Through any challenging time, using affirmations is an effective strategy to control our mindset, reduce anxiety, and improve our overall ability to believe in ourselves. Mothers could use affirmations to help get them through the hardest days, as this job is the toughest one in the world. And it starts at the beginning — the very beginning. Birth affirmations are a way women can coach themselves and find the inner strength to endure labor and delivery.

What are Birth Affirmations?

Birth affirmations are personal statements you choose to help you endure the intense and painful labor and delivery experience. They are a mindfulness technique — you are training your brain to focus on your strength.¹ And how capable you are. And how you are, in fact, ready for this and that you will get through it.

Positive birth affirmations might include statements like “My body is strong” and “Every contraction brings me closer to my baby.” But it’s truly up to the mother to decide what types of messaging will resonate with her and effectively reduce negative and sabotaging thoughts.

Birth can be grueling, and mothers often feel defeated when things don’t go as planned. (Because babies don’t always follow birth plans as they make their way into this world. They are already letting us know that they run the show!) That’s why having a few positive words of encouragement for labor and delivery in your proverbial “back pocket” (likely just written down somewhere where you can see them easily or even saved in your phone) might be just the trick you need to get through that final push.

7 Benefits of Birth Affirmations

The true benefits of birth affirmations will vary from mother to mother, but in general, they serve to calm the mind and recenter your focus so you can find the inner strength you need to keep going.¹ Here are some potential advantages of using birth affirmations:

1. They Can Foster a Connection With Your Body and Your Baby

By training your mind via birth affirmations, the mother will continuously center herself around what her body is doing and how two lives are coming together to achieve something that is heroic and miraculous.

2. They Can Help You Feel Empowered and Believe That, Yes, You Can Do This

Sometimes, especially when we’re really far into the labor and delivery process, moms need a boost of confidence, as we can feel defeated by exhaustion and pain. Positive birth mantras empower us to believe that we are stronger than we realize and still have the energy to continue. The emotional support provided by affirmations helps solidify a feeling of competence in the mother.²

3. Birth Affirmations Can Help with Pain Management

Pain management, in general, can often be managed via mindfulness techniques like repeating birth affirmations to oneself.^1,3 Labor and delivery is definitely a painful experience in which such mindfulness training can be very effective because the pain during childbirth serves a function — it lets us know what our body is doing — and we must be in tune with the pain. However, taking slow, deep breaths, picturing certain images in the mind, and repeating positive birth affirmations over and over can help us cope and work through the pain.^3,5

Affirmations “are not intended to ‘fix’ or solve your pain,” Psychology Today explains. “The practice keeps your attention in a powerful place and your brain can create new circuits in response. However, it is also important to allow yourself to feel the mental or physical pain before you redirect.”⁴

4. They Can Help You Feel More in Control

One of the hardest parts of labor and delivery for me was the lack of control and not knowing how it would all go. And while, yes, it’s true that there are some things we have to leave up to the powers that be (and let baby run the show!), positive birth affirmations can help us remember that we can control our mindset.

5. Birth Mantras Help in Reducing Stress

Stress tenses the body, prolonging labor and releasing stress hormones called catecholamines. Stress hormones suppress oxytocin, the hormone that gets your uterus contracting. Less oxytocin means a slower, longer labor that might need to be augmented with Pitocin, a synthetic oxytocin.⁶ It is hard to relax when the body is in pain, but training the mind to be calm is one way to help fight those stress responses as painful contractions hit.

But mindfulness techniques (like telling yourself positive affirmations over and over or seeing them written on the wall where you can read them throughout the labor and delivery process) can help reduce stress and increase the likelihood that birth will go according to plan.

6. They Lead to Reducing and Releasing the Fear of Labor and Delivery

With my first child, I was scared of what would happen to my body through labor and delivery and if my baby would be okay. Like stress, fear can cause the body to tighten and tense, making for longer labor, and anxiety or nervousness in pregnant women increases the risk of dystocia (difficult or obstructed birth).⁷

Birth affirmations remind the fearful mother, especially if this is her first experience through labor and delivery, that she is strong, capable, and can handle whatever is coming her way.

7. They Reduce the Likelihood of Unwanted Medical Interventions

Many pregnant mothers desire a birth with limited or no medical interventions, and positive birth affirmations can help achieve that by keeping the mind and body more calm and the mother more focused on what she needs to do. Having delivered three babies, I know first-hand that the longer labor takes, the more likelihood of medical interventions. Doctors want to get that baby out to minimize the stress labor can put on both the mother and baby. Relaxing your body and mind might help your labor move along more quickly and reduce the chances of medical interventions.²

How To Use Positive Birth Affirmations During Your Labor

One way to use positive birth affirmations during labor is to memorize key phrases you believe will help you endure the process best. Repeat them and consider asking your support person(s) in the room with you to say them as well.

You also might consider writing them down onto affirmation cards or hanging them on the wall where you can see them easily through all phases of your labor. Another option is to have your birth affirmations on a recording of some kind where you can hear them through a speaker in the room or even headphones if you prefer a softer, more personal connection.

But most importantly, as the mother, you need to be all-in. In my experience, birth mantras will only work if you’ve chosen statements that resonate with you, that you’ve practiced through your pregnancy, and that you embrace with your whole being. Jotting down a few motivational sentences on your way to the hospital isn’t going to cut it — utilizing birth affirmations means figuring out what works for you, knowing what you need to hear when things are really, really hard, and practicing saying them to yourself over and over until you believe them.

25 Labor Affirmations To Consider Using

Labor affirmations come in all forms, and finding a list that truly resonates with you is important. I need to hear that I am strong and can do hard things. What do you need to hear when things are challenging for you? Here are some examples of labor affirmations and birth mantras:

1. My body knows how to give birth.

2. I trust my body.

3. My body is strong.

4. I can do this.

5. I am ready for this.

6. I trust that my baby’s birth will happen when needed.

7. I accept that my baby’s path to being born is right.

8. I relax my body so that my baby can relax.

9. I breathe deeply and calm my mind and body.

10. My body is doing its job.

11. I find more strength with each inhale and release pain with each exhale.

12. I will meet my baby soon.

13. Each contraction brings me closer to my baby.

14. This pain is temporary.

15. I am stronger than the pain.

16. I have the power and strength to birth this baby.

17. I am proud of how strong I am.

18. I am brave.

19. I am safe. My baby is safe.

20. I can do hard things.

21. I can let my body take over and do what it needs to do.

22. I am doing my best and doing an amazing job.

23. I know I can do this because I’m already doing it.

24. This is our journey together — mine and my baby’s. And we’re doing it.

25. Women all over the world are doing this right now too. We’re all in this together.

There are endless options for birth affirmations that might resonate with you. Learn what works for you through other stressful moments in your life and start compiling mantras to consider as you near labor and delivery. Soon, you’ll have your list ready, packed neatly in your hospital bag, or taped to the wall in your delivery room. You got this, Mama. You are strong and brave.

