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Congratulations! If you are showing the positive signs of labor (progressive contractions, water breaking, etc.), then a baby is working on making his/her way into this world! At this point in time, you may be feeling a couple of different emotions:
 Dad supporting Mama in labor The Realities of Labor and Birth Do you know what a laboring woman truly looks like? It’s okay if you don’t. Actually, I don’t know if there are a lot of people out there that really do. They may have never witnessed a live birth, or they have only been exposed to birth in the media (SO unrealistic). Before I became a doula, I was very naïve. I was unaware of the impact of medical interventions on birth. I didn’t know there were moms out there that were opting for natural birth, let alone giving birth in their homes. I had no idea labors could last +24 hours. I didn’t even know doulas existed. I wasn’t aware that when your water breaks, you don’t have to rush to the hospital. And you definitely don’t have to labor in bed or push while lying on your back. If you already knew these things, how powerful was that moment when you were presented with the realities of birth? Going to my first births as a doula was so eye opening and educational. From my experiences, I wanted to share some general information and tips that can help you better understand and navigate through this process: Childbirth is physiological. There are so many hormones that come into play during labor and birth. If mom is feeling anxious or tense, adrenaline is released. This hormone can hamper labor progress, causing it to stall or stop all together. Laboring mamas need to feel supported—which will cause a release of oxytocin, the “love hormone.” Partners and support people: be in tune with mom’s emotions. Matching her mood and simply being present will positively affect labor progress. You can read more about the role of hormones in labor here. Early labor can last a while and feel mellow or chill. In early labor, distraction is KEY! Engage in regular, everyday activities until you can no longer distract yourself. Do you have a lunch date with girlfriends planned for today but are hesitant because you're in labor? Go ahead out and grab a bite. As one childbirth educator in our community says, you can get pretty fast service if you tell your waiter you’re in labor! ;) But really...take the dog for a walk, call your mom to chat, watch a movie or play some card games with your partner. Do whatever helps to pass the time. Remember that this is the longest stage of labor. If you can manage it, try resting or napping for a period of time. You want to reserve as much energy as possible for the more intense parts of labor. With that being said, eat light foods and keep up your fluid intake. Nourishing your body in the early stages of labor will prevent you from running on empty when you’re pushing your baby out. Call your doula and let her know you are in labor. She may not meet with you at that very moment, but it’s nice to give her a heads up. By the time you are ready for her to join you and your partner, she will have all of her ducks in a row. If you’re planning a hospital birth, try laboring at home for as long as possible. This will help decrease the chance of interventions. If you are feeling lonely or unsure, this would be a good time to invite your doula over. She can provide reassurance, perspective, and suggestions. If mom and baby are both healthy, there is no need for continuous electronic fetal monitoring (EFM). When mom arrives at the hospital, the nurse will want to hook her up to the EFM for about 20-30 minutes. This is just to make sure mom and baby are doing well. Once she assesses mom and baby’s well-being, and everything looks okay, mom will be taken off of the EFM. Typically, the nurse will come in about every hour or so to get a quick reading (subsequent readings are much shorter than the one upon arrival). If labor is moving at a fast pace, the nurse will come in more often. EFM is usually considered necessary when other interventions are introduced, such as Pitocin or an epidural. At prenatal appointments with your care provider, ask for his/her opinion on routine practices and interventions. This may give you a good idea of what to expect once you go into labor. If you find that you are unhappy with the way your care provider handles things prenatally, try switching care providers! Unless you are nearing your due date, it is most likely not too late to switch. Eat to hunger and drink to thirst. I know I mentioned this up above, but it is just so important to note once again! Most hospitals offer clear foods for laboring women. These include: jello, gummy bears, ice chips, popsicles, broth, etc. I encourage expectant mamas to pack light snacks in their hospital bags. Consider brings crackers, granola bars, fruits and veggies, etc. Not nourishing your body in labor can have adverse effects on the laboring process. Movement and breathing are powerful coping mechanisms in labor. Moms will find what works for them in labor, but I always find that breathing techniques and position changes really do the trick. There is no one right way to breathe, but as labor becomes more intense, mom may find that her breathing style changes. Just like transitioning from walking to jogging to running, heart rate and breathing patterns will pick up. Changing positions often will also help with labor progress and baby’s descent. What works in early labor may not work in active labor, and that’s okay! Women typically rely on more than one comfort measure and position to cope with labor pain. Active labor, especially while in the transition phase, is intense! This is the part of labor that media loves to play off of. I always think of Alison screaming, “GET OUT” when giving birth in the movie, “Knocked Up.” Yes, the moments leading up to full dilation can be very intense, but mom may also turn inward. She may be very to herself, very quiet and focused on each contraction. Don’t be alarmed if she is very primal in her labor. She may be moaning, chanting, keeping a rhythm of some sort (Check out Penny Simkin’s write up on "The 3 R’s in Childbirth Preparation" to get a better idea of coping rituals). In this phase of labor, support people often hear mom say, “I can’t do