What Are the Signs of Labor, Stages of Labor & What Can I Expect During Each Stage?

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(With Gail Heathcote, Certified Nurse Midwife-CNM) Knowing what to expect during labor & understanding why your body is doing what it’s doing helps you have less pain & speeds up labor. Understanding what to expect in labor helps you relax. Staying relaxed helps your muscles efficiently contract & keeps you out of the fear/pain cycleSo you can meet your baby in less time with less pain.   

Gail Heathcote, Certified Nurse Midwife (CNM), takes us through each stage of labor describing what you might experience & important “things” to keep in mind.  

For example, did you know drinking & consuming calories during labor is super important? Your body is STRONG, it’s working hard & is doing miraculous things to birth your baby- you need energy to sustain (like a professional athlete)- you need mom fuel.  But many hospitals don’t allow eating during labor (which goes against what the research & evidence says- see that evidence here). Gail suggests bringing honey. Honey is concentrated with loads of calories & will (most likely) pass muster with hospital staff.  She also talks about why some women experience back labor & how to relieve the pain {here’s another amazing interview on having less pain in labor, even if you’re getting an epidural}. Lots of info packed in here to help you to understand “go time”, be confident, feel excited to meet your baby!

You’ll Also Learn:

  1. How to distinguish between false labor (Braxton hicks) and true, early labor.
  2. What active labor is & why it’s considered “the real deal go time” .
  3. Why reaching 10 centimeters dilation doesn’t necessarily mean it’s time to push.
  4. How to protect your perineum during the pushing stage. 
  5. Why delayed cord clamping is super beneficial for your baby. (Many hospitals don’t do this-learn the evidence

 *We ran out of time talking about so much need to know stuff.  To learn the all important: “when to go to the hospital” question. Click here to get that lowdown.

Part 1 [private Premium Membership|Gift-Premium Membership|Coaching|Vault](or Download MP3′s  Part 1Part 2Part 3)

Part 2

Part 3

 [/private]What do you think? Share in the comments below…


[private Premium Membership|Gift-Premium Membership|Coaching|Vault]Gail Heathcote-Stages of Labor Part 1

Sarah Blight:               Hi, this is Sarah Blight with your Baby Booty Interviews where we cut through the fluff of all the information that you’re being bombarded with right now about pregnancy and childbirth and parenting so that we can give you the information that you really need to know and want to know about becoming a mom so that you can make the best decisions for you, your baby and your family.


                                    Well today we’re talking about stages of labor, what is actually going on in your body and with your baby while you are in labor and what is labor anyway and when does it really start, how will you know if you are in labor. Well today, to help us and navigate us through labor, we are chatting with Gail Heathcote. She’s a certified nurse midwife. She’s been practicing since 1998. She’s also a mom herself and she’s currently working on her doctorate in clinical practice, that’s right, clinical practice. She does hospital births here in Grand Rapids, Michigan. So thanks so much, Gail, for joining us today.


Gail Heathcote:           Thank you, Sarah.


Sarah Blight:               All right. So let’s dive right in. We have a lot of stuff to cover today. It’s a pretty ambitious topic. Let’s go right through the stages of labor. Let’s start with early labor. How will a mom know if she’s really in labor or if it’s false labor?


Gail Heathcote:           It’s difficult particularly if a mother is a first-time mom. Contractions can be mild, moderate, or strong, can be back labor or just in the front feel like cramping. Generally, she gets really excited, wants to move around, a bloody maybe present, a little more mucus. Those are some of the things that she might find that’s happening.


Sarah Blight:               So what is bloody show?


Gail Heathcote:           Mucus as the cervix stretches and the head compresses against the cervix, it stretches the tissue of the cervix. The cervix is very vascular which means it has a lot of blood supply.


Sarah Blight:               Okay.


Gail Heathcote:           And as the head presses against the cervix and/or the cervix stretches, it can just bleed very gently and you see it as mucus combined with some blood. It can be dark brown or it can be bright red blood. There should not be clots however.


Sarah Blight:               Okay, okay. So tinges of blood in the mucus is probably bloody show most likely.


Gail Heathcote:           It means your cervix is stretching.


Sarah Blight:               Okay. So we’ve heard of Braxton Hicks or prodromal labor as it’s called, which is kind of a false labor. How can a mom really differentiate between a false labor and a true early labor? Is there any telltale signs or anything a mom can do to really test to see if this is the real deal?


Gail Heathcote:           Tincture of time.


Sarah Blight:               Okay, so what does that mean?


Gail Heathcote:           If it is Braxton Hicks–


Sarah Blight:               [Laughs]


Gail Heathcote:           Braxton Hicks actually you’re entering pains and it’s the body’s way of pushing the baby into the pelvis to get it ready and it can feel quite uncomfortable. Your uterus can get really hard like a basketball and it can last up to minute, but they’re entering pains, they’re the first stages of going into labor. Truly tincture of time, it’s just a matter of if it stops or if it continues and crescendos to become stronger and more regular.


Sarah Blight:               Okay. So if you’re truly in labor, it sounds like you’ll start to see some patterns developing that kind of hold up over time, is that accurate?


Gail Heathcote:           I would say, yeah, that’s a safe statement.


Sarah Blight:               Okay.


Gail Heathcote:           Things change. So with time things change and those changes can be the presence of mucus and/or blood, may rupture your membranes and see fluid. You get more uncomfortable and those things. It just kind of crescendos over time.


