Health Conditions / Sexual and Reproductive Health / Labor and Delivery

“Do what works best for you and everyone else will hopefully do their best to support you in that,” Dr. Leonard says.2. Focus on flexibility.When Standard talks about birth plans with her patients, she refers to them as “preference lists.” “A plan doesn’t leave room for ‘but’—a ‘preference list’ does,” she explains. Here’s an example: On a traditional birth plan, you may feel inclined to include something like not wanting IV fluids during an uncomplicated vaginal delivery. A preference list would take something like that desire and phrase it differently. It may state, for example, that you’d prefer not to have an IV if you don’t need one, leaving room for the unknowns of labor and delivery. It seems like a small difference, but thinking about things this way may help you consider alternatives. Maybe you’d be open to having your care team place an IV with no fluids in the event you may need one, for example, Standard explains. The sample birth plan ACOG provides even includes this as a potential option. “Plans need to be fluid. The person making a plan needs to know that a birth plan is a starting point because birth is forever changing,” she says.Flexibility—and giving yourself grace throughout your birth experience— will also help remind you that it’s not your fault if things change course (which they likely will). Setting yourself up for success from the start by reminding yourself that flexibility and fluidity are part of the process can help ease any negative emotions that may arise if and when things change. “The purpose of the plan is to have shared decision-making and to have your voice heard—it’s not that everything goes exactly as you planned,” Dr. Leonard says.3. Talk about your plan well in advance.You don’t want to be making your birth plan as you’re driving to the hospital or when you start to realize contractions are regular. “You want to discuss it with your provider or providers; you want everybody on the team to be a part of it,” Standard says. After all, that shared decision-making is the key part, she says. Especially if you’ve experienced birth trauma or past negative birthing experiences, you’ll want to bring up preferences early on to begin conversations and voice any fears you may have. This leaves time to review things with your team and work through any challenges.When speaking with your care team, Standard always suggests remembering the acronym BRAIN:What are the Benefits?What are the Risks?What are the Alternatives?What is my Intuition telling me?Do we need to do this Now? 4. Do your research.Making sure you have quality, up-to-date information is an important and often-overlooked aspect of creating a birth plan. An example: You may want to list something like “I don’t want an episiotomy” on your birth plan. But Standard notes that while an episiotomy, a cut from the vaginal opening to the anus, used to be a routine part of birth, it no longer is. The Mayo Clinic notes that an episiotomy might only be recommended if the fetus’s shoulder is stuck behind the pelvic bone, the fetus has an unusual heart rate pattern, or forceps or a vacuum are needed.

Serena Williams opened up about a terrifying experience no person giving birth should have to go through. In a new essay for Elle, the legendary tennis player discussed how giving birth to her daughter Olympia, who is now four years old, led to potentially life-threatening complications.When Williams went into labor in 2017, Olympia’s heart rate plummeted as the contractions increased in frequency and severity. “I was scared,” Williams recalled. But after 20 minutes of deliberation, her doctor determined that she would be having a C-section, as there was not enough time to safely deliver the baby without one. “I’m not good at making decisions. In that moment, what I needed most was that calm, affirmative direction,” Williams wrote. “Since it was my first child, I really wanted to have the baby vaginally, but I thought to myself, ‘I’ve had so many surgeries, what’s another one?’ Being an athlete is so often about controlling your body, wielding its power, but it’s also about knowing when to surrender.”The experience that followed was one that changed her life forever. “I’ve learned to dust myself off after defeat, to stand up for what matters at any cost, to call out for what’s fair—even when it makes me unpopular. Giving birth to my baby, it turned out, was a test for how loud and how often I would have to call out before I was finally heard,” Williams wrote. She is referring to a health complication that occurred shortly after she gave birth. After her C-section, Williams asked her nurses whether she should be put on blood thinners as she had a history of being “at high risk for blood clots”—but she was dismissed. “No one was really listening to what I was saying,” Williams recalled. She persisted, pushing for the blood thinners. She was in “excruciating pain” and was unable to move her legs or her back, and was then seized by “full-body” coughs as she could not get enough air. These coughs caused the stitches on her C-section wound to rupture, and she had to go into surgery. Post-operation, she pressed to get a CAT scan of her lungs and to be put on heparin (a drug that helps prevent blood clots), but her nurse again dismissed her, saying the medicine Williams had taken was making her “talk crazy.”  