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.

Childbirth Challenges

The following and several more great resources can be found at Lamaze.org/PushForYourBaby

Every pregnant mom wants a healthy baby, but common maternity practices may actually make it harder to have a safe and healthy birth.

Many interventions may seem like they would make childbirth easier. But, did you know that some of the care that pregnant women routinely receive can have unintended consequences and potentially make birth more difficult and less safe?

Here is the straight scoop on some common interventions. This information, and what you learn in a Lamaze class, can help you partner with your care provider to have the best birth day possible for you and your baby.

Epidurals

Let’s be honest. Most of us would love to avoid the pain of labor and birth. But, epidurals have both “pros” and “cons.” We already know the good part – a reduction in pain for you. But there’s less talk about the downside. It’s important to know that epidurals can set the stage for slower labor, more difficult pushing and dangerous blood pressure changes all factors that can lead to a C-section.

Women don’t always get support for exploring other, more natural pain relief options like movementfocused breathing, or a warm tub or massage (ahhhh!) to keep pain in check. So, weigh the risks and benefits before agreeing to an epidural – it’s an important step in making this personal decision.

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Overuse of C-Sections

Cesarean surgery can save lives, plain and simple. But, it’s pretty major surgery, and like any other surgery, it carries risks for you and your baby. So, there should be a really good medical reason to use it, right?

It’s sad to say, but more and more babies are being delivered by cesarean, even when there’s not a good medical reason to do so. In the United States, about one in three women who give birth will end up in the operating room.

Some women are told they are too overweight, too short or too old for vaginal delivery. Others are told their babies are too big or coming out too slowly. Women who have already delivered a baby by cesarean often are told that a vaginal birth after cesarean (VBAC) is off-limits and another cesarean is their only option. Many of these reasons sound like good medical thinking, but aren’t actually supported by the research.

To help spot a cesarean you might not need, be prepared to ask your care provider questions like: “Can we wait a little longer?”, “Is my baby in any immediate danger?” and “What are the risks if I proceed with a C-section, and those if I don’t?”

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Induced Labor

An increasing number of hospitals are cracking down on inductions, and for good reason. Artificially starting labor may be good for a care provider juggling a busy calendar, or your mother-in-law who wants to book her plane tickets, but it can make labor harder and more painful for women, and stress babies and jeopardize their health. Studies have consistently shown that the risk of having a C-section for first time moms nearly doubles with induction. It also increases your baby’s chance of being born premature. That’s because due dates aren’t an exact science. Even if you and your care provider are positive about your dates, every baby matures at a different rate. Inducing labor can mean your baby is born before he or she is ready.

Aside from the risks of induction, there are specific benefits to letting labor start on its own. During the last part of your pregnancy, your baby’s lungs mature and get ready to breathe. He or she puts on a protective layer of fat, and develops critical brain function through 41 weeks of pregnancy. Cutting the pregnancy short can be tough on your baby.

Before going through with an induction, tell everyone to hold their horses, and take time to learn more about benefits of letting labor start on its own.

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The American Congress of Obstetricians and Gynecologists, as well as theSociety of Obstetricians and Gynaecologists recommends listening to your baby’s heartbeat at key points in your labor for low risk women.

Electronic Fetal Monitoring (EFM)

There isn’t a mom on the planet who wouldn’t love a way to monitor every moment of her baby’s in utero existence. We all want to know our babies are doing ok. Using the same thinking, most care providers will monitor you baby’s every heartbeat during labor using electronic fetal monitoring, or EFM. It’s worn like a belt around your belly, and as long as you don’t move, it will record every heartbeat on a little strip of paper. Your care provider will watch the monitor and that little strip of paper for signs of trouble.

Sounds great, right? Well, there’s a catch, actually, three big catches.

  1. It doesn’t work. It’s natural to think that using EFM would help care providers spot babies who are in trouble, but every study that’s ever been done has shown the same thing. Using EFM doesn’t help improve the health and well-being of babies.
  2. EFM can lie. Well, not on purpose, but studies show that EFM can frequently give a false signal that a baby is in trouble. This means an emergency cesarean for mom, even though baby is perfectly happy and healthy.
  3. EFM confines pregnant women to bed. The best way to move your baby OUT is to get yourself up and moving. If you’re stuck in bed, you’re not able to help your baby on that journey.

What’s the alternative? Studies show that a baby’s heart rate can be monitored just as safely with a nurse, doctor or midwife regularly checking in to listen at key points in your labor with a Doppler.

Talk with your health care provider about using intermittent listening, so you can move freely, relax between contractions, and avoid the anxiety that comes with being tied to a machine. Keep in mind that if you have a medical complication, if your labor is induced or sped up artificially, if you have an epidural, or if a problem develops during labor, you will likely need continuous EFM. Otherwise, it can be safer and healthier to have intermittent monitoring.

