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VBAC (Vaginal Birth After Cesarean)

Labor and birth /
Woman preparing herself for VBAC

Pain Management During Labor Epidural: What It Is, Procedure, Risks & Side Effects I’m a Doula: This Is What a Doula Does Natural Ways to Manage Labor Contractions Pitocin: What It Is, Procedure, Risks & Side Effects Induced Labor Rupture Of Membranes (Water Breaking) Preparing a Birth Preferences Document (Birth Plan) VBAC (Vaginal Birth After Cesarean) During the many years that I have been a doula, there has been an amazing shift from not even considering VBAC, to an understanding and agreement that VBAC is the preferred way to give birth when medically possible. Let’s explore what exactly a VBAC is, whether it is safe, how to prepare for one, and common questions about this method of birth. By Liat Salomon, doula April 22, 2025 Share on In This Article: What is VBAC? Conditions for having a successful VBAC Is VBAC safer than repeat cesarean? VBAC risks Tips for preparing for a VBAC Can a baby be too big for VBAC? Can I get an epidural during a VBAC? Induction of labor for a VBAC Can you go past your due date with a VBAC? Length of time between pregnancies before attempting a VBAC How long is a hospital stay after VBAC? VBAC-2 On a final note What is VBAC? VBAC stands for Vaginal Birth After Cesarean. It refers to a type of birth in which a woman who has had a previous cesarean delivery, also known as a C-section, attempts to give birth vaginally in a subsequent pregnancy. In the past, it was common for women who had a C-section to have all subsequent deliveries via C-section as well. However, in recent years, there has been a growing trend toward attempting VBACs, as research has shown that not only is VBAC a safe and viable option for many women but a vaginal birth is the healthiest and preferred way to give birth. The American College of Obstetricians and Gynecologists (ACOG) recommends that women with a low-transverse uterine incision and no contraindications attempt a VBAC. Studies suggest that the success rate of VBACs ranges from 60% to 80%, with some studies reporting success rates as high as 90% in certain populations. I know from personal experience that while VBAC can be a safe and effective option for many women, some hospitals and healthcare providers may have policies or personal preferences that discourage or limit VBAC. I strongly believe that you should have a conversation with your provider about it to make sure you have the right support when attempting a VBAC.  Another important thing that I feel needs to be said, as well: Some women may prefer a repeat C-section for scheduling reasons or because they feel more comfortable with a planned surgical delivery. That is a valid decision, too. In this post, I will try to answer some of the most common VBAC questions and concerns. Also Read: I’m a doula: this is what a doula does Pitocin: what it is, procedure, risks & side effects Conditions for having a successful VBAC Whether or not a woman is a good candidate for VBAC depends on several factors, including the reason for the previous C-section, the type of incision used, and the risk of uterine rupture. A prior successful vaginal delivery Women who have had a previous vaginal birth are more likely to have a successful VBAC. The type of uterine incision Low-transverse incisions (often called a bikini cut, a low-transverse incision is horizontal (side-to-side) and low on the uterus) are associated with a lower risk of uterine rupture during a subsequent vaginal delivery. Reason for the previous C-section Women who had a previous C-section for non-recurring reasons, such as breech presentation or fetal distress, are more likely to have a successful VBAC than those who had a C-section due to cephalopelvic disproportion or failed induction. Single fetus While VBAC with twins is generally considered safe and feasible for many women, the chance of a successful VBAC is slightly lower than that of when having a single fetus. Good health Women with certain medical conditions or pregnancy complications may not be candidates for VBAC. Is VBAC safer than repeat cesarean? I get a lot of questions and concerns regarding the safety of trying for a VBAC.Both VBAC and repeat cesarean delivery carry risks and benefits, and the safety of each option depends on the individual circumstances of the woman. In general, VBAC is considered a safe option for many women who have had a previous cesarean delivery and meet certain criteria. However, there is a small risk of uterine rupture during a VBAC, which can be life-threatening for both the mother and baby. A repeat C-section also carries risks, such as the potential for surgical complications, longer hospital stays, and a longer recovery time. Additionally, a repeat C-section may increase the risk of placenta previa, placenta accreta, and other complications in future pregnancies. VBAC risks As mentioned before, there are some risks associated with VBAC that need to be considered. As mentioned, the main risk associated with VBAC is uterine rupture, which is a tear in the uterus that can lead to serious complications for both the mother and the baby. The risk of uterine rupture during VBAC is estimated to be around 0.5% to 1%, although this risk may be higher in certain situations, such as if the previous C-section incision was a classical or T-shaped incision. Other factors that may increase the risk of complications during VBAC include maternal obesity, advanced maternal age, and medical conditions such as hypertension or diabetes. I feel that with careful monitoring and appropriate medical management, many women can safely have a successful VBAC. If uterine rupture does occur during VBAC, prompt diagnosis and emergency care are essential to minimize the risk of maternal and fetal complications. This may involve an emergency C-section and other medical interventions as needed. To prevent uterine rupture during VBAC, healthcare providers may recommend the following: Close monitoring: Women attempting a VBAC may be asked to be

