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The Real Scoop on Labor

The two most common questions women have about labor are, when will it start? and, how much will it hurt? The answer to both: Who knows? Fortunately, there are plenty of answers to other questions we all have but are afraid to ask because they seem silly, scary, or downright gross. "There's an awful lot about childbirth that is, shall we say, visually unfriendly," says Margaret Buxton, M.S.N, C.N.M., a certified nurse-midwife with the Vanderbilt University School of Nursing in Nashville, Tennessee, and a mother of two little girls. From placentas to mucous plugs to bodily fluids galore, here's what you always wanted to know about childbirth but were too mortified to mention.

Q What if my water breaks in public?

A. First off, only about one in four women experience their water breaking prior to the onset of labor, notes Buxton. And if you suspect that you're in labor, you probably won't be heading out to get your hair cut or browse for antiques. Even if your water does break unexpectedly, your amniotic fluid is more likely to leak out slowly than to gush down your legs like a raging river. (Often, the baby's head will act as a "cork.") Meanwhile, it's not like people are going to think you peed in your pants. What's actually happening will be obvious to even casual observers, and they'll probably fall over themselves trying to help. Take all the sympathy you can get, because in a few short hours your baby will begin to show you no mercy, and that won't abate for the next 18 years, if ever. You can also greatly ease your anxiety by keeping a change of clothes in the trunk of your car or in your office. One caveat: If your water does break in public, call your health care provider. Since the risk of infection increases once the protective amniotic sac is broken, your provider will want to discuss when you should be admitted to the hospital or birth center.

Q. I keep hearing about this mucous-plug thing and it sounds totally gross. When exactly is it likely to fall out, and will it clog up my toilet or what?

A. We cannot tell a lie: The mucous plug isn't pretty. It's basically a gelatinous glob that seals off the opening of your uterus (think of a cork in a wine bottle). You can lose the plug -- a thick vaginal discharge of mucus, sometimes tinged with blood -- all at once or in pieces. If you do lose your plug all at once, it's not going to be any worse than a menstrual clot, says Kate Abello, M.D., an obstetrician-gynecologist in private practice in Baltimore, Maryland. Wear a pad or panty liner and be alert for other signs of labor, which may begin soon after or still be weeks away. Note that the mucous plug is different from "bloody show" -- a vaginal discharge of stringy mucus streaked with blood that precedes labor by a day or two.

Q. Women in my family tend to have fast labors. I'm terrified mine will begin at work and I'll have to deliver in front of my coworkers and male boss.

A. The short answer to this worry is to take an earlier maternity leave; if you're not in the office, it can't happen. You sure as heck aren't going to feel like being there the last week or two and will probably have lost so many brain cells you won't be that useful anyway. Seriously, though, discuss your family history with your health care provider. "Fast labors can indeed be a hereditary thing, and your doctor will want to be more vigilant about checking your cervix for dilation," notes Dr. Abello. "Then we can make sure you're in a safe place for delivery if we see signs of quick progress." If you would like to work up until your due date, pay superclose attention to subtle signs of labor (backache and cramping are not just backache and cramping at this point!), and make a quick exit on days you just "don't feel right." You can also ask your boss if it would be possible for you to work from home during your final stretch. Worst case scenario, if you do go into labor at work, insist that your colleagues clear out an office and call 911, so some cute firefighter or paramedic who you never have to see again can do the honors.

The placenta, family invitations, and fainting husbands

Q. Someone told me the placenta looks like a big kidney. Is this true? Because if so, I'm telling my doctor to keep it to himself.

A. Well, the placenta can look that way, and frankly, you'll be lucky if yours does. "A big, red, beefy placenta that looks a lot like organ meat is exactly what we hope for," Buxton says. "A tiny, shriveled placenta may mean you didn't take care of yourself or that your baby may not have gotten the nutrients and oxygen she needed." Of course, once your baby is born you will be so ecstatic and involved with her that you will barely be aware of the staff going about their business, known as the third stage of labor (the easy part, to you). Meanwhile, your health care provider will quietly inspect the placenta to make sure it's normal and healthy and intact, but by then you'll be tallying up your little one's Apgar score and cooing about her already obvious brilliance.

Q. I was hoping to invite some family members to be with me at the birth, but now I'm getting worried I'll lose control and start screaming at everyone.

