Realistic Expectations (Founder Friday)

April 8, 2016

 

Regardless of what the experience is, we all go into endeavors with some level of expectation regarding how it will go. Expectations are great as long as they are also realistic and flexible in nature.

 

Let’s talk about the common expectations that many pregnant women have toward the end of pregnancy.

 

     1- “Full term” is 37 weeks, so my baby can come any day now! Prompt all the

         walking, sex, and every other non-medical or medical induction method they have

         heard of.

     2- Labor will begin with a massive water breaking episode in public. It will be

         embarrassing.

     3- Labor will be fast and super intense. What if I don’t make it to the hospital?

     4- You and the baby will look perfect and photo ready after birth.

 

How do we come up with these expectation? I have a theory; in America, we aren’t often at our mothers, aunts or friends births. Unless we are a veteran mom, or we work in the birth field, the only births we have seen have been made-for-television birth. Whether it is A Baby Story, The Back-up Plan, Knocked Up, Friends, or What to Expect When You’re Expecting, the movie producers need drama in order to increase ratings. A realistic birth wouldn’t be edge-of-your-seat-exciting, so what we are repeatedly exposed to is Hollywood’s version of birth. Even though we aren’t actively trying to learn how to birth while watching these funny movies, the messages are subtle and they sink over time. Births. These fictional births become our expectation.

 

37 Weeks is NOT Full Term.

 

There, I said it. Please don’t punch me.

 

Here’s the deal – for a long time we have told moms that 37 weeks is full term, and that their baby is ready to be born at any time between 37 and 42 weeks. While some babies do come at 37 weeks, and most are healthy at that point, it is NOT full term. Two things stand out from this new ACOG recommendation regarding terminology: a baby isn’t full term until 39 weeks, and a baby isn’t post term until AFTER 42 weeks.

 

Although babies born at 37 weeks are usually just fine, the vast majority of babies still have some growing to do with regards to their brain and lungs, and it is best done in utero. Current research reported by the ACOG shows that, “every week of gestation matters for the health of newborns” (American College of Obstetricians and Gynecologists, 2013). So please, be patient with yourself and trust that the baby will come when the baby is ready.

 

So now that we know that it isn’t recommended to induce labor early, what most moms really want to know is, when their baby is most likely to arrive.

 

Without intervention, most first time moms go eight full days past their estimated due date. (Oster, 2013)

 

Yup – you read that right.

 

Most first time moms will deliver on their own when they are technically considered late term.

 

Although there will always be the outliers in any bell curve, the vast majority of babies will come between one week prior to your estimated due date (EDD), and around one week after your estimated due date. This makes logical sense since your EDD is an estimation to begin with.

 

You Water Is Not Likely To Break Before Labor

 

Now, this one is funny to me, because my water did break early with three of my four babies, and it did break in public once, but that is not a very realistic expectation. Premature spontaneous rupture of membranes (PSROM) only happens in 10% (Reed, 2015) - 20% (Simkin, p. 48) of expectant women. If you’re walking around at full term (remember, that isn’t 37 weeks), you have an 80-90% chance of your water NOT breaking before labor starts. It is likely to break during transition – which is around 8 centimeters, and you will likely already be in your birth location.

 

But I digress, if you are in the 10% that do experience a PSROM, it isn’t like a 2 liter of soda opens up in your pants – although it may feel that way to you. In reality it is usually around 1 cup of fluid, and you can likely tie a sweatshirt around your waist, and exit Haggen unnoticed. Many moms don’t experience a full break either. You may notice a small leak, and think that you are consistently peeing your pants. Just for practical knowledge – pee smells like pee, and amniotic fluid smells sweet. Should you experience a small leak, that information can save you a lot of guess work.

 

If your water does break before labor, remember to document the time, odor, amount, and color. It is recommended to give your provider a heads up so that they can advise you.

 

Labor is a Marathon – Not a 5k

 

Birth is not a one size fits all. This article is looking at general trends so that you have a realistic expectation regarding labor and birth, but there are always the outliers. As long as mom and baby are doing fine, it really doesn’t matter if it is a three hour labor or a three day labor. That said, labor is quite often much longer that the media would have you believe. Since it is a marathon of sorts – current research suggests that you eat and drink as needed.

