"If your water breaks,
that means the baby is coming very soon."
If only!
"Eating the placenta is good for you."
No!
Don't go there.
"Labor usually lasts a couple of hours."
Perhaps the biggest myth that we will talk about today.
Hi, I'm Dr. Laura Riley,
and I'm a high-risk obstetrician
at NewYork-Presbyterian Hospital/Weill Cornell Medicine.
My favorite thing to do is delivering babies.
And I'm Dr. Dena Goffman.
I'm also a high-risk-pregnancy physician.
I'm the chief of OB at NewYork-Presbyterian/
Columbia University Irving Medical Center.
And today, we will be debunking myths about childbirth.
Oh, this is good.
"Wide hips mean easier birth."
This is a total myth.
And what we see as your hips
aren't even reflective of
what's going on with the bones in your pelvis,
which do matter.
Riley: The bony pelvis is connected by cartilage,
which is softer, which loosens up within the course
of the latter part of pregnancy.
So that gives the baby a little bit more room.
And then, labor, all those contractions
and the coordination that forces the head into the pelvis,
a lot of that depends on the baby, right?
I think one thing that is frustrating for people
is they will say, at 38 weeks,
"Am I going to have a vaginal delivery?"
We can't tell. Because there's so many other factors
that go into whether or not your baby
is coming out vaginally.
It's not just the baby's size.
It's the baby's position.
It's how well the baby tolerates
holding its breath every three minutes.
There's more to the story.
"The best position to labor
and give birth on is your back."
That's a myth.
What you might see on television or in the movies,
of a patient flat on their back,
is actually the worst position to labor and give birth in.
We love to have patients be in bed,
certainly on their side,
but there's also a lot of opportunity
to be sitting up and even to be walking around,
depending, again, on the situation with your pregnancy,
your baby, and your labor.
There's the opportunity, potentially, to take a shower.
Some people use birthing balls as a place to sit.
Many places now have wireless fetal monitoring,
where you actually can even monitor the baby
while you're moving around.
And a lot also depends on
whether or not you have anesthesia,
because once you have an epidural,
it is fabulous for taking away the discomfort
on your abdomen and those contractions.
But it does, in many ways, weaken your leg muscles.
So most hospitals will not allow you
to walk around with your epidural in
just because you may not be as strong.
This is definitely a myth.
"You can induce labor by eating spicy food."
So, this is a myth,
and there are a number of them out there.
All of the things that people think
you can do to induce labor.
Pineapples.
Riley: Cream cheese, bumpy roads.
Sex.
That one, there's some truth to it, right?
Nipple stimulation.
That's not a myth either.
I know it's not a myth.
Nipple stimulation actually does work.
The tough part about nipple stimulation
is that you get so many contractions at once,
your baby doesn't love it.
The sex and the nipple stimulation
have sort of valid, plausible reasons why they may help,
but I think there's not sort of a protocol
for how to do it and how to do it safely.
We know how to induce labor.
We have different medications that we can use vaginally,
medications that we can use in the IV,
and we know how to do that safely.
I think there is no evidence for spicy foods.
Sex is fine if it's comfortable
and something that you want to be doing.
Walking, being active, kind of getting out and about,
but I think this baby's going to come
when the baby's going to come.
"Your water breaks with no warning."
I know people see it in the TV and movies,
and it's a very dramatic event, and it's clear cut,
and you rush to the hospital, and the baby is born.
That's not always how it happens.
Sometimes it does break with a huge gush,
and it's very obvious.
Sometimes there's a leak, and patients are unsure.
And sometimes people don't know
whether it's urine or it's their water breaking.
If it's urine, it comes out and then it stops.
And if it's your water, it continues.
It does not stop. So put a pad on,
and if the pad is consistently wet and saturated,
you have to think, "Gee, maybe my water broke."
Sometimes we will break your water for you.
For some patients,
they will be in labor and progressing nicely in labor,
and the water will not have broken on its own.
