Pregnancy and birth are full of decisions like choosing names, prenatal screening test selection, and pain medication options. One of the first decisions you must make is who to see for your prenatal care. Midwives and doctors in the United States provide prenatal care and attend births. The midwife vs. OBGYN models of care have different beliefs and views about pregnancy and childbirth. Understanding the differences between midwives vs. OBGYN doctors will help you make this critical decision.

Midwife vs. OBGYN

What Is a Midwife?

What is a midwife? Midwives are experts in normal pregnancy and birth. Their training is focused on keeping the mother and baby as safe and healthy as possible.^2,18

Certified nurse midwives (CNMs) and certified midwives (CMs) provide the most complete care of the four types of midwives. They can provide:⁴

• prenatal care
• care during labor and birth, including delivery
• postpartum care
• newborn care for the first 28 days
• breastfeeding support
• prescriptions
• orders for and interpretation of tests
• assistance with Cesarean sections
• care in offices, hospitals, birth centers, and homes
• routine gynecological care outside of pregnancy

Midwife Training

There are four types of midwives with different experiences and education. Each type of midwife provides varying levels of care in different settings.^3,5,6,7

Certified Nurse Midwife (CNM)

CNMs are registered nurses with a graduate degree in midwifery and are certified under the American Midwifery Certification Board. They earn their bachelor’s degrees in nursing, then (maybe) work as registered nurses and return to school for a two- or three-year graduate-level midwifery education program. They are certified through the American Midwifery Certification Board (AMCB).²¹ They can deliver in all settings (home, birth center, or hospital), depending on state regulations. CNMs can prescribe drugs, including pain medication.¹²

Certified Midwife (CM)

CMs are highly trained midwives who do not have nursing training or a nursing degree. CMs have a non-nursing undergraduate degree. They then complete a graduate-level education program. They meet the same requirements and are certified through the same certification board as CNMs.²¹ CMs are recognized in the District of Columbia and the following nine states, where they can practice in any birth setting:^22,23

• Delaware
• Hawaii
• Maine
• Maryland
• New Jersey
• New York
• Oklahoma
• Rhode Island
• Virginia

Certified Professional Midwife (CPM)

CPMs are licensed and trained in midwifery only. For education, they can go to a Midwifery Education Accreditation Council (MEAC) accredited school or one that isn’t accredited.²⁴ (Depending on the program, it could take one year or up to five years to complete.) CPMs are certified through the North American Registry of Midwives (NARM).²⁵ They must also have a preceptor to supervise them and help them translate theory into practice. Through their apprenticeship (usually one to two years), students observe and assist with a minimum number of prenatal exams, births, and postpartum exams. Because they are not nurses or physicians and cannot write prescriptions, they can only deliver in peoples’ homes (home birth) or birth centers. Since they can only work outside the hospital, they don’t need physician oversight.²²

Lay Midwife

Lay midwives (also called traditional midwives) usually have informal, non-medical training and are not certified or licensed. Their training consists of independent study or an apprenticeship. Lay midwives are not licensed or certified. They don’t have nursing or medical training, and there is no legislation to guide their practice. Lay midwives are not considered healthcare professionals.²⁶

A certified nurse midwife (CNM) is the type of midwife you are most likely to encounter in a hospital setting. Most CNMs attend births in hospitals; they are licensed and can prescribe medications in all 50 states. CNMs are the most common type of midwife.³

Benefits of a Midwife

There are multiple benefits to care provided by a licensed and regulated midwife vs. OBGYN. Some of the benefits include:^8,9,11,20

• decreased interventions
• decreased Cesarean births
• reduced use of forceps and vacuums for delivery
• lower risk of preterm birth
• increased satisfaction with the birth experience
• reduced chance of an episiotomy
• less-severe tearing
• fewer epidurals
• lower cost
• hands-on approach
• increased rate of vaginal birth after cesarean section (VBAC)

What Is an OBGYN?

An OBGYN is a doctor with special training in obstetrics and gynecology. An OBGYN can be either a medical doctor (M.D.) or a doctor of osteopathic medicine (D.O.) Both are fully trained and licensed doctors.¹³

OBGYN Training

OBGYNs have an undergraduate degree (usually in a science-related field) and then attend four years of medical school. Following medical school, they complete a four-year residency program in obstetrics and gynecology. This residency program prepares them to care for women’s reproductive health and involves surgical training.^12,19

OBGYNs can also obtain certification from the American Board of Obstetrics and Gynecology. Certification is not required but is evidence that a doctor has done more than the minimum requirements.¹⁴

An OB or OBGYN specializes in women’s health. They are experts in diseases and complications, and OBGYNs are also surgeons. They perform Cesarean sections and gynecological surgeries.¹²

Benefits of an OBGYN

There are benefits to having an OBGYN care for you during your pregnancy and birth, such as:¹²

• having a broad scope of practice
• managing high-risk pregnancies
• the ability to perform Cesarean sections
• the ability to perform vacuum and forceps deliveries
  • Midwives cannot legally use forceps in the United States as a second-stage intervention²⁰

Similarities Between Midwives and OBGYNs

Certified nurse midwives and OBGYN doctors have many similarities:

1. Both are highly trained, licensed, and regulated in all 50 states.
2. Both types of specialists can prescribe medications.
3. Both place a priority on your safety and the safety of your baby.
4. Both desire you to have a positive experience.

In many settings, midwives and OBGYNs work as a team. They communicate about the patients in labor. The midwife often cares for their patients in collaboration with an OBGYN. They consult when complications arise but often remain the primary provider caring for their patients. Sometimes the OB-GYN manages complications, such as pre-eclampsia, and the midwife oversees the normal labor process.²⁸

Differences Between Midwives and OBGYNs

There are also some differences between certified nurse midwives and OBGYNs.

1. OBGYNs manage high-risk pregnancies and complications. Many midwives care for women with high-risk pregnancies in collaboration with an OBGYN. Midwives are trained to handle emergencies and complications until an OBGYN is available.¹⁶
2. OBGYNs only deliver babies in a hospital. Certified nurse midwives deliver in the hospital and birth centers. Occasionally, they also attend home births.^16,17
3. Midwives offer more options for delivery, like water births, squatting positions, and hands and knees. OBGYNs are more likely to deliver your baby while you’re in bed and on your back.¹⁷
4. Midwives spend more time with you during labor. They utilize many techniques to promote the natural progression of labor and birth. Midwives focus on providing holistic care, including education and support. Midwives see pregnancy and birth as a normal process and provide care that supports this philosophy.^15,16
5. Midwives also offer well-women care outside of pregnancy. Midwives’ model of care is all about “low tech, high touch.” They use technology such as fetal monitors and pain medications but rely heavily on their clinical experience and are more present and hands-on.²⁷
6. Another difference between a midwife and an OBGYN is that midwives believe the mother gives birth, while OBGYNs focus on the doctor delivering the baby.¹⁸
7. The most significant difference between OBGYNs and certified nurse midwives is that OBGYNs are surgeons who can perform Cesarean deliveries. Many certified nurse midwives receive training to assist in C-sections, so they may still be present at your birth even though they can’t perform the surgery.¹⁵

Doula vs. Midwife

Doulas are trained professionals who support women during and shortly after childbirth. They provide physical, emotional, and information support. Doulas help women have healthy and satisfying birth experiences. Doulas can have a positive impact on the whole family.¹

Doulas do not deliver your baby like a midwife or OBGYN does. Midwives and OBGYNs provide medical care, while a doula provides support.

Deciding Between a Midwife vs. OBGYN

There is no right or wrong answer when choosing a doctor or a midwife to care for you during your pregnancy. Some women go to a practice with both. You can ask yourself some questions to help you decide. Consider the following questions:

• Is a vaginal birth your priority?
• Do you want your care provider with you during labor?
• What are you planning to do for pain management?
• What are you hoping will happen at the hospital?
• Do you want (or need) more support in your transition to parenthood?
• Are you considered high-risk?
• Do you want to deliver out of the hospital?
• What is your philosophy regarding birth?

Tips on Deciding

Besides asking yourself some questions, let’s look at some tips to help you decide.