Whenever I get asked the question, “What do you do?” I know that I’m about to enter into a conversation — or potentially a monologue — rather than just giving a quick response. It would be wonderful if people understood what a doula does as quickly as they know: “I am a teacher,” “a counselor,” or “an accountant.” But when I reply, “I’m a doula,” I begin to prepare myself to give my explanation.

Most people don’t know what a doula is. So it never surprises me when the person I’m speaking with looks perplexed and has no idea what I’ve just said. Let me say. I don’t mind explaining. It allows me to share my passion and educate someone on a service they or a family member or friend might be interested in using.

What does surprise me and excites me is speaking with someone who DOES know what a doula is. I love hearing their stories about how they heard about doula care. Or how their friend hired a doula or their family member is a doula. Unfortunately, that only happens on rare occasions. I still find myself educating most people on what a doula is and what we do for families.

You, our readers, may not know what a doula is. Today, I wanted to take a few minutes to share the answers to some common questions. So, let’s start from the very beginning. It’s a perfect place to start. 😉

What is a doula?

The word “doula” — pronounced ‘doo-la’ — is an ancient Greek word meaning ‘woman servant, caregiver, or a woman who serves.’ ¹ More recently, it refers to a trained and experienced professional who provides continuous physical, emotional, and informational support to the mother and her partner during pregnancy, labor, childbirth, and their postpartum journey.

There are two main types of doulas: Birth Doulas and Postpartum Doulas. Birth Doulas are trained professionals who support women and their partners during pregnancy, childbirth, and immediately postpartum. Postpartum Doulas are trained professionals who support families during their transition into parenthood during the postpartum period (the first 12 weeks after birth).

A doula’s role has also evolved, and more specialties are available in doula care. There are:

• Antepartum Doulas support pregnant women on bedrest or in high-risk or high-stress pregnancy situations.
• Bereavement Doulas provide emotional, physical, and informational support to women and families processing the loss of a child.
• Adoption Doulas build relationships with the birth mother and the adopting or fostering family. Sometimes, it’s just with the birth mother or the adopting or fostering family.

What does a doula do?

Birth Doulas typically offer to meet with each of their clients several times — two, three, or four times — for prenatal visits to go over each couple’s wants and desires and educate them on the options that are and will be available to them. This allows the doula to better support each family during labor and birth.

Birth Doulas bring an entire toolbox of ideas, tricks, and techniques to the birth. Your doula may rub your back for several hours or trade off with your partner in that role when his hands are aching, and he needs to eat and rest. She may be the quiet, calm, reassuring voice whispering in your ear or the firm and anchored voice that will help you get back on track when labor starts to feel intense and overwhelming. She can help you focus on natural ways to help your labor progress (if you want to have an unmedicated birth).

Or she can help you decide which medications you want to use and when the best time is during your labor to get them. Your doula can help straighten out a baby that’s slightly malpositioned in the pelvis, and she can give you ideas on negotiating with the staff to achieve some important elements of your birth plan.

Birth Doulas offer a lot of support to the husband or partner, showing him and other loved ones how they can best help you and reassure them about what’s normal. Your doula might offer a hand massage to help you rest and relax. She can explain your options and help you brainstorm questions when facing medical interventions for you or your baby. Occasionally, doulas’ help and reassurance after birth might be key to establishing your nursing relationship.

Every labor unfolds in its unique way. A doula’s job is to bring her expertise in birth to the table. She will stay fully present and supportive, whatever your family’s needs and desires.

A Postpartum Doula’s role is unique to every family. Essentially, she will come into your home, assess your needs, and jump in to help. Your doula’s role is to nurture you as you transition into life with your new baby. This could include help with breastfeeding, suggestions, information about baby care, and resources to heal your body postpartum. She is like a teacher, sharing evidence-based information and helping you integrate the baby into your family. If you need a shower or a nap, she can help take over baby care. She can also show you how to use several different baby carriers, how to use your breast pump, suggest which diapers, diaper creams, baby detergent, etc., you might want to try, and more. Postpartum Doulas can also do light housekeeping, such as washing dishes, wiping down counters, and doing baby’s laundry.

If you have older children, she can spend time playing or working with them to adjust to the big sibling role. She can also run errands for you and pick things up if you cannot drive yet or haven’t been able to get out of the house. Doulas come in with a keen sense of what new families typically need. She will then work with you to decide how she can best support you through the transition into parenthood.

What are the benefits of hiring a doula?

Numerous studies have documented the benefits of having a doula present during labor and postpartum.^2,3,4,5,6,7 A Cochrane Review, Continuous Support for Women During Childbirth, showed many positive birth outcomes when a Birth Doula was present.² With the support of a Birth Doula, women were less likely to have pain-relief medications administered and less likely to have a cesarean birth. Women also reported having a more positive childbirth experience. Here are some of the stats:²

• Decreases the overall cesarean rate by 50%
• Reduces the length of labor by 25%
• Decreases the use of oxytocin by 40%
• Reduces the use of pain medication by 30%
• Decreased requests for an epidural by 60%
• Reduce the number of days newborns spend in the NICU (neonatal infant care unit)
• Reduce the rates of postpartum depression
• Increase the rates of breastfeeding
• Increase the positive maternal assessments of maternal confidence and newborn health

Studies show that having a Postpartum Doula after childbirth results in the following:⁴

• Greater satisfaction with the postpartum period
• Quicker birth recovery
• More likely to eat healthier and sleep more
• More confidence in parenting and childcare
• Less stress and anxiety
• A more positive opinion of baby
• More affectionate to baby
• Less incidence of postpartum mood disorders
• Higher breastfeeding success rate

These are fantastic results! Who wouldn’t want to improve their chances of having a better overall experience during labor and bringing baby home?

My husband/partner/mom/friend will be my labor support person. Do I still need a Birth Doula?

I know that dads are sometimes nervous that a Birth Doula might take over their role and that they’ll be “shut out” of the labor process. That is not the case at all! Dads and doulas actually complement each other in labor.

A doula is similar to a foreign country tour guide or a team coach. Your tour guide doesn’t take away from your trip. She enhances it for both of you. And how are you supposed to win a game if you have never played the game before? (Assuming your husband hasn’t coached you or any other women in labor.) Your coach can help lead you to victory! The same is true of a doula. She can help you both navigate the healthcare system and understand the process of labor and birth.

Doulas often find themselves reassuring dads/partners about the normal sights and sounds of labor, which can be disconcerting to even the best-prepared support person. A doula shows Dad’s techniques to help the laboring woman based on what is happening in her body—for example, if she is experiencing back labor. “We might try this counter-pressure technique. Let me show you exactly where to put your hands.” Relaxing in the bath? “How about gently pouring water over her belly with each contraction, like this.” Is mom laboring in the bathroom? “Here, let me get the birth ball so she can lean forward into your chest to rest between contractions.”

During labor, moms usually retreat into their own private “labor land.” Doulas often bond with the dad during birth as they work together to figure out the best way to support the laboring woman. This is why dads/partners are generally happy to have another “birth partner” with them for the journey!

