Oh Sh*t: Identifying When You Need Help in Pregnancy and Labor
If you’re pregnant for the first time, or if things seem a little different with this pregnancy than with previous pregnancies, it might feel scary not knowing what’s happening as you experience big changes. (Check out this primer if you want to read more about how pregnancy works.) Learning to pay attention to how you and your body are feeling and changing – whether or not you know why – is really important to ensure a safe pregnancy.
In this article, we’ll outline some key signs to pay attention to during and after pregnancy for pregnant folks who intend to carry their pregnancies to term. These signs indicate that you need to get help – so don’t ignore them.
Once you’ve confirmed – with a home pregnancy test or a test through a care provider –that you are pregnant, a good first step is finding the people you want to support you during this time. To the best of your ability, find a healthcare provider you trust and who really listens to your concerns. Accessing medical care can be challenging and expensive so be sure to search out free options in your area and call on your support network to help. For women of color and trans and other gender-diverse individuals, finding effective care providers can be more difficult due to medical racism and transphobia, so consider also identifying friends, family, and/or trustworthy adults who can support you during this time. Doulas are another great option and can act as an advocate within healthcare settings. Once you find your support network, book an appointment with a care provider to make sure you’re off to a safe start.
Obstetricians (or OB-GYNs) are doctors who have completed medical school with training specifically in pregnancy, birth, postpartum, and other aspects of reproductive health for people with uterine and vulvovaginal reproductive systems. They are trained to detect and treat medical problems, especially pregnancy and birth-related emergencies. They tend to work in hospital or clinic settings and deliver babies in hospitals, where they have full access to any medical interventions needed to help deliver the baby.
Primary care physicians (or family doctors) have completed medical school and handle general health of their patients. Some primary physicians have additional training in pregnancy and birth and deliver babies. Their focus tends to be on whole family health care, and they often have a relationship with the patient before the patient gets pregnant and gives birth. They tend to deliver babies in hospital settings and may need to refer to obstetricians if a birth emergency arises.
Midwives are trained professionals who deliver babies and provide pre- and postnatal care to pregnant people. Some have completed nursing school, and others receive midwifery licensure or certification to provide high quality maternity care. They deliver babies in homes, birthing centers, and hospitals, and in emergencies, refer care to an obstetrician. They are trained to view birth as a normal part of life, and some use medical interventions to assist birth while others prefer to use natural methods.
Doulas are trained individuals who provide emotional and social support to a pregnant person during labor. They do not have any medical training and do not provide medical care during birth. They instead offer strategies and techniques to navigate pain during labor and strengthen the laboring person’s confidence in giving birth. Doulas often work in partnership with a medical provider, like an obstetrician, family physician, or midwife.
Supportive family, friends, or partners can also be caregivers during pregnancy and labor. These supporters do not have medical training and often don’t receive a lot of formal training to navigate pregnancy and birth. Instead, these caregivers tend to rely on what they have seen, heard, and experienced with pregnancy and birth and can be both wonderfully supportive and sometimes overwhelmingly unhelpful. They can provide continuous support during labor, which helps ease labor, and can help with non-medical interventions to decrease pain, especially if they have experience or have received a little training in childbirth.
Signs that something might be wrong during your pregnancy
Often, care providers will recommend getting regular check-ups to ensure that everything is safe during pregnancy for both the pregnant person and fetus. These check-ups are really important so that any safety concerns can be identified early. If you have chronic health conditions, it’s especially important to check with a healthcare provider about overlapping symptoms and what to look out for as causes for concern.
But it can sometimes be challenging to get to appointments, and other times, you’re between appointments and something just doesn’t seem right.
These warning signs could indicate that something is really wrong:
- Heavy or unexplained vaginal bleeding
- Dizziness or fainting
- A really strong headache that won’t go away
- Extreme swelling of your hands or feet
- Intense nausea and throwing up. Some nausea and vomiting is normal during pregnancy but if you can’t keep any food or liquids down for a few days in a row, it’s time to get help.