Fortunately, she persisted: “No, I’m telling you what I need: I need the scan immediately,” Williams recalled telling the nurse. Her doctor thankfully took her concerns seriously—and her fears were eventually confirmed. “I was coughing because I had an embolism, a clot in one of my arteries. The doctors would also discover a hematoma, a collection of blood outside the blood vessels, in my abdomen, then even more clots that had to be kept from traveling to my lungs. That’s what the medical report says, anyway. To me, it was just a fog of surgeries, one after another.” Williams wrote. Over one week, Williams underwent four back-to-back operations, including the C-section. She admits she might not be alive had she not advocated for her health, emphasizing that the type of dismissal she endured is one Black people encounter far too often. “In the U.S., Black women are nearly three times more likely to die during or after childbirth than their white counterparts,” Williams wrote, a figure that is supported by the Centers for Disease Control and Prevention. “I know those statistics would be different if the medical establishment listened to every Black woman’s experience.”Related: 8 Ways We Can Actually Reduce Black Maternal MortalityWilliams has won 23 Grand Slam titles during her iconic career, but since becoming a mother, her priorities have understandably shifted. Or as she puts it, her body had “switched allegiances.” Her daughter is now her focus while triumphing in tournaments has become more of a desire than a need. “I have a beautiful daughter at home; I still want the titles, the success, and the esteem, but it’s not my reason for waking up in the morning. There is more to teach her about this game than winning,” Williams wrote. Despite her “seemingly endless” labor and her “body’s wreckage,” Williams still says she had “a wonderful pregnancy” and considers herself to be “one of those women who likes being pregnant.” Still, she recognizes that her path could have been very different had she not spoken up when it mattered the most: “Being heard and appropriately treated was the difference between life or death for me.”

New research published in the journal Obstetrics and Gynecology last week emphasized the extreme financial risk of being pregnant and giving birth in the U.S. “Pregnancy and delivery are associated with increased risk of catastrophic health expenditures in the delivery year,” the researchers wrote, defining catastrophic health expenditures as spending more than 10% of annual family income on out-of-pocket health costs. The costs tended to be most exorbitant for people with low incomes. To investigate the financial risk involved in pregnancy and birth, researchers at Mount Sinai performed a retrospective, cross-sectional study using U.S. Department of Health and Human Services’ Medical Expenditure Panel Survey data from 2008 to 2016. They compared the medical spending and employment status of 4,056 birth parents with the same records of 7,996 reproductive-aged women who were not pregnant in a given year. The study found that 9.2% of birth parents experienced catastrophic health expenditures in their delivery years, compared with 6.8% of those who hadn’t delivered children in a given year. With premiums included, those numbers rose to 21.3% and 18.4% respectively. Birth parents with low incomes had the greatest odds of catastrophic health expenditures; 18.8% of families with incomes at less than 138% of the federal poverty level had catastrophic health expenditures in the year they gave birth. That number rose to 29.8% when premiums were included. “Pregnancy and delivery are critical periods of time with high health care utilization. Our study demonstrates that this health care utilization can be a financial burden for expectant parents,” study author Jessica A. Peterson, MD, maternal-fetal medicine Fellow in Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, said in a press release. “This burden primarily affects those at lower incomes.”Researchers noted that the risk of significant spending for birth parents did not noticeably decrease with the implementation of the Affordable Care Act (ACA). In fact, birth parents on private insurance had higher risks of catastrophic health expenditures. “Medicaid and public coverage were more protective from high out-of-pocket costs than private insurance, particularly among low-income families,” the researchers said. The ACA, also known as Obamacare, was signed into law in March 2010. The objective was to provide affordable health insurance for people in the U.S., including coverage for medical, dental, and vision services that they otherwise would not have been able to access. In 2021, 31 million people were enrolled in coverage related to the ACA, making this the highest total on record, according to the Office of Health Policy. The act has faced significant problems over the years, though, including monthly premiums rising significantly. Many agree that the act requires improvement and reform. The Obstetrics and Gynecology study also found that parents who had just had children were more likely to be unemployed, with 52.6% of birth parents reporting unemployment for at least part of the year compared with 46.6% of the people who hadn’t given birth. This, of course, can then affect insurance coverage. “Given the association between pregnancy, delivery, and catastrophic health expenditure—as well as the protective effects of public insurance—it is imperative that we create policies that not only ensure insurance coverage for pregnant people, but also make it affordable,” Dr. Peterson said.Related:

