Should I have a homebirth?

Well, you’ll think we’re biased for saying it, but the answer is no. While birth can be and usually is a very benign event, the truth is that the safest place for you to deliver your baby is in a hospital. It is the safest option for your and your baby’s health, in case anything were to go wrong. We cannot completely predict who will have issues at the time of delivery, or leading up to it. We know of certain risk factors that increase the chance of serious events happening, but ultimately, a number of things could happen to even the healthiest people. 

The biggest risk factor for issues at delivery, believe it or not, is being nulliparous (a woman who has not delivered a child before). The reasoning behind this is because we do not know if you have an adequate pelvis for childbirth and you are at the greatest risk for shoulder dystocia and stalled labor. In the next section, we discuss some complications that can arise during pregnancy. One thing that all of these complications have in common is that the quicker we identify them and come up with a plan to treat them, the better it is for you and baby. That identification and treatment is best facilitated if you are in a hospital under the care of nurses and physicians that can monitor for these things. 

The bottom line is that studies consistently show that even with low-risk and well-selected patients, home birth is consistently more dangerous for mom and baby.

What is delayed cord clamping and what length of time is best?

After the baby is born, there should be a pause before clamping the cord (as opposed to immediately clamping it). This is called delayed cord clamping or optimal cord clamping. The baby is placed on your chest/belly depending on the length of the cord and as long as the baby appears healthy, your doctor will wait at least 60 seconds OR until the baby gets their first good cry before clamping and cutting the cord and detaching the baby from the placenta. Studies have shown that at least 60 seconds is optimal, but longer than that is okay as well. The baby can get an additional 80 mL of blood during this time. The extra blood has been shown to improve hemoglobin and iron stores within the first year of life, and improve cognitive, motor, and behavioral development. After this, the doctor will clamp the cord and hand someone of your choosing the scissors to cut the cord. Then, while you pay attention to your new baby, the placenta will be delivered with gentle traction and you will no longer be pregnant!

Delayed cord clamping is the standard of care and has been for several years.

Should I store my baby’s cord blood?

The reality of cord blood banking is that it is a huge expense for little to no benefit for the average person. Private cord blood banking has an initial collection fee anywhere from $1,000-$2,000 and then an annual storage fee that can be around $200 per year depending on the bank. Cord blood contains stem cells that can be beneficial in the treatment of different blood and bone marrow disorders. If there is a family history of a disease with a known genetic component, then there may be an argument to storing it, but not everyone has the money and not every disease can be predicted so you have to weigh the risks and benefits for your situation. 

There is very little research involving stem cell therapies that involve using blood from umbilical cords and there is a real concern over how many stem cells can be retrieved from these frozen samples after a few years in the freezer. It is questionable if any child so far as ever benefited from having cord blood frozen, so it’s probably best to keep it limited to a few rare situations involving some rather rare diseases as part of a research protocol

Is there a best way to push?

The most effective pushing is usually done when you take in a deep breath, fill up your lungs, and then hold that air in while you bear down, tuck your chin to your chest, and push as hard as you can into your bottom. We encourage you to hold those breaths for 10 seconds and attempt two to three rounds of 10 seconds of pushing if the contraction allows it and you are able. Typically, the moms that scream or let the air out tend to have less effective pushing but sometimes that’s okay! The lungs filled with air push the diaphragm down, increasing your internal abdominal pressure which helps with the pushing and contraction combined. Still, feel free to scream, cry, or do whatever you need to do to get through it. No one is judging you. The reality is, labor can be a long process, and your doctor can give you feedback on what pushing methods you should try to yield the best results.

The position you’re in while pushing can vary widely. When you lay on your back and pull your legs back, MRI studies have shown that this creates the most space for the baby. That is not what is commonly claimed by a lot of birth advocates who argue for pushing while squatting or in some other upright position. However, those positions tend to put pressure on the lateral sides of the pelvis (at your hips) and make the pelvis wider but narrower from front to back, which is where it really matters.

The truth is, women should be allowed to push in whatever position they are most comfortable and different positions will provide different degrees of pain relief for different women. We will help you know if your pushing is effective and if you might be better served in a different position.

