
• What to Do If You Can’t Decide if You Want an Epidural or Not?
• Is a “Walking Epidural” A Real Thing?

Induction of Labor

Sometimes, catheters are placed in your cervix and blown-up with saline to open your cervix.

Most often they used something called a “cooks balloon” where it is shaped sort of like a snowman where the middle section isn’t as thick. Then, they blow-up the balloon within your cervix to sort of gently push it open with the pressure of the balloon.

Some doctors place these in the office and then send you home. Some do them in the hospital, and may even use other medications in conjunction with it.

These are often used when your cervix isn’t really ready for the induction but it is necessary, like I talk about in my 37 week induction post. I have a whole post on what to expect at a foley bulb induction that you might find helpful. They’re becoming more and more common!

Risks of a Catheter

The main risk is a possibility of infection. Your urinary tract is sterile and should not have an induction of bacteria into it. Obviously, when you go “up” a hole that normally goes “out” it can be hard on it. However, most people don’t have an issue and we do several things to try to minimize any infection.

The other risk is that some people are just REALLY bothered by them. However, many people find they are less annoying than they thought they might be (and in several scenarios you don’t feel it at all if you’re numbed with anesthesia).

Benefits of a Catheter

It depends on why you are having it placed:

Epidural: Since you aren’t able to get yourself out of the bed to use the restroom this prevents your bladder growing large and possibly blocking the baby from coming down into the birth canal.

Caesarean Section: If the bladder isn’t drained before the surgery there is an increased chance of them cutting into the bladder which can cause a whole host of huge issues. Also, as you will be unable to use the restroom for about 12 hours after the surgery, it keeps the bladder from getting in the uterus’s way and cramping back down (preventing bleeding).

Magnesium Sulfate: Magnesium Sulfate is used for preeclampsia or preterm labor sometimes. Because the magnesium is given at such high levels (to help your smooth muscle relax) it is important that we make sure your kidney function isn’t being affected. We monitor urine output very precisely hourly. If, after the initial bolus and some infusion it is shown your kidneys are functioning well with it, it may be appropriate to remove it if you prefer.

Preterm Labor: If a patient is placed on STRICT bedrest, we will use a catheter to prevent them from needing to get up to use the restroom.

Honestly, on my first baby I had NO idea how to weigh these risks and benefits, and I didn’t know you could ask for the catheter of your choice.

The principles taught in here are a game changer for learning to tailor things (EVEN the catheter) to your needs. When you understand WHY we’re doing something, and you understand a few alternatives you understand what works for you (and also when it’s not working for you and you need something else).

If there is ANYTHING you’re worried about at delivery I can’t recommend taking that class any more. It’s going to:

• Teach you common interventions, so they don’t scare you (because outside of the hospital, they would!)
• Get your partner involved so you don’t have explain everything to them
• Show you how to take care of both yourself and your baby as you transition into life postpartum.

It really is a game changer for getting the birth you’re hoping for!

Ok, we’ve talked a lot about what it is, and what it’s for — but how does it it GET IN YOU? I’m glad you asked (because I think going through things in advance makes them a whole lot less scary):

Urinary Catheter Placement Process

The nurse will open the sterile package, and put on the sterile gloves.

The urethra is prepped with the provided solution (varies depending on facility).

The catheter tip is lubricated.

The nurse stabilizes the urethra (done differently in men vs women).

The catheter is placed in the urethra and success is noted when urine flows out.

If the catheter is in-dwelling the nurse will blow-up a balloon to keep the catheter in the bladder.

If the catheter is not going to stay in, they will drain out the urine until it is done and then remove it.

If the catheter is in-dwelling, the nurse will attach it to your leg in some method (tape or a stabilizing product), so that it doesn’t pull on your bladder.

That’s it.

I even have a youtube video on it:

I know that things like this (things that go “in” an “exit only” hole in our minds) can seem really scary. I know a LOT of birth can seem scary. Come join me in The Online Prenatal Class for Couples where we prepare you to be prepared NOT scared — in just a few hours!

And, if you’re not quite sure you’re ready for that whole thing, check out my free prenatal class. It’s your first step toward getting in the driver’s seat of your birth.

The post How is a Foley Catheter Used in Labor? appeared first on The Pregnancy Nurse®.