I’m still working towards taking my birth-story power back.When I heard my doctor utter the dreaded words, “It’s time to consider a C-section,” my heart shattered into a million sharp pieces. It was May of last year. My baby was crowning. I’d already been through more than 22 hours of labor, the last two of which I spent attempting to push my baby into the world through horrendous back labor that felt like my spine would break with each contracted breath while my epidural was only working, of course, on one side of my body.So, ignoring my doctor’s suggestion, I closed my eyes and continued to push with all of my might as if maybe the next few pushes would finally force my baby’s head to descend.But his head didn’t budge.I was told to switch to different birthing positions, like lying on my side and kneeling at the foot of the bed, to see if they would help. They didn’t. My doctor tried a few different interventions after that, all of which proved unsuccessful in moving my baby farther out into the world.In a more serious tone, my doctor looked me in the eyes and said, “The baby’s not moving, and I don’t want him or you to go into distress. It’s time to prep for a C-section.”I cried.I knew that it was, indeed, time to move to a C-section to ensure the safety of both me and my baby. But because I’d never seriously considered that I would have a C-section, I wasn’t able to truly process this transition in plans. All I knew was that I felt like my power being was taken away and I had been relegated to a witness to my child’s birth rather than an active participant. I retreated into myself so deeply that it would take months after my baby’s birth to even begin to unpack my emotional distress.I was not one of those pregnant people who had a very detailed birth plan. I really only knew that I wanted an epidural and for my baby to breastfeed shortly after birth. I naively assumed that I would have a vaginal birth because I had an uncomplicated pregnancy, my baby was well-positioned, I went into labor almost to the day of my expected due date, and I didn’t have any pre-existing conditions that were cause for concern. I confidently planned a vaginal delivery and only spent the smallest amount of time learning about what a C-section delivery entailed, just for academic purposes.So, when I was prepped for major surgery in what felt like the blink of an eye, I prayed—to the universe, fate, God, anyone who was listening—that I and my baby would survive. That I would get to hear him cry tears of consciousness as he entered into the world.Thankfully, my surgery went really well. My baby immediately cried out when he was born, and my doctor lifted him up so that I could see his wet little body. I cried tears of relief and joy, and I knew at that moment that I’d made the right decision to have a C-section.

Doing Kegel exercises is a bit like flossing—it’s a tiny little thing that you know you should be doing regularly to keep a crucial part of your body healthy, but for some reason, it just completely slips your mind until the next time someone asks you about your track record. (Or, more likely, the next time you click an article like this one.)And, hey, that’s not your fault. Unlike brushing your teeth, washing your face, and wiping front-to-back, doing Kegel exercises probably isn’t something that was drilled into you growing up…or even as an adult. Instead, most people don’t even hear about the importance of Kegels until after having a child or winding up in a pelvic floor physical therapist’s office with a health issue to solve. While these pelvic floor exercises (first introduced to the world by gynecologist Arthur Kegel in 1948) are often associated with postpartum recovery, they’re definitely not just for new parents. In fact, almost everyone can benefit from making them part of their daily fitness routine. Plus, you can do them pretty much anytime and anywhere (yes, even while on a boring Zoom call that could have been an email). Below, we asked an ob-gyn and a pelvic floor physical therapist to tell us all about Kegels, what they can do for you, and how to know if you’re even doing them the right way.What are Kegel exercises?So, what is a Kegel exercise, exactly? Quite simply, a Kegel is a contraction of the pelvic floor muscles. “We have approximately 24 pelvic floor muscles located in the pelvis, arranged in three layers,” says Amy Hill Fife, a pelvic health physical therapist with a private practice in Grand Junction, Colorado. All those muscles have pretty important jobs, which is why strengthening these muscles can benefit you in a variety of ways.Back to top.What do Kegel exercises do?When done correctly and consistently, Kegel exercises can strengthen your pelvic floor muscles, which have four primary functions. The first role is to help support all of your abdominal organs, including the small and large intestine, the uterus, the liver, and the kidneys. The pelvic floor muscles also provide sphincteric control for your bladder and bowels, which basically means they keep you from leaking stool or urine, Fife explains.There’s also a sexual function. “Some of the pelvic floor muscles go into a rhythmic contraction when you climax,” Fife explains. And the final function is core stability—the Kegels work together with abdominal muscles, hip muscles, and back muscles to help you maintain core balance and strength.People may have a weak pelvic floor for various reasons, like pregnancy and childbirth. A weakening of these muscles is also a common part of aging.Weak pelvic floor muscles present just like any other muscle weakness in your body, explains Fife. Typically, the muscles will either lack strength, endurance, or both. “Common signs of a weak pelvic floor include leaking urine with cough, sneeze, or exercise, inability to control sudden bladder urges (so you rush to the bathroom), pelvic pressure, difficulty holding back gas, decreased ability to achieve an orgasm, and decreased sensation when having penetrative intercourse,” explains Fife.