Surround Yourself with a Caring Birth Team

The following article and more can also be found on the Lamaze website for parents, Lamaze.org

 

By Barabra A. Hotteling, MSN, WHNP, LCCE, CD(DONA)

Giving birth will be one of the most memorable events of your life. It may be hard to imagine how you will respond to the powerful physical and emotional aspects of labor. But no matter how you feel, it is bound to be easier if you are surrounded by a team of people you trust before, during and after the birth.

A Doula’s Role

The word doula means “woman care-giver” in Greek; its origin refers to the female who attended to the lady of the house during childbirth. Historically, doulas were aunts, sisters, cousins or friends who helped cook and clean, as well as offered support. Today’s doulas perform similar services. There are thousands of professionally traineddoulas in North America and around the world, available to any woman who wants continuous non-medical support at childbirth. Studies show that the presence of a doula at a birth results in shorter labors with fewer complications and fewer interventions, such as Pitocin, forceps or cesarean. Research shows that women supported by doulas request pain medication less frequently; they also report greater satisfaction with the birth and their partner’s participation.

Doulas provide a variety of services, depending on your personal preferences. Even though you probably won’t need to meet with your doula until your third trimester, it’s best to start interviewing prospective ones early, to make sure your first choice can accommodate you. Once labor begins, doulas can help in many ways, including reminding you to listen to your inner wisdom. Having someone by your side to answer questions and let you know that you are doing well can empower you to see the light at the end of the tunnel. A doula can help you advocate for your preferences to other members of your support team, allowing you to relax and focus so childbirth is ultimately more satisfying.

A Partner’s Compassion

While a doula can provide incredible support, your partner is still your most vital source of emotional comfort. He or she knows the subtle signals that express your needs, as well as your preferences for touch, music, scents and tastes. Most important, your partner is likely to be the lighthouse you focus on during contractions. He or she may choose to participate in your birth in a variety of ways, but that love and presence cannot be replaced by anyone else. Talk to your partner now about his or her role, what you think you’ll need during this time and who can best help you get it.

The Rest of the Team

If you are giving birth at home or in a birth center, your midwife will pay attention to the physical condition of you and your baby and guide you through labor and birth. In a hospital, doctors and nurses will evaluate your progress and attend to your physical needs, but because they have other patients, they usually are unable to provide the continuous support that leads to the best birth experience. Consider inviting family or friends who can stay with you throughout labor and birth. Show them your birth plan and encourage them to go to childbirth classes with you or take a tour of the birth center or hospital if you are not giving birth at home. Often, women do not want anyone other than their partner present at birth; others feel more comfortable with greater support. As you learn more, choose the birth team that helps you feel most empowered and confident on the big day.

60 Tips for Healthy Birth: Part 4 – Avoid Interventions that Are Not Medically Necessary

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Avoid Interventions that Are Not Medically Necessary

1. Learn why avoiding interventions that are not medically necessary is important for you and your baby.

2. Ask your care provider (the earlier, the better) about the kinds of interventions they use and when they use them. You can ask about their rates of interventions, but you’ll  most likely get more accurate and telling answers with more open-ended questions, like, “For what reasons would you recommend an induction?” and “Why would I need a cesarean?”

3. Take a quality childbirth education class to really get to know different interventions and how they interplay with one another. For example, you cannot be induced without having continuous external fetal monitoring and IV fluids.

4. Learn about the interventions used regularly at your chosen place of birth. Sometimes, those rates are available publicly and sometimes (more often), they are not. You can also ask during your hospital tour or at a prenatal visit with your care provider. But your best bet is to ask local doulas and childbirth educators, who will most certainly have insider knowledge.

5. Research and practice a variety of coping and comfort measures, as well as position changes, to use during your labor and birth.

6. Consider hiring a doula, who is trained on the use of interventions and can offer additional resources for you to make the best informed decision about your care. A doula will not advocate on your behalf, but can help you be a better advocate for yourself.

7. When you hit 40 weeks and there is no sign of labor, remind yourself that 40 weeks is not a deadline but a vague estimate and that a healthy pregnancy can go to 42 weeks and beyond. Also remind yourself that you will not, in fact, be pregnant forever. As uncomfortable as you may be at 40 weeks of pregnancy, the healthy choice in most cases is to let labor begin on its own.

8. If faced with the decision to induce your labor, first find out why, and second, find out your Bishop’s Score. And, learn why an induction might be necessary and when it is not.

9. Make sure your partner or birth support person (spouse, partner, friend, family member) knows about your birth preferences and understands how best to support you during birth. Your birth partner will be an invaluable asset to your birth experience.

10. Interventions can be medically necessary and life-saving. If interventions become necessary, find out how you can keep your labor as healthy as possible.