Sarah Blight:               Okay. So the only way to really know if you’re in true labor is just to let time go by and see if things peter out or things continue moving on?


Gail Heathcote:           Exactly. Exactly.


Sarah Blight:               Okay. Okay. So there’s no quick way to know.


Gail Heathcote:           I only wish there were a formula.


Sarah Blight:               Yeah.


Gail Heathcote:           There’s not.


Sarah Blight:               Okay. Okay. So is there typically pain involved in early labor? Let’s say that and you mentioned rupturing membranes which is when your water breaks, sometimes that doesn’t happen for women and probably for most people it doesn’t happen before true labor really begins. So is there pain involved at this point for women in early labor?


Gail Heathcote:           Well pain has a real subjective definition, isn’t it? Because one person’s pain can be another person’s discomfort. So is there an awareness of tightening, stretching pressure? Yes. But again everybody’s definition of pain is quite different. I’ve had women come in at 1 cm very miserable and I’ve had women come in at 8 to 9 cm not sure they’re in labor.



Sarah Blight:               [Laughs]


Gail Heathcote:           So again, it’s true, everybody’s definition and the way they tolerate that discomfort and change is quite subjective.


Sarah Blight:               Okay. So what is the most important thing for a woman to remember when she’s in early labor?


Gail Heathcote:           Rest, hydration, calories.


Sarah Blight:               And why do you say those, why do you say that?


Gail Heathcote:           Why do I say what?


Sarah Blight:               Rest, hydration and calories. Why is that so important?


Gail Heathcote:           Rest is imperative. The term labor is apt, it’s laborious and generally with a first-time mom, it can be 10 to20 hours. Hydration it’s like running a marathon, a marathon runner needs hydration to keep them hydrated. I don’t what other way to say it.


Sarah Blight:               Yeah.


Gail Heathcote:           Anybody who’s engaging in any athletic endeavor needs fluids and/or calories and calories are absolutely imperative because it is like a marathon. I was talking to you husband online and he asked me about caloric intake and I mentioned to him that a good suggestion for women to bring into labor, sometimes it’s honey, just a tablespoon of honey or those little sticks of honey. Sometimes we have women put lemonade in ice cube trays, the small little ice cube trays and then they can suck on that. That’s fluid as well as calories, sugar.


Sarah Blight:               Hmm, okay. So what is it about honey that makes it such a good idea to have? Is it because it’s kind of liquidy so it would pass muster with the hospital?


Gail Heathcote:           Pass muster with the hospital but it’s also concentrated.


Sarah Blight:               Okay, okay.


Gail Heathcote:           So you get more bang for your buck.


Sarah Blight:               Got you. So you can sneak it in and you’re not really breaking any rules. [Laughs]


Gail Heathcote:           I really want to dispel that myth about breaking rules.


Sarah Blight:               Okay.


Gail Heathcote:           I think if we were talk, in fact I was just at the hospital until about 9 o’clock this morning. I was there all night and I and the nurses, we talked frequently about labor and the necessity for fluids and they all recognize it as well as the providers.


Sarah Blight:               Uh-hum.


Gail Heathcote:           You can’t expect somebody to engage in an athletic event without fluids and/or calories. However, we’re always mindful of the fact and we’re very well aware of the fact that women’s gastric emptying slows when they’re pregnant in general, but specifically in labor and so we’re very judicious if you will about what we put in to a mom’s stomach.


Sarah Blight:               Uh-hum.


Gail Heathcote:           Because sometimes what you put in, you see back at 7 to 8 cm.


Sarah Blight:               [Laughs] Yes.


Gail Heathcote:           Moms throw up, they get sick.


Sarah Blight:               Uh-hum.


Gail Heathcote:           So when anticipating that, you want to make wise choices about what’s offering and honey certainly is a concentrated of carbohydrate, sugar, it’s really a good choice.


Sarah Blight:               Okay. Great idea. Is there anything a mom really should not do or really might want to be mindful of to stay away from during this early labor phase?


Gail Heathcote:           I don’t think so. I think a lot of mothers are really very excited and that’s quite understandable. But they are up and calling and excited.


Sarah Blight:               [Laughs]


Gail Heathcote:           Again, it’s understandable but I encourage mothers to rest.


Sarah Blight:               Uh-hum.


Gail Heathcote:           This is the time when you need to kind of get your nest together and just spend some time with your partner or your children and just conserve your energy and just wait.


Sarah Blight:               Okay.


Gail Heathcote:           You know, we all know as mammals if you were to take and I always tell patients this. Any mammal that you were to take and say for example a cat, a cat that was in labor, generally mammals will go to a dark, quiet, safe environment to birth.


Sarah Blight:               Uh-hum.


Gail Heathcote:           If you were to take a mammal, I will use the example of the cat, if you were to take that cat and put that cat in the middle of a mall, labor stops.


Sarah Blight:               Yeah.


Gail Heathcote:           And that’s not unlike what we see in the hospital.


Sarah Blight:               Uh-hum.


Gail Heathcote:           I can talk to a mom and we agree, we make the decision, we have the conversation about our labor, we all make the decision, she goes into the hospital and then the nurses will call me and say yes she arrived but she’s not contracting. So I say and the nurses now know, we put you in a bathtub and we close the lights and we leave you be. Again, we try and recreate that very safe, quiet dark environment for birth to begin again.



Sarah Blight:               That’s really a great tip and for the women watching if your provider doesn’t suggest that, feel free to suggest that to your provider because that sounds like a really great idea that that option is available to you. Okay, let’s move on to active labor. What is happening, I guess what is different about active labor than early labor?


