Prenatal yoga is a fantastic way to stay active during pregnancy, preparing both body and mind for labor. “One of the many benefits of yoga is that it deepens your connection with your body,” says Brihony Smyth, certified yoga teacher and instructor of Alo Moves Prenatal Glow series. “During pregnancy, yoga can benefit expecting mothers as it can help with relaxation, tension release, increasing blood flow, overall feeling good, and so much more.”

As you move through the third trimester and start to think about labor, certain yoga poses can help prep your body for the big day. “Yoga helps to produce oxytocin, the feel-good hormone we naturally release from our pituitary glands,” shares Steph Ball-Mitchell, certified prenatal yoga teacher and founder and lead trainer of Online Yoga School. She also explains that oxytocin is the hormone involved in labor contractions.

Related: 6 expert tips on how to prepare for your first birth

Can you use yoga poses to induce labor? Not exactly, but they can help. “If the baby is not yet in the right position, or the cervix hasn’t softened yet, these won’t induce labor,” shares Kate Lombardo, Yoga Director at Yoga Renew Teacher Training (and mom-to-be). “They’ll only work if it’s go-time.” Which means you can safely employ these poses throughout your pregnancy. But once you’ve reached full-term, at 37 weeks? These poses are certainly worth a try to get things going.

One thing to note: As with starting any new exercise regimen during pregnancy, be sure you’re cleared by your doctor or midwife before beginning.

Try these 4 yoga poses to induce labor

Malasana or yogi squat

Also called “garland pose,” malasana is a gentle squat that opens the hips and pelvis—perfect for labor prep. It’s also a pose that some women may find themselves naturally gravitating toward during labor. “This position opens the inlet of the pelvis to allow for baby to move down towards the cervix,” shares Lombardo. “It also puts you in a position to relax the pelvic floor, which is important through the labor process as well.”

How to do it: Ball-Mitchell says to start by stepping the feet just past hip distance with toes facing slightly out. “Lengthen your spine and keep your hands on your thighs for support as you slowly begin to bend the knees and lower the hips down into a squat.”

Ball-Mitchell suggests placing a rolled towel under the heels to help if heels come up. Smyth suggests using a block, the tall way, for extra support, “Make sure to take your elbows to your inner knees to help you push your knees out and really reap the benefits of the pose: stretch your adductors and inner groin muscles.”

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Related: 6 ways you can induce labor naturally

Goddess pose

Celebrate your inner fertility goddess with this pose that opens the hips and pelvis. Lombardo explains that Goddess pose “puts both of the legs in external rotation, which helps to open the pelvis and make room for baby to move downwards into the right position for birth.”

How to do it: Start by standing with the legs wider than hips distance, around three to four feet apart. “Turn both heels to face in and the toes to face out,” explains Lombardo. “Bend the knees and lower the hips about halfway down as if coming to a high squat position.” You can place your hands on your hips or bring them to a prayer position at the heart.

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Baddha Konasana or bound angle

Bound angle is a seated yoga pose perfect for opening the hips and pelvis to help bring baby into the world. ” It opens and lengthens the pelvic floor while strengthening the outer hips,” Ball-Mitchell shares. “It also helps to calm the mind and prepare for labor and delivery.”

How to do it: Start seated with the soles of your feet together and knees wide. “Engage your glutes to open your abductors and inner groins,” Smyth explains. “Focus on mildly folding to get the stretch to the back of your body and erector muscles.” Ball-Mitchell and Smyth also encourage using yoga props like blankets or blocks under knees or thighs for extra support.

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Related: 5 ways to prepare your body for labor—from strength training to meditation

Tabletop pose

Anything that keeps the pelvis and hips moving and relaxed can be a blessing for a very pregnant mama. “A lot of women actually labor in this position,” Ball-Mitchell shares. Add a few hip circles or cat-cow tilts, and you have a perfect labor-inducing flow. “During pregnancy, you can’t really work or strengthen your core or front body,” Smyth explains, “But this pose can help strengthen your back and side body muscles which will help you support and protect the weight of your belly and body.”

How to do it: Start in a tabletop position with wrists under shoulders and knees under hips. Ball-Mitchell suggests placing a blanket under the knees for extra comfort. “Move your knees back and your wrists up about an inch. Bring your hips forward on an inhale, and begin circling your hips to the left, going only as wide as is comfortable for you,” she explains. Let your breath guide your movement, inhaling to circle the hips wider and exhaling to bring them back in.

Smyth also suggests gentle cat-cow while in tabletop to open up the lower back and pelvis even more. “Focus on your cow pose, drawing your shoulder blades down and opening your chest,” she says.

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A quick word of caution

Using yoga poses to induce labor can be helpful, but if you’ve never done yoga before or are unsure how your body will respond, you may want to check in with your OB-GYN or midwife before trying them. “I’d recommend attending a prenatal class and [connecting with] a teacher or instructor who guides you through poses and helps with modifications,” shares Smyth.

Home programs are an option if local classes aren’t accessible to you. “If you’re starting at home, make sure to practice what feels good, take it easy, make sure not to go too deep into poses,” Smyth explains. She encourages mamas to use yoga for labor as a tool for stress or pain relief instead of an opportunity to push themselves. “Overall, your practice should feel good in your body. You should avoid practicing poses that make you feel dizzy or bring discomfort to your body.”

There is just SO much to think about when it comes to what to expect during labor for first-time mamas, and much of it focuses on the physical side—contractions, dilation, mucous plugs—but there’s also a lot of mental and emotional preparation that needs to happen as well.

When we reached out to experts for their top tips about what to know about giving birth for the first time, most of their advice focuses on the mind-body connection and how it relates to a positive birth and postpartum experience. So while you’re packing your hospital bag and practicing breathing exercises, you can also keep these tips in mind.

Here’s what to know about giving birth for the first time

The average week to give birth for first-time moms may not match the due date

First things first: That date you have circled on your calendar? It may not be the day you actually give birth. “It’s important to remember a due date is an estimate, nothing more!” says Melissa Dennis, MD, an OB-GYN in Chicago with over 20 years of experience delivering babies. “Patience is key while waiting for labor to begin.”

Lawana Brown, MSN, WHNP-BC, WHNP Program Director, and Assistant Professor for the School of Nursing at Regis College shares that, “An online search of available research articles puts the percentage of mothers delivering on their due date at about 4% to 5%.” So as you creep closer to the 40th week, know that you and your baby are right on track even if labor hasn’t yet begun.

Related: What month will my baby be born? Here’s how to calculate your due date

Babies don’t always follow birth plans, and that’s OK

A birth plan can be a way to discuss and outline all your preferences for labor and delivery—from who you want in the room with you to what kind of pain management you prefer. It helps you think through what you envision for an ideal birth. “Birth plans are a good way for you to let your provider know what your wishes are,” says Brown.

