Tag Archive for: giving birth

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How to Choose the Right Doula

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When it comes to childbirth, having a supportive team can make all the difference in the world. In addition to your OBGYN, a doula can provide extra support during the labor and delivery process. At Madison Women’s Health, we enjoy collaborating with skilled and empathetic doulas.

With so many options, it can be difficult to know what to look for when choosing a doula and knowing what questions to ask them. Based on our experiences and feedback from patients, these are the most important qualities to look for when you’re choosing a doula for your birth.

What is a doula?

First of all, it’s important to understand what a doula does and doesn’t do. A doula is a support person for the laboring couple. They provide emotional and physical support throughout the labor and delivery process.

This includes advocating for the patient’s needs and desires, especially for first-time deliveries. Doulas are not medical professionals and do not provide medical care, but they can work alongside your medical team to provide additional support.

What is the difference between a doula and a midwife?

The primary difference between doulas and midwives is their training. Midwives are typically nurses first and have years of training. Doulas, on the other hand, have limited training. In Wisconsin, there is no formal education requirement to become a doula, although many choose to become certified by an organization. Doula certification typically includes attending seminars, workshops and live births. Neither doulas nor midwives have surgical training, so a physician is required in the event a C-section becomes necessary.

Can a doula come to my prenatal appointments?

At Madison Women’s Health, we encourage our patients to bring their doula with them to appointments. This allows us to work together as a team and ensures everyone is on the same page. We want to partner with doulas to help our patients have the best experience possible.

If you let us know you’d like to bring a doula, we can set aside extra time to answer all of your questions and make sure you feel comfortable.

What does a doula do?

1. Collaborates with medical team

Although doulas do not have medical training, their experience allows them to facilitate important discussions between the patient and the medical team. Their collaboration in the birthing process can make it smoother for the mother and the rest of the care team. A good doula should be able to communicate effectively with the patient, her partner, and the healthcare team. They should listen attentively and be able to offer guidance and support without being pushy or judgmental.

2. Helps patients know what questions to ask

A good doula should help expecting mothers prepare for labor and delivery by providing them with a list of questions to ask their OBGYN ahead of time. This can help ease any anxiety the patient may have and ensure they feel informed and confident going into the experience and during child birth.

3. Helps the patient feel comfortable and at ease

A doula should be committed to being there for the patient during the early stages of labor, meeting the patient at the hospital and providing techniques that help with relaxation and focus.

They may also bring supplies that make the environment more soothing, such as essential oils, low lights and music. By taking care of these details, doulas allow their clients to focus on the experience of labor and delivery.

4. Provides support during early labor

Doulas should be available to support their clients during the early stages of labor. Some might provide guidance over the phone or in-person support while the patient labors at home. This can help patients stay more comfortable and calm before heading to the hospital.

5. Meets the patient at the hospital

If they are not already with the patient at home, a doula will meet the patient at the hospital to greet them and provide continuous support throughout the rest of the labor and delivery process.

6. Suggests relaxation, mindfulness and focus techniques

Giving birth can be a stressful and overwhelming experience, so a good doula should be equipped with various techniques to help their client relax and stay focused during labor.

Many doulas offer massage as a way to help relieve tension and promote relaxation during labor. This can be a valuable tool for managing pain and stress during the process.

Mindfulness techniques, such as meditation and deep breathing, can be incredibly helpful during labor and delivery.

7. Offers flexible solutions

Labor and delivery can be unpredictable, and the best doulas can adapt to changing situations. They should be able to change their approach if needed and provide different types of support depending on the patient’s needs.

8. Provides emotional support

The best doulas are empathetic people who understand the patient’s emotions and offer emotional support throughout labor and delivery. They validate the patient’s feelings and provide a calming and supportive presence during what can be a stressful time.

9. Contributes to continuity of care

Doula may be available to the patient throughout her pregnancy, labor, and the postpartum period. They provide ongoing support and answer any questions or concerns that arise during this time. Many are trained in providing breastfeeding education or support. Before choosing a doula, ask for specifics about these services before and after labor.

10. Acts as a liaison with the doctor

Finally, a good doula should act as a liaison between the patient and their OBGYN so that everyone is working toward the same goal in a safe manner. This includes helping the patient define their preferences for labor and delivery and communicating those preferences to the doctor.

We welcome doulas!

At Madison Women’s Health, we believe that by working together as a team, we can help our patients have the best experience possible. We’re here to answer all your questions and provide the support you need to have a safe and happy childbirth experience!

Dr. Karla Dickmeyer M.D. Founding partner of Madison Women's Health OBGYN ClinicDr. Dickmeyer has been providing healthcare for women in the Madison area since 1998 and is a founding member of Madison Women’s Health. Her specialties include minimally invasive surgical techniques, high and low risk obstetrics, pelvic floor disorders and postmenopausal medicine.