Does perineal massage help prevent tears?

Perineal massage a few weeks leading up to delivery may decrease the chance that you tear, but it does so by causing unwanted (and permanent) relaxation of the vaginal tissues. It isn’t worth it. During labor, your doctor or midwife may provide some slight pressure on the perineum while you are complete and pushing. This can be seen as a massage, but in reality we are just helping to slowly stretch some of those muscles in the pelvic floor as the head begins to descend. This encourages the tissues to relax rather than contract right back after a contraction and push the baby back after the progress you just made with your pushing. At the actual moment of crowning of the baby’s head, studies have shown that a grip of the perineal tissues (applying counterpressure to the stretch of those tissues) can help prevent significant tears at the time the head delivers out of the vagina, the moment when most tears occur.

Do I need cervical checks during labor?

Cervical checks can vary based on institution. It is definitely true that more cervical checks lead to an increased risk of infection. That being said, some checks are necessary to determine labor progress. We can optimize the risk/benefit ratio. Checking every two hours is common in some practices but is usually not necessary. In the latent phase of labor, from 0-6 cm, checking every X amount of hours is not necessary. If you are being induced and you have a cervical ripening agent in, like a cervical medication or a catheter balloon, then at the time of placement you are checked and the next check should occur when a decision is being made: for example, do you need another dose of medication or can the catheter be removed? This may be many hours (usually at least four hours).

How often the cervix is checked should be based on patient feedback (feeling more pressure, contractions getting stronger/closer together, etc.), and no more often than every four hours usually in latent labor. Even in active labor, from 6-10 cm, we don’t worry about “failure to progress” until four hours of no cervical change. Therefore, we can check at four hours and usually still have all of the information necessary to determine if something should be done about slow labors.  Remember, sometimes there is a good reason to check more often, especially if you get towards the end and continue to feel a lot of pressure or even begin feeling the urge to push. We want to check you as few times as necessary while still making sure we can monitor your progress.

What should I bring in my hospital bag?

This is a preference thing: there is no right or wrong answer here. You are not required to bring anything aside from your ID and insurance card if you have them. The rest of your bag should be things that bring you comfort. 

If you do a labor and& delivery tour at some point before you deliver (most hospitals offer this), you can ask what amenities they have that you may want (bath, bouncy bouncing balls, fan, etc.) If they do not have these things then you may want to bring them. 

Things the hospital will provide: sanitary pads for you after delivery, diapers, formula, bottle nipples, food/drink, gowns, and hygiene products for showering.

Things you may want: phone charger, socks, snacks, your own clothes/robe/toiletries that you prefer, multiple changes of clothes (you may be very sweaty/uncomfortable during the labor period), slippers, shower shoes (hospital showers should be clean but still), etc. Think about going away on a trip to a hotel for 3 days or so and pack whatever you would take for that

What does losing my mucus plug mean?

Many women will sometimes pass a large plug of mucus (and maybe some blood) at some point during cervical dilation. As the cervix dilates and thins, the mucus buildup that was there in the cervical canal can come out. It has also been called “the bloody show” if its blood tinged. Losing this plug doesn’t actually have any diagnostic or predictive value for us as doctors. Many people think “it’s go time” when they lose it or that they are going to progress faster after its expulsion. Unfortunately, women can start to dilate a small amount early and lose it even weeks before they actually go into labor. Sorry to disappoint you, but the baby is going to come when the baby is going to come. 

Does drinking red raspberry leaf tea, bouncing on a ball, having sex, etc. help start labor?

Babies love being unpredictable. If there were a way to induce labor through drinking tea, exercise, sex, or some other magic, we would tell you. Like eating dates, there are dozens of such claims and the reason so many fibs exist is simple: women eventually go into labor and sometimes they will falsely contribute whatever they did immediately prior to labor as the reason things got going. The stronger the correlation of the timing between the onset of labor and the thing they did, the stronger the belief. But actually the body just does what it is going to do on its own terms. Unless you go into labor spontaneously, the only thing we can do to induce its onset is medication.