Category: Healthy Pregnancy

By the time Emily Theys got to 41 weeks pregnant with her first child, the baby was showing no signs of coming out. Theys was only a couple of centimeters dilated and not fully effaced, and her doctor predicted that her baby was on the bigger side (while Theys has a smaller frame). An induction was ordered. On the morning of the induction, the doctor started the Pitocin drip at 7 a.m.
You may have heard of Pitocin inductions—and horror stories and tales of success alike—but before you agree to a Pitocin induction, it’s important to know what Pitocin is and how it can affect your labor and birth.

What is Pitocin and how does it work?

Pitocin is the synthetic form of oxytocin, the naturally occurring hormone thought to control—at least in part—uterine contractions (in addition to being the “love hormone”!).
Pitocin works by causing the uterine muscles to contract periodically, causing the contractions required for vaginal delivery.
Pitocin is administered through an IV and is increased gradually until the patient is in labor, explains Sara Twogood, MD, an OB-GYN and assistant professor at the Keck School of Medicine of the University of Southern California. The dose is usually increased every 30 to 60 minutes.
The dosage often varies from woman to woman: “Some women will need a very little dose and some will need the maximum dose,” explains Twogood. “We can’t predict that ahead of time. I usually tell women that with their first baby, we anticipate delivery about 24 to 36 hours after the induction starts. For women with their second, third, fourth babies, the induction process is usually a lot faster.”
The fetal heart rate, uterine contractions, and patient are monitored to ensure the baby is tolerating the contractions and the dose is adjusted as needed. (That said: Pitocin won’t work unless your cervix is favorable—meaning you have a relatively high Bishop Score and your cervix is soft and effaced.)

Pitocin and C-Sections: Are they related?

When Theys’ Pitocin induction started, she was immediately hooked up to a monitor. By the middle of the afternoon her water broke. Although she was having contractions—she could see them on the monitor—she couldn’t feel anything, despite not having an epidural.
She’d expected to endure the Pitocin with no additional drugs (“I have a high pain threshold!”), but soon it became unbearable. She kept at it by watching the monitor so she could see when a contraction was coming. “It helped because I could see when it was going to end. But soon they became really unbearable, like sharp lightning pains to my gut and through me. I was doubled over, clenching onto something.”
Over the next few hours, with the Pitocin turned down, Theys never dilated to more than 9 centimeters and, 24 hours after her water broke, she was rushed into an emergency c-section.
[pullquote align=”center”]“I think Pitocin sometimes gets a bad reputation, but looking at it from this perspective can be helpful.”
—Sara Twogood, MD[/pullquote]
Theys is far from the only one who’s been induced with Pitocin only to end up in the operating room. A 2004 study showed that of over 1,600 women who had Pitocin used either to induce labor or to augment spontaneous labor, the former group had a higher-than-average c-section rate.
However, according to Twogood, the main reason Pitocin is associated with an increased risk for c-sections has more to do with the indication for Pitocin than the Pitocin itself, assuming Pitocin is being used safely. In other words, Pitocin is used to augment labor when it is is not progressing as expected.
“Labor not progressing as expected is associated with an increased risk for a cesarean,” she says. “Using Pitocin in this scenario can help decrease the need for a cesarean. I think Pitocin sometimes gets a bad reputation, but looking at it from this perspective can be helpful.”
Rosemary Dardick, mom of 3-year-old Ella, in L.A., was administered Pitocin—and it did lead to a vaginal birth. Dardick was induced on her due date because she had started to show signs of preeclampsia; her induction process started with misoprostol, which barely did anything. The next day her doctors tried to induce labor with a balloon (also known as a Foley bulb)—a procedure she wound up enduring twice.
“Those were awful from start to finish,” she says. “They hurt while they were being inserted and the first one hurt coming out too. The second one worked faster than the first. Ella was sunny side up and it wasn’t clear if she was going to be able to turn herself around.”
[pullquote align=”center”]“The main—and intended—effect of Pitocin is painful uterine contractions.”
—Sara Twogood, MD[/pullquote]
After receiving Pitocin, however, Dardick’s contractions progressed very quickly. “Whereas before I would mainly be able to tell I was having a contraction by looking at the monitor, I definitely felt them after the Pit,” she says. “The epidural was awful and I still have lingering effects from it, but I can’t imagine laboring without it after the Pitocin.”
The dosage was turned up and down for Dardick, too. “They tried to labor me down for an hour or so Monday morning so I’d be able to rest for a bit, but after two days of prodding, Ella was suddenly ready to go immediately,” she says. “In fact, the nurse almost delivered Ella because the doctors couldn’t get to my room fast enough. So while the inducement lasted a long time, I was only in active labor for about 30 minutes. She’d turned herself around and was no longer sunny side up.”

