Contractions throughout pregnancy are normal and healthy.

Until they're not.

Generally speaking, the preterm labor guideline is to call if you have six contractions in an hour, but I've seen that many times before and still not had it actually be preterm labor. 

More importantly than six in an hour (which averages out to a contraction every 10 minutes) is are they getting STRONGER, LONGER, AND CLOSER TOGETHER? If you are preterm, even just two out of those three would probably be reason to go in and get it checked out. 


Stronger: How much of your attention do these contractions command? Do you have to stop what you are doing to breathe/cope? Is it pain or just a noticeable tightening?

Imagine you were at a job interview, negotiating your new salary. Are these contractions intense enough that your new boss would stop in the middle of offering you a lot of money to say, "Hey, are you OK? Do you need to go to the hospital?" just by looking at your face? Braxton Hicks (practice) contractions rarely HURT, you should be able to fake that they aren't there if the situation required it. 

Longer: How long is each contraction lasting? Just a few seconds? 15? 30? 60? 90? If they are increasing in length, that is a concern.

Closer together: Contracting every 15 minutes seems disconcerting, but if they just stay at that, or space out more, or the pattern is wonky (like once it will be 12 minutes and then nothing again for 40 minutes) its not a big deal. But if you go from 15, to 12 to 10 to 8, you should go to L&D to get checked out. 

Dependng on how close you are to your due date, its possible that medication can be given to stop your labor, or that a shot will be given to help your baby's lungs develop. More likely though, you will be monitored and sent home, not in labor after all. The thing is though, your care-provider would rather have that happen than have you deny to yourself that your contractions are really labor and not go in until it's way too late to do anything about it. Different hospitals have different policies about when they will attempt to stop labor and when they will just let the baby come. If you are dealing with concerning contractions, you should ask your care-provider when the guidelines change for your particular birth place. The six contractions in an hour is a guide for them to be able to stop labor, and if you are past the point where they would choose to do that, many care-providers would say to just come in when your contractions are about 4-5 minutes apart. 

Please remember, if you are ever unsure about what to do, call or your doctor or midwife to get medical advice!

Yes. It is true that you can refuse everything and anything offered to you by your care-provider. Even if they tell you it is "required" or "policy" you can refuse. But, you might have to go beyond using the word "No." If you see that something is about to happen to you or your baby that you really don't want, your best friend is the magic phrase, "I do not consent." If they still hesitate, offer to sign something. That should do it for sure.

But let's back up a moment. Who wants to give birth on the defensive, guns a blazin, ready to beat off routine interventions with sticks? Not you? Not me either.

The best way around this scenario is to foresee it! Interview your care-provider about his/her use of interventions. What is routine? An IV? Just a saline-lock? What if you don't want either, then what? Who is induced? When? For what reasons? How often are episiotomies cut? What is the policy on monitoring? Intermittent? Continuous? Internal? What about Pitocin? How many birthing moms receive augmentation of any kind?

Many places will give lip service to a birth plan, but you can tell when you ask nitty gritty questions, such as, "What is your personal Cesarean rate?" whether your provider gets defensive, or is truly supportive of the kind of birth you desire.

I cannot stress this enough. Choose a provider and birth place that will be supportive of the birth you are planning. If you want a hospital birth, find one with a 25 percent (or lower!) C-section rate, not one with a 40 percent C-section rate. The highest indicator of whether it will happen to you is how often it happens to everyone else.

It is never too late to switch providers. You want to be comfortable with someone, to trust them. If you feel like you are planning to go into your birth at war with your provider, refusing every decision they try to make for you, why did you hire them in the first place?

Now, back to those interventions. So far, I've made it sound here like they are all terrible and anyone with half a brain should say no to all of it, but the truth is, many interventions have at least some reason why they became routine in the first place. The problem I see is when people research the risks without learning about what the intervention was meant to accomplish. 