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Breech Baby

Labor and birth /
Pregnant woman with baby in breech position

Pain Management During Labor Epidural: What It Is, Procedure, Risks & Side Effects I’m a Doula: This Is What a Doula Does Natural Ways to Manage Labor Contractions Pitocin: What It Is, Procedure, Risks & Side Effects Induced Labor Rupture Of Membranes (Water Breaking) Preparing a Birth Preferences Document (Birth Plan) Breech Baby A breech baby is one of those topics no one feels the need to talk about – until they realize that the baby is not flipping, and by that point it might be a bit late.  By Liat Salomon, doula January 2, 2025 Share on In This Article: What is a breech baby? Signs of a breech baby Causes of a breech baby Risks to the baby when delivered in a breech position What is the success rate of delivering breech babies? Are breech deliveries more painful? How does labor start with a breech baby? Breech baby head shape How to turn a breech baby Additional methods for turning a baby in a breech position Sleeping positions to turn breech baby Conclusion What is a breech baby? A breech baby is a term used to describe a baby who is positioned bottom-down (feet or buttocks first) in the mother’s uterus, rather than head-down, which is the normal position for a baby preparing for birth. About 3%-4% of full-term pregnancies result in breech presentation.  In most cases, a baby will settle into the head-down position between 32 and 36 weeks of pregnancy. However, some babies may continue to change positions up until the onset of labor. A breech baby can turn head-down during labor, although this is less likely as the baby grows larger and has less room to move around in the uterus. There are three types of breech presentations: Frank breech The baby’s buttocks present first, and the legs are flexed at the hips and extended at the knees, so the feet are near the baby’s head. Complete breech The baby is in a sitting position with the knees and hips both flexed, so the feet and buttocks are presenting. Footling breech One or both of the baby’s feet are presenting first rather than the buttocks. It’s important to note that not all babies will turn head-down on their own or with medical intervention, and some breech babies may require an alternative birth plan. Unfortunately, the number of skilled obstetricians (OBs) that can assist in a vaginal breech birth has dramatically decreased—it used to be a common practice, as long as the baby was in a front breech position. Today, a planned cesarean delivery (C-section) is the more common recommendation. The decision on whether to perform a C-section or attempt a vaginal delivery will depend on the specific circumstances and risks involved. Also Read: I’m a doula: this is what a doula does Rupture of membranes (water breaking) Signs of a breech baby There are a few signs that a baby may be in a breech position: Feeling a hard lump at the top of the uterus: In a head-down position, the baby’s head will be in the pelvis and the rest of the body will be in the upper part of the uterus. If the baby is in a breech position, the head may be up near the ribcage, making it feel like a hard lump. Feeling kicks in the upper abdomen: If the baby is in a breech position, the legs and feet may be extended up toward the mother’s ribs, causing the mother to feel kicks in the upper abdomen. Difficulty breathing or heartburn: When the baby is in a breech position, its head may be pressing against the mother’s diaphragm, making it harder to breathe or causing heartburn.  Unusual findings during pelvic exams: A healthcare provider may be able to feel the baby’s buttocks during a pelvic exam, which can indicate that the baby is in a breech position. Ultrasound confirmation: An ultrasound can confirm whether the baby is in a breech position.  It’s important to note that some women may not experience any symptoms or signs of a breech baby. In fact, most of my clients who ended up having a breech baby did not know it until they were told about it after an ultrasound. Causes of a breech baby The exact causes of breech presentation are not always clear. However, some factors may increase the likelihood of a breech presentation. One of the factors is premature birth. Babies that are born before their due date have less time to assume the head-down position. Another factor is placenta previa, where the placenta lies low in the uterus and obstructs the baby’s head-down movement. Additionally, multiple pregnancies, such as carrying twins or triplets, can cause a breech baby because of limited space for the babies to move around. Uterine abnormalities, such as an irregularly shaped or small uterus, can also make it difficult for the baby to turn head down. Also, a low level of amniotic fluid in the uterus can contribute to the baby’s breech position. Maternal health conditions, such as diabetes or high blood pressure, can also increase the risk of having a breech baby. Women who have previously given birth to a breech baby are more likely to have another breech baby in a subsequent pregnancy, although, in my experience, it is only if there are known uterine abnormalities. Risks to the baby when delivered in a breech position There may be some potential complications when a baby is in a breech position during delivery. One of these complications is difficulty delivering the baby’s head, which is the largest part of their body. Another potential complication is umbilical cord prolapse, where the umbilical cord becomes compressed between the baby and the birth canal. This can lead to a lack of oxygen supply to the baby, which can result in serious complications or even death. Breech babies are also at a higher risk of experiencing birth injuries, such as hip dysplasia, nerve damage, and bone fractures, due to

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Natural Ways to Manage Labor Contractions

Labor and birth /
Pregnant woman sitting on a birthing ball trying to manage labor contractions in a natural way