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C-section vs Vaginal Birth: What are the Risks and Benefits?

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Just as every pregnancy is unique, every birth is, too. Some women use pain medications, others do not. Some women labor for a couple of hours, and others for 24 hours or more. Some women deliver vaginally, while others deliver by C-section. For some women, a C-section is their choice. For others, it is medically necessary for their health or the health of their baby. In the U.S., the C-section rate is about 30%. In Wisconsin in 2019, the rate of C-sections was 26%.

One of the topics that will come up in your prenatal appointments with your OBGYN is a C-section versus vaginal delivery (also sometimes called a “natural birth”). Your doctor will ask if you have a preference and if one or the other may be medically necessary.

When we talk about delivery options, some women are skeptical or afraid. It’s OK to feel those emotions and to ask questions. In fact, we’re glad to answer your questions — that’s why we’ve created this article. We hope that our candid answers can help alleviate your fears.

Why Do Women Receive C-Sections?

Women receive a C-section for one of two reasons: 1) it’s their preference 2) it’s medically necessary for either them or the baby.

That’s it.

OBGYNs don’t have a hidden agenda or a quota of C-sections to perform. They don’t get to go home sooner if a baby is born via C-section. In fact, our preference is that every birth could be a vaginal delivery. But sometimes, C-sections are simply the best, safest choice. We always make sure the benefits outweigh the risks before recommending it.

Ultimately, the decision is yours.

A woman may choose to have a C-section because:

  • she is afraid that vaginal delivery will be too painful
  • she doesn’t want to worry about the baby experiencing stress during labor
  • she doesn’t want to have vaginal tears
  • she knows when she will meet her baby
  • she had a C-section before

Other times, women receive a C-section because it becomes medically necessary. Sometimes, it will be an emergency decision. As often as possible, we want to give you time to discuss the situation so you understand why we may recommend it. That way, it is truly a joint decision with you and your OBGYN.

The most common medical reasons a woman receives a C-section are:

  • If labor is not progressing on schedule:
    Called “failure to progress,” this means that either the cervix isn’t dilating or the baby is not descending into the birth canal after a significant amount of time. Usually, this is because of fit—the baby is simply too large for the birth canal.
  • If the baby is breech:
    When a baby is in breech position, his or her bottom or feet are down instead of their head. A breech baby birth presents more risks, such as injury to the baby’s hip and thigh during delivery. The umbilical cord could flatten during a breech birth, which could reduce oxygen to the baby and cause brain or nerve damage.
  • If the baby is showing signs of stress during labor:
    A fetal heart rate monitor will help your OBGYN see how your baby is handling delivery and if intervention is needed.
  • If the placenta is covering her cervix (placenta previa):
    This could cause bleeding during pregnancy and unsafe, severe bleeding during labor.
  • If she previously had surgery on her uterus.
  • If she previously had C-sections.

A woman can receive a C-section at any point in the labor or delivery process, whether she is at 0 cm dilated or 10 cm.

Which is safer, C-section or vaginal birth?

Both forms of delivery can be safe, and both can carry different types of risk.

C-Section Benefits

There is no injury to the pelvic floor with C-section delivery. A C-section can prevent vaginal tears. And a C-section can speed up delivery when the baby is showing signs of stress, if the baby is not progressing down the birth canal or if the baby is in a dangerous position for delivery.

The C-section itself is not painful. If the C-section was planned, the woman would get a spinal injection before the surgery to numb the area. If the woman labored first, she would receive an epidural catheter. During the C-section, she would feel tugs and pressure, but would not feel pain.

C-Section Risks

Even though C-sections are one of the most common surgical procedures in the U.S., the fact that they require surgery means they do carry some risk. The biggest risks include blood loss (twice as much as vaginal delivery) and the risk of infection at the incision site. Each C-section also increases the risk of scar tissue build-up, which can increase the risk of the placenta attaching to a scar in the uterus instead of the uterine wall.

Vaginal Birth Benefits

As the baby progresses down the birth canal, amniotic fluid in their lungs gets squeezed out. This helps the baby breathe more readily on their own after birth. As the baby passes through the vagina, they are also exposed to good bacteria, which can improve their microbiome and boost their immunity.

Vaginal delivery is best for a woman who wants to have several children.

Pain relief during vaginal delivery is possible by using medications or non-medicated methods.

Vaginal Birth Risks

Vaginal birth also carries some risk, such as blood loss and risk of infection. Other risks include the baby being unable to fit in the birth canal, pelvic floor injury, vaginal tearing, and umbilical cord accidents.