• Talk with your partner or closest support people.
• Remember, this is your decision. Try not to let family and friends pressure you. Listen to your intuition.
• Make a list of priorities regarding your pregnancy, labor, and birth. Determine which type of provider best matches your needs.
• Look into how the different midwives and OBGYNs practice. How large is the group? Will your doctor or midwife be at your birth? How long are the prenatal appointments?
• Pregnancy and birth have a unique set of needs. Your gynecology provider may or may not be the one that best matches your needs. Only you know the answer to this.
• You can decide after your first prenatal visit. Some women see different doctors and midwives before settling on the one they feel most comfortable with.
• Consider the birth setting that you prefer. Your choice of provider is closely connected to where you give birth.
• Confirm which maternity providers your insurance covers. Midwives are only sometimes listed in your plan if employed in a physician practice.¹⁸

You now have much to consider regarding choosing a midwife vs. OBGYN. Both have pros and cons. But maybe a team approach can give you the best midwifery care and OBGYN expertise. It’s essential to take your time and do your research. Your decision is vital for you and your baby. Every situation is unique, and only you know the best provider. Welcome to parenting by making this first significant decision!

Your labor experience isn’t always the way you expect it to be. I’ve given birth to five babies, including twins, and had an emergency Cesarean section. I have also delivered thousands of babies as a nurse midwife. Each delivery was different. I’ve made a list of things I wish I had known when I gave birth to my two oldest before I was a nurse. I’ve also included things my patients have said they wish they had known to prepare better.

Things I Wish I Knew Before My Labor Experience

Here are 14 things I wish I knew before my labor experience and things other women said they wish they knew before theirs.

1. Hospital Bag

It’s called a hospital bag because it’s not a suitcase! You don’t need to bring half your wardrobe, entertainment center, or kitchen appliances. Many expectant mothers haul way too much stuff to the hospital. Remember, you must move your belongings from triage to your labor room and again to postpartum.

A checklist can help you determine what to pack for your labor experience. Only bring your bag to the hospital once you know they have admitted you. Your support person can grab it for you.

2. False Labor

You may go to the hospital for labor and be sent home. It happens a lot! False labor contractions called Braxton Hicks can be confused for labor.² Some women may visit the hospital several times before they’re admitted. You may also be sent home if your contractions are labor, but it is still very early.

Real labor contractions have the following characteristics:^1,2

• Come at regular intervals
• Getting closer together
• Last 60-90 seconds
• Continue even when you rest or change positions
• Become stronger with each one
• The pain usually starts in the back and moves to the front
• There is often a bloody mucus discharge called bloody show

3. Birth Plans

Birth plans need to be renamed to birth preferences. It’s impossible to plan your birth. So many things can happen. You only know what you will want in labor once you are experiencing it.

It’s great to have ideas about how you would like to labor in a perfect situation. Writing out your thoughts helps you organize and communicate your wishes to your partner and healthcare team. Studies have found that women have more positive labor experiences when having a birth plan.^3,4

However, keep in mind that you cannot plan for things such as:

• How your baby tolerates labor
• If you are exhausted or sick when you go into labor
• Back labor
• Prodromal labor
• Induction of labor
• Complications

The most important thing to plan for is that unexpected things will happen. The main goal of any plan should be the safety of you and your baby.

4. Get Out of Bed

Labor is easier if you can get up and move. Getting out of bed can help you have:⁵

• Faster labor
• Increased comfort
• Increased likelihood of giving birth vaginally
• Better sense of control
• Decreased need for pain medications

5. Get in the Water

One of the best places out of bed to labor is in the shower or tub. Being in the water has many advantages, including:⁶

• Decreased need for pain medications
• Promotes relaxation
• Increased energy
• More efficient contractions
• Improved blood circulation
• Decreased anxiety
• Reduced stress-related hormones

Many women don’t want to move once they are in bed. But they are much more comfortable once they are up, especially in water. I’ve repeatedly seen stalled labor pick up pace with movement and time in the water.

6. Support

You will need support, but possibly not how you thought. Maybe you have gone to birthing classes with your partner and read about coping with labor pains. You may imagine that you want massages and foot rubs. Then contractions hit, and you don’t want anyone to touch you.

Discuss how your partner can support you through labor and be prepared for various support techniques. If you have many options, you will find what works for you when the time comes.

7. Your Body is in Charge

During the labor experience, your body is in charge. You cannot stop or pause contractions. The different sensations you feel may be new and overwhelming. At times, you may feel out of control.

When I had my first baby, I imagined being calm and focused. I ended up screaming my baby out. The labor was very fast. I felt I didn’t even have time to come up with an idea of coping before the next wave started. After my daughter was born, I remember thinking, “Wait! I didn’t even get a chance to do my breathing techniques.”

8. Pushing

Pushing is usually hard work. At some point during their labor experience, most women will say, “I can’t do this! But somehow, you will. You will dig deep and find the strength and courage to push your baby out.

The pushing stage can be long. It is normal to push for up to three hours with your first baby and up to two hours when you have had a baby before.¹⁴ However, it usually takes much less time.

Even with an epidural, the urge to push is often intense. But some women don’t feel that urge and must learn how to bear down. I have heard many women say it was a relief to be able to push after going through labor. They could finally do something with the contractions.

9. Birthing Positions

The traditional position for pushing is on your back with your legs pulled back. While this position works for many women, there may be better options for your labor experience. Talk with your healthcare team and try different positions.

Any position where you are upright will allow gravity to help. When you are vertical, your pelvis has more room to open. When squatting, the bottom part of your pelvis has about 20% more space. Contractions are stronger and more effective, and women often find being upright more comfortable.⁷

Other positions that are beneficial are side lying and hands and knees. Side-lying can decrease your risk of tearing and make you more comfortable. Hands and knees allow your pelvis to open in all directions and may reduce tearing.⁷

10. Labor and Birth are Not Like TV

Birth does not fit neatly into 30 minutes like it does on TV. There are often hours of just waiting or working through contractions. The average first labor lasts 12 to 24 hours, from the first mild contractions to having your baby in your arms.⁹

Birth is often messy. Losing up to 500 ml of blood with a vaginal birth is normal.⁸ That is equal to about 2 cups of blood. Amniotic fluid, pee, poop, sweat, and vomit may also be present.

Birth is often noisy. Women make various noises during the labor experience, from moaning to grunting to screaming.

11. Delivering the Placenta

Your baby is finally in your arms. You cry happy tears that you are through with labor. But wait! You aren’t done yet. You still must deliver your placenta. It is normal to take up to 30-60 minutes after a vaginal birth.¹⁰ It often comes out within a few minutes.

Fortunately, your placenta is soft, not like your baby’s head. You may push a time or two to deliver it, but it’s nothing like pushing out your baby.

12. Stitches and Ice Packs

Okay, so now you are finally done. Not so fast! Between 53% and 79% of vaginal deliveries will result in some tearing.¹¹ Those tears, or lacerations, usually need to be repaired. In my experience with labor, repairs can take three to four minutes to over an hour.

The good news is you have a new baby to hold and distract you. Your doctor or midwife will make you as comfortable as possible with the epidural you already have or by injecting local anesthetic.

Ice packs for your perineum after delivery will become your best friend. Using ice packs decreases your pain and swelling.¹³

13. Uterine Massage

Heads up. Nothing is comforting or relaxing about uterine or fundal massage.

As part of your labor experience, your nurse will check frequently to ensure your uterus is firm after birth. These checks are done by massaging your uterus through your abdomen. Massaging your uterus helps it to contract and decrease bleeding.¹² This all sounds great, but it is not comfortable. It can be pretty miserable.

The best approach is to do your best to relax and take slow, deep breaths. If you fight the process, it will take longer and be more uncomfortable.

14. Your Nurses

Your labor and delivery nurses will be your biggest cheerleaders, educators, supporters, and comforters. Most parents are surprised at how much their labor nurses do for them.

If you appreciate your nurses, give them a thank-you note, treats, or another token of appreciation. Nurses cherish thank-you cards. I know many nurses who keep every one of them forever.

Every labor experience is different. No matter what, there will be surprises. There will likely be even more than a list can count, but be flexible and know that you can tackle whatever may come your way.

You’ve heard of it. You don’t want it. But you may not be able to avoid it. It’s back labor. Most women have heard of back labor from family or friends or experienced it themselves. It can be excruciating pain in the lower back during labor pains and doesn’t always let up between contractions. Fortunately, counter pressure during labor can reduce your pain and anxiety. There are two main types of counter pressure that you may find helpful. Let’s learn all about them.