Preparing a Birth Preferences Document (Birth Plan) Knowing When It’s Time: When to Head to the Hospital for Labor Rupture Of Membranes (Water Breaking) I’m a Doula: This Is What a Doula Does VBAC (Vaginal Birth After Cesarean) Epidural: What It Is, Procedure, Risks & Side Effects Breech Baby Pain Management During Labor Pitocin: What It Is, Procedure, Risks & Side Effects Induced Labor Natural Ways to Manage Labor Contractions Labor contractions are a natural part of the childbirth process. While experiencing pain during labor is normal, there are several natural ways to help manage labor contractions and make the process more manageable. By Liat Salomon, doula February 27, 2024 Share on In This Article: Natural ways to manage labor contractions Should I try to sleep through contractions? Other positions to try to get relief Natural ways to manage labor contractions It’s important to remember that every pregnancy and labor experience is unique, so what works for one person may not work for another. Here are some natural ways to manage labor contractions: Breathing techniques Deep breathing: Inhale slowly through your nose, allowing your abdomen to rise, and then exhale slowly through your mouth. Try to control your breath, and almost “surf” on it. Also, see if you can feel (when practicing) that with every exhale, you relax your perineum. Making low sounds or grunting can be a way to release tension and manage the discomfort of contractions. Relaxation techniques In the weeks leading to the birth, learn and practice Hypnobirthing meditations. One very good tool is the GentleBirth app, which offers a variety of great meditations. Visualization: Close your eyes and imagine a peaceful place or visualize your baby descending through the birth canal. This should also be practiced in the weeks before the birth; during birth you will not struggle with trying to think of a place or a time, and your body will already be “programmed” to do it almost on command. Position changes Change positions frequently: Walking, swaying, rocking, or changing your position can help ease discomfort. You can take short walks around your room or corridor, or simply sway back and forth while standing. Use a birthing ball: Sitting on a birthing ball and gently rocking back and forth or in a circular motion can provide relief. Use a birthing stool, and if you do not have access to one, sitting backward on the toilet can offer the same effect. Hydration and nutrition Stay hydrated: Drink water or clear fluids to prevent dehydration. Coconut water is a good alternative but keep away from other fruit juices.  Eat light, easily digestible snacks: An omelet, yogurt, salads, and soups are great. Massage Gentle lower back or foot massages from a partner or a trained doula can help relax tense muscles and reduce discomfort. Heat therapy Warm compresses or a heating pad on your lower back or abdomen can alleviate pain. I love using the good ol’ hot water bottles. Aromatherapy Some women find relief through the use of calming essential oils like lavender or chamomile. Ensure you’re in a well-ventilated room and use tissue paper or a separate cloth to put the oil on (in case you become nauseous). Music and distraction Create a playlist of soothing music or listen to guided relaxation exercises to divert your attention from the pain. Support and encouragement Think of affirmations that might help you manage contraction and regain confidence in your ability to keep going. Warm baths or showers Soaking in a warm bath or taking a warm shower can help relax your muscles and ease tension. Note: Sitting in a bath is not recommended if your water already broke. Visualization and affirmations Create positive affirmations to focus your mind on the strength and power of your body during labor. Also Read: I’m a doula: this is what a doula does Knowing when it’s time: when to head to the hospital for labor Should I try to sleep through contractions? Sleeping through contractions during the early stages of labor is highly recommended. Resting during this phase can help you conserve energy for the more active phase of labor when contractions become more intense and frequent.  The side-lying position is often considered the most comfortable. Here’s how to do it: Lie on your side with your knees slightly bent. Place a pillow between your knees to support your hips and keep your spine aligned. Use another pillow to support your head and neck. You can switch sides if one side becomes uncomfortable, or you can lie on your preferred side. This position is beneficial for several reasons: It helps relieve pressure on your back, which can be especially helpful if you’re experiencing back labor. It allows for good blood circulation to both you and your baby. It’s a relaxed and natural position that can make it easier to fall asleep or rest between contractions. It’s essential to listen to your body and adjust your position as needed. Be prepared to change positions or use other comfort measures as your labor advances. Other positions to try to get relief Here are some positions that you can use to try to find relief: Sitting upright or semi-reclined Sitting up slightly or reclining in a semi-upright position can also provide relief during early labor. Use pillows or cushions to support your back and find a comfortable angle. Supported hands and knees Some women find relief from back pain by getting on their hands and knees, either on a bed or on the floor. This position can help take pressure off the lower back. Prenatal yoga poses Prenatal yoga poses, such as the child’s pose or cat-cow stretch, can help you find relief and relaxation. I wish you a wonderful and happy birth! Questions? If you have any questions about this topic/article, please feel free to contact me through email at:  liat@doulatalks.com Liat Salomon is a certified doula since 2010 and is working in the San Francisco Bay Area in California. She has assisted

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I’m a Doula: This Is What a Doula Does

Labor and birth /
Doula supporting a pregnant woman during labor

Natural Ways to Manage Labor Contractions Knowing When It’s Time: When to Head to the Hospital for Labor Pitocin: What It Is, Procedure, Risks & Side Effects Rupture Of Membranes (Water Breaking) VBAC (Vaginal Birth After Cesarean) Epidural: What It Is, Procedure, Risks & Side Effects Breech Baby Preparing a Birth Preferences Document (Birth Plan) Pain Management During Labor Induced Labor I’m a Doula: This Is What a Doula Does Choosing to be a doula is not a career decision. It is a calling. Being there for women when they are doing the most primal and basic of things — bringing another human being into the world — is definitely not a “day job.” By Liat Salomon, doula February 27, 2024 Share on In This Article: So what IS a doula? What services does a doula provide? What are the advantages of having a doula? Doula certifications What is the difference between a doula and a midwife? Choosing the right doula for you Doulas are for partners, too! I can’t say that being a doula was my childhood dream — primarily because I never heard of a doula growing up. All the birth stories I heard had the words “hospital”, “doctor”, and “pain” in them. Never anything else.  I can’t even say that it was my dream career when I was in my twenties: I worked as a journalist/news editor and loved it. But then life happened, as it usually does.  The birth of my first child was wonderful. Really. It wasn’t easy, but I felt so great after, so when I went in to give birth the second time, I had no doubt it would be the same.  Except it was not.  Looking back on both births, I realized that the key difference was that I didn’t have Valerie with me the second time. Valerie was who I kept looking for to help me go through contractions. I was looking for her massages, her confidence, and guidance — and basically just knowing she was there.  It took me nearly three years before I realized that what I wanted to do was “become Valerie.” So what IS a doula? A doula is a Greek word meaning “a woman who serves.” Today, the word doula refers to someone, usually a woman, who supports a person (and their partner) giving birth. The support includes physical, emotional, and mental support before and during labor. Also Read: Epidural: what it is, procedure, risks & side effects Preparing a birth preferences document (birth plan) What services does a doula provide? Not all doulas offer the same service packages but, generally speaking, doulas provide a range of services to support women and their partners during pregnancy, childbirth, and the postpartum period. Some of the services include: Prenatal support A doula can provide emotional and informational support during pregnancy, helping women and their partners prepare for childbirth, answering questions about pregnancy and childbirth, and providing guidance on birth preferences and options. Labor support During labor, a doula provides emotional and physical support to the mother and her partner. This can include providing massage, helping with relaxation and breathing techniques, suggesting different positions, and providing reassurance and encouragement. Advocacy A doula can help advocate for the mother’s wishes and preferences during childbirth, helping to ensure that the mother’s voice is heard and her needs are met. Personally, I feel that my job is to make sure that the birthing person and their partner advocate for themselves by encouraging them to ask A LOT of questions during pregnancy and during the birth — to make sure they always make the right decisions and that their “voice” is heard. Postpartum support Some doulas provide support to the mother and her partner in the postpartum period, such as helping with breastfeeding, providing emotional support, and assisting with newborn care. Overall, doulas can help to create a more positive and empowering birth experience for everyone involved. What are the advantages of having a doula? Numerous studies have confirmed the advantages of having a doula present during childbirth. These studies have shown that having a doula can lead to a range of benefits for the mother, the baby, and the birth experience overall. Here are some examples of the findings: Reduced risk of medical interventions A study published in Birth: Issues in Perinatal Care found that having a doula present during childbirth was associated with a reduced risk of infant mortality and a higher likelihood of spontaneous vaginal delivery. In addition, a Cochrane Review of 26 randomized controlled trials involving more than 15,000 women found that having a doula present during childbirth was associated with a reduced risk of C-section, shorter labors, and reduced use of pain medication. Also, a study published in the Journal of Midwifery & Women’s Health found that women who received continuous labor support from a doula had a lower incidence of fetal distress and were less likely to have their labor augmented with synthetic oxytocin. Shorter labors Studies have shown that women who have the support of a doula during labor tend to have shorter labors, on average, compared to women who do not have a doula present. Improved birth outcomes Research has found that having a doula present during childbirth can lead to improved birth outcomes, such as fewer complications and a lower risk of infant mortality. In addition, having a doula’s support can also help make sure that the baby is born in a more ideal position, which may help in mitigating tears and bruises. Increased satisfaction with birth experience Studies have consistently shown that women who have the support of a doula during childbirth report feeling more satisfied with their birth experience overall. A study published in the Journal of Obstetric, Gynecologic, and Neonatal Nursing found that women who had the support of a doula during childbirth were less likely to have postpartum depression and reported feeling more satisfied with their birth experience. Increased likelihood of breastfeeding Research has found that having a doula

