Updated: Jun 12, 2020
Our culture can have a tendency to glorify and over-dramatize childbirth. Questions like: When you’ll go into labor, how it will transpire, what your options are, how to prepare for it, and what the outcome will be are all critical childbirth questions that have become mired in myth and miscommunication. Messages that pregnant women receive from TV, movies, social media, and the media in general can be detrimental (when your expectations fall short of reality) and isolating (when your experience doesn’t follow the norm).
We at EmmaWell want to dispel the disconnect between expectations and evidence and help you avoid common misconceptions, so you can come out on the other side having made informed, appropriate choices, and feeling content with a healthy baby.
Myth 1. Your due date is when you’ll go into labor.
For many expecting moms, the due date assigned to your baby signifies a momentous occasion on the calendar. “What’s your due date?” becomes a familiar refrain once your belly reaches third-trimester girth. Your baby shower, babymoon, and maternity leave all might be planned around this singular date. In reality, your due date is a (somewhat) arbitrary estimate calculated by your care provider by adding 280 days to the first day of your last menstrual period. It’s an imprecise science because not everyone has a 28-day cycle, not everyone ovulates on the 14th day, and most don't record the exact date her period starts. So, for women with irregular menstrual cycles, doctors often use the fetal measurements taken during their first-trimester ultrasound to adjust the estimated due date.
So, what percentage of babies would you guess are born on their due date...25%? 10%? The correct answer is a mere 4-5%. In fact, is considered normal to give birth any time between the 37th and 41st week of pregnancy. According to CDC data from 2017, 26% of American babies were born between weeks 37 and 38; 57% between weeks 39 and 40; 6% in week 41; and less than 1% at 42 weeks or beyond.
The moral of the story is to manage your own expectations, and stay flexible. Be prepared for baby baby to come before your much-anticipated due date, and try hard not to be too disappointed if your baby hangs out a while longer. In addition, if you find out that your cervix has started to dilate at 37 weeks, there may not be a need to rush home and wait by the door with your hospital bag. It could take another four weeks for the real action to kick off. The same expectation-setting rule can apply to late arrivals. After furnishing a comfortable home for your baby for nine months, you might feel ready to put up an eviction sign towards the end. But if your due date passes uneventfully, we hope you'll continue to ride the wave of eager anticipation instead of turning impatient and discouraged, because you’ll be equipped with the knowledge that pregnancy length can vary widely.
Myth 2. Labor is a quick process.
As our favorite OB providers like to say: it’s called “labor” for a reason. For a first birth, labor typically lasts 12 to 24 hours. There is, of course, a wide range of variability (noticing a theme?). Labor might be over in a matter of hours for one woman, while for others, it can last a few days. Understanding how it usually starts can help you prepare, and surrounding yourself with trusted friends and a supportive team of OB providers is always helpful.
Believe it or not, labor does not always begin with a dramatic gush of amniotic fluid in a public place without warning, as is so often depicted in movies and shows. In the movies, you'll often see two loud pushes producing a (completely clean and unnaturally large) newborn baby. Real-life labor is beautiful in its own way, but does have a tendency to drag out and lose its "dramatic appeal". Your water often breaks right before birth when you are already admitted at the hospital, and might even need to be proactively punctured by your doctor to speed up the labor process. And instead of the "gush", many women only experience a steady trickle of fluid.
More often, labor begins with regular contractions, which cause the cervix to open (dilation) and soften, shorten, and thin (effacement), allowing the baby to move down into the birth canal. The contractions might feel so mild and sporadic that they can be hard to distinguish from Braxton Hicks contractions and you might not even realize you’re in the first stage of labor. On average (but again, a wide variability is the rule), your cervix dilates approximately one centimeter per hour when you are in labor.
Once your contractions become stronger, last longer, and get closer together, chances are that it’s time for the real work of active labor, during which your cervix will dilate all the way to 10cm. Contrary to what Hollywood would have you believe, the birthing process is a true labor of love that, for most women, can deplete every ounce of her strength and stamina.
Myth 3. A hospital birth means medication and intervention.
There seems to be a popular assumption that laboring in a hospital means that you can’t have an unmedicated, low-intervention birth. Your OB provider and care team will try their best to avoid forms of pain relief or assisted delivery methods that you don't desire. You will not be forced to have a medicated birth if that is against your wishes, as long as your provider feels it is safe for you and your baby.