A vaginal birth after a C-section (VBAC) is possible, even after two or three C-sections, but it also carries some additional risks with labor. Uterine rupture, which is where the scar from the C-section breaks open, is one of the risks of VBAC. While it is rare, occurring in less than 1% of women, it is dangerous. Your OBGYN will monitor you closely during labor.

Whether you can have a VBAC depends on the reason(s) for your previous C-section, where the incision was made, whether you had other surgery on your uterus, how many C-sections you’ve had, when you last gave birth, and other reasons. Your OBGYN will discuss these factors with you to determine the safety of a VBAC in your situation.

Which form of delivery has the best recovery?

Just like nearly everything about pregnancy, the answer to this question is “it depends.” Some women recover faster from C-section than from a vaginal delivery, and other women recover more quickly from a vaginal delivery than from a C-section.

Here are some points to consider:

C-Section Recovery

Because a C-section is a surgery, more pain medications are usually needed during recovery. Usually, women receive ibuprofen, Tylenol, or even narcotics for the first 3-7 days. (Any pain medications prescribed would still be safe for breastfeeding.)

Activity after a C-section is more limited. A woman who has a C-section shouldn’t lift anything heavier than her baby for about six weeks. She should receive help around the house and caring for any other young children. She shouldn’t drive for about two weeks or while taking narcotics.

Women who labored before receiving a C-section generally have the longest recovery time. Not only do they need to recover from the surgery, but they also need to recover from the labor itself.

C-sections themselves don’t affect weight loss after birth, however a longer time of remaining less active will make weight loss more challenging.

Vaginal Birth Recovery

Because surgery isn’t involved, recovery is generally shorter. Soreness and discomfort usually last for a few weeks but can be treated with over-the-counter pain medication, such as ibuprofen. Your OBGYN typically will recommend that you do not exercise strenuously for six weeks. Taking it easy for six weeks after delivery helps to support your pelvic floor muscles while they heal.

Talk to your OBGYN about C-Sections and Vaginal Births

At Madison Women’s Health, we want you to feel comfortable and well-informed about your decisions.

During your prenatal check-ups, we will talk to you about vaginal birth (which some people call “natural birth”) and C-sections. We will give you our recommendation based on your health history. And we will support the decision that you make.

If it becomes medically necessary to change from your original birth plan, we strive to explain the reasons behind our recommendation so you can continue to feel supported throughout the birth of your child. Our goal is always to have a safe and healthy delivery, resulting in a healthy and thriving mom and baby.

Dr. Ashley Durward, MD of Madison Women's HealthDr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

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Epidurals for Labor: Risks, Benefits and Other FAQs

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It’s no secret that giving birth is painful! But every woman finds a way to manage the pain of childbirth — whether that’s through breathing exercises, position changes, or an epidural.

During your third trimester, your OBGYN will ask you about your preference for pain management during labor. Whatever your decision, you can change your mind even during labor (up until a certain point). Our goal is to support you so that you can have a positive birthing experience, whatever that looks like for you.

About 70% of women in our practice choose to receive an epidural during labor. And all of them have had very similar questions, fears and concerns about the process.

What is an epidural?

An epidural is a common type of anesthetic used in labor for pain relief. Epidurals are the best option available for relieving labor pain. An epidural can be given at any time during the labor process.

While you are sitting up an anesthesiologist will first numb your skin and then insert a needle and a tiny tube (called a catheter) into the lower part of your back. The needle is removed and the catheter is left in place so that medication can be delivered through the tube. The medication typically runs continuously until delivery, with more medication given through the tube as needed.

The process takes about 15 minutes to complete. As long as you’re able to get into the right position and stay still for the time it takes to place the catheter, you can receive the epidural at any point during labor. That means that you can still receive an epidural even if you initially thought you didn’t want one!

Is the epidural needle painful?

Before the epidural is placed, you’ll be given a numbing injection. The first injection will feel like a short bee sting. This lasts only for a moment. Once that area is numb from the injection, the anesthesiologist will place the catheter to deliver the pain relieving medication. It takes about 20 minutes for contraction pain to subside.

An epidural creates a feeling of numbness from your belly to your toes. You may still feel pressure during labor, but the pain will be drastically reduced. If you are still uncomfortable even after having the epidural placed, the anesthesiologist may give you additional medication through the catheter or place the catheter in a slightly different position.

Because you will feel numb, it will be hard to move your legs. You won’t be able to walk around with an epidural in place. You may not feel as great of an urge to push, but you will still be able to push. Your team will help you know when and how to push through your contractions.

You also won’t feel the need to urinate, so we will place a foley catheter in your bladder.

Will an epidural harm my baby?

Medication from an epidural does NOT harm your baby. Because the anesthesia from the epidural doesn’t enter your bloodstream, it will not transfer to your baby through the placenta.