But once you go into labor, the baby may not follow your plan. Dr. Dennis prefers the word preferences over plan. “If things do not go according to plan, disappointment can follow, and as your physician, I want to maximize joy during this experience!” she says. She suggests sharing with your provider to discuss all the available options, so you’ll be mentally ready for all scenarios.

Birth classes can increase confidence during labor

If you’re like most first-time mamas, the unknowns can keep you up at night. “Part of the anxiety of pregnancy and birth is not knowing what to expect,” shares Stephanie Hack, MD/MPH, board-certified OB/GYN, and mom of three (including a newborn). A birth class can help ease some of those fears by teaching you about what to expect and even some pain management techniques. Brown adds, “I had four babies, and each time I did the birth preparation class. It takes away some anxiety when you know what to expect.”

On the other hand, Kelli Burroughs, MD, department chair of Obstetrics and Gynecology at Memorial Hermann Sugar Land Hospital, also points out that birth classes aren’t for everyone. “For some individuals, these classes provoke anxiety due to the amount of detailed information.” In this case, learning what to expect from friends or family members, reading books or watching documentaries could be more helpful than in a structured class setting.

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Positive thoughts can curb anxiety in the delivery room

As your labor progresses, keep thinking about how amazing it will feel to finally meet your baby. “Believe in yourself and your ability to have a successful pregnancy. Women’s bodies are designed to bring forth life into our world,” says Dr. Burroughs.

You can practice affirmations and thoughts with your partner during prenatal visits. One study even found that having a positive attitude about labor and labor pain was associated with shorter delivery. While you can’t necessarily control how you feel in the moment, thinking positively about what your body is capable of could help.

Address mental health to make life easier before, during and after labor

Thankfully, discussions surrounding mental health and childbirth have become more mainstream in recent years. “Addressing depression and anxiety prior to pregnancy is just as important as addressing high blood pressure,” says Dr. Burroughs. “The healthier a woman is physically and mentally prior to pregnancy, the less risk associated with exacerbation of underlying medical conditions.”

Even if you’ve been feeling great throughout your pregnancy, it’s normal to feel some anxiety in the days leading up to your due date or even once contractions begin. If you feel overwhelmed, talk to your partner or doctor about your feelings and seek out help.

Related: Postpartum depression and anxiety are more common than you may think—here are the resources you need

Support systems are key to a successful labor and postpartum experience

Think of a support system as your cheerleader during pregnancy and labor. “I have always described labor and delivery as the end of a marathon,” says Dr. Dennis. “It’s exhilarating but can also be mentally and physically challenging.”

Dr. Dennis believes that creating a support system before labor is essential. “In addition to leaning on partners, family and friends, meeting with a mental health provider and pelvic floor physical therapist proactively provides support and knowledge to first-time parents… and knowledge is power.”

Brown also reminds new mamas, “Celebrate the strength of this body that allowed you to carry a life and bring it earthside!” And Dr. Hack adds, “Take pictures, celebrate, and enjoy the experience as much as you can.” You’ve got this mama, and the reward is worth all the hard work. 

Sources

Beigi SM, Valiani M, Alavi M, Mohamadirizi S. The relationship between attitude toward labor pain and length of the first, second, and third stages in primigravida women. J Educ Health Promot. 2019;8:130. Published 2019 Jul 29. doi:10.4103/jehp.jehp_4_19

“As a doula, I work closely with my clients throughout pregnancy to provide information on healthy pregnancy practices, nutrition, birth choices, breastfeeding and postpartum care,” explains Carson Meyer, birth doula and founder of C & The Moon. “I get to know each client’s unique individual needs and preferences to best assist them through their journey.” 

Doulas help build the bridge that helps support a family’s transition into parenthood—but doula services can be expensive, and may not be covered by insurance. It’s not an option for every family, which is why it’s especially important to be your own advocate in pregnancy, labor and birth stories.

Related: My husband won’t be my birth coach—and we’re both okay with that

Making doula services more accessible

Meyer is also an advisor for Little Honey Money, a cash fund baby registry that enables new families to register for wellness or pregnancy support gifts, like a doula, prenatal massages or breastfeeding support, spreading out the cost of giving birth and these helpful services among family and friends.

According to Lori Bregman, doula, co-founder of Seedlife and advisor to Little Honey Money, having a doula or understanding how to advocate for yourself like one is essential, particularly given the reality of doctors appointments. 

“These days doctors appointments are limited to 10 to 20 minutes,” explains Bregman. “In those 10 minutes, it’s hard to establish a real connection and have all your questions and concerns answered.” 

While platforms like Little Honey Money and Poppy Seed Health (which offers on-demand support from a doula, midwife or nurse) are making doula services more accessible, it’s still powerful to understand how and when to advocate for your rights. 

Set yourself up for success

Even without a doula, it’s possible for both you and your birthing team to create an honest, positive foundation for your birthing experience. 

As you start meeting with your medical experts, one way to begin advocating for yourself and encouraging openness is to share any past trauma that may resurface during your pregnancy or labor. 

“Share your family history if you feel it is relevant to helping them understand a bit more about you,” encourages TaNefer L Camara, MS-HCA, IBCLC Mom, Lactation Consultant, Doula, and Maternal Health Strategist. “Share your learning style and how best to communicate or how you prefer to receive information.” 

Other ways to help set the stage for success is to put your birthing plan and desires on paper, so that anyone who needs to reference it has it available to them. 

Your birthing team, plus friends and family can also take it upon themselves to help you advocate for yourself by being privy to your birthing plan or reading books like The Birth Partner by Penny Simkin.

Know what red flags to look for in your medical care

“Your care provider for pregnancy, labor and beyond should partner with you,” explains Tesiah Coleman, MSN, WHNP-BC, AGPCNP-BC, CLC, the director of virtual care at Tia, and a doula and health equity advocate. “Steer clear of providers who dominate the conversation or decision-making. If they can’t listen to you during your prenatal visits, then they certainly won’t while you’re in labor.” 

Coleman adds: “If a provider insists on a treatment or plan you don’t agree with, ask for a record. You can say things like ‘can you please put in my chart that I do not agree with this plan and am asking for an alternative.’ Make sure you ask to see the clinical note after it’s written. Typically they would rather work with you than risk writing that disclaimer and having something go wrong.” 

Other red flags to look out for include doctors dissuading you from seeking additional support (like doula support), mention of a big baby, encouraging inducing labor for non-medical reasons, disregarding your fears or concerns around birth, or anything that makes you feel personally uncomfortable. 

Practice self-advocacy

Hardly anyone is an expert at advocating for themselves, particularly in tense or medical situations. Everyone has to practice and reaffirm their right to do so. 

“It can be intimidating to advocate for yourself in medical situations because your medical provider is supposed to be the expert,” explains Josephine Atluri, mindfulness coach & author of 5 Minute Mindfulness for Pregnancy.  “However, it’s your body and you know best how you are feeling. It is in your right to ask all the questions that are weighing on your mind and to advocate for things that you want to pursue in your medical treatment.”