 

photo credit: Rick Bolin via photopin cc

How to Use Water for Comfort in Labor

Water can be a very useful and comforting natural pain-relief tool during the different stages of labor, and can be used whether or not you are planning a water birth. In a 2012 overview of Cochrane systematic reviews of pain management options for women in labor, researchers from the University of Liverpool and National Institute for Health Research found results that may suggest immersion in water provides improved labor pain management and increased satisfaction with childbirth experience, with few negative effects. Water can also act as a catalyst to speed up labor by relaxing your perineum, allowing for speedier dilation.

So what is the best way to use water during labor? Keep reading to learn your options for laboring with or in water.

Water birth. Some hospitals, most all birth centers, and home birth provide you with the option of a water birth. This is done in special portable tubs designed for water birth or in a standard bath tub. Water birth allows you to fully immerse in water, taking advantage of the weightlessness effect of immersion as well as the relaxing effects of warm water. When immersed in water during labor, be task a member of your birth team is periodically checking the water temperature to make sure that it is within the 95 -100 degrees Fahrenheit range. It is also important to keep your water bottle within reach to maintain hydrated. Most practitioners will advise a woman to remain out of the tub until she is dilated to 5 cm, which usually coincides with the point when her contractions pattern is consistent. Getting into the tub before that point could slow down your labor. But, every labor situation and woman are different and should be assessed individually. For more information on water birth, visit Waterbirth International.

Bath tub. Perhaps you’re not planning a water birth. The bath tub, whether laboring at home or in the hospital, can still be an effective pain relief option. If you get into the tub during early labor, keep in mind that it can slow down your contractions. Sometimes, a good soak in the tub acts as a litmus test for “am I really in labor?” If your body isn’t quite ready, your contractions may slow down or altogether stop. Later on in labor, spending time in the tub with the lights down low can provide peace, comfort, and relaxation through your contractions.

Shower. Have you ever taken a long, hot shower after a rough, hard day? How did it make you feel? The shower can have similar effects during labor. The water pressure and heat running over your body during labor can feel wonderful. Plus, standing in the shower allows you to both take advantage of gravity while getting relief from water. If your body is tired, you can also bring a chair in the shower to allow for more rest. (Stay safe and avoid slips by laying down a towel on the shower floor.) Many hospital shower heads are detachable, which would allow someone from your labor support team to aim the water jet in the area that feels best (many women appreciate lower back, some also like the water on their belly). Add to the calming atmosphere by turning off or down the bathroom lights — set out candles (battery-operated if you are in the hospital) for a more relaxing environment. It may sound like a lot of effort, but it really does not take much time to prepare (that’s what your labor support team is for!) and the payoff is huge.

 

Did you use water during your labor or birth? How did it affect your experience?

 

 

 photo credit: HoboMama via photopin cc

Keep Moving During Labor

When women give birth in the movies, they are generally portrayed one way: lying down, in bed. But research shows that moving freely in labor improves a woman’s sense of control, decreases her need for pain medication, and may reduce the length of her labor. Sometimes it is hard to move in labor due to routine procedures or lack of support and space. A recent US study found that 71 percent of laboring women did not walk at all during active labor. Instead, women often labor in bed propped up with pillows. Many women who have labored this way say next time they want to be more upright. This following list provides steps you can take to increase the chance that you will be able to maintain freedom of movement during labor.

  1. Choose a care provider and your birth place carefully to make sure you will be encouraged and supported to move and change positions. Find a care provider who will support you in choosing the positions that work best for you. When choosing a birth setting, look for birth balls, rocking chairs, squatting bars, and tubs.
  2. No matter where you give birth, stay home until you are in active labor, when contractions are five minutes apart and last about one minute. If your cervix is not dilated more than 4 centimeters when you arrive at your birth setting, consider going home or for a walk until your cervix dilates more. It’s often easier to move and respond to your labor at home. You can rock, slow
    dance, walk, or sit on your birth ball. Listen to your body and rest when needed.
  3. Once at the birth setting, request that your care provider not use any unnecessary intervention that may make it harder to move around. This will mean that continuous monitoring of the baby’s heart rate (“continuous EFM”) and intravenous lines (IVs), are only used when needed for medical reasons. If there is a medical reason for these, tell your care provider that you want to maintain as much freedom of movement as possible. There may be ways to minimize the effect of these interventions on your ability to move freely.
  4. Arrange to have continuous support in labor from a professional labor assistant (a doula) or a close friend or family member who makes you feel safe and confident. Ask them to remind you to try different positions or activities in labor.
  5. Consider the impact that pain medications will have on your ability to freely move during labor. All pain medications make it hard to stand or walk in labor. It is usually impossible when an epidural is used. You may hear about a “walking epidural” but this usually just allows you to move your legs in bed or walk short distances. Pain medications often lead to the need for other interventions, such as IVs and continuous electronic fetal monitoring, which restrict movement. Choose to birth at a place that provides easy access to a tub. Using water in labor decreases the need for pain medication. If you want an epidural in labor as a pain coping technique, wait until labor has progressed and you have already used lots of movement to help the baby rotate and move down in the pelvis. Encourage your support team to learn about ways to support a woman with an epidural and encourage movement compatible with epidural use.
  6. Attend a childbirth class that focuses on active labor, giving you and your partner plenty of movement and position options. Keep a list of the positions that you like best and bring it with you as a reminder in labor. Practice positions and movements before your labor begins, so you and your partner feel comfortable and confident using them.