If you're unsure whether or not your water has broken,
it's better to come in and let us tell you yes or no
rather than stay at home,
because if your water has broken
and there's a long time before your delivery,
you do increase the risk for getting an infection.
"If your water breaks,
that means the baby is coming very soon."
If only!
Yeah, we wish.
This is not always the case.
It is all over the map.
Because a lot depends on how many children you've had.
If it's your fourth baby
and you're contracting and your water breaks,
it's coming fast. If it's your first baby,
your water breaks, you're not contracting,
it could be 12, 24 hours.
So it's hard to know.
Contractions that come consistently
with the baby's head against the cervix
are what makes the cervix open.
The cervix has to get to 10 centimeters before you can push.
So that process is the process of labor.
If your water breaks in the course of that process,
great, but that doesn't tell us the timing.
For some subset of our patients,
the water will break and the patient may not be in labor.
That happens in probably 8% to 10% of patients.
So if you think your water is broken,
you should call your provider and say,
"My water's broken. I am contracting or not contracting.
And when should I come in?"
Because that answer is going to vary
depending on the circumstances around your pregnancy.
"Eating the placenta is good for you."
No!
Don't go there.
Absolutely not.
Please, please don't eat your placenta.
Many patients will ask about
the utility of eating the placenta.
There was some suggestion that eating the placenta
after birth might prevent depression, anxiety,
and while we're completely supportive
of doing anything to prevent those issues,
I think we have to recognize that there's no science
behind the placenta being helpful to that.
There was actually a recent publication
from the American Academy of Pediatrics
that outlined some of these less traditional practices
surrounding birth, and this one is specifically mentioned,
and that paper calls out the infectious risk
without added benefit.
So we are happy to have these conversations,
to talk with patients
through shared decision-making processes,
but our recommendation will almost always be
you should not eat the placenta.
Instead of eating the placenta,
it's really important to pay attention
to your nutrition; your hydration;
your rest, when you can, with a newborn;
and lots of support from family and friends.
"Labor usually lasts a couple of hours."
There are occasionally patients
who've had children in the past
who start to contract at home
and come in and quickly have a birth with us,
but it is definitely the exception, not the rule.
Depends on how many kids you've had.
Labor usually lasts, I'd say 12 to 24 hours
is average for your first baby.
Second, third, way faster, thank goodness.
Goffman: The labor process
has multiple stages and phases.
The early part of labor can take a fair amount of time.
Some people will start with cramping.
Then the cramping is, like, unbearable,
and then they'll realize it's contractions.
Those contractions, then, are maybe 20 minutes apart,
and then they're 10 minutes apart.
And you actually need a lot of contractions
that are three minutes apart, consistently,
to soften the cervix.
And most people will do some of that at home
for several hours,
and then they'll call us and say, "I think I'm in labor."
And then we'll say, "Come on in."
Once you get to sort of that 6 or so centimeters,
things start to speed up.
And then you eventually get to 10 centimeters,
and then the real work happens.
Goffman: Usually, you will begin to push
shortly after you are determined to be 10 centimeters.
And then that pushing process
is called the second stage of labor,
and it's from the time that you're fully dilated
until the time that your baby is out.
Once the cord is clamped and cut,
then we go on to the next step,
which is, we need to deliver the placenta.
We then are going to do some things
to help prevent you from bleeding,
so that's sort of the last piece,
making sure that we identify and repair
tears that were created during the birth process.
"Doctors slap the baby on the back after birth."
That's a myth.
That's old school.
And the movies.
I was just going to say, I think, actually, it's the movies.
I think that it comes from the desire
to stimulate the baby to take a big deep breath
after we clamp the cord.
But you don't really have to do that.
The babies do it on their own.
They start crying.
So sometimes you will see us rub the baby's back
or tap the bottom of the baby's feet
just to sort of make it go, "Ah!"
And then it takes a deep breath,
coughs up fluid, and then starts screaming.
"An epidural increases the chance of needing a C-section."
Myth! Epidural does not increase
the risk of needing a C-section.