What is Back Labor?

Most laboring women have at least some discomfort in their backs, but back labor is different. It’s most painful during a contraction, but constant pain can be present between contractions. Women who have experienced back pain describe it as:^1,2,3

• Intensely painful
• It is more painful than regular labor pains, but it happens in the back
• Worsening with each contraction
• Not going away between contractions
• Pain with spasms in the lower back
• Located in the center of your lower back just above the tailbone

As a nurse midwife, the best description I’ve heard from a woman is that “it felt like a knife was in my back all the time, but then the knife was twisted during contractions. I didn’t even notice contraction pain in my abdomen.”

Causes of Back Labor

People commonly believe back labor is caused by your baby’s head position. Typically, a baby is born with its face and body toward your back. This position is called occiput anterior (OA). The occiput is the back of your baby’s head.^1,2,3

When your baby is the other way up, it is called occiput posterior (OP) or “sunny side up.” Back pain can happen in this position when the back of your baby’s head pushes against your coccyx or tailbone and spine instead of their soft, flat face.^1,2,3

About 15% to 32% of babies are in the occiput posterior position when labor starts. By the time of delivery, only about 5% to 8% are in this position. Most babies find their way into the correct position by the time they are born.²

Some studies indicate that other things besides your baby’s position may contribute to back labor. These factors include the following:²

• The shape of your pelvis
• Tight or loose pelvic ligaments and muscles
• Having a short torso with a long baby
• Bad posture

Remember, babies who are occiput posterior don’t always cause back labor. Also, back labor does not always result from how your baby is positioned.

How Does Counter Pressure Work?

There are several techniques to help with back pain in labor. Counter pressure is one of the most beneficial. It works in two ways.

First, when you experience firm pressure, endorphins are released. Endorphins are hormones made in your brain. These hormones bind to specific receptors in your brain and block pain sensations.^8,9 Endorphins are your body’s natural painkillers.

A second way that counter pressure can help with back labor pain is that it relaxes the pelvis, muscles, and ligaments. Pressure to the lower back helps ease the area’s tension and tightness. Relaxation helps with pain but also makes room for your baby to get into the right position.³

Benefits of Counter Pressure During Labor

Researchers and mothers report multiple benefits of using counter pressure during labor for back pain. These benefits include:^4,5,6,7

• Decreased back pain
• Reduced anxiety
• Increased relaxation
• Partner involvement
• Safety

A Step-By-Step Guide On How To Apply Counter Pressure

There are two main types of counter pressure for back pain during labor. One is direct pressure on the center of your lower back. The other involves squeezing your hips together. We will look at how to do each one. Alternating between these two pressure points for labor is often helpful.

Counter pressure is typically given to the sacrum during labor to relieve back pain. Here is how your support people can provide pressure correctly:^3,9,10

1. Position of mother: The mother should position themselves on their hands and knees, side lying, leaning over a bed or birthing ball, or leaning against a wall. Any position where she has support and can stay balanced when pressure is applied.
2. Location on mother: Apply pressure to the mother’s sacrum. This is the triangular-shaped bone at the lower part of their back, right above the tailbone or coccyx.
3. Position of support person: Position yourself where you can use the weight of your body to apply pressure to their lower back.
4. Balance: It helps if you also hold the front of the mother’s hip bone to balance both of you.
5. Counter pressure: Use your hand’s heel, palm, or fist to put steady, strong pressure on the painful area. A tennis ball also works well. Use your body weight to lean in and give pressure.
6. Timing: Counter pressure is given from the start of each contraction until it ends.
7. Communication: The key is to listen to the mother. They can tell you how much pressure feels the best and exactly what spot to push on.

Pro Tip

Use heat or ice and the counter pressure for even more pain relief.

How To Apply Counter Pressure With a Double Hip Squeeze

The double hip squeeze is also called the labor hip squeeze. One or two support people can use this technique. As the name suggests, squeeze both hips together to relieve lower back pain. Here are the steps your support people can take:³

1. Position of mother: The mother should position herself where she can lean forward. She can stand, sit, be on hands and knees, or lean over a bed or birthing ball. Both hips need to be accessible.
2. Location on mother: Find the right spot on the mother by imagining a line from the top of her hip bones to the top of her butt crack. The area outside the imaginary line is where you will apply pressure.
3. Position of support person: Stand or kneel behind the mother and place the palms of your hands on the fleshy part of each butt cheek right outside the imaginary line. Your fingers should be pointing up and make the shape of a “W.”
4. Balance: Maintain your balance by kneeling or standing with your legs apart on a solid surface.
5. Hip squeeze: Use the flat or heel part of your hands to push up and in on both sides together toward the mother’s shoulders, giving steady pressure. Two people can provide pressure, one on each side. Usually, the stronger the pressure, the better.
6. Timing: Apply pressure during contractions. Continue as long as it helps the laboring mother, or you are tired and need to switch out. Providing counter pressure can be exhausting.
7. Communication: Listen to the mother to know what pressure feels good. They can also tell you if you need to adjust your hand position.

Pro Tip

The pressure helps flare the pelvis slightly, providing pain relief and allowing your baby to find the correct position.

Back labor pain can be relentless, but counter pressure during labor can be a lifesaver for women experiencing this excruciating pain. Counter-pressure techniques are excellent tools your support person can use to help you. By following the steps and communicating with the laboring mother, support people can give effective relief and comfort during labor.

Women have many options for coping with pregnancy discomforts and labor pain — there isn’t one right way to have a baby. Understanding all the available tools and options can empower you to make the best choices for you and your baby. Pain management options include massages, counter pressure, TENS units, epidurals, and breathing techniques. But one of the oldest tools is gaining attention — the rebozo.

What Is a Rebozo?

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The rebozo is a unique woven cloth like a scarf or wrap. These special wraps originated in Latin America and have been around for generations. Mexico has a long tradition of using these beautiful pieces of cloth for pregnancy and daily life. In Mexico, the rebozo, or Mexican shawl, is used as clothing or to carry babies. Women also use it to carry heavy loads on their heads.⁴ Traditional Mexican midwives use the Mexican shawl before, during, and after birth.¹

Rebozos come in many beautiful colors and materials. Initially, they were made from 100% cotton, but now they are sometimes made of other materials. They start at about 4 ½ feet long and come in different sizes. For pregnancy or labor, they should be long enough to wrap around your body and overlap. The scarf should have texture so it doesn’t slip.⁴

The rebozo for labor involves a midwife or support person, like a doula, using the scarf to gently move a women’s abdomen, hips, or buttocks while standing, lying down, or on hands and knees. It is used this way before and during labor.¹

Rebozos are used during pregnancy and labor by less than 2% of women planning to have a vaginal birth.¹ It is one of many options if you plan on medication-free labor. But it can also be helpful if you have medications and other interventions.⁷

Benefits of Using a Rebozo

Even though there is limited research on rebozo use during pregnancy and labor, many women have given positive feedback about using it. Midwives also claim the benefits for labor. Possible benefits include:^1,2,3

• Reduced labor pain
• Increase in contractions
• Shorter labor
• Promotes natural birth
• Decreases the use of oxytocin
• Involves your partner and promotes teamwork
• Encourages your baby to descend in your pelvis
• Encourages your baby to get in the correct position for birth
• Increases psychological support
• Decreases anxiety

How To Wear a Rebozo

How you wear a rebozo depends on how you plan to use it. You can fold it lengthwise during pregnancy and wrap it snuggly under your pregnant belly. Some women like to wrap it around their hips as well. You then tie the scarf together on the side or bottom.

The cloth is usually used as a sling to wrap around your belly, hips, or buttocks during labor. You can even wear it to carry your baby after they are born. Some women also wear wraps around their heads and necks in labor for comfort.

Rebozo for Pregnancy

A rebozo scarf can be worn around or under your abdomen and hips during pregnancy to provide extra support. The additional support can help with pregnancy discomforts such as back pain. It may also help with round ligament pain. Your round ligaments run up the sides of your abdomen and get stretched during pregnancy, sometimes causing sharp and painful spasms.⁴

At the end of pregnancy, a wrap may help to get your baby into your pelvis if they are still floating up high. It can be beneficial for someone who has had a lot of babies and has weak abdominal muscles.²

Techniques for Labor

Wrapping a rebozo around a laboring belly and moving it in different ways may help to move a baby into the correct position and down into the pelvis.⁵ Always check with your doctor or midwife to ensure that using a shawl in this way is safe for your situation.