Side Effects of Pitocin

Remember Theys’ horrific contractions? She wasn’t wrong that they were truly unbearable. “The main—and intended—effect of Pitocin is painful uterine contractions,” says Twogood. “It’s thought these contractions are more painful and stronger than spontaneous labor contractions, but this is clearly very difficult to study and know.”
In addition to extremely painful contractions, for some women, Pitocin can cause water retention. Other side effects may be skin flushing, fast heart rate, nausea, or vomiting. But Twogood is quick to point out that most women tolerate Pitocin very well.

Why Doctors Induce With Pitocin

“Inductions are usually recommended when the risks of continuing the pregnancy are higher than the risks of induction and delivery of the baby,” explains Twogood. This means that the baby is premature but continuing the pregnancy is too dangerous.
Some other indications include preeclampsia, chronic hypertension, gestational or pre-gestational diabetes, cholestasis of pregnancy, placental insufficiency, concern about fetal well-being or fetal growth restriction, low amniotic fluid, intrauterine infection, premature and/or prelabor rupture of membranes, twins, or going past your due date.
Many doctors rely on other medications or methods to induce labor before getting to Pitocin. The most common ones? Cervidil, transcervical balloon catheter, misoprostol (or Cytotec), and rupturing the membranes. “Membrane sweeping, nipple stimulation, and castor oil may help, and I use these techniques when we are trying to coax spontaneous labor,” Twogood says, “but they are not as effective as the other techniques so I don’t rely on them solely when induction is medically indicated.”

Risks of Pitocin Induction for Mom

You can’t move around.

Once on Pitocin, you have to stay in bed and be strictly monitored, which means no more wandering around, sitting on a birthing ball, or any of the other laboring techniques you may have learned.

You can’t eat anything.

This is because you risk asphyxiation if you need an emergency c-section—which requires going under anesthesia.

It might not work.

According to the Mayo Clinic, 75 percent of inductions end in a vaginal delivery—which means that 25 percent end in emergency c-sections, like Theys’.

Too strong contractions can tear the uterus.

This is more of a problem for women who are opting for VBACs (vaginal birth after c-section).

Risks of Pitocin Induction for Baby

Some babies don’t react well to the intense contractions that come along with Pitocin, which can lower their her heart rates, sometimes necessitating an emergency c-section.
As for other effects on the baby after birth, Twogood says, “Pitocin does cross the placenta and may have similar effects as in the mother, but that is rare. Newborns to mothers who received Pitocin during labor are not treated or evaluated differently than newborns who were not exposed, and there’s no evidence or link to adverse neonatal outcomes.”

Pitocin Use After Delivery

Sometimes the uterus won’t stop bleeding after birth, so Pitocin is used to stop the bleeding by “squeezing down on the raw blood vessels exposed as the placenta is released.”

Pitocin and Autism: Is there a link?

According to the American College of Obstetrics and Gynecology, there is no causal link between the Pitocin and autism spectrum disorder (ASD). A document endorsed by the Society for Maternal–Fetal Medicine states that “although the cause of ASD is unclear, it demonstrates a strong genetic predisposition and multifactorial influences. A wide variety of exposures, including many perinatal factors, have been linked to ASD but the suggested associations in many cases are weak, inconsistent, or both among studies, and cannot be equated with a cause and effect relationship ”

Pregnancy is hard. Another person is literally growing inside of you, pregnancy hormones have your body and emotions all over the place, and you know your feet are still attached to your legs even though you haven’t seen them in weeks. As if that’s not enough, Mother Nature decided to throw in a curve ball with Braxton Hicks contractions.
Braxton Hicks, put shortly, are your body’s way of warming up for labor. But how do you know if you’re experiencing real contractions or the practice variety?
We spoke to OB-GYNs Janelle Cooper, MD, at Baltimore’s Mercy Medical Center and Chase White, MD, at the Department of Obstetrics and Gynecology at Einstein Medical Center in Philadelphia, to find out everything you need to know about Braxton Hicks contractions.

What are Braxton Hicks contractions?

“Braxton Hicks contractions are contractions that happen before the onset of labor. They can also be defined as contractions that occur in the third trimester that usually do not result in cervical dilation,” says Cooper. “The uterus is made of muscle tissue, and naturally muscles will contract from time to time, so Braxton Hicks can be felt earlier in pregnancy, sometimes even early in the second trimester.”

In addition, Braxton Hicks may actually help prep the uterus for labor.

“Braxton Hicks contractions may be a part of the process of remodeling the uterus in preparation for labor,” White explains. “Later in the third trimester, the irregular contractions that many women experience are not only the classic disorganized ‘Braxton Hicks’ contractions, but are actually normal, effective contractions. They occur infrequently at first, becoming more frequent as the pregnancy progresses. They start the process of cervical shortening, softening, and opening that ultimately results in active labor and then birth.”

What do Braxton Hicks feel like?

Some women describe Braxton Hicks contractions as feeling sort of like your abdomen suddenly tightens all over: not exactly painful, but not all that comfortable either. Others describe it more as a cramping sensation.
And according to Cooper, some of her patients have said Braxton Hicks contractions feel like “[the] baby is balling up tightly and then releasing the position.”

How will I know the difference between Braxton Hicks and real contractions?

