Baby's Crying Already?

The most joyous sound a new parent hears is that first cry the baby makes after he or she is born. But would you believe that your little one is already crying inside you? It's true, according to researchers, who found that third-trimester fetuses show crying behaviors-quivering chin, open mouth, deep inhalations and exhalations, and startle responses-when a loud noise and vibration were sounded near the mom's belly. It's known that the crying reflex is well developed even in premature infants, so it's not surprising that babies are perfecting this skill long before they're ready to emerge (and it explains why they're so good at crying once they come out!).

Something else to keep in mind: If you do actually experience a noticeable public gush of fluid, you can be sure that no one around you will stare, point, or chuckle. Instead, they will either offer you help or discreetly ignore you. After all, no one is likely to overlook the fact that you're pregnant, so it's just as unlikely they'll mistake amniotic fluid for anything else.

The bright side of a water break (in public or at home) is that it's usually followed by labor, typically within 24 hours. If labor doesn't start spontaneously within that time, your practitioner will probably start it for you. Which means your baby's arrival will be just a day away, either way.

Though it really isn't necessary, wearing a panty liner or maxipad in the last weeks may give you a sense of security, as well as keep you fresh as your vaginal discharge increases. You also might want to place heavy towels, a plastic sheet, or hospital bed pads under your sheets in the last few weeks, just in case your water breaks in the middle of the night.

Baby Dropping "If I'm past my 38th week and haven't dropped, does it mean I'm going to be late?"

Just because your baby doesn't seem to be making his or her way toward the exit doesn't mean that exit will be late. "Dropping," also called "lightening," is what happens when a baby descends into mom's pelvic cavity, a sign that the presenting part (first part out, usually the head) is engaged in the upper portion of the bony pelvis. In first pregnancies, dropping generally takes place two to four weeks before delivery. In women who have had children previously, it usually doesn't happen until they go into labor. But as with almost every aspect of pregnancy, exceptions to the rule are the rule. You can drop four weeks before your due date and deliver two weeks late, or you can go into labor without having dropped at all. You can even drop and then undrop. Your baby's head can appear to settle in and then float up again (meaning it's not really fixed in place yet).

Often, dropping is obvious. You might not only see the difference (your belly seems lower-perhaps a lot lower-and tilted farther forward), you might feel the difference, too. As the upward pressure of the uterus on your diaphragm is relieved, you can breathe more easily, literally. With your stomach less crowded, you can eat more easily, too-and finish up your meals without a side of heartburn and indigestion. Of course, these welcome changes are often offset by a new set of discomforts, including pressure on the bladder (which will send you to the bathroom more frequently, again), the pelvic joints (which will make it harder to walk ... or waddle), and the perineal area (sometimes causing pain); sharp little shocks or twinges on the pelvic floor (thanks to baby's head pressing hard on it); and a sense of being off-balance (because your center of gravity has shifted once more).

It is possible, however, for baby to drop unnoticed. For instance, if you were carrying low to begin with, your pregnant profile might not change noticeably after dropping. Or if you never experience difficulty breathing or getting a full meal down, or if you always urinate frequently, you might not detect any obvious difference.

Your practitioner will rely on two more indicators to figure out whether or not your baby's head is engaged: First, he or she will do an internal exam to see whether the presenting part-ideally the head-is in the pelvis; second, he or she will feel that part externally (by pressing on your belly) to determine whether it is fixed in position or still "floating" free.

How far the presenting part has progressed through the pelvis is measured in "stations," each a centimeter long. A fully engaged baby is said to be at "zero station"; that is, the fetal head has descended to the level of the prominent bony landmarks on either side of the midpelvis. A baby who has just begun to descend may be at 4 or 5 station. Once delivery begins, the head continues on through the pelvis past 0 to +1, +2, and so on, until it begins to "crown" at the external vaginal opening at +5. Though a woman who goes into labor at 0 station probably has less pushing ahead than the woman at 3, this isn't invariably true, since station isn't the only factor affecting the progression of labor.

Though the engagement of the fetal head strongly suggests that the baby can get through the pelvis without difficulty, it's no guarantee. Conversely, a fetus that is still free floating going into labor isn't necessarily going to have trouble negotiating the exit. And in fact, the majority of fetuses that haven't yet engaged when labor begins come through the pelvis smoothly. This is particularly true in moms who have already delivered one or more babies.

Changes in Baby's Movements "My baby used to kick so vigorously, and I can still feel him moving, but he seems less active now."

When you first heard from your baby, way back in the fifth month or so, there was ample room in the uterus for acrobatics, kickboxing, and punching. Now that conditions are getting a little cramped, his gymnastics are curtailed. In this uterine straitjacket, there is little room for anything more than turning, twisting, and wiggling-which is probably what you've been feeling. And once your baby's head is firmly engaged in your pelvis, he will be even less mobile. But this late in the game, it's not important what kind of fetal movement you feel (or even if it's only on one side), as long as you feel some every day. If, however, you feel no activity (see next question) or a sudden spurt of very panicky, frantic, jerky, or violent activity, check with your practitioner.

Going Down?