Sifting, or “manteada,” involves a rhythmic jiggling of the pregnant abdomen or pelvis with a wrap. Gentle sifting with the cloth may relax tight abdominal muscles, ligaments, and fascia.⁵ Fascia is thin connective tissue that holds your organs and muscles in place.⁶ Sifting may also help your baby to rotate into a good position for birth.⁵

To do rebozo sifting, you get on your hands and knees, and the scarf will wrap around your belly like a sling. Your midwife or support person will hold the ends of the wrap and jiggle or “sift” it from side to side.⁵ One person can do the sifting, but it is easier with two people, each taking an end of the scarf.

Another way to do sifting is to wrap the scarf across the hips or buttocks and gently shake it back and forth. This technique relaxes your pelvic floor muscles.⁵ The mother can lie down, lean on a wall, or be on her hands and knees for this type of sifting.

The wrap can also be used for the pushing stage of labor. Hold onto both ends of the wrap while your partner or other support person holds it in the middle. Then, pull on the cloth while you bear down and push. This technique can help you focus your pushing efforts on the right muscles. It is beneficial if you have an epidural and have little sensation to push.⁸

Rebozo for Postpartum

Good news! You can also use your rebozo after your baby is born. You can wear it around your belly for support in a similar way as you did during pregnancy. This support often feels good as your body adjusts to giving birth and returns to pre-pregnancy shape.

You can also use a rebozo to wear your baby by wrapping it around you and your child. This takes some practice and skill, so finding someone experienced to help you or watching videos is helpful. For safety, your baby must be wrapped high on your chest so you can easily lean forward and kiss them.⁹

A wrap is also helpful if you are uncomfortable breastfeeding in public. You can drape it over your baby and shoulder to provide privacy. In a pinch, you can even use it as a blanket for your baby.

When To Not Use It

There are a few situations when using a rebozo for sifting is not recommended:⁵

• If it’s painful
• If you have had recent round ligament muscle spasms
• With a placental abnormality such as an abruption
• Threat of miscarriage

The rebozo, a traditional woven scarf from Latin America, can be a valuable tool for pregnancy and labor. Its historical significance demonstrates the versatility of this ancient cloth as both a cultural staple and a midwifery tool. While scientific research on rebozo techniques is somewhat limited, its potential benefits for reducing labor pain, promoting contractions, and encouraging natural birth are worth exploring. Modern birth practices encourage holistic options. Embracing various pain management techniques can empower you to make personalized choices that support a positive childbirth experience.

Many amazing events happen in childbirth. But one of the most fascinating is the en caul birth. With an en caul birth, your baby is born inside the amniotic sac or bag of water. This phenomenon has fascinated parents and medical professionals for centuries.¹

An en caul birth is considered rare. There are many cultural beliefs and superstitions regarding this unusual birth. Some people believe an en caul birth is magical and brings fame and fortune, but there are few benefits or risks. Some parents desire to try to have this type of delivery because it is natural and unique.⁴

What Does En Caul Mean?

When the amniotic sac doesn’t break before your baby is born, you have an en caul birth. A baby born in the bag may also be called a “mermaid birth” or a “veiled birth.” It’s not a good or bad thing. It’s simply unusual.⁵

Usually, the amniotic sac breaks before contractions start or during labor or pushing. The fluid releases and continues to leak until your baby is born. A doctor or midwife may break the bag of water to induce or stimulate labor. If the bag is still intact when you start pushing, it will likely break with the increased pressure created. But if it doesn’t, you may have an en caul birth.⁶

“En caul” is different than “caul.” Caul means that a piece of the membrane is over your baby’s face, head, or chest when she is born, but the bag is not intact. The portion of the membrane may look like a veil or helmet.⁷

What an En Caul Birth Looks Like

During an en caul birth, your baby is born in what looks like a large squishy water balloon full of fluid. Often, a portion of the bag delivers first filled with liquid as it pushes out of your vagina. The rest of the sac with your baby’s head and body follows.⁶

The bag of water has two membranes that are fused. You can see through the membranes. Your baby will be curled up in the bag and get oxygen through the umbilical cord. You can see how your baby was nestled in your uterus before birth.⁶

After Delivery

Once your baby delivers en caul, the doctor, midwife, and nurses all ooh and ahh over the wonder and point it out to you. Then, your provider gently snips the bag with scissors or another instrument or pokes a hole with a finger. The water pours out. The membranes then cling to your baby. Your doctor or midwife carefully pulls them away from your baby’s face so she can breathe. Finally, you get to hold your baby for the first time. Cutting the cord and how your placenta delivers will be like any other birth.⁶

 

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How Common is an En Caul Birth?

Very little information is available about how often an en caul birth occurs. The commonly quoted statistic is less than 1 in 80,000 live births. At this rate, many doctors, nurses, and midwives have never seen an en caul birth.¹

En caul births can happen with both vaginal and Cesarean deliveries. With a cesarean birth, the surgeon can attempt to deliver your baby in the bag without breaking it. However, this is not a typical surgical procedure.¹

An en caul birth is more likely with a preterm or small baby. They are also more common if you haven’t had any previous births.¹

Midwife Perspective

En caul births are not tracked at delivery, so any statistic is only an educated guess. I’ve been a midwife for 22 years and a labor and delivery nurse before that. I have not kept track of how many en caul deliveries I have done, but it’s between 5 to 10 vaginal births. I have delivered over 5,000 babies. These numbers do not match with the 1 in 80,000 births estimate.

My numbers made me curious about how common en caul birth is. So, I surveyed 71 United States nurses, midwives, and OBGYN doctors, and this is what I found:

• Who: The survey included 58 labor and delivery nurses, one director of nursing, seven midwives, and five OBGYN physicians. Experience levels varied among those surveyed from under five to over 20 years.
• Percent: Of those surveyed, 80% have seen at least one en caul birth.
• Number: There was a wide range of how many en caul births those surveyed have seen, from only one in over 20 years of experience to “countless” in less than 20 years of experience. The majority have seen one or two such births.

What I take away from this small survey is there is a wide range of experience with en caul births. It happens more than the often reported 1 in 80,000 births. More research can help determine accurate numbers.¹

Benefits of an En Caul Birth

The benefits of an en caul delivery involve avoiding the risks present when the amniotic sac breaks before delivery. Such risks include the following:²

• uterine infection
• placental abruption, when the placenta pulls away too soon
• umbilical cord compression leading to your baby not tolerating contractions

The most severe, umbilical cord compression happens in cord prolapse. A prolapse occurs when your baby’s umbilical cord falls through your cervix and into the vagina before your baby’s head. The cord gets squeezed between your baby’s head and the pelvic bones depriving your baby of oxygen. This almost always leads to an emergency Cesarean delivery.⁸

Amniotic fluid provides a cushion around your baby. It helps protect him and the umbilical cord from squeezing and bruising during labor and birth. An en caul birth gives this protection through the birthing process.⁹

Risks or Complications

An en caul birth has few potential complications. One case study found a severely low number of blood cells (anemia) in a baby born by Cesarean via en caul delivery. But the anemia was most likely caused by an abnormal umbilical cord and not the en caul delivery.³

If labor is not progressing, breaking the amniotic sac can stimulate labor. Your provider may recommend an internal fetal heart rate or contraction monitor. Either of these requires your water to be released. Hoping for an en caul birth could delay labor progress or recommended interventions and lead to complications.¹⁰

How to Increase Your Chance of an En Caul Birth

Labor must progress without breaking the amniotic sac to increase your chance of an en caul birth. It means not breaking your bag of water to speed things up if everything progresses normally. Induction of labor can make this difficult. You can still use Pitocin to stimulate contractions if needed.¹¹

Whenever you have a cervical check to evaluate your labor progress, your doctor or midwife’s fingers risk breaking the amniotic sac. Limiting vaginal exams can increase your chance of an en caul birth.¹²

It is essential to talk with your doctor or midwife about your desires. Many doctors routinely break the amniotic sac during labor. Even if you decline this intervention, your body may have its own plans, and there is little you can do to control when your water naturally breaks.

En caul birth is fascinating, but there needs to be more research on how common it is or its risks and benefits. When a baby is encased in the amniotic sac, we get a small picture of how life was in the womb. It is one of the most natural and safe types of birth. But this type of birth is also difficult to plan for. Talk with your delivery provider to attempt this type of birth. It could also be their first time experiencing this type of unique delivery.

