If you’re pregnant and approaching your due date (or have already watched it come and go), it can be hard to think about anything other than your impending labour and delivery.
You may have packed your hospital bag and talked through your birth plan with your partner, doula or medical providers, but no matter how many articles you read, podcasts you listen to, or YouTube videos you watch, you won’t truly know what birth feels like until you get there.
This element of the unknown can be terrifying or exciting – and sometimes both.
Since there’s so much variation between one birth and the next, no one can reliably predict for you what yours is going to look like. It can, however, be helpful to address your biggest concerns and fears beforehand.
We’ve rounded up a list of the things you’re most likely to wonder but least likely to ask (yup, including that). Below, experts who have witnessed the arrival of many babies share the gritty details of what goes on during labour and delivery.
Am I going to poo?
While there is a real likelihood that some poop will come out of you while you’re pushing, a nurse or midwife will probably have it cleaned up before anyone (even you!) has a chance to realise that it happened.
It’s also possible that by the time you reach this stage of labour, the thought of a little public pooping will no longer bother you at all.
“Most birthing people lose all inhibition at some point in labour and don’t really care if they poop in front of other people,” Lisa Greaves Taylor, founder of Birth Matters NYC and director of East River Doula Collective, told HuffPost.
“Hospital staff don’t make a big deal out of it at all ... it’s almost like it never happened; they don’t fuss and clean it up quickly and discreetly,” Greaves Taylor continued, adding that if your partner is up near your head while you’re pushing, they probably won’t see it.
“It’s not really possible to prevent it,” labour and delivery nurse and childbirth educator Mandy Irby told HuffPost. “It’s pushed out either by the pushing muscles when you’re pushing your baby low into the pelvis or by the baby’s head as it squeezes through the pelvic outlet.”
How bloody is it going to be?
While, again, this varies quite a bit between one birth and the next, Greaves Taylor said there’s not usually an alarming amount of blood involved, and it’s likely to be less than what you fear.
“You might have something called ‘bloody show’ which is like period blood during labour. As long as you’re not changing more than one heavy duty/overnight maxi pad per hour, this is within the range of normal,” she explained.
Bloody show can also occur hours – or even days – before your labour begins. There may be some blood that comes out with your mucous plug as your cervix starts to dilate and prepare for labour. The mucous plug seals the opening of your cervix to prevent germs from entering while you are pregnant.
The bloodiest part of the whole thing is usually the third and final stage when you deliver the placenta, Greaves Taylor said.
“The dark red bleeding from the uterus immediately after birth is expected to be up to 500mL,” explained Irby. “This can look like and feel like a lot as the uterus contracts and shrinks in size to stop the bleeding on its own.”
Since this part comes after the main show when you bring forth a tiny human, your attention will likely be elsewhere. While you’re focused on hearing your child’s first cries and meeting them face to face, your birth attendants will carefully monitor the amount of blood that you’re passing and may give you some massage or medication to help control the bleeding.
This post-birth bleeding, known as lochia, will continue for a while, usually tapering off about six weeks after you give birth.
Is it better to have an episiotomy or tear naturally?
An episiotomy is an incision in the perineal tissue between the vagina and the anus. Making this cut allows the baby to be delivered more quickly in an urgent situation. It can also make room for a doctor to use a vacuum or forceps to help deliver the baby.
In the past, many patients were given an episiotomy because it was thought that it would prevent more severe tearing from occurring, and would heal better than a natural tear. (The practice of giving one to every patient in this way is referred to as “routine” episiotomy.) But research shows that routine episiotomy does not reduce the number of serious tears.
“We’ve seen a big decrease in our episiotomy rate over the past few decades,” said Greaves Taylor.
The best time to talk to your provider about episiotomies is before you go into labour. Ask them under what circumstances they deem an episiotomy necessary, and what kind of an incision they usually make.
Greaves Taylor suggested asking about a mediolateral incision (as opposed to a midline one), “which means the incision does not go straight toward the anus. This is because if it tears further, you don’t want it to tear toward the anus which can be a lot more complicated healing process”.
Will things down there ever look the same again?
“Vaginal and vulvar tissue heals quickly!” Irby said. This part of your body may go back to its previous state, or it may feel and look a bit different after what Irby refers to as “the great stretch.” If you had tearing or an episiotomy, there will also be a scar.
“It’s impossible to predict ahead of time what the situation will be after everything has healed fully,” Irby said.
Greaves Taylor concurred. “Some vulvas never look quite the same, and others do. Everyone’s different,” she said.
How will I know when I am really in labour?
There will come a point, Greaves Taylor said, where you just know – but for first-time parents it can be tricky to identify early labour. She suggested: “If you’re having contractions and want to test to see if it’s really labour: drink a bunch of water and take a warm bath. If the contractions fizzle out, it wasn’t labour.”
She added that it can be helpful to assume that you aren’t yet in labour for as long as possible. “The sooner you pay attention the sooner you want to be done, and first-time labours usually last 18 hours on average,” she said.
Why is it important not to go to the hospital too early?
First-time parents are usually warned by medical providers, doulas and childbirth educators not to go to the hospital “too early” — but what qualifies as early? And why wait?
“Generally you want to labour at home at least until contractions are lasting a full minute, are so intense that you can’t carry on a conversation through them at all and they’re stopping you in your tracks, and it’s been like that for no less than an hour,” said Greaves Taylor.
There are a few reasons not to go in earlier. First, you may be sent home and told to come back when labour has progressed, which can be inconvenient and discouraging.
Second, labour often slows when someone arrives at the hospital. “The hormones that are so necessary for giving birth are suppressed by, for example, lack of privacy and bright lights,” Greaves Taylor said.
Finally, being at the hospital means you are more likely to receive interventions, such as continuous foetal monitoring. If you are stuck in a hospital bed on a monitor, your movement is restricted and it may be more difficult to manage your pain.
“The sooner someone goes to the hospital, the more likelihood there is of unnecessary interventions being pressured/used to ‘speed things up,’” said Greaves Taylor.
What does a contraction feel like?
Everyone feels contractions differently based on their own body and how the baby is positioned.
You may feel a contraction in your belly, pelvis or back, and you might feel contractions differently as your labour progresses.
“Most people feel a strong crampiness/squeezing in the belly region and wrapping around the back. Some people feel like they have to pee. Some people feel intensity down into their upper legs. ... Other people notice it mostly in their back,” Greaves Taylor said.
What does the urge to push feel like?
People often describe the urge to push as similar to the urge to vomit, or a sensation of throwing down rather than throwing up.
“When your body gives you this gift, you don’t have to ask anyone how to push because your body just makes you do it,” Greaves Taylor explained.
The urge to push is actually triggered in the rectum, she continued, “which is part of why one sign of entering the pushing stage is feeling like you have to poop.”
What positions are best for labouring and pushing?
Most of us have an image in our heads of a woman lying on her back with her knees pulled up to her chest, pushing out a baby — but there are many possible positions that can encourage labour to progress and help make pushing more effective.
“All fours is the position that studies have shown to lead to the least tearing,” said Greaves Taylor.
Other possibilities include sitting on the toilet or an exercise ball, and squatting. Some hospitals have a squat bar that attaches to the bed that you can hang onto for help with this position. Any upright position takes advantage of gravity and can help move labour along.
Irby recommended positions that make use of a peanut ball, as “they are productive but also can be restful.”
“Whatever position feels the best and most productive to you at the time is the most optimal for you,” Irby said. “Almost any labour position can also be a pushing position, so it just depends on what feels effective.”