Childbirth: The Survival Guide for First Time Fathers

I was never confident in my ability to just ‘be cool’ while my wife gave birth to an entire child, so for the sake of remaining upright in the delivery room, I decided the anatomy of birth was better left unknown. I avoided videos, skipped labor chapters in baby books, and entered the hospital with no expectations regarding blood or pain or placentas. When it came to birth…ignorance was bliss. And this, in hindsight, was just the worst goddamn approach.

Because when labor started, and contractions disabled my wife’s ability to speak, and the medical people—now flying in and out of the delivery room—started talking about broken water and bloody show, I, balls deep in the most momentous moment of my entire existence, just sat there like some horse’s ass.

The lesson here? Know your stuff. When your partner is in early labor, know how to relieve her discomfort. As labor intensifies, know when to leave for the hospital. Most importantly, childbirth is controlled by a woman’s hormones, which can either thrive or falter based on the surrounding environment, so know how to create the right environment. How many baby books and birth classes will you have to endure to learn all this stuff? Zero. It’s all right here.

Birth: The 2 Minute Anatomy Lesson

For the average guy, interest in female anatomy begins and ends with where he sticks his wiener. But for the soon-to-be father, knowledge must penetrate a little deeper, and here’s why: medical people use labor lingo like you and your buddies use dude and fuck. Without a basic understanding of the pieces, process and terminology, you’ll have no idea what is happening. Consider this your crash course—everything you need, and nothing you don’t.

The Organs

Uterus (womb)
The uterus or womb is a hollow muscular organ that houses the fetus during pregnancy. As seen above, it has 2 parts; the body and the cervix.

Before conception, the body is the size and shape of a pear. It then expands with the growing fetus, and by full term, reaches the size of a goddamn watermelon! The walls of the uterus contain a muscle that is—depending on your definition of strength—the strongest in the human body and responsible for contractions during labor. Safely inside the womb is the amniotic sac, a membrane that contains the fetus and amniotic fluid. This fluid protects the fetus and provides lubrication to prevent his body parts from growing together.

Cervix
Below the body, in the lower region of the uterus, is the cervix—a cylinder-shaped pack of tissue covered cartilage that connects the body to the vagina. Think of the cervix as the baby’s gatekeeper. During pregnancy, it remains hard and closed to contain the 11 pounds worth of fetus and fluids. Then as labor begins and progresses, it effaces (softens) and dilates (opens), preparing for delivery.

The status of the cervix offers the single best estimate as to the arrival of the baby and is therefore continually monitored. Beginning in the final weeks of pregnancy and throughout the entirety of labor, the cervix will be poked, prodded, and assessed.

Vagina (birth canal)
The vagina is a multi-purpose organ, and for this purpose—giving birth—it is often referred to as the birth canal. Joined in the back by the cervix, the vagina stretches to many times its normal size as the fetus passes through and into the real world, completing his transformation into a breathing, eating, never sleeping baby.

Placenta
The lifeline of the fetus, the placenta does the work of the lungs, heart and digestive system while these organs develop. Attached to the uterine wall, the placenta delivers oxygen and nutrients from the mother’s blood through the umbilical cord to the baby.

The Terminology

Cervical effacement (aka thinning, softening, or ripening)
As labor approaches, hormones called prostaglandins transform the cervix from hard and inflexible to soft and stretchy—picture the consistency of your nose vs that of your lip. Effacement is measured in percentages. For example, a doctor may determine the cervix is 50% effaced, or halfway between not effaced and fully effaced.

Cervical dilation
As the cervix softens, it is able to dilate, creating a passage from the womb to the birth canal. Dilation is measured in centimeters, ranging from 0 (not dilated) to 10 (fully dilated).

Mucous plug
During pregnancy, the opening of the cervix is plugged with mucus, which protects the womb from outside infection. As the cervix dilates, this plug is dislodged and can pass through the vagina and, say, into a toilet. Its passing isn’t necessarily a sign that labor has started, but that it will start soon—usually within a few days.

Bloody show
Bloody show is a blood-tinged mucous plug. Because the blood is a result of ruptured capillaries in a dilating and effacing cervix, it is a sign that labor is underway.

Contractions
The tightening and relaxing of the uterine muscle, contractions push the fetus from the womb out into the real world.