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Induced Labor

Labor and birth /
labor induction procedure explained to a pregnant woman by a healthcare provider

Knowing When It’s Time: When to Head to the Hospital for Labor Pitocin: What It Is, Procedure, Risks & Side Effects Rupture Of Membranes (Water Breaking) I’m a Doula: This Is What a Doula Does Epidural: What It Is, Procedure, Risks & Side Effects VBAC (Vaginal Birth After Cesarean) Pain Management During Labor Breech Baby Natural Ways to Manage Labor Contractions Preparing a Birth Preferences Document (Birth Plan) Induced Labor In the U.S., it is very common for health providers to offer an induction at 39 or 40 weeks. There are some medical conditions that require it, but oftentimes the recommendations have to do with outdated protocols or convenience reasons—and are not justified. By Liat Salomon, doula February 27, 2024 Share on In This Article: Labor induction methods How painful is induced labor? Does the cervix have to be dilated before starting an induction? How long does it take from induction to labor, and how long will it take to give birth? What happens if you don’t dilate after being induced? What are the risks for mom and baby of inducing labor? How many inductions end in C-sections? When should you not get induced? When do you ask for an epidural during induction? How to prepare for labor induction How to make labor induction easier Can you walk around after being induced? Can you sleep during induced labor? How to induce labor naturally How long do you stay in the hospital after an induced birth? When I moved to California I thought that my days talking about excessive inductions were over. Boy, was I wrong…. I was blown away by the staggering number of inductions done here! Labor induction is the process of artificially starting labor in a pregnant woman. This may be done for a variety of reasons, including if the woman is past her due date, if there are concerns about the health of the mother or baby, or if the woman has a medical condition that makes continuing the pregnancy risky. In the past few years, there’s been an increase in the number of inductions being performed. There are multiple reasons for it, but the bottom line is that there are too many inductions being done—with no real medical reason—due to a protocol that does not look at someone’s actual condition and only takes into consideration a generic birthing person. One common reason for labor induction is if the birthing person is past their due date. Pregnancy is typically considered full-term at 37 weeks, but the average length of pregnancy is actually closer to 41 weeks. In fact, statistically, first-time babies are born at 41+5. Another reason for labor induction is a health concern for either the baby or the mother. For example, if the baby is not growing as expected or if the mother has a medical condition such as high blood pressure or liver issues, it could potentially put her and/or the baby at risk if the pregnancy continues. In addition, certain medical conditions can make continuing the pregnancy risky for the mother, such as pre-eclampsia, placental abruption, or placental insufficiency. In these cases, inducing labor may be necessary to protect the mother’s health. Labor induction methods Several methods can be used to induce labor. One common method is to use medication to stimulate contractions. This can be done using oxytocin, a hormone that naturally occurs in the body and helps to stimulate contractions, with the medication Pitocin or through the use of prostaglandins (such as misoprostol), which are hormones that help to soften and thin the cervix. The choice of method will depend on various factors such as the woman’s health condition, the baby’s health, and the stage of pregnancy. Here are some other common methods used for inducing labor: Membrane sweeping This is a procedure in which a healthcare provider will use their fingers to sweep around the cervix, separating the amniotic sac from the cervix. This can help release hormones (prostaglandins) that may start contractions and initiate labor. Balloon catheter This method involves inserting a small balloon catheter into the cervix to help it dilate and soften, which can help trigger contractions. Breaking the water A healthcare provider can manually break the amniotic sac (which contains the fluid surrounding the baby) using a special tool. This can stimulate the release of hormones (prostaglandins) that may start contractions and initiate labor.For further information on water breaking, you can read my article: “Rupture of membranes (water breaking)“. I will say that breaking the water is my least favorite form of induction. I feel that it starts a whole new set of protocols and is not reversible. Also, after the water is broken, you can expect contractions to get a lot more intense—right from the start—instead of building gradually. It’s important to note that all of these methods carry some risks, and induction should only be considered and done when medically necessary! Also Read: Pain management during labor Epidural: what it is, procedure, risks & side effects How painful is induced labor? Induced labor can be more painful than spontaneous labor as the body is being forced into labor before it’s fully ready. The intensity of the pain can vary depending on the woman’s pain tolerance and the methods used for induction. The contractions experienced during induced labor can be more intense and frequent, and may feel different than natural contractions.It’s important to have emotional support from partners, family members, and healthcare providers, as this can help manage anxiety and stress during labor and delivery. Does the cervix have to be dilated before starting an induction? The only induction method that requires dilation is membrane sweeping (stripping).Other forms of induction do not require a certain dilation to begin, and some of them, like a catheter, are intended to start dilation. How long does it take from induction to labor, and how long will it take to give birth? The time it takes from induction to the start of active labor can vary depending on