Oh, you’ll know, my sweet little starfish. But just in case you don’t, there are some key differences between Braxton Hicks and real contractions.
Typically, Braxton Hicks contractions:

• Are irregular and pretty infrequent. You may have several Braxton Hicks contractions in a row and then nothing for several days. Or you may have Braxton Hicks contractions once or twice a day but nothing that can be timed regularly.
• Do not increase in intensity. As mentioned before, Braxton Hicks are usually uncomfortable—not painful—and they don’t increase in intensity as they occur.
• Frequently disappear with no warning. Braxton Hicks are just as likely to stop with no warning as they are to start.

On the other hand, real contractions are pretty much the opposite of Braxton Hicks. Real contractions can be regularly timed, increase with intensity, and are most definitely painful as they progress.
Every woman is different, of course, but most women (myself included!) report real contractions to feel like the worst period cramps of your life rather than an abdominal tightening sensation.

Causes of Braxton Hicks Contractions

“Certain factors, like not drinking enough water throughout the day, or abdominal trauma as in a car accident, can trigger Braxton Hicks,” says Cooper. In addition, Braxton Hicks can be triggered by overexertion and even orgasm!
Before you throw your bag in the car and rush to the hospital, though, there are a couple of tricks you can try to test whether you’re experiencing Braxton Hicks contractions or the real deal.

• Dehydration is a big trigger for Braxton Hicks. If you’re experiencing these practice contractions, first try drinking a big glass of water to see if they subside.
• Sometimes you can experience Braxton Hicks if you’ve overdone it, say in a prenatal fitness class or just working around the house. If you feel that familiar tightening, take a break. Put your feet up, relax, and put on an episode of The Office.
• Braxton Hicks can also be caused by a full bladder. If it’s been a while since you had a bathroom break, and you’re experiencing irregular contractions, take a pee break.
• Sex can also trigger false contractions, since orgasm stimulates the uterus. Now, I don’t recommend you stop having sex (or orgasms!), but taking a short bath (30 minutes or less) after sex may help alleviate Braxton Hicks contractions.

Braxton Hicks Contractions and False Labor

Let’s recap: Typically, Braxton Hicks contractions are fairly painless, irregular, and can often be alleviated by drinking a glass of water or resting. But sometimes—especially as you near your due date—Braxton Hicks can mimic real contractions pretty darn well, which is known as false labor.
[pullquote align=”center”]“The onset of preterm labor can be subtle, and it is sometimes impossible to distinguish between normal uterine irritability, like Braxton Hicks, and true preterm labor without a physical exam or other tests.”
—Chase White, MD[/pullquote]
During false labor, your contractions may come more quickly, are more painful, and may even increase in intensity. White says the difference is that false labor can actually contribute to cervical ripening and dilation, which could lead to preterm labor.
“If you are still preterm (before 37 weeks) but the contractions are coming frequently (I use 4 or more contractions per hour as my threshold), it is essential that you speak to your OB-GYN and come in to be evaluated,” White cautions. “The onset of preterm labor can be subtle, and it is sometimes impossible to distinguish between normal uterine irritability, like Braxton Hicks, and true preterm labor without a physical exam or other tests.”
To determine whether you’re really in labor, your doctor will probably recommend that you bypass the office and head straight to the hospital. Once you’re there, you’ll get hooked up to a fetal monitor to check on baby, and you’ll probably have a cervical check to see if you’re dilated.
White prefers to think of these kinds of contractions as “early labor” when it occurs at term. He continues, “These regular contractions are not the disorganized uterine contractions that classically we call ‘Braxton Hicks.’ Rather, they are part of the preparation for active labor.  While they will sometimes abate on their own, sometimes they will become progressively more frequent and then transition into active labor.”

Braxton Hicks Q+A With Janelle Cooper, MD

I get Braxton Hicks every time I exercise. Should I stop working out?

“Exercise is great in pregnancy, but if you’re in pain, or having Braxton Hicks, you may want to stop at that time and consider a decrease in the intensity or length of your workouts going forward.”

Are you sure Braxton Hicks contractions don’t lead to labor?

“They don’t lead to labor. Think of Braxton Hicks as a dress rehearsal for labor.” The dress rehearsal comes before the show, but really, it’s just practice.

I know Braxton Hicks are supposed to be painless, but can they cause pelvic pain and cramping?

“Generally, they are painless. But they can be painful and may cause any discomforts of pregnancy (back pain, hip pain, vaginal pain or pressure) to amplify, resulting in additional pelvic pain and possibly cramping.”

Can you please tell my partner that frequent back rubs are proven to alleviate Braxton Hicks?

“Back rubs (or foot rubs) from a partner help to calm and soothe overall and may distract from the contractions, so I’d recommend trying it!”