this anymore.” Mom may feel defeated and ready to throw in the towel, especially if she is exhausted. She may ask for pain medications or say, “If I could just go to sleep and wake up tomorrow, I could do this.” This irrationality is totally normal. Offer encouragement and remind her of your birth plan. Often times, laboring mamas get so caught up that they cannot see the light at the end of the tunnel. Remind her that you both are getting a baby out of this! It can be hard to keep that in perspective. There is a resting phase. Before mom enters the 2nd stage of labor, the pushing stage, she may doze off. Support people may be surprised at her ability to relax after such intense and frequent contractions. At this point in time, mom’s uterus is playing catch up and will give her a “break” before she feels the urge to push. Know that this is completely normal, and if mom experiences this lull, encourage her to shut her eyes and rest for a moment. Typically, moms will get a second wind when it’s time to push, but any bit of rest until then will help! Visit the bathroom frequently. This may sound like a "Duh!" statement, but a full bladder can cause labor to stall. If you feel like you have to pee, go sit on the toilet. If you don't, that's cool. But try out some contractions while you're sitting there. As humans, we have this natural instinct to let go when we sit on the toilet. Really opening up and relaxing may be just what you need to dilate fully. You never know! Mom can use spontaneous pushing to get her baby out. When mom is fully dilated, she will be encouraged to push. Remind her to wait for that natural urge. Like I stated above, she may not feel that urge right away, and that’s okay. I think it’s said best in “Our Bodies, Ourselves: Pregnancy and Birth:” “Pushing your baby out works best when you do just what your body wants, without external direction. Bear down when you feel the urge. Your pushing efforts will be more effective and powerful if you push when your urge is the strongest. If you have an epidural and cannot feel the contractions well, your care provider and support people can help you identify when to push down.” To get a better idea of spontaneous pushing, check out this video created by Mother’s Advocate. Last, but definitely not least, I wanted to briefly touch on the topic of informed decision making. Understand that I offer these suggestions and details to help you decide what is best for you and your family, not to tell you the correct way of handling these events. Giving birth entails so much more than "having a healthy baby," and sometimes the people around a laboring/ new mom do not get that. My goal as a doula is to help moms and partners achieve satisfying birth experiences--whatever that looks like to them.** When moms and partners are involved in the decision-making process, they feel more informed and empowered than those that do not. Giving birth is something that women do, not something that happens to them! Mamas, please remember that this is your body, your baby, and your birth! **There is a lot to cover when it comes to talking about the process of labor and birth, and I know I didn't cover all of the details in this blog post. If you're reading this post-birth, what kinds of support did you benefit from during your experience? Were there specific comfort measures, positions, or mantras that got you through? Looking back, is there something you would have done differently? I truly appreciate you taking the time to share your personal stories. Sources:Podcast: Birth on TV and the movies
http://motherloveblog.com/2012/02/24/podcast-birth-on-tv-and-in-the-movies/ WombEcology by Michel Odent http://www.wombecology.com/?pg=physiological Our Bodies, Ourselves: Fetal Monitoring http://www.ourbodiesourselves.org/book/childbirthexcerpt.asp?id=81&chapterID=21 Restricting Oral Fluid and Food Intake in Labor http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003930.pub2/abstract The 3 R's in Childbirth Preparation http://www.pennysimkin.com/articles/Three_r's.pdf Get Upright and Follow Urges to Push (video) http://www.youtube.com/watch?v=NjtM4EtSs34 Childbirth Connection: Informed Decision Making http://www.childbirthconnection.org/article.asp?ck=10081
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In our last blog post, we discussed the ways in which your body prepares for labor. There’s usually a lot going on that we don’t even recognize as “progress.” For example, when you go into the office for a prenatal appointment and your doc says, “I’d say you’re about…one centimeter,” you might be thinking, “That’s nothing, and my due date’s in two days! This baby is never going to come out.” I’m here to tell you that there’s more to it than that. Don’t be too hard on yourself, and have faith in your body. It knows exactly what to do! In this blog post, I will list the possible, probable, and positive signs of labor. Again, please remember that every woman is different. Some women experience lots of these symptoms, while others don’t even recognize when they’re experiencing pre-labor. It’s typically not until mamas look back, in hindsight, and think to themselves, “Oh…well I was awfully crampy that day, I visited the bathroom frequently, and I went to town cleaning our kitchen.” The symptoms listed below, of course, don’t promise a baby today or tomorrow. BUT the more symptoms that are present, the more likely it is that you are closer to entering the gates of Labor Land :) Possible Signs Cervical change Remember those cervical changes we talked about in the last blog post? Although they don’t promise labor to kick in tonight or next week, they are great signs of progress. Before your cervix can dilate, it needs to thin out. Your cervix will also need to soften and move forward in position, too. Crampiness You may experience some abdominal cramping, which could feel very similar to menstrual cramps. Sometimes this cramping will extend out to your thighs as well. Restless backache This nagging backache is different from the backache you may experience from long periods of being upright or standing. It can come and go, and it often feels like back pain associated with a menstrual period. You may feel like you need to change positions often to get comfortable. A warm rice sock or heating pad can do wonders for lower backache!