I think that misinformation comes from the fact
that some patients probably get the epidural so early
that they're not even in labor,
and then it becomes intervention after intervention
after intervention,
and some people end up with a C-section.
They'll explain the risks, they'll explain the benefits,
and they'll explain the alternatives,
which is always to not have one.
But the risks that they will talk about
are a tiny risk of infection
and a very small risk of a headache after the procedure.
Again, this is shared decision making at its best.
It's great to have options
for what you're going to use to manage labor,
because labor is painful.
"Get the epidural early, before it's too late."
That's a myth.
Yeah, this is a myth,
but it's a really common one that we hear.
We wouldn't want you to get an epidural
if you're not in labor.
There really is no "too late,"
unless it's that the baby's coming
or that you're unable to really sit still
for them to place the epidural itself.
I think it's our job to sort of work with you
to figure out, when is that just right for you?
And it may not be the same for every patient.
Riley: If you show up and you're 10 centimeters
and you're like, "I want an epidural,"
I will actually talk you down from that ledge.
Because it's not that you can't get the epidural;
it takes about 15 minutes to get the effect of the epidural.
So 15 minutes into your 10 centimeters and pushing,
your baby might be out by then.
Have the conversation with the anesthesia team,
even if you're not ready to commit.
Meet the people, learn about the risks and benefits
before you're in the active phase of labor,
incredibly uncomfortable, when it becomes harder
to listen and process information.
"C-sections are the 'easy way out.'"
Riley: Myth! Goffman: Myth.
You don't want a C-section
unless you need to have a C-section.
If you compare maternal risks
associated with a vaginal delivery to a C-section,
essentially, everything is
a little bit higher with a C-section.
And what do I mean by "everything"?
You have a greater risk of infection,
a greater risk of bleeding,
and a greater risk of having a blood clot
after the delivery.
And the recovery is definitely longer.
The surgery itself is complicated.
So we, in general, don't want you to have surgery
unless there's a reason.
"You need to cut the cord as soon as the baby's out."
So, this is a myth.
We've really moved towards something
called delayed cord clamping,
which means we deliver the baby,
we place the baby on the patient's abdomen or chest,
the cord is still connected from the baby's belly button
to the placenta that's still in the uterus,
and there's still blood flow going through that cord.
And there have been studies showing that there are benefits
to not clamping and cutting immediately
if you don't have to.
We keep an eye on the clock,
we keep an eye on mom and baby,
and then, when the timing is appropriate,
we'll clamp the cord and either cut it,
but typically ask you or your support person
or whoever else is participating in the birth
if they'd like to participate by cutting the cord.
It's harder than it looks,
and I do say that often to the support person
when I hand them the scissor.
Sometimes it takes more than one snip with the scissor
to sort of get through that cord.
It doesn't hurt the baby.
That's another question I get all the time.
"Doing yoga poses can turn your breech baby."
Have you seen any studies?
I haven't seen good evidence that it's true.
If you're asking us,
"Is there scientific research to say that downward dog
or the flashlight or the voices helps?"
I think the answer would be no.
I think if you ask us, "Do any of these things hurt?"
I also think the answer is no,
as long as you can safely do a downward dog and yoga.
I definitely find patients worried about it
when they have an ultrasound at 28 weeks
that the baby is breech,
and I think the answer to that is that's totally normal.
When you're approaching 37 weeks,
then is when we have to start having a conversation
about, how do we want to handle this breech?
That's true, but there are plenty of times
where the baby is breech at 37 weeks,
you schedule a C-section for 39 weeks,
and you come in on the day of your C-section
and the baby's head-down. So it happens.
Kid are still moving and still quite active,
even after 37 weeks.
Knowledge is power.
Thinking about the labor process and the birth process,
talking to your provider,
getting a sense of the practice, the unit,
what things are like there
are actually really, really important
to help lead to a really smooth, positive birth experience.
I think that this is where the birth plan is helpful.
Having some knowledge and knowing what you can expect,
I think, just gives you a much better birth experience.