Gail Heathcote:           Be more specific.


Sarah Blight:               Okay. So when is that transition? Is it how many centimeters you’re dilated that –


Gail Heathcote:           Yeah.


Sarah Blight:               — that basically denotes that you’re in active labor? Okay.


Gail Heathcote:           Well from a physiologic standpoint it is. So 4 to 5 cm is generally considered active labor.


Sarah Blight:               Okay.


Gail Heathcote:           Some women can walk around in fact for a week or two weeks 3 to 4 cm generally not 5. By the time the cervix is dilated to 5 cm, women are in labor and they will not stop. It’s the point of no return if you will.


Sarah Blight:               Okay.


Gail Heathcote:           We know things are going to get serious from that point. So active labor is change in cervical dilatation. You also see changes in maternal behavior. Mothers become much more focused within, self-consoling behaviors, they’ll identify that they want to stand or they want to get in the tub. They’re more uncomfortable, they’re more restless a little more anxious.


Sarah Blight:               Okay. So it sounds like a lot of women and every woman is different but it sounds like a lot of women kind of need to focus more to get through the contractions at 5 cm.


Gail Heathcote:           Absolutely.


Sarah Blight:               Okay, okay. So when you walk in and see a woman in active labor and this is a pretty general question but just to give women an idea and again every woman’s different and labors differently but just to give an idea. When you walk in and see a woman at say 5 cm, laboring in the hospital, what typically do you see or what can you see when you walk in the room? How are they, where are they, what are they doing?


Gail Heathcote:           Active. They’re quite active and depends on where the discomfort is. If they’re feeling pelvic pressure, if they’re feeling back labor, if they’re feeling it in the front, they’ll assume different positions to help that. Again I’ll say that they kind of go inward, they concentrate on their breathing. The people that are around them usually are getting closer. So the intensity is accelerating of the discomfort as well as the attention to what’s going on within.


[0:12:34]                      End of Audio

Part 2



Sarah Blight:               Okay. So let’s talk about that. What is going on within generally speaking when a woman is in active labor? Where is the baby, what’s happening with the baby in the womb?


Gail Heathcote:           That’s a very broad question still.


Sarah Blight:               [Laughs]


Gail Heathcote:           But I’ll attempt to answer it. Basically, the uterus is contracting and the uterus is like — have you ever seen the rubber band balls that people make?


Sarah Blight:               Uh-hum.


Gail Heathcote:           That’s the uterus. It’s wrapped in muscle and that muscle then tightens to push the baby through the pelvis. So the cervix is not only opening and dilating but it’s thinning and the baby is getting lower into pelvis. You reach a point at about, transition 8 to 9 cm when the head is so low in the pelvis, it activates what’s called the Ferguson reflex. The Ferguson reflex, you’ll see it as a real change in the behavior and the mother will involuntary bear down so say, oh, I’ve really got to push and that’s a reflexive response. So if you were to try and say to a mother don’t push, there’s no way she can’t push. That is because the head innervates nerves in the pelvis and the head has to be low enough in the pelvis so that mother has an involuntary urge to push.


Sarah Blight:               So typically the most optimal position for a baby to be in is obviously head down.


Gail Heathcote:           That’s correct.


Sarah Blight:               That’s the best position. So while you’re in active labor and going through the thinning of your cervix and your cervix is getting bigger, it’s expanding and your muscles are contracting, the baby is just inching its way down the birth canal towards the opening of your vagina. Is that accurate?


Gail Heathcote:           Yes, yes and no.


Sarah Blight:               Okay.


Gail Heathcote:           It’s nothing less than a miracle that we’re born truly.


Sarah Blight:               Yeah.


Gail Heathcote:           There’s what’s called seven cardinal movements of birth.


Sarah Blight:               Okay.


Gail Heathcote:           The baby has to negotiate seven different movements, flexion, extension, rotation, etc. It has to navigate if you will its way not only into the pelvis but through the pelvis, and it depends on the size and shape of the baby’s head and which way the baby is presenting into the pelvis and also the size and shape of the woman’s pelvis. Now as human mammals, we have four different sizes and shapes of our pelvis and some shapes are more amenable to vaginal birth, i.e., gynecoid shaped pelvis, the shape of a heart.


Sarah Blight:               Uh-hum.


Gail Heathcote:           But there are some that are not so amenable to vaginal birth one of those would be platypoid and it’s more of an oval shape. So there are many, many variables that go into a successful vaginal birth.


Sarah Blight:               Okay. You said it depends on a lot of different factors but generally speaking, how is the baby able to navigate? The contractions are creating room because you’re expanding and then you’re contracting but how is the baby able to — I mean it just really is a miracle. I’m trying to get my head wrapped around it, how is the baby — is the baby’s head turning at this point or what are some tricks for the baby to kind of navigate through the passage way?


Gail Heathcote:           Well again as I just said, it depends on the strength of the contractions.


Sarah Blight:               Uh-hum.


Gail Heathcote:           So the power and there’s really three things we look at. We look at power and that’s the power of the contraction. We look at pelvis, the size and shape of the mother’s pelvis and then we look at passenger and that’s the baby, how big is the baby, how is the baby presenting into the pelvis. So it really is a match you need to come up with, a match between the size of the mother’s pelvis and the size and shape of the baby’s head in order for it to fit through. Some do easily, some do with a great deal of struggle and some don’t at all.


