Every pregnant woman at some point in her pregnancy will begin to wonder if she is in labor. Most women have a few false starts. Braxton-Hicks contractions can be confusing and can become frequent and regular – at least for a short time – before going back to their irregular pattern. Women frequently have physiologic discharge or will urinate and wonder if their water is broken. So how can you tell real labor from false labor?

The answer is time. Real labor is progressive in every way, but you won’t be able to see this until some time has passed. If you’re having some regular contractions, the best thing to do is to see what happens over the next two to three hours. If you are really in labor, your contractions will become more frequent (maybe going from every six to seven minutes apart to every three to four minutes apart), last longer (going from, say, 30 seconds in length to 45 or 50 seconds in length), become more painful, regular, predictable, and persist. False labor, on the other hand, may start strong but will lose steam and wane over two to three hours.

If it’s your first baby, you have plenty of time. Labor will likely last many hours and you will have plenty of time to arrive at the hospital. If it’s your fourth baby, then you already know what to expect. If you are reading this anyway, your labor probably won’t last that long and you should head to the hospital a little sooner.

In some cases, your doctor may ask you to come to the hospital a bit earlier; for example, if you’re positive for group B Strepococcus, then you will need four hours of IV antibiotic therapy in addition to however long it takes to get to the hospital, get admitted, and get an IV started before the baby is born.

If your water breaks, you should probably head to the hospital. This may be a sign that your labor is already very advanced, since water tends to break on its own at an average of about 8 cm. If your water is broken and you’re not already in labor, then you should still go to the hospital because your labor likely needs to be augmented or induced. If you have had a previous Cesarean delivery, then you should come to the hospital much sooner because you do not want to risk laboring at home. A trial of labor after Cesarean is a good idea for most women, but because of the risk of uterine rupture, that trial of labor should happen at the hospital to maximize the safety for mom and baby.

You can’t always tell; but, in general, once your water breaks, it keeps coming. Ruptured membranes are not just a small gush or a little bit of spotting; if you think your water has broken, clean up and see if the leakage persists. If it does or you are unsure, you probably need to be examined.

Discharge is common in pregnancy but usually never results in more leakage than would fill a small pad or panty liner. If you are getting cervical checks at your later appointments, the gel we use can sometimes appear later as a leakage of fluid but it is usually only a small amount and you would not see continued leakage.

Probably the most common reason why women believe that their water has broken is because they have peed on themselves. Most women cannot believe that they have peed on themselves, especially if they never felt the urge to pee, but in the third trimester with the baby’s head smashed right against your bladder, this is a common occurrence. If it happens on your bed sheets or in your underwear, you won’t always be able to tell that it is urine by smell or color alone. Amniotic fluid has a unique odor that is like a combination of ejaculate and bleach; that may not be helpful if you’ve never smelled amniotic fluid before, but when you do maybe you’ll recognize it.

All of this being said, large gushes with continual leakage after the fact should be assessed at the hospital or your doctor’s office. You may be ready to rock and roll!

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. 

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.

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.

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

You might, but don’t worry about it. We are all used to it and completely unfazed by it. If you ask us if you did, we will probably lie to you and say no (the only lie you will hear from us, we promise). The reality is that you have a big head pushing down right against your rectum while you’re pushing. In fact, we tell you that the pushing you do to deliver the baby should feel like “the biggest poop of your life,” because you are directing all that pressure down towards your bottom. If it happens, then you’re pushing in the right spot! It will be wiped away and no one will have a second thought about it.

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.

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.

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.

Inductions happen for lots of good reasons – but also some not so good ones. Unless there’s a medical reason to do so, you shouldn’t be induced before 39 weeks’ gestation. Even at 39 weeks, induction might not be the best idea unless your body is ready for labor. Checking your cervix can help determine this. Otherwise, it might be better to wait until 41 weeks. After 41 weeks’ gestation, it’s unusual that going any further makes much sense due to increasing risks for the baby and no benefit to the mother in terms of decreased Cesarean rate (in fact, the risk of Cesarean actually goes up for most women after 41 weeks).

Sometimes you might need to be induced much earlier, but it should be because you have a medical problem like high blood pressure or some other complication.