How long does the epidural last?

The epidural is intended to last for the duration of your labor and will be removed after you deliver your baby. It will take a couple of hours for the numbness to completely go away. You will be able to walk around after the epidural wears off.

To manage pain after delivery, you’ll be given ibuprofen. Ice packs can also be applied to help with discomfort after labor.

What are the side effects from an epidural?

Epidurals are very safe. Serious complications are rare. The most common side effect we see is a decrease in blood pressure. To prevent this, you will be given extra IV fluid before having an epidural placed. If needed, the anesthesiologist may also give you medication to bring your blood pressure up.

Who shouldn’t get an epidural?

Occasionally there are circumstances where women can’t get an epidural. Occasionally we see this in women who have a low platelet count. Additionally, women who are taking blood thinners (such as heparin) to prevent a blood clot during pregnancy should not receive an epidural within 12 hours of taking that medication.

Will an epidural slow down delivery or cause me to need a C-section?

Some women are actually able to deliver more quickly after receiving an epidural because they feel more relaxed. They can push through the stronger contractions because they are in less pain. Other women may be in labor a little longer because they do not feel the urge to push to the same extent.

Your labor and delivery team will monitor you and your baby to be sure that you are progressing through labor at a safe rate.

There is no evidence that receiving an epidural makes you more likely to require a C-section. In fact, if you do need a C-section, having an epidural in place can help you be prepared for the C-section more quickly.

Other Ways to Manage Pain During Childbirth

An epidural is not the only way to manage pain during childbirth. You have several options available to you. You are also able to make changes to your birth plan while you are in labor.

Non-medicated pain control options

There are several non-medicated (or non-pharmacologic) pain control options. Read about other methods of pain relief during childbirth.

Intravenous (IV) and Intramuscular pain relief:

Pain relieving medication (opioids) can be given to help take the edge off of labor pain to make it more tolerable. This medication is either given to you through an IV or as an injection.

Opioids given through an IV catheter do enter your bloodstream, therefore they do transfer to your baby. Side effects include grogginess or sleepiness for both you and your baby.

Conclusion

We don’t judge your reasons for or against receiving an epidural.  Some of our patients choose not to receive any pain medications during labor while others request an epidural as soon as possible. (You may be surprised by how many women change their minds during labor!) There isn’t a right or wrong way of giving birth, and you aren’t more or less of a mom or a woman based on your pain management decision.

Whether you want a less painful labor or a medication-free labor, we are here to support you. Our goal is that you and your baby are safe and healthy!

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Pregnancy Hospital Bag Checklist: What to Pack in Your Birth Bag

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Your due date is getting closer. Your baby’s nursery is coming together. You’ve oohed and aahed over all the cute little baby things showing up. (Hello, baby showers and online shopping!) You’re ready to meet your little one and bring baby home!

The final step is to make sure you’re ready for your stay at the hospital where you will birth your baby. Pack a spare backpack or carry-on suitcase with your hospital essentials by Week 36. Keep it in an easy-to-access place at home.

Our guide to what you should pack in your hospital bag will get you ready for the big day. Whether you’re a spontaneous traveler or one who is prepared for every last possibility, there are a few “must haves” to put in your hospital bag for you, your baby, and your support person. This list will be the same whether you have a vaginal birth or a C-section.

Printable Pregnancy Hospital Bag Checklist - What to pack in your hospital birth bag

Printable Hospital Birth Bag Checklist

Clothes for You

The hospital has the essentials — a gown and disposable underwear — but you may want to change into your own clothes. And you’ll definitely want to bring something clean to wear home. Choose clothes that are comfortable and loose fitting. Your breasts will be swollen and your waistline will still be about the same as it was a month or two ago. We don’t recommend packing your prettiest undies — you’ll probably prefer briefs that can accommodate extra large, absorbent pads or even cold packs.

Essential:

  • Nursing bra (2) or nursing tank (2)
  • Underwear (2-3 pairs)
  • Socks (2-3 pairs)
  • Going home clothes (your favorite maternity yoga pants and shirt are just fine but others prefer something special!)

Optional:

  • Birthing gown
  • Pajamas
  • Robe
  • Slippers / Flip-flops
  • Lounge wear

Clothes for Baby

The hospital will provide a tiny t-shirt, hat, and swaddling blanket to dress your baby during your hospital stay. This will be the simplest “outfit” for every day you’re in the hospital. Newborns make lots of unexpected messes, as you’ll soon discover!

However, you’ll need to put your baby in some actual clothes for the drive home, or maybe even for pictures at the hospital. Most babies will fit in size NB clothing however you could also pack a 0-3 month outfit just to be on the safe side if your baby is larger.