You may be in for a surprise-and a treat-at one of this month's weigh-ins. Most expectant moms who reach the end of pregnancy also reach the end of pregnancy weight gain. Instead of watching the numbers on the scale go up (and up), you may start seeing those numbers go nowhere-or even go down-over the last few weeks. What's up (or rather, down) with that? After all, your baby isn't losing weight-and your ankles (not to mention your hips) are still plenty puffy, thank you very much. What's happening, actually, is perfectly normal. In fact, this weight gain standstill (or downward trend) is one way that your body gets ready for labor. Amniotic fluid starts to decrease (less water equals less weight), and loose bowels (common as labor approaches) can also send the numbers down, as can all that sweating you're doing (especially if you've been nesting overtime). And if you think this weight loss is exciting, wait until delivery day. That's when you'll experience your biggest one-day weight-loss total ever!

"I've hardly felt the baby kick at all this afternoon. What does that mean?"

Chances are your baby has settled down for a nap (older fetuses, like newborns, have periodic interludes of deep sleep) or that you've been too busy or too active to notice any movements. For reassurance, check for activity using the test on page 289 page 289. You may want to repeat this test routinely twice a day throughout the last trimester. Ten or more movements during each test period mean that your baby's activity level is normal. Fewer suggest that medical evaluation might be necessary to determine the cause of the inactivity, so contact your practitioner if that's the case. Though a baby who is relatively inactive in the womb can be perfectly healthy, inactivity at this point sometimes indicates fetal distress. Picking up this distress early and taking steps to intervene can often prevent serious consequences.

"I've read that fetal movements are supposed to slow down as delivery approaches. My baby seems as active as ever."

Every baby's different, even before he or she is born-especially when it comes to activity levels, and particularly as delivery day approaches. While some babies move a bit less as they get ready to arrive, others keep up an energetic pace right until it's time for that first face-to-face. In late pregnancy, there is generally a gradual decline in the number of movements, probably related to tighter quarters, a decrease in amniotic fluid, and improved fetal coordination. But unless you're counting every single movement, you're not likely to notice a big difference.

Nesting Instinct "I've heard about the nesting instinct. Is it pregnancy legend, or is it for real?"

The need to nest can be as real and as powerful an instinct for some humans as it is for our feathered and four-legged friends. If you've ever witnessed the birth of puppies or kittens, you've probably noticed how restless the laboring mother becomes just before delivery-frantically running back and forth, furiously shredding papers in a corner, and finally, when she feels all is in order, settling into the spot where she will give birth. Many expectant mothers do experience the uncontrollable urge to ready their nests, too, just prior to childbirth. For some it's subtle. All of a sudden, it becomes vitally important to clean out and restock the refrigerator and make sure there's a six-month supply of toilet paper in the house. For others, this unusual burst of manic energy plays itself out in behavior that is dramatic, sometimes irrational, and often funny (at least, to those watching it)-cleaning every crevice of the nursery with a toothbrush, rearranging the contents of the kitchen cabinets alphabetically, washing everything that isn't tied down or being worn, or folding and refolding baby's clothes for hours on end.

Though it isn't a reliable predictor of when labor will begin, nesting usually intensifies as the big moment approaches-perhaps as a response to increased adrenaline circulating in an expectant mom's system. Keep in mind, however, that not all women experience the nesting instinct, and that those who don't are just as successful in bearing and caring for their nestlings as those who do. The urge to slump in front of the television during the last few weeks of pregnancy is as common as the urge to clean out closets, and just as understandable. Make that more understandable.

If a nesting urge does strike, make sure it's tempered by common sense. Suppress that overwhelming urge to paint the baby's nursery yourself; let someone else climb the ladder with the bucket and roller while you oversee from a comfy chair. Don't let overzealous home cleaning exhaust you, either-you'll need energy reserves for both labor and a new baby. Most important of all, keep the limitations of your species in mind. Although you may share this nesting instinct with members of the animal kingdom, you are still only human-and you can't expect to get everything done before that little bundle of joy arrives at your nest.

Getting Ready These days, it almost goes without saying that becoming educated about childbirth is one of the best ways to prepare for this momentous experience. So by all means make sure you and your coach are as educated as you can be: Read the next chapter, along with any other materials on labor and delivery you can get your hands on; watch DVDs; take a childbirth class together. But don't let your preparedness stop there. Be as prepared for matters practical and aesthetic, and plan, too, for your entertainment. Consider, for example: Are you interested in having the event videotaped (if that's allowed where you're delivering), or will a few photos suffice? Will music soothe your soul when your soul needs it most, or will you prefer some peace and quiet? What will distract you best between contractions-playing poker with your partner or solitaire on your cell phone, checking e-mail on your laptop, or watching reruns of your favorite sitcoms on TV? (Of course, also be prepared for the possibility that once those contractions begin, you may have little patience for distractions.) Don't forget to include the materials you'll need for the activities you've planned (including batteries for that camera, plus your phone charger) in the suitcase you'll be taking to the hospital or birthing center (see page 356 page 356 for a complete packing list). for a complete packing list).

How Is Baby Doing?