Quick checklist for place of birth

  • Safe place to walk
  • iPod, smart phone, other MP3 player for dancing music
  • A tub
  • Birth ball
  • Rocking chair
  • Squatting bar
  • Telemetry (portable device used for continuous fetal monitoring)
  • Policy for intermittent auscultation (heart rate monitoring)
  • Policy for respecting women’s choices for labor support

For more information on the importance of maintaining movement during labor, check out the Lamaze Health Birth Practice video all about walking, moving, and changing positions during labor.

Lamaze Care Practices: What They Are & How They Can Help

Common sense tells us and research confirms that the Six Lamaze Healthy Birth Practices featured in these video clips and print materials are tried-and-true ways to make birth as safe and healthy as possible. But don’t take our word for it — click through to watch each of the short clips to learn more about safe & healthy birth and how best to achieve it, no matter where you give birth.

Introduction: Safe and Healthy Birth Practice - Download PDF

#1: Let Labor Begin on Its Own - Download PDF

#2: Walk, Move & Change Positions - Download PDF

#3: Have Continuous Support - Download PDF

#4: Avoid Unnecessary Interventions - Download PDF

#5: Get Upright & Follow Urges to Push - Download PDF

#6: Keep Your Baby With You - Download PDF

Download the complete booklet here.

Lamaze International partnered with InJoy Productions and their new Mother’s Advocate program to provide you with this free, evidence-based educational material.

Lamaze Breathing: What You Need To Know

Once upon a time, the hallmark of Lamaze chidbirth education was “breathing” (hee, hoo, hee, hoo). Over the years, Lamaze has evolved into a comprehensive approach to childbirth, part of which are comfort measures for labor; breathing is one of the suggested comfort measures. So what does it mean to “breathe?” Here’s a little on what you should know (excerpted from The Official Lamaze Guide: Giving Birth with Confidence by Judith A. Lothian and Charlotte DeVries):

 

Breathing in Pregnancy:  A Daily Check-in
Finding the time, energy, and peace to face your fears—or do anything that requires mental focus—is a challenge in our culture. One pregnant woman shared that after years of working at her office, she’d tuned out the sounds of phones ringing and computers clicking. She didn’t even notice how noisy her office was until an older coworker looked at her across the bank of desks and said, “You’re bringing this child into a world of sounds my babies never heard.”

It’s true: In just a decade or two, technology has changed the world dramatically. From cell phones to ATMs, from microwave ovens to Facebook friends, from high-definition DVDs to iPods, technology fills our days with vivid images and messages. It’s a noisy, busy world that can crowd out the peace we need to connect with ourselves.

Connecting with yourself is an important task during your pregnancy.  It’s a big job to pay attention to all the physical, emotional, and spiritual changes you’re experiencing. It takes concentration to envision a future that includes a new role and a new person. Finding a place of stillness for a few moments each day can help you do this crucial work.

Even if your space and your schedule are crowded, you can find a place and time to keep a daily appointment with yourself. Perhaps you can retreat to the corner of your bedroom, the bathroom, a closet, or an empty room at your workplace. Perhaps you can sneak a moment before others wake up, after they’ve gone to bed, before you get in the shower, or during your lunch break. You might want to “check in” at the same time each day so you treat this appointment with yourself as the important time it is.

Your daily check-in may be a few moments of silence, meditation, or prayer. You can use this time to get in touch with not only your feelings, but also your body and the little one who is taking up more and more of it. Close your eyes for a moment and listen to your breathing, then take an inventory of yourself: Are there any tense areas in your body—neck, shoulders, throat, hands, back? Is anything nagging at your mind? Doing a full-body and -mind check will help you identify what needs to be released, relaxed, or dealt with.

 

Breathing Benefits from Yoga Practice
Yoga, an ancient form of exercise that includes breath control, meditation, and body postures, has become popular among pregnant women. It’s easy to understand why: Many yoga exercises include movements that open the pelvis. Yoga also teaches rhythmic breathing, concentration, stamina building, and relaxation. Some women who do yoga report improved physical coordination and more balanced emotions.

