Test Your Knowledge on Comfort Measures for Labor

How well do you know the best comfort measures to use during labor? Test your knowledge below with this quick, free quiz we created. Did you know that the best place to learn ALL of the comfort measures for labor (yes, ones that really work) is in a quality childbirth class? If you are pregnant and haven’t signed yourself up for a class yet, do it before the big day!

 

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New Medical Guidelines Released to Prevent Cesareans

Earlier this week, the American Congress of Obstetricians and Gynecologists (ACOG) along with the Society for Maternal-Fetal Medicine (SMFM) released a joint Obstetric Care Consensus: Safe Prevention of the Primary Cesarean Delivery, in response to rapidly rising first-time cesarean birth rates that have shown no improvement in the death rates for moms or babies. (Complete details on the consensus can be found on ACOG’s website.) In the statement, the two groups put forth several new recommendations that propose to help prevent the first cesarean for women. If you are pregnant, you can use these new guidelines as a conversation starter during a prenatal appointment — find out how these new suggestions measure against your care provider’s routine practices. A sample summary of the recommendations is below.

A long first stage of labor — more than 20 hours in first-time moms — should not be cause for a cesarean. Many women are put on a time clock to dilate to 10cm, when in reality, a long labor alone should not be cause for a cesarean. If you hear statements like, “Your labor has stalled,” “You are not progressing,” or “Failure to progress,” followed by a recommendation for cesarean, ask: “Is my baby OK? Am I OK? What’s the risk in waiting or doing nothing right now? (or, what’s the alternative?)”

First-time moms should be permitted to push for at least 3 hours (2 hours for second-time moms) before recommending a cesarean. Unlike what Hollywood and The Baby Story show us, pushing can take a while. It’s important for moms to be given enough time to push out their baby, as long as mom and baby are both doing well.

Because induction raises the risk of cesarean, it should not be performed before 41 weeks unless medically indicated. Yes, 41 weeks! Allowing  baby enough time to continue developing and for your body to gear up for labor will give you the best chance of having a healthy mom and baby.

Ultrasounds performed late in pregnancy to determine your baby’s weight should be used only if there is clear indication, as these ultrasounds are linked to increased rate of cesarean for a “big baby,” which is rarely a good reason for cesarean. Ultrasounds have been shown, time and again, to be off by up to (or more than) a pound in either direction. If cesarean is suggested because your baby is estimated to be too big — get a second opinion from a care provider in another practice.

Continuous labor support — like that provided from a doula — is “one of the most effective tools” in improving birth outcomes. Good labor support is not just a “nice to have,” but a key component to improving your care during birth. Lamaze has known this for quite some time — check out our Healthy Care Practice number 3, “Bring a loved one, friend or doula for continuous support.

Being pregnant with twins does not automatically mean a cesarean, if twin A is in a head-down position for birth — even if the second twin is not head down. Vaginal birth for twin mamas — it IS possible!

Baby’s position in labor should be determined — especially if there are problems with baby moving down the birth canal — and if possible, an attempt should be made to manually re-position baby before suggesting a cesarean. A posterior baby (where baby faces toward your front instead of your back)  can cause problems in labor. Often, a baby will correct its position before birth, but not always, and this can cause issues. If you suspect an issue with your baby’s position during labor, mention it to your care provider. You can ask for ultrasound in labor to verify. Ask for help with trying to get baby in a better position for birth.

5 Ways to Be Your Own Best Advocate for During Birth

When seeking to maximize your comfort and minimize interventions during your hospital birth, there are simple things you can do to advocate for yourself. Be sure to also share these tips with your partner and birth support team, as they will be able to help advocate on your behalf while you are busy laboring. 

1. Request your nurse. While this isn’t always a possibility, you can ask upon check in for a nurse who is comfortable supporting a mom who is laboring without pain medication (if that is your preference). Similarly, if you end up with a nurse who is not the best fit, you can ask (politely) to have a different nurse.

2. Get out of the bed. Laboring in a bed, on your back, is a very uncomfortable position to experience contractions. But upon entering the hospital, you are asked to get into bed to be monitored, insert an IV port, and other general hospital procedures. You do not, however, have to do this lying down in bed! You can let your nurse know that you would like to sit up in bed, stand, sit on a birth ball, or kneel — positions that are all compatible with most hospital admittance procedures.