 

Labor is broken down into three stages –

Stage one is labor (early, active, and transition)

Stage two is pushing (rest, descent, and crowning)

Stage three is the afterbirth.

 

For a good number of moms, early labor is more like a warm up. It is best coped with by ignoring it, and is often only truly recognized in hindsight. The Birth Partner states it well, “often the mother sneaks into labor with unclear, on-again-off-again signs, like an orchestra tuning up before a performance” (pg. 42). While this is frustrating for expectant moms, labor often progresses this way for a reason. It is helping get the early work out of the way, so that dilation can go smooth and contractions can be efficient once active labor begins. Because there is so much early work to do, it takes about 2/3-3/4 of the total labor time (Simkin, p. 69). This can be a matter of hours or days, so don’t get discouraged if the going seems slow. Those first centimeters often take the longest.

 

Active labor is considered to be from around 5-6 cm to 8 centimeters. The time line differs for every mother, but a general guideline is 3-7 hours for a first time mom, and 3-ish hours for a veteran mom. Active labor is very position dependent, and pain meds play a big factor. Since the use of pain meds often limits mobility, it can be tricky to use gravity to your advantage in active labor. The final stage of labor is transition (8-10 cm), and can take anywhere from fifteen minutes to a few hours. Although most moms consider this to be the most intense part of labor, it is often the shortest phase.

 

Stage two is from 10 centimeters until you have birthed your baby. On average, stage two can take from a few minutes to over three hours (Simkin pg. 90). There should not be time limits provided that mom and baby are doing well. Keep in mind that a longer pushing phase doesn’t mean that something isn’t right, or that mom isn’t pushing effectively. “A longer birthing stage may be due to the position of the baby’s head in the pelvis; some babies need time for the gradual molding of their heads, or the tucking of their chins and wiggling or rotating into the best fitting position” (Simkin pg. 90).

 

Stage three is the afterbirth, and that is often expelled quite quickly with skin to skin and immediate breastfeeding. While it can seem quite scary after just pushing a baby out, it has no bones and come out very easily in most cases. Once expelled, you will notice that the afterbirth cramping continues, and even increases when you nurse. This is because your uterus is clamping down to its pre pregnancy size. If you have large or worrisome clots, alert your medical provider.

 

I don’t provide this information so that you can watch the clock and predict how long labor will take. I offer is as a very general guideline, so that you go into labor with the real expectation of a long process. It is highly unlikely that you will miss the signs of labor and not make it to your birth place, so don’t worry too much about that common Hollywood mishap.

 

You Will Both Be Less Than Clean Post Birth.

 

Let’s be real here, you just birthed a baby. That is hard work, and as such, you may not think that you look your absolute best. Your baby has also worked quite hard, and he or she may not look like the babies you have seen in the movies. One of the reasons for this is that, the movies and television don’t use real newborn babies. Real babies have cone heads, bruising, vernix, blood, they can be purple or blue at birth, and they don’t always cry right away. These things are all normal, although they can be alarming if you aren’t prepared for them. As such, you will also likely be sweaty (pushing is a workout), you may have the shakes (adrenaline), you will likely have blood and vernix on your as well, and you just completed the marathon of your life. Give yourself grace. You worked hard, and trust me, that first shower may well be the best shower of your entire life.

 

So, go into labor knowing the actual hard truths. Be patient with your baby and your body. You both have a lot of work to do to bring him or her earth-side, and when you are left alone to do that work, you usually work together quite perfectly. Don’t rush the process. Instead, embrace the adventure that is childbirth; it’s a pretty epic ride.

 

 

 

 

 

Works Cited American College of Obstetricians and Gynecologists. (2013, October 22). Ob-Gyns Redefine Meaning of "Term Pregnancy". Retrieved March 2016, from ACOG: http://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Ob-Gyns-Redefine-Meaning-of-Term-Pregnancy Reed, D. R. (2015, November). Pre-labour Rupture of Membranes: impatience and risk. Midwife Thinking. Retrieved March 2016, from http://midwifethinking.com/2010/09/10/pre-labour-rupture-of-membranes-impatience-and-risk/ Simkin, P. (2008). The Birth Partner: A complete guide to childbirth for dads, doulas, and all other labor companions (Third edition ed.). Boston, Massachusetts: The Harvard Common Press.

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