C-Section Recovery · Postpartum Recovery · Prenatal Hand Expression ·

5 Steps to Labor Ready!:Step 2: Pregnancy Empowerment (Part 2)

Let’s talk about the things no one fully explains.

The aches.
The cervical checks.
The shifting emotions.
The role your partner actually plays.

Pregnancy isn’t just a countdown to delivery day, it’s a series of physical and hormonal changes that evolve every trimester. Some are uncomfortable. Some are surprising. Some are completely normal but rarely talked about openly.

When you know what to expect starting from early round ligament pain to late third-trimester pressure, your body feels less mysterious and labor feels less intimidating.

This isn’t about eliminating discomfort.
It’s about understanding it.

Because when you understand what your body is doing, you stop fighting it and start working with it.

💛 Nurse’s Note

As a doctorate-prepared nurse specializing in perinatal care, I’ve supported countless women through pregnancy, labor, and postpartum recovery. The education and recovery tools I recommend are thoughtfully chosen with both clinical insight and real motherhood in mind.

So, we left off on Part 1 of Pregnancy Empowerment talking about your partner setting the stage and creating an environment to help create surges of oxytocin and help labor progress. So it seems fitting to address the thing that most people are afraid of: PAIN.

The question so many moms have is how painful is this going to be? Or, will I be able to stand this pain? New moms often ask, what is it going to be like? So to help you deal with contraction pain, it’s important for you to first understand that in the lower part of the uterus, is where you have most of your nerves. The nerves go around to the back and in some people extends down into the legs.

Now everyone has different structures and numbers of nerves here. Some have a lot, and some not as many. That is why it is important as you are going through labor that you stay open minded to having some type of pain medication. You may be going into labor wanting no medication at all and that is fine. Just remember, you do not know what or how all your nerves will be like until it is happening. Sometimes there is a lot of pressure around pain medications and epidurals during labor from family or friends. Just know you are not a failure and it is not a reflection on how you perform. Remember it is your labor and your body. You choose mama. 

We have seen some amazing births where woman didn’t experience that much pain and then we have seen some where every contraction was excruciatingly painful. Everyone experiences pain differently so no Judgement Here! 

Because your uterus does not have a lot of nerves at the top, you will typically just feel tightening but you will feel the pain down lower and around your back because that is where all the nerves are. 

PARTNER

Now this is where partners come in as the most important person on the planet.

With a little practice, you are better than anyone else at providing support with these 2 maneuvers that are helpful. Practice them in pregnancy and I promise you these will be very helpful in labor itself. 

Penguin walk:

Remember that all the nerves are lower so we are going help to lift up on mama's belly and actually really release discomfort and decrease the feelings of pain. 

First: Stand behind your soon to be mama, put your arms around lifting her belly gently, this should feel good and supported.

SECOND: Next snuggle in close, keep pressure holding up her belly gently, and walk like a penguin in unison. Practice this before otherwise it may seem awkward when you try it for the first time in pressure. 

COUNTER PRESSURE:

Lower back pain and/or labor, can be really painful and for lack of medical terms, nasty.

Partners you will apply firm, steady pressure to the lower back and hip area. You will apply this pressure at the beginning of the contraction, maintain it throughout, and release the pressure at the end of the contraction. This works well while mom is on hands and knees, sitting on a birthing ball, or leaning over the bed. You can also use a tennis ball. There is a lot of information on effective counter pressure to help control pain.

CERVIX

The cervix is really interesting. It is the opening of your uterus that leads into the vagina, which is the outlet for your baby’s entrance into this world. Think of your cervix as a round doorway that needs to stretch outward and get thinner before your baby can pass through it. 

Your Cervix is a gateway between your uterus and the outside world.

Your Cervix when you are not pregnant is like the consistency of your nose. Once you get pregnant, at a few months, it softens, due to the hormones and feels more like the lips. The idea is that you want your cervix to get as soft and “favorable” as possible for labor by the end of your pregnancy.

HOW DO WE DO THAT?

Well, we need PRESSURE on the cervix to help it soften and shorten. Pressure from the baby’s head, release of hormones or manipulation of the cervix.