In addition to medicated pain relief options such as an epidural, spinal block, and IV analgesics, other coping methods for pain during labor, often practiced in birthing centers or at home with a midwife, are also available in the hospital. Medication-free pain management options include breathing techniques, aromatherapy, massage, acupuncture, acupressure, yoga, changing positions, lying on a birthing ball, applying ice or heat pads to your back, or moving rhythmically. With an unmedicated birth, endorphins released during the birthing process can provide natural pain relief and promote bonding with your baby afterward.
The catch is that pregnant women (especially first-timers) can’t judge in advance how painful the process will be, and most deliveries do require some sort of intervention. A medically uncomplicated birth would entail that labor starts on its own and progresses steadily. The baby would need to be positioned head-first and pass completely through the birth canal by the force of contractions and pushing. These natural processes are glorified by the media (of the social and traditional variety), commanding that a woman’s body is designed to birth a baby and inherently knows what to do. The truth is that modern medicine offers many options to relieve the intense pain of childbirth, as well as various interventions when the health and wellbeing of the mother and/or baby are at risk.
Myth 4. Your birth experience will go according to plan.
In spite of your best-laid plans, babies are full of surprises. Preparing for labor essentially means accepting that it might not go the way you expect. This is why we at EmmaWell advocate for Birth Goals, (vs. "Plans"), because the first step of becoming a parent is learning to give up control!
Instead of detailing the minutiae of your dream birth experience, educate yourself on labor comfort measures and consider an overall birth strategy, with corresponding goals. EmmaWell’s maternal guidance app provides lots of information on this topic for you to feel informed and prepared for childbirth. You should communicate your preferences and desires to your care team, whose primary goal is to ensure a safe outcome for you and your baby. Ultimately, accept that your expectations might need to shift, either because you change your mind (e.g. regarding pain management) or because an alternative (e.g. intervention to assist delivery) is the safer route.
Moms who have already gone through the process of childbirth sometimes presume that their subsequent experience will be exactly the same. If their first birth was traumatic, they might delay or forego getting pregnant again. On the other hand, if their first labor progressed by the book, they might be thrown for a loop if things don't go smoothly the next time. Your labor experience with your second, third...or sixth baby might follow a similar path, but it also might be completely different from that of your firstborn. Generally, with subsequent births, contractions progress more quickly and the active part of labor is shorter because your birthing muscles have stretched before. Most moms find childbirth to be easier after the first time simply because they have learned strategies and feel more prepared.
Myth 5. Hips don’t lie - They reveal how easy delivery will be.
You may have heard the expression “good child-bearing hips,” but the size or spread of your hips has no bearing on your birth experience. The pelvis is not composed of solid bone; rather it’s made up of several ligaments and bones designed to loosen and move as you give birth. Likewise, the skull bones inside a baby’s head are not yet fused together, which allows the head to squeeze through the birth canal. As labor begins, your body releases the hormone relaxin, causing the pelvic floor to relax and the pelvic bones to slightly separate. Although the ligaments around your pelvis stretch in preparation for childbirth, your pelvis shape doesn’t change.
Decades ago, doctors used to X-ray a pregnant patient’s pelvis area at a prenatal checkup to get a sense of its structure. Today, doctors often physically examine your pelvis as part of a comprehensive exam, including screening for a condition [cephalopelvic disproportion] that prevents the baby’s head from fitting through the mother’s internal pelvis. A number of factors come into play during childbirth, and pelvic shape is just one of them. As we learned in EmmaWell's Birth Prep Basics webinar (back by popular demand on 6/16), it all boils down to the three “P”s: Passenger (baby), Power (of contractions), and Passage (pelvis). If one of these three “P”s stalls during delivery, then your care team might need to pivot from your intended birth strategy (if you have one).
In cases when the baby can’t be delivered via the vaginal route safely through augmentation or assistance, a C-section is often pursued. According to recent medical research, 32% of births in North America occur via C-section delivery. Notwithstanding the many different reasons - both personal and medical - behind the high C-section rate, this delivery method helps to avoid some of the high-risk complications during childbirth. It should not be chosen lightly, as it is major surgery that requires opening your abdomen and exposing major organs. However, a C-section might be necessary when the benefits outweigh the risks.
Ultimately, the way your baby enters the world is not nearly as significant as the new little person in the world that you created. If your baby’s path out of the womb happens to be life-saving, you have another reason to feel fulfilled...and relieved you didn’t fall for these misconceptions.
To learn the nitty-gritty of what really happens during childbirth and how you can prepare, join EmmaWell’s upcoming live Birth Prep Basics webinar and Q&A this Tuesday, June 16th at 7pm.
With Warmth and Wellness,
Your EmmaWell Team