Sarah Blight:               Okay. So it sounds to me like birth position might play a role and how you are positioned during labor might help–


Gail Heathcote:           Absolutely, yeah.


Sarah Blight:               — might help baby?


Gail Heathcote:           Absolutely helpful but however sometimes in the event say for example a posterior baby and a pelvis, a platypoid pelvis, it’s a very difficult situation and we do more multiple positions changes. We have birth balls, we have squat bars, we use the toilet, we do leaning over the bed, we do all fours. We get quite creative in the hospital both myself and the nurses and I’d say any other provider as well in trying to find that sweet spot if you will to help that baby’s head to rotate into the optimum position in the pelvis to help it go through.



Sarah Blight:               And posterior just for the mamas who don’t know is what?


Gail Heathcote:           Posterior, generally babies are born with their noses pointing down towards the floor, posterior is when they’re born with their noses looking up to heaven.


Sarah Blight:               Okay. And this is –


Gail Heathcote:           So they’re back, they’re upside down.


Sarah Blight:               And why is that a more difficult presentation for the baby to be born in?


Gail Heathcote:           It’ the diameter of the baby’s head–


Sarah Blight:               Okay.


Gail Heathcote:           — that presents more of a challenge as it comes through the pelvis.


Sarah Blight:               Okay.


Gail Heathcote:           Optimal is for the back of the head to come through, the occiput.


Sarah Blight:               So let’s talk about back labor for a moment. There might be some mamas who have heard about back labor and since we’re talking about the posterior position, which I know, there is a relationship there, can you tell mamas what the relationship is between back labor and a posterior baby?


Gail Heathcote:           So anybody could go on YouTube and find videos of posterior births and I’d really encourage you folks to do so so they get a real visual of the maternal spine as well as the fetal spine. But basically this is what it is. The fetal spine is coming along the maternal spine and there’s a great deal of discomfort because again the baby is turned around the opposite direction. So there’s a lot of pressure on the small of the back as the baby comes down.


Sarah Blight:               Uh-hum. Okay.


Gail Heathcote:           Again, go to YouTube, they have some excellent videos that will show you this.


Sarah Blight:               Is it possible to have back labor and not have a posterior baby?


Gail Heathcote:           I suppose so. I suppose if mother had a preexisting injury to her back, if she had very tense lumbar muscles that could be it. But generally when mothers have this unrelenting very, very uncomfortable back pain with contractions, we say to ourselves the fetal spine is going along the mother’s spine and causing a great deal of stretching and pain.


Sarah Blight:               So you’re back to back at that point?


Gail Heathcote:           You are.


Sarah Blight:               [Laughs] Okay.


Gail Heathcote:           Generally if you ask mothers and we will, we’ll say if you were at home, where would you be? What position would you do and many mothers would say I want to be on my hands and knees rocking.


Sarah Blight:               Uh-hum. Uh-hum.


Gail Heathcote:           Or I want to lean over a birth ball or I want to get in the tub and have warmth on my back or I want to have somebody squeeze my hips or I want to have somebody press on the middle of my back. Generally, mothers will kind of know what will help them feel better.


Sarah Blight:               That’s really amazing especially since women, first-time moms have never been through it before, but you know what feels good in that moment, which is really cool.


Gail Heathcote:           Well I think a lot of these mothers right at the very end of their labors have experienced some back pain if the baby is posterior. So they have that sense already of what this feels like and maybe have tried some things at home.


Sarah Blight:               Okay. So you recommend to ease back labor just try different things and see what works for you?


Gail Heathcote:           Absolutely.


Sarah Blight:               Okay, perfect. Okay. So at what point would a mom if she chooses to have an epidural or chooses to have drugs during her birth, at what point would she receive typically the drugs? Would it be during active labor?


Gail Heathcote:           Whenever she wants it.


Sarah Blight:               Okay.


Gail Heathcote:           Whenever she needs it and that’s something that’s negotiated. So if she expresses the desire, we’ll have a conversation about where she is in her labor and we can give suggestions. So for example if a mother, first-time mother is say 7 to 8 cm and the baby is negotiating the pelvis really well and her labor is progressing perfectly, I may make the suggestion she try a little Stadol or she get in the tub. But if moms want either IV medications or epidural that’s completely up to them and there’s no time, there’s not time that’s too late. Sometimes there’s times it’s too early.


Sarah Blight:               Okay.


Gail Heathcote:           Because the lovely thing about epidurals is it makes mothers relax but it can also slow down labor. So you want to make sure that you’re in a really good labor pattern before you do it because then what you may come up against is the need to start pitocin, which I must tell you nobody wants to do.


Sarah Blight:               Okay. And let’s get back to Stadol for a second. For the mamas who don’t know, what is that?


Gail Heathcote:           It’s an IV drug that’s given generally through a Heplock or if moms have IVs we just put it into the tubing. It’s a medication that makes mothers very relaxed in between contractions. Generally, they’ll still get them but they don’t mind them as much and there’s a little amnesiac effect. So they don’t remember as much for an hour. They just really kind of wind knocked out of their sails, and they’re able to just close their eyes in between the contractions and then they’ll wake up and they’ll contract again and then they’ll rest. It only lasts for about an hour to an hour and a half depending on how much you give and whether you give it IV or IM. Sometimes we’ll try a combination of giving some IV so it works right away and then we’ll give a little bit IM so it lasts a little longer.



Sarah Blight:               What does IM mean?