After the second dark line appeared on my at-home pregnancy test, joy and excitement jolted through my veins.
But some worries snuck their way in, too: Would our baby make it to full term? Would he or she be healthy? Was I fit to be a mom?
I struggled to reconcile the doubts in my mind even though I was incredibly thankful for the new little life inside of me. And I’m not the only one! More than one in 10 women experience anxiety during pregnancy.
If you’ve experienced a miscarriage or dealt with infertility, the first trimester can be an emotional roller coaster. Even if you’ve had smooth-sailing baby-making in the past, getting through those first 12 weeks isn’t always easy.

The first 12? 13? 14? How long is the first trimester, anyway?

Surprisingly, there isn’t a consensus on how long the first trimester lasts. Based on various sources, 12 to 14 weeks is generally accepted. The most common definition seems to be that the end of your 12th week marks the conclusion of your first trimester. According to one pregnancy app, that means your baby will be the size of a lemon!
Because the highest percentage of miscarriages occur in the first trimester, it’s common (and understandable) to be nervous and take all the precautions you can. But if you’re in the thick of first trimester anxiety, there’s hope! There are plenty of ways to help you stay relaxed during these initial weeks so you can enjoy more of the journey with your new precious gift.

First Trimester Tip 1: Focus on what you can control.

Human beings tend to love being in the driver’s seat, but some things are entirely out of our hands.
“The statistics around first trimester miscarriages are tough,” admits certified nurse midwife Theresa Starr. It may be helpful to know, though, that approximately 50 percent of miscarriages in the first trimester are due to fetal chromosomal abnormalities, not anything the mother did.
While smoking, drinking, and using drugs can impact your chances of miscarriage, not much else does, thank goodness!
For instance, attending a regular aerobics class or missing one prenatal vitamin shouldn’t be cause for concern. (I’m even guilty of obsessing over having sniffed a lemongrass essential oil!)
“We usually don’t know why a first trimester miscarriage happens. We let women know that they couldn’t have prevented it—that there was nothing they did wrong, and that a miscarriage probably won’t affect their ability to get pregnant in the future,” explains Starr.
So rather than letting unnecessary worry occupy your headspace, focus your energy on what you can control: your diet, exercise, and the amount of rest you get each night.
“Eating healthy and participating in regular exercise will help you feel better both physically and mentally. Making small changes during pregnancy will help you and baby be as healthy as possible,” explains certified doula and childbirth educator Marisol Garcia.

Aim for a well-rounded first trimester diet.

Wondering what to eat in the first trimester? Focus primarily on receiving a breadth of nutrients.
A well-rounded diet of healthy fats, carbohydrates, proteins, fruits, and vegetables are recommended for expectant moms.
“Studies have shown that women who have a balanced diet and consume 80–100 grams of protein per day are less likely to feel morning sickness. Eating smaller and more frequent meals helps too,” shares Garcia.
But don’t worry if you miss a day of healthy eating; just get back on track tomorrow!

Practice light to moderate exercise during the first trimester.

The American College of Obstetricians and Gynecologists states that if you’re healthy and have been given the go-ahead from your doctor, it’s safe to continue or start most types of exercise. In fact, studies show that exercise benefits both you and your baby. Not too surprising, right?
But to ensure you’re getting in proper first trimester workouts, it’s helpful to know what’s safe and what’s not.
The most general recommendation is that you can continue any exercises you were doing previously. For instance, “if you lifted weights prior to getting pregnant, you can continue doing so. Just remember your center of gravity shifts, so take things a bit slower. Stay well hydrated and avoid activities where you have a risk of falling,” explains Starr.
[pullquote align=”center”]“When you’re taking care of your body, you’re likely to experience less anxiety, because you’re doing everything physically that you should be doing.”
—Theresa Starr[/pullquote]
Hiking and swimming have become my go-to pregnancy workouts—giving my skis (both downhill and water) a break for the season.
“When you’re taking care of your body, you’re likely to experience less anxiety, because you’re doing everything physically that you should be doing,” says Starr.

First Trimester Tip 2: Choose your sources for information wisely.

“I really encourage expectant moms to learn as much as they can—but in a healthy way,” says Galena Rhoades, PhD, research associate professor of psychology at the University of Denver and project director of MotherWise Colorado.
It’s convenient to pop every question into a search engine, but it can sometimes cause more harm than good if you’re not careful about which sites you’re visiting. Dr. Google isn’t actually a doctor—and it’s not your friend either.
Rhoades further explains that not all online sources should be avoided but that you should be mindful of the sources you choose. “If you’re reading an online forum, it’s hard to know how accurate that information is. You’re likely to find information that keeps you worried, because people typically don’t post about things that go well.”
As Starr notes, it’s best to “focus on factual information with scientific evidence.”
Outside of the internet, books written by professionals are another avenue for seeking reliable information, explains Rhoades. If you’re unable to find a definitive answer online or in a book, don’t hesitate to call up your OB provider.

First Trimester Tip 3: Establish a support system (even if you’re not sharing the news publicly yet).