The way we get PRESSURE is by moving around, walking, squatting, exercises and sex. YES. Sex is fabulous for people in the end of pregnancy as long as there are no contraindications that your provider has advised you like placenta previa, unexplained bleeding, or preterm labor.

Inside the cervix, there is an amazing little thing called a “mucus plug” and everyone is always curious about the mucus plug. Well, the plug is there to protect anything from being able to get into the uterus.

Inside the cervix there is this amazing little plug designed to stop any infection from coming up into the uterus.

At the end of pregnancy, the body will start to lose this. Some loose it a little at a time and some lose it all at once, they sit on the toilet and say OH WHAT IS THAT? It actually looks like a little mucus tampon.

 It could have some tinge of pink, a little dried blood or have different colors like white, yellow or green if it comes out all at once.

Most people though will loose it a little at a time. SO what happens is women will say they have more discharge at the end of pregnancy and what is happening is they are losing bits of the mucus plug.

You do not need to collect or bring the mucus plug to show us at the hospital. We know what one looks like! 😊

The Cervix does a magical trick of DILATING and EFFACING.

When your healthcare team performs a vaginal exam, they are checking the cervix and they will ramble at you 3 numbers.

The first number is the cm DILATED. Dilation is how open the cervix is.

Now, the first thing to know about dilating is that the baby doesn’t actually have a tape measure and neither do nurses or doctors to come up with this number. We sort of just made it up. Truly. The numbers are estimates to how open the cervix is, but it really is just saying the cervix is GONE.

This may help explain the differences in cervical checks. Sometimes you are going along and doing great, but you might have 2 different nurses or healthcare providers check your cervix and one might say, “I think you are 4 cm” and one might say, “I would say 5-6 cm”. Don’t sweat it. As long as you are going in the right direction, you are doing great!

EFFACEMENT is how long or short the cervix is. This is the second number you will hear and it is expressed as a percentage.

The cervix is generally quite long, and as labor progresses it thins down and gets out of the way until it is paper thin and can barely be felt. This allows the babies head to come completely through the opening and down into the vagina to be born. How effaced the cervix is expressed in percentages and the greater the percentage is means the more your cervix has effaced and shortened.

For instance, if the nurse says 20% effaced, that means there is 80% of the cervix left and that is thick. The goal is to get to 100% effaced, which means it is paper thin and the babies head can come through without causing any tearing!

SO, as labor progresses, the babies head will put pressure on the cervix and cause the cervix to OPEN or DILATE and THIN or EFFACE. BOTH of these are required in order to begin pushing.

Sometimes, one will happen without the other – for example, you might have a check and you are 4 cm dilated and only 20% effaced – labor for 3 hours – check again and now you are 5 cm dilated and 80% effaced. Often this feels frustrating because you only dilated 5 cm and now you feel like giving up or just staying pregnant forever!

BUT – you went from 20% to 80% effaced! Meaning – the cervix is very thin and this is a significant change and you are  progressing in labor.

Station is also measured in cm above or below the middle of your pelvis. Before you are in labor generally the station of your baby is -3 station meaning the baby head is very high and not engaged into the pelvis. Once your labor starts to progress and your contractions become more regular and strengthen, the baby begins to work their way down through the birth canal into the pelvis and more engaged.

The station will go from a -3 all the way to +3 when the baby head is crowning at the perineum making their entrance into this world. So, as you can see effacement, dilation, and station are very important when it comes to see the progression of your labor. 

The way to know how you are progressing is through a cervical exam while you are in labor. Often this can be a bit uncomfortable. Even more so if this is your first exam or if the baby is high sometimes the healthcare provider often have to reach for your cervix. To make this a bit more comfortable, make two fists and place them under your buttocks, relax your legs the best as you can, and take some slow deep breaths. By tilting your pelvis up, it makes it easier for the doctor to reach your cervix. The less tense the less painful the exam. Often your provider will begin to do vaginal exams towards the end of your pregnancy at your prenatal visits so you may be use to it somewhat. 

During labor cervical checks are done usually when you arrive to see the starting point unless your water has spontaneous ruptured and you are not in labor then often, they will not do an exam to prevent infection to develop later. This is also true in limiting cervical check when in labor once your water is broken. 