Sore breasts during pregnancy are common and often come with sensitivity and aching. During the first trimester, many women can’t stand the shower running on their breasts or clothing touching their nipples. The thought of their partner touching their breasts causes them to cringe. All these experiences are typical and a good sign that you have a healthy level of hormones.^1,3

Many changes occur in the breasts during pregnancy as they prepare to feed your baby. Milk glands and ducts develop, blood flow increases and breast tissue grows. The enlargement is a welcome change for some women but brings even more soreness for those who start with large breasts. There are a few tips to help relieve the discomfort of sore breasts during pregnancy.³

Why Do Women Get Sore Breasts During Pregnancy?

Sore breasts during pregnancy are due to hormone changes. Ah, yes. We can blame a lot on hormones. The hormone estrogen rises early in pregnancy. This hormone rise increases blood flow to your breasts. Estrogen also increases the number and size of milk ducts in preparation for breastfeeding. Milk ducts carry milk from inside your breast to your nipples.^1,2

The hormone progesterone dominates later in pregnancy. This hormone controls the growth of fatty breast tissue. It also helps the lobes to enlarge and develop. The lobes are part of the breast that will produce milk.^1,2

The sore breasts during pregnancy that most women experience come from the growth of the milk duct system and the development of many more lobules.¹

What Do Sore Breasts During Pregnancy Mean?

Having sore breasts is one of the first signs of pregnancy. You may experience sore breasts within a week of conception. This soreness and sensitivity usually lessen significantly by the end of the first trimester.³

Sore breasts during pregnancy mean your body is doing exactly what it should. It’s increasing hormone levels and preparing your breasts to feed your baby.

Are Sore Breasts During Pregnancy Normal?

Having sore breasts during pregnancy is typical. One study found that 76% of expectant mothers experience breast pain or tenderness during the first trimester.⁴

Other Breast Changes in Pregnancy

There are many expected breast changes during pregnancy. Each trimester you’ll experience different changes and discomforts. Some women notice most of these changes, while others only a few. They are all normal.⁵

First Trimester

• Sore and tender
• Swollen
• Nipples stick out more
• Start to enlarge

Second Trimester

• Larger and heavier
• Soreness may decrease from the first trimester
• Nipples and areola (around the nipples) may get darker and larger
• Veins in your breasts become more noticeable
• You may get stretch marks on your breasts
• Colostrum (the first milk) may start leaking from your nipples

Third Trimester

• Your breasts may get even larger and heavier
• Colostrum may start leaking if it hasn’t already

Breast enlargement has a wide range of what’s expected. Some women hardly notice a difference, while others enlarge several bra sizes. On average, breast size volume increases by 96 ml.⁷

It’s important to know that it doesn’t matter how much your breasts grow. The size change does not determine how much milk you will make for your baby. The size or shape of your nipples also doesn’t affect your breastfeeding ability.¹⁰

How to Alleviate Discomfort

The best alleviator of breast pain and soreness during pregnancy is time. The first trimester is when you experience the most discomfort. After that, most women are much more comfortable. There are a few tips you can try to alleviate discomfort, like the following:⁵

• Avoid washing the area around your nipples with soap. Soap can irritate and dry out the skin. Only use water.
• Wear a bra that gives good support. Consider getting measured for the correct size. Cotton bras are often more comfortable against sore nipples.
• Try a nursing sleep bra at night. A soft cotton bra without underwires or hooks may be most comfortable.
• Allow your breasts to air dry after showering or bathing.
• Wear breast pads if you are leaking colostrum. The washable type tends to be more comfortable.
• Take an over-the-counter pain reliever. Discuss with your doctor or midwife about what is safe for you to take.
• Cold compresses may help relieve some discomfort. Frozen vegetables work well too.
• Do what feels right. Some women like to massage their breasts or use lotions. Most women avoid the shower directly on their breasts in the first trimester.
• Talk with your partner about your pregnancy discomforts. Let them know what does and doesn’t feel good right now.

When to Be Concerned By Sore Breasts During Pregnancy

Non-cancerous cysts and lumps can develop in your breasts during pregnancy. Some of these lumps need treatment even though they are benign. Let your provider know if you feel anything like a lump in your breast.⁶

Breast cancer occurs during pregnancy in about 1 in 3,000 pregnancies. Most lumps in the breast during pregnancy are benign. But because it can happen during pregnancy, it’s essential to get diagnosed and treated promptly.⁸

Let your doctor or midwife know if you have any of the following:⁹

• A mass or lump in your breast.
• Unusual pain in one area of your breast.
• Puckering or dimpling of the skin.
• Rash or redness on your breast.
• Nipple discharge that is not colostrum, such as bloody discharge.

Tender, aching, sore breasts during pregnancy are a common rite of passage for mothers-to-be, thanks to estrogen and progesterone hormones. These hormones prepare your breasts for breastfeeding by increasing blood supply and growing ducts and lobes. Breast soreness also serves as an early sign of pregnancy. Fortunately, the soreness and sensitivity improve significantly by the end of the first trimester. You can expect many breast changes during pregnancy. But be aware of any unusual changes and report these to your healthcare provider immediately.

You took a home pregnancy test, and it’s positive. You are over the moon excited, but now what? It’s time to find a healthcare provider to care for you during pregnancy. You have several options, including a doctor, a nurse practitioner, or a midwife. But what is a midwife?

What is a Midwife?

The word “midwife” means “with woman.” Midwives are trained experts in normal pregnancy and birth. They focus on keeping everything with mom and baby as normal as possible.^15,16

There are several types of midwives. The most highly trained are called certified nurse midwives. They independently care for low-risk women and often collaborate with an OBGYN to care for high-risk women. Midwives play an essential role in promoting the health of mothers and babies.^3,5

Midwives have cared for pregnant women in their homes for centuries. The practice of midwifery goes back long before doctors received training. As physicians became trained, they took over the field of childbirth in the United States. By the 19th century, physicians attended almost all births in hospitals. Today, midwives in the United States attend about 8.7% of hospital births. In other countries, the numbers are much higher.^6,7

Types of Midwives

There are four types of midwives. Each provides varying levels of care to women and newborns. When choosing a midwife, it’s good to understand the differences to select the type that best meets your needs and provides the safest care.^1,2,3,4

Certified Nurse-Midwife (CNM)

Certified nurse-midwives are registered nurses who complete a graduate-level nurse-midwifery program. They pass a national certification exam from the American Midwifery Certification Board (AMCB). CNMs care for women from their teenage years through menopause, not just during pregnancy. Their training is usually hospital-based, but CNMs can practice in any birth setting. With their licensing, CNMs can prescribe medications in all 50 states.

Certified Midwife (CM)

Certified midwives are highly trained but are not nurses. CMs have a non-nursing undergraduate degree, usually in a health-related field. They complete a graduate-level midwifery degree and pass the same national board exam as CNMs. CMs also care for women throughout their lifespans and can practice in any birth setting. They can practice in nine states and can prescribe medications in six.

Certified Professional Midwife (CPM)

Certified professional midwives receive training through either an apprenticeship or an educational program. Certification does not require a degree. They meet certification requirements through the North American Registry of Midwives (NARM). Their training focuses on providing midwifery care in homes and freestanding birth centers. CPMs are not nurses. They care for women during pregnancy, birth, and 6-8 weeks after delivery. CPMs can practice in 28 states.

Lay Midwife

Lay midwives, sometimes called traditional midwives, are not certified or licensed. They usually have informal education such as self-study or an apprenticeship. Lay midwives do not have nursing or medical training and are thus not considered healthcare professionals. They are not licensed, certified, or legislated.