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Pain Management During Labor

Labor and birth /
Hands held in support of pain during labor and birth

Knowing When It’s Time: When to Head to the Hospital for Labor Epidural: What It Is, Procedure, Risks & Side Effects I’m a Doula: This Is What a Doula Does Natural Ways to Manage Labor Contractions Pitocin: What It Is, Procedure, Risks & Side Effects Rupture Of Membranes (Water Breaking) VBAC (Vaginal Birth After Cesarean) Breech Baby Induced Labor Preparing a Birth Preferences Document (Birth Plan) Pain Management During Labor By Liat Salomon, doula February 27, 2024 Share on In This Article: Nitrous oxide (laughing gas) Opioids Epidural anesthesia Conclusion The discussion around the use of pain medication during labor tends to be an emotional one. Some women feel it is important for them to give birth more ‘naturally’, i.e. unmedicated, and may feel that they are giving up and get disappointed in themselves if they end up asking for pain medication. I personally feel that pain medications are simply tools and that the decision to use or not use them should be made after considering and reviewing all the subjective information in real time, during labor. I also think women should feel free to change their minds during labor (in either way) without being judged or criticized. I feel that it is important to remember that labor pain is a natural and normal part of the childbirth process. I recently read an interview with a midwife that spent time with African tribes, watching and documenting women in labor. What struck me the most was  her saying that when she asked the local midwives how they help manage pain, they seemed surprised at the question. To them pain is such a natural and expected part of labor, and there is no reason to “help” with it. They just go through it. I often tell the women I work with that each woman’s experience of pain during labor is unique, and there is no “right” or “wrong” way to manage it. The intensity of labor pain can vary greatly from woman to woman, and even from one labor to another.The pain can be felt as a series of waves or contractions that build in intensity and then subside. It is typically felt in the lower back, pelvis, and abdomen, and may radiate down the legs. The pain can be accompanied by other physical sensations such as pressure, stretching and pulling. While labor pain can be managed in several ways, including using breathing and other relaxation techniques, movement, such as changing positions, walking, swaying, massage to the lower back, shoulders and legs, and hydrotherapy such as a bath or shower, (for more information on this, check out my article “Natural ways to manage labor contractions”), in this article I will talk in detail about medical pain management – pain medication. Here’s a review of the different types of pain medication that can be used during labor: Nitrous oxide (laughing gas) Nitrous oxide, also known as laughing gas, is a gas that is inhaled through a mask.When inhaled, nitrous oxide can help to reduce the sensation of pain and anxiety, making it a popular option for women who want to avoid more invasive pain management options, such as an epidural. Nitrous oxide can also help to increase feelings of relaxation and reduce the intensity of perceived pain. Some women may find that it provides only partial relief and may need additional pain management options. Nitrous can also be used throughout labor, including during the pushing stage. Another advantage of nitrous oxide is that it does not interfere with the woman’s ability to move around and change positions, which can be beneficial during labor.I feel it is especially useful when a woman is tired and needs a short break. I like that it has relatively mild side effects, like nausea and lightheadedness, and I mostly like that once a woman decides to stop using it, it clears in a minute or two. Also Read: I’m a doula: this is what a doula does Knowing when it’s time: when to head to the hospital for labor Opioids Fentanyl (sometimes referred to as “IV medication”, without naming the medication itself) is often offered during labor, and is administered through an IV. Fentanyl can help reduce pain, but can also cause drowsiness, nausea, and respiratory depression in both the mother and baby. Personally, I would not recommend using fentanyl during labor because it crosses the placenta and affects the baby, potentially with dire results. If the labor suddenly picks up (due to the pelvis relaxation) the baby will be born under influence of fentanyl, which may result in a “sleepy baby”, a watered down term for a baby that has serious respiratory difficulties. Epidural anesthesia This is a common pain relief option that involves the insertion of a small catheter into the epidural space in the lower back. A local anesthetic and sometimes a narcotic are then administered through the catheter to numb the lower half of the body, including the uterus and birth canal. An epidural is typically very effective at relieving pain, but it may also have side effects, such as decreased blood pressure, headaches, and shivering. In rare cases, an epidural may cause more serious complications, such as infection or nerve damage.It is important to know that use of an epidural may decrease the frequency of contractions, causing them to occur at wider intervals after it is administered. This usually happens if an epidural is used in early labor, and rarely during active labor (5-6 CM). If the problem of contraction infrequency persists, your provider will typically suggest adding Pitocin. After getting an epidural you will stay in bed until giving birth, but in most cases you can still change positions while being in bed to continue promoting and advancing toward a vaginal birth. For a more in-depth look at epidurals, check out my article “Epidural: what it is, procedure, risks & side effects”. Conclusion The decision to use pain medication during labor is personal, and, if requested, the different medications should be

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Knowing When It’s Time: When to Head to the Hospital for Labor

Labor and birth /
Pregnant woman contemplating whether it's time to head to the hospital for labor