Gail Heathcote:           Intramuscular.


Sarah Blight:               Oh.


Gail Heathcote:           A shot.


Sarah Blight:               A shot. Okay. Okay, got you. Okay. So during this point and again I want to say I realize everyone is different but just generally speaking how close are contractions together, you know, during active labor? And you said active labor can last anywhere from — I mean there’s obviously a wide gamut of — I mean I know women who’ve had active labors of literally like 45 minutes–


Gail Heathcote:           Absolutely.


Sarah Blight:               — to two days literally.


Gail Heathcote:           Uh-hum. Right.


Sarah Blight:               So there’s obviously kind of no cardinal rule but typically you see contractions in active labor that are established and then they pick up speed and they increase in –


Gail Heathcote:           Intensity and frequency.


Sarah Blight:               — intensity and in frequency. Okay.


Gail Heathcote:           Yes. And generally at 8 cm, physiologically you see a surge of oxytocin or pitocin endogenous. So a mother releases her own oxytocin and sometimes you’ll see this period of quiet where the mothers become very quiet and they withdraw and then all of a sudden they wake up and they really get uncomfortable and that’s because of that release of oxytocin during transition that just helps them with that last stage.


Sarah Blight:               Okay. Let’s talk about transition. I’m glad you mentioned that. What is transition?


Gail Heathcote:           8 to 9 cm to complete dilatation.


Sarah Blight:               Okay. So it’s 8 cm basically to 10 cm. Is that as large as your cervix will get or that’s the largest that is best for baby to born?


Gail Heathcote:           Okay. Think of it this way, if I had a turtleneck on –


Sarah Blight:               Uh-hum.


Gail Heathcote:           If I had a turtleneck, I put the turtleneck here, that’s my cervix and then the turtleneck my head comes through and this is where the turtleneck is, this is 10 cm.


Sarah Blight:               Okay.


Gail Heathcote:           So basically what is means is the cervix has come down around the head.


Sarah Blight:               Okay.


Gail Heathcote:           It’s not covering. So –


Sarah Blight:               Okay.


Gail Heathcote:           — the analogy a good one is a turtleneck.


Sarah Blight:               Okay, I like that. That’s a good visual. I’m a visual learner so that helps me out.


Gail Heathcote:           Uh-hum.


Sarah Blight:               Okay. So you’re 10 cm and that typically is transition. What things is a mama most like experiencing during transition? You mentioned –


Gail Heathcote:           Well –


Sarah Blight:               — the flood of oxytocin.


Gail Heathcote:           Uh-hum. 7 years old 8 cm is the beginning of transition and 10 cm is the start of second stage or when you start pushing. The question you ask is what do moms experience?


Sarah Blight:               Uh-hum.


Gail Heathcote:           Pressure.


Sarah Blight:               Okay.


Gail Heathcote:           A lot of discomfort.


Sarah Blight:               Okay.


Gail Heathcote:           Rectal pressure and as the head moves down against the rectum, it feels as though you have to have a bowl movement.


Sarah Blight:               Uh-hum.


Gail Heathcote:           So they’ll say I feel a lot of pressure in my bottom and I say to them that’s exactly what you should be feeling, that’s a really good thing.


Sarah Blight:               Okay. So that just means that baby is in the right place? [Laughs]


Gail Heathcote:           Absolutely. And you also start to see them exhibit that Ferguson reflex, that involuntary like grunt.


Sarah Blight:               Okay.


Gail Heathcote:           Because the baby is low.


Sarah Blight:               So how long does transition typically last?


Gail Heathcote:           I’m not going to put a timeframe on it because –


Sarah Blight:               Okay.


Gail Heathcote:           — truly everybody is very different.


Sarah Blight:               Okay. So it can take you a while to go from 8 to 9 to 10?


Gail Heathcote:           So let’s say an hour to two hours, oh, excuse me, a centimeter every hour to every hours.


Sarah Blight:               Okay.


Gail Heathcote:           In general.


Sarah Blight:               In general. But obviously there are exceptions to every rule.


Gail Heathcote:           Very much so.


[0:14:27]                      End of Audio

Part 3



Sarah Blight:               Yeah. Okay. You talked about second stage, the pushing stage and this is you were talking about the Ferguson reflex and how women just feel the unbearable, uncontrollable urge to push I should say. We hear the magic number 10 cm and I know when I was in labor with my first, I thought that that really meant you must push at 10 cm, but is it the same for every woman? Does every woman feel that urge to push smack the second you reach 10 cm?


Gail Heathcote:           No and it has to do with one central feature.


Sarah Blight:               Okay.


Gail Heathcote:           How low the baby’s head is in the pelvis.


Sarah Blight:               Okay. Okay. So –


Gail Heathcote:           We leave many mothers what we call labor down.


Sarah Blight:               Okay.


Gail Heathcote:           Laboring down which means you let the mother relax and let the baby come down on its own and we frequently do this with epidurals.


Sarah Blight:               Okay.


Gail Heathcote:           She maybe 10 cm but we just kind of hold off and let her rest and the contractions in and of themselves will bring the baby down lower and lower and lower, laboring down.


Sarah Blight:               Are the contractions at this point because the baby is so low, do the contractions, are they as painful or as severe as they were before?


Gail Heathcote:           Yeah.


Sarah Blight:               Is your body working still really hard to move baby down at this point?


Gail Heathcote:           So I don’t know how long marathons are. What are they 23 miles?


Sarah Blight:               26.2.