My first example will be routine IV fluids. Risks include possibly inflating the baby's birth weight, not to mention discomfort at the IV site. But, they also provide tons of hydration to the birthing mom which is tres important during labor. I have seen several mothers refuse a routine IV, but then not take the necessary steps to keep themselves well nourished and hydrated. If your birth plan says you will be eating and drinking throughout your labor, then you'd better do it! I encourage moms to sip on a beverage of their choice after every single contraction. 

Another intervention that can become necessary is a catheter. This is rare in a natural birth (and required in a medicated one) BUT, if you aren't getting up to regularly empty your bladder, and the baby is coming down, but your bladder is filling up, it can get dicey. It's hard to fit a baby past a giant full water balloon. If you do not have an epidural, you need to get up and pee, at least once an hour. Not peeing can cause your labor to stall and interventions to be required.

The last intervention I'm going to discuss is actually a baby one, and that is the Vitamin K shot. This shot helps prevent baby from bleeding extensively in the first week or so of life before baby makes adequate amounts of his/her own Vitamin K. Many families refuse this shot, feeling that it is unlikely that baby will be injured or bleeding within a week of the birth. But then, at the same time, if those same families are planning a circumcision, you'd better believe that shot is necessary. 

When you make your choices, sometimes other choices go hand-in-hand. There's no such thing as choosing an epidural but refusing IV fluid. So do your research, make sure you truly connect with and trust your care-provider and remember, when all else fails, "I do not consent!"

As a community service, and because it is something I believe in, I offer doula support for teen births free of charge. 

While meeting with 15-year-old Kyla, who was planning an open adoption for her baby, I asked her if she would be willing to share her birth and her story for publication on my blog. She gave her permission, as did every other person involved in this story. First names are used with permission. 

Kyla had several bouts of prodromal labor throughout her pregnancy, and her due date had been changed several times. She was familiar with the routine of going to the hospital and going back home again before I even met her.

It was Friday, January 25, when Kyla texted me in the late evening letting me know she'd been contracting since about noon after having had her membranes swept the previous day. She was very nervous and more than anything did not want to cry wolf, but after contractions continued even through a bath, she wanted to give me the heads-up I'd asked for. After chatting for awhile, we agreed that it wasn't time for me to come over yet, but that she should carry on, try to drink as much as she could, and sleep if possible. I told her to call me when contractions were longer, stronger, and closer together. I also added that they should be intense enough to command her attention. 

Kyla checked in again at 11 p.m. to let me know she was going to try to sleep. When morning came and I hadn't heard from her, I texted her to find out if her contractions had petered out over the night. It turned out that they hadn't, and she was able to sleep through some of them, but not all of them. At 10:30 a.m., she let me know that they were about 5 minutes apart and hurt more than they had before. I told her I would see her soon.

When I arrived at her home, she was sitting on the couch with her partner, Tony. She tensed her face when she had a contraction, and told me that she was feeling some back pain as well. I helped her relax, taught her how to breathe slowly in through her nose and out through her mouth, like she was blowing out a birthday candle. I also suggested that she try the hands-and-knees position over the side of her couch, since the back pain suggested to me that her baby could be posterior (sunny-side up) and this position would take some of the pressure off of her back. 

As soon as we made this change, Kyla's contractions went from 5 minutes apart to 3 minutes apart, and increased in intensity. Since Kyla was planning a medicated birth, she wanted to head off to the hospital. 

We arrived at the hospital at about 1 p.m., where a cervical check revealed Kyla was 3.5 cm dilated and 90 percent effaced. I told her that was great work and not to worry that they weren't immediately admitting her, but instead sending her on the one hour hospital hall walk.

We only made it about 40 minutes of walking before Kyla's legs began to hurt, and she felt more back pain. I asked her if she'd like to go back to triage until it was time for her next check, and she said yes. 

When we made it back to the room, we found that Kyla's dad had just gotten off work and had come to visit with her. She was glad to see him and they exchanged a few jokes between her contractions. Her mom took this time to go get her bags from the car (she was sure Kyla was in active labor and would be admitted) and Tony had a short break.