Epidural: What It Is, Procedure, Risks & Side Effects Rupture Of Membranes (Water Breaking) I’m a Doula: This Is What a Doula Does Pitocin: What It Is, Procedure, Risks & Side Effects Pain Management During Labor VBAC (Vaginal Birth After Cesarean) Induced Labor Natural Ways to Manage Labor Contractions Breech Baby Preparing a Birth Preferences Document (Birth Plan) Knowing When It’s Time: When to Head to the Hospital for Labor “But how will I know when to go?” “What if I get there too early/too late?”I get these questions A LOT!There seems to be a lot of stress surrounding this decision, and it actually IS an important decision — one that may determine the course of the labor from that point on. By Liat Salomon, doula February 27, 2024 Share on In This Article: Regular contractions Water breaking Heavy bleeding Rectal pressure Decreased fetal movement Other symptoms Going to the hospital too early may cause contractions to subside and space out. Lights, noises, stress of changing location, and an unfamiliar environment — all may cause your brain to produce more adrenaline, which will interfere with the production of oxytocin, the hormone responsible for contractions. Another effect may be that your pain level will increase due to the rising stress level and not being able to maintain the “oxytocin bubble” that also helps manage pain. The concern is that if contractions start spacing out and your pain level rises, it will lead to medical interventions, which might not have been necessary had you stayed laboring at home and arrived at the hospital later when the effect of the location change on the labor process would be minimal. When I say medical interventions, this could include different types of inductions or the use of pain medications.  The timing of when to go to the hospital for labor can depend on several factors, such as your pregnancy history, your obstetrician or midwife’s recommendations, your own preferences, and, of course, the labor progression. This can be a tricky decision. However, here are some general guidelines that can help you determine when it’s time to go to the hospital: Regular contractions Timing contractions One reason to head to the hospital is when you start having regular contractions that are getting stronger and closer together. If this is your first baby, using the popular 5-1-1 method (contractions – from the start of one to the start of the next – are 5 minutes apart, lasting for 1 minute, and have been this way for at least 1 hour) will get you to the hospital too early. The early labor stage for first babies is expected to be significantly longer, and with contractions at 5-1-1, you may still be in early labor and not in active labor. First baby Personally, I recommend that if this is your first baby, you should wait until contractions are 3-4 minutes apart (or 3 contractions in 10 minutes), each contraction about a minute long, and all of this has been going on for at least an hour to an hour and a half. Second baby and up For the second baby and up, a 4-1-1 method is OK to start heading to the hospital. Also Read: Epidural: what it is, procedure, risks & side effects Natural ways to manage labor contractions Water breaking If you have been having good, frequent contractions and your water broke, it’s time to go to the hospital. Please note that if your water broke and it is clear but you are not having any contractions, you can stay home, rest, and wait for them to start. For a more in-depth look at water breaking, check out my article “Rupture of membranes (water breaking)”. Heavy bleeding If you experience heavy vaginal bleeding, it may be a sign of a problem with the placenta, so it’s important to seek medical attention right away. Please note that it is normal to have “bloody shows”, a discharge type with blood in it. It is not just normal but an actual sign of progress, and you should expect to see it, in growing amounts, until you give birth. Rectal pressure As labor progresses and the baby is descending and pushing more and more on your cervix, we expect dilation to increase and the baby to get lower in your pelvis. At some point, you can expect to start feeling a “pooping” sensation in your rectum. At first, you will feel it only during a contraction and not very strongly, but at some point, it will get stronger and more present. Later it will stay even after the contraction is over. This is a good sign to head to the hospital. Decreased fetal movement If you notice a decrease in your baby’s movement or you don’t feel any movement for a few hours, call your healthcare provider or go to the hospital immediately. Other symptoms If you experience other symptoms like severe, sharp abdominal pain, fever, or vomiting, it’s important to contact your healthcare provider or go to the hospital. There is one more thing to consider when trying to decide about going to the hospital. I like to call it the “I can’t take it anymore meter”. We use the term “can’t take it” very often and very loosely, even if we do not really mean it or absolutely can take it. I recommend that if you say, “I can’t take this anymore”, you will have someone around you ask two questions: Are you sure? What is it exactly that you can’t take anymore? The first question is to see if it is one of those cases where we say it but don’t mean it. For example, making you think about it may result in agreeing to revisit it again in an hour. The second one is even more important: if you can’t take the pain and wish to go in to get an epidural, that’s one thing, but if you want to go in because you are curious to

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Rupture Of Membranes (Water Breaking)

Labor and birth /
A pregnant woman experiencing rupture of membranes (water breaking)

Knowing When It’s Time: When to Head to the Hospital for Labor Epidural: What It Is, Procedure, Risks & Side Effects Pitocin: What It Is, Procedure, Risks & Side Effects I’m a Doula: This Is What a Doula Does VBAC (Vaginal Birth After Cesarean) Pain Management During Labor Induced Labor Preparing a Birth Preferences Document (Birth Plan) Natural Ways to Manage Labor Contractions Rupture Of Membranes (Water Breaking) By Liat Salomon, doula February 27, 2024 Share on In This Article: Water breaking signs What does water breaking look like? Water breaking vs discharge or urine Should I go to the hospital as soon as my water breaks, even with no contractions? Does it hurt when your water breaks? Artificially rupturing the amniotic sac How long after my water breaks will I deliver? Mucus plug Water breaking during labor is a term used to describe the rupturing of the amniotic sac, which contains the fluid that surrounds and protects the developing fetus in the uterus. When the amniotic sac ruptures, the fluid inside it may leak out of the vagina, which is commonly referred to as “water breaking”. In most cases, the water breaking is a natural part of the labor process and occurs as the body prepares for delivery. However, in other cases, the amniotic sac may rupture before the labor actually begins. There is no set level of cervical dilation that a woman must reach before her water breaks. In fact, a woman’s water can break at any point in the pregnancy, including before labor has even started. The timing of the water breaking is influenced by a variety of factors, including the baby’s position, the amount of amniotic fluid present, and the strength of the amniotic sac. Once the water breaks, labor typically begins within a few hours. If the water is clear and does not have a greenish tint in it (this tint is known as meconial water), you can stay home and wait for contractions to begin. Drinking a lot of fluids is recommended, and I would add a recommendation to sleep/rest to be prepared to manage contractions when they start. Once there are a few more signs that labor is progressing, including a good pattern of contractions (see more information in “Knowing when it’s time: when to head to the hospital for labor”), you should start heading to the hospital.  When the water breaks, the amniotic sac that protects and surrounds the baby ruptures, which means that the baby is no longer protected from the outside environment. This can increase the risk of infection, which is why healthcare providers generally recommend that women give birth within 24 hours after their water breaks. However, it’s important to note that the risk of infection depends on several factors, including the woman’s and baby’s overall health, whether there were any complications during pregnancy or labor, if the woman is positive for Group B Streptococcus (GBS), and how long it has been since the water broke. If you are being responsible, taking your temperature every two hours, not going into a tub, and minimizing vaginal exams, the risk of infection is lower. If the woman has not gone into labor within 24 hours of the water breaking, healthcare providers may recommend an induction of labor or other interventions to help speed up the process and reduce the risk of infection. It is OK to keep asking if there is a true subjective need for you to be induced or is it just following protocol. If it is a protocol-based recommendation, you can decide to continue waiting for birth to begin. While waiting, continue drinking, checking your temperature, and paying attention to the baby’s movements. Water breaking signs The signs of water breaking during labor can vary from woman to woman. Some common signs that may indicate that the amniotic sac has ruptured and the water has broken include: A sudden gush of fluid This is the most obvious sign of water breaking, and it can be a significant amount of fluid that soaks through your clothing and onto the floor. A slow trickle of fluid In some cases, the fluid may leak out slowly over time, so you may feel dampness in your underwear or notice a steady trickle of fluid. A sensation of warmth or wetness You may feel a sudden sensation of warmth or wetness in your vaginal area. It’s important to note that not all women experience the same signs of water breaking. Some women may not notice any signs at all, while others may experience a combination of the above signs. When the amniotic sac ruptures, the fluid might leak out of the vagina slowly, which can be mistaken for urine or increased vaginal discharge. The leakage may be continuous or intermittent and may be accompanied by a feeling of wetness or dampness. It is important to be aware of the signs of a slow leak of amniotic fluid, as it may increase the risk of infection and may require medical attention. Signs of a slow leak may include:  A sudden increase in vaginal discharge A persistent feeling of wetness in the vaginal area A strong odor to the fluid, which may indicate infection A change in the color or consistency of the fluid, which may also indicate infection What does water breaking look like? In most cases, the water breaking looks like a clear, odorless fluid that comes out of the vagina. However, the color and consistency of the fluid can vary depending on several factors, including the stage of labor, the baby’s position, and the woman’s health.Here are some common characteristics of the fluid that may come out when the water breaks: Clear or slightly pinkish in color In most cases, the fluid is clear or slightly tinged with pink, which is a sign of normal fetal blood circulation. Watery or slightly sticky The fluid is usually thin and watery, although it may be slightly sticky or mucus-like. Odorless Amniotic fluid is