As your pregnancy nears its end (yes, it will will end), your practitioner will be keeping a closer eye on your health and that of your baby-especially once you pass the 40-week mark. That's because 40 weeks is the optimum uterine stay for babies; those who stick around much longer can face potential challenges (becoming too big to arrive vaginally, experiencing a decline in their placenta's function, or a dip in amniotic fluid levels). Luckily, your practitioner can tap into plenty of tests and assessments of fetal well-being to make sure all's well and will end well: end), your practitioner will be keeping a closer eye on your health and that of your baby-especially once you pass the 40-week mark. That's because 40 weeks is the optimum uterine stay for babies; those who stick around much longer can face potential challenges (becoming too big to arrive vaginally, experiencing a decline in their placenta's function, or a dip in amniotic fluid levels). Luckily, your practitioner can tap into plenty of tests and assessments of fetal well-being to make sure all's well and will end well: Kick counts. Your record of fetal movements (see Your record of fetal movements (see page 289 page 289), though not foolproof, can provide some indication of how your baby is doing. Ten movements an hour is usually reassuring. If you don't notice enough activity, other tests are then performed.

The nonstress test (NST). You'll be hooked up to a fetal monitor (the same kind that's used during labor) in your practitioner's office to measure the baby's heart rate and response to movement. You will be holding a clicker contraption (like a buzzer on a game show), and each time you feel the baby move, you'll click it. The monitoring goes on for 20 to 40 minutes and is able to detect if the fetus is under any stress.

Fetal acoustical stimulation (FAS) or vibroacoustic stimulation (VAS). This nonstress test, in which a sound-and-vibration-producing instrument is placed on the mother's abdomen to determine the fetus's response to sound or vibrations, is useful if there's a question about how to interpret a standard NST.

The contraction stress test (CST) or oxytocin challenge test (OCT). If the results of a nonstress test are unclear, your practitioner may order a stress test. This test, done at a hospital, tests how the baby responds to the "stress" of uterine contractions to get some idea of how the baby will handle full-blown labor. In this somewhat more complex and time-consuming test (it may take a number of hours), you're hooked up to a fetal monitor. If contractions are not occurring on their own, you'll be given a low-dose IV of oxytocin (or you'll be asked to stimulate your nipples) to jump-start the contractions. How the fetus responds to contractions indicates its probable condition and that of the placenta. This rough simulation of the conditions of labor can, if the results are unequivocal, allow a prediction to be made about whether or not the fetus can safely remain in the uterus and whether it can meet the strenuous demands of true labor. If the results of a nonstress test are unclear, your practitioner may order a stress test. This test, done at a hospital, tests how the baby responds to the "stress" of uterine contractions to get some idea of how the baby will handle full-blown labor. In this somewhat more complex and time-consuming test (it may take a number of hours), you're hooked up to a fetal monitor. If contractions are not occurring on their own, you'll be given a low-dose IV of oxytocin (or you'll be asked to stimulate your nipples) to jump-start the contractions. How the fetus responds to contractions indicates its probable condition and that of the placenta. This rough simulation of the conditions of labor can, if the results are unequivocal, allow a prediction to be made about whether or not the fetus can safely remain in the uterus and whether it can meet the strenuous demands of true labor.

A biophysical profile (BPP). A BPP generally evaluates, through the use of ultrasound, four aspects of life in the uterus: fetal breathing, fetal movement, fetal tone (the ability of your baby to flex a finger or toe), and amniotic fluid volume. When all these are normal, the baby is probably doing fine. If any of these are unclear, further testing (such as a CST or a VAS) will be given to provide a more accurate picture of the baby's condition. A BPP generally evaluates, through the use of ultrasound, four aspects of life in the uterus: fetal breathing, fetal movement, fetal tone (the ability of your baby to flex a finger or toe), and amniotic fluid volume. When all these are normal, the baby is probably doing fine. If any of these are unclear, further testing (such as a CST or a VAS) will be given to provide a more accurate picture of the baby's condition.

The "modified" biophysical profile. The "modified" biophysical profile combines the NST with an evaluation of the quantity of amniotic fluid. A low level of amniotic fluid may indicate that the fetus is not producing enough urine and the placenta may not be functioning up to par. If the fetus reacts appropriately to the nonstress test and levels of amniotic fluid are adequate, it's likely that all is well.

Umbilical artery Doppler velocimetry. This test uses ultrasound to look at the flow of blood through the umbilical artery. A weak, absent, or reverse flow indicates the fetus is not getting adequate nourishment and probably not growing well.

Other tests of fetal well-being. These include regular ultrasound exams to document fetal growth; amniotic fluid sampling (through amniocentesis); fetal electrocardiography or other tests (to assess the fetal heart); and fetal scalp stimulation (which tests how a fetus reacts to pressure on, or pinching of, the scalp).

Most of the time, fetuses pass these tests with flying colors, which means they can continue to stay put until they're good and ready to make their debuts. Rarely, the test results can be labeled "nonreasurring," which really isn't as unreassuring as it sounds. Because these tests yield plenty of false positives, a nonreassuring result doesn't definitely diagnose distress, but it will mean that your practitioner will continue to test your baby, and if it turns out that there's any indication of fetal distress, will induce your labor. (For information on labor induction, see page 368 page 368.)