When the nurse came back to perform the next cervical check, Kyla was thrilled to hear that she had made it to 4-4.5 cm and was being admitted. She was also told she could have an epidural at any time. Kyla decided to do a few more laps of walking and then told the nurse she was ready for medication. She went ahead and tried the narcotics but didn't notice any difference at all in her pain level. I helped her cope with her contractions while we waited for her IV to be placed. 

Kyla benefited from counter-pressure on her hips, massage on her lower back and a lot of coaching when it came to controlling her breath and relaxing her face. We tried horse lips (blowing out the air of your breath in a raspberry sound) and a few low moans. Mostly, she tended to tense up, so I offered her my hand to hold and squeeze in exchange for doing her best to relax her face.

Kyla couldn't get an epidural until a full bag of IV fluid went in, which took longer than she was expecting. She was surprised at how much labor hurt, and disappointed that the narcotics didn't seem to help at all while she waited for anesthesia to come with the epidural. We spent most of this time focusing on breathing and relaxing. The hands and knees position was no longer an option because Kyla was back on the monitors. She felt that sitting up was better than laying down, but not as good as walking.  It actually only took about 45 minutes from when she asked for the epidural to be ordered to when it was placed, but for her, it felt like a very long time. I was asked to leave the room while the epidural was being placed, but Tony was able to remain with her. She told me later than she panicked when she received the numbing shot, but was able to calm down and hold still well enough for the anesthesiologist to do his job. Relief did not begin immediately, but Kyla reported that each contraction was getting easier to deal with until finally she couldn't feel them anymore.

At approximately 5 p.m., Kyla's next check revealed that she was at 5 cm. It was around this time that the adoptive parents, Tyler and Courtnay, arrived and greeted Kyla. They asked if there was anything she wanted, anything at all. The hospital room had a TV and DVD player, and multiple people had asked Kyla if she wanted to watch a movie to help pass the time. Tyler was headed out to get some food anyway, and again told Kyla he was happy to pick up a movie from Redbox. She finally admitted she'd love to see "Pitch Perfect" again. Courtnay and Tyler hadn't seen it, so Kyla thought it would be nice if they'd like to join her and her family to watch the movie. 

Of course, since Kyla had been in prodromal labor for at least 24 hours, and she'd seen the movie two times before, she didn't exactly make it through the whole thing.

When the movie was over, Kyla was checked again and found to be 7-8cm dilated. She started to have transition symptoms at this time, including vomiting and the shakes. This part of labor was rough for her and only got rougher when she realized she was starting to feel her contractions again. Anesthesia was paged, but during the lag time, Kyla needed some help coping with the intense transition contractions that she previously could not feel. With a calm voice and a gentle touch, I did my best to address her fears and empower her to make it through this short (but scary) time that she unexpectedly had to cope with pain again. 

I told her billions women have been doing this for all of human history and there are thousands that are out there doing it right now, right along with her. We talked about how it feels like something must be horribly wrong because how can it hurt this much, but it does and it's normal. No damage is taking place, and the shivers are from hormones and because her body is working so hard. She looked into my eyes and calmed down a touch. Once she stopped trying so hard to stop the shivering and just relaxed, it went away. Anesthesia arrived, repositioned her epidural line and increased her dosage. Pitocin was added to her IV as well, because while all of this had taken place, her next check revealed she was still at 8 cm after two hours. 

Just after midnight, the doctor came in to break her water (at Kyla's request to help speed things up) and check her again. Kyla was at 9 centimeters, had no fever and baby was doing well, so the doctor told her that it was fine to just keep on keeping on.

Kyla tried her best to nap again at this point, but it was hit and miss for her. Finally, we decided that everyone except for Tony needed to leave the room because the side conversations, even in whispers, were disturbing her sleep. Tony laid down on the couch and took a quick catnap while Kyla rested as well. At about 2:30 a.m., on Sunday, Jan. 27, the nurse declared that Kyla was complete and the baby was at a +2 station and it was time to push. When I returned to the room to check on Kyla, I found her giving the nurse a small practice push so the nurse could evaluate where she was at. Because of the strong epidural, Kyla felt no pain during pushing, only the pressure of the baby's head moving down, but she definitely felt the exhaustion of the late hour and how little sleep she'd gotten the night before. With all her might, Kyla worked and worked to move her baby down. 