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Pitocin: What It Is, Procedure, Risks & Side Effects

Labor and birth /
Pregnant woman receiving Pitocin through IV during labor

I’m a Doula: This Is What a Doula Does Natural Ways to Manage Labor Contractions Induced Labor Pain Management During Labor Knowing When It’s Time: When to Head to the Hospital for Labor Preparing a Birth Preferences Document (Birth Plan) Rupture Of Membranes (Water Breaking) VBAC (Vaginal Birth After Cesarean) Epidural: What It Is, Procedure, Risks & Side Effects Pitocin: What It Is, Procedure, Risks & Side Effects By Liat Salomon, doula February 27, 2024 Share on In This Article: Oxytocin and its role in labor induction The right time to use Pitocin Administration and dosage of Pitocin Does Pitocin affect dilation? Will I be able to rest while receiving Pitocin? How to manage pain while on Pitocin Understanding the risks: common side effects of Pitocin for mom and baby Does the use of Pitocin increase the risk of a C-section? Boosting your oxytocin: tips and techniques for increasing hormone levels naturally Conclusion In the last few years, there has been a significant rise in labor induction rates in the U.S. The medical community happily adopted the ARRIVE trial without questioning it, and doctors began recommending induction to a growing number of women at 39-40 weeks pregnant, regardless of the subjective medical situation. Some medical conditions indeed require medical intervention. However, an induction is a tool that is best used in moderation and only when absolutely needed. There are different methods or medications that are used to induce labor. This article will review the use of Pitocin. Pitocin has had a very bad reputation over the years. I feel that recently, as it became more and more clear what the best ways to use Pitocin are, it became safer, can allow more control over the process, and, when used correctly and for the right reasons, it is a good tool to have. Oxytocin and its role in labor induction Pitocin is a synthetic form of the hormone oxytocin, which is naturally produced by the body. Oxytocin is also known as the “love hormone” and is involved in various physiological processes, including stimulation of contractions in the uterus during labor and the release of breast milk. The mechanism of action of Pitocin is like that of the natural oxytocin hormone. It acts on the uterine smooth muscle to cause rhythmic contractions, to either start labor artificially or to augment slow or irregular contractions. The right time to use Pitocin For best results, Pitocin should only be used when it is determined that the cervix is ripe and ready. The cervix must be soft enough to allow contractions to be effective and, in turn, get the cervix to shorten, which will then cause it to open (dilate). If the cervix is not ready, there might be a need to offer prostaglandins (either vaginally with Cervidil, or orally with Misoprostol/Zitotec). Also Read: Induced labor I’m a doula: this is what a doula does Administration and dosage of Pitocin Pitocin is typically administered intravenously (IV) through an IV line inserted into a vein in the arm. It is delivered continuously through an infusion pump, which is carefully monitored to ensure the correct dosage is delivered. The dosage of Pitocin depends on several factors, including the woman’s gestational age, the stage of labor, the strength and frequency of contractions, and the health of the baby. In general, the initial dosage of Pitocin is low and is gradually increased until the desired effect is achieved. The half-life of oxytocin in the bloodstream is about 3 to 5 minutes, meaning that it is rapidly metabolized and eliminated from the body. Does Pitocin affect dilation? Pitocin can help stimulate uterine contractions and facilitate dilation of the cervix during labor. However, the rate at which dilation occurs varies and can depend on several factors, including the woman’s previous pregnancy history, her age, and the position of the baby. In general, dilation of the cervix typically occurs gradually over the course of several hours to a few days. The average time it takes to progress from 1 cm to 10 cm of dilation is usually between 6 to 20 hours, although this can vary widely and can be shorter or longer depending on the individual woman and the specific circumstances of her labor. It is important to note that while Pitocin can help to speed up the dilation process, it can also increase the risk of certain complications, such as uterine hyperstimulation or fetal distress. Will I be able to rest while receiving Pitocin? The purpose of using Pitocin is to help labor progress, and just like with spontaneous or natural contractions, we hope that at some point the contractions are intense enough to promote labor. In that case, sleeping or even lying down will not be comfortable. I always suggest getting as much rest before labor really kicks in, and usually, when Pitocin levels are low, it is still possible. When it gets uncomfortable to rest, you can start walking around the room, get on all fours in bed, sit on a birthing ball, and even use a shower (the nurse can cover the IV tubes). How to manage pain while on Pitocin Pain during labor and delivery is a subjective experience, and women may experience pain differently. The pain associated with Pitocin-induced contractions can vary from woman to woman. Although Pitocin-induced contractions can be stronger and more frequent than natural contractions, it may also depend on several factors including individual pain tolerance, the stage of labor, and the strength and frequency of the contractions. Same as with natural contractions, you can choose to use pain management techniques, such as breathing exercises, massage, shower/bath, and pain medication. Understanding the risks: common side effects of Pitocin for mom and baby Pitocin is a commonly used medication, but like all medications, it has associated risks and side effects. Some of the most common risks and side effects of Pitocin include: Uterine hyperstimulation Pitocin can cause the uterus to contract too strongly or too frequently, which can lead to uterine hyperstimulation and

