Q: My water broke! What should I do? Your caregiver has probably told you what their protocol is for this - some request that you come in right away, while others suggest staying home until an active labor pattern is established (this could be several hours away). Most want you to at least call in and let them know. If it's the middle of the night, sleep. Otherwise, take a shower, eat, and relax in preparation to greet your labor when it begins. Q: My doctor wants me to come in right away, but can I stay home for a while if I want to? Ask your doctor what the reasons are they want you to come in. Often it is to make sure the umbilical cord has not slipped past the baby and into your vagina (very rare, especially if your baby is not premature or breech). Another concern is a slight risk of infection because the baby's protective bubble is gone (avoiding vaginal exams reduces this risk). Reassuring your doctor that you do not feel anything in your vagina, and that you will not put anything into your vagina, and that you will monitor your temperature to watch for any developing infection, often enables mothers to negotiate a delayed admittance to the hospital. After a certain number of hours (12-18), antibiotics are recommended to help prevent infection. Q: It's been several hours since my water broke, but I'm still not having any contractions. What should I do? There are many ways to encourage labor to begin. Walking, nipple stimulation, female orgasm (not intercourse), and stair climbing are the easiest. Other options are certain herbs, castor oil, and acupressure. Of course, discuss any of these with your caregiver beforehand. And remember, stress, exhaustion, lack of nutrition or water, and anxiety are labor hindrances. Fetal malposition is also a very common cause of delayed or slow labor. Q: My caregiver wants to start Pitocin; what does this mean? Pitocin, a synthetic hormone, is one way to cause your uterus to contract, and if your cervix is favorable (determined by a Bishop's Score), it has a better chance of working. Unfortunately, Pitocin often starts a chain reaction of interventions, and has a moderate failure rate, especially for first-time moms (20-40% of inductions end in Cesarean surgery). Internal contraction monitoring, continuous external fetal monitoring, and restriction of food and drink are standard with Pitocin, and pain medications are more often requested. Of course, there are many factors that go into the decision of starting Pitocin or not, including fetal position and the risk of maternal exhaustion. Often, just waiting or using other natural induction methods can be successful, but the outcome of either route cannot be predicted. Q: What can I do if my baby is suspected to be malpositioned? There are many ways to encourage a baby to turn so as to put more even, direct pressure on the cervix to trigger contractions and aid dilation. Walking, pelvic tilts, lunges, hands & knees, and open-knee-chest positions are best bets. Check with your caregiver for any contraindications to these exercises. Pitocin can cause other problems when combined with a malpositioned baby. The baby can get 'wedged' into the unfavorable position, and sometimes the uneven forced pressure of the head on the cervix can cause cervical swelling or lack of dilation. Q: Can I take a bath after my water breaks? Some caregivers are quite comfortable with this, while others routinely prohibit it. There is at least one published study that found water does not enter the vagina. Some have theorized that your own bathtub may be safer than the hospital's (your body 'knows' the bacteria in your own house). A shower is almost always not a problem. Q: When should I call my doula? As always, call whenever you feel concerned, nervous, or just want to review your options. I will always recommend you let your caregiver know as well.