 Kyla pushed harder than she thought possible. She only could feel a slight urge, so she mostly relied on the nurse to tell her when a contraction was building, how long to hold each push for and how many times per contraction to push. Tony held one leg and I held the other, while we all encouraged her and told her how great she was doing. Indeed, each push, I could literally see the baby's head move down just a touch more than before. The nurse helped support Kyla's perineum with warm compresses and did some massage to help her stretch, which Kyla said she wanted. Kyla was making great progress, but was also getting very tired. We encouraged her to lay her head back and rest between contractions.

Then, suddenly something amazing happened. I was standing between Kyla's legs and saw that during her pushes she moved the baby more than she ever had before. Maybe two to three times more per push than what she had been accomplishing with all of her previous pushes. I got very very excited and told her that this was astounding. The nurse said, "Yes, whatever you did that time, keep doing it!" I wondered if there actually was a concrete "it" to keep doing, so I asked Kyla between contractions if she knew what it was that she'd done differently. "Yes!" she said. "I didn't curl around my baby. I stayed flat." 

Pushing continued in the new position. The baby's head was molding and Kyla's tissues were stretching. It was truly a case of slow and steady wins the race. Baby's heartrate was picture perfect the entire time. The biggest struggle was Kyla's exhaustion and mental defeat. She kept asking how much longer, and looked absolutely wiped between each contraction. It turned out that what she really needed was to hear that she could do it, but not from me, and not from the nurse. She and Tony took a moment to reconnect and it seemed to give her a second wind.

The photo to the left was taken about 8 minutes before the baby was born. When Kyla was hitting the wall, what she most needed was a little love and encouragement. Just after I took this picture, Kyla's baby began to crown and the doctor was called in. 

Kyla gave another mighty push, the baby's head was out and the doctor told Kyla she need to get the baby's shoulder out ASAP. There was a lot of commotion, but Kyla remained focused and did what she knew she had to do. The doctor unwrapped the cord from the baby's neck (not a single decel! Amazing!) and pulled him out. She clamped his cord and Tony cut it, as was stated in the couple's birth plan.

The baby's APGARs were 7/9 and he was born at 5:14 a.m. after about two and a half hours of pushing. He was 8 lbs and 2 ounces. 

As per Kyla's request, he was not put directly on her stomach, but instead taken to the warmer, weighed, wrapped and bundled up first. 

Kyla chose to have only her partner and me, her doula, in the room with her while she gave birth, but it turns out that the rest of her support team was standing right outside the door of the birth room, watching the computer monitor to see as best as they could, how things were going. Once the baby was wrapped, Kyla got a chance to hold him.

This month's blog post is late. Maybe your baby is too. There are lots of fancy words for it, overdue, past dates, postdates, postdate pregnancy, but no matter what you call it, the main issue is that you had a countdown going that's now gone into the negatives ...

If you find yourself in this situation, its likely you've considered googling "natural induction techniques" because you are, to put it quite plainly, tired of being pregnant. Emotionally, you feel like your baby should be here by now and each day that you don't go into labor makes you feel more and more like you just never ever will.

The good news is that actually, the opposite is true. The later your pregnancy goes, the more likely you are to go into labor on any given day. Here is a wonderful chances of labor calculator that gives a visual representation of how as each day goes by, the chances that today will be the day just get higher and higher. 

Of course, this doesn't necessarily mean that its 100 percent safe for you to remain pregnant indefinitely, there can be medical reasons that babies need to be evicted. If you go over dates, your doctor or midwife might refer you for a NST or BPP to check on the baby. If they let you go home afterwards, your baby is fine.

I get asked all the time, "But isn't there something I can do to help get this baby out?" and the answer is, well, maybe? Sometimes having sex can work well if you were close anyway. Other people swear by spicy food or eating pineapple, but I've never seen much come of these. Long walks never hurt. But I caution you to be careful about doing anything more drastic than these gentle nudges. If you are trying to avoid a hospital induction, ask yourself, why? Is it because you feel it is unnecessary? 