Whether you’re feeling all of the lovely first trimester symptoms like fatigue and nausea or you’re one of the lucky few who aren’t, having support gives you strength when you need it most.
Many women fall into telling someone or not telling someone they’re pregnant based on what they feel they should do rather than what’s best for them. “Instead, make a mindful decision of who you want support from,” encourages Rhoades.
You may feel obligated to first share the news with your parents or sister, when perhaps having a best friend or co-worker by your side would be beneficial.
Form a plan with your partner regarding who you want to share your pregnancy news with and when, so you can get the support you need.
Unsure of who to lean on?
“Look for people who are supportive and in line with your beliefs,” suggests Garcia. Almost everyone has an opinion about pregnancy and parenthood, so “direct your energy to someone who carries similar views.”  
Rhoades also stresses the importance of building a community of women or couples who are going through the same experience. Sometimes this happens naturally if you have friends or family who are pregnant at the same time. Other times you may need to find a pregnancy support group or a studio that specializes in prenatal yoga.

First Trimester Tip 4: Practice self-care (and don’t be shy about pampering yourself!).

With so much focus on the baby, we can forget to take care of ourselves during pregnancy (surprise, surprise). But self-care is vital: It helps keep us healthy, sane, and energized.
Having worked with expectant moms for more than 20 years, Starr expresses the joy of pregnant women now having a range of self-care options: prenatal massages, prenatal yoga, and even guided meditation apps. Even something as simple as taking a bath (sounds amazing, right?) or asking your partner to make dinner can offer you the relief and care you need.
That’s right: Go ahead and put your feet up!
“It’s also important to release any tension and insecurities within you,” explains Garcia. If you’re experiencing problems with your loved ones, address insecurities and emotions before your baby’s arrival to help ensure healthier relationships both during pregnancy and parenthood. If you feel tension in your body, practice meditation, prenatal yoga, and relaxation exercises at home.
No matter how you decide to pamper yourself during your first trimester (which you should definitely do), just be sure it’s safe. The American Pregnancy Association recommends not elevating your body temperature to 101º F or above as it can cause concerns during pregnancy. So steer clear of hot tubs, saunas, and steam rooms to eliminate this risk.

First Trimester Tip 5: Bond with your baby daily.

Early on in the pregnancy, it can be tough to feel connected with your baby, says Starr, “especially if you’re not feeling well due to morning sickness and fatigue.”
I mean, come on, who’s feeling connected after perching over the toilet all morning?
[pullquote align=”center”]“When you take a moment to remind yourself that there’s a baby growing, you become more mindful of what your body’s doing, and that’s incredibly valuable.”
—Galena Rhodes, PhD[/pullquote]
But bonding with your baby for at least a few minutes each day can reduce your anxiety and stress while pregnant, says Rhoades. “Set aside time by yourself or with your partner to think about and talk through what you’re experiencing. When you take a moment to remind yourself that there’s a baby growing, you become more mindful of what your body’s doing, and that’s incredibly valuable.”
If you’re experiencing anxiety while pregnant, Rhoades recommends setting aside dedicated time to worry as well. Rather than letting fearful thoughts infiltrate your work day or distract you when you’re out with friends, you can say to yourself, “OK, I have time to think and worry about this tomorrow.” Devoting time to worry has long been a technique used by therapists to treat anxiety, and it can be particularly helpful to expectant moms.

First Trimester Tip 6: Connect with additional resources.

“Women feel increases and dips of hormonal changes during pregnancy and postpartum. It’s important to practice self-care and address any mental health issues with your medical professional,” explains Garcia. Even though you may be excited about the new baby, it’s still a huge life change, whether this is your first or fourth child.
So remember: You’re far from alone.
“It’s incredibly common to experience stress while pregnant,” Rhoades confirms. “If you’ve been feeling worried or anxious for several days or more in the last two weeks, it’s worth talking with your provider or therapist.” Professional assistance can be found in a counselor, therapist, or even books.
Processing what’s happening for you and learning techniques to manage your stress, anxiety, or depression will benefit you throughout your pregnancy—and after you welcome your beautiful new baby into the world.

Being pregnant—especially if it’s your first pregnancy—is like wandering into a whole new frontier with your phone’s map app open only to find out you’ve got spotty service. You’ll get all the information eventually, but it feels like it comes at you in bits and pieces. Case in point: the signs of labor.
Maybe your best friend told you she knew she was in labor the second she spotted some blood in her undies. But what about that woman in your prenatal yoga class who said she always knows she’s ready to deliver when she starts vomiting? And aren’t pregnant women in the movies always going into labor with dramatic gushes of amniotic fluid?
If all those stories (and over-the-top dramatic scenes) have you confused about what really happens when you go into labor, you’re not alone.
The truth is, everyone experiences labor differently, says Mary Fleming, MD, an OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania.
“For some it is a gradual process that occurs over weeks; others may not perceive any discomfort until active labor ensues,” Fleming says.  
So how will you know when you’re in labor? And what signs of labor mean it’s time to call the doctor? Here’s what the experts have to say.