Friends and family members can also be wonderful labor support people, but their role differs distinctly from a doula. Doulas bring specialized training in birth and labor support. She has seen many births in various settings and can help familiarize you with what to expect at each stage. She doesn’t have the same emotional attachments as your family, so separating herself from your choices is easier.

A doula is there to support you in whatever kind of birth you want, whatever that looks like for you. You don’t have to worry about what a doula might say or do in any given situation, as you may with some friends or family members. She’s there for your unconditional support. She can also support your friends and family, just as she supports dads and partners in the birth space.

I’m getting an epidural. Do I still need a doula?

Doulas come to your birth with an open mind and an open heart. She is not there to carry out some agenda; she’s there to help you have the best birth possible, whatever that looks like for you. She’ll talk in-depth during prenatal meetings to learn more about what kind of birth you envision. Then she’ll put all of her energy into helping you get there. And if you get into labor and, for whatever reason, plans change, a doula can help you cope with the unexpected turn of events.

There’s a lot a doula can do if you opt for pain medication, including position changes and other tricks to help your baby descend. She can also help you cope with the medication’s physical side effects to continue making your journey as comfortable as possible.

I also hate to say it, but sometimes pain medication doesn’t work as expected, but mom’s movements and coping tools are suddenly limited with those medications — a doula will get you through it.

What if I need to have a C-section? Do I still need a doula?

A doula can do many things to help make a cesarean birth the most loving, family-centered experience possible. For example, she can be with you before the surgery to help with relaxation and brainstorming questions for your healthcare team. She can help advocate for some things you might want during the surgery. For example, working with surgeons and anesthesiologists to allow skin-to-skin contact on the operating table while the surgeon finishes the operation. This is so much more family-centered than taking the baby to the nursery or the recovery room to wait for you, and we have found that it significantly decreases birth trauma for the mother. But it often requires some advocacy with the staff—a doula can help with those negotiations.

Doulas can sometimes stay with you and your partner in the operating room during the surgery. However, this is always a case-by-case decision by your surgeon and anesthesiologist. If a doula is allowed in the OR, she can help explain what is happening during the surgery. She can show your husband or partner some physical comfort measures that may help you deal with the sensations of surgery. Sometimes, a baby needs to go to the nursery or the NICU after a cesarean birth. In this situation, the dad or partner generally goes with the baby, and the doula will stay by your side. This helps mothers not feel so alone as the surgery is finished and recovery begins, and it helps partners not feel so torn between mom and baby.

In most cases, the baby will go with the mom to a recovery area, where a doula can help you establish nursing and skin-to-skin bonding. And finally, if the cesarean is unexpected, a doula will offer a compassionate, listening ear to help you process the birth. She can also connect you with resources.

I will have help from my family after the baby is born. Do I still need a Postpartum Doula?

Your husband/partner, family members, and friends can offer wonderful support in the days and weeks postpartum! Some of their skills may spill over into the postpartum doula realm, and others are quite different. Postpartum Doulas are great listeners and can support you in forming your parenting philosophies based on research-based information. Postpartum Doulas are an objective source of information and support. They can help you and your husband or partner adjust to life with this new little person. Many family members and friends have found that they are actually more involved in caring for mom and baby with a Postpartum Doula’s help. This is because they learn exactly how to be most supportive.

Caring for a new mom and baby can also be overwhelming for others. Postpartum Doulas can help share that nurturing role. She can also help dads and partners know how to help the new mom. Additionally, she will reassure them about what is normal for babies and postpartum mothers. Siblings have a big adjustment, too, and a Postpartum Doula can help ease that transition. They can spend time playing and talking about their new role and help the parents with tips on interacting and entertaining older children during the intense weeks when mom is healing and a newborn needs so much attention.

Postpartum Doulas can also help new families recognize the symptoms of imbalance and connect them with resources for help. They are good listeners and can lend an empathetic ear to the new mom. Or help take care of other household responsibilities while she is focusing on getting well. There is also some evidence that using a Postpartum Doula can help reduce the chance of developing postpartum depression.⁸

Overall, a doula believes in ‘mothering the mother.’ She has the experience and training to support women during these different times to make their experiences during pregnancy, birth, and motherhood the best they can be.

For more, listen to our podcast episode where two doulas talk about a doula’s role.

Umbilical cord prolapse is rare but can happen to anyone during any pregnancy, whether it’s your first or your fifth. However, it only occurs in about 1 to 6 deliveries out of every 1,000 births. The odds are in your favor. But this emergency means ensuring you have a qualified and experienced person helping with your delivery.²

The umbilical cord is your baby’s lifeline. It gives your baby nutrients and oxygen while still in your womb. When the umbilical cord prolapses or falls through the cervix into the vagina or birth canal before the baby, this can cause the baby’s oxygen and nutrients to decrease, which could lead to severe complications such as fetal distress, fetal demise, hypoxia, or hypoxic-ischemic encephalopathy, cerebral palsy, brain damage, or stillbirth.^1,3

What Is Umbilical Cord Prolapse?

Umbilical cord prolapse happens after your water breaks, and the umbilical cord slips out of the uterus, through the cervix, and falls into the vagina or birth canal ahead of the baby during labor or delivery. In a typical delivery, your baby drops through the dilated cervix before the umbilical cord. If the umbilical cord comes first, it can get squished by the pressure of your baby’s body. Each contraction of the uterus also squeezes the cord. This life-threatening event requires immediate medical attention as it can create severe complications for the baby, such as compromised blood flow and oxygen supply. This complication usually occurs during labor, typically right before or during delivery.¹

What Causes Umbilical Cord Prolapse?

We can’t predict who will have a prolapsed umbilical cord with their delivery, but several risk factors can increase the risk of a prolapsed cord, including:^{1, 2}

• Premature rupture of membranes: When your water breaks before the baby’s head engages in the birth canal, the cord will have more space to slip through.
• Malpresentation: If the baby is in a breech position (when any other part of your baby comes out first instead of the buttocks), it can increase the chances of a prolapse.
• Multiparity: You are at a slightly higher risk if you have had multiple pregnancies and deliveries (usually five or more).
• Polyhydramnios: When there is excessive amniotic fluid in the uterus, it can increase the chances of cord prolapse.
• Preterm labor: Preterm births are more prone to umbilical cord prolapse.

But umbilical cord prolapse can happen without these risk factors. Certain conditions may increase the chances of a prolapse. These other risk factors include:^1,2

• Fetal congenital disorders
• Placenta previa
• Irregularly shaped umbilical cord (too long, very thin, etc.)
• Assisted vaginal delivery (using a vacuum or forceps during delivery)⁴
• Low birth weight (weighing less than 5 pounds, 8 ounces, or 2.5 kilograms at birth)⁵
• Being pregnant with twins, triplets, or more (also known as having a multiple pregnancy)
• Irregular cord insertion to the baby (velamentous cord insertion)⁶
• High fetal station (the fetal station is the baby’s position relative to your pelvis during labor)
• Macrosomia (your baby is larger than the average newborn).⁷
• Procedures like amniotomy, when your provider breaks your water for you or inserts a balloon to ripen your cervix.⁸

How Is It Diagnosed?