In that case, why are you trying to induce yourself? Taking something, such as castor oil, to try to get labor going is still inducing. Sometimes it doesn't even work and you find yourself suffering miserable pain and still pregnant. Other times it works too well and your body goes into hard labor quickly without a chance for you to build up your coping skills. Think of it this way, at least pitocin can be reduced or stopped if baby has trouble dealing with the intense contractions it can cause. 

I stand by my business name. Your best bet is to wait it out. And yes, I will still be waiting with you. 

Pregnancy is not a dry event.

No one tells you this ahead of time, but by the end of it, you will either be changing your underpants many times a day, or making good friends with a box of pantiliners. Even just normal vaginal fluid often greatly increases throughout pregnancy, not to mention sometimes leaking a bit of urine while coughing, laughing or perhaps even sleeping.

But what if you wake up soaked? How do you know what it was and what to do about it? The first thing you need to do is get yourself to a bathroom and observe a few things. Do you need to pee? Can you pee? If you can, then you should! Is there any red or pink on the toilet paper when you wipe? If yes, this is a great sign. Next, go back to the wet spot (either in your bed or in your underpants) and observe the color of the fluid in question? Urine is light yellow and has an odor everyone is familiar with, especially when you get up really close for a good whiff. Amniotic fluid is clear* and has either no odor*, or can occasionally smell a touch like semen. If you've had sex in the last 24 hours, this is a consideration, but if you haven't or there is a LOT of liquid, this is likely not the culprit.

The next test is to put on clean underpants and wait awhile. If your water has broken, more often than not, it will continue to leak. If your new underwear is wet within the hour, its a pretty safe bet that you are ruptured. (That's doctor-speak for YOUR WATER BROKE!!!!!!)

However, if you still aren't sure, put on a maxi pad (the kind you'd use for a period) and try to go back to sleep. The next time you wake up to pee -- it won't be too long, you're 9 months pregnant, remember? -- check to see how wet the pad is.

It is also possible for your bag of waters to spring a leak and leak slowly for a few days. This kind of leak can sometimes lead to labor and sometimes it will repair itself. True story. 

Another little-known fact is that your water can break TWICE! Each amniotic sac is actually comprised of an amnion and a chorion, like two balloons, one inside the other. Most of the time, they break together, but occasionally, just the outer one will break and then later the inner one will. If you think your water broke, but you do not continue to leak fluid, this might be what has happened. Another theory is that sometimes the baby's head will come down and plug up the hole, stopping the water from leaking, but that one can usually be easily fixed by changing position. Stand up, sit down, lay down, do some yoga poses. When you stand back up again, if your water is broken, you should get some indication of a leak.

What to do if it IS your water?

Call your doula and your care-provider. Remember every birthing practice has different rules on this. Some want to induce five or six hours after a water break (if you aren't having contractions already, that is) others will wait 12, others 24 or more. In some parts of the world, the rule isn't that the baby should be born 24 hours after a water break, its that the baby should be born 24 hours after the first vaginal exam.

Standard of care may be different if you are GBS positive. Some women have had luck going in, getting their IV antibiotics, and then being released again to wait at home as planned until they are in active labor. This is definitely a policy that will be different everywhere you go. If it's important to you, ask!

Do not have sex or try to check yourself if you suspect your water may be broken. It's the act of pushing the germs UP toward the baby that increases your risk of infection. If you are clearly not in labor yet, and you are sure your water is broken, there's no rule that says you have to let your care-provider check you at that point either. Why introduce more risk?

If this happens to you (remember, only about 10 percent of labors begin with a water break) then you have a lot of choices to make. Do you induce? Wait and see? Try to get things started more naturally? Talk with your partner, your doula and your care-provider to figure out what will work best for your situation.

Happy laboring!


*If the liquid in question is green or brown, or has a foul smell, call your care-provider ASAP

This guest post is by Elizabeth Carrollton. I feel that this is an issue that is much more common than most people realize. I especially like the prevention tips at the end of the article.
~Suzanne DeSelms


For most women, childbirth seems like the hardest part of the journey through pregnancy and the postpartum period. It is hard work, both physically and emotionally, to experience the process of pregnancy, childbirth and motherhood.