3. Get monitored and then get off. Most hospitals require a standard 15 minutes per hour monitoring on an electronic fetal monitor. If you’re not familiar with this device, it is made up of two elastic bands that are wrapped around your belly — one to monitor your contractions and one to monitor your baby’s heartbeat. Take note of the time you began monitoring so you can politely remind the nurse (who may have gotten tied up with other patients) when it’s time to come off. Also note that you can be monitored in other positions than lying back in bed. Most nurses are willing to work with you to find a position that is most comfortable, as long as you speak up.

4. Protect your hospital room environment. Turn down the lights, keep the door closed, adjust the thermostat, close the curtains (or keep them open!), ask for more pillows (they’re usually in a cabinet), ask for an ice pack or heating pad (some hospitals carry disposables), turn down the volume on the monitor. There are many things you can do to make your hospital room more comfortable, private, and peaceful.

5. Ask questions about procedures and ask for time to think it over when presented with a decision. Sometimes, nurses, midwives, and doctors get so caught up in the routine of their job, they forget to take the time to explain what they are doing. If you have a question about anything related to you or your baby’s care, ask! And if you are faced with making a decision (unless it’s an emergency), it’s ok to ask for more information and for more time to think it over.
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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.

Why You May Want to “Labor Down” Before Pushing in Birth

Congratulations, you are completely effaced and dilated to 10 cm — you’re ready to push out a baby! Or are you?

Many of us have come to believe that pushing during birth begins when you have reached the magical 10 cm. But in fact, there is a beneficial practice that can come before pushing called “laboring down.” Instead of forcefully and actively pushing with each contraction immediately after reaching 10 cm, laboring down allows your body to naturally bring baby further down and rotate while you follow only natural, gentle urges to push (or not push at all). This process can last for up to 1 to 2 hours.

Pushing is hard work, and while many women find it satisfying to begin working with their contractions by pushing, it can be helpful to allow yourself a span of time to let your body do the work naturally before exerting the energy it takes to push out your baby. First-time moms may push for 1-3 hours, or it could be 10-20 minutes. And because it’s impossible to predict the amount of time you’ll spend pushing, laboring down is an effective way to help you conserve energy by reducing the amount of time spent actively pushing.

Similar to laboring down, some women may experience a “rest and be thankful” phase after reaching 10 cm. With this normally occurring phenomenon, labor seems to “stall” and you experience no natural urge to push for around an hour after completing dilation. Instead of pushing with each contraction during this time (which exerts a lot of energy), you may want to consider waiting until you have the natural urge to push. Like laboring down, rest-and-be-thankful allows your body to rotate and bring baby down without exerting a lot of energy on your part.

So whether you’re laboring down or resting and being thankful, when should you start pushing? When you begin to feel the overwhelming urge to forcefully bear down with your contractions, it’s a good sign to go ahead and push. If your urge to push isn’t overwhelming (or if you never feel the urge, as is common when you have an epidural), you can wait until your baby’s head is visible (your partner or care provider can let you know).

 

Did you “labor down” or have a “rest and be thankful” phase? Share your experience!

 

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60 Tips for Healthy Birth: Part 2 – Walk, Move Around and Change Positions Throughout Labor

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 Walk, Move Around and Change Positions Throughout Labor

1. Learn why walking, moving around, and changing positions throughout labor is important for you and your baby during labor.

2. Limit interventions, like epidural and routine IV fluids, both of which can restrict your ability to move during labor.

3. Bring a trusted friend, family member, your partner, or doula to serve as your birth support person who will be in charge of reminding you to change positions and offer suggestions for movement that keeps labor progressing, facilitates baby’s positioning, or allows you to rest in between contractions.

4. Find a care provider who supports evidence-based practices for a healthy birth, including remaining mobile during labor.

5. Make sure your place of birth is one that encourages women to move around and change positions during labor.

6. Request intermittent fetal monitoring (usually 20 minutes out of every hour) instead of continuous fetal monitoring, which is more restrictive for movement and has been shown to increase the risk of more interventions.

7. Labor as long as possible at home, where you are free to move around as much as you like.

8. If you need to have an epidural, ask your care provider and anesthesiologist about having a lower dose epidural to be able to move and change positions easily, and possibly get up and walk short distances (though many hospitals do not permit this).

9. If you must be monitored continuously or hooked up to an IV (like you would during an induction), you can still get out of the bed! Enlist the help of your support person(s) to help you move around with wires in tow.

