Real Talk 29th October 2019 by Valerie Loftus

Poop, Pubes, And Tearing: What No One Tells You About Childbirth

Let's get real about it.

Last month, we broke down a few of the lesser spoken-about aspects of pregnancy, from severe morning sickness to its effect on your feet (yes, feet). Now, we’re moving on to the myriad mysteries of childbirth. Again, we’re not trying to scare anyone with these articles, just provide a little bit of education. Buckle up!

‘Waters breaking’ is not like it is in the movies

We’ve been somewhat misled on how the waters break. In TV shows and films, women gush out a neat little puddle on the floor, immediately feel contractions, and then give birth a few hours later. We spoke to Dr Venita Broderick, Consultant Obstetrician and Gynaecologist at the National Maternity Hospital, who informed us that your waters will gush out, yes, but also continue leaking until the baby is born.

“This does not necessarily mean that you will go into labour straight away. There is no urgency, but it’s best to make your way to the hospital,” advises Dr Broderick.

“In many hospitals you may be kept in at this point, but sometimes you may be able to go home if everything is okay. Approximately 8 out of 10 women will go into labour within 24 hours of the waters breaking – if not, labour would be induced at this point.”

Labour can be induced for many reasons, for example if the baby is overdue (women are usually offered inductions from about 40 weeks + 10 days), if the mother suffers from preeclampsia or diabetes, or if there is a concern that the baby is not growing well.

Birth plans aren’t really essential

You might think you should be rocking up to the hospital with a binder filled with precise instructions for how you’d like the birth to go, but this is not really necessary and may be more of a hindrance than a help.

According to midwife Shelley Carlyle, many stipulations that people include on their birth plans (like putting the baby skin to skin immediately after birth, or asking for your consent before doing anything) are things they would do anyway. You’re better off researching what happens in labour and discussing your wishes with a healthcare professional and whoever is going to be there with you, so they can support you as best they can.

“Pregnancy, birth and babies are extremely unpredictable, and sometimes having a birth plan can be a guarantee that you’ll feel let down by your birth experience, even if everything went well,’ says Shelley. “Being mentally prepared and having the ability to express your wishes, or a birth partner who can do that for you, is much better than having a few things written down on a piece of paper.”

You’re not guaranteed an epidural

Pain relief is probably on many an expectant mother’s mind, and there are a few options – inhaling Entonox, AKA ‘gas and air’; the TENS machine, which passes a gentle electrical current through adhesive pads placed on your back, reducing the nervous system’s ability to send pain signals to the brain; and the much talked-about epidural.

According to Dr Broderick, approximately 30% of first-time mothers choose to have an epidural, but not everyone is guaranteed to get one. Here are some factors that may affect the decision:

  • What stage in labour you’re at – you can’t have one too early, or too late
  • Where you’re giving birth – not all units have 24/7 anaesthesiologists, and there may not be one available to start your epidural
  • Whether your baby is in distress
  • And your medical history, as some conditions do not permit the use of epidurals.

So if you can get an epidural, what happens? “An epidural can take 30 minutes or more to site, and you must sit in quite an uncomfortable position to have a very large needle inserted into your back,” says Shelley. “You must stay still during all of this, even during contractions.” It’s worth remembering that no pain relief can completely dull the pain of labour. “They didn’t call it labour for nothing,” Shelley reminds us.

“For some, an epidural may not work, as every body reacts to drugs differently. Even if it is effective, you’ll still feel pressure pain, but you’ll not be able to feel anything from the waist down.”

Vaginal tears are a real possibility

Let’s not sugarcoat it. We all know that a baby’s head is bigger than the opening of your vagina. The area can stretch enough to allow the baby to come through, but the odds of having a vaginal tear are high. Sometimes, doctors will need to make a cut themselves to assist the delivery.

“It’s very common for first- time mothers to need an instrumental delivery, such as vacuum or forceps, if she was pushing for a long time or if there was a concern that the baby was in distress. Usually with this kind of delivery, a little extra space is needed and a small cut called an episiotomy is made under local anaesthetic,” says Dr Broderick. “The stitches are dissolvable, and the area usually heals up well.”

First- or second-degree tears can heal up in a week or so, but around 1% of women will have a more complicated tear in which the external muscle close to the rectum is injured. Again, most women recover well from this with help from physiotherapy.

Around 30% of Irish babies are born via C-section

In what cases would you have to have a caesarean birth? Well, a planned C-section would usually happen at 39 weeks if the baby is in breech (or facing the wrong way for delivery) or in some cases, if you’re expecting twins. However, emergency C-sections can be necessary in both spontaneous and induced births when there’s a lack of progress in labour, or the baby is suspected to be in distress. If you’re wondering what happens during a C-section, Dr Broderick has an abridged version for you.

“Usually the mother is awake for the C-section, with an epidural or spinal aesthetic given. She will feel ‘touch’ and pressure, but not pain. Delivery of the baby takes two to three minutes, and the rest of the surgery takes about 30 minutes. It would be usual to stay in the hospital for four to five nights afterwards. Plenty of pain relief is given and you would expect to be walking around the next day. Recovery can take four to six weeks, and the new mother may need some extra help with the baby, driving, and lifting heavy items.”

As you might have guessed by now, labour and delivery are extremely unpredictable. “Sometimes things happen very quickly. Be sure to ask questions if you are unsure as to what is happening and why,” says Dr Broderick. “We always advise first-time mothers to attend antenatal classes, ideally run by the hospital they are attending.”

And finally… midwives do not care about your pubes

We’ll let Shelley take it away on this one. “We do not care, we have never cared, nor will ever care about body hair in labour. Do whatever you feel comfortable with, but don’t do anything for our benefit. Everyone poops in labour – if someone tells you they didn’t, it’s probably because the midwife cleaned it all away before they realised. It’s a normal sign of progress in labour to have a bowel motion. It’s not our first rodeo, we have seen worse things, please do not worry about us. You’re about to have a kid! Worry about that instead.”

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