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Birth, one step at a time

The birth process, demystified: What actually happens, minute to minute, hour to hour, on the day you’ve been not-so-patiently waiting for? Here’s a play by play of the (literal) baby steps that will take you into the delivery room—or the birthing center —and back out again, with a plus one.

Let's talk different kinds of births

The two major types of births are vaginal and Cesarean section, a procedure in which the baby is removed from the abdomen via incision. Within these categories, though, there are other methods that can be used to help usher your baby from your uterus into the world. “Natural” birth often takes place outside the hospital setting, relies on breathing and body positioning for pain management, and can happen in a tub or small pool (this is known as a water birth). Induced labor, on the other hand, may take place if you have certain medical conditions, including diabetes, preeclampsia, a uterine infection, if you’re past term and haven’t gone into labor on your own, or if you're expecting multiples. With this method, your doctor administers a drug called pitocin, a synthetic version of the hormone oxytocin, which stimulates contractions and labor. In a vaginal delivery, docs might use techniques like forceps delivery, in which the baby is pulled out with a clamp-like tool, or vacuum extraction, when suction is used to assist your pushes.

What happens, and when?

Contractions

The first contractions of your labor are likely to begin 8-12 hours before the onset of active labor. These first contractions will typically feel like pressure, similar to intense period cramps or a bad stomach ache. As your cervix dilates and thins out (also called effacing), you may feel contractions in your belly, your back, or even your legs; it’s all normal. You can tell the difference between true labor contractions and Braxton Hicks, or “practice contractions,” by paying close attention to your body: the intervals between true contractions will shorten, while Braxton Hicks will stay consistent. While you might experience Braxton Hicks as early as the second trimester, they are most likely to occur in the third. They are nothing to worry about, and unless you believe you are having true labor contractions, you don’t need to take any action, though walking and deep breathing may decrease your discomfort.

Labor

There are three main phases of a vaginal birth. In the first, your amniotic sac may rupture (this is what is known as your water breaking), and you will lose the mucus plug that seals your cervix during pregnancy, sometimes along with what’s called “bloody show,” or a tinge of cervical blood. Your contractions may have already begun, or they may not come for hours. There is a risk of infection after your water breaks, so when that happens, you should head to the hospital.

As your cervix continues to dilate, you’ll move into active labor and your discomfort will intensify. This is when you’ll want to go to the birthing center, hospital, or other location you’ve chosen to give birth, and it’s also the time to consider your needs for pain relief, such as an epidural.

Delivery

In the second stage of birth—that is, the actual delivery—you’ll be cued to breathe and push. This is when you’ll want to assume the position you want to deliver in. Contrary to what we see in movies, you don’t have to be on your back—you can deliver on your knees, squatting, on all fours, even sitting.

Once your baby is born, there is still one more stage: the delivery of the placenta, which you’ll need to push out. Finally, if you’ve had an episiotomy, which is a surgical cut made in the tissue between the vaginal opening and the anus (also known as the perineum), or experienced vaginal tearing, you’ll receive stitches, given under a local anesthetic if you delivered medication-free.

C-sections

While the timing and pace of everyone’s labor and delivery will be different, most vaginal births will follow a similar sequence. But what about Cesareans? C-sections can be scheduled or unscheduled, and the reasons to have one are myriad, ranging from medical conditions and convenience to traumatic emergencies, which makes a standard experience difficult to define. If this is your situation, you’ll want to speak at length with your doc and get a sense of the particulars of your Cesarean process.

Your Birth Plan

With modern medical science and the experiential wisdom of centuries of practice, there are now so many ways to birth a baby that the choices can feel overwhelming. That's why it's important to have a plan—and when it comes to labor and delivery, the best plan is to expect the unexpected.

So what is a birth plan, exactly? It's more than just a general sense of what your ideal birth experience might look like. A true birth plan details your specific preferences for everything, like where you’ll be and who will be there with you, to medical matters like options for pain relief, to smaller but still important wants and needs like dimmed lighting and taking photos. The best birth plans—and by that we mean the ones that result in empowered delivery experiences—are flexible, created with the conscious awareness that nothing might end up going as planned. To get into this adaptable headspace, try thinking of your birth plan as a set of goals and ideals, rather than a strict agenda.

One helpful strategy, borrowed from marathon running, is to articulate tiered goals: an A-goal, a B-goal, and a C-goal. Instead of saying only “I want a completely medication-free birth at home,” consider declaring a natural home birth as your A-goal, and perhaps vaginal delivery as your B-goal, and skin-to-skin contact with your baby immediately following birth as your C-goal. Though simple, this bit of performance psychology can offer much needed relief from the pressure to adhere to a strict plan. Moreover, during the pain and exhaustion of labor, you will be in a much stronger position to make informed, thoughtful choices if you have articulated your tiered goals.
A birth plan template can be tremendously helpful in organizing your choices.

It takes a village: resources to draw support from

To create your birth plan and to arrive at your labor and delivery with a calm, cool mentality, don’t be afraid to enlist support. Books like Gentle Birth Choices and the iconic What to Expect When You’re Expecting are troves of information, but don’t be afraid to ask parents in your communities to share their birthing experiences as well. No one really knows how to have a baby until they actually have a baby, so availing yourself of the experiential expertise around you will surely increase your chances of moving through the birth process with empowerment and confidence.

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M. K. Steines

M.K. Steines is a writer based in Tucson, where she is an MFA candidate in nonfiction at the University of Arizona. Her work can be found around the web and in print. Instagram @redstateblues

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