VAGINA

This is another question we hear a lot – HOW IS THAT GOING TO FIT THROUGH AND COME OUT OF MY BODY?

Normally, the vagina is straight and there is a lot of muscular control of it. At the end of pregnancy, the lining of your vagina changes and the tissues, nerves, and muscles allow expansion to make room for the baby. Its temporary and allows the vagina to expand like an accordion and later it changes and goes back again. Don't worry!

PLACENTA

Another fascinating part about pregnancy is how this little fetus inside of you can live within your uterus up to 40-42 weeks and grow into this beautiful baby. This is all because of the organ that develops called the placenta. 

The baby’s umbilical cord attaches to the placenta and provides the baby with the nutrients they need to grow and it filters out cellular waste, protects the baby from infections, and it supplies the baby with the oxygen they need, and helps regulate the baby’s temperature.    

What is magical about the placenta is that it releases hormones that help start labor and it helps at the time of birth.

During your ultrasounds you will usually find out where your placenta is located. Depending on where your placenta is positioned and located can affect how you feel the baby kicking and moving. 

Sometimes the placenta will attach to the front of your abdomen, and you will hear providers say you have an anterior placenta, and you may not feel the baby kick as much in the front of your belly, because your placenta is blocking you from feeling them.

The most common place for the placenta to attach is the back side of the uterus, which providers will say posterior placenta and you will feel the baby kick you in the front side of your tummy. 1/200 pregnancies have placenta previa, where the placement of the placenta in the uterus is near or over the opening of the cervix.

There are different degrees of placenta previa such as complete previa, partial, and marginal. Placenta previa puts you into a high-risk category and this is usually discovered through a routine ultrasound or after an episode of bleeding.

Your provider will monitor you more closely and inform you what to watch for and note any type of bleeding.

Without going into a lot of medical terms basically placenta previa is covering the cervix and when labor occurs or your amniotic membranes rupture, the placenta starts to detach from the lower uterus causing bleeding. Depending on the degree of placenta previa, they can resolve before delivery. However, if not a C-section will be needed.

END OF PREGNANCY

 Let’s talk about the final weeks and days leading up to your birth and how you should prepare physically and emotionally. First let us talk about some gestational milestones.

  Before 37 weeks you are considered pre-term. 37 weeks you are considered early term. 39 weeks you are considered full term, 41 weeks you are considered late term, and hopefully you do not have to go to 42 weeks which is considered full term.

  Remember that only 5% of women actually deliver on their due date so keep in mind if this is your first baby, or if you went to full term in your other pregnancies, it is common to go to full term this time too. Which is the same if you delivered early in previous pregnancies, you have a higher likely to have a preterm delivery again.

Trimesters

 Each trimester has different issues that moms face. However, the last trimester can be the most challenging for some. Everyone is different, but usually by week 36 you are over being pregnant and your body begins to start to naturally prepare for the birth of your baby.

You will begin to notice more aches and pains that come leading up to the final countdown. During pregnancy your body produces relaxin and progesterone hormones which relax muscles and loosen ligaments, so you may find after a long walk or after exercising you may experience more pain.

 It is important to keep active during pregnancy, just be mindful in the last few weeks that you could be at a higher risk for strains. You may remember the round ligament pain you may have had in your second trimester as your uterus and surrounding ligaments stretch, well in your last semester you may notice this even more as you try to get up from sitting position or rolling over in bed, you may feel a quick sharp jabbing pain in the lower groin and belly. This is very normal and should only last a few seconds. Usually by just changing positions, using pillows while on your side, the use of a belly band for support, or by taking a warm bath can alleviate the pain.

 During pregnancy you will have weight gain, fluid shifts, and your uterus is stretching and expanding making room for baby. These are all normal for pregnancy, but it can cause Sciatica during the last semester. The sciatic nerve is the largest nerve in the body. It starts in the lower back, running down the back and legs and all the way to the ankles and feet. You may feel a sharp pain shooting down your back and into the legs with some numbness and tingling. For some relief of Sciatica, it can help if you lie on the side that is not affected using a pillow between your legs. Warm compresses or a warm bath can be helpful too. Depending on the severity of the pain massage or chiropractor adjustments can be helpful.