Essential:

  • Long-sleeve snap-up or zip-up onesie with feet
  • Receiving blanket for the car seat.

Optional:

  • Size NB or 0-3 month size clothes for the baby’s stay in the hospital.
  • Size NB or 0-3 month size clothes for going home. Consider the baby’s comfort (for example, while wearing their special outfit in the car seat – avoid bows in the back).
  • Receiving blanket.
  • Socks.
  • Baby mittens so the baby doesn’t scratch itself.

Toiletries for You

Much like a hotel, the hospital provides the essential toiletries, like shampoo, soap, conditioner, toothbrush and toothpaste. However, most of our patients tell us they prefer their own brands instead of what the hospital provides.

Essential:

  • Specialty skincare items or prescriptions
  • Contacts / Glasses

Optional:

Pack a toiletry bag with travel- or trial-size supplies you may wish to have on hand.

  • Lip balm
  • Nipple cream (if you plan on breastfeeding)
  • Deodorant
  • Brush and/or comb
  • Soap/shampoo/conditioner
  • Face wash or wipes
  • Lotions
  • Hair dryer and other hair products
  • Makeup and brushes / sponges

Linens / Bedding

The hospital will make sure you have clean sheets, towels and wash cloths. You’ll also have a bed with several pillows and blankets. If you have a hard time sleeping with a different pillow, it might be a good idea to bring your own.

Essential:

  • Nothing extra — the hospital’s got you covered (literally)!

Optional:

  • Larger bath towel (1-2)
  • Your favorite pillow
  • Your favorite blanket
  • Lightweight sleeping bag / pillow for your support person (hospital will also supply linens for fold out bed)

Food & Snacks

During active labor and delivery, you probably won’t feel like eating very much. But your support person might!

At Meriter, you can order off the menu between 6 AM and 7 PM. There’s also a mother’s area with healthy snacks like granola bars, cheese sticks, juice and cereal. The hospital has vending machines with other food items. Some people also order takeout / delivery from nearby restaurants.

Essential:

  • Special dietary needs for you or your support person

Optional:

  • Portable cooler with your favorite snacks
  • Reusable water bottle with electrolyte flavor pouches

Birthing Room Ambiance

One way that many women manage pain is by creating a calming environment. The birth center at Meriter is well-stocked with things like birthing balls, tubs, and even holiday lights so your room can be dimly lit. You may want to pack a few extra things from home, though, to help you stay as comfortable as possible.

Essential:

  • Any item you have a specific attachment to that will keep you calm. For example, a good-luck trinket given by someone close to you. Or the photo of a loved one who you wish could be with you.

Optional:

  • Essential oil & diffuser  (candles are not allowed)
  • Flameless LED candles
  • More strings of lights

Entertainment / Technology

While you’re waiting to go into active labor, waiting for baby to finish nursing, or simply in need of something to keep your mind busy — you’ll probably want some form of entertainment.

Meriter Hospital has TVs and DVD players in their birthing rooms, and every room has WiFi access. Now that so many people have streaming services like Netflix and Hulu, most download their favorite shows ahead of time or stream on demand.

Essential:

  • Phone charger with an extra long cord
  • Power cords for laptop, tablet, or any other tech you bring.

Optional:

  • Tablet or laptop
  • Camera
  • Passwords for your streaming services
  • DVDs
  • Portable bluetooth speakers
  • Book
  • Music playlist – downloaded, several hours long

Baby Care

Meriter Hospital has everything your baby will need in their first few days. Things like diapers, wipes, and even formula in bottles. In fact, they will send a lot of things home with you. You don’t need to bring diapers, wipes, or bottles. Even if you choose to cloth diaper, you will prefer the ease of the hospital’s disposable diapers those first few days.

Essential:

  • Car seat with newborn insert.
  • Assemble the car seat, install the base, practice putting it in and getting it out of your vehicle.

Paper Work

Essential:

  • Insurance information
  • ID
  • Pediatrician’s contact information, including phone, email and fax

Optional:

  • Birth plan if you have one (3 copies – one for your support person, one for your doula, one for your OBGYN)

Leave these things at home:

  • Breast pump & accessories: you’ll have access to one at the hospital if you need it
  • Nursing pillow: most moms who bring this don’t use it
  • Diapers/wipes: the hospital will give you plenty!
  • Sheets
  • Candles: Candles aren’t allowed in the birthing center. Instead, bring flameless LED candles or an essential oil diffuser.

What if I Forgot Something!

No worries! The hospital really does have everything you need for labor and immediately following labor. You can also send someone back to your home to get your hospital bag if you prefer to use your own things.

While you won’t be able to control or plan for every aspect of your labor and delivery, you can make it more enjoyable by bringing some of the comforts of home.