Water breaking
Contractions, pressure from the descending fetus, or both cause the amniotic sac to rupture, sending a rush or slow trickle of amniotic fluid out of the womb. Most of the time (85%), labor precedes broken water. In almost all other cases, labor will begin within 24 hours. Regardless, broken water warrants a call to the doctor, because the fetus is no longer protected by the amniotic sac.

The Process: A 5 Step Guide to Birth

Nobody knows exactly how labor starts, but it’s believed that the fetus sends a message to the mother, informing her he’s ready for life outside the womb. From there, hormones trigger cervical effacement and contractions in the uterus.

Labor then progresses through 3 phases (early, active and transitional). Once the cervix dilates to 10cm, it’s time for pushing and delivery. After delivery of both the baby and placenta, your new family will be sent to postpartum for exams, monitoring, and other administrative items.

So, uh, how long does all this take?
Since no two births are the same, tying the process to a single timeline is often misleading—early labor alone can last several hours or several weeks, and both would be considered normal. But if your partner has the average birth for a first time mom, then your experience will look just like this:

The Many Roles of the Ultimate Labor Dad

If you’ve ever wondered how the female body can deliver an 8 pound baby, the short answer is it can’t—not without the hormones that promote labor. These hormones (oxytocin and endorphins) flourish in environments of relaxation, safety, and support. In a stressful or tense environment, however, the body produces adrenaline, which can impede labor and even cause complications.

Your role during childbirth is to create this tranquil environment, and the best way to do that is with preparation. Here’s what to expect and how to respond during each stage of the process.

Early Labor

Most often, early labor occurs at home. Use this time to a) help your wife relax—she’ll need the energy, and b) get things ready for the hospital.

Get ready. If you read our post on pregnancy, then you’re already packed. Nice job! If not, late is better than never, so install the car seat (baby legally can’t come home without one), and of equal importance, prepare your survival kit.

Know when to go: The 5-1-1 rule. First, know to call the doctor immediately if your partner experiences:

• Broken water
• Bright red bleeding or discharge
• Decreased fetal movement

Hopefully, and most likely, things will go smoothly, and you can follow your doctor’s instructions regarding when to call or come in—standard protocol being the 5-1-1 rule, or when contractions are 5 minutes apart, 1 minute in duration, and have been this way for 1 hour. Simple enough…assuming you know how to time contractions.

Time and record contractions. The life of a contraction is as follows: begins, increases in intensity, peaks, then subsides completely before the start of the next one.

• Duration is measured from beginning to end. The length of the contraction below is 1 minute.
• The time between contractions is measured from beginning of contraction 1 to the beginning of contraction 2. The time between contractions below is 5 minutes.

Early contractions will likely be 10-20 minutes apart, so don’t go overboard with the timer. If you—armed with a stopwatch—are continually in the face of a laboring woman, you might not live to see your child. Start with once an hour or so, and in the meantime…

Be a distraction. In a good way. Watch a movie, play Connect Four, take a walk. Do anything besides sit and stew on the fact that you’re literally having a baby.

Eat. This might be your last chance. This is also a good time for your partner to have a small snack (crackers, toast, cereal) IF her doctor says it’s okay to do so—the rules of eating during early labor vary by medical professional.

Know pain management techniques. While early contractions won’t take the breath away, they are uncomfortable. Here are 3 basic techniques for relief during early labor.

Apply counter pressure. Many women experience back labor caused by the baby’s head pressing against the pelvis. Applying pressure to the lower back can offer relief. Try tennis balls or the heels of your hand, and use a circular motion.

Suggest a position change. Doing so can relieve pressure from the descending fetus. Have her lie on her side with pillows between her legs, sit backwards on a chair like AC Slater, or get down on her hands and knees.

Alternate hot and cold. Have heat and ice packs on hand.

Active and Transitional Labor

Your role in the final stages of labor will depend on the birth plan. If your partner elects for a natural birth, learn about breathing and advanced pain management techniques commonly covered in birthing classes. If she elects to take pain relief like an epidural, the breathing methods commonly seen in movies won’t apply. My wife opted for an epidural, so some of this section is written from that experience.

