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Part 1: The Labor 

[00:00:00] Right. Hello, tribe. All right. It's Tuesday and I'm on call this week, and that means laborers. So I decided let's talk about the laborers as I keep talking about it. So there are different times that your doctor might tell you to call so that you can go into the hospital. It's not always cut and dry. 

Many of you are gonna take a childbirth education class. Many of you are not. Some of you might have a doula right now during covid, many of you probably don't have doulas because a lot of hospitals are only. One birth assistant and that person is probably your partner. So that leaves a lot unknown for a lot of patients. 

And what we consider as the doctor's like, oh, it's very clear. This is what you need. And don't worry. We know that it causes a lot of anxiety for you. So I wanted to just review. These are my things I tell my patients, you should ask your doctor. She might have a different set of reasons for you to call. 

She might feel more comfortable with you staying at home at times that I might tell my patients to go in or vice versa. So certainly run these things by your [00:01:00] doctor, but let's kind of break down towards the end of the pregnancy. Pregnancy is considered basically, even though we say nine months, it's really 10 months because your due date, your e d d, estimated date of delivery or edc, estimated date of confinement is 40 weeks from your last period. 

That's the day that you are due. But we all know that babies don't necessarily come out on those days. People, the babies can come out anywhere from 37 to 41 weeks and be considered full. So that means that in my book, when I start talking to my patients anytime after 36 weeks, which is typically when we do the beta strep culture, to look for the bacteria that you might carry that might warrant you needing antibiotics in labor. 

That's when I start saying these words, Hey, any day now you might go into labor. It could be today, it could be tomorrow, it could be next week. I say some version of that because what I really want patients to understand is, Oh my gosh. The unknown. As much as there's actually no predicting when it's gonna happen, most patients aren't gonna [00:02:00] go into labor at 36, 37 weeks. 

Most of 'em are gonna go closer to their due date, but I am never shocked when I've seen a patient, she seemed fine, she had no complaints of labor, and then all of a sudden, I wake up and I find out, wow, she went into labor in the middle of the night. I'm never shocked if it's any time after 36 or 37 weeks, 36 weeks is still considered preterm, but in many hospitals, at least in our hospital, you, the baby does not have to go to the NICU unless there is some reason, meaning if the baby is under 36 weeks, our NICU automatically puts the babies there because. 

Younger babies and smaller babies sometimes have trouble with their temperature regulation and other aspects like feeding, whereas babies over 36 weeks don't. So even though 36 to 37 weeks is preterm, those babies in our book don't need to go to the nicu. So what would we do after 36 weeks? Well, that's the time where you start seeing your doctor every week, and that's typically because there's always that small chance towards the end of the pregnancy. 

Even if you've had no issues, your blood pressure might go up. So that's why you see the doctor Weekly. They will [00:03:00] always weigh you. Dip your urine, check your blood pressure. These are not the times, even during covid to miss those appointments unless you've really had a detailed ex, um, discussion with your doctor about things that you could do at home if you happen to have a blood pressure cup at home, things like that. 

But that is not something at the end where we would feel as comfortable with you kind of. Scr, um, stretching out the intervals during your, your appointments because the end is when all of a sudden things might happen outta the blue. And if we all keep our wits about us and are proactive, we can take care of those things and still be safe. 

So how is labor going to show up, especially for first time moms? Let's talk about that first. Labor can take a really long time, like when I. Long time. I don't just mean hours, like 10, 12, 15 hours. I mean, it can be 24, 36 hours of labor and sometimes that's true labor and other times you'll have all of the makings of labor. 

It will be really painful, but you'll kind of either be home, back and forth to the doctor, to the doctor's office or back and forth to the hospital being told you're like [00:04:00] fingertip. One centimeter barely changed and it's so frustrating. But that's what many of us will label prodromal labor, meaning this pattern that is. 

Before the actual labor starts, but it's really frustrating. It's very painful. It can be really confusing and sometimes it's just so exhausting that patients really need some good sleep. So what we used to label therapeutic rest, we don't do it as much anymore, but some hospitals still probably do, and I certainly would offer it to patients if they need, if they're coming in into the ho, in and outta the hospital a couple times where everything's fine with them, everything's fine with the baby. 

they're contracting, they're in pain, but they're not yet in active labor where their cervix is starting to change, we will actually give them medication, like morphine to help them sleep, and it somehow seems to either kick them into a good labor pattern or stop everything altogether. So that's a prodromal situation where you're just frustrated because you're in pain. 