What Midwives Do

The scope of care midwives give depends on the type they are. We will focus here on CNMs and CMs as they can provide the most comprehensive care. Other types are limited in the care they can give and where they can provide that care. CNMs and CMs can provide care that includes the following:⁵

• Pregnancy care
• Labor and birth, including delivering your baby
• Postpartum care after your baby is born
• Sexual and reproductive health
• Gynecologic health, including annual exams, cervical screenings, and breast exams
• Family planning services such as contraception
• Preconception care
• Primary care for teens
• Newborn care for the first 28 days of life
• Breastfeeding support
• Prescribe medications, including pain medications for labor
• Assist with Cesarean births if they have additional training
• Order and interpret lab results, ultrasounds, and other diagnostic tests
• Manage medical emergencies until a physician arrives
• Provide wellness education and counseling
• Provide services in clinics, private offices, hospitals, telehealth, birth centers, and homes

Difference Between an OBGYN and a Midwife

OBGYNs, or obstetricians, are medical doctors who specialize in women’s health. As doctors, they have an undergraduate degree, attend four years of medical school, and then a four-year residency in obstetrics and gynecology. Obstetricians are experts in complications and disease processes. OBGYNs are also surgeons and perform Cesarean deliveries as well as gynecological surgeries.¹⁷

Midwives are not doctors. Certified nurse midwives and certified midwives provide comprehensive care to women. They can provide medical interventions and procedures but are not surgeons. They tend to have a more holistic approach and focus on promoting natural birth and minimizing unnecessary interventions. Midwifery centers on wellness, health, empowering women and families, shared decision-making, and emotional support. Typically, they spend more time at the bedside caring for and interacting with their patients.⁸

See also: Midwife vs. OB-GYN: What’s the Difference?

Difference Between a Nurse Practitioner and a Midwife

A women’s health nurse practitioner (NP) has a nursing degree with advanced practice education and training. Certified nurse-midwives attend births, but nurse practitioners do not. NPs care for women throughout their life, including during pregnancy. You can see a nurse practitioner for your pregnancy, but a doctor or midwife will attend your birth.¹⁸

Difference Between a Doula and a Midwife

A doula has training and certification to provide you with physical and emotional support during labor. Some doulas also offer support in your home after your baby is born. Doulas are not required to have a medical or nursing background. Midwives are responsible for monitoring the health of you and your baby, while doulas are responsible for offering support.⁹

See also: Doula vs. Midwife: What’s the Difference?

Benefits of Midwifery Care

Midwifery care provided by educated, trained, regulated, and licensed midwives have many benefits, including the following:^10,11,12,13

• Lower rate of interventions
• Higher satisfaction with the birth experience
• Less likely to have a preterm birth
• Less use of vacuum or forceps for delivery
• Fewer episiotomies
• Decreased risk of Cesarean birth
• Lower rate of labor induction
• Decreased severe tearing
• Lower use of epidurals
• Lower cost
• Increased chance of a positive start to breastfeeding
• More hands-on approach
• The mother has an increased sense of control
• Higher rates of vaginal birth after a Cesarean section

Questions to Ask Before Choosing a Midwife

Choosing a midwife is an important decision. So it is essential to ask questions to ensure the midwife you choose is right for you. Some questions to consider are:

• Are they a certified nurse, certified professional, or lay midwife?
• What is their education and training?
• How many years of experience do they have?
• How many babies have they delivered?
• What is their philosophy of care?
• Are they accessible and available?
• What is their collaborative relationship with other healthcare providers?
• Do they work with a group?
• Do they deliver babies at home, in a birth center, or in a hospital?
• If they deliver out of the hospital, what is their plan for transferring you to the hospital if the need arises?

When understanding what a midwife is, knowing they have different practice models is essential. Some follow you through pregnancy and birth; you know they will be there when the big day comes. Unfortunately, this arrangement is not typical anymore. Many work in groups, with one on-call each day for deliveries which will be the one to care for you during labor and catch your baby. It can be helpful to meet all the midwives in the group so you will be comfortable when you go into labor.

Midwifery can be an essential part of healthcare. They provide comprehensive care to women during pregnancy, childbirth, after delivery, and for routine gynecological care. Certified nurse midwives and certified midwives work with a team of healthcare providers, including nurses, physicians, and doulas. Midwifery care has many benefits for the mother and child and is an option to consider when pregnant.

Most parents look forward to the miracle of childbirth, but what happens when the journey takes a dangerous turn? Enter shoulder dystocia, a complication that can turn the birthing process into a terrifying ordeal for everyone. Shoulder dystocia is a medical emergency that occurs when your baby’s head delivers, and one or both of her shoulders get stuck behind your pelvic bone. It is a rare but severe condition that can cause long-term consequences for you and your baby.⁴

Let’s explore shoulder dystocia in more detail, including what it is, why it happens, how common it is, and what to do if it happens.

What Is Shoulder Dystocia?

Shoulder dystocia is a complication of childbirth that occurs in approximately 1 in 150 vaginal deliveries, or 0.7% vaginal births. The condition happens when your baby’s shoulder becomes impacted behind your pubic bone during delivery, which prevents the baby’s body from being delivered. It is considered an obstetric emergency because it can lead to a prolonged and difficult delivery that can cause complications for both the baby and the mother.¹

Why Does Shoulder Dystocia Happen?

Shoulder dystocia can happen for various reasons. Risk factors include:^1,2,4

• Fetal macrosomia (a large baby)
• Obesity in the mother
• Excessive weight gain during pregnancy
• Diabetes
• Long labor
• Prolonged pushing stage of labor
• Previous history of shoulder dystocia
• Use of forceps or vacuum to deliver the baby
• Induced labor
• Baby is in the wrong position
• Mother has a small or abnormally shaped pelvis
• Mom is older than 35
• Delivery after the due date
• Having an epidural

Even though there are risk factors for shoulder dystocia, it usually happens unexpectedly. Because it is difficult to predict, it is also difficult to prevent.²

One of the risk factors for shoulder dystocia is having a large baby. Estimating fetal weight is difficult and inaccurate. Induction of labor does not prevent shoulder dystocia. Your provider will recommend a Cesarean delivery to avoid shoulder dystocia if your baby’s estimated weight is 11 pounds and you don’t have diabetes. If you have diabetes, your doctor will recommend Cesarean birth if your baby is estimated to be 9 pounds, 15 ounces, or larger.²

Complications of Shoulder Dystocia for the Mother

Many risk factors can lead to shoulder dystocia, but it can happen to anyone. There aren’t any symptoms. Your doctor or midwife will notice the condition when it occurs. Often the first sign is when your baby’s head delivers but then pulls back in. When this happens, it’s called the “turtle sign.”⁴

Shoulder dystocia can lead to serious complications for both you and your baby. For mothers, the difficulties include:^2,3,4

• Postpartum hemorrhage: Excessive bleeding can occur after delivery, which can be life-threatening. Postpartum hemorrhage is the most common complication for the mother.
• Lacerations: If shoulder dystocia occurs, you are more likely to have large tears in your vagina, rectum, or urethra.
• Nerve compression: Compression of specific nerves can cause numbness, tingling, or burning pain in your outer thigh.
• Separation of pubic bones: Two bones form the pubic bone with cartilage in between. These can become separated, leading to pain and difficulty walking.
• Uterine rupture: This occurs when the wall of your uterus tears open.
• Rectovaginal fistula: This is an abnormal connection between your rectum and vagina.
• Psychological stress: When your baby’s shoulder gets stuck, it is frightening and often traumatic.

Complications of Shoulder Dystocia for the Baby

Complications for the baby from shoulder dystocia include:^2,3,4

• Brachial plexus injury: This is an injury to the nerves in the baby’s neck and shoulder that can cause weakness or paralysis of the arm. The weakness or paralysis usually resolves but can be permanent. Such injury is the most common complication for your baby.
• Compressed umbilical cord: Your baby’s umbilical cord can get pinched between the arm and pelvic bone. When this happens, your baby’s oxygen and blood flow are cut off.
• Fractured collarbone: The baby’s collarbone can break during delivery, causing pain and discomfort. These fractures usually heal without complications.
• Fractured upper arm: Baby’s upper arm can break when delivering it. These fractures usually heal well.
• Hypoxic-ischemic encephalopathy: This is a rare but severe condition where the baby’s brain is deprived of oxygen, which can result in brain damage and other long-term complications.
• Death: In rare cases, babies won’t survive shoulder dystocia. This risk is very low at 0.4% of cases.