Atluri encourages starting by asking yourself why you’re having a hard time asking for help or advocating for yourself, as shining a light on what may be stopping you can help you figure out where to go next. 

Leaning on different breathing and meditation techniques either before or during the moments you’ll need to advocate for yourself can also be helpful. 

Clarissa Edmondson, CBE, doula, pregnancy & infant loss advocate and advocate at Poppy Seed Health, shares a template that can be useful when practicing advocating for yourself in real time: 

• I am _____ weeks pregnant, and I would like information on better preparation for my upcoming birth. My expectant due date is ___________. 
• I would love information on the birth process, I am planning a ________ (hospital/home birth). I would prefer a ___________ (medicated or unmedicated birth). 
• Lastly, I would like information on navigating postpartum. 

Related: 4 simple things you can do to have a better hospital birth

You deserve a safe and healthy pregnancy and birth

Knowing your medical rights and reminding yourself that you are always in your right to refuse or delay care or get a second opinion also helps build your confidence ahead of having to speak up for yourself in a medical situation. 

Most importantly, it’s key to remember why you’re advocating for yourself. 

“You are advocating for a healthy pregnancy, birth and postpartum,” explains Edmondson. “[You’re] protecting yourself and your baby, and making sure that you have all your options readily available to you.” 

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But as it turns out, breathwork may have benefits throughout pregnancy—not just in labor.

First introduced in 1951, the Lamaze Method’s use of breathwork was groundbreaking—and has since paved the way for more breathwork tools to take center stage in our collective dialogue. 

Related: Alex Elle on generational healing and community care

But breathing exercises are still an underutilized tool in general, says Davi Brown, head of education and community at Breathwrk, a breathwork-focused app, and certified breathwork instructor. 

“During the birthing process, from conception to postpartum and beyond, many shifts are taking place in the body and mind that breathing exercises can support by lowering blood pressure and heart rate, improving mood and increasing feelings of bonding, reducing symptoms of pain, nausea and anxiety, and helping you to relax when you need it most,” Brown says. 

It’s a powerful practice that’s always accessible, and can be safe and effective for pregnancy when used in the right way.

Benefits of breathwork

Even something as simple as consciously breathing through your nose instead of your mouth and slowing down your breathing rate can have big benefits. 

“Breathing predominantly through your nose during waking and sleeping is one of the most scientifically supported breathing interventions and definitely the most widely taught by teachers,” Brown says. “By simply shifting to breathing through your nose throughout the day and night, you’ll be slowing down the breathing rate, modulating cognitive function, purifying the air and supporting proper airway structure.”

Related: Dear mama, you deserve a beautiful breastfeeding experience—and mindfulness can help

Breathwork also can help alleviate some common pregnancy symptoms, like nausea and morning sickness. Just lengthening your exhale can activate the vagus nerve and engage your parasympathetic nervous system to help relax and calm the body and the digestive system. 

It can also help relieve that shortness of breath you may get later in pregnancy. By the middle of the second trimester, as many as 76% of pregnant people experience shortness of breath, or dyspnea. “Intentional breathing at specific rates can help alleviate this,” Brown notes. 

How to practice breathwork safely in pregnancy

The following are important factors to remember if you’re practicing breathwork while pregnant. 

Focus on exercises that are designed for pregnancy. Working with a trained breathwork instructor or using a program that’s specifically designed for pregnant people will ensure you’re using techniques that are safe for you and your developing baby.

Don’t hold your breath for long periods. Holding in your breath for extended periods (more than 7 counts) is contraindicated in pregnancy for fears that it could slow oxygen delivery to the fetus. Talk to your doctor if you have concerns.

Avoid short, rapid inhalations. This type of breathwork, while helpful in other times, can trigger hyperventilation in pregnancy.

Don’t get too hot. Some types of breathwork may work to raise your body temperature, which is not advised during pregnancy. 

Listen to your body. If you start to feel dizzy or lightheaded, stop practicing and return to a normal breathing rate.

Related: The new mama’s guide to pregnancy symptoms

Breathwork for pregnancy and postpartum

Here are specific breathing exercises and breathwork techniques to use throughout pregnancy, birth and into the postpartum period. 

The first three breathing techniques outlined below (Nausea, Sleep and Active) are all deemed safe for pregnancy. 

For your safety, we recommend practicing breathwork while sitting or lying down. If you feel lightheaded, please stop immediately. Do not practice while driving or in water. 

First trimester

Suggested breath: Nausea 

“Controlled breathing has been found to help significantly reduce symptoms of nausea, which can be useful during the first trimester when the likelihood for nausea is high,” Brown shares.

Throughout pregnancy

Suggested breath: Sleep

“It’s important to prioritize rest and relaxation throughout the process of growing another human inside of you,” says Brown. The Sleep breath can help you wind down from the day. Repeat for just four breaths.

Labor and birth

Suggested breath: Active 

“The Active breath was developed in partnership with Loom, which provides online education for reproductive and sexual wellness, for when contractions are intense and 3 to 5 minutes apart,” Brown says. 

Postpartum

Suggested breath: Uplift

“Rhythmic breathing can help your body and mind relax and can also increase feelings of bonding and love,” Brown notes. After birth, there are numerous physical, mental and emotional steps toward recovery and this breath is meant to support them all. 

Sources

​​Aybar DO, Kılıc SP, Çınkır HY. The effect of breathing exercise on nausea, vomiting and functional status in breast cancer patients undergoing chemotherapy. Complement Ther Clin Pract. 2020;40:101213. doi:10.1016/j.ctcp.2020.101213

Breit S, Kupferberg A, Rogler G, Hasler G. Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in Psychiatry. 2018:44. doi:10.3389/fpsyt.2018.00044

Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing–an experimental study. Pain Med. 2012;13(2):215-228. doi:10.1111/j.1526-4637.2011.01243.x

Choi HS, Han SS, Choi HA, et al. Dyspnea and palpitation during pregnancy. Korean J Intern Med. 2001;16(4):247-249. doi:10.3904/kjim.2001.16.4.247

Craighead DH, Heinbockel TC, Freeberg KA, Rossman MJ, Jackman RA, Jankowski LR, Hamilton MN, Ziemba BP, Reisz JA, D’Alessandro A, Brewster LM. Time‐Efficient Inspiratory Muscle Strength Training Lowers Blood Pressure and Improves Endothelial Function, NO Bioavailability, and Oxidative Stress in Midlife/Older Adults With Above‐Normal Blood Pressure. Journal of the American Heart Association. 2021 Jul 6;10(13):e020980.

Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018;12:397. doi:10.3389/fnhum.2018.00397

Lothian JA. Lamaze breathing: what every pregnant woman needs to know. J Perinat Educ. 2011;20(2):118-120. doi:10.1891/1058-1243.20.2.118Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med. 2005;11(2):237-244. doi:10.1089/acm.2005.11.237

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During pregnancy, the inflammatory response is highly activated. Increased levels of hormones during pregnancy can make your gum tissue more sensitive and supercharge your body’s natural inflammatory response to plaque, encouraging your immune system to attack the bacteria in it. This can lead to inflammation and gingivitis, a gum condition that causes swelling and redness around the teeth.

Studies indicate that 40% to 80% of pregnant women experience gingivitis between the second and eighth month of pregnancy, making keeping up with dental hygiene and appointments more important than ever. It’s always important to prioritize your oral health, but especially while pregnant because gingivitis, if left untreated, can progress to periodontitis and become severe, increasing the risk of adverse pregnancy outcomes.

Symptoms of gingivitis

When gingivitis is left untreated and advances to periodontal disease, gums can separate from the teeth, which is a major contributor to tooth and bone loss.

Key symptoms of gingivitis in pregnancy may include:

• Dusky red or dark red gums
• Tenderness in the gums
• Swollen or puffy gums
• Gums that bleed easily when you brush or floss, even when gently
• Bad breath
• Receding gums

If you have any of these signs or symptoms, a call to your dentist is in order.

How pregnancy contributes to gingivitis

Half of your baby’s DNA comes from your baby’s father, which is “foreign” to your immune system. It’s essential that pregnancy induces a series of complex maternal immunological changes to prevent rejection of your baby, so your immune system becomes suppressed, which increases your susceptibility to a number of infections, including gingivitis.

How to prevent pregnancy gingivitis

Prevention of pregnancy gingivitis starts with good oral hygiene. In addition to eating a healthy diet and avoiding sugary foods, there are several effective ways to prevent or reduce plaque buildup while pregnant:

1. Brush your teeth thoroughly, at least twice a day for at least two minutes, with an anti-gingivitis or anti-plaque toothpaste.
2. Opt for an electric toothbrush to maximize your cleaning potential.
3. Make sure your toothbrush has soft or extra-soft bristles.
4. Use special care to brush around the gum line.  
5. Replace your toothbrush every three months.
6. Floss daily at bedtime.
7. Use a natural, anti-gingivitis mouthwash.
8. Maintain your regular professional dental cleanings.
9. Chew gum sweetened with xylitol, which inhibits the growth of the bacteria that produces plaque.

Gingivitis can affect pregnancy outcomes

Adverse pregnancy outcomes like low birth weight, very low birth weight, preeclampsia and gestational diabetes can be the result of gingivitis that has advanced to more severe disease. 

However, if you find yourself with more than a bit of gingivitis, rest assured that there are ways to handle it safely during pregnancy and reduce risks. Your baby’s organ development happens during the first trimester and is when the adage “less is more” is truly applicable, so studies show the best time to have treatment is the second trimester (weeks 17 to 28).

In every case, be sure to check in with both your dentist and your birth care provider about safe treatment options during pregnancy. 

Sources

Corbella S, Taschieri S, Del Fabbro M, Francetti L, Weinstein R, Ferrazzi E. Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association. Quintessence Int. 2016;47(3):193-204. doi:10.3290/j.qi.a34980

Edwardsson S, Birkhed D, Mejàre B. Acid production from Lycasin, maltitol, sorbitol and xylitol by oral streptococci and lactobacilli. Acta Odontol Scand. 1977;35(5):257-263. doi:10.3109/00016357709019801

Ehlers V, Callaway A, Hortig W, Kasaj A, Willershausen B. Clinical parameters and aMMP-8-concentrations in gingival crevicular fluid in pregnancy gingivitis. Clin Lab. 2013;59(5-6):605-611. doi:10.7754/clin.lab.2012.120619

Favero V, Bacci C, Volpato A, Bandiera M, Favero L, Zanette G. Pregnancy and Dentistry: A Literature Review on Risk Management during Dental Surgical Procedures. Dentistry Journal. 2021; 9(4):46. doi.org/10.3390/dj9040046

Natri H, Garcia AR, Buetow KH, Trumble BC, Wilson MA. The Pregnancy Pickle: Evolved Immune Compensation Due to Pregnancy Underlies Sex Differences in Human Diseases. Trends in Genetics. 2019 July; 35  (7): 478-8.  doi.org/10.1016/j.tig.2019.04.008

Tarannum F, Faizuddin M. Effect of periodontal therapy on pregnancy outcome in women affected by periodontitis. J Periodontol. 2007;78(11):2095-2103. doi:10.1902/jop.2007.060388

Xiong X, Elkind-Hirsch KE, Vastardis S, Delarosa RL, Pridjian G, Buekens P. Periodontal disease is associated with gestational diabetes mellitus: a case-control study. J Periodontol. 2009;80(11):1742-1749. doi:10.1902/jop.2009.090250

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Because I had an epidural, I didn’t feel the tearing during delivery or the postpartum stitches my OB-GYN gave me right after. But I definitely noticed the stitches as they burned every time I went to the bathroom until they came out a few weeks later.

The uncomfortable stitches also made postpartum bowel movements pretty unbearable, although I did take warm baths as often as I could to relieve the pain. This was one of the most unpleasant parts of childbirth for me. Luckily, current research has lots to offer in terms of tips and techniques to help lower your risk of severe perineal tearing during birth.

What is a perineal tear?

The perineum is “the diamond-shaped inferior outlet of the pelvis” in a woman’s body, which is at risk of trauma and tearing during labor occurring mostly along the posterior vaginal wall toward the anus, according to a 2018 study.

In 2015, researchers found more than 85% of women having a vaginal birth will suffer some form of perineal trauma, with spontaneous tears requiring stitches occurring in at least one-third of women in the U.K. and U.S. So, if you’ve experienced tearing during childbirth, know that you are not alone.

Degrees of perineal tears

There are four degrees of perineal tears:

• First degree tear: Superficial injury to the vaginal mucosa that may involve the perineal skin.
• Second degree tear: First-degree laceration involving the vaginal mucosa and perineal body.
• Third degree tear: Second-degree laceration with the involvement of the anal sphincter.
• Fourth degree tear: Third-degree laceration involving the rectal mucosa.

As you can imagine, third- and fourth-degree perineal tears are associated with “significant pain, discomfort and impact on quality of life and intimate relationships” according to a 2020 study.

What is an episiotomy?

An episiotomy is a surgical cut of the vagina and perineum, designed to prevent serious tears during childbirth. However, performing a routine episiotomy (in which a physician gives you one as a matter of course) guarantees the mother will have perineal trauma and sutures after delivery.

Should I get an episiotomy?

There are some benefits to an episiotomy. A 2005 study found women who have never given birth are more likely to experience tearing, but a mediolateral episiotomy may help lower the risk for anal muscle tears. 

However, a 2004 study revealed that avoiding episiotomy increased the rate of intact perineum and only having minor perineal trauma, while lowering postpartum perineal pain. A 2017 study found that being more selective with episiotomies (as opposed to performing routine episiotomies) resulted in fewer women with severe perineal and vaginal trauma. These add to the growing evidence that routine episiotomies should be avoided.