- Thoughts about harming yourself or the fetus
- A fever over 100 degrees Fahrenheit / 38 degrees Celsius
- Changes in your vision: your vision is more blurry than usual or you see spots
- Trouble breathing
- Chest pain or fast beating heart
- Intense belly pain that doesn’t go away
- Vaginal itchiness, unusual discharge from the vagina, or pain during urination. These could be signs that you have a sexually transmitted infection.
- Fetus’s movements stop or slow significantly. After about 4 months of pregnancy, you may start to feel the fetus moving. If there are significant changes in the movements or you don’t feel anything at all at 6 months, go see a healthcare provider right away.
If you experience any of the above, go see a healthcare provider as soon as you can. If any of those listed issues go unaddressed, it can result in a potentially life-threatening health concern for you or a fetus. It is often assumed that it is the pregnant person’s fault if something goes wrong in pregnancy, but remember that complications can happen completely outside of our control. What is in your control is knowing the warning signs of potential complications and reaching out for help as soon as you can to address them.
Help! Labor is Painful!
Going into labor can feel really scary. Media has done a good job convincing us that the pain of labor is unbearable and that we need professional medical help immediately when labor starts to help us get through the experience. However, many laboring individuals can and do confidently navigate the pain of childbirth without immediate medical help, especially if they know to watch out for warning signs signaling something might be wrong.
In fact, labor can actually start several days, or sometimes weeks, before the baby is ready to be born. Many people experience “false labor”, officially called Braxton-Hicks contractions, in which your body starts going through some of the signs of labor as a practice for the real thing. It can feel a lot like actual labor.
These are some signs that you might be experiencing Braxton-Hicks contractions:
- You’re having painful surges or cramps in the front of your abdomen but the surges are not regular and don’t get steadily worse
- The painful surges or cramps stop if you shift positions or rest
- The pain of the surges or cramps stays around the front of the belly or pelvis (rather than in your back)
These painful surges tend to go away after some time and do not result in a baby being born. They are not a cause for concern and can be managed without a care provider. Calling on a non-medical support person can be helpful to help navigate the discomfort and associated emotions.
Knowing when you go into real labor should be obvious, right? In movies, we often see the pregnant person’s water breaking as a clear sign that it’s time to go to the hospital or get home and call a midwife to start delivering the baby. When someone’s water breaks, it means that the amniotic sac that holds and protects the fetus during pregnancy ruptures, releasing fluids and signaling that the baby is ready to come out. But only 1 out of 10 pregnant people have their water break before labor actually starts, so there are additional signs you can watch out for that signal that you may be going into real labor.
These tend to include:
- Strong and frequent surges called contractions that occur at least every 10 minutes. These may feel like increased pressure in your pelvis, vagina, and/or lower back. They will start getting faster and more painful and won’t stop or decrease in intensity if you shift positions. You can use a stopwatch to time them to see if they’re consistent or getting faster.
- Pain in your lower back that doesn’t stop even if you shift positions
- Flu-like symptoms such as nausea, vomiting, or diarrhea
- Increased vaginal discharge, fluids exiting the vagina, and/or vaginal bleeding. This may include the release of a mucus plug - mucus that seals your uterus to allow the fetus to develop - which may exit your vagina all at once or in smaller pieces with a bit of blood.
The pain and intensity of labor, especially if it’s your first time, can feel overwhelming. Help navigating labor can go a long way to making it feel more manageable and less overwhelming. Some people decide to call their care provider and head to a hospital or birthing center to get medical help as soon as labor starts. This can sometimes be an expectation of the care provider - different care providers have different expectations about when a person in labor should have medical help so pay attention to the guidance of your care providers and follow their recommendations - or sometimes it can feel more comforting to the laboring person to get medical help right away to help manage the pain and any potential complications. Other people decide to labor on their own for a while, using non-medical techniques like movement, massage, deep breathing, and vertical positions to help navigate the pain. A support person, such as a friend, doula, partner, or family member, can help guide the laboring person through these techniques. Having emotional and physical support when you go into labor, regardless of where you’re laboring, can go a long way in reducing the perception of labor pain and can increase the likelihood of having a pleasant birth experience. Also, people who have a consistent support person with them during labor (like a friend, doula, or midwife) can lessen their labor by several hours - so having help during labor can be hugely beneficial in a number of ways!