No! Except in some very rare emergency cases, episiotomies should never be performed. If your doctor performs routine or frequent episiotomies, then he may not be practicing up-to-date medicine. We have known since the mid-1980s that episiotomies are harmful and unnecessary except in a handful of rare emergencies, such as severe shoulder dystocia.

This doesn’t mean that you might not tear, but however badly you might tear, an episiotomy likely would have made things much worse.

We hope not! But some women do, of course.

Cesarean delivery is definitely over-used in the United States. There are some good reasons why a woman might need one:

• If she has had a prior “classical” Cesarean delivery (where the incision on the uterus is made higher than normal)
• If she has had more than two prior regular (“low transverse” incision) Cesareans
• If she has placenta previa, where the placenta covers (or is very close to) the cervix or vasa previa (where placental blood vessels cover the cervix)
• If her baby is breech or sideways (and the doctor is unable to turn the baby to be head down)
• If her baby does not tolerate labor (this should be relatively rare and there are some specific criteria that can indicate this)
• If her baby is too big, which is more than 5,000 grams (or about 11 lbs) for a nondiabetic mother or more than 4,500 grams (or just under 9 lbs 15 oz) for a diabetic mother
• If her labor doesn’t progress or she is unable to push the baby out after sufficient time (many doctors don’t give women enough time for these things; however, we have criteria that we follow to determine if this is happening)
• If she has triplets or quadruplets, or monochorionic-monoamniotic twins
• If she has active genital herpes or uncontrolled HIV

Those are just about all of the reasons, aside from the more emergent ones we won’t go into here. We don’t know for sure, but as many as half of all Cesareans performed are unnecessary. Most of the unnecessary Cesareans are related to impatience. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) will, if followed, result in significantly fewer Cesareans if doctors follow them.

Probably not. This is a trick question, though. You have to separate out laboring in the water and actually giving birth in water. Most of the known advantages of water birth are actually related to the process of laboring in water while the known disadvantages of water birth are associated with giving birth in the water.

For example, the benefits of reduced pain during the first stage of labor (that is, the part leading up to pushing), a shorter first stage of labor, and less need for anesthesia all occur before the birth itself takes place. At the same time, the reported disadvantages of a water birth all take place during the actual process of delivery, including newborn aspiration, drowning, infections, hyponatremia, depressed Apgar scores, and umbilical cord rupture. So, it probably makes the most sense to labor in the water and then get out when it’s time to push and have the baby on dry land.

If you think about it, nature designed the birth process to happen on dry land. One of the benefits of a vaginal delivery compared to a Cesarean delivery is that the baby gets most of the amniotic fluid squeezed out of her lungs while traveling through the birth canal so that her first breath, once delivered, is full of nice, clean air. This doesn’t always happen with a Cesarean delivery and, consequently, babies have higher rates of respiratory problems with Cesarean birth as compared to vaginal birth. In any event, when a baby is born vaginally underwater, the first inspiration by the baby may be underwater and therefore lead to aspiration of water with subsequent increased risk of infections, drowning, and other respiratory problems. Keep these things in mind when you read about water births being more natural than land births. There’s nothing natural about it at all. In fact, water births are a rather modern invention. Currently, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend against deliveries occurring underwater.

If you’ve had a previous Cesarean delivery (or two), you may be a candidate for a trial of labor after Cesarean (TOLAC). This is a complicated issue. The short answer is that most women with only one prior cesarean delivery should try VBAC (vaginal birth after Cesarean), but you should read more about it here.

Unfortunately, there has not been quality evidence showing that chiropractic alignment will help with delivery. Until there is solid evidence supporting it, we don’t recommend it. One thing often recommended is the “Webster technique.” This is supposed to ensure that the breech or transverse baby is head down by the end of the pregnancy. Most babies will be head down by 37 weeks’ or so and this technique is no better than random chance at making sure your baby is head down at term. Don’t waste your money.

No. If this were the case, we would ask patients to eat dates as their due-dates approached and avoid them before that. Alas, there is no evidence to back up this claim. So, eat the dates or don’t, but your cervix will do what it is going to do regardless.

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. 

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