Gail Heathcote:           Okay. This is your 23rd mile.


Sarah Blight:               Okay.


Gail Heathcote:           You’re exhausted, you don’t know if you can do it but you have no other choice.


Sarah Blight:               Okay and baby is right there?


Gail Heathcote:           Well sometimes you can be 10 cm and the head can be up quite high and again that’s when you just hold off. Because sometimes there’s simply no good in having the mother push, you’ll exhaust her if the baby’s head is really high. So we try –


Sarah Blight:               So that’s –


Gail Heathcote:           Go ahead.


Sarah Blight:               No, was just going to say that is really good to know because I think in a lot of — well I know in our childbirth class, it seemed like 10 cm you’re good to go. Like that’s where you want to get to and there was really there a discussion of maybe your baby is not ready yet to come out and if you’re pushing and expending all of that energy and it’s not really doing anything, you are going to get tired out.


Gail Heathcote:           Exactly.


Sarah Blight:               That’s a really good point. Okay, cool. All right. So tell us about the crowning or as a lot of people call it, the ring of fire. What is happening and what does it feel like?


Gail Heathcote:           The ring of fire feels like fire. When you take tissue and you stretch it, it’s painful. So I don’t know a better word to describe it. People always say ring of fire and yeah, we know what that is, but it’s due to the fact that the tissue, the vaginal and perineal tissue is stretching.


Sarah Blight:               Okay. Now I know a lot of women could be disheartened because they push at this point. So I’m guessing if the baby is crowning most likely you’re pushing –


Gail Heathcote:           Uh-hum.


Sarah Blight:               — or maybe baby is just making its way out through the sheer force of the contractions, but I know a lot of women get a little disheartened because then baby kind of goes back inside and then kind of surges. Can you tell us why that’s an important part of the process?


Gail Heathcote:           Yeah. Here’s another analogy for you. We live in the Midwest and although most Marches we have a lot of snow, this is the analogy. It has to do with being stuck in a snow bank, okay. So the car is the baby –


Sarah Blight:               Okay.


Gail Heathcote:           — and the snow bank is your pelvis.


Sarah Blight:               Okay.


Gail Heathcote:           And so if the baby, I don’t know if we can get it, what you have to do is get the baby under your pubic bone and so you push and the baby rocks forward and then the you stop pushing and the baby comes back. It is this rocking back and forth. So what I tell moms I say imagine this baby as the car and your pelvis as the ditch and you really are pushing upwards. So you’re going to put on the gas, the baby rocks back, you’re going to put on a lot bit more and the baby rocks back and then the last time, you want to gun it to get out of the ditch. What we’re trying to do is lock the baby’s head under the pubic bone so it doesn’t go back.


Sarah Blight:               Oh, okay.


Gail Heathcote:           Yes and that’s imperative, that’s a real milestone because once the baby stays there then we’re well on our way.


Sarah Blight:               And does this help with protecting your perineum also? That kind of the process of kind of baby coming out and going back in, does that help warm up your perineum to kind of minimize hopefully tearing?


Gail Heathcote:           Yes. It’s just gently stretching the tissue.


Sarah Blight:               Uh-hum.


Gail Heathcote:           Yes, very protective.


Sarah Blight:               Okay. So if you were to go guns a blazing and just by sheer force just pop that baby out, the chances of tearing in your perineum, which you can tell us what the perineum is.



Gail Heathcote:           The perineum is the perineum, your bottom basically.


Sarah Blight:               Okay.


Gail Heathcote:           You look to the outside of your bottom.


Sarah Blight:               Okay. So the perineum can tear during labor and sometimes it does and sometimes it doesn’t, it depends obviously on a lot of different factors. But this process of baby going in and out, it seems like it would be a good warm-up for protecting your perineum?


Gail Heathcote:           Absolutely right. You never want to stretch a muscle quickly. You want to just gently stretch it.


Sarah Blight:               Okay.


Gail Heathcote:           It has less of a tendency to tear.


Sarah Blight:               Okay, all right. And can you talk quickly about the tearing because I know a lot of women do experience that as well as episiotomies.


Gail Heathcote:           Uh-hum.


Sarah Blight:               What –


Gail Heathcote:           What is it that you want to know?


Sarah Blight:               What is an episiotomy?


Gail Heathcote:           When you actually cut, you take a scissors and you cut.


Sarah Blight:               Okay.


Gail Heathcote:           You cut the perineum. So if you’re visually looking at the outside of a mother’s bottom, that’s the perineum.


Sarah Blight:               Okay.


Gail Heathcote:           And an episiotomy is where you take your fingers you put it inside the vagina. You take the pair of scissors and you gently make sometimes a very, very small opening. Now I would say almost without exception all providers know there have been huge meta analysis done, studies, with the central question being asked, is it better to let women tear or cut. For years, we thought if we did a very clean cut that the repair, i.e., healing would be better.


Sarah Blight:               Uh-hum.


Gail Heathcote:           But now we know sometimes if you do a cut, it can extend. When the mother pushes, it can extend more than what you wanted. So in general we try and protect the perineum and we just let that tissue if it’s going to separate, we just let it do it on its own.


Sarah Blight:               Okay. And so what are things that you do to help a mom protect her perineum during labor?


Gail Heathcote:           Warm compresses, pushing slowly, just gently easing that tissue rather than whoop, like that.


Sarah Blight:               Uh-hum. Uh-hum.