 

Lamaze Classes and Breathing
Lamaze classes prepare women for a safe, healthy birth by providing the most current, evidence-based information about birth, simplifying birth, and helping women navigate the maze of modern obstetrics. Be wary of “Lamaze” classes that spend a lot of time practicing relaxation and breathing and little or no time building your confidence or discussing how to keep things simple and how to have the safe, healthy birth you want in the birth setting you have chosen.


Breathing: Finding Comfort in Labor
When allowed and encouraged to, a woman will naturally move, moan, sway, change her breathing pattern, and rock to cope with contractions, eventually finding the right rhythm for her unique needs. Such active comfort-seeking helps her baby rotate and descend and helps prevent her labor from stalling. As her contractions get stronger, her body releases endorphins—nature’s narcotic—to ease her pain.

Conscious Breathing
Conscious breathing (especially slow breathing) reduces heart rate, anxiety, and pain perception. It works in part because when breathing becomes a focus, other sensations (such as labor pain) move to the edge of your awareness.

Conscious breathing is an especially useful labor tool because it not only keeps you and your baby well oxygenated, it’s also easy to learn and use. It’s naturally rhythmic and easy to incorporate into a ritual. And best of all, breathing is the one coping strategy that can’t be taken away from you—even if you’re stuck in bed attached to an electronic fetal monitor and intravenous fluids.

Conscious (or patterned) breathing used to be the hallmark of Lamaze childbirth education. For many women, it’s still an important way to stay relaxed and stay on top of their contractions. It’s true that conscious breathing can help you relax and feel less pain during contractions.  There’s no “right” way to breathe in labor, despite what others may tell you. Slow, deep breathing helps most women manage the pain of contractions. But the right way for you to breathe is whatever feels right to you. Issues like your number of breaths per minute, breathing through your nose or your mouth, or making sounds (like hee-hee) with your breaths are only important if they make a difference for you.

It may help you to have a visual focus to accompany your conscious breathing. You can recall an image with your eyes closed, focus on a picture or special object from home, keep your eyes on your partner, or simply stare at a spot on the wall. You may also find that as labor progresses, faster, shallower breathing—like a dog gently panting—feels better. You’ll figure out what works best for you. And what works best will probably change as you move through labor.

Many women “practice” breathing during pregnancy by using conscious breathing when everyday life presents stressful situations, like being caught in traffic, running late for an important meeting, or worrying about any number of things.

Find Your Rhythm
At some point in labor, you’ll “find your rhythm” or “get in a groove,” much like a marathon runner does. You’ll be living in the moment, doing without thinking.  To others you’ll appear to be in another world. Your movements will be rhythmic; you’ll relax between contractions; you’ll respond to contractions in the same way over and over again, perhaps shaking your arms, rolling your head, breathing slowly, chanting, or praying.

You’ll be totally focused, but you won’t necessarily look comfortable. You’ll look like you’re working very, very hard—which you are. When this happens, you’ll know endorphins are working their magic—dulling your pain and helping you ride your contractions intuitively. You’ll be doing exactly what you need to do. You won’t need to be rescued; in fact, the worst thing that could happen to you at this point is to be disturbed or interrupted. A healthy dose of encouragement, support, and respect are all you’ll need from your support team.

Do you have experience with conscious/patterned breathing during labor? How did it affect your birth experience?

22 Ways to Make Your Birth Easier

By Lyn Dee Rankin, LCCE, CLS

21 ways to make your birth easier? It is all in the birthing bag that every pregnant woman should assemble in her last trimester. This is the bag that goes with you for birth — different from the suitcase you pack for the hospital stay after the baby is born. Wherever you choose to birth, you and your labor support people can be well prepared for the potential use of many items to make labor easier. The image of the Mary Poppins bag comes to mind. Different items serve specific purposes, but may simply serve as a distraction or a much needed change to support relaxation, focus, confidence and resolve so as to move through intensifying uterine waves (contractions). Consider the following:

  1. Written birth plan/preferences: It is helpful for all involved to have a reminder handy of what your preferences are. A mother-led birth helps result in a satisfying birth.
  2. Clothing to maximize freedom of movement in labor in and out of a birthing room (light shirt, sweater or robe and slippers or warm socks); anything to replace or cover a typical hospital gown.
  3. Focal Point: Many women practice relaxation using both internal and external focal points. Use one you can take with you.
  4. Favorite music or relaxation narrative on a portable device: Several compilations from smooth, relaxation, to motivating, movement music may be chosen during different times in labor for calming “zoning out” or rocking and dancing to encourage baby’s descent.
  5. Lollipop: Especially sour candy on a stick promotes salivation to keep mouth moist and deliver sugar for energy. The stick allows taking out to breathe.
  6. Breath spray or mouthwash: If support partners are breathing closely with birthing mom….
  7. Juice: A small can of sweet juice or energy drink to add to ice chips.
  8. Washcloth for cooling moisture. Colored so it can be distinguished from facility’s white ones.
  9. Lotion/oil for massage.
  10. Lip balm: It just feels good.
  11. Distractions: Cards, portable game for prolonged labor and distraction
  12. Back massage devises: Commercially designed rollers or just tennis balls in a can. (The balls alone are useful for easing back labor and the entire can rolled in a towel works well too.)
  13. Aromatherapy
  14. Mood lighting if birthing room has limited light control.
  15. Birth ball if not provided at facility.
  16. Hair accessories to pull hair from face.
  17. Labor log to record timing of uterine waves and other sign posts of labor (don’t forget a pencil/pen).
  18. Timing Device to track progress through length of uterine waves — stop watch, watch with a second hand, etc.  Reminding a laboring woman of her progress through each uterine wave builds confidence and resolve, one wave at a time.
  19. Labor positions on a list or a set of cards of each position to post around the labor room. It is essential that labor support partners promote movement and changes in positioning throughout labor.
  20. Support partners’ notes for reference. Childbirth educators usually provide summaries of labor signs and suggested appropriate coping techniques. Written narratives for relaxation and mediation will ease labor. No one is expected to remember it all!
  21. Support partners’ snacks: A well-nourished, comfortable support partner will be your best advocate.
  22. Support partners’ trunks or bathing suit for joining you in the shower or tub.

AND DON’T FORGET…

Key phone numbers: Birthing facility, doctor, support persons and family.

Last minute additions:  Wallet and insurance documents, glasses and contacts and respective cases, camera and phone.

Lyn Dee Rankin is an experienced educator, having taught children and adults since 1976 in multiple areas of Health Education and served on educational boards. As an independent, non-hospital Lamaze Certified Childbirth Educator, she has prepared hundreds of couples for safe and healthy births, and has had both a vaginal and cesarean birth, and breastfed both of her children. 

 

What Does a Contraction Feel Like?

This is probably the most oft-asked question by first-time expectant moms, preceded only by “How will I know I’m in labor?” The textbook answer is something along the lines of, “The way a contraction feels differs from woman to woman, but in general, you will feel a all-over tightening of your uterus and pain or cramping that may begin in your lower back and radiate to the front of your uterus.” Of course, if you do a Google search or spend any time on an expectant moms’ web board, you’ll come across responses that range from “intense menstrual cramps” to “pressure and back pain.” Some women experience what they describe as very intense pain while others describe contractions as nothing more than dull, crampy aches. And, your experience with labor can also vary greatly from one child to another.

Having just [very] recently experienced labor and birth again for the third time (this time without any medical pain relief), I would describe a contraction in active labor as an all-encompassing kind of pain. There was the tell-tale uterine tightening, but then the sensation is something that is hard to describe — I felt it mainly in my abdomen, but it was so intense, my whole body reacted to the feeling. Since labor with my first child, I’ve always said that with a contraction, it’s as if there’s no way to escape it when it’s happening — you just have to succumb — but yet when each contraction is over, the pain relief is immediate and complete. I would describe the experience as intense and painful, but manageable. It was nothing my body couldn’t handle as long as I was free to move and do what helped me cope with the pain. Now, the minute I had to be confined to a certain area or position, it was awful! For example, the car ride to the hospital was NOT fun!

Here is how nine other women describe their contractions:

Throughout my pregnancy, the Braxton Hicks contractions felt like little charlie horses over the top of my belly. When I was in labor for my first child, I remember finally deciding to get the epidural and when the medicine started to work, it only worked for half of my body. One side was bearable while the other side felt like it was being squeezed and twisted as far as it would go. I couldn’t believe the difference. I would have preferred to have all or nothing! Also, having had three kids now, I will say that the difference between contractions with and without Pitocin is night and day.

–Vanessa

I think contractions feel like a combination of nasty period cramps and horrible bowel movement cramps at the same time. I know they say they start in your back, but I felt like mine started everywhere at the same time.

–Maddy

My contractions with my second pregnancy were completely different from my first. With my first, they were the textbook example of a contraction. The pain started at my sides and worked it’s way to the middle of my stomach. They started out like pretty mild menstrual cramps and then became completely unbearable. With my second labor, I suffered from pubic symphysis dysfunction and all of my contractions started in my lower back and moved to the front of my lower abdomen and into my pubic bone. They were really severe very quickly after my water broke. And with every single one I felt the urge to push. Of course, the doctors and nurses told me not to since I was only 4 cm dilated! I labored for 36 hours! I now wonder if I should have listened to my body and pushed a little it would have went faster. Who knows. Labor is a funny thing. I just learned that every labor and pregnancy will be different!