Loose, frequent stools This sign can be tied in with backache and cramping (like I stated earlier, this could just feel like you’re about to start your period). And guess what? It’s also related to those cervical changes happening in your body. When the cervix thins out, or effaces, it releases prostaglandins. Increased levels of these hormone-like substances will also make you poop. Although not fun, it’s totally normal to experience an upset stomach and multiple trips to the bathroom before labor begins. Probable Signs Non-progressing contractions (Braxton-Hicks or Pre-labor contractions) Many people call these contractions “false labor,” but there is nothing false about it! These contractions may not dilate your cervix, but they help it to efface, soften, and get into an anterior, or forward-facing, position for labor and birth. These contractions are “non-progressing” because they are not longer, stronger, and/or closer together.” Often, they will begin when you’re up and moving and will slow down or completely stop when you change activity. Here’s a great example of a gal experiencing Braxton-Hicks: “Today, I went out for a walk with my husband. I began to feel a tightening in my abdominal area, which I thought were contractions. We took note of how often they came and went, excitedly hoping this was the real thing. They lasted about 30-40 seconds and came every 10 minutes or so. By the time we got back to our house, I was exhausted. When I climbed into bed for a nap, I noticed that the contractions came less and less...and eventually stopped. I felt a bit disappointed, but after discussing with my doula, we decided I was experiencing Braxton-Hicks.” Braxton-Hicks may occur on and off for hours or even days before labor really kicks in. Try not to stress too much, and carry on with normal, everyday activities. Distraction will be your best friend in pre-labor and early labor! Losing your mucus plug/experiencing bloody show This is exactly what it sounds like. The mucus plug’s purpose is to block the cervix and prevent bacteria from sneaking up into the uterus and causing an infection. When a mama loses her mucus plug, it’s because her body is trying to clear the birth canal and make way for baby’s awaited descent. The mucus plug is typically clear and may be pink, brown, or blood-tinged in color. Because there is an increase in vaginal discharge in pregnancy, sometimes women don’t even realize that they have lost their mucus plug. Losing your mucus plug does not necessarily mean you are going into labor right now. But when it does happen, take note and let your care provider know at your next appointment. If you are really excited and want to share the news with someone, call your doula. If she is anything at all like me, she will love this info and share in your happiness! If discharge is bright red in color or there is a great amount of discharge, call your care provider. This could be a sign of complications that need taken care of right away.  I think her water just broke... Water breaking (leaking or gush) Are you surprised by this “probable” sign of labor? In movies and television, we often see women go immediately into labor after their water breaks abruptly. They are rushed to the hospital and have a baby in their arms in the next scene or two. Obviously, this isn’t very realistic, although there are women out there that experience fast and intense labors. Actually, only 1 out of 10 women begin labor with their water breaking. This is known as a premature rupture of membranes, or PROM. Typically, a woman’s water won’t break until she’s in the active phase or pushing stage of labor. Sometimes the water won’t even break at all! When this happens, baby is born in the caul. Pretty amazing, right? When your water breaks, you may experience a gushing or leaking of fluids. I’ve labeled “water breaking” as a probable and positive sign for this reason: Sometimes, labor may not begin spontaneously, or on its own, after mama’s water breaks. If this happens to you, your care provider will most likely want you to come in for a check-up. He/she may want to induce labor depending on how much time has passed since your water broke. Be sure to address this topic at prenatal appointments in order to better understand your care provider’s protocol regarding PROM. Positive Signs Progressing contractions Progressing = longer, stronger, and closer together. You will need to be experiencing at least 2 out of the 3 variables to label the contractions as “progressing.” As your contractions continue to progress, take notes. Where are you feeling them? How often are they coming? Are the contractions getting longer? These tidbits will help you better understand where you’re at in labor and when you decide to head to the hospital (if you are planning a hospital birth). Water breaking (leaking or gush) To add to the snippet above, if your water breaks and you begin to experience progressing contractions, you are in labor! Take