However, once the hard work and discomfort of childbirth has been forgotten, a woman's body is still working hard to heal and recover from the dramatic changes that have taken place. Connective tissues need to shrink and regain their strength, abdominal muscles slowly regain their tone, and organs that were dramatically affected by the enlarged uterus have to migrate to their original positions in the pelvic cavity.

If women are not careful to prioritize their physical and pelvic health in the long run, they can find themselves susceptible to a condition called Pelvic Organ Prolapse (POP). In most cases, POP is diagnosed when women are nearing or experiencing menopause. However, in cases of pelvic injury
or trauma, it may be diagnosed earlier on.

Pregnancy and childbirth are the key factors in developing POP, however,
smoking, obesity, menopause and/or a genetic predisposition can also play a
role in its development. Attention to pelvic health during and after pregnancy can help women avoid developing POP, or keep its symptoms in the mild to moderate range.


Preventing Pelvic Organ Prolapse After Childbirth
There are several things women can do to prevent the onset of POP after
childbirth. While it's never too late to focus on pelvic health, the sooner
women act to prevent POP, the better.

• A healthy lifestyle
As mentioned above, smoking is a common factor in POP because chronic coughing puts undue strain on pelvic tissues. Women should try to quit smoking as soon as possible. Eating well, exercising regularly and maintaining a target weight can also help to keep pelvic tissues and organs healthy and strong.

• Pelvic floor exercises
There are specific exercises that can help women strengthen their pelvic floor and upper vaginal muscles. These can play an important part in postpartum recovery, in addition to staving off the symptoms of POP. Kegel exercises are the most famous type of pelvic floor exercises, but an OB-GYN or health care practitioner can suggest additional exercises.

• Pelvic physical therapy
Women who have experienced a traumatic vaginal birth, or who have a family history of pelvic organ prolapse, may want to consider seeing a pelvic physical therapist. The therapist can suggest additional exercises, utilize electrical stimulation if necessary, and suggest other lifestyle changes that can help promote pelvic health.

• Pelvic massage
Postpartum and/or pelvic massages have been shown to be effective when
used in conjunction with other preventative measures. Maya massage, Shiatsu and Myofascial Release are massage techniques that can realign pelvic organs, increase circulation and facilitate postpartum healing.

These preventative measures can also be used as conservative treatment options for women diagnosed with POP. Many established medical organizations advise that women use the most non-invasive and
conservative methods for treating POP symptoms, before turning to surgical intervention.

If postpartum women are proactive in maintaining a healthy and strong pelvic floor, they will be less likely to develop POP or require surgical treatments. That's good news, since one popular surgical treatment — using transvaginal mesh implants — has proven to have a high rate of complications. 

In fact, there have been several vaginal mesh recalls after reports of problems.


Elizabeth Carrollton writes to inform the general public about defective
medical devices and dangerous drugs for Drugwatch.com.

Have you ever wondered how it is that all women dilate to 10 cemtimeters, no matter whether they are giving birth to a four and a half pound preemie or a ten pound linebacker?

Well, the short answer is that they don't! In the initial stages of dilation, a doctor, nurse or midwife will feel the opening in the cervix, and tell you the approximate diameter of that hole. So from 1-4 or 5 centimeters, they are actually measuring it just how you would imagine.

But from 5 or 6 centimeters until 10 centimeters, what they are really measuring is how much cervix is left, and then subtracting from 10. So an "8" doesn't necessarily mean that there is a hole that is exactly 8 centimeters in diameter, it means the care-provider feels approximately 2 more centimeters of cervix remains. Many women do not dilate in a perfect circle. Often times, the cervix will dilate in an oval shape, or a pear shape (that's what causes the famous "anterior lip,"  which is a subject for another post) and the care-provider will round or guesstimate when assessing dilation.