–Bri

I agree with Vanessa, contractions with Pitocin versus without it are so so different….black and white. And with my first, it was back labor so it was also totally different. They were throbbing and long and it felt like my back was going to split open. With my home birth, the contractions felt like a deep, deep ache. Deep down inside my body, almost as if the sensation of my cervix spreading combined with my son descending were like my bottom was going to fall out…but in a good way. A productive way. Thinking back, they weren’t painful as much as a feeling that snapped me into the present.

–Pamela

With my second, I felt only a long, long awful pain across my entire abdomen. From the outside, you could feel that my whole abdomen was rock hard and it felt like a charlie horse, only a million times worse. The pain didn’t change or come and go, just remained for hours. On the monitors, it was showing that I was contracting every two minutes when I got to the hospital, but again to me the pain and hardness never stopped and started, just constant. With my first son, the pain was fairly textbook as menstrual pains that got worse, deeper, and closer in time as labor progressed.

–Alicia

With each of my four births, my contractions have been different. For number one, I was induced with Pitocin. I had been planning an unmedicated birth, but was told in my childbirth education classes that it was impossible to have Pitocin without an epidural, so each contraction was a fight for the birth I wanted. Ultimately, I had an epidural that didn’t work, and I dilated completely unmedicated. The second time I was also induced with Pitocin, but was absolutely certain that I would have an unmedicated birth, so each contraction was a validation that I was strong, and could do it. With my third (I had become a doula and childbirth educator), I had absolute trust in my body, and each contraction literally felt orgasmic. They were intense, but after the peak of each one, I felt the same rush that I do after an orgasm. It was amazing! With the fourth, I was in complete denial for most of my very rapid labor, so each contraction was almost a surprise. I had intense back labor, but if I vocalized throughout the contraction it was bearable.

–Liz

With my first, I felt no Braxton Hicks or at least I didn’t know what I was feeling. My labor started with what I could only describe as a “funny feeling” in my belly…I didn’t feel cramp-like sensations or hardening until later on. As I progressed, I definitely felt the tightening, hardening feeling with intense cramps but all in my abdomen area…nothing in my back. With this one, I have been having BH contractions for quite some time. They began early on for me and the sensation felt like the baby was doing a twirling or twisting motion. Eventually, I realized that they were BH contractions and felt the classic hardening, tightening in my abdomen.

–Becky

With my first birth, they started out similar to menstrual cramps and gradually became more intense like extreme bowel movement cramps. It was that menstrual cramp feeling in the beginning, though, that distinguished them from the Braxton Hicks cramps I’d had through the pregnancy and let me know it was “real” labor. Once I was about halfway dilated it felt like one big constant contraction, with no rest in between, even though the monitors showed a brief break between them.

The contractions felt different with my second birth, though, and I wasn’t sure I was really in labor. They didn’t feel the same way they did the first time around, and my BH contractions had been so intense and uncomfortable (painful, not just the tightening feeling) the last month or two of my pregnancy, that I constantly felt like I was in early labor. My baby was “sunny side up” that time too, so more of the pain was in my back. My mother and mother-in-law had told me they never knew when they were having contractions, just felt the pressure of pushing at the end. That astonished me. My mom literally never knew when she was having contractions, just knew that she “felt funny.”

–Brittany

I am an old woman, and my kids are 14 1/2 and almost 11, so it is hard to remember the details of the sensation of contractions. I had a c-section after pushing non medicated for 5 hours with my fat, 9lb 37 week direct OP baby (occiput posterior — baby who is facing up instead of back), and a non-medicated VBAC with my second, so feel like I really got a sense of what things felt like. They started as menstrual cramps, and an ache in my lower back, moving around and increasing in intensity deep in my pelvis. I did not have back labor with either, even the OP babe. I have to say that I did not think they were that bad, I mean, intense, yes, requiring deep focus and coping, yes, but the worst pain I ever felt? No! It was very freeing to surrender to the contractions, doing whatever felt good, no matter how crazy or silly it seemed. From my two datapoints, I seem to take forever to labor/dilate to 3 cm, and then go from 3-10 really fast! Labors last about 36 hours each, in both labors, I immersed myself in the tub, completely, except for my nose, when I had the intense contractions, removing all the sensory stimulation, ears underwater, eyes closed, remaining really loose. Alternately, I did a lot of deep vocalization. As I said, hard, yes, intense, yes, all encompassing, yes, body wracking, yes, but incredibly painful — no. If I could, I would labor and birth once a year! No pregnancy, no baby to keep, just a big ole labor and birth! It was the hardest, most intense, but doable work I have ever done!

–Sharon

 

 

Pros and Cons of 11 Common Labor Positions

By Paulina G. Perez, RN, BSN, CD, LCCE, FACCE

Movement and positioning in labor work magic. Movement enhances comfort by stimulating the receptors in the brain that decrease pain perception. The result is that you are able to tolerate increasingly strong contractions. When contractions become very strong, endorphins are released and pain perception decreases even more. Ultimately, your movement in response to your contractions decreases pain and facilitates labor – a win-win. Movement also helps the baby move through the pelvis, and some positions enlarge pelvic diameters.