Your provider and staff are trained to watch for this during labor and delivery. They will look for common signs and symptoms of cord prolapse. These may include:^1,2

• Visible or palpable umbilical cord protruding from the vagina.
• Fetal heart rate changes, such as decelerations or bradycardia (when the baby’s heart rate slows down too much).⁹
• Sudden and severe fetal distress.
• A prolapsed cord can be felt during a vaginal examination when they check your cervix’s dilation progress.

How Will Your Provider Manage a Prolapsed Cord?

If umbilical cord prolapse is suspected, your provider will quickly relieve the pressure on the prolapsed umbilical cord to make sure the baby receives adequate oxygen and blood supply. This may involve changing the mother’s position, elevating her hips, or using the Trendelenburg or knee-chest position.¹⁰

Your provider could also insert a gloved hand into the vagina to manually move the baby’s head off the cord. Delivery of the baby must occur as quickly as possible to prevent any potentially life-threatening outcomes. In most cases, the provider will perform an emergency Cesarean section to expedite the delivery and minimize the risk to the baby. A fetal monitor will continuously show the baby’s heart rate, which will help the provider decide what plan to follow.^1,2

Can It Be Prevented?

Unfortunately, a prolapsed umbilical cord cannot be prevented. It’s also difficult to detect during pregnancy because of the frequent movements of the baby and the cord. Some of the risk factors for a prolapsed cord can be noted as part of the mother’s birthing plan so that the parents and the medical providers know the possibility of a prolapsed cord. But it comes down to your provider acting quickly if a prolapsed umbilical cord occurs.

Can Babies Survive a Prolapsed Umbilical Cord?

Most babies do survive a prolapsed umbilical cord. In hospitals, the number of babies that die from a prolapsed umbilical cord is about 3%. However, one study did show the rate as high as 7%. When a baby is born outside of a hospital setting, the infant death rate is almost 20 times higher.¹

Umbilical cord prolapse is a rare obstetric emergency during or just before delivery. Still, your healthcare team will work quickly to deliver your baby if they detect a problem. There’s not much you can do to avoid one, but knowing the risk factors and what action needs to be taken may help you in the unlikely event it happens during childbirth.

Your doctor may suggest a labor induction for many reasons. Whether you are overdue or you have pregnancy complications such as preeclampsia or placental problems, there comes a point where your baby may be safer on the outside than staying in. However, sometimes your baby doesn’t know that and needs a nudge to come out, like with a Foley bulb induction. There are many modes of encouraging your baby and your body to start labor. After assessing you, your provider will choose the best one for you, depending on your body’s readiness.

One of these methods of labor induction is called a Foley bulb. A Foley bulb, also called a balloon catheter, can soften, thin, and dilate the cervix. This may also cause labor contractions to start. Even if the Foley bulb does not directly start contractions, a cervix dilated by a Foley balloon is more susceptible to future contractions of active labor. Once your cervix appears ripe for labor, you can move on to other modes of induction.¹

What is a Foley Bulb?

A Foley bulb was initially designed as part of a urinary catheter or a tube that drains urine from the bladder. When used for this purpose, the bulb is threaded through the urethra and into the bladder. Once it is in the bladder, the balloon is inflated with salt water to hold the entire catheter in place to drain urine. You may have a Foley catheter placed during labor and delivery, especially if you have an epidural.^1,2

How Does a Foley Bulb Work for Labor Induction?

The balloon part of the Foley catheter can also ripen your cervix to induce labor. Instead of being threaded through your urethra to your bladder, the deflated balloon is inserted through your vagina and cervix. Your cervix must be slightly dilated for insertion to take place.³

The Foley bulb sits under your baby’s head at the bottom of your uterus. Once in place, your provider will inflate it with one to two ounces of water. This inflation holds the balloon in place and puts pressure on your cervix to help it dilate.^1,3

How Long is the Foley Bulb in Place?

The Foley bulb can remain in your uterus for up to 24 hours. If cervical dilation has not happened by this point, your provider may remove the balloon and try a different method of cervical ripening and induction.^1,4,5

If the Foley bulb is successful, it will fall out on its own, perhaps even less than 12 hours after insertion. Typically, the balloon falls out when your cervix is dilated to 3 centimeters. Sometimes, a Foley bulb can stretch your cervix enough so that your water breaks, and it can sometimes cause contractions to start.¹

How Does a Foley Bulb Induction Feel?

A Foley bulb induction may feel like a pelvic or cervical exam, like when your provider checks you for dilation. Some women experience significant pain with the Foley balloon, especially when it is initially inserted and inflated. Others report only pressure. The pressure and pain will likely lessen after insertion and sit in your cervix.¹

A healthcare team member can either insert the Foley bulb using their fingers or a speculum. Studies show the speculum was the more painful method of insertion. If you are planning for a Foley bulb induction, consider asking your provider if they can insert it manually.^6,7

What are the Risks of Foley Bulb Induction?

A Foley bulb induction is safe, but there are a few risks. It may fall out and not work, and it may be painful. Reaching the desired dilation from a Foley bulb can also take a long time. Rarely, it can cause infection by introducing germs into the uterus.¹

What are the Benefits?

A Foley bulb induction uses no medications and is a relatively low-cost, effective intervention. A Foley bulb induction dilates the cervix to 3 centimeters about 70 percent of the time. Your provider can remove it at any time if necessary. It is safe for women who have undergone a Cesarean section because it does not pose a risk of an overstimulated uterus. You can combine a Foley bulb induction with medications to ripen the cervix if necessary.¹

What are the Alternatives?

Despite the benefits of a Foley bulb induction, there are alternatives to consider for ripening the cervix.

Breaking Your Water

An alternative to a Foley bulb induction is breaking your water. Your provider may suggest this to increase pressure on your cervix and start labor. However, breaking your water may be more effective once your cervix is ripe and is only safe if your baby is already low in your pelvis.³

Membrane Sweep

With your consent, your provider may attempt a membrane sweep using a gloved finger to separate the amniotic sac from your cervix. This causes the release of chemicals that sometimes help labor to start within the next 24 to 48 hours. These natural chemicals are like medications sometimes used to ripen the cervix. However, a membrane sweep avoids induction and is not considered a formal induction technique.³

Medications

Instead of a Foley bulb to ripen your cervix in preparation for an induction, medications such as Cervadil or Cytotec (misoprostol) can be used. They can be administered orally, in your cheek, or vaginally.⁴

These medications are slightly more effective at ripening the cervix. Still, they are also more likely to cause uterine hyperstimulation, fetal distress, and the need for instrumental vaginal delivery like forceps or vacuum births. They cannot be used if you have had previous uterine surgery, including a C-section.^3,8

Pitocin through an IV is also an effective induction agent, but it works better on a ripe cervix. Pitocin alone takes a long time to ripen your cervix, and prolonged exposure to Pitocin during labor increases your risk for postpartum hemorrhage. However, Pitocin is the only medication safe for cervical ripening in patients with a history of uterine surgery.³

Inducing labor can be overwhelming and can take a long time. You can take it one step at a time by using the Foley balloon by ripening your cervix without medication. Many people find this a manageable place to start when encouraging their bodies to kickstart labor without medication. Learning your induction options based on your cervical status can help you and your provider determine where to start.