Choosing whether or not to have an episiotomy should be discussed with your OB-GYN before delivery, as an episiotomy may not be necessary in most low-risk labor and deliveries. 

How to prevent perineal tears

Some of the risk factors for perineal tearing are outside your control. A 2019 study showed that a high incidence of perineal trauma was linked to maternal age, the number of babies born (parity), the induction of labor, gestational age, fundal pressure, and nationality.

A 2020 study found common risk factors for third- and fourth-degree perineal tears included carrying infants who were large for their gestational age and having interventions used during labor and birth including instrumental deliveries. Another 2020 study found instrumental delivery, midline episiotomy and a persistent occiput posterior position during childbirth were associated with more severe perineal tears. Avoiding these things as much as possible could help prevent tears.

A 2021 webinar by Evidence Based Birth lists the following risk factors for severe tears:

• Care provider
• Giving birth for the first time
• Higher birth weight of baby
• Forceps or vacuum use
• Episiotomy
• Shoulder dystocia
• Prolonged or very short pushing phase
• Occiput posterior fetal position
• Family history

There are a few specific techniques pregnant women can utilize to prevent perineal tears.

Lateral or upright birthing positions

When giving birth in the hospital, I was directed to lie flat on my back with my feet in the stirrups. However, some studies have found that different birthing positions may lower your perineal trauma.

A 2012 study found that giving birth in the lateral position (lying on your side) resulted in less perineal trauma compared to childbirth in the lithotomy position (on your back with feet in stirrups). This position also resulted in fewer episiotomies. Giving birth in the upright position (standing or squatting, kneeling upright or on hands-and-knees, and using a birth seat) was also shown to reduce episiotomy rates. 

Warm compress

Some evidence shows that applying a warm compress to the perineum area during labor may reduce third- and fourth-degree tears. Also, women who used warm packs on the perineum during labor had significantly fewer third- and fourth-degree tears, less pain during and after birth, and were less likely to have urinary incontinence, according to a 2007 study.

Perineal massage

Perineal massage during labor may reduce third- and fourth-degree tears during childbirth, according to a 2017 study. A review study of perineal massage during labor—with most women having their midwives perform perineal massages in the second stage of labor (during or between pushing time) with the index and middle fingers using a water-soluble lubricant—found a significantly lower incidence of severe perineal trauma. Adding perineal massage to your birth plan is definitely worth considering.  

Water births

Opt for a water birth to help lower your risk of perineal tearing! One study found that hospital-based deliveries with second-stage water immersion had a lower risk of perineal lacerations.

Hands-off technique

The hands-on technique for childbirth is used to control the fetal head during delivery, while the hands-off approach involves not touching the perineum during the crowning process. The hands-off technique has been shown to maintain intact perineum and reduce perineal pain and episiotomy use while not increasing the risk of severe perineal trauma, postpartum hemorrhage, or longer duration of second-stage labor compared to hands-on technique, according to a 2020 study.  

A note from Motherly

Although no amount of perineal tearing or stitches feels good, lowering your risk for severe tears can make a huge difference in your labor and recovery experience. Talk to your OB-GYN or midwife about any of these techniques to see if they are an option for your birth plan.  

Sources

Aasheim V, Nilsen ABV, Reinar LM, Lukasse M. Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database Syst Rev. 2017;6(6):CD006672. Published 2017 Jun 13. doi:10.1002/14651858.CD006672.pub3

Abedzadeh-Kalahroudi M, Talebian A, Sadat Z, Mesdaghinia E. Perineal trauma: incidence and its risk factors. J Obstet Gynaecol. 2019;39(2):206-211. doi:10.1080/01443615.2018.1476473

Aquino CI, Guida M, Saccone G, et al. Perineal massage during labor: a systematic review and meta-analysis of randomized controlled trials. J Matern Fetal Neonatal Med. 2020;33(6):1051-1063. doi:10.1080/14767058.2018.1512574

Dahlen HG, Homer CS, Cooke M, Upton AM, Nunn R, Brodrick B. Perineal outcomes and maternal comfort related to the application of perineal warm packs in the second stage of labor: a randomized controlled trial. Birth. 2007;34(4):282-290. doi:10.1111/j.1523-536X.2007.00186.x

Dannecker C, Hillemanns P, Strauss A, Hasbargen U, Hepp H, Anthuber C. Episiotomy and perineal tears presumed to be imminent: randomized controlled trial. Acta Obstetricia et Gynecologica Scandinavica. 2004;83: 364-368. doi:10.1111/j.0001-6349.2004.00366.x

Dekker R. Evidence-Based Birth. The evidence on the top 5 ways to prevent tearing during childbirth. 2021 webinar.

Foroughipour A, Firuzeh F, Ghahiri A, Norbakhsh V, Heidari T. The effect of perineal control with hands-on and hand-poised methods on perineal trauma and delivery outcome. J Res Med Sci. 2011 Aug;16(8):1040-6. 

Frohlich J, Kettle C. Perineal care. BMJ Clin Evid. 2015 Mar 10;2015:1401.

Goh R, Goh D, Ellepola H. Perineal tears – A review. Aust J Gen Pract. 2018;47(1-2):35-38. doi:10.31128/AFP-09-17-4333

Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2017;5(5):CD002006. Published 2017 May 25. doi:10.1002/14651858.CD002006.pub4

Huang J, Lu H, Zang Y, Ren L, Li C, Wang J. The effects of hands on and hands off/poised techniques on maternal outcomes: A systematic review and meta-analysis. Midwifery. 2020;87:102712. doi:10.1016/j.midw.2020.102712

Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev. 2017;2(2):CD000081. Published 2017 Feb 8. doi:10.1002/14651858.CD000081.pub3

Meyvis I, Van Rompaey B, Goormans K, et al. Maternal position and other variables: effects on perineal outcomes in 557 births. Birth. 2012;39(2):115-120. doi:10.1111/j.1523-536X.2012.00529.x

Pergialiotis V, Bellos I, Fanaki M, Vrachnis N, Doumouchtsis SK. Risk factors for severe perineal trauma during childbirth: An updated meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2020;247:94-100. doi:10.1016/j.ejogrb.2020.02.025

Poen AC, Felt-Bersma RJF, Dekker GA, Devillé W, Cuesta MA, Meuwissen SGM. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. BJOG: An International Journal of Obstetrics & Gynaecology. 1997;104: 563-566. https://doi.org/10.1111/j.1471-0528.1997.tb11533.x

Ramar CN, Grimes WR. Perineal Lacerations. StatPearls Publishing. 2021. 

