VIDEO TRANSCRIPT: THIS TRANSCRIPT WAS GENERATED USING AN AUTOMATED SERVICE SO WE APOLOGIZE FOR ANY TYPOS AND SPELLING ERRORS.

Signs for labor (1st time mamas!)

[00:00:00] Hi everybody. Okay. Lots of labor happening, so I figured while I'm actually, can you see it's raining. I'm waiting outside the hospital for someone in labor. Um, I decided, I'm gonna review what are the times that I tell patients to go to the hospital when they think they're in labor? What are some things that go on? 

I feel like this. Is basic, but obviously people need to know reminded of that fact cuz I just got off the phone with a patient who needed to know. Um, and I know she knows cuz she and I have discussed it. But it's always a good reminder. So this might be one of my briefer ones. Let's see. Smack down. You know I say I'm gonna be brief and then I end up hammering for 10 minutes, but I'm gonna try to make this quick. 

I'm gonna divide between first time mom, second time mom, first time moms labor can take a long time, like long time, like it could take over 24 hours for. , any labor in my world that is less than 24 hours with your first baby, less than one to two hours of pushing with your first baby is actually really good. 

Even better is like less than 15 minutes, but that's, I mean, 15 hours. But that's a unicorn. [00:01:00] I mean, it's not, listen, some women go really quickly, but in general, it's best to set your expectations and manage your expectations and think that with your first baby, it's gonna be longer because it often. And that's different than if you're getting induced. 

So we're talking about spontaneous labor today. Spontaneous labor meaning going into labor. So first we'll talk about first babies, and we're gonna talk about labor versus breaking your water. Then we're gonna talk about second or third babies. So first baby, when do I say to go in? I say if one of four things happen, and again, let me say this is an assuming. 

that there's nothing else going on. Like if you think your head is gonna explode or you feel like you have really, um, black spots in your vision, then it could be blood pressure or pre-eclampsia. That's a different issue. We're talking about labor, so assuming you feel fine, but for these labor things, these are the times you call your doc. 

And every practice is different. But many practices do what we do, which is you call the office, you don't go straight to the hospital and you don't call the hospital. You call the office. The office either during the day gets one of the doctors, or if it's night, the [00:02:00] answering service calls the. some places, I guess you called the doctor directly. 

I don't know where those places are, but I'm sure they exist. Um, but then we talk to you and then we help decide and we say things like this, if one of these four things happen, please call us. So if your water breaks, sometimes it's obvious big GU of fluid all over the floor. , sometimes it's not so obvious. 

Kind of a gush of fluid, kind of still gushing, gushing one gush. Then it stopped. I don't know. So if it's a gush that's obvious, you call If it's like one little gush and then you're not really sure, talk to your doctor. But I would say, okay, you could put on a pad, walk around, see if another couple of gushes come out, and if so, that's probably your water breaking, believe it or not. 

Sometimes it's urine and sometimes it's just vaginal discharge that has liquified and gushed out and can really mimic your water. But since we don't know, we would say either go to the hospital or come to the office depending on like the circumstances and the time of day and all these different factors so that we can help do some [00:03:00] tests to see if you've broken your water. 

Interesting semen, like what comes out when you have sex? Heterosexual male, female sex semen. When it sits in your vagina, you probably know this will liquefy. So it's not uncommon for patients to be like, I don't know if my water broke. Did you have. Oh yeah, I did. And then that could be the semen that liquified and squirt it out. 

So again, number one is if you think your water broke, number two, I say if you are bleeding, like a period meaning mucusy, bloody like stringy mucusy with some pinkish or brownish or reddish, that's just your mucus plug. Or it could be a little bit of bloody show if you are bleeding like a period, like heavy, like a period. 

I tell patients. It's either labor, which it could be, again, that could be the bloody show of labor, beaning, more advanced labor, or rarely. It could be that other things are happening that we need to evaluate. Like your placenta is wanting to do some funky things. So if you are bleeding like a period, I say, [00:04:00] please call your doctor. 

Third thing, if you don't think the baby's moving well, how much should a baby be moving? Well, every baby's different. So unfortunately, I don't wanna say things like 10 times an hour, cuz I think that seems crazy because many babies do not move 10 times an hour. So the bottom line is, it's a little bit of a vague, fuzzy answer within a very concrete answer, which is this. 