10. Familiarize yourself with the many different labor positions you can use to help promote comfort and facilitate labor and birth.

How Will You Fuel Your Labor?

Labor and birth is hard, physical work. Your uterus is a muscle — the strongest muscle in the human body, in fact. With each contraction, your uterus contracts and releases (approximately 200-400 times or more throughout labor, depending on the length of labor). Add to that the force it takes to push out a baby (a whole lotta force!), and you’re looking at a woman who is really working hard during labor and birth — sometimes for more than 24 hours!

Like any other major, prolonged physical activity (sports game, running, hiking, swimming, biking, etc.), labor and birth require hydration and nutrition to maintain your stamina. And, similar to other physically demanding events, you may do better to seek food and drink that digests easily and is packed with nutrients and electrolytes. For example, laboring women don’t usually crave a loaded slice of pizza and a giant Coke (though some do!). The following list of great labor foods are staples that laboring women often turn to, and provide the best bang for the buck, so to speak:

  • Water — it’s on the top of must-haves; sip it often throughout your labor to stay hydrated
  • Coconut water — natural electrolytes!
  • Fruit juice or smoothies
  • Sports drinks
  • Honey sticks
  • Yogurt
  • Simple carbohydrates, like bread, muffins, crackers, and plain pasta
  • Hard candy — not very nutritious, but can cure a dry mouth and curb nausea
  • Gel packs — used by endurance athletes because they are easy to digest and process quickly for a boost of energy
  • Soup broth
  • Applesauce
  • Fruit
  • Eggs

You might be thinking, “But I’ve heard you can’t eat during labor?” For many years, doctors have restricted laboring women from eating and drinking during labor (ice chips only!), but the evidence has emerged and it has found, in fact, that it is safe to drink and eat during labor and birth. To learn more, read a review of the research by Evidence Based Birth and a study on eating and drinking in labor from the Cochrane Summaries.

 

How did you fuel your labor?

 

 

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When to Head to the Hospital in Labor

It’s the million dollar question for nearly every first-time mom nearing the end of her pregnancy. Knowing when to head to the hospital so that you don’t arrive too early and not so late that you have your baby on the side of the road is a hard to nail down. It’s not a perfect science, but there are some tips that can help guide you to know the right time for you. Most care providers give the standard “5-1-1″ guidelines for when to call them and/or head to the hospital: when your contractions are consistently 5 minutes apart, lasting for 1 minute each, and going on for at least an hour. But this could mean that you are at the hospital earlier than you had wanted, with several more hours of active labor ahead.

Review the following questions and begin to formulate a plan for when you will go to the hospital when you are in labor. Talk it over with your care provider and birth support team for input.

What are your goals? Do you want to stay in the comfort of your own home as long as possible in labor? Or, do you feel more comfortable in the hospital setting? Are you seeking a low intervention birth? Or, are you planning on having an epidural for pain relief? Knowing your goals for labor will help you decide how long to labor at home.

Ask for professional feedback. If you’ve hired a doula or if your doctor or midwife know about your wishes to labor at home as long as possible, call them for feedback when you’re in a good labor pattern. Talk to them for a 10-15 minutes, while you’re having a few contractions, so they can help assess where you are in labor and whether or not you should go into the hospital.

Take note of what’s happening between contractions. As your labor progresses closer to transition (7/8 cm dilation), you will most likely begin to decrease your activity between your contractions. Prior to this point, you may feel like walking, talking, and moving around in between contractions. When you stop feeling the ability to be mobile in between contractions, you may want to consider going to the hospital.

Listen to your gut. In this time of information overload and “Are You in Labor” online quizzes, we often overlook the most important natural instinct we have: our intuition, or “gut feeling.” When in labor, take a few moments to sit quietly by yourself and find out what your gut is telling you. Many women who’ve had babies will tell you: “you’ll just know.” And usually, it’s true.

 

How did you know when it was time to go?

The Straight Scoop on Inductions

The holidays are upon us. If you are due on or near a major holiday, you will be more likely to face the decision of whether or not to get induced to go into labor. But before you succumb to the pressure of planning your baby’s birth date to avoid a holiday, first consider the realities — and risks — of induction. Lamaze created a the following infographic to illustrate the problems with, pressures of, and decision points surrounding induction. For more information on induction, check out the resources on Lamaze.org.