Sidebottom AC, Vacquier M, Simon K, et al. Maternal and Neonatal Outcomes in Hospital-Based Deliveries With Water Immersion. Obstet Gynecol. 2020;136(4):707-715. doi:10.1097/AOG.0000000000003956

Wilson AN, Homer CSE. Third- and fourth-degree tears: A review of the current evidence for prevention and management. Aust N Z J Obstet Gynaecol. 2020;60(2):175-182. doi:10.1111/ajo.13127

It’s clear that pregnant Black women are more likely to experience poor treatment  by the medical establishment than other races. It’s why there has been a push for home births.

But due to insurance, various health needs, and differing living situations, not everyone can birth at home. So how do you have an empowering birth when you have to stay in the hospital?

These four tips can help Black women have better hospital births.

1. Educate Yourself

Don’t just assume what your insurance will and won’t cover. Look up your plan online to find out what the basic services are, as well as what doctors and hospitals are in your network, if you are not already familiar.

Although websites are usually very good at giving basic information, giving the insurance company a call and asking directly about what benefits are covered for pregnant and birthing people will let you know right away what your options are. Most insurance plans won’t cover midwives, but you may be able to have one if they work for the hospital.  

Thanks to the Affordable Care Act, many prenatal care needs are covered—but there are still things you need to check into. At the very least, you’ll want to ask your insurance company about deductibles and policy limits. Also check in about which hospitals and doctors work in your insurance network, including specialists. We all hope for healthy babies and pregnancies, but if you need additional care, you’ll need to know which doctors will be available to you.

This is also a good time to find out which OBGYN offices are in your network, if you do not already have a stable doctor, and where they have hospital privileges. Each hospital is different when it comes to the care options they offer. For example, did you know that some hospitals have birthing pools available? Some are family first and create a more home-like environment in the delivery room where siblings and partners can comfortably stay. Others are much more clinical. Some keep the baby in the room the entire time with the parent, others have a nursery.

See what’s available to you and make a choice based on what’s the most comfortable for you. You can schedule tours at most hospitals so you can see up close what they’re like, long before you give birth. Keep in mind that your insurance may not cover all of these options, or may only cover a partial amount, so keeping on top of contacting them, early and often, is the best practice.

As Black women, it’s really important to know what sort of interventions and care are available to us. Talk to your family about their medical and birthing history to learn if you have family members who had health issues or complications. If there are any health problems that can be screened for, then asking about coverage for screening and intervention during your pregnancy should be a priority. Unfortunately, we have to very proactive in our care.   

We need to be extra vigilant in educating and advocating for ourselves, says Shannon “Nola” Solomon of Doula Nola in Orlando, Florida.

“Completely understand your medical circumstances,” Shannon says. “If you have preeclampsia, you may need more intermittent monitoring and be on a ‘countdown.’ Know how you handle certain medications. If you get nauseous when you get pain meds, if they offer you morphine it’s not a good option for you.”

Also understand your rights as a patient, and have a plan in mind for how you’d want any potential emergencies to be handled—Babble has a helpful guide to get you started.

For the full story visit mater mea by clicking here.

This piece is part of mater mea’s Empowered Birth series, highlighting ways Black women can have birth experiences that leave them and their families feeling safe and respected. Click here for more stories.

This story by Donyae Coles first appeared on mater mea.

Weighing in at just a little more than a pound, it is a marvel to see. It has two distinct surfaces—the spongy, blood-soaked side that was attached to your uterine wall before delivery, and the smooth and shiny vascular side from which the remarkably firm but pliant umbilical cord sprouts, attached to your baby.

You may have found yourself wondering, What in the world? It’s so big! (And bloody!) 

Emerging from you, and definitely not looking like a baby, your first inclination might have been to think, Wow, something else I made! And even though you did indeed carry this amazing other “being” in your womb for ten months, you would be incorrect in thinking it came from you. 

The placenta is your baby’s organ

The first organ to develop after conception, the placenta is a product of your baby—not you, mama. 

At conception, your baby began life as a single cell slightly smaller than the period at the end of this sentence. During the very first cell divisions, some cells formed the embryo, and others  formed the placenta. The resulting ball of cells containing placental cells and embryonic cells all had one common origin before they implanted into your womb—your baby’s genes.

Not only is it amazing to realize that the placenta is actually part of your baby, to think about what it was tasked with to ensure your baby developed in order to thrive after they were born is equally as mind-blowing. 

How does the placenta form?

The placenta develops quickly because it has to do the jobs of other developing organs until they become fully functional. Less than a week after conception, specialized cells on the surface of the embryo produce hormones that alert your body to the presence of your baby and allow it to burrow into your uterine wall, kicking off a cascade of events resulting in branches of capillaries from your baby intermingling with your own arterial blood supply. Two or three weeks later, those branches began to fill with support cells and blood vessels. 

By the time you realized you were pregnant, the mature configuration of these structures, now known as chorionic villi, was established and ready to go to work. Your blood flow to the placenta began around 12 weeks after conception, at a rate of about 16 ounces (half a litre) every minute. And over the course of ten months, the placenta develops a vascular network over 300 miles (500 km) in length!

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What does the placenta do?

The placenta is your baby’s life-support system before birth, whose principal function is to supply them, and their brain in particular, with oxygen and nutrients. 

According to Dr. Yoel Sadovsky, leading placental researcher and director of Magee-Womens Research Institute (MWRI) in Pittsburgh, “the placenta serves as the lung, the kidneys, the liver, the endocrine system… and is essential for immune defense of the baby.”

The placenta serves several functions:

• Like the liver, it metabolizes nutrients
• Like the lungs, it exchanges oxygen for carbon dioxide
• Like the kidneys, it excretes waste
• Like the gut, it generates energy
• Like the endocrine system, it produces hormones
• Like the immune system, it defends against infections and rejection

The placenta could be viewed genetically as your baby’s twin, since both arose from a single fertilized human egg and have identical genes. As a matter of fact, some cultures treat the placenta as the dead twin of the baby, giving this “tree of life” full burial rites.

Even though it may be the “afterbirth,” the placenta certainly is not an afterthought.

This magnificent and humble organ not only is key to establishing life inside your womb, but also in ensuring that life outside your womb will be possible for your baby. It’s no wonder the National Institute of Child Health and Human Development (NICHD) established The Human Placenta Project to bring together scientists and engineers from all over the world to further understand the “mystery, miracle and science of the placenta.”

Sources:

Burton G, Fowden A. The placenta: a multifaceted, transient organ. Philosophical Transactions of the Royal Society B: Biological Sciences, 2015 March; 370(1663). doi:10.1098/rstb.2014.0066

Young SM, Benyshek DC. In search of human placentophagy: a cross-cultural survey of human placenta consumption, disposal practices, and cultural beliefs. Ecol Food Nutr. 2010 Nov-Dec;49(6):467-84. doi: 10.1080/03670244.2010.524106. PMID: 21888574.

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Here’s the thing, mama: You’ve got this—and we’ve got you. By taking a few of those little details off your to-do list (like definitely check out these food subscription boxes and start adding to your cart STAT), you can clear up some mental space and instead, focus on anticipating that wonderful moment when you’ll meet your baby. 