Signs Your Body Is Getting Ready for Labor

The goal of every pregnancy is to reach labor, that time when your body is readying for delivery, or the actual arrival of baby. For most folks, that happens sometime after the 37th week of pregnancy, which is what doctors call term labor or sometimes full-term labor.
That said, labor can happen any time after 20 weeks of pregnancy, says Jimmy Belotte, MD, PhD, interim medical director in the division of general OB-GYN at Montefiore Health System in New York. “When it occurs between 20 weeks and 36 weeks + 6 days, it is referred to as preterm labor.”
Just when it will happen is hard to say, Belotte explains, as every pregnancy is as different as the parent and baby involved.
But there are signs that your body is getting ready to go into labor.

Signs of Labor: When Baby Drops

With most pregnancies, especially those considered full-term, a baby will “drop” in the uterus. Typically this will happen near the end of the third trimester, Fleming says, as the fetus prepares for the labor process.
“The head will begin descending into the pelvis,” Fleming says. “Women will usually feel more fullness and pressure in the pelvis and sometimes in the vaginal area. This process helps to apply pressure to the cervix and is part of the early stages of the labor process.”
As a baby drops, the height of the fundus, which is a term a doctor uses to refer to the top of the uterus, will also shift downward, away from the chest. Depending on your body, that “drop” may be visibly apparent to friends and family.

Signs of Labor: Mucus Plug

Another sign your body is readying for labor? You might pass the mucus plug, which is literally a thick chunk (or plug) of mucus that dislodges from the cervix shortly before labor. The plug may be accompanied by pinkish vaginal discharge or spotting, akin to the breakthrough bleeding that can happen when you’re ovulating.
Just how long it will take from the time a baby drops or the mucus plug drops into the toilet is hard for doctors to say because these processes can vary widely. But they’re both things to mention to your OB-GYN or midwife, as they’re signs that something is beginning to happen!

Signs of Labor: Cervix Dilation

Your medical practitioner will likely check to see if your cervix has dilated or started to open up, which is yet another sign that the body is preparing for labor, Fleming says.
[pullquote align=”center”]You can walk around with a cervix that’s dilated an inch or two for days or even weeks without feeling it or going into full blown labor.[/pullquote]
This is not something that can typically be felt—in fact, you can walk around with a cervix that’s dilated an inch or two for days or even weeks without feeling it or going into full blown labor—but a cervical exam will allow your doctor or midwife to get a gauge of whether the cervix is readying for labor and just how much.
After 39 weeks, some providers may suggest stripping the membranes of the cervix. The optional process is considered a safe and simple way to induce the body to kickstart labor, if not always effective.
“If possible, the provider will use her/his finger to sweep along the inside of the cervix where the cervix and the bag of water/membranes meet,” Fleming says of membrane stripping. “The process may be uncomfortable but usually lasts for 20 seconds or less.”
It’s an optional procedure, Fleming says, and it’s one that should only be performed late in the third trimester by a medical professional.

The Sign That Labor Has Started: Contractions

While your body can start prepping for labor weeks (or sometimes months) in advance of the real thing, you won’t be in actual labor until you’ve started contractions, Fleming says.
“The definition of labor is consistent contractions that cause cervical change,” she explains. “We instruct women to contact their provider when they start having contractions that they can time, every 5 to 10 minutes over a two-hour time span.”
During that phone call, your healthcare provider can assess if it’s time to make a trip to their office or a hospital or whether it’s time for them to come to your home if you’re having a home birth.
[pullquote align=”center”]“The contractions have to be strong enough and consistent enough to cause the cervix to open before the diagnosis of labor can be given.”
—Mary Fleming, MD[/pullquote]
If it’s “go time,” a cervical exam will come next to determine whether the contractions are actually causing cervical dilation, meaning you’re in true labor, or if you’re having Braxton Hicks, a term for false contractions that don’t have any effect on the cervix.
“We know it is often frustrating for first-time mothers who have contractions to be told they are not in labor,” Fleming says, “but the contractions have to be strong enough and consistent enough to cause the cervix to open before the diagnosis of labor can be given.”

Wait, what’s a contraction?

Hey, if you’ve never given birth before, you’ve probably never felt a contraction either, so it’s no surprise most people don’t know the difference between a Braxton Hicks contraction and a “real” one.
Braxton Hicks contractions can start as early as the first trimester but may only be felt late in the second trimester, according to Belotte. “They are different from the labor contractions because they are sporadic, last longer than regular labor contractions, and tend to not be so painful,” he adds.
As for the “real” contractions, there is no one right way to experience contractions. They vary depending on the person feeling them.
“Some women will describe contractions as back pain and others as pelvic pressure,” Fleming explains. “Most will feel a tightening across their abdomen that intensifies for 30 seconds and up to one minute and then relaxes.”
Mild contractions are typically uncomfortable enough to be noticeable but don’t necessarily interrupt normal activities, while intense contractions can make it difficult to walk or carry on a conversation.
“Again, because all women experience pain in a different way, it is normal for some women to experience intense contractions in early labor and for others not to feel much intensity until closer to delivery,” Fleming says.

Isn’t water breaking a sign of labor?

