What to Expect

You have been counting down to your baby’s arrival for months. The time is near. And while it’s OK to be nervous, knowing what to expect and being prepared can make your delivery experience go more smoothly.

“Most healthy women will have healthy pregnancies with labor at full term. In the weeks leading up to the due date, we will discuss certain signs of labor that might tell a woman it’s the real thing,” explains Jessica W. Kiley, MD, obstetrician and gynecologist at Northwestern Memorial Hospital.

Here’s a checklist of things to do as you prepare to finally meet your little one.

1. Have your gear ready.

Several weeks before your due date, you should have your hospital bag packed. Items to include:

• Robe, slippers, socks, nursing tops and comfortable clothes to wear home
• An extra set of clothes in case baby spits up on you
• Weather-appropriate clothes and receiving blanket for the baby to wear home
• Personal toiletries
• A written copy of your birth plan and breathing tips from birthing class if you have one

You may also consider bringing comforts from home, such as a body pillow, personal speakers or essential oils. You should also install your baby’s car seat ahead of time, as you won’t be able to leave the hospital without one properly installed in your car. And, of course, have your nursery set up at home with a crib, changing table, diapers and other necessities for your baby.

2. Know the first signs of labor.

“Some women will have a slow build-up of minor aches or cramps, much like menstrual cramps,” explains Dr. Kiley. “For many, it’s a slow, gradual process, with irregular and infrequent contractions hours or days prior to labor.”

Some may experience the fluid-filled amniotic sac surrounding the baby rupturing, commonly referred to as having your “water break.” If your water breaks, you could experience a continuous trickle of fluid or a more obvious gush of liquid. However, this only occurs in a small percentage of women, and does not necessarily mean you are in labor. If your water breaks before contractions begin, your physician may need to induce labor.

“The water might break before the onset of contractions, or they may come first,” says Dr. Kiley. “A simple guideline is that you’re in active labor if you’re feeling painful contractions 5 minutes apart in a regular, consistent pattern that lasts more than an hour.”

3. Know what a labor contraction feels like.

If this is your first little one, you may not know what to expect. Contractions are the gradual tightening of the uterus. Dr. Kiley explains, “It feels like a slow, gradual squeeze, almost shaped like a hill. Imagine at the peak of the hill, it hurts and can be difficult to talk through.” The feeling tends to take your breath away.

4. Recognize a false alarm.

Braxton Hicks contractions can occur any time throughout pregnancy, and while uncomfortable, they are not painful. “It a hardening of the belly, but not as significant as the tight squeeze,” explains Dr. Kiley. Braxton Hicks contractions can frequently occur in the last few weeks of your pregnancy. Braxton Hicks are contractions that:

• Aren’t regular or strong
• Often go away when you walk, lie down or change position
• Often go away after drinking fluids

Dehydration can trigger these contractions, so be sure you’re drinking plenty of water. To alleviate any discomfort, try gentle breathing or taking a warm bath.

5. Know when it’s time to go to the hospital.

Latent labor is a very unpredictable phase. For some, it is a short interval, and for others, it can be very prolonged. Whenever possible, it's best to do the early phase of labor at home where you are most comfortable.

While you are at home, try these tips for staying comfortable:

• Rest and stay in bed until it is no longer comfortable.
• Walk or take a warm shower or bath. If you believe your water has broken, you’ll still experience leaking after standing up. Call your physician if you suspect your water has broken.
• Use a warm — not hot — heating pad on your lower abdomen or back.
• Stay hydrated. On average, you should aim for drinking 8 to 10 glasses of water per day.
• Eat foods that can be easily digested, such as soups, fruit or yogurt.

Dr. Kiley suggests paying attention to the regular patterns and timing of contractions as a sign of active labor. Talk to your provider about how close together your contractions should be when you go to the hospital.

6. Recognize red flags.

Your care team is here to support you. Whether in labor or at any time during your pregnancy, call your healthcare provider or clinic right away if you notice any of these signs:

• Fluid from your vagina, with or without contractions
• Bleeding heavy enough that you need a sanitary pad
• Decreased movement by your baby
• Severe pelvic pain or persistent pain in your abdomen or back
• Fever at or above 100.4 degrees F
• Sudden onset of vision changes (blurring, double vision, seeing spots)
• Persistent nausea or vomiting more than three times daily or inability to tolerate food or liquids for two days
• Inability to have a bowel movement after three to four days, especially if accompanied with severe pelvic pain
• Pain or difficulty urinating, especially if accompanied by blood in the urine or a scant amount of urine output for the day
• Fainting episodes or persistent dizziness
7. Understand that sometimes inducing labor is necessary.

If you are experiencing uncontrolled hypertension, preeclampsia, diabetes or signs of inadequate growth of the baby, your physician may recommend labor induction. Labor can be induced by stimulating uterine contractions, either through intravenous medication or alternative methods.

“Elective induction of labor in the week prior to the due date is becoming more common based on recent research, which demonstrates some benefit,” says Dr. Kiley. “It can be considered on a case-by-case basis and should involve a thorough conversation between the woman and physician.”

8. Plan for pain relief.

Once you are in active labor, you may opt to have pain medicine administered. The most common pain management method is an epidural catheter, which allows a regional anesthetic to be injected into the epidural space in the spinal column.

Epidurals are a common form of pain control during labor. Long thought to be available only during a certain window of time, an epidural can be placed at virtually any time during labor. While it can slow down labor progression, it won’t stop your contractions from occurring, and it won’t increase the chance of needing a cesarean section (C-section). An epidural can cause some numbness in the legs, but this is normal and will resolve after the epidural is discontinued.

Other pain relief options are also available. Your care team will work with you to see what is right for you and your needs.

9. Have a plan — but be flexible.

Establishing a birth plan is a great way to share your birthing preferences. A birth plan is usually a one- or two-page statement of your preferences and can include details such as:

• Where you’ll be giving birth
• What environment you’d like to have
• Who you would like in the room
• What pain control techniques you wish you employ
• Whether you want your partner to cut the umbilical cord
• Your preference for skin-to-skin contact immediately after birth

“Birth plans have become very common. Some will be very detailed and specify unique desires, but a vast majority describe things we already do,” says Dr Kiley.

And while it’s good to have a plan, remember to be flexible, too. “In some cases, an issue arises that requires a change in the birth plan, or the OB may offer a different treatment option,” explains Dr. Kiley. Ultimately, plans will be discussed with your care team in order to ensure the safety of both you and your child before, during and after birth.

10. Know you have a team on your side.

“The labor and delivery and postpartum units are comprised of a large team of dedicated individuals,” says Dr. Kiley. In addition to your OB/GYN or midwife, you will likely encounter an anesthesiology team, and a host of individuals there to support you throughout your birthing experience and the early hours and days of motherhood. Lactation consultants and breastfeeding counselors will be available to support and guide you. Your nurse can explain how to take care of your baby’s needs. The pediatrician will monitor your baby’s health.

“It’s a privilege to be a part of this process for women and their families. It’s our job to provide support, and we like to be reassuring,” says Dr. Kiley. “It’s fun to be closely involved in this exciting event in a woman’s life.”