If you are having a vaginal delivery, a non-complicated birth is what you would likely want. But sometimes you and your medical provider may require assistance through forceps delivery. Going into labor is exciting, but it can also be nerve-racking. You are excited to meet your little bundle of joy, but you may also have a million questions running through your mind, like what are forceps, and what is a forceps delivery? These questions are entirely normal, and though you might be informed on a gazillion pregnancy and delivery-related topics, it’s normal to worry about your child’s birth.

What is Forceps Delivery?

Forceps delivery is a form of operative vaginal delivery involving forceps to deliver the baby. Though there are over 700 different types of forceps, they are classified into three main groups:^1,2

• Outlet forceps
  • Scalp is visible
  • Fetal skull reached the pelvic floor, and the head is on the perineum
  • Rotation does not exceed 45 degrees
• Low forceps
  • Leading point of fetal skull at >= +2, not on pelvic floor
  • Rotation 45 degrees or less (LOA/ROA to OA or LOP/ROP to OP); or rotation greater than 45 degrees
• Mid forceps
  • Baby’s head is above +2 centimeters

Typical components of forceps include handles, a lock, shanks, and blades. Though all forceps look similar and have similar features, medical providers use different ones depending on the baby’s position.²

How Common is Forceps Delivery?

The use of forceps has declined in recent decades, and a study, which took into account 22 million vaginal deliveries from 2005 to 2013, found that forceps were used only in 1.1% of cases. The decline in forceps deliveries has been associated with fears of an increase in the risk of tearing, injury to the baby, and lack of experience among doctors.³

What Causes You to Have Forceps Delivery?

Your medical provider may suggest forceps delivery for several reasons:^1,4

• You’re too tired to push anymore.
• Your health history may mean pushing for too long may be a problem.
• Your baby’s heart rate is a concern.
• Your baby doesn’t want to come out, and labor stalls.

A forceps delivery isn’t a choice your doctor can take lightly due to the increased risks of injuries. Hence specific criteria must be fulfilled to go ahead with it. The following criteria are recommended for a forceps or vacuum-assisted delivery to take place:³

• Complete dilation of the cervix.
• Membrane rupture
• The head of the fetus is engaged.
• The fetal position is known.
• There’s an estimate of the weight of the fetus.
• Mom’s pelvis should be adequate for the baby to pass through.
• Administration of anesthesia.
• The mother’s bladder is empty.
• Consent is given with an explanation of the risks and benefits.
• A backup plan is in place.
• When pushing isn’t feasible, the mother has a cardiac or neurologic disease.

How is the Procedure Performed?

Depending on the baby’s position, your provider will select the proper pair of forceps for the procedure. The fetus naturally undergoes a set of movements to negotiate the birth canal called cardinal movements. There is some professional disagreement on whether there are seven or four of these cardinal movements, which include engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion.^1,5

If the fetus does not complete all the cardinal movements, your provider can use forceps to help it. For example, if your baby only engages your pelvis, it will need help completing the rest of the movements to descend through the birth canal.

If all the conditions for a forceps delivery are complete, your provider can begin helping the baby through the birth canal. You’ll continue pushing, and someone will use rest periods between contractions to place the forceps on either side of your baby’s head or feet. They’ll use a contraction to apply gentle traction with the forceps to guide the baby out while you push. Your provider may also perform manual rotation to get the baby in an appropriate position.¹

Risks vs. Benefits of Forceps Delivery

Forceps delivery isn’t risk-free, though it does have many benefits, which has led to doctors calling for training in obstetrics to use forceps.

Evidence suggests the use of forceps in deliveries is associated with a lower failure rate than a vacuum. Using forceps also means a Cesarean section isn’t performed, which means less time in the hospital compared to a woman who has undergone a C-section and a faster recovery time. Another significant benefit is that forceps can come in handy when a baby needs to be delivered quickly, as in the case of fetal distress.²

Trauma due to the use of forceps can occur to the mother or the fetus. Maternal trauma includes increased perineal and vaginal trauma such as third or fourth-degree tears, urine and fecal incontinence, hematomas, and long-term complications of pelvic organ prolapse.³

Fetal trauma includes injury to facial nerves, trauma to the skull and brain (skull fracture and intracranial hemorrhage), and even death.³

Forceps Delivery vs. Vacuum Delivery

Despite forceps and vacuum delivery being operative vaginal deliveries, they have considerable differences and benefits.

The advantages of forceps over vacuums include the following:^2,3

• Faster delivery of a fetus in distress
• Lower failure rate
• Unlikely to detach from the fetus’s head
• Allows rotation of the fetus
• Less encephalopathy and bleeding from the scalp
• Fewer cases of cephalohematoma
• Fewer cases of retinal hemorrhage
• It can be used in premature fetuses

The disadvantages of forceps include:²

• Stronger anesthesia is needed for the mother.
• Facial bruising and injury to the facial nerves resulting in paralysis palsy are more common while using forceps.
• Greater perineal trauma, which means trauma to the mother’s genitalia.

Delivery assisted by a vacuum is generally better for the mother, whereas delivery assisted by forceps is usually better for the fetus.³

Recovery

Recovery from a forceps delivery is usually shorter than a C-section and about the same time as an unassisted birth which is why there are calls to train medical professionals to use forceps. Forceps can also prevent other complications due to a C-section, such as infection, repeat Cesarean sections and pain.

Forceps delivery can cause tearing, so appropriate measures must be taken to prepare to suture the lacerations while preparing for the delivery itself. Severe tearing may take longer to heal.¹

The use of forceps delivery has declined over the years, and not all hospitals or medical colleges train physicians and students to use forceps, leading to its decline. It is essential to ask your medical provider if they are trained in using forceps for delivery in case you need to undergo this procedure. A trained professional can ensure the best possible outcome for you and your baby.

Medically induced labor can be a nerve-wracking situation for many pregnant parents. It is necessary and can be comforting to be aware of the available options, like using Cytotec for induction. Understanding the risks and benefits of your choices will allow you to make a decision with your healthcare provider.

Cytotec, also known as misoprostol, is a common labor induction agent. However, as with any medication, there are concerns about its use, the impact on maternal and fetal outcomes, and the risks versus benefits. Advocating for yourself and your baby is a paramount responsibility. Read on to learn more about this method of induction.

What is Cytotec for Labor Induction?