You know your baby's movements, your baby might slow down towards the end of pregnancy because the baby's big, getting bigger because the fluid is getting less. But the baby should not be not moving and you should not be having to sit there going. I think I felt a movement. Did I feel a movement? Maybe not. 

I'm not sure If you are not sure. And you are at the end of your pregnancy, you need to call your doctor because at the end of the pregnancy, every now and then, that placenta has done all its work and it's just tired. And your baby's decreased movement or your perception of her decreased movement is maybe a sign that she's like, knock, knock. 

I just don't wanna be here anymore. And sometimes. She is better off outside your uterus than inside. So again, if you think the baby's not moving as evidenced by a [00:05:00] change in what you are used to, then you should call your doctor and be evaluated because that is something important. And when it comes to things like if you have a Doppler at home, our pregnancy kid is launching next week and we're gonna be. 

Part of the kit is the Doppler. Please do not use it in that circumstance. If you're not sure you're feeling the baby move and you happen to have a doppler, don't just listen with your own doppler and be like, yep, everything's fine. Because we don't just listen to the short heartbeat when we're not sure if the baby's moving. 

We do in more expanded tests to be sure that not only is her heartbeat there, but that she's thriving. So again, if you don't feel movement, you call your doctor. And then fourth and final and hardest is if you think you are in active labor, meaning, Contractions that are rock hard and painful every three to five minutes for at least an hour is what I say. 

So let me break that down while I'm the first one to tell you. I love the hospital. The hospital's amazing. The hospital's, the place you wanna be when you need to be there so that if God forbid something happens, we are there to take care of you because that's why you're there, right? You're not there cuz it's fancy. 

You're not there because it [00:06:00] smells great. You're there because while Labor's an amazing process and has been going on for Len, Labor can do things that are not always amazing for women and babies and therefore the medical professionals have studied to be able to be there for when you need us. So while, like yesterday I talked about birth plans and I am all for not being too definite about your birth plan and saying it has to be this way. 

I'm also all for, by the way, less intervention is better if it's done safely and with the right parameters and with the right mindset. Let's assume your water didn't break, you're not bleeding, and you're feeling the baby move. And the only thing that we're talking about is actual labor contractions. And what I tell patients is you're gonna start having contractions. 

Your belly's gonna start getting hard and tight if it's hard and tight and not painful or crampy, like a period, but not hard and tight. Those are probably Braxton Hicks. As long as your baby's moving, you're not bleeding, your water hasn't. Stay at home. But once it starts getting hard and tight and painful, hard and tight and painful, [00:07:00] then start watching the clock when it's like eight to 10, 10 to 12, 20 to 15, or it's like every five for 15 minutes and it stops. 

Those are labor maybe, but they're probably really early, or they're false labor or prodromal labor, which is this annoying period of time that kind of precedes labor sometimes. And it can be exhausting, but it can happen. So while you're more than welcome to call your. , you're also better off probably if she agrees you should talk to her about this in your office. 

You're probably better off trying to stick it out at home until it becomes very regular and every three to five minutes for at least an hour. But what if I miss my epidural? You're thinking in your mind, and I'm gonna say to you what I say to my patients, which is First time Mama is rarely not. Never, rarely, Mr. 

Epidural. Because even once your contractions get to every three to five minutes, rock hard paint for at least an hour. You're probably gonna walk in the hospital like a couple centimeters dilated. And if you're one of those lucky women who walks in like nine centimeters dilated, [00:08:00] if it's your first, you're still probably gonna have time to get your epidural. 

And if you're one of those really rare unicorns, I shouldn't say unicorns, cuz they do exist. So really rare, beautiful creatures who goes into rip roaring fast labor with her first, didn't even really know she was laboring and all of a sudden the baby's coming out. While it feels overwhelming, I would imagine to do this without an epidural. 

I haven't done it, but I've seen many women, many women and Herald and many women through it. I would still say you're actually quite lucky. So it's a win-win. Either way. Try to stay home as long as possible cuz just like I said, the hospital is an amazing place of intervention when you need it. , but it's also a place of intervention even when you don't need it. 

This is what we're groomed to do. Like we are trained to be there and do things, which means if you're there kind of just wanting to, to hang out, it's hard for the doctors and nurses to allow that to happen. So you are probably better off in your own home where you can eat and drink what you want, where you can take a hot bath, where you can take a hot shower, where you can be really mobile and things like that as long as it's safe. 

