How to Prepare for Vaginal Delivery
Although you can never predict exactly what will happen during childbirth, the majority of birthing parents in the United States are giving birth vaginally: 68% in 2020, according to the Centers for Disease Control and Prevention. (This statistic looks at all births, including people who delivered by repeat cesarean section. The rate of vaginal delivery for first-time birthing parents is even higher.)
Planning ahead and understanding labor and vaginal delivery can make the experience feel a little less daunting. Here’s what you can do in advance to prepare for labor, as well as some information on how vaginal birth typically progresses.
Take Classes During Pregnancy
“Every birth is unique, and we can’t control the labor process,” says Talitha Phillips, a labor and postpartum doula and CEO of Claris Health in Los Angeles. “That said, the more educated you are, the better prepared you are to make decisions along the way. You’ll feel like you’re a part of the process and not that it’s being done to you.”
One of the best ways to get a road map for childbirth is to take a birthing class. These classes are offered online as well as at most hospitals and birth centers.
In a typical birth class, you’ll learn about the signs of labor and discover methods to cope with discomfort, like focused breathing, visualization, positioning, and relaxation techniques.
There are also classes that specifically address breastfeeding and/or chestfeeding. If you plan to nurse your baby, it’s a good idea to take one of these courses six to eight weeks before your due date, says Erin Carroll Manning, a newborn care specialist, parent educator, and founder of Gentle Giraffes, in Boston, which offers newborn care and family services.
Know Your Pain Relief Preferences
During one of your prenatal appointments, talk to your doctor or midwife about pain management.
"I love to have these conversations as early as possible," says Phillips, who notes that it can be challenging or overwhelming to make decisions about pain relief during labor. "This is why it's important to do your own research and to decide in advance which types of medication you're comfortable getting."
Each pain relief medication has pros and cons. The most common intervention in the United States is an epidural block, also known simply as an epidural. This medication, which is administered by an anesthesiologist into the space around your spinal cord, effectively relieves pain below the waist and can be used at just about any point in labor.
With an epidural, your mobility is somewhat limited, so it may be hard to get out of bed and walk around. It’s also possible you may have to push slightly longer than you would without an epidural—but epidurals do not slow down labor (there’s a common misconception that they do).
The hospital may likely also offer opioids like morphine, meperidine (Demerol), and fentanyl, which are given through an IV or an injection. These quick-acting drugs offer some relief for an hour or two, says Sheryl A. Ross, M.D., a board-certified ob-gyn at Providence Saint John’s Health Center in Santa Monica, California. In other words, they take the edge off the pain.
It’s important to note, though, that these drugs do enter the bloodstream. Side effects include making the birthing parent feel nauseated and drowsy and making the baby sleepy after delivery. For this reason, it’s not recommended to receive these medications late in labor when you’re close to pushing.
Less common is self-administered nitrous oxide, which is inhaled pain relief. It’s sometimes offered at birthing centers or hospitals. It’s less invasive, but Ross warns that it may cause nausea, vomiting, and dizziness.
You may opt for no pain relief at all. Studies suggest that for parents who want to avoid medications, having a labor support person such as a doula increases the chance that they’ll attain this goal. A doula or support person is able to help adjust the focus to other aspects of the labor process and provide relief with massage, relaxation techniques, hypnosis, or other visualization techniques.
It’s okay to want to wait and see how you feel in labor. But it’s good to know your options ahead of time.
Write a Birth Plan
As you’re thinking about vaginal delivery, it’s especially helpful to prepare a birth plan. This set of instructions and preferences is shared with your doctor and nurses and can include information such as who you want with you during labor, whether you’d like drugs to help with the pain, and which cultural or religious practices (like circumcision) you expect once the baby is born.
You may consider asking your doctor to sign the plan to indicate that they’ve agreed to it, suggests Phillips. “That way, you can let the hospital know upon arrival that your doctor is on board,” she says.
Pack a Bag
In the third trimester, get your hospital bag ready to go. Remember to pack toiletries, snacks, socks, slippers, a nightgown (unless you’d rather just stay in the hospital gown), and a robe. Also pack for your baby: a going-home outfit, socks, and hats and mittens if they’re seasonally appropriate. If you have a partner or other loved one who’s planning to stay with you at the hospital, they can pack an overnight bag, too.
Know the Stages of Labor
Keep surprises at a minimum by gaining an understanding of the order of how things generally go during labor and vaginal delivery.
The first stage of labor is the longest. This basically includes everything we typically think of as labor, Phillips says, except for the pushing part.