When You Will Deliver "I just had an internal exam and the doctor said I'll probably be going into labor very soon. Can she really tell exactly how close I am?"

Your practitioner can make a prediction about when you'll give birth, but it's still just an educated guess-just as your original due date was. There are clues that labor is getting closer, which a practitioner looks for beginning in the ninth month, both by palpating the abdomen and doing an internal exam. Has lightening or engagement taken place? What level, or station, has the baby's presenting part descended to? Have effacement (thinning of the cervix) and dilation (opening of the cervix) begun? Has the cervix begun to soften and move to the front of the vagina (another indicator that labor is getting closer) or is it still firm and positioned to the back?

But "soon" can mean anywhere from an hour to three weeks or more. A practitioner's prediction of "you'll be in labor by this evening" could segue into a half month more of pregnancy, whereas a forecast of "labor's weeks away" could be followed hours later by birth. The fact is that engagement, effacement, and dilation can occur gradually, over a period of weeks or even a month or more in some women-and overnight in others. Which means that these clues are far from sure bets when it comes to pinpointing the start of labor.

Do-It-Yourself Labor Induction?

So what happens if you're overdue, and still as pregnant as ever (make that more pregnant than ever), with your baby showing no signs of budging? Should you just let nature take its course, no matter how long that course takes? Or should you take matters into your own hands, and try some do-it-yourself labor induction techniques? And if you do take matters into your own hands, will it even work? While there are plenty of natural methods you can use to try to bring on labor (and plenty of old wives' tales to go along with them), it's hard to prove that any of them will do the trick. Some women swear by them, but none of the homegrown methods passed from mom-to-be to mom-to-be has been documented as consistently effective. That's probably at least partly due to the fact that when they do appear to work, it's difficult to establish whether they actually worked-or whether labor, coincidentally, started on its own at the same time.

Still, if you're at the end of your rope (and who isn't by 40 weeks?), you might want to give these a try: Walking. It has been suggested that walking can help ease the baby into the pelvis, thanks perhaps to the force of gravity or the swaying (or waddling) of your hips. Once your baby puts pressure on the cervix-literally-labor just might get going. If it turns out that your stroll doesn't jump-start labor, you'll be no worse for the wear. In fact, you might be in better shape for labor, whenever it actually does begin. It has been suggested that walking can help ease the baby into the pelvis, thanks perhaps to the force of gravity or the swaying (or waddling) of your hips. Once your baby puts pressure on the cervix-literally-labor just might get going. If it turns out that your stroll doesn't jump-start labor, you'll be no worse for the wear. In fact, you might be in better shape for labor, whenever it actually does begin.

Sex. Sure you're the size of a small hippo, but hopping (make that hoisting yourself) into bed with your partner may be an effective way to mix business with pleasure. Or not. Some research shows that semen (which contains prostaglandins) can stimulate contractions, while other research has found that women who continue to have sex late in pregnancy might carry their babies even longer than those who abstain. The bottom line? Go for your bottom lines, if you're game to try (and get a good laugh while you're at it). After all, it may be the last time in a long time that you'll actually be able (or willing) to have sex. If getting busy brings on labor, great-if it doesn't, still great.

Other natural methods have potential drawbacks (even though they've been passed down from midwives to old wives to new doctors). So before you try these at home, discuss them with your practitioner first: Nipple stimulation. Interested in some nipple tweaking (ouch)? How about some nipple twisting (double ouch)? Stimulating your nipples for a few hours a day (yes, hours) can release your own natural oxytocin and bring on contractions. But here's the caveat: Nipple stimulation-as enticing as hours of it may sound (or not)-can lead to painfully long and strong uterine contractions. So unless your practitioner advises it and is monitoring your progress, you may want to think four times-twice for each nipple-before you or your spouse attempt nipple stimulation. Interested in some nipple tweaking (ouch)? How about some nipple twisting (double ouch)? Stimulating your nipples for a few hours a day (yes, hours) can release your own natural oxytocin and bring on contractions. But here's the caveat: Nipple stimulation-as enticing as hours of it may sound (or not)-can lead to painfully long and strong uterine contractions. So unless your practitioner advises it and is monitoring your progress, you may want to think four times-twice for each nipple-before you or your spouse attempt nipple stimulation.

Castor oil. Hoping to sip your way into labor with a castor oil cocktail? Women have been passing down this yucky-tasting tradition for generations on the theory that this powerful laxative will stimulate your bowels, which in turn will stimulate your uterus into contracting. The caveat for this one: Castor oil (even mixed with a more appetizing drink) can cause diarrhea, severe cramping, and even vomiting. Before you chug-a-lug, be sure you're game to begin labor that way.

Herbal teas and remedies. Raspberry leaf tea, black cohosh-these herbal remedies might be just what your grandmother orders to bring on labor, but since no studies have been done to establish the safety of any herbal treatments as labor inducers, don't use any without getting the green light from your practitioner first.

And while you're pondering the effectiveness of the do-it-yourself methods, remind yourself that you will will go into labor-either on your own or with a little help from your practitioner-in a week or two. go into labor-either on your own or with a little help from your practitioner-in a week or two.