Printable Pregnancy Hospital Bag Checklist - What to pack in your hospital birth bag

Download this printable checklist when you’re ready to get your hospital bag packed!

 

Dr. Sarah Yanke, M.D. of Madison Women's HealthDr. Sarah Yanke has been providing healthcare to women in Madison since 2010, specializing in high and low-risk obstetrics, contraception, management of abnormal uterine bleeding, and minimally invasive surgical techniques. She is a Board Certified Fellow of the American College of Obstetrics and Gynecology.

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Giving Birth: Labor & Delivery Tips for First-Time Moms

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Giving birth can be both exciting and terrifying for first-time moms. Just as the rest of your pregnancy has differed from others’, your birth experience will be unique to you and your baby. As you think about the big day when you’ll finally meet your little one, you probably have questions about what to expect!

Here are some of the most common questions I’ve been asked about giving birth for the first time.

Getting Ready for Baby

How important are birthing classes?

Prenatal classes or birthing classes can help you understand what to expect during your labor and delivery. You’ll learn about creating a birth plan, common things that happen in a hospital, and how to manage pain. At Madison Women’s Health, we refer our patients to Unity Point Meriter for prenatal classes. You can begin taking prenatal classes at the start of your second trimester. We recommend completing them before your 37th week of pregnancy.

Prenatal classes can be online or in person. Check with the hospital to see what they currently offer. Prenatal classes typically include a birth center tour. There are classes for singletons and multiples. They are helpful in understanding various things that can happen in labor and delivery that are not common things you see on TV (like ways to monitor your baby’s heart rate and the use of forceps or a vacuum if needed to safely deliver your baby).

Tip: Prenatal classes will help you think of questions you may want to ask your OB during your prenatal check-ups. Keep a list! Classes are a good supplement to your 10-15 minute prenatal visits.

Who can be with me at the birth?

Before the COVID-19 pandemic, there were no restrictions on how many people could be with you during the birth. During any Public Health Emergency, guidelines may change. It’s always a good idea to verify how many people can be there with you.

At the time this article was written, Meriter allowed one support person (in addition to a doula) to be with you. This person can be anyone — your partner, a friend, or a relative. Choose someone who will be supportive and encouraging. Currently, your support person must be the same person throughout the birthing experience. In other words, your support person cannot be your spouse for a few hours, then your mother, and then your sister.

Tip: A doula is considered part of the medical team and is therefore allowed to be involved in your care during the pandemic.

What is the difference between a midwife and a doula?

Midwives have been trained in obstetric procedures. They can interpret fetal monitoring, make recommendations on labor management, and recommend a C-section if it is needed.

Doulas have been trained in the emotional, psychological, and physical support of moms throughout pregnancy, delivery. and postpartum. They have not been medically trained, but their attention and focus on the mom has been shown to improve birth outcomes. Women who use a doula are more likely to have a delivery without pain medications and their labors tend to be shorter.

Tip: A doula does not make medical recommendations or replace your midwife or doctor, but rather they offer extra services and individualized prenatal and labor support.

Read more about choosing the right doula.

What will the labor and delivery room or birthing room look like?

Our patients deliver their babies at Meriter Hospital, which has large birthing rooms. You’ll appreciate having more space to walk around in early labor or sit on a birthing ball. You’ll be able to control the temperature and dim the lighting. Your room will have a couch, perfect for your support person to nap on if needed.

Tip: Meriter’s birth rooms also include a comfortable tub. While we don’t offer water births (in accordance with ACOG recommendations), water immersion during labor can help with relaxation and easing labor pain.

What should I pack in my hospital bag?

If you have to drop what you’re doing and immediately go to the hospital, they will have all the essentials. I usually tell patients, however, that it’s a good idea to have a bag ready to go around 36 weeks. There are things you will want to help make your stay more comfortable.

Here are some ideas for your hospital bag:

    • Toiletries: Shampoo, conditioner, soap, toothbrush and toothpaste, hair brush, deodorant. While we have these things at the hospital, you’ll probably prefer your own.
    • Comfy clothes for you.
      • Slippers, socks, or flip-flops.
      • Robe and/or nightgown. If you plan to breastfeed, choose a nightgown that opens in the front (although the hospital ones are great for this!)
      • Clothes to wear home. Comfortable maternity clothes are usually your best bet. Include a nursing bra if you plan on breastfeeding.
    • Going home outfit for your baby. Your baby will be swaddled and diapered during the hospital stay, but most parents want a photo-worthy outfit for the big trip home.l
    • Snacks for your partner / your support person. The hospital has a cafeteria (open during the day) and vending machines, but your partner may want to consider anything special they want. Sometimes light snacks are okay in early labor, but we recommend against eating in active labor for safety reasons (and you usually won’t feel like it!).
  • Phone charger. Family and friends will want frequent updates and you will fill up your camera roll quickly.