  Vaginal Discharge increases during pregnancy. It is usually odorless, clear, and may have a consistency of egg-whites. It is important to not use any douches and it best to wear cotton underwear. If you notice an unpleasant smell, experience any itching, or burning talk to your provider because this can be a sign of an infection and you may need treatment.

What is normal during this time? When you are pregnant you have an increase amount of blood volume, which can cause sensitive areas to bleed. For instance, you may see some spotting when you wipe or a few drops of blood in your underwear, after you have sex or after your provider does a cervical exam in the office. Your cervix is highly vascular, and it has a lot of blood vessels, which can cause the spotting or a small amount of blood.

Having a baby is a beautiful experience but leading up to the birth can be very unpleasant. Some of the late-stage symptoms you may experience is insomnia, heartburn, varicose veins, gas, constipation, hemorrhoids, swelling and shortness of breath. These are all things that are normal at the end of pregnancy and no cause for great concern.

  Most of these concerns can be addressed with exercise. Walking is a fabulous exercise for pregnancy, and you should aim to walk around 30 minutes a day unless your doctor has advised against it. There are so many benefits to walking to stop most of these problems!

When should you be concerned? 

 If you should notice any of the following signs or symptoms, you need to call your doctor immediately. Bleeding that is enough to fill a panty liner or more, leakage of fluid (place a pad on to measure soaking, smell), fever, pain, chills, consistent back or pelvic pain, painful or frequent urination, vaginal itching or burning, vomiting or diarrhea, sudden swelling or redness in legs or arms, rash, headache that is accompanied with blurry vision, swelling, dizziness, or abdominal pain, if you ever trip or fall, or if you have decreased fetal movement.

 When you should call 911?

If you think you won’t make it to the hospital and you are about to deliver your baby, if your water breaks and you see or feel umbilical cord, if you have a seizure, difficulty breathing and shortness of breath, any chest pain, if you pass out, or if you have severe vaginal bleeding call 911.

Monitoring and Tests towards the end of pregnancy

 Often throughout your pregnancy you will have ultrasounds done for a variety of reasons, but generally the main reasons are for the health care provider to see how your baby is growing and developing. Later, during your pregnancy you will have other types of noninvasive test to make sure you have a healthy birth. Some of these tests are:

 Kick Counts

  There are so many tests that we can do at the end of pregnancy, but nothing is more valuable than tracking fetal movement! This is the single most important thing you can do for safety. These are called kick counts.

 Kick counts is something you can do yourself and soon you will become very familiar with your baby’s movement patterns and activity and you will notice if you feel less activity you will start to recognize changes in your baby’s pattern.

 The recommendation is to start kick counts when you are 28 weeks pregnant. Generally, by week 28 your baby’s movements are strong and becoming predictable. You will soon discover that your baby will choose the time of day to be more active. Try to choose the same time every day when your baby is the most active.

  Lay on your left side in a comfortable position and time how long it takes to feel 10 distinct movements. These movements can be jabs, kicks, rolls, or punches. Normally you will feel at least 10 movements in an hour. If you do not feel 10 movements during that hour period do not panic. Get up and have a quick snack and something to drink and then lay back down and try again. If you do not feel 10 kicks within two hours, you should call your provider. 

Non-stress Test

This is a test that monitors the baby’s heart rate for about 20-40 minutes.

You will be placed on the same type of monitor that you will be using when you are in labor at the hospital. You will have two sensors placed on your belly usually held on with a belly band or two belts.  One sensor will monitor the baby’s heartbeat and the other sensor will monitor uterine contractions if you are having any. Often you may have contractions that you are not feeling. This type of test will monitor the baby’s heart rate in a non-stressful situation to ensure the baby is getting enough oxygen.

Not every pregnant mother will have a non-stress test. Some of the reasons your doctor may have you do these would be because you are pregnant with multiples, you have gestational or type 1 diabetes, high blood pressure, heart disease, fetal growth restriction, or you have extended past your due date.

