For first time mom’s the signs and symptoms are actually pretty specific (having said that, many women will report being ‘unsure’ if they were in real labor.) To help you avoid being in that pregnant and confused category, here are some the key things for you and your partner to watch for:

• Mucous plug: this is often an actual event for first- timers. It is a few tablespoons of egg white looking mucous that is streaked with pinkish, brownish blood. It has been acting like a cork throughout the pregnancy, and “comes out” anywhere from hours to days before labor begins. It could be a plop into the toilet bowl or surprise in your panties. It is useful in that it is a sign that labor is brewing; that you have a matter of hours to a matter of days before labor begins.
• Amniotic Sac: The bag of waters can break spontaneously in 2 ways; either a high leak that creates a trickle of fluid or a low break that results in Niagara Falls! If you are having a trickle or increasing dampness that requires a light days pad-be suspicious, your water may have broken. If you have a gush of fluid, your water has broken. In both cases, you need to call your OB/Midwife/Hospital to get your next set of instructions. They may have you stay home for a bit OR they may want you to come in to be evaluated.
• Contractions: Uterine contractions (an internal tightening, pelvic pressure and the entire abdomen gets hard) that come in a regular pattern are the surest sign that labor is starting. The difficulty that most people have is distinguishing between ‘practice’ Braxton-hicks contractions and real labor contractions. The words I use to help determine false from real labor are: STRONGER, LONGER, CLOSER. Contractions that get stronger, last longer and get closer together over time indicate true labor. This is in contrast to false labor, when contractions are short, irregular and intermittent.
• Who do we call? At your next prenatal visit ask them who do you notify when you are in labor, the water has broken or you think it’s time to GO! This answer varies on your doctor and hospital, so ask ahead of time and have their number clearly posted on the frig

Kick counts: In labor at home, you will want to continue doing kick counts (one way to check in on your baby’s well-being from home) once an hour. You are looking for an average of 5 fetal movements in an hour; many babies will move 15 times in the first 5 minutes! The point is that after you get 5 distinct movements, you can stop counting. After you are admitted to the hospital, the healthcare team will take over monitoring the baby.

If you have any questions/concerns while home in early labor-CALL! Much better to check in with your OB/Midwife or the labor and delivery unit, than to stay home worried or unsure about what is going on…pay attention to your instincts!

This is so important, you have no idea! In sharp contrast to what so many prenatal education classes would have you think-the healthcare team has the same goals you do: Healthy Mom/ Healthy Baby! They are not out to control or take over your birth; they are the people who can help you achieve the kind of birth you desire.

Unfortunately so many expectant parents are taught that the doctors and nurses have some kind of hidden agenda, that their support is qualified and that they are just trying to get you in and out the door as quickly as possible…in the vast majority of cases, this is not the case.
Is there a bad apple in the batch from time to time? Yes. Can I guarantee that every labor will be assisted by a passionate and committed and highly trained healthcare provider? No. I can tell you that most of the time in hospitals across the country; the medical team provides the best care possible.

The following tips will help build a firm base for you to spring from in labor and delivery:

• Prenatal Conversations: Spend a minimum of 5 minutes each day, beginning at 36 weeks (at least) discussing concerns, priorities, coping strategies and pain; if you have a cesarean birth, will the partner stay in the operating room or go with the baby to the nursery etc. etc. Jot some of the most important key points down and take them with you to the hospital (in lieu of a formal, lengthy birth plan.)
• Introductions: When you arrive at the hospital in labor, partners, introduce yourselves to your labor nurse. Let her in on the goals that you have identified (goals not plans-!) Let her know of any pregnancy history or special concerns, like: “my sister had a nightmare birth a few years ago; I am still terrified from just hearing about it.” Or “I am really focused on avoiding an episiotomy; will you help me with that?” Communicating things about yourselves that will help her meet your goals.
• Flexibility: The medical team wants to know that you have reasonable expectations of yourselves, your bodies and of them! When you are communicating with a voice of reason and making decisions along the way as labor unfolds, they are able to work with you in more of a team capacity. The difficulty arises when couples have rigid expectations and have made plans about the way labor will go-this can set up a defensive environment that becomes more about combat then birth…
• Hospital: Keep in mind that you are not checking into a hotel. This is a place where lives are being saved, while babies are being born! The personnel do their very best to meet needs efficiently and effectively as possible; there may be times when you need to wait your turn while they are prioritizing their care.

When you think about it, we humans make noise in response to pain…the last time you were hanging pictures in your living room, and accidentally hit your thumb with the hammer, did you respond with a breathy “he-he-hoo-hoo?” I don’t think so. You uttered a few choice words, and made a loud “aghhhhh!” sound. Which is exactly why McMoyler Method recommends moaning in response to labor pain; patterning what we do in response to other kinds of pain in our lives.

Does moaning take the pain away? No. It does, however, give the brain something to do in response to the pain. Left with no clue how to respond, women will often end up screaming, which can trigger the Fear/Tension/Pain response. Grantley Dick Read is credited with this cycle of events in labor: she becomes fearful of the pain, which increases the tension in her body which increases the perception of her pain. Allowed to continue on this cycle, she is likely to whirl into something that looks like panic. Panic looks and feels like out of control-which is often an expectant woman’s biggest concern.

Expectant parents can practice the moaning response; start by humming, you will notice a reverberation in your chest, now allow your jaw to unhinge, so that your mouth is slightly open, now when you hum, it comes out as a soft moan.…

Moaning is a natural phenomenon. Think about the morning after the New Years Eve party, when you sat in the privacy of your bathroom with the NY Times for half an hour. Or the Mexican vacation that ended up with Montezuma’s revenge-these were not necessarily silent situations; they are often accompanied by a moaning of sorts, which is the body’s response to discomfort or pain.

To doula or not to doula…that is the question.

I have been inundated recently with email from doula’s who are, for the most part, up in arms about the McMoyler Method stance on labor doulas. For those that don’t know, a “doula” is someone hired by expectant parents to accompany them to the hospital to provide emotional support.

For the record, I have worked with many doulas in labor an delivery and think that there are some very good ones; there are also those that have stepped over the line, to the point of actually interfering with the health care team whose legal responsibility it is to insure the health and safety of their patients…this is going to far, and is unfortunate.

McMoyler Method advocates partner support in combination with the care from the health care tem in the hospital. Some may want to bring a dear friend or family member for additional support, otherwise, I recommend saving the investment on doula support for post-partum, when you really need the extra help at home. (For those that continue wanting to hire a doula for labor support, I suggest asking the OB/Midwife for name of people they recommend.)

Doulas have a passion for birth, and a genuine interest in contributing to the birth process, this I do not doubt. On the other hand, doulas are typically not healthcare professionals, without a license and no credential. So when they start practicing medicine within a hospital setting, it becomes concerning…

Thanks to my book and DVD/Webcast: The Best Birth, my views are now much more public. Based on my experience, I say that a woman in labor, accompanied by a motivated partner, receiving guidance from a team of healthcare professionals, will accomplish their goal of a safe, healthy and satisfying labor and delivery.