Remember that so much related to pregnancy and delivery is out of our control. No matter how much we plan, the reality is often far from our expectations. Be prepared to change strategies to help navigate labor pain, and be open to asking for help from unexpected sources. And remember that as you go into actual labor, there are times when having a care provider with medical experience present is necessary, both to help ensure a safe delivery and to navigate any potential complications.
Signs that you may need the help of a medical care provider during labor
You’re in labor. You are navigating the contractions. Maybe your water has broken or maybe it hasn’t. It’s for sure time to call a care provider with medical experience when:
- Your contractions are 5-1-1: happening every 5 minutes and lasting at least 1 minute for at least 1 hour. This means the baby is getting close to being born, and having a trained medical provider present can go a long way to ensuring everyone’s safety.
You also need to call a medically trained care provider for the following urgent conditions:
- If the fluid from your water breaking is green or brown
- If you start bleeding during labor and the blood is bright red (rather than pink or brown)
- If you have blurred or double vision, a severe headache, or sudden swelling
- If you can’t keep liquids down for more than 8 hours
- If you start going into labor or your water breaks 3 weeks before your due date (at 37 weeks or earlier). This is considered preterm labor. Fetuses tend to need as much time as possible of the typical 40 weeks to develop fully, so doctors are able to do a lot of things to prevent labor from happening too early if you seek medical help right away. Premature birth can lead to complications so make sure you get medical help if you think you’re going into labor early.
The vast majority of people give birth with no complications at all, especially if they have a care provider present with medical training. But if you experience any of the signs above, call a medically trained care provider right away as these could indicate a serious safety concern and require immediate medical attention.
If you’re ever unsure about what’s happening during labor, it’s always ok to call a care provider with any questions or concerns. Calling a care provider early in the labor process allows them to check in on your progress, make recommendations on when to get medical help, and monitor any potential complications. It can also help you feel secure in knowing that your labor and delivery are progressing safely.
Signs that something might be wrong after delivery
There are also some complications to watch out for after you have given birth. These signs are especially important to pay attention to because many of them can lead to death or very serious conditions if not managed immediately. Some pain, bleeding, fatigue, and discomfort are normal after giving birth - labor is tough work for both our minds and our bodies! - but you should get medical help immediately if you experience any of the following:
- Chest pain
- Trouble breathing
- Thoughts of hurting yourself or your baby (This could be a sign you have postpartum depression–read more here.)
- Very heavy bleeding. Some bleeding is normal but if you’re soaking more than one pad per hour, get help.
- A cut that isn’t healing. Tears in the vagina or perineum are common during birth but seek help if they are not getting better.
- A temperature higher than 100 degrees Fahrenheit / 38 degrees Celsius
- A red or swollen leg, especially one that is warm or hurts when you touch it
- A bad headache that doesn’t go away with medication
Often, care providers will request several follow-up visits after birth so they can identify any potential complications for either you or the baby. Attending these appointments can go a long way to ensuring your health and safety post-birth. Remember: if you have chronic health conditions, it’s especially important to check in with a healthcare provider to know what to expect and get any extra help you may need.
Women of color, especially Black women, are at higher risk of post-birth complications due to medical racism and systematic oppression. Trans and gender-nonconforming individuals also may find challenges in accessing affirming post-birth care. You may need to advocate for yourself and find supportive individuals to help advocate for or with you. Medical racism, transphobia, and homophobia unfortunately have a huge impact on pregnant and postpartum people seeking care, so consider what you will need in order to navigate the medical system and still ensure a safe pregnancy, birth, and postpartum period.
While the warning signs in this article may seem scary, knowing about them can help lessen fears and reduce worry about pregnancy and labor. By tuning into how your body is feeling and knowing when to get help, you may be able to better relax into the experiences of pregnancy and birth and feel more confident in recognizing an emergency situation. With the knowledge of what warning signs to look out for, combined with knowing generally what to expect, you can feel better prepared to make informed decisions for your safety and the safety of your fetus.
- Pregnancy, Childbirth, and the Newborn: The Complete Guide by Penny Simkin, Janet Whalley, Ann Keppler, Janelle Durham, and April Bolding
- The Doula Book by Marshall Klaus, John Kennell, and Phyllis Klaus