The positions shown here facilitate the normal, natural process of labor. What position should you use? Follow your body. Move freely in response to what you feel. Your body will let you know just what position is best at every point in your labor.
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Standing Supported SquatSTANDING SUPPORTED SQUAT

Pros
  Realigns your pelvis to increase the opening by up to 15 percent
 Allows you to be supported by your standing or sitting partner, the wall or a squat bar
 Takes advantage of gravity
 Makes contractions feel less painful and more productive
 Lengthens your trunk and helps your baby line up with the angle of your pelvis
 Movement causes changes in your pelvic joints, helping your baby through the birth canal
 May increase your urge to push in the second stage of labor  

Cons
  Requires a strong partner
  May be tiring for both of you  
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SITTING ON TOILET

Pros
 Helps relax perineum
 You get used to an open-leg position and pelvic pressure
 Uses gravity  

Cons
 Pressure from toilet seat may be uncomfortable 
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SittingSittingSITTING
 
Pros
 Good for resting
 Uses gravity
 Can be used with continuous electronic fetal monitoring  

Cons
 May not be possible if you have high blood pressure   
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SQUATTINGSquatting
Pros
 Encourages rapid descent
 Uses gravity
 May increase rotation of baby
 Allows freedom to shift your weight for comfort
 Allows excellent perineal access
 Excellent for fetal circulation
 May increase pelvis diameter by as much as 2 centimeters
 Requires less bearing-down effort
 Descent is encouraged by the position
 Your thighs keep baby well aligned  

Cons
 Often tiringSquatting
 Sometimes hard for health-care provider to hear fetal heart tones
 May be hard for you to assist in birth if you wish to do so
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SIDE-LYING

Pros
 Helps get oxygen to the baby
 Good resting position
 Helpful if you have elevated blood pressure
 Fine with epidural
 Can make contractions more effective
 Easier for you to relax between contractions during the second stageSide Lying
 Can slow a birth that’s moving too fast
 Your partner can assist in the birth by supporting your legs
 Lowers chances of tearing or the need for episiotomy
 Good access to perineum  

Cons
 May be hard for health-care provider to access fetal heart tones
 No help from gravity
 If no one can hold your legs, you must support them on your own
 You may feel too passive in this position

WALKING

Pros
 Uses gravity
 Contractions are often less painful
 Baby is well aligned in your pelvis
 May speed labor
 Reduces backache
 Encourages descent  

Cons
 Not recommended if you have high blood pressure
 Cannot be used with continuous electronic fetal monitoring

STANDING

Pros
 Uses gravity
 Helps get oxygen to the baby
 Contractions are more effective and less painful
 May speed labor
 Helps create a pushing urge  

Cons
 Poor control at birth
 Hard for health-care provider to see the baby

LEANING OR KNEELING FORWARD WITH SUPPORT

Pros
 Can help shift the baby if needed
 Uses gravity
 Birth ball can be used
 Contractions are often less painful and more productive
 Baby is well aligned in your pelvis
 Relieves backache
  Easier for your partner to help relieve your back pain
  May be more restful than standing
  Good for pelvic rocking
 Less strain on your wrists and arms  

Cons
  Hard for health-care provider to help with birth

KNEE-CHEST

Pros
 Good for back labor
 Assists with rotation of baby, if needed
 Takes pressure off hemorrhoids
 Good position to avoid tearing or episiotomy
 Good delivery position for large baby
 Helpful if fetal heart tones are low  

Cons
 Hard for your support team to maintain eye contact with you
 Hard for you to see what’s going on

SEMI-SITTING

Pros
 Comfortable
 Good use of gravity
 Good resting position
 Works well in hospital beds
 Good visibility at birth for your support team
 Easy access to fetal heart tones for your health-care provider  

Cons
 Access to your perineum can be poor
 Mobility of your coccyx is impaired
 Puts some stress on your perineum but less than when lying on your back

ON BACK WITH LEGS RAISED

Cons
 Works against gravity
 Compresses all major vessels
 Tearing or need for an episiotomy is more likely
 No use of gravity to aid in birth 

LEANING OR KNEELING FORWARD WITH SUPPORT

Pros
 Can help shift the baby if needed
 Uses gravity
 Birth ball can be used
 Contractions are often less painful and more productive
 Baby is well aligned in your pelvis
 Relieves backache
  Easier for your partner to help relieve your back pain
  May be more restful than standing
  Good for pelvic rocking
 Less strain on your wrists and arms  