Prepare for check in. Many hospitals now permit pre-registration, allowing you to complete a portion of the paperwork prior to arriving for delivery. If offered, certainly do this, because the less administrative bullshit required of a laboring woman, the better life is for everyone. Still, upon arrival, expect someone from the hospital to:

• Issue ID bracelets
• Ask you to sign some consent forms
• Show you to your room
• Give your wife a hospital gown
• Examine her cervix
• Start an IV (not all the time but often)
• Discuss pain medication
• Hook up the fetal monitor

Ask how to read the fetal monitor. Most hospitals use a fetal monitor—a device resembling a Power Ranger belt, which wraps around your partner’s belly and measures both fetal heart rate and contractions. The readings are then displayed on a monitor and printed on continuous feed paper.

Either by (poor) design or coincidence—maybe a nurse was out sick—I was in charge of reading the fetal monitor during my wife’s delivery. This was a big deal because, as is often the case with an epidural, she couldn’t feel her contractions. So as the monitor spiked I would say something like DURRRR get ready to push honey. Then she’d push, and I’d count 1-2-3-4-5-and-relax. Then the midwives and I would all hoot and holler and congratulate my wife on a great push.

Anyway, the more you understand, the more useful you can be, and the more useful you can be, the better you will feel.

Set the Mood. Once you get settled:

• Dim the lights.
• Control room temperature
• Massage your partner’s hands and feet
• Play some slow jams. Research shows that music decreases anxiety, in some cases more effectively than anti-anxiety medication. Seriously, Bose Soundlink Mini wins labor and delivery MVP. If you’re waiting to pull the trigger on a Bluetooth speaker, now is the time.
• Just be there. Hold her hand, look her in the eye, tell her everything is fine, and goddammit, you both are in this together.

Roll with the punches. The final stages of labor are intense and nerve-racking as your partner prepares—physically and emotionally—to deliver this baby. This is also when labor might start to get the best of her, so be flexible and don’t take it personally if one minute she’s asking that you rub her back and the next that you BACK THE FUCK OFF.

Update those who need updating. If you need to send one last update, do so now. Because with the cervix fully dilated to 10cm and the baby descended into position, it’s time for…

Pushing

What surprised me most about pushing was the synergy. It was nothing like the frantic fiasco I imagined. There was counting and resting and coordination as mom and contraction bore down together. The additional nurses who arrived for the main event each had a role. I had a role. The medical people will take the lead, so follow it, but be ready to assume the following responsibilities:

Contraction notifier. Using your newfound knowledge of the fetal monitor, as that little line starts to climb uphill, signalling a contraction, notify your wife so she can prepare to push.

Body part holder. If you’ve ever seen a dog take a shit, then you’re aware of the coordination involved. Every muscle from head to tail aligns and contracts so Spot can dump and get back to chasing squirrels.

The midwives continually instructed me to pull my wife’s legs and push on her back—like I was folding her in half—so she could bear down and ‘wrap around the baby’. I imagine this is the same efficiency of that in the shitting dog. It was hard work rolling my wife into prime pushing position, which makes it the perfect job for the strapping labor dad.

Encouraging progress updater. Because your wife is focused on pushing and isn’t best positioned to see the action, update her on the progress. When you see the head, tell her. Help her visualize the baby, and then stick that visualization in front of her like a rabbit at the race track. Eventually—in what is sure to be one of the most fucked up visuals of your very existence—the tiny, hairy baby skull will appear from the vagina (or crown), and delivery is imminent.

Delivery

Once the head is out, the doctor will likely halt the process to clear the mucus from your half-born baby’s nose and mouth. Then with one final guided push, the baby (and so much fluid) will burst from the vagina like the end of a water slide. You are now officially a father…congratulations and holy shit. Here’s how to deal:

Expect a newborn. I have never anticipated anything like the first sight of my child. I spent so much of the pregnancy imagining her appearance that—by the time the girl was born—she was almost mythical. Try not to do this, because a newborn isn’t pretty. Expect the following:

• Swollen face and genitals
• Cone-shaped head
• Pink or gray skin tone—pigmentation doesn’t show up until after birth
• A lot of vernix—a cottage cheese-like substance that protected baby in the womb

Know there is no right way to feel. 25-40% of new fathers report feelings of indifference after the birth of their child, while other dads cry tears of joy in the delivery room. This is a major life event. You’ll respond in your own way, and that’s okay.