Group B Strep Test

A Group B streptococcus test also known as group B strep test is usually done when you are 36-37 weeks or if you arrive in preterm labor, it could be administered earlier. This test consists of a swab of your vagina and rectum area, using what looks like a large Q-tip. Group B streptococcus is a common bacterium in the gastrointestinal tract, which over 25% of women carry and generally does not cause complications in moms.

Some risks to mom if they occur can be urinary tract infections, infection of the placenta and amniotic fluid, and infection in the blood. It also can increase the risk of wound infection after a C-section. However, the biggest concern is that group B strep can spread to the baby during a vaginal delivery.

Not all babies develop an infection, however those who do develop an infection can develop life threatening complications such as inflammation of the lungs (pneumonia), meningitis, and an infection in the blood called sepsis. If the Group B test is negative, there is no action needed. If it is positive, you will be given antibiotics during labor to prevent group B strep disease in your baby. You will be given IV antibiotics during labor-at least four hours before birth. The antibiotics will destroy bacteria in the birth canal and reduce the baby’s risk of developing an infection.

Pre-Term Labor

You may start feeling contractions. Contractions occur towards the end of your pregnancy or even throughout your pregnancy when the uterus muscle tightens and flexes. These contractions are what help push the baby down into the birth canal and out into the world! Woohoo! However, sometimes, it can be difficult to tell the difference between non-labor and labor contractions.

There are different kinds of contractions you may experience. The first is the Braxton Hicks contractions. These are mild contraction that you can experience weeks before you go into labor. They are essentially “warm up” contractions. These contractions usually come on at night after a long day and generally only result in a quick tightening and hardening of your uterus, which is mostly felt only in the front, not from the top down. Dehydration can also cause these to begin. For the most part, Braxton Hicks contractions are normal and you do not need to go to the hospital.

HOWEVER, if your contractions continue and remain consistent before 36-37 weeks, you may need to rest and drink some water and call your provider if they do not subside and you are experiencing 4 or more contraction in an hour.

Preterm Labor occurs between 20- and 37-weeks’ gestation. If you are in preterm labor, you may have contractions that result in some type of cervical change. The key thing to note here is CERVICAL CHANGE. Even if you do not have any known risk factors, you should be aware of the warning signs of preterm labor. Contact your healthcare provider if you are experiencing any of the following symptoms:

  • Contractions (where you abdomen tightens like a fist every ten minutes or more often.
  • Change in vaginal discharge or leaking fluid or bleeding from your vagina.
  • Pelvic pressure (the feeling that your baby is pushing down
  • Low, dull back ache
  • Cramps that may feel like your menstrual period
  • Abdominal pain, with or without diarrhea.

 Who is at risk for Preterm Labor?

Although half of preterm births occur in women with no risk factors several issues can make preterm term delivery more likely such as:

  • Previous preterm labor or birth- Women who have had preterm deliveries before or experienced preterm labor in a previous pregnancy
  • Twins or triplets- this can be caused from the added weight and pressure
  • Fetal Birth Defects
  • Cervical Abnormalities- such as a short cervix or certain previous cervical surgeries
  • In vitro fertilization known as IVF
  • Age- under 17 and over 35 are at highest risk
  • Ethnicity
  • Polyhydramnios-too much amniotic fluid
  • Others include diabetes, high blood pressure, autoimmune, and blood clotting disorders.

Some lifestyle and environmental risks that can lead to preterm labor are:

  • Late or no prenatal care
  •  Smoking
  • Drinking alcohol
  • Using illegal drugs
  • Domestic violence
  • Stress
  • Lack of social support
  • Exposure to certain environmental pollutants

  If you go into the hospital to be evaluated with preterm labor they will usually put you into a triage area and they will put an external monitor on you to see if you are having any contractions as well as to monitor the fetal heart rate. They may do a vaginal internal ultrasound to measure the length of the cervix and a cervical exam to see if your cervix is dilated or effaced.