So feel free to pack your bags, but don't keep the car running. Like every pregnant woman who preceded you into the birthing room, you will still have to play the waiting game, knowing for certain only that your day, or night, will come-sometime.

The Overdue Baby "I'm a week overdue. Is it possible that I might never go into labor on my own?"

The magic date is circled in red on the calendar; every day of the 40 weeks that precede it is crossed off with great anticipation. Then, at long last, the big day arrives-and, as in about half of all pregnancies, the baby doesn't. Anticipation dissolves into discouragement. The stroller and crib sit empty for yet another day. And then a week. And then, in about 10 percent of pregnancies, most often those of first-time mothers, two weeks. Will this pregnancy never end?

Though women who have reached the 42nd week might find it hard to believe, no pregnancy on record ever went on forever, even before the advent of labor induction. Studies show that about 70 percent of apparent post-term pregnancies aren't post-term at all. They are only believed to be late because of a miscalculation of the time of conception, usually thanks to irregular ovulation or a woman's uncertainty about the exact date of her last period. And in fact, when early ultrasound examination is used to confirm the due date, diagnoses of postterm pregnancy drop dramatically from the long-held estimate of 10 percent to about 2 percent.

Even if you do end up among those 2 percent of women who are truly overdue, your practitioner won't let your pregnancy pass the 42-week mark. In fact, most practitioners won't even let a pregnancy continue that long, choosing instead to induce by the time your baby has clocked in 41 uterine weeks. And, of course, if at any point test results show that the placenta is no longer doing its job well or that the amniotic fluid levels have dipped too low-or if there are any other signs that baby might not be thriving-your practitioner will take action, and depending on the situation, either induce labor or perform a cesarean delivery. Which means that even if you don't end up going into labor on your own, you won't be pregnant forever.

"I've heard that overdue babies don't continue to thrive. I just passed my 40th week-does that mean my baby should be delivered?"

Just because your pregnancy has exceeded those 40 allotted weeks doesn't necessarily mean that your baby has worn out his or her uterine welcome-or that a speedy exit is called for. Many babies actually continue to grow and thrive well into the tenth month. But when a pregnancy goes post-term (technically, at the 42-week mark), the once ideal environment in a womb can become less hospitable. The aging placenta can fail to supply enough nutrition and oxygen, and production of amniotic fluid can drop off.

Babies born after spending time in such an inhospitable environment are called postmature. Their skin is dry, cracked, peeling, loose, and wrinkled, having already shed the cheesy vernix coating that previously protected it. Being "older" than other new arrivals, they have longer nails and more hair, and are generally open-eyed and alert. Because they are usually larger than term babies, with wider head circumferences, and because they may sometimes be in distress, postmature babies are more likely to be delivered by cesarean. They may also need some special care in the neonatal intensive care nursery for a short time after birth. So, though the majority of post-term babies arrive home a little later than scheduled, they arrive completely healthy.

To prevent postmaturity, many practitioners choose to induce labor when it's certain that a pregnancy is past 41 weeks and the cervix is found to be ripe (soft and ready to dilate) or sooner if there are complications of any kind. Other practitioners may choose to wait it out a bit longer, performing one or more assessment tests (see box, page 348 page 348) to see if the baby is still doing well in the uterus, and repeating these tests once or twice a week until labor begins. Ask your practitioner what game plan he or she usually goes with when a baby's late.

Massage It, Mama Got nothing but time on your hands as you wait for baby's arrival? Put your hands (or a special someone else's hands) to good use-and give yourself a rub. Perineal massage can help gently stretch a first timer's perineum (that area of skin between your vagina and rectum), which in turn can minimize the "stinging" that occurs when baby's head crowns during childbirth. And here's another plus you'll appreciate: It may also help you avoid an episiotomy and tearing, according to some experts.

Here's how to give your perineum the right rub: With clean hands (and short nails) insert your thumbs or index fingers (lubricated with a little K-Y jelly if you'd like) inside your vagina. Press down (toward your rectum) and slide your fingers across the bottom and sides of your perineum. Repeat daily during the last weeks of pregnancy, five minutes (or longer) each time. Not in the mood for a perineal massage? It's certainly not something you have to do. Don't bother if you don't feel comfortable with the concept, it seems too weird, or you just don't have the time. Though anecdotal evidence has long supported its effectiveness, clinical research has not yet backed it up. Even without the rubbing, your body will still stretch when the time comes. And don't bother with perineal massage if you've already popped out a baby or two. Your perineum doesn't need, and probably won't benefit from, the extra stretching.

One word to the wise: If you do go the massage route, proceed gently. The last thing you want to do right before labor is to pull too hard, scratch yourself, or irritate the sensitive skin down there. Bottom line: Massage with care.

Of course, chances are good your baby will decide to check out of your womb sooner than later-and without any prompting.

Inviting Others to the Birth "I'm really excited about having my baby and I want to share the experience with my sisters and best friends-and, of course, my mom. Would it be weird to have them all in the birthing room with me and my husband?"