Cut the umbilical cord. As soon as the baby is born, the doctor will clamp the umbilical cord and hand Jr. to your wife for skin to skin contact—this calms baby and regulates body temperature and heart rate. After a minute, you’ll have the opportunity to cut the cord, which has a consistency unlike anything you’ve ever experienced. Then baby is handed back to the staff where they will do the following:

• Assign an Apgar score based on an assessment of baby’s condition (appearance, pulse, reflex, tone, and respiration).
• Issue a matching ID band to prevent you going home with some random-ass baby.
• Measure height, weight, and head circumference.
• Apply eye ointment to prevent infection.
• Return baby to your wife as she prepares to deliver the placenta.

Prepare for the placenta. Anywhere from 5 to about 30 minutes after delivery of the baby, the placenta will detach from the uterine wall and descend through the birth canal. Once delivered, it will be examined—enthusiastically in some cases. The resident who analyzed my daughter’s ran over to show me the thing like he had just used it to win a science fair. It’s appearance was shocking, by the way, and most closely resembled that of a jellyfish having just been tossed from atop the Empire State Building. Be ready for it.

Anyway, now that your partner has completed both of her deliveries, she will be inspected and stitched (if necessary). Then the cleaning crew will come in and whisk away the fluids and bloody bedding, and within 10 minutes, it will look like nothing ever happened. Then you’ll pack your shit and your newly established family and head to the postpartum floor.

Postpartum

The main event is over, but your hospital adventure has just begun. Thanks to the 1996 Newborns’ Act, which mandates insurance agencies cover postpartum care for at least 48 hours after childbirth, you’re likely 2 days away from being home.

Now, it may be sooner—the average stay is 40 hours—but research shows that being discharged prior to 48 hours increases the risk of rehospitalization. Besides, there’s a lot to do and even more you’re gonna want to learn before you become the (oh god) primary caregiver.

Ask an insane amount of questions. The postpartum nurses spend entire days caring for newborns and recovering mothers. Additionally, most are experts on breastfeeding, which you’re about to discover is maybe the most frustrating aspect of newborn care. Who better to learn from than the pros? Watch and take notes as they swaddle, dress, and change baby. Here is a checklist of skills to acquire before discharge:

• Changing
• Burping
• Swaddling
• Dressing
• Sponge bathing
• Feeding and basic troubleshooting

Regulate visitors. Childbirth is a lot of things (emotional, exhausting, bloody). One thing it is not, however, is something I’d like to share with a shit ton of visitors. The room is small, your wife is recovering, your baby is adjusting, and the medical people are in and out constantly—all valid reasons to postpone visits until you get home.

Keep your wife comfortable. The hospital staff will assist with her recovery, but you can help with physical tasks like retrieving baby for feedings.

Let baby room-in. Years ago, babies stayed in a nursery while their mothers recovered in postpartum. You’ve probably seen the cartoons of a young couple staring through the window of a room lined with babies in bassinets—that’s the nursery.

Recent research, however, shows that the mom and baby who stay together (or room-in) in the days after delivery have an easier time breastfeeding and bonding. As a result, many hospitals now encourage rooming-in, while some have eliminated the nursery option altogether.

You, too, can bond. You don’t need boobs to bond with your baby. In fact, many studies show that a new father is just as nurturing as his partner. And even if you’re not a natural nurturer, bonding with a newborn is easy. The key? Take off your shirt and snuggle up. Skin to skin contact comforts baby, familiarizes him with your scent, and can help regulate his heart rate, breathing, and temperature.

Bring baby to his screenings. While chances are slim, some babies are born with life-threatening conditions that, without a screening, could go undetected. Because early intervention is critical in maximizing long term potential, all 50 states require some sort of newborn screening, including exams for hearing loss, congenital heart disease, and blood tests for approximately 50 other conditions.

Complete a few final administrative items.

1. Complete paperwork for a birth certificate.
2. Request a social security card.
3. Schedule baby’s first well-child visit with his pediatrician—typically 48 hours from discharge.

Enjoy the experience. The birth of your first child is a major milestone, so enjoy it. Because once you buckle that car seat and exit the hospital parking lot…you’re on your own. Welcome to The First Week of Fatherhood.