Gail Heathcote:           Different positions help. But I would say kind of a controlled pushing, not holding your breath, although sometimes there are times that you want to do that but that opened lotus, us making lots of noise is also protective because it doesn’t cause as much pressure down there. It’s more of a gentle pushing. So mothers many times I’ll say to them make noise, yell if you want, but there are times also that I say I’m looking for power, I’d really like you to hold your breath for this moment in time and give me power.


Sarah Blight:               Uh-hum. Okay. So holding your breath when you push by breathing or singing or whatever you want to do through it?


Gail Heathcote:           Exactly. Yes.


Sarah Blight:               Okay. All right so the baby crowns and then the baby’s head comes out. At this point, what is the mom probably feeling after the head comes out?


Gail Heathcote:           Well the head is the biggest pressure but sometimes the shoulders can be equally.


Sarah Blight:               Uh-hum.


Gail Heathcote:           Like babies who are big and they have a broad shoulder diameter. So there can be also pressure when the shoulders are born. Head is one thing that’s the major thing but then the shoulders are the second obstacle that needs to be managed.


Sarah Blight:               Okay. So the shoulders come out next and then it’s kind of it seems like just a gush of the rest of the body coming out?


Gail Heathcote:           Generally yes.


Sarah Blight:               Generally?


Gail Heathcote:           Yes. Uh-hum.


Sarah Blight:               Okay. Let’s talk about the delivering of the placenta because I think a lot of women forget that you’re not only delivering a baby –


Gail Heathcote:           Right.


Sarah Blight:               — but you’re also delivering a placenta. First of all, talk to us about what the placenta is and then we’ll get to when it comes out.


Gail Heathcote:           What a placenta is.


Sarah Blight:               Yes, what does the placenta do?


Gail Heathcote:           It’s an incredible organ and, Sarah, I mean it would take hours and hours to talk about what a beautiful organ the placenta is. Basically, I’ll just put it in this frame. It’s the conduit between the mother and the baby. That’s it.


Sarah Blight:               Okay. So it delivers what?


Gail Heathcote:           Oxygen, blood supply, nutrients, hormones. It’s the conduit between the mother and the baby and babies are actually quite good parasites. They take from the mother what they need, nutrients, oxygen.


Sarah Blight:               Okay.


Gail Heathcote:           And the placenta if there’s any problems with the placenta for example if mothers are post due and the placenta as it gets older starts to calcify, there are healthy placentas and placentas that sometimes aren’t functioning really well. That’s something that we’re very concerned about with some mothers who may have medical disorders, for example diabetes, smoking, high blood pressure. Those things can compromise the integrity of the placenta. It’s an incredible organ and it has to be in top form to feed that baby all that it needs.



Sarah Blight:               So it’s interesting the placenta is an organ that your body makes that’s temporary and then after your baby is born, what happens? How does your placenta come out?


Gail Heathcote:           The uterus contracts. The uterus is a movable organ. The placenta is stationary so as the uterus contracts down it shears or cuts off the placenta. It really does shear it. What you’ll see at the perineum is you’ll see a lengthening of the umbilical cord and that’s generally when the mother’s uterus is going and clamping down and it shears off the placenta and then you’ll see the cord lengthen and then you have the mother push and the placenta will come out.


Sarah Blight:               Wow, okay. So at this point, I know in my personal experience I don’t even remember the placenta coming out because I had my baby to look at and to hold at this point. Should the baby after birth, is the best thing for the baby to put on the chest, the mom’s chest right away to have skin to skin? What is it typically do you practice?


Gail Heathcote:           Delayed cord clamping.


Sarah Blight:               Okay and why?


Gail Heathcote:           It’s very important.


Sarah Blight:               Okay.


Gail Heathcote:           It’s a transfusion to the baby and I’ll give you an example.


Sarah Blight:               Yeah.


Gail Heathcote:           A lot of parents will bring in cord blood donation kits which I really think is a wonderful thing whether they donate it or store it.


Sarah Blight:               Uh-hum.


Gail Heathcote:           But once the baby is born if you’re going to collect cord blood, you need to clamp the cord to collect the cord blood.


Sarah Blight:               Uh-hum.


Gail Heathcote:           I asked a neonatologist at Spectrum once. I said if you were having a baby and you wanted to do cord blood donation, what decision would you make? Would you collect the cord blood, which means you have to clamp the cord straight way or would you delay cord clamping and this neonatologist said without hesitation I would give the blood to my baby. It’s an autotransfusion. So I don’t think that there’s many providers out there that don’t recognize the benefit to the baby of delaying cord clamping.


Sarah Blight:               Uh-hum.


Gail Heathcote:           What was your second question?


Sarah Blight:               So how much — well I have another question now. Does it really make a difference for your baby to get that blood? How much blood are we talking about for them? Is it a big difference?


Gail Heathcote:           It’s a huge difference. It’s like a transfusion and babies do well in the nursery later. Sometimes they have a little bit more hyperbilirubinemia but not enough that it causes problems. But these babies it’s an autotransfusion and it depends on how much flow is going through the placenta. We generally wait two sometimes three minutes until the cord gets limp so if you feel it you can’t feel any blood flowing through it.


Sarah Blight:               Okay and you were talking about hyperbilirubinemia, which is what?


Gail Heathcote:           Hyperbilirubinemia it’s jaundice.


Sarah Blight:               Oh, okay. [Laughs]


Gail Heathcote:           Jaundice.


Sarah Blight:               Okay. Jaundice.