Related: Your birth plan worksheet: The Motherly Guide to Becoming Mama

While there is only so much you can do ahead of time, one of the best tasks to cross off your list early in the third trimester is packing up a hospital bag. Trust us, the moment you start feeling contractions is not when you want to toss together the bag in a rush. 

When packing your hospital bag to give birth, you shouldn’t have much of a problem with remembering the essentials… Comfy robe? Check. Baby’s going home outfit? Check. Swaddling blankets? Check. Phone charger? Check. Makeup and hair care products? Check. (And before you pack, don’t forget—there are a few hospital supplies you’ll probably score at the hospital itself!)

But what else should you bring? Well, among the Motherly team, there have been plenty of hospital bags packed.

Here’s what we wish we would have remembered to include in our hospital bag:

1. Thank You cards

After delivery, your top priorities should be resting and bonding with your baby. But, if you have a moment (and you almost certainly will), this is a great opportunity to write thank-you notes to the doctor, nurses and support staff who have helped during labor, delivery and recovery.

MyExpressionInvites

• $12.95

Watercolor Elephant Thank You Cards

Adorned with a soft and lovely watercolor painting of an elephant, these adorable cards are the perfect fit to thank anyone who has helped you on your journey to motherhood.

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marrygrams

• $5.50

Thank You Notes for Medical Staff

This option already has pretty fitting wording for thanking the medical staff who saw you through your labor, but you can also choose to personalize your order too.

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GMEPaper

• $20

Baby Footprint Thank You Notes

Simple and sweet, these baby footprint thank you notes are a fitting choice to show your appreciation to anyone who has been by your side through this journey. Customizable by color and name, these can double as baby shower thank you notes, making them a sensible and easy choice.

SHOP

2. Nourishing snacks

We all know hospital food is, well, less than amazing. Prepare yourself by stocking up your bag with some nourishing, delicious snacks to help fuel you after welcoming your baby. We’re partial to Nunona’s whole food, plant-based bites that can help boost your milk supply.

Nunona

• $36.99

Nourishing Mama Balls

Make sure you toss some of these delicious, nutrient-packed snacks from Nunona into your hospital bag. Your body will thank you as you give it good, healthy fuel to feel stronger during these first few days postpartum.

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Tejari and Co.

• $10

Plant-based Super-food Protein

Plan ahead and grab some of these super-healthy sachets full of plant-based super-food proteins. Tejari and Co. has all the recipes you’ll need to pre-make muffins, cookies, breads, or any other delicious snacks you might crave from the hospital room.

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Verb

Caffeinated Energy Bars

All-natural energy-boosting bars from Verb are a must for your hospital bag. They’ve got a ton of tempting flavors that you can mix and match, including cookie butter, s’mores, and hot fudge sundae. The texture is soft and crunchy so they satisfy in a real food kind of way with the addition of caffeine from green tea to put some pep in your step.

SHOP

Related: The best foods to support your postpartum recovery

3. Postnatal supplements

Just like how prenatal vitamins support your body and your baby’s development during pregnancy, specially formulated postnatal supplements can also help—starting after your baby’s arrival. By adding these to your hospital bag, you’ll get the vitamins and minerals needed to replenish your body after the incredible feat of bringing a baby into the world.

Ritual

• $35

Essential Postnatal

Ritual’s postnatal is formulated to include key nutrients for moms postpartum with added support for lactation. Each capsule is packed with 15 traceable ingredients—including vitamins A, D, C, E, B12, zinc, magnesium, and iron, among others—all of which will help keep Mom healthy during this exciting, but often very challenging time in her life.

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Perelel

• $49.50

Mom Multi Support Pack

This mom multi support pack from Perelel is a must for your hospital bag as it will provide all sorts of vitamins you’ll need—including collagen, an anti-stress blend, an omega DHA + EPA blend to help with brain development and mood support, and a beauty capsule for hair, skin, and nail health.

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4. Compression socks

For many mamas, one not-so-joyous part of the postpartum experience is continued swelling in the lower legs and feet. (This is especially common if you have a cesarean section or get IV fluids.) An upgrade over regular socks, compression socks will help minimize discomfort from swelling.

Pear

• $65

3-pack "Be Kind" Compression Socks

Made without AZO dyes, formaldehyde, phthalates, or other harmful chemicals, Pear’s compression socks are also anti-odor and moisture-wicking for optimal comfort and improved circulation.

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Bombas

• $84

Women's Everyday Compression Sock 3-Pack

Bombas makes it their mission to help you feel more comfortable, and to help others in need. For every pair of socks purchased, Bombas donates a pair of socks to a homeless shelter, as they know that socks are the #1 most requested clothing item. Making this purchase will make your legs feel better, and you’ll be helping someone in need as well.

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Aoliks

• $22.99

Compression Socks

This option is friendlier to your bank account and provides endless choices of colors and patterns so you can really pick a style that works for you (while increasing circulation and reducing discomfort in your legs). Who said compression socks weren’t cute and trendy? We sure didn’t.

SHOP

5. Earbuds

It’s crucial that throughout your hospital stay—through labor, delivery, and recovery, that you try to rest your mind and body. One way to do that is to listen to sounds that soothe and relax you, whether that means playing “Midnights” by Taylor Swift on a continuous loop, or binge-ing a murder-mystery podcast. Just make sure to bring some earbuds to help you decompress a bit and take a few moments for yourself.

Apple

• $89.99

2nd Generation AirPods

There are endless options out there for earbuds and the Apple AirPods are just one of them, but they do tend to be among the most popular. This set of 2nd Gen AirPods isn’t the latest Apple product to hit the market, but they’ll work just fine (and you’ll rest easier knowing you didn’t drop hundreds of dollars on something that will likely get covered in spit up).

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Heydey

• $49.99

Bluetooth Wireless Earbuds

Also, no need at this point to drop a ton of cash on noise-canceling earbuds because you’ll want to make sure you can hear baby’s coos and cries. This affordable option from Heyday by Target is a great choice to ensure you can listen to your Adele, or your Beyonce, or your favorite audio book and practice a little self-care while also being the fab mom that you are.

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6. Hand lotion

Whether it’s because you’ve been frantically washing your hands 900 times a day to keep germs off baby, or because the cold, sterile hospital air is doing a number on your cracked knuckles, or you just want to spoil yourself for 30 seconds of self-care and nourish your skin with the glorious gift of hydration, lotion is a must for your few days at the hospital as you get ready and then recover from having a baby.

fresh

• $20

Milk Hydrating Hand Cream

Milk Hand Cream is a popular choice due to its creamy, non-greasy, light-weight feel and an ingredient list that includes glycerine, squalane, and jojoba as well as multiple soothing plant-based milk products. (And pssst! They have an amazing body lotion too!)