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Restricting Movement During Labor & Pushing

In contrast to what you see in movies and on TV, lying on your back in a hospital bed is not the only way to give birth! In fact, walking, moving around and changing positions throughout labor makes the birth of your baby easier. Movement is the best way for you to use gravity to help your baby move down the birth canal and through your pelvic bones. Staying upright actually increases the size of your pelvis to make it easier for your baby to fit and rotate as necessary.

When it comes time to push, staying off your back and pushing with your natural urges can be key to making it as easy as possible on you and your baby. Be wary of anyone trying to “direct” your pushing. Nobody should be counting for you or telling you to hold your breath. It increases the risk of pelvic floor damage and actually can deprive your baby of oxygen! Keep in mind that if you have an epidural or continuous EFM, this will drastically restrict your movement during labor.

Learn more about how movement in labor, as well as pushing upright and with your natural urges, can improve your chances of a healthy, safe birth.

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Restricting Eating and Drinking in Labor

They don’t call it labor for nothing! For many women, labor is a physically intense experience that puts many demands on the body. Unfortunately, women are routinely restricted from eating or drinking in labor, which can mean running out of energy when it’s needed it most. The restrictions come out of concerns that, if a woman ends up needing surgery, she should have an empty stomach. But research shows that modern anesthesia techniques make complications from food in the stomach exceedingly rare, and that laboring women can safely eat and drink in labor. So, be prepared. Make a point of discussing this with your care provider and be sure you’re able to get the nourishment you need to do the hard work for labor.

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Adequate Support

If you traveled to an exotic country and didn’t speak the language, you probably would consider hiring a tour guide to ensure your vacation was safe and fun. More and more, women are recognizing the same need in labor. Research shows that women who have continuous labor support from a friend, family member, and especially, the help of a professional labor assistant known as a “doula,” have easier and slightly shorter labors.

Many women count on having a nurse by their side to provide this support. Sometimes that happens, but most labor nurses are caring for several women at the same time and don’t have the time to provide contraction-by-contraction support. Dads often are expected to fill this role, but they are new to the process, too, and often need cues on how to best be supportive to their laboring partners.

So, think through interviewing a doula or consider whether you know someone who is especially knowledgeable about childbirth. Having someone you trust by your side can help you manage your labor, support good decision-making and help make sure you’re able to communicate your wishes to your health care provider.

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Separating Mom and Baby

Labor is over and your bundle of joy has finally arrived! But before you know it, your baby is whisked out of your arms or away to the nursery. That’s because in many hospitals, it’s standard procedure to separate mom and baby for a period of time, to complete some nursing tasks. However, research has shown that it’s best for mothers and their healthy baby to stay together after birth. Talk to your care provider and make sure they allow “rooming-in,” which will maximize your time with your little one and opportunities for breastfeeding. Don’t forget to talk about what will happen immediately after birth, too. Many things like weighing, measuring and bathing are not urgent and can be delayed, or done at your bedside or right on your tummy to ensure you and your new baby don’t miss a beat.

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What’s Next?

So, how do you get a better idea of the care your doctor or midwife will provide? Ask good questions! Take a look at some suggestions.

Talk Back

How about you? Are you hoping to avoid certain interventions in your baby’s birth? Have you experienced interventions that made your birth harder? Did you successfully avoid an intervention that helped make your birth easier and safer? Tell us your story in our comments section here.

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.
photo credit: santheo via photopin cc

Evaluating the Research on Home Birth Safety – A Link Round Up

In the last two weeks, two studies were released on the topic of home birth safety. And that’s where the similarities end. The studies’ reports completely oppose each other — the Midwives Alliance of North America (MANA) study states that “among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies,” and the study from the New York-Presbyterian/Weill Cornell Medical Center showed that “patients [who] delivered babies at home by midwives had a roughly four times higher risk of neonatal deaths than babies delivered in the hospital by midwives.”

How can it be that two studies evaluating the same thing reported results that are so vastly different? Well, the answer is lies in how the studies were created and reported. As a family working to evaluate your options and preferences for place of birth, it’s important that you read both studies, as well as what both the critics and proponents have to say, and then decide for yourself the best option for you and your family. Below are links to the original studies and subsequent reviews:

Midwives Alliance of North America (MANA) study

New York-Presbyterian/Weill Cornell Medical Center Study

Review from Science & Sensibility

Review from The Daily Beast

Review from Citizens for Midwifery

Review from Live Science

Review from Huffington Post

 

 

 

60 Tips for Healthy Birth: Part 6 – Keep Mother and Baby Together – It’s Best for Mother, Baby, and Breastfeeding

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 Keep Mother and Baby Together after Birth

1. Learn why keeping mother and baby together is healthy for you, your baby, and breastfeeding.

2. Ask your care provider about routine practices after birth. Does she encourage mom and baby to stay together?

3. During your hospital tour, ask the tour guide what nursing staff does to help mom and baby get off to the best start after birth. Do they promote skin-to-skin care? Do they delay routine newborn procedures until mom and baby have had a chance to feed?