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Epidural: What It Is, Procedure, Risks & Side Effects

Labor and birth /
Epidural being injected to a pregnant woman during labor

Pain Management During Labor Pitocin: What It Is, Procedure, Risks & Side Effects Rupture Of Membranes (Water Breaking) Knowing When It’s Time: When to Head to the Hospital for Labor I’m a Doula: This Is What a Doula Does VBAC (Vaginal Birth After Cesarean) Induced Labor Breech Baby Natural Ways to Manage Labor Contractions Preparing a Birth Preferences Document (Birth Plan) Epidural: What It Is, Procedure, Risks & Side Effects By Liat Salomon, doula February 27, 2024 Share on In This Article: How is an epidural administered? At what stage of labor is an epidural given? How long does labor with an epidural last? Does an epidural make you dilate faster? Does labor still hurt with an epidural? Can you walk after an epidural? Epidural risks and side effects to mother and baby Conclusion Hearing the words “pain medication” and “epidural” usually prompts a lot of emotional reactions. Some women feel that it is an achievement to give birth without using pain medication at all, and get disappointed in themselves and feel that they are giving up if they end up asking for pain relief.  I personally feel that pain medications, including epidural, are simply tools. The decision to use or not use them should be made after reviewing and considering all the information. Also, I feel that women are allowed to change their minds during birth (in either direction) without being judged or criticized. It’s important to remember that labor pain is a natural and normal part of the childbirth process. Each woman’s experience of pain during labor is unique, and there is no right or wrong way to manage it. The intensity of labor pain can vary greatly from woman to woman — and even from one labor to another. One of the most effective and widely used forms of pain relief during childbirth is an epidural, which involves the administration of a local anesthetic into the epidural space of the spine. This results in numbness in the lower body and can significantly reduce the intensity of pain during labor. However, epidural has some potential risks and side effects, so it should be discussed with a healthcare provider and considered carefully before use. Also, it is important to note that an epidural may not be appropriate or effective for every woman. Some women may have medical conditions or complications that make an epidural contraindicated. Let’s explore the different questions that might come up when considering an epidural during childbirth. How is an epidural administered? Most people refer to epidural as a medication, but, in fact, the epidural space is the area between the spine and the outermost layer of the spinal canal, located in the lower back, aka lumbar spine region. It contains the nerves that transmit pain signals from the uterus and birth canal to the brain. The actual medication contains a combination of an anesthetic and an opioid.The procedure for administering an epidural begins with the woman sitting up and leaning forward or lying on her side. The anesthesiologist will clean the skin on the lower back and inject a small amount of local anesthetic to numb the area. They will then insert a needle into the epidural space and thread a tiny, flexible catheter through the needle. The needle is then removed, leaving the catheter in place. The medication is delivered through the catheter using a pump, which allows the woman to receive a continuous dose of pain relief. Some women are concerned about the size of the needle or the pain involved in inserting the catheter. The needle is a normal-size needle and once the skin is numb, you should not feel pain when the epidural is placed. It is normal to feel some light pressure in the back as the doctor inserts the needle and catheter, and sometimes a small zing in one of the legs. The epidural usually takes effect within 15 to 20 minutes, and the level of pain relief can be adjusted by the anesthesiologist. The epidural medication typically lasts for the duration of labor and delivery, although some women may require additional doses. At what stage of labor is an epidural given? An epidural is typically administered during active labor, which is the stage of labor when the cervix is dilated to at least 4 to 5 centimeters, and regular contractions have begun. Some women may choose to have an epidural early on in labor, while others may wait until the contractions become more intense and frequent. When using it earlier, there is a risk of contractions spacing out, which could require a need to start adding Pitocin to encourage contractions to become regular. Also Read: Knowing when it’s time: when to head to the hospital for labor I’m a doula: this is what a doula does How long does labor with an epidural last? On average, labor with an epidural can last longer than without an epidural.However, the impact of an epidural on labor length can vary depending on individual circumstances and medical practices, including the individual woman’s labor progress and the stage of labor in which it was administered.  Some studies have suggested that the use of an epidural may increase the likelihood of needing interventions such as vacuum-assisted delivery or cesarean section, which can also impact the length of labor. There are instances where an epidural may have a positive effect on labor and help relax the pelvis, which may prompt quicker progress.  Sometimes an epidural may be turned off when it is time to push to help the mother regain sensation and push more effectively. Does an epidural make you dilate faster? There is no clear consensus on whether an epidural makes you dilate faster during labor. Some studies have suggested that an epidural can slow down the process of cervical dilation, while others have found no significant impact on dilation. One possible reason for the conflicting results is that an epidural can affect the body in different ways, depending on the dosage of

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