Gail Heathcote:           But I remember the question you asked is it important to put the baby on the mother’s chest, absolutely.


Sarah Blight:               Okay and why is that, what do you see in your experience for moms to that have that?


Gail Heathcote:           [0:13:40] I’ll put the question to you why do you think it’s important? You’re a new mom, why was it important for you to have your baby on your chest?


Sarah Blight:               Well first of all, I wanted to see what this baby looked like but I think it was the whole bonding with our baby.


Gail Heathcote:           Yeah. And that’s exactly right. For mothers, it is that you need to eyeball them, you need to check them all over, you need to smell them and smooch on them. But also we find as care providers that the temperature control if you put babies on mothers’ chests is incredible. Babies don’t get cold, they stabilize their temperatures.


Sarah Blight:               So let’s get back to the placenta for a minute, what happens to the placenta after it’s delivered? We’ve heard and I’ve done a little bit of reading about placenta encapsulation or the benefits of the placenta after baby’s born, is that something that a mom can request to take home with her? Can she take her organ home with her?


Gail Heathcote:           Absolutely. We have a consent form at Spectrum. You sign it and the nurses will put it in a red biohazard case, simple as that. Yes, you can have your placenta.


Sarah Blight:               Okay. And that’s a whole different interview but I just wanted to ask that you can ask for your placenta to take it home with you.


Gail Heathcote:           Now that’s at Spectrum, I can’t speak for Metro or St. Mary’s but I can speak for Spectrum.



Sarah Blight:               But you can always ask and if they you know, –


Gail Heathcote:           Absolutely.


Sarah Blight:               It’s always up to them.


Gail Heathcote:           Absolutely. Uh-hum.


Sarah Blight:               Okay. What happens after the baby is out and the placenta is out? What is happening? Typically, if a mom is experiences tearing the baby is on her chest now hopefully, what is happening now for a mom?


Gail Heathcote:           Well it depends if she needs repair. Generally, what we’ll try and do is leave the mother and the baby well enough alone for the first hour. If I need to do a repair, I do it then as quickly as possible and you’ll generally find that the nurses and the provider who is in the room, once baby and mom are stable, we try and leave. It’s a really very sacred time for the three of them to be together.


Sarah Blight:               Okay. Is there anything else that you want mamas to know about labor and what happens during labor that maybe you typically see that patients don’t understand prior to labor or something you want them to know?


Gail Heathcote:           I think the choice in who you go to as your provider is absolutely critical. That the relationship needs to be a democracy and not a dictatorship.


Sarah Blight:               Uh-hum.


Gail Heathcote:           That you find somebody that encourages conversation and there will be times that we may or may not agree, but there’s an attitude of respect that it can be discussed but to have trust in the people that are caring for you is absolutely critical. I think to do a birth plan and what a birth plan does is it helps the couple verbalize their intention. I think for mothers to remain open minded, you never know how this journey is going to end.


Sarah Blight:               Uh-hum.


Gail Heathcote:           We enter into the journey with you really not knowing how it’s going to end. It really is a journey and all along the way, you make decisions and make assessments and adjust what you’re doing and your recommendations accordingly. So be open to suggestions, be a part of your care. I think it’s really critical. Take classes. There’s a lot of really good classes. There’s really great Bradley instructors in town, Lamaze, you know, hospitals have their own classes. There’s incredible hypno birthing classes. I know Carly you’ve had her on here to talk about hypno birthing.


Sarah Blight:               Uh-hum.


Gail Heathcote:           So there’s so many educational opportunities for people to kind of inform themselves and then have the conversation with their provider and the nurses is just really essential.


Sarah Blight:               Wonderful. Well thank you so much, Gail, for whizzing us right through the stages of labor. I know it was really fast and we can only hope for labors that fast. [Laughs] But we appreciate you sharing your insight with us.


Gail Heathcote:           Thank you, Sarah.


Sarah Blight:               Yeah thank you so much.


Gail Heathcote:           All right. Thank you, Sarah.


Sarah Blight:               And to all the mamas who are watching, if you have any questions or comments, leave your suggestions or comments or questions below in the comment section and we’ll definitely make sure they get answered. Thanks everybody for watching.

[0:18:22]                      End of Audio


  • Shelby Quinlan

    Such great information! Being aware does make the process much less scary and uncomfortable, especially as a person who has a fear of any medical type of procedure (which birth does not have to be), because being in a hospital was scary enough for me! Being aware helped me feel I had a little bit more control. My mantra was “my body is wise and knows exactly what to do”. It helped me stay focus and reminded me everything I was feeling was natural and would bring my baby to me!

    • yourbabybooty

      Yes! The first time I had ever stayed in a hospital was when I gave birth to my son. That, in and of itself, took some getting used to. I’d venture to say it’s the same for lots of women like us! Great mantra! It’s so helpful to have a truth that you can say to yourself during labor…great tip!

  • Cana Hartman

    Wonderful article, and it got me thinking about the placenta; I wasn’t really thinking of it as a “incredible organ”. I vaguely recall hearing about a mom planting a tree in the backyard over hers. Now I’m researching encapsulation. Not sure if I’ll do it or not, but just another cool option that has been brought to my attention. Thanks!

    • yourbabybooty

      We’re working on an interview about encapsulation, in the meantime, if you have questions let me know. I encapsulated mine! They’re sitting in my fridge as we speak:) You can also do a tincture (which wouldn’t cost you anything, I can tell you how to do it:) So happy you’re finding our info helpful!