A. It's the stuff of many a movie or TV show: Mom on the delivery table cursing out her husband for getting her into this mess. If you've ever been in a hospital maternity unit, you certainly may have heard a few screams. Still, you're not likely to morph into a totally different personality, says Trish Booth, a former childbirth educator and doula in Manlius, New York, and the author of Pregnancy Q&A: Authoritative and Reassuring Answers to the Questions on Your Mind. "You do not become someone else in labor -- it's an intensification of who you already are," she explains. "If you turn inward and get quiet under stress, that's what you'll do in labor. If you yell and scream normally, then you may during childbirth too."

Q. Is it true -- do women really end up pooping when they push the baby out?

A. There's a very good reason they tell you pushing the baby out feels like a bowel movement -- you're probably having one of those too. "The vagina and rectum are parallel, so when the baby's head begins to crown, anything in the rectum gets expelled as well," explains Buxton. "It's just physics. Women get upset because it's a private thing, but like vomiting, it's no surprise to anyone who works in a labor room. We just discreetly clean it up and move on." And rest assured that no one is going to allow your baby to land in poop -- this event happens in the early stages of pushing, not when the baby comes out.

Q. My husband fainted at my last birth -- he said all the blood was too scary looking. I'm not squeamish, however, and would like to try to watch the birth in the hospital mirror this time around. Do I dare -- and what do I do about him?

A. We love dads -- we wouldn't be procreating without them, after all -- but not all men are created equal when it comes to delivery-room support. Research shows that men fear losing their partner more than anything else about childbirth, explains Booth. Labor can be frightening for them to watch, and when it comes to medical decisions, "many dads will defer to anyone in scrubs," she says. Chances are your partner will hold up better the second time around -- just like you, he has some idea of what to expect -- but don't force a 360-degree view on him if he seems wary of the idea. The beauty of the delivery-room mirror is that it is easily adjustable. Your health care provider can angle it so that you can see what's going on while Dad averts his eyes. And if you change your mind, it can be quickly rotated so you don't have to watch either. Actually, the reverse often happens: "Watching your own progress can be a good motivational tool," says Buxton. "Moms get inspired to push harder when they see the head coming. And dads who come into the delivery room insisting they don't want to see any blood may totally change their tune and become fascinated if the caregivers explain what's happening. The next thing you know, Dad's putting on gloves and catching the baby."

Waxing necessities and the truth about episiotomies

Q. A few of my friends got a full-monty wax job before they delivered. I can't imagine that, even if I weren't pregnant. Is it really necessary?

A. There is a trend toward vaginal shaving and waxing among women, especially younger ones, in our society in general, but it's hardly something you need to do if you're not inclined, assures Buxton. In the more primitive days of childbirth (like only a few decades ago), women were routinely shaved and given an enema when they were admitted to the hospital. The logic: It provided a more hygienic environment for delivery. Fortunately, that attitude went the way of leaving dads out in the waiting room. Waxing isn't necessary and certainly doesn't matter to your doctor.

Q. I've heard the pain relievers can make you nauseous. What if I start to throw up on top of everything else coming out of my body?

A. Some pain relievers can, and likely will, make you nauseous, most notably the analgesic family, also known as narcotics, which includes Demerol, Nubain, and Stadol. These medications don't remove your pain, but "dull" it instead. If you're prone to queasiness, you may want to pass on them altogether, or ask for an antinausea medication to be given with them. An epidural can sometimes cause your blood pressure to drop, which can leave you feeling a bit light-headed and therefore queasy. But bear in mind that not having any type of anesthesia doesn't guarantee that you won't vomit. You know how they say contractions come in waves? Normal, active labor alone is enough to make some women spill their guts. That's one of the reasons why women are advised not to eat much after labor begins. But here's an unexpected plus: The same reflex that causes you to vomit helps push the baby out. "I've had moms-to-be who were only four or five centimeters dilated; then they vomit and suddenly hit ten centimeters," notes Buxton.

Q. Will I still be the same "down there" when this is all over? Even if I have an episiotomy?

A. Trust us: You're probably not going to be too worried about this right after having the baby. Sex will not be nearly as enticing as sleep, and when you begin to feel amorous again, all will be healed and you will have had time to perform a gazillion Kegels to regain your muscle tone, if you're that motivated. As for the tightness factor, if your episiotomy or tears are repaired well and you exercise to get your muscle tone back, especially between pregnancies, your pelvic floor should return to normal, insists Dr. Abello. Sex can feel different at first because scar tissue may need some stretching, but take it slowly and gently and the pleasure will return. Buxton recommends doing Kegels while nursing your baby -- not only to regain muscle tone, but because they promote blood flow, which will help your perineum heal. And remember: There are other ways to be intimate when you're not in the mood for sex.

Babytalk contributing editor Stephanie Wood is a freelance writer and mom of three in Blauvelt, New York.