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alo

• $20

Restorative Hand Cream

Vegan and cruelty-free, this hand cream by alo also has squalane, as well as shea butter and skin-soothing arnica to nourish your skin. Free of parabens, phthalates, and artificial colors and dyes, this choice will give your hard-working hands the soft, natural hydration they need.

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Gold Bond

• $3.99

Ultimate Healing Hand Cream

Looking for a classic brand that’s been around since our moms were having us in the hospital? And that’s super affordable? Gold Bond has stood the test of time as one of the best hand creams out there and it’s easy to see why. It works. Grab a tube (or, at this price, a few tubes) and toss them into that bag for some quick and easy skin relief.

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7. Chapstick

Whether you’re a mom who brings her full makeup bag or you toss the bare essentials in a tote and roll out, don’t forget the basics that are key to your comfort—like your favorite chapstick. It’s those comforts from home that you’re used to—like a balm to moisten your dry lips—that will help you be your best self at such a pivotal time in your life.

Burts Bees

• $11.99

Superfruit Lip Balm 4-pack

Sometimes, you just go with a tried-and-true classic that you know works. Burts Bees is one such product. You can do the more traditional route with their standard beeswax lip balm, or switch it up and try their Superfruit Lip Balm 4-pack. But either way, you’re getting the famous, natural, cruelty-free Burts Bees lip balm we’ve all loved for decades.

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Vaseline

• $3.49

Rose Lip Balm

Another brand our moms and grandmas swore by—because it works—is Vaseline. This cute pink tin is basically just that. It’s a Vaseline lip balm with a tint to make lips a little more rosy, but it’s the same Vaseline hydration we grew up with that still works wonders for dry skin.

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Dior

• $38

Dior Addict Lip Sugar Scrub

How about a little sugar for Mom after she’s delivered another human into the world? She definitely deserves it! This lip sugar scrub exfoliates your lips with grains of sugar and leaves them soft, glossy, and with a natural pink glow. Perfect for when you want a little glamour as you take your first “Mommy and Me” selfie.

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Whether you’re expecting in months or mere days, let Motherly guide you with our registry featuring curated collections of essentials for you and baby. Click here to check out Motherly’s essential registry guide. 

A version of this article was published November 24, 2021. It has been updated.

While it looks different for everyone, there are a few early signs of labor to look out for. As I share in The Motherly Guide to Becoming Mama, “Remember that you do not have to figure out on your own if you’re in labor. Your provider has a way for you to reach them at any time, so they can help guide you through this: when to leave for your birthing place, if applicable, and what to do to best take care of yourself and your baby in the meantime.”

We also cover signs that labor is approaching in The Motherly Birth Class, an online class that may be covered by your health insurance plan or HSA/FSA benefits.

$25

The Motherly Birth Class

Support for the entire birth experience, from preparation to postpartum.

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As for you how are feeling right now: Never hesitate to reach out to your provider if you’re unsure—yes, even at 2 am, and especially if you are earlier than 37 weeks pregnant, which could mean you’re experiencing preterm labor.

What are the early signs of labor?

Here are the 5 most common early signs of labor you might be curious about.

1. Is nesting an early sign of labor?

In the days or hours leading up to labor, some may get a serious boost of energy. Just like a mama bird getting her nest ready for her hatchlings, you may find yourself busy getting things ready for your little chickadee. Remember to schedule in plenty of rest, fluids and snacks so you have energy for birth. And be careful, no climbing ladders to dust the top of the ceiling fan, please.

2. Is losing your mucus plug an early sign of labor?

During pregnancy, a small glob of mucus sits in your cervix to help protect the baby from bacteria. As your cervix starts to get softer in preparation for labor, the mucus plug may fall out (it looks like when you blow your nose when you have a cold).

Some women lose their mucus plug weeks before they give birth, while others only lose it when they are actively in labor—so while it’s not a tell-tale sign that your baby is coming soon, it is a good sign that things are at least moving in the right direction. This early sign of labor is sometimes called the “bloody show” because it can have a streak of blood in it. It’s most likely totally normal, but never hesitate to call your provider if you need to be reassured! And if you see more than a teaspoon worth of blood, call.

Related: Try these 4 yoga poses to induce labor—safely

3. Is diarrhea an early sign of labor?

A hormone called prostaglandin is released in your body as it prepares to go into labor. Prostaglandin helps to make your cervix softer and looser (so it can dilate), but it also makes your bowels looser—in other words, you might have diarrhea, and/or more frequent trips to the bathroom. Make sure to stay hydrated by drinking plenty of water and juice.

4. Will your water break in early labor?

We’ve all seen the movies where a woman is minding her own business when suddenly her water breaks, and the entire world seemingly grinds to a halt. While it is a REALLY exciting moment, it’s usually not that dramatic. In fact, only about 10% experience their water breaking before labor starts—it usually breaks during labor.

When your water breaks, it may be a big gush of fluid or it may be a small but steady trickle. If your water breaks at home call your doctor or midwife to give them a heads up and discuss the plan. Then, remember TACO:

• Time: What time did your water break?
• Amount: How much fluid came out?
• Color: Ideally it will be clear. If it’s green or brown, call your provider right away
• Odor: Amniotic fluid does not have much of a smell to it. Anything yucky smelling could indicate a problem, so again, call your provider

Note: It’s super rare, but occasionally an emergency called a prolapsed cord can occur. If your water breaks and you think you feel the umbilical cord in your vagina, get in an elbows-and-knees position and call 911 right away.

5. Cramping & contractions in early labor

Ultimately, labor is about contractions—your uterus is a big (awesome) muscle that contracts to help dilate the cervix, and ease the baby down and out.

Early labor is when your cervix dilates from zero to six centimeters

Early labor is usually the longest part of labor, especially for first-time births. It often starts with mild contractions that feel a lot like menstrual cramps. They’ll probably be irregular (anywhere from 5 to 30 minutes apart, and short (about 45 seconds). Contractions will gradually become more frequent, longer and more intense. Many women describe a tightening sensation that starts in their lower back and moves towards their belly.

When you start to have contractions that aren’t going away, call your provider to give them a heads up. There is a good chance they’ll encourage you to stay home during early labor. You’ll be more comfortable there, and your risk of medical interventions decreases by staying home longer.

In active labor, your cervix will dilate from six to eight centimeters

During active labor, contractions are more regular (about every three to four minutes), last longer (about 60 seconds), and are much more intense—they now require all of your attention, and can cause a fair amount of discomfort. Many describe a downward pressure, along with some degree of pain, but this varies for everyone!

You’ll likely head to your birthing place during active labor.

If you’re in active labor, the general rule is 4-1-1.

You’re in active labor when contractions are four minutes apart, lasting one minute each, and this has been going on for one hour. But again, call your provider so they can help with the plan.

And then… well then you become a mama.

Related: Experts share 6 tips on how to prepare for your first birth

A version of this story was originally published on Oct. 18, 2021. It has been updated.