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Labor Day: We Asked a Midwife
What to Expect

If there’s one thing the experts agree is guaranteed about pregnancy and birth, it is that “it will likely be very different from whatever you might be imagining.” This is Julia Bower, a CNM (certified nurse midwife) in Austin, Texas. Bower has delivered over 800 babies in her over her twenty-plus-year career. In case you are unfamiliar, certified nurse midwives like Bower are health care professionals who have a graduate degree in midwifery and have passed a certifying exam. Certified nurse midwives (as well as certified professional midwives, though they don’t necessarily have a degree) are licensed by their state* to provide much of the same care as ob-gyns and are experts in low-risk births.

We asked Bower to give us her unfiltered play-by-play of childbirth.

Step by Step

Pregnancy

  • The baby and the mother grow the placenta together.

  • The placenta is known as the Tree of Life.

  • Hormones will darken your nipples and create a line on your lower abdomen, called the linea nigra, during pregnancy, but good news: Both usually go away.

  • People often worry about sushi, but a more dangerous food during pregnancy is raw or undercooked meat: You can get toxoplasmosis from it, which can seriously harm the baby. Bad sushi might give you food poisoning, but that just hurts you; it doesn’t pass to the baby. But limit tuna and high-mercury fish and eat only very fresh, high-quality sushi.

Labor and Delivery

  • On average, a first-time mother (if not induced) delivers six days after her due date.

  • Not many babies are actually too big for a vaginal delivery. Ultrasounds are notoriously inaccurate in estimating fetal weight in the third trimester. They can be off by two or more pounds in the last month of pregnancy and should not be used to justify induction.

  • A woman will leak fluid, mucous, and blood from her vagina. Let me put it this way: Almost all women poop a little when they’re pushing; almost none of them care. But it’s something to think about when considering whom to invite to the birth.

  • Some people nap during labor, even if for just a few minutes off and on between contractions.

  • Self-control is not helpful in labor. Even though they’re in great shape, superathletes actually can have harder labors in my experience. It takes a lot of self-control to run an ultramarathon, but mind over matter just does not work when you’re having a baby. It’s really important to let go in labor: You can’t muscle your way through it. Some athletes find labor more challenging than a marathon, for example, because we do not know exactly where the finish line is and when we will cross it. Will it be in six hours or forty-eight?

  • On the other hand, runner’s brain can be helpful—if you love that feeling of getting into the zone when you’re working out, that’s a great place to be during labor. Similarly, a meditation practice can really help you in labor.

  • The best way to jump-start labor or get it going is to use a double breast pump for an hour or more (with breaks). But I do not recommend stimulating labor unless medically necessary—I think if everything looks good with the mother and baby, women should talk to their provider about going into labor on their own. Stimulating the breast stimulates oxytocin production, which stimulates contractions. Castor oil also works for some people, but usually people do not take enough to stimulate labor. You generally need two to four ounces, depending on whether you tend toward constipation or diarrhea.

  • Coconut water is great to drink during labor—it gives you electrolytes without the sugar.

  • Many hospitals and doctors use a time clock for progress in labor that’s determined by the Friedman Curve. It was developed in the 1950s. A doctor named Emanuel A. Friedman took averages from the labors of first-time moms (many of which had been given drugs to spur contractions) in the hospital and concluded that women should dilate at one centimeter per hour. This conclusion (and other aspects of the Friedman Curve, including when active labor should start and how long women should push) have been disproven, but many practitioners still use it as a guide or rationale for recommending pitocin or C-section, when really what she needs is more time.

  • The common point at which labor can stall out is six to seven centimeters, right before transition, the most intense phase of labor. Women can hover here for a while before they realize they cannot control the labor. If given time, most will choose to let go into the power of their experience and make the transition to the pushing stage. The best thing to do is to wait, try a different position, walk, take a nap, take a shower, get in a tub, or (and) try to rest and relax to get ready for transition and pushing.

  • The first labor is typically longer, the second is faster, but the third and beyond can go either way, with some starts and stops. But it is almost never as hard as the first.

  • Most babies come out blue. They pink up as they start to breathe with their lungs, but people often panic when they first see the baby.

  • About a quarter of all babies have their cord wrapped around their neck in some way. It’s the first thing you check for when the head comes out, and if it is wrapped, then you slip it over the head as the baby’s coming out. It becomes a problem only if it’s super tight, which is rare.

  • The umbilical cord keeps pulsing and delivering nutrients and oxygen to the baby for up to an hour after birth, so we wait to cut the cord until it stops pulsing, so that the baby gets all of it, including valuable stem cells.

The Aftermath

  • Research shows that tears heal less painfully than episiotomy.

  • If you’ve had a C-section or a long, hard labor, it’s normal for your milk to take longer to come in.

  • Nursing can be the most difficult postpartum issue for most parents. It hurts; it’s emotionally trying—you’re struggling to nourish your baby: Plan for support. If you get good support, it gets much easier.

  • Ideally, couples will plan for support for the first two weeks postpartum from family, friends, or postpartum doulas to help with laundry, grocery shopping, cooking, cleaning, etc.

  • Your nipple dispenses breast milk through a few small holes, like a showerhead, not a hose.

  • Putting cold green cabbage leaves on your breasts will help if they are engorged. (Purple cabbage leaves don’t have the same chemical in them so they do nothing for engorgement.)

  • If your breasts are engorged, it can be hard for the baby to latch on—your breast is like a bowling ball. If you apply a little heat and express a little milk out, it’s easier for the baby to latch on.

  • You really need to stay on top of fruits and vegetables after birth to get your GI tract going again (especially if you’ve had an epidural or opiates, both of which slow down the GI tract even more).

  • You can read the books, go to all of the classes, and watch that one DVD (you know it if you’ve seen it). But odds are, you’ll still find yourself feeling unprepared at go-time. And that’s just fine.

*Both certified nurse midwives and certified professional midwives pass national certifying exams: CNMs pass an exam by the American College of Nurse Midwives, and CPMs pass an exam by the North American Registry of Midwives. CNMs more often work and are trained in hospitals; CPMs mostly work and are trained in out-of-hospital birth settings (home and birth centers).

Julia Bower, C.N.M., is a registered nurse and midwife living in Austin, Texas. She has a Bachelor of the Arts in Human Biology from Stanford University and her Bachelor of Science from Johns Hopkins University. She began her career as a Labor and Delivery nurse more than twenty years ago. In 1997 she completed her graduate degree in nursing from the University of New Mexico, focusing on nurse midwifery. She opened her own homebirth practice in 1999, providing prenatal, birth, postpartum, and newborn care. She has delivered more than 800 babies in her career and is a member of the American College of Nurse Midwives and the Association of Texas Midwives and is a Texas Advanced Practice Registered Nurse.

The views expressed in this article intend to highlight alternative studies. They are the views of the expert and do not necessarily represent the views of goop. This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.

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