note of when your water broke as well as the color and odor of the fluids. Amniotic fluid is usually colorless and odorless. If the water has an odor, it could be a sign of infection. If it is stained, it usually means baby has pooped in utero. This is not atypical for a mama who has gone past her estimated due date, but it could also be a sign of fetal distress. If your amniotic fluid contains a color or odor, it is best to contact your care provider to let him/her know. If you have any questions regarding labor and birth, contact your care provider and/or doula. While your care provider can provide you with medical support, your doula will be there to offer emotional, physical, and informational assistance. Stay tuned for the next part of the 'Labor Progress' series, as we will be discussing ways to keep labor moving once it's here! Sources:Baby Born in Caul ~
http://techboys.typepad.com/techboys/2006/11/amazing_picture.html Nesting Jessica Alba~ http://www.zimbio.com/pictures/HUw3C0WU5tl/Jessica+Alba+Mom+Go+Shopping+Beverly+Hills/SMjTVHxdKEu Water breaking~ http://www.lilsugar.com/Dramatic-Water-Breaking-12047192 Let’s talk about labor progress, shall we? I am in awe of how women work with their bodies during labor and birth, especially because of the major changes happening throughout the process. But labor progress isn’t an “all or nothing” type of thing. A pregnant woman’s body can begin to “prep” for labor long before baby signals, “I’m making my way out!” When an expectant gal visits her care provider days or weeks before her estimated due date, the main point of progress discussed is dilation. But there is so much more to it than that! If you want to know more about your baby and the changes happening in your body, think about talking with your doc or midwife about these questions:
Please stay tuned for Parts 2 & 3 of "Labor Progress," as we will be discussing the signs of labor as well as how to keep labor moving once it's here.
Thanks for reading!  Photo Credit: Meredith Atlas L.M., Loving Hands Midwifery The ways in which society views and manages childbirth have evolved over time. Decades ago, women were not able to actively be a part of the labor and childbirth experience. Routine procedures involving chloroform, forceps, and solitude during labor and birth left women feeling “dehumanized” and alone. Many of these women knew of no other way to birth and had very little say in what happened in the delivery room (Harper). Today, however, we have come to understand that birth is a natural, physiological process. Having a supportive birth team and the freedom to express birth preferences can result in a more satisfying and empowering experience for the laboring mother. For women looking to make the most out of their birthing experience, a doula makes the difference. The ancient Greek word “doula” historically meant “woman who serves.” Currently, the term “doula” refers to a trained labor support professional that assists women and their partners before, during, and immediately after childbirth by providing educational, emotional, and physical support. Doulas act as an important aspect of birthing culture because they have the ability to positively alter the ways that individuals perceive and experience childbirth (Simkin, Way). A doula’s key role is to provide continuous emotional, informational, and physical support to laboring women. She provides physical, hands-on comfort and emotional reassurance by using a variety of techniques, whether it is during prenatal and postpartum visits or during labor and birth. Doulas do not only support laboring women, but also support their partners as well. During pregnancy, the doula will help an expectant couple to map out their birth preferences; during labor, she assists the couple in carrying out these wishes. Rather than speaking for her clients, a doula will facilitate communication between the clinical care provider, the mother, and the partner. The doula does not take the partner’s place. Instead, she provides guidance by modeling numerous techniques the partner can use during labor and birth to bring the mother relief and encouragement. The doula may use relaxation techniques to help the laboring woman, such as visualization, mental imagery, and breathing exercises. She helps women find comfortable laboring positions, such as hands and knees, side-lying, kneeling, and semi-sitting. The doula finds ways to help the woman feel most comforted by using tools like hot and cold packs, a birth ball, hydrotherapy, body movement, verbal reassurance, massage, counter pressure, and aromatherapy. She can also assist in constructing a relaxing atmosphere for the laboring mother and her partner-- a special, intimate space where positive memories are created (M. Klaus, J. Kennell, P. Klaus). The benefits of labor support to the mother and her family are extensive and extraordinary. Recent studies show that a doula’s continuous support reflects an array of short