- Giving birth is physically and emotionally demanding, and it can be scary if you’ve never done it.
- INSIDER spoke to a maternal-fetal medicine specialist and an OB-GYN about labour, vaginal tearing, sex after giving birth, and more.
- Here are their answers to 26 common questions about giving birth for the first time.
If you’re about to give birth for the first time, you probably have a lot of questions. What does pushing actually feel like? How long does it take for your body to stop looking pregnant? Is vaginal tearing something that happens?
INSIDER spoke with Dr. Shannon Clark, a maternal-fetal medicine specialist and an associate professor at the University of Texas Medical Branch, Galveston, and Dr. Talitha Bruney, an OB-GYN at the Montefiore Medical Center, about labour, epidurals, cesarean sections, and more. Here are their answers to 26 common questions about giving birth.
What actually happens when your water breaks?
What’s known as your water breaking is when membranes in the amniotic sac – the fluid-filled sac where the baby or babies are growing in your uterus – rupture, causing amniotic fluid to flow from the vagina.
Although movies tend to portray a pregnant person’s water breaking as a dramatic gush of fluid, Clark said this isn’t always what happens. Some people feel only a slow trickle.
When your water breaks, does that mean the baby is about to come out?
“It is not typical for a baby to come right after water breaks,” Clark said. “However, if there is a gush of fluid along with vaginal bleeding like a period, painful contractions start soon after, or the woman has a history of fast labors, getting to the hospital urgently is recommended.”
But your water breaking means you’re in labour, right?
According to the American Pregnancy Association, your water can break in the early stage of labour, which precedes active labour and typically lasts 8 to 12 hours. Sometimes, Bruney said, it can break without you being in labour at all.
She told INSIDER: “Water breaking does not necessarily mean you’re in labour or that you’re going to go into labour. Most women will go into labour within 24 hours of breaking their water, but some women do not, and they may need a little bit of help or assistance.”
In any case, she said, it’s a good idea to go in and have a doctor evaluate you if you suspect your water has broken because once the seal breaks between the amniotic sac and the outside world, there is an increased risk of infection.
What if your water doesn’t break at all?
Contractions can start regardless of whether your water has broken.
“A lot of women go into labour and have contractions, and sometimes they will break their water on their own,” Bruney said. “Sometimes the doctor has to break their water for them in the hospital. That is very common, and that’s because everybody is different, and every labour is different.”
Is it true that you can’t eat during labour?
Doctors prefer your stomach to be empty in case you have to go in for an emergency surgery like a C-section, Bruney said. Also, while you’re under intense regional anesthesia, such as a spinal block or epidural, the food you’ve eaten could come back up, and you could choke on it.
“Because labour is such an unpredictable process, there can always be a potential for requiring a procedure even after the baby is born,” Bruney said. “We want to be prepared, especially since pregnant women have huge uteruses pressing on their stomachs, and that pressure only worsens when lying down, so we prefer they have an empty stomach. That’s why there usually isn’t any food except ice chips when women are admitted on to the labour floor.”
Why do some people experience such long labors?
Some people give birth within hours of arriving at the hospital, and others have long labors that last for multiple days. Clark said there’s no definitive explanation for the variance.
Labour, which refers to the entire process of childbirth, from the moment contractions begin until after the placenta is born, is broken up into three main stages: early and active labour, the birth of the baby, and the delivery of the placenta. Contractions start during early labour and typically last from 30 to 45 seconds at 5- to 30-minute intervals. They get longer and closer together during active labour, occurring at three- to five-minute intervals for about 45 to 60 seconds each time.
While you can’t predict how long your labour will be, Clark said certain groups are more likely to have longer labors: “Women who may experience longer labors include first-time mums, women with large babies, and women who started the induction process with a closed and thick cervix.”
“Every woman is different,” she said. “It is important to keep in mind that active labour does not start until 5 to 6 centimeters of dilation in the presence of regular uterine contractions. Women who have their labour induced may be in the hospital for up to two to three days, but aren’t in labour the entire time.”
Why doesn’t everyone get an epidural?
An epidural is a pain-relieving injection into your back that you can get during labour. Bruney said that if you’ve had spinal surgery, have a medical condition that causes you to bleed or bruise easily, or have a condition that affects pressure around your brain, you might not be able to get an epidural.