Cons
  Hard for health-care provider to help with birth

KNEE-CHEST

Pros
 Good for back labor
 Assists with rotation of baby, if needed
 Takes pressure off hemorrhoids
 Good position to avoid tearing or episiotomy
 Good delivery position for large baby
 Helpful if fetal heart tones are low  

Cons
 Hard for your support team to maintain eye contact with you
 Hard for you to see what’s going on

SEMI-SITTING

Pros
 Comfortable
 Good use of gravity
 Good resting position
 Works well in hospital beds
 Good visibility at birth for your support team
 Easy access to fetal heart tones for your health-care provider  

Cons
 Access to your perineum can be poor
 Mobility of your coccyx is impaired
 Puts some stress on your perineum but less than when lying on your back

ON BACK WITH LEGS RAISED

Cons
 Works against gravity
 Compresses all major vessels
 Tearing or need for an episiotomy is more likely
 No use of gravity to aid in birth

Epidurals: Food for Thought

In a series of posts on our sister blog Science & Sensibility, Dr. Michael Klein, family practice physician, pediatrician, neonatologist and Senior Scientist for the Centre for Developmental Neuroscience and Child Health and the Family Research Institute, shares the research, history and implications — positive and negative — for epidural use. Over the next few weeks at Giving Birth with Confidence, we’ll be sharing snippets of Dr. Klein’s posts on epidurals for your review.

Prior to the availability of epidural analgesia, the childbirth education movement utilized a variety of techniques that were physiologically and psychologically helpful to reduce pain, such as breathing and imagery. These methods began to take hold in the culture in the 1950s and 1960s but today are less prominent in many childbirth education classes. Some classes are more focused on teaching women compliance with particular hospital technological methods and approaches, routines and policies, rather than on teaching women coping skills.

In the late 1970s and early 1980s, the first studies appeared, showing the value of continuous emotional and physical support by a caring, trained and knowledgeable woman, whose responsibility was to focus solely on the labouring woman rather than on the institution or equipment – the doula. Backed by randomized studies,(2-4) it has become apparent that this emotional and physical continuous supportfrom a doula gives a woman more confidence and ability to work with her labour. All studies to date have demonstrated that hospital-based nurses cannot function as doulas,(5, 6) even if those nurses are midwifery-trained. It is not the fact of being either a midwife or a nurse that matters, but the fact that when these care providers are employed by the hospital, their primary allegiance is to the institution, and they are professionally responsible for the conduct of the labour and the safety of both mother and fetus. A doula who is employed by the woman is responsible only to her. Autonomous midwives in the Canadian context are strongly supportive of doulas, with whom they frequently work in collaboration.

Pain moderation by transcutaneous nerve stimulation (TNS) or intradermal water injections can be very helpful, especially in the earlier stages of labour. Other non-pharmacological methods like water baths or showers or movement, including the use of birth balls, are also helpful for many women who find that partial pain relief is sufficient to help them through contractions. Doula care provides a complementary approach which can reduce the need for an epidural or delay epidural usage until the active phase of labour, when some of the negative effects of epidural analgesia are reduced. In particular, during her labour, doula care and non-pharmacological approaches allow the mother more opportunity to produce her own oxytocin. Natural oxytocin has some important effects: it is the anti-stress hormone, and helps contractions to be more productive; it is also the ‘love hormone’ that later goes on to enhance the bonding process following the baby’s birth—an effect suppressed by synthetic oxytocin, little of which enters the brain of either mother or fetus.

Is epidural analgesia the best form of pain relief?
Epidural analgesia is a very effective form of pain relief, meaning that compared to a variety of other pharmacological and non-pharmacological methods, it provides generally consistent pain reduction. If there were no problems associated with epidural analgesia, almost everybody would want it. Unfortunately, though, associated with its use there are various undesireable effects, including:

  • longer first stage labours
  • longer second stage labours
  • increased incidence of maternal fever directly caused by the epidural, which often leads to the use of antibiotics in both the labouring woman and her newborn
  • increased rates of operative vaginal delivery (forceps and vacuum)
  • increased perineal trauma with and without instrumental births – including severe tears into the rectum (3rd and 4th degree tears).
  • a variety of complications such as a placement of an epidural too high on the spine (leading to breathing problems).
  • failure of the epidural to provide any pain relief, or insufficient pain relief—requiring the continued use of other methods of pain relief
  • increased need for a bladder catheter
  • maternal hypotension leading to worrying fetal heart rate changes
  • an increase in the likelihood of the need for a cesarean section – this last complication being the subject of great debate, which will be discussed further

Of course, some of these problems may occur whether the epidural was or was not truly needed. And when an epidural is truly needed for pain relief or to solve a specific problem, it can dramatically change a situation for the better and can improve outcome. It is only when epidurals are used routinely, and especially very early in labour that these complications are more likely to occur.

Photo from Wikimedia.