 One test that can help predict if there is a likelihood of going into labor within the next 7-14  days is called the Rapid Fetal Fibronectin. Fetal Fibronectin is a “glue like” protein that bonds the baby to the uterus and holds the baby in place during development and is usually not detectable in vaginal secretions during week 16-35. If the fetal fibronectin is leaking into the vagina during the 16-35th week of pregnancy can be a sign that your body is preparing to deliver early. Your provider will use the rapid fetal fibronectin test, along with your obstetric history and their clinical judgement to manage your care. The Fetal Fibronectin test is not painful and is collected with a certain swap that looks like a Q-tip and is sent to the lab to test for a negative or positive result.

   If you are in preterm labor, there are interventions that your provider will do to try to stop the labor to decrease the risks involved for a preterm infant. However, sometimes your body decides not to react to the interventions and the baby’s choosing to come is not always as predicted. When trying to stop your preterm labor the provider will usually have the nurse start an IV to make sure you are hydrated. If contractions continue you may be given tocolytic medications that can help stop labor for a short time.

 The first medication they will give you is a shot that goes in the muscle called betamethasone, which is a corticosteroid. It can help with the development of the maturity of the baby’s lungs.

 The other common medication is called magnesium sulfate, and this will help to provide neuro protection for the baby’s brain if they do end up delivering early. During this time of slowing the labor it can help buy some time in case you need to be transferred to a higher level of care hospital with a NICU who can care for your preterm infant.

Generally, if you are 35 weeks and under is when they would transfer you to a hospital with a level III NICU. Some level II will keep 34 weeks which determines on different factors. It is best to ask your provider before and where you are planning to deliver and what they take care of as far as gestational weeks for preterm delivery.

I know this all can be scary, but it is important to know that preterm births count for only 10% of live births in the United States and because the advances in medicine the outcomes and care provided have very good statistics compared to some years ago. Out of the 10% of preterm deliveries the vast majority of these births happen after 34 weeks and at that point they have about a 98% survival rate. Even babies who are born at 26 weeks who are called micro preemies have a survival rate between 80-89% survival rate. The advances of medicine is pretty amazing. 

Is it over yet?

There comes a time in the majority of women who are just simply over being pregnant and they look for any sign that labor is approaching.

Labor is a unique experience and sometimes it can be over in a matter of hours and sometimes it can really test the emotional stamina of a mother and linger on and on. Often you will find yourself preparing your home for the arrival of your baby. You will find yourself cleaning and organizing with burst of energy, some call this nesting and often you find that the baby’s arrival is coming sooner than later.

As we mentioned before your mucus plug protects the baby from bacteria that may travel up the cervix into the uterus. Often one sign that labor is approaching is when you lose your mucus plug. However, keep in mind this could be days or weeks once you lose your mucus plug that your body goes into labor. Your mucus plug can be clear, brown, or pink blood tinged and often is like a small blob or in pieces you may find in your underwear or when you wipe. If you notice this before the 36 week of pregnancy or if you see more than a teaspoon of blood at any point during your pregnancy, make sure you call your provider.

Often you may notice that you are having more back pain as labor approaches this is different than what you may have experienced throughout your pregnancy with the growing pains. Some moms will experience back pain as labor starts. Often early contractions start in the lower back and then wrap around your abdomen. Back pain is often common based on the position of the head of the baby. Some ways to help with this back discomfort is moving around and change position, taking a warm shower, sitting on your birthing ball, or having your partner roll a tennis ball on your lower back.

You may notice some shooting pains in your rectum, pelvis, or vaginal area lasting a few seconds that occurs towards the end of your pregnancy when the baby drops into the pelvis. If you notice pelvic pain lasting longer than a few seconds mention this to your provider so they can assess you further.

Towards the end of your pregnancy your body will release hormones that will help soften your cervix. This hormone is called prostaglandins and as much as we want to welcome this hormone to do its work it can also cause diarrhea. Remember in between bathroom runs to stay hydrated by continuing to drink your 8-10 glasses of water and eating small frequent meals.

We think one of the hardest things for moms as they see these signs approaching, is that they have their bags packed, and they are ready to go to the hospital. WAIT! Remember, even with the symptoms we just mentioned it could be days away still before your body is ready.

We are going to talk about the Journey of labor next! So, I hope I see you there. 

 

 

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