She said that for most healthy people, there’s no risk in getting an epidural, adding, “In my experience, most women who don’t want an epidural don’t want it because they’d like to do it natural, or without the assistance of mediation.”
Are epidurals the only form of medication?
There are several ways to treat pain during labour that don’t involve an epidural, such as local anesthesia and spinal blocks. However, Bruney said, epidurals typically manage pain the most effectively.
“It’s numbing that area completely, so though you may feel pressure, you don’t feel the pain of the contraction,” she said. She added that intravenous narcotics work by dulling the senses rather than taking the pain away.
Why do you have to be 10 centimeters dilated to push?
Before you can start pushing, a doctor needs to check if your cervix has opened enough for the baby to pass through into the birth canal. Generally, when the opening is 10 centimeters wide, you’re fully dilated.
“Ten centimeters is the traditional definition of ‘complete dilation,’ but this may vary slightly based on the size of the baby’s head,” Clark said. “The cervix may be completely dilated at 9 centimeters on one baby and 10 centimeters on another.”
She said it’s important to resist the urge to push the baby out before the cervix is completely dilated, as “the cervix may tear or it can become swollen,” making it harder to give birth.
What’s the difference between cervical dilation and crowning?
Crowing occurs after your cervix has dilated. It happens when the baby’s head “starts to separate the labia when pushing with contractions” and “stays visible at the vaginal opening in between contractions,” Clark said.
What does pushing actually feel like?
“Most patients report that [it feels] like taking a very large bowel movement,” Bruney said. “I tell patients it feels like you’re trying to pass a basketball in the bathroom, because it’s that amount of pressure in the area. It’s just the sensation of having to go to the bathroom.”
Bruney said people who receive a strong epidural sometimes don’t feel anything during the pushing process.
Why are some people told to concentrate on breathing when pushing?
“Taking slow, deep breaths rather than short, shallow breaths during labour is beneficial for both mum and baby by allowing adequate oxygenation,” Clark said. “Also, during painful contractions, women tend to hold their breath, so reminding them to take slow, deep breaths during contractions helps with oxygenation, concentration, and pain control.”
Is it true that you might poop during delivery?
Clark said: “The vagina, urethra, and rectum pass through a sling-like structure composed of muscles called the pelvic floor. The rectum lays closely behind the vagina, so as a woman pushes, the pressure from the baby’s head can cause stool to come out of the rectum.”
But she said there’s no need to worry – doctors expect it.
“This is very common,” she said. “In fact, many women say they feel like they have to defecate during labour, when in reality it is the pressure from the baby’s head when it’s time to push. It is a similar sensation.”
Who delivers the baby?
Although you may see the same OB-GYN throughout your entire pregnancy, they might not be the person who delivers your baby.
“Oftentimes, practices are made of up several obstetrical care providers who alternate taking night and weekend calls delivering babies for the practice,” Clark said. “As a result, the provider who sees a woman during her prenatal visits may not be the provider who delivers her.”
She said it’s a good idea to familiarise yourself with the different providers so you can feel more comfortable if your OB-GYN isn’t around for your delivery.
Who else is in the room when the baby comes?
Bruney said the number of doctors present when you deliver depends on a few factors, such as the type of hospital you’re at. She said academic hospitals generally have more people in the room because residents and the doctors supervising them will attend to the delivery, and she added that there can sometimes be a pediatrician on standby as well as a patient support team.
Do you have to lie on your back to push the baby?
Many people associate the pushing process with the lithotomy position, where you’re on your back with your legs raised and spread. But “there are many different positions in which to labour and push,” Clark said. “A woman can lie on her side, do knees to chest, or stay in the typical dorsal lithotomy. There is no one way that is best. Whatever works for mum and is safe is recommended.”
Can you really tear your vagina?
Yes – according to studies of people in the UK, about 90% of people who have vaginal deliveries experience some form of perineal tearing.
There are different degrees of tears, ranked based on their severity. “Small tears, like a first degree or a second degree, are usually nothing a patient should worry about,” Bruney said. “But a fourth-degree laceration is a tear that goes all the way through to the rectum. … These are not common. It can happen, but most women will have a first- and second-degree laceration and heal very well.”
If the vagina is supposed to stretch, why does tearing happen?
Many of the factors that cause tearing aren’t in your control. Bruney said: “Yes, the vagina is supposed to stretch and accommodate a baby, but babies come out in different sizes. Women also come in different shapes and forms. And when it’s the first baby, women are more likely to tear because the perineum has never been stretched to that capacity before.”