Forget what you’ve seen on TV. Most women do not experience a giant gush of water flowing out between their knees, signaling that they’re suddenly in labor and need to get to the hospital stat.
It’s not typical for your water to break at the beginning of labor. In fact, “for most women, their water breaks during labor,” Fleming says.
Water can break spontaneously (on its own) or because your healthcare provider breaks it for you with a procedure called artificial rupture of membranes (AROM).
If your water does break before labor begins, it may be a big gush. Then again you may simply notice your clothes are wet or wake up to find a clear puddle of fluid in the bed. Water may “break” and leak out slowly over time as well, Fleming says, as the membranes of the amniotic sac do not reseal.
“For this reason, liquid will continue to drain from the vagina in small amounts until delivery,” she says.

Early Labor vs. Active Labor

Once your body is revved up and “in labor,” your provider still may say you’re not quite ready to be rolled into the delivery room. Sigh. That’s because labor is broken down into two parts: early labor and active labor.
“Early labor starts when regularly recurring, painful labor contractions are felt by the mother, leading to cervical changes including progressive shortening, thinning, and opening (dilatation) of the cervix up to a point of rapid acceleration of the rate of cervical dilatation,” Belotte says.
Typically, early labor is the longest phase. It can be just a few hours for some folks. Then again it can go on for days (literally) for others.
A mom-to-be is monitored during early labor to determine whether dilation is progressing; the baby’s heartbeat is monitored also to ensure that the baby is healthy and handling the pressure of getting ready for delivery well. It’s during early labor that practitioners typically decide whether a delivery may be done vaginally or require surgical intervention.
If the answer is the former, at around 6 centimeters of dilation, active labor typically begins. It’s shorter and faster than early labor, Belotte says, and is associated with the fetus moving lower and lower, while the cervix continues to dilate to 10 centimeters, which is the size needed for vaginal delivery. Active labor is what turns into delivery!

On paper, the obstetrician was perfect. She took Kate’s insurance. She had graduated from a prestigious medical school. She was well regarded in the medical community.
In fact, the obstetrician seemed so perfect that Kate (who has asked that her last name not be used) was willing to ignore her rushed manner on her first visit. “It was a red flag, but not a deal breaker,” Kate said of the doctor’s flurried manner and lack of conversation with Kate’s husband.
“But then when I miscarried at 13 weeks—a really devastating loss when you’re 40—her manner was so cold and she actually referred to the fetus as ‘shriveled up,’ which just felt unkind,” Kate recalls.
It wasn’t long before Kate and her husband “fired” the obstetrician they had so carefully chosen and decided to entrust their next pregnancy to a physician who was in many ways her total opposite—an older man who was both kind and warm.
For many women who are trying to conceive or are already pregnant, choosing an obstetrician doesn’t require a whole lot of trial and error: They call up their health insurance company or pull up the company’s provider list and they choose a name of a provider who is located somewhere near their home.
But some are lucky to find a provider at all. An estimated 11 percent of women between the ages of 19 and 64 don’t even have health insurance.
But for those who do—and for those who have a choice in the matter—the decision of who should serve as your obstetrician is one that can’t be taken lightly. After all, an obstetrician does a lot, specializing “the care of pregnant patients, labor, and birth,” explains Lisa Valle, DO, an obstetrician and gynecologist from Providence Saint John’s Health Center in Santa Monica, California.
While some moms prefer a midwife to deliver their baby, obstetricians still deliver more than three-quarters of the babies in America. These are the physicians in whose hands we literally place our babies.

Questions to Ask an Obstetrician

Whether we pay them out of our own pockets or our health insurance picks up the tab, obstetricians are like any other physician: They work for us.
Now imagine hiring someone to work for you without asking them a few basic questions before you hand them a keycard and offer them access to your computer system. You wouldn’t do it, would you?
Of course, some women already have a gynecologist, a physician who specializes in the care of a women’s reproductive system, whom they love and trust.
“In the United States, our training for obstetrics and gynecology is combined into one four-year residency,” Valle says. “As a result, many elect to practice both, however, not all gynecologists elect to practice obstetrics.”
If you feel safe and comfortable with your current gyno, ask them if they’re an OB-GYN, meaning they practice obstetrics as well as gynecology. On the other hand, if you’re starting fresh in a new town or just want to see a new provider, setting up an interview to learn if they’re the right fit for your health needs (and those of your baby) is A-OK.
But what should you be asking your future obstetrician? Here are a few questions to help you make heads or tails of this big decision.

Will my obstetrician be there when I deliver?

Sure, you may want this one doctor to be there for every single appointment and there on the day you give birth, but obstetricians are human beings too! Instead of asking if they will be there on the day you deliver, ask what their procedure is for delivery.
Do they recommend that you see a range of physicians in their practice so you know everyone and therefore have a familiar face in the delivery room? Do they guarantee there’s always someone in their practice who will be on call?
Obstetricians want the best for their patients, but they also want patients to know that if they’re not right there the minute they pick up the phone, it’s nothing personal.
“I wish patients knew that it is not possible for one doctor to be available all the time and to handle all issues that come up,” OB-GYN Janelle Cooper, MD, tells HealthyWay. “I wish patients knew that although we are dedicated to our careers we also have lives outside of medicine and we cannot be available 24 hours a day.  
“Many pregnant women have a hard time with that when they have only seen you their entire pregnancy but they have to be delivered by one of your partners. Often this is because we have been working all night the day before and went home to rest or are seeing other patients in the office.”

