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By OBGYN and fertility expert Dr. Kenosha Gleaton

I’m torn between natural birth and using pain medication. Help! 

You are not alone. This is a big decision. A useful strategy when considering the above is to identify your “WHY” and let it guide you. “WHY” do you want natural labor? What deep convictions compel you to seek a natural birth? Does a natural birth align with your birthing goals? If your why is significant, then it will help sustain you during the labor process. Try making a pros/cons list of natural vs medicated birth and see points resonate most with you. And finally, don't allow fear to sabotage this process. Your body is fearfully and wonderfully made and beautifully-equipped to handle your birth journey. Seek peace and trust the process. So what's your why? 

When should you start preparing for labor? How early? 

There’s no set rule for preparing for labor, but I usually recommend that patients have their bags packed by 36 weeks. 

In terms of childbirth preparation classes, these can be started as early as the second trimester dependent on your specific goals. Discuss your plans early with your ob provider for specific guidance. 

How can I best physically prepare to give birth? 

I’m glad you asked. Labor holds true to its name—its WORK! Just as you’d never sign up for a marathon and show up ten months later without preparation, the same should go for childbirth. 

Walking, stretching, prenatal yoga, and prenatal massage are excellent ways to prepare physically for labor. If you were active in other aerobic activities prior to pregnancy, many of these can and should be continued. Check with your OBGYN about which specific physical activities are safe to continue. 

Tips for staying calm for anxious first time moms with true anxiety? 

For patients with a true diagnosis of an anxiety disorder, then it's possible that you’ll need treatment throughout pregnancy and postpartum. Treatment typically includes counseling, behavioral feedback, medication, and occasionally all three. Several anxiety medications are safe during pregnancy and breastfeeding. 

Other recommendations are to identify your anxiety triggers and create a strategy for addressing those triggers—before they arise. A preplanned coping protocol can go a long way! Involve your support system or counselor if needed. I also love positive affirmations! Affirmations are calming to the mind, body and spirit. 

For somebody who is terrified of needles, what is an epidural really like? 

For most patients, the epidural experience is better than they imagined. With some exceptions, most epidurals are placed fairly quickly and offer a great option for pain control. Try to remind yourself that an epidural in the hands of an experience provider is not much different than getting an IV in your arm. 

📖 Shop the modern guide to pregnancy, Bumpin' 

What is the low down on a “walking epidural?” Can you really walk? 

The notion of walking with an epidural sounds like a wonderful way to avoid bed confinement during labor, however, the term is a bit misleading. A walking epidural is similar to the classic standard epidural, but the placement of the needle is a bit different because the walking epidural will also access the fluid surrounding the spinal cord. Walking epidurals aka combined spinal-epidurals (CSE) allow for less medication administration through the epidural, thus more movement of lower extremities. This is helpful for women who desire to change positions easily or feel greater control while pushing. Unfortunately, many women feel more intense contractions and pain with the walking epidural, and as a result, often convert to the standard epidural.

Thoughts on vaginal birth vs. c-section? 

I am a huge supporter of vaginal birth as the primary birthing option unless medical conditions preclude this route. ACOG also supports vaginal delivery as the preferred method for childbirth unless contraindicated. 

What are some common misconceptions about labor? 

  1. I will be electively induced and will meet my baby two hours afterwards: Myth! Inductions are often longer—since the body is being forced into labor—and often “perceived” as more painful. If you sign up for elective induction, just be prepared for the duration which can be a few days. 
  2. Epidurals cause permanent back pain or paralysis: Myth! Serious complications from an epidural, including paralysis, are extremely rare. Some women have discomfort in the lower back (where the catheter was inserted) for a few hours or days, but it doesn't last permanently
  3. If I get an epidural too soon, it will wear off: Myth! The catheter allows for continuous medication infusion. 
  4. My water will break dramatically like on TV: Rarely! Most times patients' water won't break at all, until the provider breaks it. 
  5. Losing your mucus plug means your going into labor: Rarely! Often mucus plugs are lost several weeks before labor starts. 

Thoughts on freebirth?

I don't recommend freebirth. If you’re considering freebirth, please talk to your OBGYN about your considerations to find an alternative that can yield a supportive birthing experience that is acceptable to you. When childbirth goes awry, seconds count. This birth option is not worth risking the wellbeing of your precious baby. Watch Judith’s brave, yet heart wrenching, story about freebirth in this clip.

Gestational diabetes during labor and how will it go? 

Gestational diabetes (GDM) or pregnancy induced diabetes is fairly common and up to 10% of women will develop this. Controlling sugar levels is important during pregnancy, but also imperative during labor to avoid poor sugar control in the newborn. Think of glucose control during labor as the last leg of a very long marathon, with the finish line in sight!

During labor, your sugars will be checked every one to six hours depending on your labor stage. You will likely have insulin ordered and administered if needed to keep blood sugars in a safe range. If your blood sugars drop too low, you will be offered glucose in the IV or by mouth if appropriate for your labor stage. 

If your GDM has not been well controlled during pregnancy, your provider will anticipate the potential for a large baby and may ask other staff members to step in for your delivery. 

After delivery, you will likely stop any medications that were prescribed for GDM since blood sugars regulate quickly after the placenta is delivered. 

Your newborn will be watched closely by the neonatal team to ensure their blood sugar levels are optimal. 

I have had two laparotomies—would it be safe to have vaginal birth? 

This depends on the operation performed during the laparotomy. If these laparotomies involved surgical incisions into the uterus, attempting a vaginal delivery may not be recommended. However, if these surgeries were unrelated to the uterus, you’re likely ok for vaginal birth. I’d recommend speaking with your OBGYN to discuss specifics regarding your situation. 

How to make labor less painful?!

Epidural, IV pain medication, warmth, and relaxation techniques including massage, prayer, and meditation. 

How to prepare for natural birth? 

Invest in a strategy! You must choose your method and choose early. There are various birthing techniques out there and those who commit to one, are often the most successful. Again, choosing natural birth without preparation is akin to signing up for a full marathon (26 miles) without ever having ever run a 5K (3.1 miles)!