Most moms are taught that 10 is the magic number, and are then confused when alternate terms are used. Personally, my favorite term is "complete" because it is accurate and hard to misunderstand. But recently, I have heard several doctors or nurses tell a woman that her cervix is "gone" or that there is "no cervix left" which can be very confusing! Most people associate the word "gone" or "no" with the number zero, which can feel to the woman like she has gone backwards. She wonders, "Wait, if I was 6 centimeters at my last exam and now they are saying there is no cervix, what does that mean? Have I gone back down to a 0?"

She is waiting to hear that magic number 10, which many care-providers never use because it is an arbitrary made-up number. Some women will be complete with a "hole" that is only 8 centimeters in diameter, others will dilate to 11 or more!

Remember, "10 centimeters" and "complete" both mean that there is no more cervix blocking the baby's exit. Often all the care-provider will feel at this last exam is the baby's head. So if your doctor tells you your cervix is gone, now you know that's a good thing!

What is prodromal labor? In short, it is contractions that do not just continue to get longer, stronger and closer together until a baby is born. Also sometimes known as "false" labor, prodromal labor contractions may have a pattern, or they may not. They may be painless, similar to Braxton Hicks (practice) contractions, or they may be painful enough to warrant the mother believing this is the real thing.

The reason that the term "false labor" has fallen out of fashion is because it is discrediting the mother's experience. Calling her sensations a "false labor" could make her feel invalidated. She wonders, "Did I imagine that pain?" and "If this was false labor, what's real labor going to feel like?" She might also doubt herself. "They told me when it was time, I would know, but then I was wrong!"

The thing about prodromal labor is that although it can happen in any pregnancy, it is more common in a subsequent one. This can be an extra frustrating to an experienced mom who has already been through labor before and is just sure she will recognize it when it comes again.

Another important reason to shy away from calling it "false" labor is that it incorrectly assumes that the contractions aren't DOING anything. This is simply not true! Every contraction does something, whether it is toning the uterus (like warming up before a long run) or making changes in the cervix.

Labor progresses in six ways, but most people only think of dilation when talking about whether a woman is progressing. Prodromal labor contractions often prepare the body for labor in one of the other ways, such as moving the cervix from posterior to anterior (from back to front) softening/ripening it (it goes from firm like the tip of your nose to soft like your lips) or effacing/thinning it. This is the shortening of the length of the cervix, often measured in percents. If you've ever seen my balloon demonstration, then you understand why effacement is so important!

These changes may all take place in one fluid, linear labor (more common in a first pregnancy) or in choppy pieces (more common in subsequent ones). Often women will notice that contractions will come in the evening, maybe even starting to establish a pattern. If they are smart, these moms will first text or call me to give me a heads-ups, and then eat, drink and go try to sleep. Perhaps they will wake up the next morning and realize, "Guess that wasn't it!"

If it is it, hopefully they can catch a few hours of sleep or even just some rest before things get really intense.

True active labor contractions will get longer, stronger, and closer together. No matter what you are doing. Walking, resting, bathing, showering, thinking about them, not thinking about them, timing them, ignoring them or wishing with all your might that they would go away. It won't matter.

Prodromal labor, however, will usually respond to changes you make. Often drinking more water will help quiet these contractions down. Also, sometimes a long prodromal labor (non-patterned contractions over days or even weeks!) can be because your body is trying to move your baby to a better position. Try the Miles Circuit to help with this one.

And remember, I always want to know what's going on. I would rather have many "false alarms" then have a mother NOT call me when its really time because she isn't sure that this is it. Think of it this way. You can be 100 percent sure that you know when NOT to call.

Am I in labor right now? Nope.
Could I be? Nope.

If you can't answer nope to both of these questions, its a good idea to give me a heads-up. If nothing else, I will listen to you have a contraction or two on the phone and let you know what I think and set a time for us to check in with each other again.

Happy laboring!

The most common question that pregnant women ask me is, "How will I know when it's time to go to the hospital?"

Many express an interest in staying home "as long as possible" especially those who desire a natural birth. But how long is that exactly? And how do you know when its REALLY time to go?