It's. Coming and going just like contractions, but it's not making your cervix change. The four times. I tell patients that they should call us because these are signs of labor where we would say, go to [00:05:00] the hospital. Three are fairly straightforward. If you think your water breaks. Now my. My, um, caveat too, it's straightforward is sometimes there will be a gush of fluid. 

You'll think it's your water, but you're actually not sure. Is it my water? Is it pee? Did I have discharge? Sometimes if you've had intercourse, the semen sits there and it electrifies and that gushes out. So to me, when I say if you think your water breaks, what I mean by that is if you have a big gusher fluid coming, Please call us because we're not sure if it's your water or not, but we should send you to the hospital or bring you to the office to check it out, because at least for me, I don't love the patient staying home for too long. 

A couple of hours might be okay, but I don't want them home for 12 to 24 hours waiting for labor. That doesn't mean that it's wrong for you to stay home for 12 to 24 hours. Your doctor or midwife might feel comfortable, so talk to them about it. But I don't typically, and my partners don't because we like patients to be where we can kind of watch them once the water has. 

Sometimes that kind of cushion around the baby is now leaking out. [00:06:00] And so the umbilical cord can sometimes get compressed, which is rarely anything concerning. But we like to be able to monitor the baby and the chance of infection tends to go up a little bit. Again, it doesn't mean anything dramatic. 

Your water broke. Oh my God. Rush to the hospital. It means, Hey, I think my water broke. Okay, take a shower, go to the hospital. What if you're GBS positive? Same thing. You don't have to rush to the. But I would say don't dillydally, because when your water's broken, you're going to get antibiotics for that beta strep, the G B s bacteria. 

So again, one is if you think your water broke, two is if the baby's not moving in the same pattern that you're used to by the end of the pregnancy, you might have noticed the baby's movements have decreased a little bit, but the baby should still be moving, so you shouldn't be like, Hmm, baby's not moving at all. 

And I think that's really normal cuz the baby's getting bigger and the fluid's getting less. To me the answer is no, that's not right. Your baby should still be moving. Maybe not as vigorously, maybe not as frequently. A slight difference in your movement is very common as the baby gets bigger and the fluid gets [00:07:00] less. 

But you should have already been able to establish that this pattern is what I'm used to, and if it's suddenly really different. You should call a doctor. It's rarely anything terrible. It usually just means the baby was taking a nap, and once you get to the hospital, things are okay, but occasionally it's a sign that the baby is saying to us, Hey, I don't wanna be in here anymore. 

This placenta's kind of done it's work because the placenta is what is helping feed the baby. And the baby can only get so much oxygen, nutrients from the placenta or towards the end. That sometimes changes. Again, it's rare that it causes anything really concerning, but it's not something to. Third is if you are bleeding, and I say to my patients, if you are bleeding like a period, because you might notice you pee and then you have some kind of a schmear of pinkish or a schmear of brownish stuff, that's usually just the beginning of your mucus plug starting to dissipate. 

That might be. Your cervix starting to change. If it's, even if it's really mucusy, bloody, it might be your bloody show, but that's typically okay. Again, to me, please ask your [00:08:00] doctor. Um, but if you're bleeding like period, that can mean something else. So it's important to go to the hospital because occasionally it's just that your cervix is changing quickly. 

But occasionally it's that the placenta has decided that it wants to detach a little bit. That can happen frequently. It actually just happened to a patient of mine last week. We suspected it. Her placenta seemed like it had detached a little bit. She was bleeding a tiny bit more during labor than we are used to seeing. 

We discussed it. We knew the precautions. The baby was fine the whole time the baby came out. There was no issue with it other than just being alerted to it because sometimes when someone bleeds heavily, they can have uterine contractions that are either too intense or their uterus can relax too much. 

So again, if you think your water. If you think the baby's not moving or if you think that you're bleeding like a period, those are three obvious times that you should call the doctor, in my opinion. Please ask your doctor. I didn't mention the mucus plug, did I? No. Cuz the mucus plug really is pretty inconsequential to us. 

You guys seem to get really [00:09:00] excited about the mucus plug and there are like things, people talking about it in plugs and stuff like that. But when patients call us sometimes at like four in the morning like, Hey, I lost my mucus. , we're all like, uh, okay, that's, thank you. Goodbye. Goodnight. Go to sleep. 

We'll see you maybe in a couple days. Who knows? Because your mucus plug does not signify anything other than the cervix, which was a tube that had a clog of mucus in there, could no longer hold that clog. So it either came block like out like a big snot, or you might not have noticed it because slowly over time, as your cervix is starting to thin out, that mucus plug is just dissipating. 