She said that tearing happens more frequently with “very large” babies and compound presentations, which are rare cases where a limb or hand comes out alongside the head, and that sometimes, with people who have quick labors, “everything happens so quick that the vagina doesn’t have a chance to stretch and accommodate as well.”
Will tearing change the way my vagina looks?
If you experience any serious lacerations while giving birth, you’ll likely receive stitches. But there’s a good chance you’ll recover completely within a matter of weeks, especially it’s a first- or second-degree laceration, Bruney said.
“The repair is simple, and there’s not much bleeding,” she said. “I often tell patients the vagina is very forgiving. It has so much vascularity and great blood flow that it heals very, very well. Most women after four to six weeks can’t even tell that they had a laceration.”
Do the contractions stop once the baby is out?
After you give birth, your body still has to heal. “After a vaginal delivery, the uterus continues to contract over several days,” Clark said. “This can be quite painful. If a vaginal or perineal tear occurred, this can add to the pain and recovery time as well.”
You can use heating pads or nonsteroidal, anti-inflammatory drugs to manage postpartum pain.
Are C-sections less painful?
A cesarean section is a surgical procedure in which doctors remove your baby from your uterus. Before the surgery, you get either general anesthesia, which puts you to sleep, or an epidural, which numbs the lower half of your body but keeps you awake during the operation.
If you have a C-section you won’t push your baby through your vagina, but your body will still need time to recover, Clark said. The American College of Obstetricians and Gynecologists says that the healing time can range from four to six weeks and that you might experience vaginal discharge, bleeding, and pain near the incision site throughout that time.
“The recovery time is shorter after a vaginal delivery, and vaginal deliveries are considered to be less painful than a C-section,” Clark said. “However, a significant tear from a vaginal delivery can be quite painful. Women are different, have different pain thresholds and different recovery times.”
Can I have a C-section anyway?
Bruney said that while people sometimes request or ask about having a scheduled, elective C-section delivery, doctors usually don’t encourage them unless they’re absolutely necessary.
“C-sections are surgical procedures that come with risk – it’s abdominal surgery,” she said. “Often, unless there is an indication or a reason to actually do a surgery, we really don’t recommend it. Childbirth is a normal process and many women are able to have a vaginal delivery without complication.”
Moreover, doctors aren’t too keen on people volunteering for C-sections – particularly with first-time parents – because having the procedure increases the likelihood that you’ll need it again for a future birth and puts you more at risk of complications.
Does the stomach return to its normal size right away?
Clark said that because pregnancy stretches your rectus abdominis muscles, or abs, the muscles need time to return to their normal shape after you give birth. The same is true for your uterus.
“After delivery, the uterus is about 20-week size at the umbilicus,” she said. “The uterus involutes over time – about four to six weeks – back to its normal size.”
How will my vagina feel after childbirth?
Pushing a baby out requires a lot of effort from all the muscles in the pelvic region, Bruney said, so you can expect your vagina to feel a little sore for a few days after giving birth. She said applying cold ice packs and spraying cool water can help.
“During that first week postpartum, women may suffer from mild incontinence, where they feel like they can’t hold their urine,” she said. “That’s actually pretty common; you just pushed a baby out. All of those muscles are stretched to their max capacity. I encourage women to do their Kegels, so the body bounces back.”
Is there any bleeding?
After you give birth, you’ll likely experience some bleeding that’s similar to a heavy menstrual period, Bruney said.
“It’s very normal to have this bleeding that dwindles over time for two or three to four weeks,” she said, adding that you should be concerned only if there are persistent clots or very heavy bleeding for several weeks straight, in which case you should go to your doctor.
How long do you have to wait before you can have sex again?
Bruney said that most people can and will safely resume sexual activities within six weeks. How soon you decide to do so depends on how you physically feel more than anything, and oral sex or masturbation may be more comfortable than penetrative sex.
She said: “We traditionally tell women four to six weeks, and what we’ve noticed is by the time some women come in for those six weeks, they have already resumed intercourse. It’s really up to the patient to decide.”
- Read more:
- 21 answers to the most uncomfortable pregnancy questions you were too embarrassed to ask
- 18 tips for working out while pregnant
- All the celebrity babies who were born in 2018
- 12 people share how their sex lives changed after they had kids
- 13 things I wish someone had told me before I had a second baby
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