 

 

What to Know if Your Labor Stalls

Labor is unpredictable. We have no way of knowing in advance when labor will begin, how long it will last, or how it will feel. Sure, there are some universal markers and generalizations about the process of labor, but every experience is different, and the variables are numerous. First-time mom vs. mom with a subsequent baby, baby’s position during labor, home or birth center birth vs. hospital birth, pain med-free birth vs. heavy intervention birth, complications vs. low-risk mom… the list could go on. All of these factors influence the course of labor and birth.

Perhaps one of the most variable parts of a woman’s labor is length. Healthy babies and mamas can come through a labor that lasts 3 hours, 12 hours, or 48 hours (or longer). Despite this fact, many health care providers in the United States place time limits on a woman’s labor in the hospital. It is not uncommon for a doctor to recommend the use of Pitocin to speed up labor if a woman’s cervix has not changed dilation in two hours. As a standard practice, obstetricians are encouraged to govern labor by Friedman’s Curve, an analysis developed in 1955 by Dr. Emanuel Friedman that dictates how a woman’s body should progress in a normal labor. The problem with this? According to Rebecca Dekker, PhD, RN, APRN, of Evidence Based Birth, who recently investigated this practice:

“Modern researchers have come to the definitive conclusion that we can no longer apply Friedman’s curve to women of today’s world. Too many things have changed since 1955. Women are no longer sedated during labor, but epidurals are commonplace; Pitocin is used much more frequently for both labor induction and augmentation, women are older and tend to weigh more, and forceps are hardly ever used. All of these things can either slow down or speed up the rate of labor.”

A “abnormal” labor, according to Friedman’s Curve, is one in which a woman is dilating less than a centimeter an hour. Care providers who adhere to these guidelines will often prescribe Pitocin to speed up labor, or if the stall continues (with no dilation for 2 or more hours), may call “failure to progress” and recommend a cesarean. According to Dekker’s article, research published this year from a sample of 38,484 women showed that “10%, or 1 in 10, of all first-time mothers in the U.S. had a cesarean for failure to progress during the years 2002-2008 (Boyle, Reddy et al. 2013).”

So, if 1cm an hour dilation is considered too stringent and outdated, how long can you safely labor before intervention is called for? In 2012, the American Congress of Obstetricians and Gynecologists, the Society for Maternal Fetal Medicine, and the National Institute for Maternal and Child Health came together and issued new guidelines for stalled (or, “arrested”) labor. Among the guidelines, as posted in Evidence Based Birth’s article:

“Progress in the first stage should not be based solely on cervical dilation but must also take into consideration change in cervical effacement and fetal station. Similarly, progress in the second stage involves not only descent, but also rotation of the fetal head as it traverses the maternal pelvis.”

“Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed as long as the maternal and fetal conditions permit.”

“1st stage arrest can be diagnosed ONLY if a woman has reached 6 cm and the water has broken, AND if there has been no cervical change for 4 or more hours of adequate contractions or 6 or more hours of inadequate contractions. If the mom is still less than 6 cm, then she needs additional time and interventions before an arrest of labor can be diagnosed, because she is still in early labor.”

Stall during pushing can be “diagnosed if there has been no improvement in descent OR rotation of the baby after at least 4 hours in first-time moms with an epidural, at least 3 hours in first-time moms without an epidural, at least 3 hours in experienced moms with an epidural, at least 2 hours in experienced moms without an epidural.”

Stall of an induced labor can be diagnosed if there is “failure to have regular (every 3 minutes) contractions and failure of the cervix to change after at least 24 hours of oxytocin (and if the water has been broken, if possible).”

How can you avoid unnecessary interventions due to a stalled labor? First, be sure to talk with your care provider well in advance of your birth. Find out her policies on allowing a normal labor to progress. If you are in labor and your care provider recommends Pitocin or cesarean due to stalled labor or “failure to progress,” there are three questions to ask your care provider that will help you assess your situation:

  • Is my baby OK?
  • Am I ok?
  • What’s the risk in doing nothing or waiting? 
You can also ask your care provider about using natural techniques to get labor moving again, including:
  • Walking, moving, changing positions
  • Laboring in the shower
  • Change in environment (time alone, dimmed lights, music, etc)
  • Nipple stimulation
The most important thing to know about a stalled labor is that it is usually not an emergency. As long as you and baby are healthy, you may have options outside of medical intervention.

Have you experienced a stalled labor? How did you handle it? How did your care provider react? 

 

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