Someone's having a birth day party (your baby, in fact), and if you're like more and more moms-to-be, the guest list is getting longer and longer. There's definitely nothing weird about wanting to have those who are closest to you by your side on the big day-and, in fact, it's a trend that's gaining popularity in birthing circles.

Why is more merrier for some women on labor day? For one, the widespread use of epidurals has made labor less laborious for many. With little or no pain to deal with-or breathe through-there's more opportunity to socialize (plus, it's a lot easier to be in a party mood if you're not groaning and panting). For another, hospitals and birthing centers are also enabling the maternity mob, making some birthing rooms bigger (more equipped to handle the overflow of guests) and more comfortable (complete with sofas and extra chairs for visitors to plop down on while they're waiting for the headliner to make his or her debut). Some even have Internet access to keep guests busy when there's a break in the action. Policies have become more lenient, too-and at some hospitals and birthing centers, even open door (for as many as can fit in the door, that is). And having a gaggle of girlfriends and relatives may be just what the doctor-or midwife-ordered, too. Many practitioners reason that having more distraction, support, and back-rubbing hands makes a mom-to-be happier and more relaxed during labor-always a good thing, whether it's a medicated birth or not.

Foods to Bring It On?

Hungry for labor? Ready to do-or eat-anything that might trigger that first real contraction? Though there's no science backing them up, plenty of old wives (or old friends) will tell you about a last supper that ended with a trip down labor lane. Among the often heard: If your stomach can take the heat, dip into something spicy. Or order something that gets your bowels-and hopefully your uterus-in an uproar (a crate of bran muffins, chased down by a bucket of prune juice, perhaps?). Not in the mood for something so stimulating? Some women swear by eggplant, tomatoes, and balsamic vinegar (not necessarily together); others say pineapple buys a ticket on the Labor Express. Whatever you dig into, remember that unless your baby and your body are ready to take the labor plunge, it's unlikely that dinner's going to pull the trigger.

Sounds Like a Plan How far along in labor should you be before calling your practitioner? Should you call if your water breaks? How can you make contact if the contractions start outside of regular office hours? Should you call first and then head for the hospital or birthing center? Or the other way around?

Don't wait until labor starts to get the answers to these important questions. Discuss all of these and other labor logistics with your practitioner at your next appointment, and write down all the pertinent info; otherwise, you'll be sure to forget the instructions once those contractions kick in.

Also, be sure you know the best route to your place of delivery, roughly how long it will take to get there at various times of the day, and what kind of transportation is available if you don't have someone to drive you (don't plan on driving yourself). And if there are other children at home, or an elderly relative, or a pet, be sure you've made plans for their care in advance.

Keep a copy of all the above information in the bag you're likely to be using and in the suitcase you've packed, as well as on your refrigerator door or bedside table.

Clearly, there are lots of good reasons why you might want an encouraging entourage in the birthing room with you. Still, there are a few caveats to consider before you issue the invites: You'll have to get the medical- powers-that-be to sign off on your guest list (not all practitioners are mob friendly, and some hospitals cap the number of guests you're allowed). You'll also have to be sure your spouse is on board with the guest list (remember, even though you'll be doing most of the work, both of you are co-hosting the party, and he won't want to be relegated to B-list). Think about, too, whether you'll really be comfortable with so many eyes on you during a very private moment (there will be moaning, grunting, peeing, probably a little pooping-and you will be half-naked). Something else to ponder: Will those you've invited (your brother, your father-in-law, for example) be comfortable with what you're inviting them to view-and might their discomfort put you on edge when you most need to be relaxed? Will you want everyone standing around chatting when you're craving peace and quiet (and rest)? Will you feel obligated to entertain your guests when you need to be focused on birthing your baby?

If you decide you'd like the company, just remember to put flexibility on the list, too. Remember (and remind your guests) that there's always the possibility your intended uneventful vaginal birth may turn into an unexpected C-section, in which case only the expectant dad will be allowed to follow the party into the OR. Or that you'll decide-say somewhere around the second hour of pushing-that you're not up to guests anymore and they might be shown to the door for delivery. (And if you do end up regretting your decision to invite a crowd, don't worry about hurting anyone's feelings by sending the guests packing; as a woman in labor, your feelings are the only ones that matter.) Not feeling like inviting a crowd? Don't let trends-or pushy relatives-guilt you into a full birthing room. What feels right for you and your spouse is the right decision.

Another Long Labor?

"I had a 30-hour labor my first time around and finally delivered after three hours of pushing. Though we both came out of it fine, I dread going through that again."

Anyone brave enough to go back into the ring after such a challenging first round deserves a break. And chances are good that you'll get one. Of course, though the odds of an easier childbirth are significantly improved the second time around, there are no sure bets in labor and delivery rooms. Your baby's position or other factors may alter these odds. Short of a crystal ball, there's no way to predict precisely what will happen this time around.

But second and subsequent labors and deliveries are usually easier and shorter than first ones-often dramatically so. Less resistance will be met from your now-roomier birth canal and your laxer muscles, and though the process won't be effortless-it rarely is-it probably will seem like less of an ordeal. The most marked difference may be in the amount of pushing you have to do; second babies often pop out in a matter of minutes rather than hours.