 

It’s Time!

At what point do I need to go to the hospital? How long should I labor at home?

Most women can spend time in early labor at home. We recommend calling if you have painful contractions every 5 minutes for 1-2 hours to keep us in the loop. Call sooner if your doctor has given you more specific instructions due to medical conditions.  If you have had a more complicated pregnancy or if you live far from the hospital, you may be asked to come in sooner. If you think your water has broken, we recommend calling to discuss the best time to come in, which is usually early for safety reasons.

Tip: Everyone has a different pain threshold. A good measure of “painful contractions” means you need to stop and breathe through them without focusing on anything else.

How long is labor for first-time moms?

There are three stages of labor and how long each lasts is very unpredictable for first-time moms. The whole event can last hours or days. Your first labor will be the most unpredictable, while second labors are generally faster.

What are the stages of labor?

Stage 1a: Latent Labor

Contractions during early labor will feel mild, like deep menstrual cramps, and will be irregular. Early labor helps soften, shorten, and thin your cervix. It can start a few days or a few hours before birth.

Stage 1b: Active Labor

During active labor, your contractions become more frequent, regular, and painful. You are considered to be in active labor when your cervix has dilated to 6 cm. The rate of cervical change is more consistent and predictable from this point to “complete” dilation (10 cm). Your doctor will check your cervix to let you know when it’s ok to begin pushing. If you push too soon, before your cervix has fully dilated, you are at risk of tearing your cervix and having significant bleeding.

Stage 2: Pushing Stage / Birth

The second stage is the pushing stage. This stage can last a few minutes or many hours (up to 4 or more if the baby is making progress through the birth canal).

You may think, “how will I know when to push?” If you don’t have an epidural during labor, the urge to push is often very strong. If you have an epidural, you may not notice the urge to push in the same way. We will help you know how and when to push with your contractions.

Stage 3: Placenta Delivery

The placenta generally delivers within 30 minutes of giving birth. We sometimes massage your uterus to help with this (although we say massage, this can be uncomfortable). We strongly recommend every woman receive oxytocin as well. These steps are important to decrease the risk of excess bleeding following delivery.

Giving birth: Labor tips for first-time moms

What should my partner do during labor?

Talk about this with your support person ahead of time so expectations are clear. Some women prefer their partner help with coping with labor pain. Others prefer a more hands off approach. Talk together ahead of time to determine what you are comfortable with.

Tip: Your support person can be supportive in many ways. This can be giving you sips of water and ice chips, holding your hand, being responsible for music, rubbing your back, etc. Do what works best for both of you.

Can I eat and drink while I’m in labor?

If you are undergoing an induction or are at the hospital in early labor, sometimes light snacks are reasonable. A lot of women get nauseous and throw up in labor and are at risk for aspiration, a serious complication. We therefore recommend against eating in active labor.  If there’s a possibility of needing a C-section, it is safest to have not had food recently. Most women are not hungry anyway! Water, clear juice, and ice chips are satisfying.

Tip: If you have an I/V, you will be properly hydrated. If your lips get dry from your breathing exercises, ask for some chapstick.

Pain Management

What does giving birth feel like?

Labor pain feels different for everyone, but some general principles include:

  • Braxton Hicks contractions — These are common, even as early as the second trimester. You’ll feel your uterus gradually tighten and get soft. This is not painful.
  • Early labor — Contractions can feel like strong menstrual cramps lasting 30 to 60 seconds (like a charley Horse in your uterus). Some women feel these contractions in their back.
  • Active labor — These are cramps that can’t be described by words.  You may feel intense pelvic pressure as you “transition” to 10 cm and your baby descends into the birth canal.
  • Pushing stage — Along with the muscle pain of contractions, you will feel stretching and pressure in your vagina.

What are my options to treat labor pain?

Non-Pharmacologic Pain Control:

  • Changing positions: You may feel better standing up, resting on your hands and knees, or sitting on a birthing ball. Your body will tell you what is working!
  • Taking a warm shower or bath: The warm water can relax tense muscles. Water immersion has been shown to lower pain scores.
  • Massage: Your support person, nurse, or doula can massage your back and provide counter pressure during contractions
  • Breathing techniques: You’ll learn breathing techniques during your prenatal classes. Staying relaxed and calm helps with pain control.

Pharmacologic Pain Control:

  • I/V Narcotic: Some women have good pain relief with an IV or subcutaneous injection of a narcotic medication. We don’t recommend this option if we suspect you will deliver within an hour. This is to let the medication clear from you and your baby’s system before delivery. .
  • Epidural: You can request an epidural at any time you are in pain in labor. Some women request an epidural almost immediately, while others choose to have it done later. Medication from an epidural does not transfer to the baby. Learn more FAQs about epidurals for labor pain.