There are several medical options for inducing labor. Mechanical methods such as membrane stripping, amniotomy, or the artificial breaking of water, and foley balloons may induce or augment labor. Medication options for induction include Cervidil (dinoprostone), Pitocin (oxytocin), and Cytotec (misoprostol).²

Cytotec is an FDA-approved medication for decreasing the risk of gastric and duodenal ulcers resulting from frequent consumption of nonsteroidal anti-inflammatory drugs (NSAIDs), especially in high-risk populations such as older people or smokers.⁴

Cytotec has been shown to produce uterine contractions that may jeopardize a pregnancy. Therefore, experts do not recommend misoprostol in childbearing-age persons unless birth control measures are in place. According to the FDA, Cytotec can cause abortion, premature labor, or congenital disabilities.^3,4

Why Do Doctors Use Cytotec for Labor Induction?

Doctors use Cytotec for labor induction because it can produce uterine contractions.^3,4

Misoprostol is a synthetic prostaglandin. Prostaglandins can encourage the onset of labor by stimulating the cervix to soften and stretch. This process may also cause uterine contractions. Using Cytotec to induce labor is appropriate once your baby is at term or you require a medical induction.¹

Cytotec is beneficial if an “unfavorable” cervix needs ripening. An unfavorable cervix can be long, firm, and closed. Cytotec can help to soften and shorten the cervix in preparation for active labor and delivery.⁶

How is Cytotec for Labor Induction Given?

Cytotec is an oral medication you can swallow or take as a buccal (between gum and cheek) or sublingual (under the tongue) medication that dissolves. Cytotec for labor induction can be given vaginally or orally. Hospital systems and providers have different policies, procedures, and protocols. Ask your provider how your choice of birthing place uses Cytotec.⁵

Vaginal Cytotec

Traditionally, vaginal Cytotec is given as a 25-microgram tablet inserted vaginally every four hours. The body slowly absorbs vaginal Cytotec, which has a longer-lasting effect.^2,6

Oral Cytotec

There is no professional consensus on a safe oral Cytotec dose. Doctors use a variety of dosing regimens. Traditionally, oral Cytotec of 50 micrograms every four hours until you achieve active labor.⁶

Conversely, low-dose oral Cytotec is successful at inducing labor while being cost-effective. You can receive low-dose Cytotec as an oral solution with a tablet crushed and mixed in water about every two hours until you achieve an active labor contraction pattern.¹

Oral Cytotec has a fast onset but quickly clears the body, making low-dose oral Cytotec a popular choice in labor management.²

Risks of Cytotec

Prostaglandin administration (Cytotec and Cervidil) for labor induction may cause:²

• nausea and vomiting
• diarrhea
• fever
• uterine hyperstimulation
• fetal distress associated with uterine hyperstimulation
• uterine rupture

It is important to note that Pitocin, or oxytocin, has similar risks.⁸

Benefits of Cytotec

Here is what you need to know about the benefits of Cytotec for labor induction:⁵

• High-dose vaginal Cytotec (50 micrograms or more) and low-dose oral Cytotec solution (less than 50 micrograms) have produced the most vaginal births within 24 hours.
• Low-dose oral Cytotec is associated with lower rates of Cesarean birth.
• Low-dose oral Cytotec had less uterine hyperstimulation — contractions that are too strong, frequent, or long — than the vaginal insert Cervidil.
• Low-dose oral Cytotec gave the most benefit to the pregnant parent and baby.
• Cytotec labor induction decreased the need for Pitocin augmentation.⁷

What to Expect Before Using Cytotec for Labor Induction

Currently, the FDA does not approve Cytotec as a labor induction medication. This is because of its ability to terminate a pregnancy in the first and second trimesters. Cytotec for labor induction is considered an “off-label use,” though it has been widely studied and safely used.⁷

The risks associated with Cytotec and other induction medications sound dangerous for a pregnant parent and baby. It is essential to understand that when these medications are given, your medical team continually monitors your and your baby’s status and uterine activity to ensure your labor pattern is appropriate and your body and unborn baby are responding well.

Safety and appropriateness of medication administration are vital. If at any point this is not the case, your provider will take steps to decrease uterine hyperstimulation or fetal distress.

Cytotec for labor induction is effective and safe for parents and babies when used correctly, despite not being approved for this use. As a patient and as a parent, there are always options. Always bring any concerns you have about medical treatment to your team. It is also important to remember your medical team is highly specialized and has your and your baby’s best interests at heart.

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.

Labor and delivery can be an intense time. You are trying to manage your pain while anticipating finally meeting your sweet new baby and making the best decisions to keep yourself and your baby healthy. When your provider suggests a second-stage intervention like a vacuum birth to help labor along and keep you and your baby safe, understanding the benefits and risks is a good idea.

A vacuum-assisted birth may also be called “vacuum extraction” or “operative vaginal birth,” though “operative vaginal birth” can also mean a forceps delivery. Understanding what a vacuum birth is, why it might be used, some benefits and risks, and recovery is essential.

What Is a Vacuum Birth?

A vacuum birth uses a suction device to help quickly guide and pull the baby out of the birth canal. The suction device can be made of either metal or a softer material. The metal device is more likely to cause injury, but the soft material detaches from the baby’s head more often.¹

A medical provider applies the vacuum to a specific spot on a baby’s scalp located over the hard area between the baby’s front and back fontanelles or soft spots. When correctly placed, the vacuum can help position the baby’s head to flex, rotate, and come down and out of the birth canal easily.¹

Once a provider confirms the correct placement, they turn the suction on and increase it until the device indicates it is in the “green zone.” Your provider will pull down on the vacuum using one hand while using the other hand to make sure the device stays attached to the baby’s head. They apply suction each time you have a contraction and are pushing. The suction can stop once the baby’s head is visible and emerging, and the rest of the delivery proceeds normally.¹

Why Might You Have a Vacuum Birth?

Vacuum birth can speed up a vaginal delivery if the mom or baby is not tolerating labor and the baby needs to come out quickly. It is faster than a C-section, which can be critical if the baby is in danger. It is also less invasive than a C-section, especially when the baby has already descended into the pelvis. This usually makes for an easier recovery for the mother.^2,3

Some maternal indications for vacuum birth include exhaustion, a prolonged pushing phase, or pre-existing cardiovascular or neurological conditions preventing her from pushing.¹

Your provider might also perform a vacuum birth if fetal heart rate issues indicate the baby is not tolerating contractions or pushing.¹

When Can a Vacuum Birth be Done?

Pregnancy should be at least 34 weeks along for your provider to consider a vacuum delivery.¹

Vacuum birth can only be used during the second stage of labor or the pushing phase. This means the cervix must be fully dilated, and the baby’s head must be engaged in the mother’s pelvis. Your bag of waters must also be broken.¹

Other requirements for vacuum delivery include the following:¹

• An empty bladder
• A pain control plan in place, such as an epidural
• An estimate that the baby’s head will fit through the mom’s pelvis

To start a vacuum birth, your provider must have your informed consent for the procedure and a backup plan for a C-section if the vacuum delivery fails.¹

How Common is Vacuum Birth?