“In serious cases, a weakening of the pelvic floor could eventually result in your pelvic organs dropping and creating a bulge into your vagina, rectum, or bladder—known as pelvic organ prolapse,” says Sherry Ross, M.D., ob-gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California.Symptoms of a prolapse range from uncomfortable pressure in the pelvic area to leakage of urine. Fortunately, Kegels can help delay or even prevent pelvic organ prolapse and other symptoms related to a weak pelvic floor. According to Dr. Ross, doing Kegels consistently can lead to noticeable changes to your pelvic floor strength in about eight to 12 weeks.Since pregnancy is one of the reasons the pelvic floor muscles can weaken, Dr. Ross recommends all pregnant people do Kegel exercises for pregnancy. By helping to strengthen these muscles, they can prevent symptoms such as urine leakage and pelvic organ prolapse caused by a vaginal delivery. A 2020 Cochrane Review1 of 46 trials involving 10,832 women concluded that starting a structured pelvic floor therapy practice early in pregnancy may help prevent urinary incontinence later in pregnancy and after delivery.Experts also recommend a better knowledge of your pelvic floor to give you better control during the pushing phase of a vaginal delivery. (Also, you don’t have to actually give vaginal birth to affect pelvic floor muscles—simply being pregnant, especially multiple times, can affect your pelvic floor’s strength.)Worth noting: While Kegels can help weak pelvic floor muscles, they can actually exacerbate pelvic floor muscles that are too tight. While consistently working out these muscles—just like any other muscle in the body—is beneficial for most people, stop and check in with a health care provider if you ever experience any pain with Kegels. “Some people’s pelvic muscles are too tight or they have pelvic pain due to muscle tightness, and if they do more Kegels they will likely make their problems worse,” warns Fife. In these cases, a pelvic floor physical therapy can actually help you learn how to “un-Kegel.”Back to top.How do you know if you are doing Kegels correctly?If you’re new to this, it’s important to make sure you learn how to do Kegel exercises properly before you start pumping out a bunch of reps. It starts with figuring out where those pelvic floor muscles are—because they’re internal, you can’t actually see what happens when you tighten or relax them. The easiest way to identify them is to stop the flow of urine while you’re peeing, says Dr. Ross. “Hold the contraction for three seconds then relax, allowing the flow of urine to continue,” she says. “Repeat this a couple of times and you’ll have identified your Kegel muscles.” (That said, you don’t actually want to perform Kegels regularly while you’re peeing, so once you’ve identified these muscles, find another time to do them.)

James Van Der Beek is a proud dad again. On Monday, the Dawson’s Creek actor celebrated welcoming his sixth child with his wife, Kimberly, by posting a gallery of photos and videos on Instagram. “Humbled and overjoyed to announce the safe, happy arrival of Jeremiah Van Der Beek,” he wrote.But it hasn’t been an easy road for the parents. James, 44, shared that Kimberly, 38, experienced two late-term miscarriages before the birth of Jeremiah.“After experiencing late-term #pregnancyloss twice in a row (both at 17+ weeks), we kept this one quiet. Truthfully, I was terrified when I found out,” he wrote.Kimberly told The Make Down podcast that these experiences were, understandably, both emotionally and physically hard on her. “I understand that I am very blessed to be able to birth five children. I’ve also had five miscarriages, two of which were really hard experiences,” she said. “The last two miscarriages, they’ve been really extreme. The one in November, it was losing a ton of blood, losing consciousness over and over again and feeling like, ‘Am I going to die?'”In James’s post, he shared what was different this time around. “We found a doctor here in Texas who diagnosed the last two as having been caused by an ‘incompetent cervix.’” If that term makes your skin crawl, James is with you: “I asked him what kind of misogynistic old dude invented that term and he laughed—which made me like him even more.” As James notes, this complication has other names as well, like having a “weak cervix.” (“Cervical insufficiency” is another term for it, but “incompetent cervix” is still very much in use.)The cervix is the lower part of the uterus that opens into the vagina. In a healthy pregnancy, the cervix remains closed and firm until you approach your due date, when it begins to soften, get shorter, and open. In the case of cervical insufficiency, it begins to open too soon, potentially leading to premature birth or pregnancy loss, according to the Mayo Clinic.