This stage has a latent and an active phase, says Sara Twogood, M.D., a board certified ob-gyn in Los Angeles and co-founder of the healthcare company Female Health Education.
Latent labor can last as long as 24 hours. During this time, you’ll have regular contractions that feel mild and slowly become more and more regular.
You’ll likely spend most of your latent phase in the comfort of your own home. “If I could just give one piece of advice, it’s stay home as long as possible to allow your body to stay relaxed, to progress, to eat, and to avoid interventions,” Phillips says. “Staying home allows a lot of mobility and opportunity for labor to progress naturally.”
It’s important to talk to your doctor or midwife about your plans for latent labor so they can advise you if there are any indications for you to come in sooner (such as testing positive for group B strep). And just be ready to leave for the hospital at a moment’s notice.
You can walk around, shower or bathe, empty your bladder, and frequently change positions. If you’re hungry, have a snack or a light meal. Some people like to bounce on a ball or rock back and forth, Ross says, adding, “Being in motion is helpful and comforting.”
In active labor, contractions will happen regularly and be painful, strong, and long. “I like when patients are in touch with me when they’re contracting every five minutes for two hours,” Ross says. This is when you’ll want to head to the hospital—depending on how far away you are and your doctor’s orders.
The active phase is shorter than the latent phase, but length ranges widely, Twogood says. For someone on their second (or third, or fourth) childbirth, it can be from around 30 minutes to up to eight hours. For first-time labor, it can be even longer.
During active labor, your water may break if it hasn’t already, and your legs may start to cramp. It can be difficult to stay calm now, but do what you can to relax. Continue to move around or change positions as needed.
Once your cervix is completely dilated at 10 centimeters—and your doctor gives you the go ahead—you’ll be ready to push out the baby, Ross says. And the doctor or midwife will help guide the baby out of the birth canal.
Ross says that if this is your first vaginal delivery, you may be pushing for up to three hours. If this is your second or third child, the baby may come within 30 minutes. Once the baby has fully arrived, the umbilical cord will be cut. And you’ll finally get to meet your little one.
The third stage of labor is when you’ll deliver the placenta, which grows in your uterus and gives the baby food and oxygen through the umbilical cord. This process can take from one minute to a half an hour. “You don’t want to force it,” Ross says. “You want to give the body and uterus time to release it on its own. It’s a natural process.”
During the third stage, you may still be experiencing contractions, and they may still be quite painful. What’s happening, Twogood says, is that the uterus, which has changed dramatically, is contracting to a smaller size.
At this point, Phillips says, the doctor will check to see whether all that pushing has caused tears that need to be repaired and addressed.
Understand What Happens When Things Don’t Go As Planned
In any pregnancy and delivery, complications may arise. Know that your doctor or midwife is ready for anything and will intervene. Plus, it’s important to have at least one supportive person—a birth partner and/or a doula—to help you make decisions and to potentially help you advocate for yourself.
Some of the more common complications include perineal tears (vagina and nearby tissues tearing during delivery), labor not progressing (contractions weakening, cervix not dilating), water breaking before 34 weeks, an abnormal heart rate for the baby, umbilical cord issues (e.g., getting caught on the baby’s arm, leg, or neck), or excessive bleeding (due to uterus tears).
If the labor is not progressing despite many interventions, a common Plan B is a cesarean section. In other situations where the baby or birthing parent’s health is in jeopardy, labor may be induced, which means that contractions are stimulated with medication to start or progress the labor.
Be open-minded with the delivery process as much as possible. “Don’t plan too much. Go with this process. Expect the unexpected, always,” Ross says.
Prep a Recovery Kit
Even though you’ll have a baby to care for, it’s still important to care for yourself after you give birth, too. After a vaginal delivery, you’ll experience bleeding like a very heavy period, and you’ll likely be very sore. You may have hemorrhoids and/or a tear that needs to heal, and it’s likely you’ll be constipated.
Prepare a postpartum recovery kit for yourself so you’ll have the things you need within reach. This can include:
- Maternity sanitary pads
- A sitz bath
- Over-the-counter pain relievers
- Numbing spray or cream
- Laxatives or stool softener
- A peri bottle (a squeeze bottle for spraying your labia after urinating)
- Witch hazel pads
- Ice packs
- Over-the-counter hemorrhoid cream
Recovery time can vary based on how your labor and delivery went, the number of stitches, and how your body heals. Typically, recovery time is a minimum of six weeks, which is around the time you’ll likely see your provider for a postpartum checkup. But continue to be patient with yourself and treat yourself with TLC after that, too.
“It took you nine months to get there,” Ross says. “Give yourself nine months to go through recovery, too.”
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