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Pregnant women: print this out and hand it right to your partner, you will thank me later.

By now you’ve already gone through the excitement of a positive pregnancy test, received the hugs and high fives from friends and family, and made the decision whether to find out if you’re expecting a he or a she. Now, though, it’s starting to sink in: you have to have this baby! This cheat sheet is by no means everything that your partner will need to know on the big day, rather it is something to fall back on if it’s go time and all the information from childbirth classes fly out the window.  

By now you’ve learned more about the uterus and cervix than you ever thought you would; even heard about something called a mucus plug. Now it’s time to connect the dots, to understand just what’s going on down there, in there, and out here. The uterus and cervix, believe it or not, are actually one in the same. The cervix is the gateway to the uterus, which contains your baby, the placenta, amniotic sac and nearly a gallon of fluid!

Early Labor: How to Know & What to Do!

When the early stage of labor begins, the cervix begins to thin out and become softer, allowing it open easily.  She may feel what is described as a shooting or pricking sensation along with mild cramping, similar to PMS cramps for some. She will probably be able to maintain a nice conversation with small pauses while going about her business. The best thing to do is to go about what you had planned and focus on your last few hours or days as just a couple (or more!) It’s also important to note here that if she has had a cervix check done at the midwife or doctor’s office, it may not mean much. Some women are 4 centimeters for weeks before going into labor. My mother went from 0 centimeters to nearly having me in the hospital parking lot!!

Active Labor: What now!?

The next stage is active labor, this is when the cervix begins to open at a more rapid pace and your baby begins to make the journey into the pelvis. This is strong, amazing work, and she should be treated as it is by everyone in the room. Contractions become stronger, longer, and take on a regular pattern, happening every few minutes.

This is the time to encourage and support every single minute. Suggest that she relax her mouth and muscles while contracting, letting out deep sounds from her belly along with deep breaths to give oxygen to your baby (fun fact: the mouth, anus and vaginal muscles are all related! Relaxing and opening them helps labor progress effectively.

Physical support is critical during this time frame. You don’t have to be a licensed massage therapist to give her fantastic pain relief, just rub wherever you see her tensing up, especially the shoulder area. Alternate hot and cold cloths on her face and the back of her neck, this will help with her constant temperature changes.

Encourage changes in position, being on all fours, sitting and bouncing on a Pilates ball, and side lying on the bed are all great choices.  Avoid laying on the back as much as possible, contrary to popular belief, this can actually close the pelvis and make baby journey uphill.  Make sure you always have a water bottle handy, offering it to her constantly, even putting the straw right in her mouth. Snacks on hand will keep her energy up, but remember too that labor can be a time for puking. So choose foods that are high in protein, healthy fats and natural sugar while keeping in mind that it needs to be able to come back up as easy as it goes down.

When to make the call

By now, you may be wondering if it’s time to head into the hospital or call the midwife (for home birthing families.) While there is no right or wrong answer, short of actually seeing the baby coming out (CALL 911!) it’s a personal decision.

The general rule is 4-1-1: contractions that are 4 minute apart, lasting at least 1 minute, for 1 hour, but we all know that not everyone plays by those rules, babies included.  Some better signs to look for are emotional markers.  She may begin to enter a phase of self-doubt, you may hear the tell tale “I can’t do this!” mantra.  It’s common shortly before the quickest and most intense part of labor, transition; by the way, the appropriate response to this is always “You are doing it!”

She may be short on conversation and might be short with you, period. Don’t take this personally, it means that she is in the labor zone and conserving energy whenever she can. Physically, you may notice that she is starting to get closer to the ground and, sorry to say, but she may start farting. A lot. Your partner may also poop a bit. If you need to take a moment to giggle, let it all out now; we can almost guarantee that she is self-conscious about this. If she does do either, put down the air freshener. Most birthing women will poop on the table.  Pretend it didn’t happen, instead tell her how she’s getting so close to having her baby! She will thank you later. Isn’t it funny that in labor, rudeness and flatulence are encouraged? These are all great signs that point towards going in.

You will need to speak to you practitioner about the procedure for calling and arriving at labor and delivery before hand.

At the Hospital!

Once at the hospital, your support is a top priority! Quite a few first timers believe that their doctor, midwife or labor nurse will be there 24/7, but this is rarely the case. Nurses are the unsung heroes of the maternity ward (bring them cookies, seriously) and often take on a huge patient load to help many mamas birth. Your care provider usually comes in to “catch” your baby and maybe to discuss options with you once in awhile. There are exceptions, of course, but this is why it pays to be prepared (and hire a doula their expertise will help greatly…just saying!)

As she enters the transition phase, contractions will come very close together and she may look like she is in a totally different place. She may not be able to respond, so consider suggesting position changes, keep giving her water and food (depending on hospital policy) and through each contraction, remind her of how close she is. This is the most common time to ask for pain relief, usually while she is in the middle of a walloping contraction. Remind her that she is going to be holding her baby very, very soon and maybe suggest: “Let’s talk about an epidural in three more contractions,” so she can make a real, informed choice at a better time. Generally though, transition only lasts thirty minutes to an hour before pushing begins, it is both the hardest work and the most relieving as it means you are almost there!