Tip:  Each woman has different anatomy and experiences pain differently, so please be careful not to put pressure on yourself to make decisions about your labor based on others experiences. Women who give birth with an epidural have no less of a “natural birth” than someone who did not use pain medication. Each birth is equally as beautiful!

Special Circumstances & Preparing for Unexpected

What about giving birth to twins? How is labor different?

If you’re pregnant with twins, we recommend that you deliver in an operating room instead of the birth room, even if delivered vaginally. While it may not feel as cozy as a birth room, an operating room allows for more room to meet these babies safely. Your OBGYN will counsel prenatally on the safest way to meet your twins, as having two babies at one time comes with more risk than one.

In the United States, the primary Cesarean section (C-section) rate is just over 30%. At Madison Women’s Health, the C-section rate for first-time moms is well under 20%.

What is the likelihood I will need a C-Section?

In the United States, the primary Cesarean section (C-section) rate is just over 30%. At Madison Women’s Health, the C-section rate for first-time moms is well under 20%.

In the United States, the most common reason a woman delivers by C-section is that labor does not progress. In most cases, this is due to cephalopelvic disproportion (when a baby does not fit). The second most common reason is because we see signs a baby is in distress in labor. The recommendation for C-section is made when the benefit of meeting a baby by surgery outweighs the risks.

Tip: Our primary goal in caring for you is a healthy mom and a healthy baby and we will explain our recommendations for that each step of the way. We also want you to have a vaginal birth! We only recommend C-sections if we think the benefit is greater than the risk.

What is an episiotomy? Will I need one?

An episiotomy is a rarely performed medical procedure that involves cutting the perineum to help the baby deliver. Historically, an episiotomy was thought to decrease severity of tearing with delivery.  We know through research that letting tearing happen naturally is more beneficial to the mom.

Tip: Episiotomies are only performed in emergency situations, with your consent, when it will help the baby deliver more quickly (a rare occurrence).

Will I tear? How is it treated?

Approximately 90% of women have a vaginal/perineal tear with delivery. Tears are graded as 1st through 4th degree, with 1st as the least amount of tearing. We recommend suturing tears to help them heal appropriately. We do this with stitches that dissolve.

Tip: A new technique, called perineal massage, has been proven to decrease the amount of tearing with delivery.

What about the embarrassing things….like pooping and pubic hair?

Most worry or feel embarrassed about these things, but we don’t even notice!

If you like to wax, I don’t recommend this past the 37th week. We don’t recommend shaving before delivery because it increases your risk of infection. Trust us, we are not paying attention to grooming!

Most women will have a bowel movement in labor or with pushing. This is good! it means you are pushing correctly.

Tip: Trust us. We really don’t care or remember!

Recovery

How long does it take to recover from giving birth?

Every woman is different in how she recovers, too. Postpartum is an awesome time, but also stressful! It is often referred to as the 4th trimester. Your sleep schedule changes, your body changes, and your interpersonal relationships change. If you choose to breastfeed, read up on our breastfeeding tips for new moms.

Vaginal Birth:

Many moms are surprised to know there is still a recovery period. You may have cramping, tailbone pain, and pain as a tear heals. Sometimes sitting and walking are tricky! There are no true lifting restrictions after a vaginal delivery, but I recommend avoiding heavy lifting for about two weeks, especially from the ground. This puts a lot of stress on your pelvic floor as it heals. Helpful tips for going home include sitting on soft surfaces, using a spray bottle after you void, using ice pads, taking ibuprofen and Tylenol, and keeping an area of all the things you will need most to care for you and baby in your home.

C-section:

The recovery from a C-section is longer because it is a major surgery.  Wait six weeks before lifting anything greater than 10-15 lbs. We will teach you how to care for your incision in the hospital and will send you home with pain medication.

Final Recommendations

What are your recommendations about giving birth at home?

Home births double your risk of complications, with two times the risk of perinatal mortality and three times the risk of neonatal seizures. We, along with the American Academy of Pediatrics and ACOG, believe the hospital is the safest place to give birth. If you decide to give birth at home, you should have a low-risk pregnancy, the help of a certified midwife, and be reasonably close to a hospital.

Tip:  Our first priorities are the health and safety of you and your baby. We will give you information and recommendations about safety and labor so you can make informed decisions throughout the process.

Bring a list of questions to your next OB visit!

Dr. Ashley Durward, MD of Madison Women's HealthDr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.

 

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5801 Research Park Blvd, Suite 400, Madison WI 53719

608-729-6300

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