And that's why you're noticing a lot more like just mucusy type of discharge without it being. Blob of stuff. So again, maybe your doctor wants you to call her. I'm betting now. Don't call her with your mu blood. Okay? The fourth time you should call in labor, which is the most challenging cuz it's what is hardest to kind of define is when you think you're in active labor. 

What I describe to patients is this, you might have really hard, tight pain. I mean a hard, tight uterus that feels weird and not exactly painful, [00:10:00] just weird. Those are probably Braxton Hicks, like hard, tight, not exactly painful, just weird and uncom. Braxton Hicks also called false labor, which I hate that term, also called painless contractions. 

Hate that term because they're weird and not painful, but super uncomfortable. But again, hard, tight, not painful, most likely Braxton Hicks or cramps like a period down below without being hard and tight. Probably Braxton Hicks. As long as the baby's moving, as long as you're not bleeding, as long as your water hasn't broken, stay at home. 

What if you start having contractions and they're every like six to eight, eight to 10, 10 to 15 minutes every five minutes for 10 minutes, and then every five minutes for 20 minutes and then it goes away. Those are all contractions. Those are probably early labor, but that means that you still might take 10, 12, 15 hours and again, as. 

The baby's moving. You're not bleeding and your water hasn't broken. Many of us would encourage you to stay home because once you get to the hospital, interventions happen iv. You can't necessarily walk around as much. You [00:11:00] can't necessarily eat and drink as much. All these little things, drinking actually has changed cuz most hospitals will allow you to drink clear liquids during labor. 

But again, ask your doctor. So what I say to patients is this, once you start having rock hard pain every five minutes for at least an hour, and you cannot even look at your partner. , that would be a good time to call us now, even better would be every three to five minutes because then you're most likely really in labor. 

It's really frustrating for you guys when it's your first baby to get to the hospital and be told like, Hey, you're one centimeter. I know you've been contracting for five hours. So in an effort to avoid that, the longer you can stay home, the better. But we also encourage patients to call us so that we can help walk through it with them. 

Second babies tend to go much faster, so I don't say that at all. What I already said with the first babies, I don't say that with the second babies. If your water breaks, you call us on the way to the hospital. If you're having contractions every six to eight minutes, you call us. Cuz you might go really fast. 

You might go from like my water broke. I feel great to like, holy cow, baby's coming out within an hour. So again, second time Mamas, you guys call your [00:12:00] doctor. . And another thing I want you guys to know that can happen in labor, because it can be really nerve-wracking, is when you're there and the nurses are watching and the doctors are watching, the baby's heart rate might all of a sudden go down. 

The heart rate is merely a reflection to us of what's going on from the oxygen point of view, and that can have to do with how much fluid is around the baby. Where the umbilical cord is, is the umbilical cord getting compressed, which it does often, which is often not dangerous, but something we see. 

What's the placenta doing? So it's a reflection. It's not the heart baby's actual heart problem. When we see the baby's heart rate drop, it's nothing to do with the heart. It has to do with the reflection of the baby's oxygen levels. So it's not uncommon for you to be lying there trying to take a nap with your. 

Partner there, and then all of a sudden 50 people run into the room. They flip you around, they put oxygen on. Maybe if they're still using oxygen, that's changing. They put you on all fours. Sometimes it's really nerve wracking and in the thick of it, people sometimes forget to say to you, you're okay. The baby's okay, but we have to flip you around. 

Two, try to get that position better so that the baby's heart rate goes back up to its normal baseline. [00:13:00] So if that happens, I know it's freaky. I know it's nerve-wracking. We always try to remember to include the patient and communicate, but sometimes we don't. And I apologize on behalf of the doctors and nurses for that, but just know that nine times outta 10, when that happens, things are okay. 

Sometimes it's a sign that the baby needs to come out sooner, and sometimes it's a sign that you're gonna need a C-section, which is also okay, as we talked about. So those are the signs and. Of Labors, labor can take a long time. Labor can be frustrating. Labor ends sometimes in vaginal deliveries and sometimes in C-sections, and as long as you and the baby are okay, that's really the most important. 

Ideally, that's happened in a situation where you felt like you've had communication. So I encourage you to try to talk to your doctors and nurses about this, and we should be all doing as good a job as we can about discussing things with you and including you so that you have a better understanding. 

You also have to remember that we've done this for a long time. Like we've gone to medical school and residency, so we can't explain everything because it would be impossible. That's why we do what we do. Just like the teachers can't explain everything to me about how they're gonna teach my children, but we can certainly include and do a better [00:14:00] job of communication. 

So I hope that helps. I'm gonna be going to the hospital soon cuz they got someone in the labors and that is it.