4. Include on your birth plan that mom and baby should be kept together after birth. Share your birth plan with your care provider and the nursing staff at your place of birth.

5. Let your partner and birth support team know that you would like to keep your baby with you after birth. With the chaos that generally happens after birth, they can help facilitate your wishes.

6. Take a good childbirth class to learn how interventions can affect birth and your baby, and how they can be avoided. Many interventions can lead to separation of you and your baby.

7. When you are moved to a postpartum room after birth, keep your baby in the room with you instead of sending her to the nursery. Babies sleep best when mom is near, and you will get the best start with breastfeeding when you are close enough to see and hear their early hunger cues.

8. Take a good breastfeeding class, which will provide information on how to get breastfeeding off to a good start, including skin-to-skin care and tips for the first latch/feed with your baby.

9. If you must be separated from your baby after birth, spend time skin to skin with your baby once she is back in your arms.

10. If you have a cesarean, ask your care provider about bringing your baby skin to skin immediately after he is out. Some hospitals perform “family centered cesareans,” where mom and baby are kept skin to skin and breastfeeding is initiated in the OR. If your hospital does not permit you to hold your baby skin to skin in the OR, ask that your partner or birth support person hold baby skin to skin while you finish out your surgery and get moved to the recovery room.

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 5 – Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

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 Giving Birth on Your Back and Follow Your Body’s Urges to Push

1. Learn why avoiding giving birth on your back and following your body’s urges to push is healthy for you and your baby.

2. Discuss early on with your care provider that you would like to do what comes naturally when it comes to positions and pushing during birth. If your care provider reacts negatively, this could be a red flag that she does not support evidence-based practices.

3. Take a good childbirth class to learn the many ways in which you can push out a baby, and in particular, the many positions you can push in/on/around a hospital bed that does not involve lying flat on your back.

4. Avoid interventions that restrict your mobility so you can easily move in any way you feel comfortable, including positions for pushing, like on all fours, standing, squatting, and side lying.

5. If interventions become necessary, involve your labor support team to help you remain as mobile as possible and get into upright positions for birthing.

6. Learn the difference between directed pushing and pushing with your body’s natural urges.

7. Include details in your birth plan about your preferences to push in a position that is most comfortable to you and to follow your body’s natural urges to push (ie, please don’t count or coach for pushing). Share your birth plan with your care provider during your pregnancy, and bring a copy of your birth plan to your place of birth to share with your nurses/attendants.

8. Consider “laboring down” to shorten the amount of time spent actively pushing and to provide you with more energy to push in upright positions.

9. If you are birthing at a hospital, ask your nurses in advance of pushing about using the squat bar. Nearly all maternity beds come with a squat bar attachment, but staff may need some time to locate it and bring it to your room. The squat bar  is an excellent tool that can help support your squatting position in labor and birth. It can even be used for women who have an epidural.

10. You may find that pushing on your back and/or pushing with the encouragement or coaching of your labor support team is actually helpful — and that’s ok, too! Labor and birth is about what works best for you and your baby to have the most healthy and positive experience.

Researching Your Pregnancy & Birth Online? Learn How to Find the Most Reliable Resources

As you probably already know, the internet is littered with information about pregnancy, birth, and parenting. But do you know how to evaluate the source of the information you’re reading? Knowing who is behind the advice and statistics provided on any given website will allow you to judge their credibility. Before digging too far into a website, take a few minutes and learn about the source:

1. Who’s behind the website? Typically, you can find this information in the “about” section. Is it a non-profit group or for-profit group? How are they funded? What’s their mission? If you cannot find this information on the website or after doing a quick Google search, it may be a red flag. Your best bet is to keep searching for more trustworthy sources.

2. Who’s the author? So you know who’s behind the site, but what about the person who’s written the blog post/article/review? What are their credentials? Who do they work for? In other words — are they qualified to give evidence-based information and how big/slanted is their bias?

3. How up-to-date is the material? When was the piece written? Women’s bodies have not changed, but a lot of what we know about pregnancy and birth has evolved. That being said, some of the most “old-fashioned” advice and information on how to have a healthy birth is still relevant today.

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

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!

 

photo credit: HoboMama via photopin cc