Mothering "Now that the baby's almost here, I'm beginning to worry about how I'm going to take care of her. I've never even held a newborn before."

Most women aren't born mothers-any more than men are born fathers-instinctively knowing how to soothe a crying baby, change a diaper, or give a bath. Motherhood-parenthood, for that matter-is a learned art, one that requires plenty of practice to make perfect (or actually, near-perfect-since there's no such thing as a perfect parent).

Time was, women routinely practiced on other people's babies, caring for younger siblings or other infants in the family or the neighborhood, before they had their own. These days, though, many women-just like you-have never held a newborn until they hold their own. Their training for motherhood comes on the job, with a little help from parenting books, magazines, and websites, and, if they're lucky enough to find one locally, from a baby-care class. Which means that for the first week or two-and often much longer-a new mom can feel out of her element as the baby does more crying than sleeping, the diapers leak, and many tears are shed over the "no-tears" shampoo (on both sides of the bottle).

Slowly but surely-one dirty diaper, one marathon feeding session, one sleepless night at a time-every new mom (even the greenest) begins to feel like an old pro. Trepidation turns to assurance. The baby she was afraid to hold (won't it break?) is now cradled casually in her left arm while her right pays bills online or pushes the vacuum cleaner. She can dispense vitamin drops, give baths, and slip squirming arms and legs into onesies in her sleep-literally, sometimes. As she hits her maternal stride and settles into a somewhat predictable rhythm, parenting an infant becomes second nature. She starts to feel like the mom she is, and-difficult though it may be to imagine right now-you will, too.

Though nothing can make those first learning process before your newborn is placed in your arms (and in your round-the-clock care) can make them seem a little less overwhelming. Any of the following can help moms- (and dads-) to-be ease into their new roles: visiting a recent arrivals; holding, diapering, and soothing a friend's or family member's infant; reading up on a baby's first year; visiting first-year websites and message boards (no one can teach you more about being a mom than another mom; check out whattoexpect.com) and watching a newborn nursery and viewing the mostdays with a first baby a cinch, starting the DVD or taking a class in baby care (and baby CPR). For even more reassurance, talk to friends who have recently become parents. You'll be relieved to know that just about everybody comes into the job with the same new-mom (or new-dad) jitters.

What to Take to the Hospital or Birthing Center Though you could show up with just your belly and your insurance card, traveling that empty-handed to the hospital or birthing center probably isn't the best idea. Traveling light, however, is (no need to lug a huge suitcase along with that big belly), so pack only what you think you'll really use or need. Be sure to pack that bag early (so you won't be turning the house upside down for your iPod when the contractions are coming five minutes apart) with as many-or as few-of the following as you'd like: For the Labor or Birthing Room [image] This book and This book and The What to Expect Pregnancy Journal and Organizer, The What to Expect Pregnancy Journal and Organizer, which has ample room for labor-and-delivery and meet-the-baby note keeping. A pen and pad may also be useful for jotting down questions and answers on procedures and on your condition and your baby's; instructions for when you go home; and the names of staff members who have taken care of you. which has ample room for labor-and-delivery and meet-the-baby note keeping. A pen and pad may also be useful for jotting down questions and answers on procedures and on your condition and your baby's; instructions for when you go home; and the names of staff members who have taken care of you.[image] Several copies of your birth plan, if you're using one (see Several copies of your birth plan, if you're using one (see page 294 page 294).[image] A watch with a second hand for timing contractions. Better yet, make sure your coach is wearing one at all times during the last few weeks of your pregnancy. A watch with a second hand for timing contractions. Better yet, make sure your coach is wearing one at all times during the last few weeks of your pregnancy.[image] An MP3 player, iPod, or CD player, along with some of your favorite tunes, if music soothes and relaxes you. An MP3 player, iPod, or CD player, along with some of your favorite tunes, if music soothes and relaxes you.[image] A camera and/or video equipment, if you don't trust your memory to capture the moment (and if the hospital or birthing center rules allow media coverage of births-most do). Don't forget extra batteries and/or chargers. A camera and/or video equipment, if you don't trust your memory to capture the moment (and if the hospital or birthing center rules allow media coverage of births-most do). Don't forget extra batteries and/or chargers.[image] Entertainment: a laptop, a Sudoku or crossword book, a handheld video game player, knitting, or whatever diversions you think will keep you from focusing too much on your labor. Entertainment: a laptop, a Sudoku or crossword book, a handheld video game player, knitting, or whatever diversions you think will keep you from focusing too much on your labor.[image] Favorite lotions, oils, or anything else you like for massages. Favorite lotions, oils, or anything else you like for massages.[image] A tennis ball or back massager, for firm countermassage, should lower backache be a problem. A tennis ball or back massager, for firm countermassage, should lower backache be a problem.[image] A pillow of your own to make you more comfortable during and after labor. A pillow of your own to make you more comfortable during and after labor.[image] Sugarless lollipops or candies to keep your mouth moist. Sugarless lollipops or candies to keep your mouth moist.[image] A toothbrush, toothpaste, and mouthwash (you may find yourself desperate for a freshen-up after eight hours or so). A toothbrush, toothpaste, and mouthwash (you may find yourself desperate for a freshen-up after eight hours or so).[image] Heavy socks, should your feet become cold. Heavy socks, should your feet become cold.[image]Comfortable slippers with nonskid bottoms, in case you feel like doing some walking during labor, and so you can do some strolling in the halls later, between baby feedings.[image] A scrunchie, clip, or hairband, if your hair is long, to keep it out of your face and tangle free. A hairbrush, too, if you think it'll come in handy. A scrunchie, clip, or hairband, if your hair is long, to keep it out of your face and tangle free. A hairbrush, too, if you think it'll come in handy.[image] A couple of sandwiches or other snacks for your coach, so he won't have to leave your side when his stomach starts growling. A couple of sandwiches or other snacks for your coach, so he won't have to leave your side when his stomach starts growling.[image] A change of clothes for your coach, for comfort's sake and if he plans to sleep over in the hospital. A change of clothes for your coach, for comfort's sake and if he plans to sleep over in the hospital.[image] A cell phone and charger (though you might not be allowed to use a cell in the room). A cell phone and charger (though you might not be allowed to use a cell in the room).