Where does this obstetrician deliver?

Where you plan to give birth will play a big role in who you choose to deliver your child. After all, if you want to give birth at home, you’re probably not going to find an obstetrician who will show up at your door with a doctor’s bag in hand.
These days most home births are attended by midwives, so if you’ve got your heart set on birthing in your bedroom, you may want to find an OB who works with a midwife, or you could go to a midwife directly.
If giving birth at a hospital or birth center is more your speed, you’ll still need to find out where your obstetrician has privileges, a special relationship that allows doctors in private practice to provide care in a hospital.
Keep in mind how far that hospital is from your home and how difficult it might be to get there when you’re ready to give birth. You probably don’t want to choose an obstetrician whose privileges are at a hospital that’s four hours from home!

What’s an obstetrician’s c-section rate?

C-sections happen, and sometimes there’s no avoiding it. But if you have your heart set on natural childbirth, taking a look at an obstetrician’s c-section rate can help determine whether they’ll be likely to support you if you plan to give birth vaginally.
“C-section rate is the number of c-sections a doctor or institution does over a specific time period,” explains Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix in Arizona.
Determining whether your possible doctor has a “low” rate or a “high” one comes down to doing a little compare and contrast. The World Health Organization, for example, recommends a c-section rate of no more than 15 percent of births, while actual rates in the U.S. range from 23 percent to 38 percent, depending on your state.
“Generally we like to see c-sections below 30 percent,” Mahnert says. “Most hospitals should have information available to patients about their [c-section] rate because this is something they should be tracking.”
Keep in mind that there are all sorts of reasons that a doctor might perform a c-section, from fetal distress to an issue with mom’s health to patient preference. And a particular obstetrician’s c-section rate may be affected by their clientele.
Are you talking to an obstetrician who primarily sees high-risk patients, for example? That may jack up their c-section rate, so be prepared to ask follow-up questions on why their rate is what it is.
Mahnert also suggests asking an obstetrician to differentiate between their first-time patient c-section rate and their repeat c-section rate, as it’s more common for a patient to have subsequent c-sections due to medical necessity.

Do you perform VBACs?

While giving birth via a c-section may necessitate another surgical birth down the line, for many folks, it doesn’t. That’s where the VBAC or “vaginal birth after a cesarean” comes in. And an obstetrician’s opinion on VBACs can be the difference between living the dream of trying a vaginal birth or being sent back into the operating room.
“If you have had one to two [c-section deliveries] and want to try for a vaginal delivery this is something very important to discuss with your OB,” Mahnert says. “They can tell you your chance of a successful vaginal delivery based on your characteristics and history. You also want to make sure your OB feels comfortable with the plan.”
Some obstetricians will not offer VBACs at all, but that’s not always within their control. Some hospitals simply won’t support the practice. It’s worthwhile to work this into your questions about where the obstetrician delivers and how they feel about c-sections overall.

What’s your take on the birth plan?

A birth plan is exactly what the name implies: a plan you put together about what you want to happen during delivery. Studies have found that mapping out a birth plan can help make the person giving birth feel more empowered, and a birth plan can ensure that you walk away from birth feeling like it was a positive experience.  
But that birth plan is unlikely to be successful if the practitioner who’s helping you bring your child into the world isn’t on board.
“All OBs should discuss your birth plan with you to make sure we are all on the same page and to make sure the items are doable,” Mahnert says. “It is important to have a realistic birth plan and understand that labor and delivery is sometimes out of our control and we need to be flexible. OB doctors want mom and baby to be healthy and happy and have your best interests in mind!”
Many obstetricians have birth plan templates, so don’t be afraid to ask your potential obstetrician if they have one that they recommend. Review it and ask questions.
“Your OB should be willing to talk this over with you and answer your questions or concerns,” Mahnert says.

What are the obstetrician’s fees?

The cost of delivery will likely come down to a mix of your health insurance company (if you have one) and your decisions on where to give birth and who you want at your side. For example, some health insurance companies will cover the costs for pre-approved doctors, which they call “in-network,” whereas you may only see part of the fees of another doctor or “out-of-network” provider covered.
Although you can ask the obstetrician about their fees, most of those questions should be directed to the front office staff, Mahnert says, as they are more familiar with the ins and outs of insurance billing.
You may also want to call your health insurance company directly, as they can outline other delivery-related fees such as the cost of anesthesia or the fee for a private room—bills that don’t come from the obstetrician’s office.
If you don’t have health insurance, be sure to mention that to the billing department. Some doctors offer sliding scale fees for patients who are paying their own way.