Vacuum birth accounts for 3-5 percent of all vaginal births in the United States. They are much more common in the South and less common in the Northeast.^2,4

As the C-section rates have climbed, vacuum and forceps deliveries have decreased. You are only eligible for an attempted vacuum birth if you and your baby meet all the criteria.²

How Effective is Vacuum Birth?

Vacuum birth is very effective if used only on eligible patients and performed by experienced doctors. One study showed that an attempted vacuum extraction failed less than 5 percent of the time it was used. Vacuum births are more likely to fail in larger, older babies, taller mothers, experienced mothers, and moms with an epidural or Pitocin augmentation.^4,5

If a vacuum-assisted delivery is unsuccessful within two or three pulls, or the device pops off the baby’s head more than three times, your provider should discontinue attempts and perform a C-section. A vacuum should not be applied for more than 20 to 30 minutes.¹

Potential Risks of Vacuum Birth

Though the rates of serious complications associated with vacuum birth are relatively low, the mother and the baby can suffer consequences.

Maternal Complications

A mother may suffer from vaginal lacerations and vaginal and sphincter pain from a vacuum birth. Your provider should use a finger to ensure that no vaginal or cervical tissue is between the vacuum and the baby’s head before suctioning. This helps to decrease the risk of vaginal injury. Mothers may also experience painful urination, difficulty passing urine, or leakage of urine after a vacuum delivery.^1,2

Fetal Complications

Vacuum birth poses certain risks to the baby from applying suction to their scalp. These risks include bruising and bleeding on the scalp, bleeding within the brain or eyes, high bilirubin levels, and neurological injury. Babies can also suffer skull fractures from vacuum delivery, which are typically minor and heal quickly. Rarely, a skull fracture might need surgery to repair.^1,2

Alternatives to Vacuum Birth

If the risks of vacuum delivery are too high, you can continue laboring as normal. This is called expectant management. Expectant management may be more effective if you turn down having an epidural. This allows you to feel the urge to push and push more strongly. “Laboring down,” or waiting to push even after you are fully dilated, which allows your baby to descend independently, can also increase the success of expectant management.⁴

However, if there is a fetal emergency, your provider will likely advise some intervention instead of watchful waiting. If vacuum assistance is not the intervention of choice, it will either be Pitocin augmentation to strengthen and speed up your contractions and get the baby out or a Cesarean section.⁴

What is Recovery Like After a Vacuum Birth?

If there are no serious complications following a vacuum birth, your recovery will be like any other vaginal birth. Soreness and stinging are normal; your provider may recommend over-the-counter pain medication for relief. If soreness persists, pelvic floor physical therapy can help you fully recover.²

If you suffer from any vaginal tearing and receive any stitches, your stitches may burn or itch, especially during urination. These stitches usually dissolve independently, or your provider may remove them at your follow-up appointment at six weeks postpartum.

You will experience lochia, or postpartum vaginal bleeding, for the next six weeks while the uterus clears any remnants of pregnancy. This is usually normal and not related to having a vacuum-assisted birth. If the amount of blood you lose concerns you, contact your provider.²

Your baby should also recover from a vacuum birth over a few weeks. Any bruising, swelling, and jaundice should gradually disappear, or they may be put under blue lights to help jaundice levels come down. Be gentle with your baby’s fragile head during the first few weeks of life. Be sure to attend all pediatric appointments for your new baby to ensure they recover, heal, and grow as they should.²

Having an understanding in advance of potential labor and delivery interventions can help you to anticipate outcomes. During your prenatal appointments, you can ask your provider about their experience and comfort with vacuum birth if you need help during pushing. While it is not the first-choice delivery form, vacuum birth can help many women achieve a vaginal delivery quickly while keeping themselves and their babies safe.

Childbirth can feel like heading into the great unknown. There are so many options, preferences, and expectations to consider. Birth positions, pain management, medical interventions, skin-to-skin, enemas, and the seemingly inevitable perineal tear. What if I have a 1st-degree perineal tear, 2nd-degree perineal tear, 3rd-degree perineal tear, or even a 4th-degree perineal tear?

The most common question I receive next to pooping during labor is, what happens if I tear? Perineal tears are a normal worry and an expected outcome of vaginal deliveries. Up to 90% of women will experience some degree of perineal tearing or laceration. Below, we will answer all your questions about perineal tears during delivery so you know what to expect.¹

What is a Perineal Tear?

Your body starts preparing for delivery in early pregnancy. Hormonal changes result in increased blood flow to your vagina, which can cause swelling, softening, and elasticity of the inside tissues. You may experience a difference in vaginal discharge. The microbiome of your vagina also changes to ensure a suitable environment for your developing baby.^5,6

The delivery of a baby causes a great deal of stress on the tissues of the cervix, vagina, vulva, and perineum. Your perineum is the area of skin, mucosal tissue, and muscle between your vagina and vulva and the anus and rectum. It is the most frequent place where tears or lacerations occur during vaginal delivery.¹

As you bravely push your newborn into the outside world, your body does its best to stretch and accommodate the head and body of your little one. A tear occurs when the tissues give way, as they often do.

What Causes a Perineal Tear?

Perineal tears occur for a few reasons, a couple of which are beyond our control:¹

• First vaginal delivery
• Large baby
• Rapid delivery
• Episiotomy

Despite your best efforts to prevent tearing during delivery, it is not so easily avoidable. But do not be dismayed. Your work to avoid tearing may decrease the severity of a laceration and aid in a seamless healing process.

Risk Factors for Perineal Tears

There are additional risk factors that may increase your chance of tearing during delivery:^1,4

• Forceps or vacuum-assisted delivery
• Fetal presentation. A “sunny side up” presentation is called an occiput posterior position or a compound hand position where your baby has a hand or arm alongside its head.
• Episiotomy. Though not routinely used in the United States, an episiotomy may be warranted in fetal distress.
• Prolonged pushing
• Asian descent

Four degrees of perineal tearing

The perineal area is full of muscles and soft tissue that provide stability and function to your pelvic floor. Perineal tears are classified by their degree of injury to the structures of the perineum:^1,4

• 1st-degree tear: As the least severe tear, this laceration involves the first layer of vaginal tissue and perineal skin.
• 2nd-degree tear: This most common laceration extends deeper into the vaginal tissue and the perineum muscles.
• 3rd-degree tear: This tear extends deep through the perineum muscles to involve your anal sphincter. The sphincter muscles surround your anus, helping you to control your bowel movements.
• 4th-degree tear: The most severe laceration extends through the anal sphincter muscles into the rectal mucosa.