All these possible complications can be terrifying. Remember, however, most babies that get stuck during delivery are born safely.⁴

What to Do When Shoulder Dystocia Happens

If your provider suspects shoulder dystocia during delivery, they will act quickly to reduce the risk of complications. The longer the shoulder is stuck, the higher the chance of complications for your baby. Usually, your nurse pulls an emergency alarm, and your room fills with extra staff to assist with the emergency. The alarms and rush of extra people can be very scary. Your provider will have little time to explain what is happening.³

Your baby’s shoulder needs to be delivered as quickly as possible so he can be born and start breathing. Doctors and midwives are trained in skills to help promptly release your baby’s shoulder. Your provider will ask you to stop pushing as they carry out different maneuvers. Following are some of the most common maneuvers they might perform:^1,2

• McRoberts maneuver: Involves laying flat and raising your legs to your chest to widen the pelvic outlet, which can help release your baby’s shoulders. This is almost always the first action taken if shoulder dystocia happens.
• Suprapubic pressure: Applying pressure to your abdomen just above the pubic bone to move the baby’s shoulders.
• Rubin maneuver: Rotating the baby’s shoulders to facilitate delivery.
• Woods corkscrew maneuver: Rotating the baby’s body to release the shoulders.
• Posterior arm: Your provider puts a hand in your vagina and delivers one of your baby’s arms. Then, the shoulder can pass through.
• Hands and knees: Midwives sometimes have you get on hands and knees when shoulder dystocia occurs. This position makes the pelvis wider and helps release the shoulder.
• Episiotomy: An episiotomy creates a larger vaginal opening allowing more room for your provider to perform the necessary maneuvers to deliver your baby.

If shoulder dystocia occurs, follow your doctor’s or midwife’s directions. Staying calm and following their instructions is the best thing you can do for yourself and your baby. After your baby is born, a pediatrician will examine your baby, and your provider can discuss with you what happened.

Prevention of Shoulder Dystocia

Although it is not always possible to prevent shoulder dystocia, there are specific measures you can take to reduce the risk, including:^1,4

• Maintain a healthy weight during pregnancy.
• Monitor fetal growth during pregnancy.
• Manage diabetes.
• Avoid vacuum or forceps-assisted delivery when possible.
• Be aware of the risk factors for shoulder dystocia.
• Consider not having an epidural in labor.

Shoulder dystocia is a medical emergency that is very stressful for everyone, including you, your partner and family, the nurses, and your doctor or midwife. The best thing everyone can do during shoulder dystocia is to remain calm and do exactly what the doctor or midwife instructs. Remember, most babies are delivered healthy even when the shoulders get stuck.

Shoulder dystocia is a rare but severe complication of childbirth that can cause long-term consequences for both the mother and her baby. It is often unpreventable. Doctors and midwives act quickly to reduce the risk of complications if shoulder dystocia happens during delivery. Discuss your risk factors for shoulder dystocia with your healthcare provider.

Imagine exercising for 12 hours and being unable to eat or drink anything. That is what labor has been like in our recent history. As you prepare for labor and birth, you may wonder whether eating and drinking are safe during childbirth. Many hospitals do not allow food during active labor, but you can usually have fluids to drink. But why can’t you eat during labor, and why can’t you drink during labor?

Let’s explore the history of food and fluids in labor and the latest research and guidelines. Spoiler alert! Hospital and provider policies often differ from what the studies say. Talking with your doctor or midwife about eating and drinking during labor is essential.

History Lesson: Why You Can’t Eat During Labor

Traditional medical practice was to restrict food and drink during labor, thinking that food or fluids could cause vomiting, leading to aspiration. In this condition, a woman inhales food or liquid into the lungs. Aspiration has many serious complications, including lung disease and death.¹

“Nothing by mouth” or NPO policies started in the 1940s when childbirth practices were quite different from today. Twilight sleep was common. Doctors gave women a combination of anesthetic medications. The doctor then delivered babies using an episiotomy and forceps. The mother would have no memory of giving birth. Aspiration was common for both vaginal and Cesarean deliveries. Doctors determined that aspiration was preventable by giving IV fluids, which is why you can’t eat during labor.^1,2,7

What Does Modern Research Say About Why You Can’t Eat During Labor?

Much has changed in anesthesia and childbirth practices since the early 1900s. You are no longer given general anesthesia for childbirth except for emergency Cesarean births. Regional anesthetics such as epidurals and spinal anesthesia are used today for labor and most Cesarean births. You get to be awake, meet your baby the minute he is born, and remember all the incredible (and not-so-incredible) details.

Modern research includes dozens of studies about eating and drinking in labor. Studies done in the past few years show the following:

Restricting Food and Drink During Labor May Not Be Necessary

Research on aspiration rates during labor shows that it is incredibly rare. A study in the United Kingdom allowed people to eat and drink in labor, and results showed one death from aspiration out of more than six million births. There was only one patient with aspiration related to labor and delivery in the United States between 2005 and 2013.^2,3,5,7

There are No Clear Benefits or Harms to the Mother or Baby

Although the studies found no clear harm, none considered a woman’s preference for eating and drinking in labor. The studies did not examine the harmful emotional impact withholding fluids and food can have. A woman’s satisfaction with her birth experience is a factor to consider.^3,4

Eating and Drinking During Labor Does Not Increase Vomiting

The ugly truth is that a lot of women vomit in labor. The good news is that eating solid foods and drinking fluids will not make it worse.⁴

High-Risk Patients May Need to Avoid Solid Foods

High-risk patients include people with diabetes, obese women, or mothers having twins (or triplets). Solid food is more dangerous than clear fluids, but the risk remains low. We now have better general anesthetic techniques and decreased use of general anesthesia. But if aspiration happens, it is a severe event.⁵

Women with Low-Risk Pregnancies Who are Allowed to Eat May Have Shorter Labor

An extensive review of 10 studies found that women who eat and drink in labor have shorter labors by an average of 16 minutes. That is a slight difference, but anyone in labor would love to cut off as much time as possible. Some research indicates it could shorten labor by up to two hours.^4,5

Eating Small but Frequent Amounts of Food Provides Calories and Energy During Labor

Little information is available about how much food and water is needed during labor, but the energy required for labor is compared to that required to run a marathon! Most women get IV fluid hydration in labor, and while some hospitals use a fluid containing a type of sugar, many do not. IV fluids make moving around in labor more complex and can cause fluid overload. IV fluids also do not ensure the right balance of nutrients and fluids to handle labor.^3,6

What are Official Recommendations on Whether You Can Eat During Labor?

Medical professionals, such as ob-gyn doctors, anesthesiologists, and nurse-midwives, keep up to date on current research and make recommendations regarding what is best. There are several recommendations on whether you can eat or drink during labor.

The American Society of Anesthesiology (ASA) has stated that “most healthy people would benefit from a light meal in labor.” ⁵

The American College of Obstetricians and Gynecologists (ACOG) recommends women in labor may not need continuous IV fluids. Oral hydration can be encouraged. But they do not recommend solid food in labor stating the risk of aspiration.⁸

The American College of Nurse-Midwives (ACNM) has guidelines about eating and drinking in labor. It states that midwives should discuss the risk of aspiration with mothers. Midwives should “promote self-determination by healthy women experiencing normal labors concerning oral intake.” Midwives should check all women for the risk of complicated delivery or increased risk for aspiration.⁹

As you can see, there needs to be more agreement among professional organizations. The guidelines also need to follow what the science says. A deep fear of aspiration continues despite research indicating the incredibly low risk. Because of that, you will see a range of practices about what laboring women can eat and drink.

Can You Eat During Labor?

So, what’s the bottom line on whether you can eat during labor? The answer is a resounding “maybe.” I recommend that you discuss your desires with your doctor or midwife. Every provider has a different viewpoint. If you give birth at home or at a birth center, you most likely can eat and drink whatever you want.

It is hard to know before labor what you will want. Some moms like to eat all the way through. Often as contractions become more intense, the desire to eat decreases. The key is to listen to your body. If you feel like eating, you need nutrients and calories. If you are throwing up, eating won’t be appealing.

If you are considered “high-risk,” you will most likely not be able to eat. High-risk conditions include multiple babies, a planned Cesarean birth, a previous Cesarean birth, severe obesity, pre-eclampsia, or if you have diabetes.

Sometimes you are allowed food before you have an epidural. Once you have an epidural, only ice chips or sips of water. Your provider will ask you to stop eating if there is any concern about your baby’s heart rate or if you have complications.

Can You Drink During Labor?

You will likely be allowed to drink clear fluids in labor wherever you give birth. Clear fluids are anything you drink that you can see through. These include water, juice, tea, black coffee, and soda.

