Healthy labor, healthy birth, healthy mom, and healthy baby is three parts preparation to one part luck, generally speaking.* Taking a good childbirth class, hiring a supportive and evidence-based provider, reading recommended books, and hiring a doula all go a long way toward getting the birth that's best -- and healthiest -- for you and your baby. But. (You knew there had to be a "but," right?) Circumstances and events can sometimes take place that can alter the course of your labor and birth and can happen no matter how well you have prepared. It's important to consider the unexpected prior to having your baby in order to set realistic expectations and perhaps feel a little less caught off guard if does happen.
Your water breaks at term (39 weeks and beyond) and you are not having contractions. Unlike what Hollywood would have you believe, only 8-10% of women experience water breaking before going into labor. But if you are one of those women, it's important to consider your options. In most cases, about 50% of womens' bodies will get the labor message and will begin contracting within 12 hours after membranes rupture ("water breaks"), and nearly all women will go into labor by 24 hours. During a prenatal appointment, talk to your care provider about his or her policy if this happens to you. Some care providers recommend induction if you have not gone into labor within 12 hours. However, research has shown that it can be safe for women who meet certain criteria to wait up to 48-72 hours to go into labor. (source) Read more information about this circumstance, including links to recent studies and recommendations at Evidence Based Birth. Take notes and bring resources to your next prenatal appointment to initiate a discussion with your OB or midwife.
You go past your due date. Way past. It's important to remember that a "due date" is an estimate, not a definite. Due dates can be off by as much as two weeks. That said, when your care provider charts a due date, that is often the guideline she or he will use to determine where you are in your pregnancy (due dates are more accurate when ovulation is known or when early first trimester ultrasound is performed to date the pregnancy). Going past your due date does not mean 40 weeks and 1 day. In fact, a post-term pregnancy is defined as one that goes beyond 42 weeks, not 40 weeks. The American College of Obstetricians and Gynecologists (ACOG) recommend that induction can be considered between 41 and 42 weeks of pregnancy and that it is recommended beyond 42 weeks. (source) Before you get to this point in your pregnancy, talk with your care provider about going past 40 weeks and what that will look like for you at their practice. More evidence-based OBs and midwives encourage moms to go past 40 weeks and up to 42 weeks to wait for labor to begin on its own. It's important, in most cases, to let baby choose her birth date in order to ensure that she is ready and mature enough for life on the outside.
Your baby is "sunny side up" (OP) during labor. Otherwise known as "back labor," this circumstance may not make or break your birth, but it can make it a very different experience than what you had imagined. When baby is positioned "OP" (occiput posterior), where the back of his head is against your tailbone and facing up (instead of the other way around, which is most common), it can cause a slower labor, a more challenging labor (with added back pain), and an increased chance for use of pain medication. The best and most sure-fire way to cope with back labor is to hire a doula. A doula will be able to suggest positions to encourage baby's rotation, have sure-fire methods for relieving back labor pain without the use of pain medication, and be able to support you optimally in labor. In the absence of a doula, you can search online and find some useful tips and tricks to help your partner, birth support person, or nurses best support you. A combination of position changes and comort measures will help relieve back labor.
Your labor goes well beyond 24 hours. Many women are surprised to learn that labor can be long. The awesome thing is that typically, your body can handle it! If you are well supported and well nourished, you are well positioned to have a healthy birth. That said, sometimes labor can be very, very long. If you are in active labor (4-6cm and beyond) for more than 24 hours, it can be an intense and overwhelming experience. Longer labors often are caused by baby's position, but can have other causes too. If this happens to you, realize that at a certain point, you may need to rest or take a break -- and that is OK. If your plan was to have as little interventions as possible but you're going on more than 48 hours without sleep and more than 24 hours of hard labor, an epidural may be the best thing for you! And, you might just need some Pitocin to strengthen your contractions (to help bring baby down). Ask your doctor to measure the strength of your contractions first, which can be done with a device called an IUPC (internal uterine pressure catheter). Interventions can be helpful when they are used for the right reasons.
*Not a scientific ratio