Tearing in Other Places

It is possible to tear in other places aside from your perineum. For example:

• Your vaginal wall and labia are susceptible, especially if your baby’s hands are near their face during their exit.^1,3,8
• Cervical tears, though uncommon, can occur and often require surgical repair. Lacerations around the urethra and clitoris may also occur.^1,9,10

How Are Perineal Tears Treated

Thankfully, not all injuries to your perineum will require stitches. You may hear your obstetrician or midwife refer to “skid-marks,” especially if it’s not your first delivery rodeo. “Skid -marks” are scratches or cuts that do not require stitching. They only need time to heal and attentive perineal care, much like a scraped knee.

Most degreed tears will require repair with dissolvable sutures or stitches. Tears are repaired as quickly as possible to control bleeding. A local anesthetic such as lidocaine may be superficially injected into the torn tissue for pain control during the repair. If you have an epidural, pain-relieving medication will continue to flow while your tear is fixed. Tissue layers are sutured one at a time, with skin-to-skin being the final layer.¹

Your healthcare team will review the basics of perineal care with you, including a peri-bottle, an endless supply of sanitary pads, and, perhaps, disposable undies.

Complications of a Perineal Tear

Complications of a perineal tear can include pain and infection. Here are the most common complications.

Pain: The Most Common Complaint

Perineal pain is an unfortunate and annoying expectation while healing from a tear. Though this discomfort should not last long, here are some suggestions that may help:⁷

• Rest. We know this is hard, but so crucial in the days following delivery.
• Sitz baths
• Pour water over the area. Those peri-bottles are great for keeping clean and avoiding more abrasive toilet paper.
• Use of stool softeners
• Ice packs or padsicles
• Analgesic creams or spray
• Over-the-counter pain medications

In a few days, the pain will subside and be replaced with soreness and possibly itching as the tissues heal. Speak with your healthcare provider if your pain is significant. Extreme discomfort could indicate more severe complications.

Other Complications of a Perineal Tear

Perineal tears, especially third and fourth-degree lacerations, can potentially cause postpartum complications. Some physical complications include:³

• Wound infection
• Wound separation or dehiscence
• Bowel incontinence
• Urinary incontinence
• Sexual dysfunction

Healthy sexual activity contributes to overall well-being. Wait for the go-ahead to resume sexual activities from your obstetric provider. If you are experiencing discomfort and pain during sex, or are experiencing incontinence, speak with your provider about your concerns.

Perineal tears are a significant concern for many, but you will heal with prudent care and rest. Want the good news? Even if you experience a 1st-degree, 2nd-degree, 3rd-degree, or 4th-degree perineal tear during your first delivery, your risk of tearing a second time is significantly reduced.

In a typical pregnancy, a baby’s head is down by delivery time. This is called the “vertex position.” The head paves the way out of the birth canal, and the baby has less potential for body parts to become stuck when coming out this way.^1,12 However, when you have a breech baby, its head is at the top of your uterus toward your chest, and either its feet or bottom are down toward your cervix.^1,13 A baby can also be transverse, meaning they lie horizontally across the cervix. These breech baby positions can make for a more complicated delivery.^1,13

How Do I Know if I Have a Breech Baby?

Your provider may be able to tell that your baby is breech after seeing the baby’s position on ultrasound, or they may be able to feel your baby’s position by palpating for certain fetal body parts on the outside of your belly.³ Finding out your baby is breech can be scary and overwhelming if you have dreamed of a vaginal birth, but not all hope is lost. You’ll still have some options for your delivery.

Options for Breech Baby Delivery

Here are some of your delivery options if you have a breech baby:

Wait It Out

If you are in your second trimester and your baby is breech, your baby will likely flip on their own. One study showed that a baby at 25 weeks or less was no more likely than a vertex baby to be breech by full-term.² As time goes on and the pregnancy progresses, a breech baby is less likely to flip to head down on their own. Still, by the time a pregnancy has reached full term, only about 4% of babies are breech. If you have some time before you anticipate delivery, you can wait and see if your breech baby flips on their own. Do not let yourself feel pressured into scheduling a Cesarean section for a breech baby when there is still time for them to flip.³

Natural Approaches To Flip a Baby

Instead, if you want to take a hands-on approach to encourage your little one to flip, there are many holistic approaches to flip a breech baby. You can try acupuncture, chiropractic care, and different body positions. If these do not work for you and you hope for a vaginal birth, you still have options.^4,5

External Cephalic Version

An external cephalic version, or ECV, refers to a provider manually rotating the baby through the mother’s abdomen. Not all pregnant women qualify for it, and it does have risks. For instance, it can be pretty painful (some providers offer an epidural). Also, some babies flip back to breech after this procedure. However, it works about half the time at rotating a baby, giving you a better chance for a vaginal delivery.⁶

Vaginal Breech Delivery

Vaginal breech birth has largely fallen out of practice in the United States; however, depending on other circumstances of your pregnancy, there is a debate that breech vaginal birth may still be safe. A large study in 2000 called the Term Birth Trial compared vaginal and Cesarean births for breech babies. Criteria for attempting a vaginal breech delivery included:^7,8

• Gestational age is greater than 37 weeks
• Frank or complete breech presentation (hips and knees are flexed, but feet are not below fetal buttocks)
• Large-enough maternal pelvis
• Estimated fetal weight between 5.5 and 8.8 pounds
• Baby’s head is flexed, not extended
• Sufficient amniotic fluid
• No fetal anomaly or condition that could cause a mechanical problem during delivery
• No known lethal fetal congenital anomalies
• No contraindications to labor or vaginal delivery
• No evidence of fetopelvic disproportion
• The fetus is not clinically large and doesn’t have an estimated fetal weight of 4,000+ grams

However, this study reported that scheduled C-sections for breech pregnancies yielded safer outcomes for babies when compared to vaginal births. Risks to the baby of vaginal breech birth include complications of getting stuck in the birth canal and a prolapsed umbilical cord.^3,9

Maternal complications are similar between vaginal and C-section births of breech babies.⁸ But one study showed that experienced providers might be able to offer vaginal breech deliveries to otherwise low-risk mothers safely. Suppose you are passionate about having a vaginal birth. In that case, it may be worth researching if any providers in your area are experienced and willing to attempt a vaginal delivery with your baby.¹⁰

Cesarean Section

If all these tactics fail to flip your baby and you don’t want to try a vaginal birth, a scheduled surgical birth is always an option. You may also be able to wait until labor begins naturally before you go in for a C-section. That way, your baby and body are still deciding on the birth time.³ If you dream of a low-intervention birth, talk to your provider about ways to make your Cesarean “gentle” or as close to a vaginal birth as possible, from the music playing in the operating room to holding your baby immediately after birth.¹¹

Learning your baby is breech can be disappointing and scary. But just because your baby is breech now does not mean they cannot flip.¹⁴ You can try holistic and at-home methods to encourage your baby to go head down. If these do not work, you may try medical interventions such as chiropractic care and ECV. If your baby remains breech, talk to your provider about your delivery options or change providers to attempt a vaginal delivery. The good news is you and your baby will be just as healthy with the proper care.^13,15 Hopefully, this comes with your ideal birth as well!