Now a worried about your water breaking. I personally [00:09:00] like our patients to get to the hospital once their water has broken. Not immediately, but within, you know, I'm gonna be vague and say a couple hours, like one to two hours. That's my preference. A lot of doctors feel more comfortable letting you stay at home longer, so you should talk about it with your doctor. 

The pros to staying home longer is your body might go into labor on your own. The cons are that the cushion of the fluid around the baby is now less, and so we worry that the baby could be getting squeezed and things like that. So, not to sound dramatic, it is a very personal thing. You should talk about it with your doctor. 

Okay? Now you get to the hospital, you get examined, you decide you're gonna. pain medicine in your, in your IV or an epidural or you're gonna wait it out and not get any pain medicine and then things can transpire and move very quickly or very slow. That's first time mom. So again, water break bleeding like a period, not feeling the baby move or contractions every three to five minutes for at least an hour. 

Any of those four things, any one of those four things, I say call the doctor. Let's say you're a second or third time mom, or fourth or fifth, anything past your. [00:10:00] Second time babies often, often come out faster than first. This week has been a conundrum for my second time babies. They have not been coming as fast as they should, but most of the time they do. 

Third is a funny crap. Shoot. You just never know. If you ask most obs we'll say second comes faster than the first third. Yeah, never know. Doesn't always come faster than the second. Still probably faster than the first. So with your second time babies, I say to patients, listen, your water breaks, honey. You call us on the way to the hospital because we are gonna tell you to go. 

Cuz you could go from like my water broke. I feel great to like, holy shit, a baby is coming outta my body within an hour. We've all seen it happen before. And again, could you, Mr. Epi. It's possible. Is it still okay and healthy? Of course, those babies come out great most of the time, but you feel overwhelmed and it's kind of messy to deliver in your car. 

So let's say your water breaks, I say call on the way to the hospital. Again, you should ask your doctor, but this is how I would manage it, is that water breaking, you can go into quick rip roaring labor. And one way to just think about like if you have a, a baby at home. and you're waiting for your mother [00:11:00] or your babysitter, someone to come and it's gonna take them two hours. 

I say to patients, just preemptively think, okay, worst case scenario, I think this kid's coming out, we're gonna put that, we're gonna put our toddler in the car, we're gonna get to the hospital. Whoever's in the car is gonna wait in the car and I'm gonna run up to labor and delivery on my own. If you have that in your mind, it's never gonna happen. 

So it's good to just preemptively think that way. If again, you think you're bleeding like a period, or the baby's not moving, of course you call your doctor and then contractions. I don't usually say wait till it's every three to five minutes with your second or third, cuz it might go fast. I usually say when it's six to eight, eight to 10, Regular. 

Painful, painful, painful. Let's have a conversation and see what's happening. Sometimes you're like, I don't really know. I'm not sure if I wanna go in. And then we kind of decide together, like give it another hour or two. Sometimes you're like, it's every six minutes. It's really painful. It's not very frequent, but what do I do? 

And then I would say go in. It sometimes means you're having a rule out labor. That's annoying to get to the hospital, be examined and then sent home, but it might be better than delivering in your [00:12:00] home or your living room if that's not your intention. Now, again, I joke, home deliveries can be unfortunately worrisome. 

Home deliveries that are unplanned tend to be actually, Really easy. That just seems like Murphy Law. Let's go back to talking about first time moms who get ruled out for labor. Like you walk in, you are contracting like crazy. Your baby is fine. We've checked the baby, we've checked your cervix. You're one to two centimeters, your fingertip to close. 

You're not very far. You're contracting. We wait for a couple hours, examine you again, and then let you go home. It doesn't mean we're saying. You're not in labor. It means we're saying you're in early labor and as long as everything's safe and healthy again, as much as we're interventionist, we also recognize that you're often better off being at home. 

Sometimes that's hard cuz you're in pain and sometimes you need pain medicine even when you're not in active, active labor. And that's okay. You talk about it with your doctor and she might say, stay and we'll give you something to kind of help take the edge off of it. And she might really encourage you to go home. 

All the pro conversation you should have with your doctor. And there I said I was gonna be eight minutes. I'm like at [00:13:00] 13. I hope that. Labor labor. Labor. Labor is a crazy, unpredictable thing, and yet it is unpredictably predictable or predictably unpredictable. Okay.