In certain situations, even clear fluids may not be allowed. If you have a planned Cesarean birth, you cannot eat or drink for several hours before surgery. Your doctor or midwife may ask you to stop drinking fluids if there is a complication or your baby is not tolerating labor. Your provider is probably concerned that you will need a Cesarean birth.

A Midwife’s Perspective

I have been a practicing nurse midwife for over 22 years. I have seen hospital and provider practices slowly shift to allow women to drink during labor and often eat. Every woman’s labor experience is different, and each person has other risk factors to consider. What works for one mother may not work for another.

For healthy women in normal labor, I see many benefits in encouraging women to eat and drink as they feel like it. It’s essential to push fluids. Adequate nutrition and hydration prevent a woman’s body from using fat for energy. When fat is used for energy, acidity develops in the blood of the mother and infant. Insufficient calories can make the uterus not function as well as it should, leading to prolonged labor. Being hungry also causes emotional stress. When a mother is stressed, her body does not work as it should, and labor can slow down.⁵

Women’s bodies are amazing. If you listen to your body, you will do what is best for you. Women that eat appear to have more energy, especially at the end of labor when they use a lot of energy to push out their babies.

If you can’t eat during labor, ensure you have access to a large meal after delivery because you will be ravenous! However, getting food can be challenging in the middle of the night, so have a plan.

Food and Drink Ideas for Labor

I recommend bringing food to the hospital if you plan to eat during labor. Getting the food you want can be difficult and even impossible. The best foods are easy to digest. Avoid heavy foods such as meat and pizza. Remember, you may see anything you eat again if you throw up. Here is a list of food and beverages I’d recommend packing for labor if you can eat:

• Fruits and vegetables
• Bread or crackers
• Soup
• Yogurt
• Energy bars
• Cereal
• Light sandwich
• Pasta salad
• Smoothies
• Coconut water

Plenty of research suggests that if everything is normal, there’s no reason why you can’t eat during labor or drink during labor. Eating light, easily digestible foods and staying hydrated can help you feel more comfortable. Taking in food and fluids may even shorten the duration of labor. Listen to your body and communicate your preferences with your healthcare team.

From morning sickness to swollen feet, pregnancy brings many physical changes. One lesser-known change is an increase in normal vaginal discharge called leukorrhea (pronounced loo-kuh-ree-uh). Experiencing leukorrhea discharge can be confusing and even scary for expectant mothers. However, understanding what is and isn’t normal for leukorrhea in pregnancy can help alleviate fears and ensure a healthy pregnancy.

Leukorrhea discharge is normal for pregnant and non-pregnant women. Let’s look at what is normal leukorrhea in pregnancy and what is abnormal. Abnormal discharge requires you to seek medical attention to get treatment. The good news is there are many tips and lifestyle changes to help prevent abnormal discharge and help maintain vaginal health.

Normal Leukorrhea in Pregnancy

Normal vaginal discharge is thin, clear to milky white, and has no noticeable or mild odor. This leukorrhea discharge is made up of mostly water but also contains microorganisms and dead cells. Normal discharge keeps the vagina and genital area clean and healthy. It also helps to lubricate the vagina and keep you comfortable.^1,3

During pregnancy, leukorrhea discharge progressively increases. Having increased vaginal discharge is one of the early signs of pregnancy. Toward the end of pregnancy, normal leukorrhea can become quite heavy, and many women wonder if this is normal. It is!²

Leukorrhea in pregnancy increases because of changes in your hormones. Estrogen levels rise during pregnancy, causing an increase in normal discharge.⁴

The large amount of leukorrhea discharge in the last trimester can frustrate many women. Many expectant mothers say they feel constantly wet and change their underwear several times daily. It can help to wear panty liners and to shower or bathe more frequently.³

Abnormal Leukorrhea Discharge in Pregnancy

There are several types of abnormal vaginal discharge or vaginal infections that you can experience. Research has found that vaginal infections are more common during pregnancy for women with low levels of education, low economic status, and poor hygiene. During pregnancy, the risk of vaginal infections increases.^2,6

Let’s look at the three most common types of vaginal infections you can have and what the symptoms and treatments are.

Bacterial Vaginosis (BV)

Too much of certain bacteria in the vagina can cause BV. It is common, with 50% of vaginal infections being BV. It is not a sexually transmitted infection but is most common in sexually active women.^4,6

Symptoms include the following:⁶

• Thin white or grey discharge
• Bubbly discharge
• Discharge with a strong fishy odor
• Pain, burning, or itching of the vagina or the outside of the vagina
• Burning sensation when you urinate

If you have BV, you must take antibiotics that kill bacteria. You take the antibiotic by mouth or insert a gel into your vagina.⁶

Vaginal Candidiasis

Vaginal candidiasis is a fancy medical term for a yeast infection. A yeast called Candida is responsible for this itchy infection. Usually, Candida lives in the vagina without any problem but can cause an infection if conditions change. Because of hormone changes, you are more likely to get yeast infections when pregnant. About 20% to 30% of women get a yeast infection during pregnancy.^7,8

Symptoms include the following:⁴

• Thick white chunky discharge
• Mild but not foul odor
• Itching around the vagina – often intense
• Painful sex
• Pain when you urinate
• Red and swollen vulva

You will need an antifungal medication if you get a vaginal yeast infection. During pregnancy, the most common treatment is topical creams applied inside the vagina. These medications are available over the counter. Some medicines are safer for pregnant women, so consult your healthcare provider regarding which medication to use.⁸

Trichomoniasis (or trich)

Trichomoniasis is one of the most common sexually transmitted infections (STI) in the world. A parasite causes it. When pregnant, this infection is serious because it is associated with preterm birth, your bag of water breaking early, and low birth weight. Only about 30% of women with this infection have any symptoms.^9,10

If you do have symptoms, they may include the following:⁴

• The amount of discharge can vary from scant to profuse.
• Foul or offensive odor
• Itching around the vagina
• Painful sex
• Pain when you urinate

If you have trichomoniasis, you need metronidazole (Flagyl.) You take this medicine by mouth. Your partner also needs to be treated. Do not have sex until both have you have completed your medication and don’t have any symptoms.¹¹

When to Seek Medical Attention

It’s time to schedule an urgent appointment with your prenatal provider if you have unusual leukorrhea discharge. Abnormal discharge includes unpleasant odor, change in color, vaginal itching or irritation, or you have pain when you urinate. Don’t try to diagnose and treat yourself.

You must also contact your doctor or midwife if you experience vaginal bleeding during pregnancy. Several things can cause vaginal bleeding at different points in your pregnancy. Anytime there is bleeding, contact your provider unless your baby is due and you have bloody mucous discharge. A mucous discharge with blood indicates your body is getting ready for labor.³

Amniotic fluid is watery and usually clear or pinkish. The fluid does not come in a single episode but will keep coming. It is easy to confuse heavy leukorrhea with amniotic fluid. Sometimes it must be confirmed if your water broke and requires an evaluation. Contact your provider or go to the hospital promptly if your water breaks.¹²

Prevention Strategies

Here are a few tips to help maintain healthy leukorrhea discharge in pregnancy:^3,13,14

• Avoid using tampons, as they can introduce new germs into your vagina.
• Don’t douche or use wipes or sprays, as these can upset your normal balance of healthy bacteria in the vagina.
• Avoid wearing tight-fitting underwear, as this can increase moisture in your vaginal area, making you more prone to yeast infections. Wear loose cotton underwear.
• Practice good hygiene after sex. Clean around the vaginal opening with soap and water after sex. Don’t engage in sexual activity that could bring bacteria from the rectum to the vagina.
• Always wipe from front to back when using the toilet to prevent bacteria from the rectum from entering your vagina.
• Eat yogurt with live cultures of bacteria or take a probiotic supplement. The live bacteria cultures help to prevent yeast infections.
• Use condoms to prevent trichomoniasis infections and lower your chance of getting bacterial vaginosis.
• Lower your amount of stress. Increased stress raises the stress hormone cortisol, increasing your risk of vaginal infections.

Who knew there was so much to know about leukorrhea discharge? Leukorrhea in pregnancy can become quite heavy toward the end of your third trimester. Even though this is normal, it can also be annoying. There are many steps you can take to help keep your leukorrhea healthy and to be more comfortable. Knowing what healthy leukorrhea is and what is abnormal can help you decide when to call your healthcare provider. If you have any concerns, please talk to your doctor or midwife.