For Postpartum [image] A robe and/or nightgowns/pj's, if you'd rather wear your own than the hospital's. Make sure it opens in the front if you'll be breastfeeding. Keep in mind, however, that though pretty nightgowns or comfy pj's can boost your spirits, they may get bled on and stained. A robe and/or nightgowns/pj's, if you'd rather wear your own than the hospital's. Make sure it opens in the front if you'll be breastfeeding. Keep in mind, however, that though pretty nightgowns or comfy pj's can boost your spirits, they may get bled on and stained.[image] Toiletries, including shampoo and conditioner, body wash, deodorant, hand mirror, makeup, and any other essentials of beauty and hygiene. Toiletries, including shampoo and conditioner, body wash, deodorant, hand mirror, makeup, and any other essentials of beauty and hygiene.[image] Your favorite brand of maxipads, though the hospital will also provide some (skip the tampons). Your favorite brand of maxipads, though the hospital will also provide some (skip the tampons).[image] A couple of changes of underwear and a nursing bra. A couple of changes of underwear and a nursing bra.[image] All the entertainment listed above, plus books (including a baby-name book if that decision's still up in the air). All the entertainment listed above, plus books (including a baby-name book if that decision's still up in the air).[image] A supply of snacks: trail mix, soy chips, cereal bars, and other healthy treats to keep you from starving when the hospital food doesn't cut it or hunger strikes between meals. A supply of snacks: trail mix, soy chips, cereal bars, and other healthy treats to keep you from starving when the hospital food doesn't cut it or hunger strikes between meals.[image] A list of phone numbers of family and friends to call with the good news; a phone card or calling card number in case you have no cell phone reception or the hospital doesn't allow cell phone usage. A list of phone numbers of family and friends to call with the good news; a phone card or calling card number in case you have no cell phone reception or the hospital doesn't allow cell phone usage.[image] A going-home outfit for you, keeping in mind that you'll still be sporting a sizable belly (you'll probably look like you're at least five or six months pregnant right after the birth; plan accordingly). A going-home outfit for you, keeping in mind that you'll still be sporting a sizable belly (you'll probably look like you're at least five or six months pregnant right after the birth; plan accordingly).[image] A going-home outfit for baby: a kimono or stretchie, T-shirt, booties, a receiving blanket, and a heavy bunting or blanket if it's cold; diapers will probably be provided by the hospital, but bring along an extra, just in case. A going-home outfit for baby: a kimono or stretchie, T-shirt, booties, a receiving blanket, and a heavy bunting or blanket if it's cold; diapers will probably be provided by the hospital, but bring along an extra, just in case.[image] Infant car seat. Most hospitals will not let you leave with the baby unless he or she is safely strapped into an approved rear-facing infant car seat. Besides, it's the law. Infant car seat. Most hospitals will not let you leave with the baby unless he or she is safely strapped into an approved rear-facing infant car seat. Besides, it's the law.

Fill 'Er Up Your kitchen, that is. Though shopping for strollers, diapers, and pint-size clothing understandably has been your priority these days, don't forget to take a time-out at the market. Even with swollen ankles and a super-size belly weighing you down, grocery and staple shopping is easier nine months pregnant than it will be again for a long time-so take advantage and stock up now so you won't have to later with baby (and car seat, and diaper bag) in tow. Fill your pantry, fridge, and freezer to the brim with healthy foods that are easy to serve-cheese sticks, individual containers of yogurt, frozen fruit bars, frozen fruit for making smoothies, cereal, granola bars, soups, dried fruit and nuts. Don't forget the paper products, too (you'll be using paper towels by the crateful, and disposable plates and cups can fill in when you don't get around to emptying the dishwasher). And while you're in the kitchen-and have the time-cook up some extra servings of your favorite freezer-friendly foods (lasagna, mini meatloaves, chili, pancakes, muffins), and store them in clearly marked single-meal containers in the freezer. They'll be ready to pop in the microwave when you're pooped (and hungry) postpartum.