term, physical benefits and long term, emotional benefits. Women supported by birth doulas tend to give birth with less medical interventions, including the use of Pitocin, forceps, vacuum extraction, and Cesarean sections. They also experience less need for pain medication and tend to labor for a shorter period of time. Women who are supported continuously throughout labor and birth tend to have a higher sense of satisfaction with their birth experience as well as higher self-esteem. A doula preserves a mother’s memories of this life-changing event and helps her advocate for herself, leaving the mother feeling empowered and fulfilled. A doula’s assistance often leads to improved maternal-infant interactions and breastfeeding outcomes. Doulas encourage skin-to-skin contact, and when mother and baby are instantly united after birth by simple, intimate contact, the relationship is nurtured to the fullest extent (Simkin, Way). Various scientific studies have been conducted since the 1970s, the first developed by Dr. John Kennell and Dr. Marshall Claus. These studies have discovered that, compared to women who received “usual” care during labor and birth, women who labored with continuous support were 26% less likely to have Cesarean sections and 41% less likely to experience vacuum extraction or birth with forceps. These women were also 28% less likely to use any analgesia or anesthesia and 33% less likely to feel discontented with their birth experience. Because of the doula’s presence and continuous labor support, the emotional, physical, and mental aspects of birth for the mother are improved (Simkin, Way). According to DONA’s Standards of Practice, the doula’s main goal is to help mothers achieve safe and satisfying births. This will be different for each laboring woman because there is no universal. Doulas advocate for the mother and her partner by providing information regarding the risks and benefits of certain procedures and then allowing the mother and her partner to make the decision that works best for them. Doulas do not perform clinical or medical tasks. This includes taking blood pressure or temperature, checking fetal heart tones, performing vaginal examinations, and/or providing postpartum clinical care. Rather than prescribing treatments and diagnosing health concerns, doulas advise clients to speak with their care providers if they have specific questions regarding clinical care. According to DONA’s Code of Ethics, every woman who desires to have a doula should be able to have one. Doulas should set reasonable fees when working with clients. If a doula is not available for a mother who requests labor assistance, it is that doula’s responsibility to refer the mother to other doulas who are available. When a doula decides to work with a client, she must demonstrate dependability. This involves creating and sharing a contract that discusses services provided, back-up support, refunds, fees, etc. Doulas should always maintain confidentiality when working with their clients. This simple action illustrates respect of privacy and will allow a mother to feel more secure in the care of her doula. Providing labor support enhances a woman’s birth experience, in both physical and psychosocial perspectives. Labor support facilitates interaction and nurtures the relationship between parents and infants. How a mother is treated during labor and childbirth influences the memories of her birth as well as the relationship she shares with her child and partner. The continuous support that a doula provides tends to create more positive obstetric outcomes for women and their babies. Women who are adequately supported in labor tend to experience less obstetric interventions during labor and delivery. Every woman is unique, and different women have different needs and wants. Nurses and care providers have many patients and very little time to provide one-on-one care. A doula, however, can offer individualized care, which places mom at the center of this novel and miraculous experience. *All content written and compiled by Lindsey Rupp. Please contact me before using anything found here.* Sources:"DONA International – Code of Ethics for Birth Doulas." DONA International. 2005. Web. 5 Jan. 2011 <http://www.dona.org/aboutus/code_of_ethics_birth.php>.
"DONA International – Standards of Practice for Birth Doulas." DONA International. 2005. Web. 5 Jan. 2011. <http://www.dona.org/aboutus/standards_birth.php>. Harper, Barbara. Gentle Birth Choices. Rochester, VT: Healing Arts, 2005. Print. Klaus, Marshall H., John H. Kennell, and Phyllis H. Klaus. The Doula Book: How a Trained Labor Companion Can Help You Have a Shorter, Easier, and Healthier Birth. Cambridge, MA:Perseus Pub., 2002. Print. Simkin, Penny, and Kelly Way. The Birth Doula’s Contribution to Modern Maternity Care: A DONA International Position Paper. 1998. A publication on the value of birth doula support. |
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