In order to answer these questions to best serve the needs of the individual mother, the first thing I need to find out is how strong is her desire to birth naturally? I use a 0-10 scale, but I have also seen a -10 to +10 scale used. The top of the scale is an unrealistic desire to feel no pain at all, to have medication begin before labor does. The bottom of the scale is an unrealistic desire to not use pain medication at all, even if there is an emergency.

If a mother answers that her desire to for a natural birth is at a 1-3, I will recommend she stay home longer than the hospital tends to suggest, especially if it is her first baby. Hospital policy used to be the 5-1-1 rule, but recently I've heard it being replaced with the 4-1-1 rule, especially for mothers who do not want interventions.

The rule means that when your contractions are four minutes apart, lasting at least one minute each, and have been that way for at least one hour, the hospital would like you to come in. 

The problem is that, especially with a first baby, this 4-1-1 usually doesn't mean you are close to giving birth. It just means that active labor is well established. If a mom expressed a desire to stay home as long as possible before labor started, I will remind her of that when she is laboring well at home and has reached 4-1-1. Of course she can change her mind, and if she truly wants to go in, we will. I remind moms at their prenatals that I am not the hospital police!

A great compromise that can happen when a mom feels that she couldn't possibly bear the car trip with contractions any stronger than the ones she is experiencing now, but maybe isn't quite as far along as she planned to be, is lobby labor! This is exactly what it sounds like. 

She gets the car trip out of the way, but instead of checking into the hospital,
just starts walking around the hospital's lobby. Many hospitals have beautiful
fountains to look at, or if it's a nice day, she can walk outside on the grounds. This way, she is not on the hospital's clock yet, but if something were to suddenly change, she is already right there and ready to check in.

Just to be clear, lobby labor is not the same as going in, getting checked at triage and then being told to walk for an hour. This is what happens when a mother shows up to the hospital too early in labor even for the hospital's standards. In most hospitals, it's usually defined as four centimeters. Lobby labor is driving to the hospital, but not alerting the staff or your care-provider of your presence until you feel that you are ready to check in. It's like you're still at home, but a lot closer. For many mothers, this option can offer peace of mind.

Question: Why make sounds along with the birthing mother? Isn't your calm presence enough?

Answer: It absolutely depends on the individual person, the emotion in the room, and what part of labor she's in. For the beginning of labor, the mother breathes through contractions and I breathe with her. My breathing guides hers. I help her control the speed of her breathing and how deep she is breathing, not by telling her she's doing it wrong, but just by modeling how to do it right.
 
If/when she begins to make noise, the principle remains the same. Deep, low, moaning sounds are productive toward birth. They are empowering. However, high-pitched screaming sounds are not productive toward birth. They are fear sounds, it usually means she is not on top of her contractions, they are on top of her, so to speak. By helping her control her pitch, I am helping her to keep fear and panic away. When I moan with her, I keep my sounds a touch lower and a touch more controlled than wherever she is at. It serves as a guide. Often, she will match me in pitch, as if I am the conductor. But at the same time, she is the one who is choosing the song, since she is the one who is in the experience. 
 
The last reason for moaning and later roaring along with the mom is so that she doesn't feel so self conscious. Many women are afraid of losing control in labor, and afraid of the sounds they might make or that they will look or sound stupid to others around them. They don't want to "bother" others. They don't want to scare their partners or to be judged by people in the hall or lobby. You know how it is much easier to sing in front of a crowd of people if you are part of a group than if you are doing a solo? By making her sounds with her, I am essentially giving her permission to express herself and not feel like everyone's eyes are on her. Her birth is no longer a solo, it becomes a duet! Sometimes partners or nurses will even join in. Most moms love this!
 
I did hear a story about a woman who told her doula to shut it, but it hasn't happened to me yet. If a client told me that she would prefer a quiet birth, I would be happy to support her in maintaining her best birthing environment. But for the most part, these aren't the women who are making the roaring sounds in the first place. Everyone is different, so of course there are mothers out there that would get more out of the doula being quiet, even while they roar, but I just wanted to stress that loud and calm are not necessarily opposites. My presence is both.