All About Pushing

First timers always ask, “when will I know to push,” trust me you will know. She may start feeling as though she needs to use the toilet really badly. She may start making grunting or growling noises. If you haven’t already, this is the time to hit the “call nurse” button.

While each practice or hospital may have different policies on pushing, evidence shows that any position other than the back is best to let gravity do the work.  Yes, babies do come out! The pushing you see on TV, with the people shouting “ONE! TWO! THREE!” are only usually used in labors where mama has had a strong epidural and is no longer able to feel the need to push.  When she knows she has to, she rarely needs someone else to guide her.  The best encouragement is to remind her to follow her body, to push when it feels best for her.  

It’s Baby Time!

When your baby is crowning, you could ask for a mirror to hand to her if she’d like to see the action or encourage her to reach down and touch her baby. This may be too much for her, so say something like “wow, he/she has a lot of beautiful hair!” this will remind her of her ultimate payoff. Then, it’s baby time! Out comes a new, amazing little creature, covered in waxy vernix; encourage having the baby placed skin to skin on your partner’s chest. Now would be a great time to remind your care provider if your partner would like to keep the cord pumping precious blood to your baby while still attached and uncut, as well as a reminder if she has chosen not to receive Pitocin to deliver the placenta unless medically necessary. The placenta, thankfully, does not have bones and usually detaches and comes out by itself within a few minutes to half an hour, usually with just one push.

After this there’s not much else to say. Bask in your love for your partner as well as your new daughter or son. Go ahead and enjoy that oxytocin high; both of you have earned it. You only get one birth experience for each child, why not do everything you can and hire the best fitting doctor/midwife and doula support for your family? Do your research, find your voice and give your partner your all, for your baby—for your whole family.

Published in Birthing Assistance

3 things that the internet, books and movies cannot tell you about labor and birth.

  1. What does it feel like?
  2. How long it will take?
  3. What will happen?

We want to know in absolute detail because we need to prepare ourselves.

So we read books, attend courses, and use google extensively to research information around subjects of the signs of labor and the stages of labor. Surely, we will find the answers there? Well, yes, we find all the answers and more. However, at some stage we realize that all we really know is what it might feel like, how long it might take, and a deeper understanding of what might happen.

So we read birth stories and watch birth movies and every single one is different! How scary is that?

So is there anything that we know for sure about labor? YES THERE IS……

Every labor is unique, individual and variable.

Let me say that again, in case you did not get it the first time.

Every labor is unique, individual and variable.

In other words – we can tell you a whole lot of facts, but afterwards there is a good chance that you will look back and say “well that never happened to me. Did I miss something? ”

Like Josie who attended my birth preparation classes and called me after her baby was born to update me. “I never had early labor” she said, “it was just BAM, straight into active and 3 hours later he was born.”

Physiologically all the things that happen in early labor must happen in order for labor to progress. However, the way we experience them on a physical level is unique, individual and variable. In Josie’s case, she never experienced anything physical until she was in active labor- at which time she made her way to the hospital to find that she was already 7cm dilated. Her body had been making physiological changes for hours (possibly days) before that – without her being aware of it. She was so chilled and relaxed that she never took much notice of it and so labor progressed smoothly; and in her case pretty quickly.

The problem with learning the facts is that a lot of them focus on the physiological changes like the dilation of the cervix. Although these signs are important, they are measured by invasive procedures like vaginal examinations (these are usually done at the hospital by your midwife or doctor). Wouldn’t it be great if a sign board flashed up saying “Well done, you have just completed early labor and you are now entering the active phase? Sharp turns predicted for the next 8 hours. Expected time of arrival 16h45 “

Well yes, that would be helpful. Lovely in fact. But totally inaccurate. For instance if you were Josie, you missed the early labor sign board and active labor for her was 3 hours not 8. For Sarah, there were sharp turns for 8 hours which turned into a steep uphill battle and resulted in emergency evacuation.

So let’s take a look at what happens on a physiological level and some of the variables in each stage.

EARLY LABOUR

How long might it be?

8-12+ hours is the average of very mild, not much happening, is-this-really-it type sensations.

What is happening in your body? What physiological changes are happening that would cause the sensations you might feel?

Your cervix is soft, ripe, and yielding. You may (or may not) experience backache or period like cramps lasting anything from 15 - 45 seconds and usually at irregular intervals. You may notice that your belly hardens and feels tight during surges. Your cervix responds to the surges by starting to shorten and open. According to the stages of labor, dilation of up to 4 cm happens in “early labor” sometimes without you even noticing it.

What might you feel?

Confused - is this it? Or is it just more Braxton Hicks? You might feel a combination of excitement and fear (of the unknown).

What should you do?

If it is the middle of the night or early hours of the morning, roll over and go back to sleep – if you really cannot sleep through the surges then get up and distract yourself, go for a walk, watch TV or find something to do that takes your attention away from just waiting for the next surge to time it. As long as possible – ignore it until it is impossible not to. At that stage you should be nearing or possibly in active labor - which for some women is the longest or most intense phase of labor. Others find pushing and birth to be the most intense.

ACTIVE LABOR

How long could it be?

6-8+ hours is the average but it can be as little as 2 and as long 20 (sometimes more).

What is happening in your body? What physiological changes are happening that would cause the sensations you might feel?

Your cervix is probably soft and open to at least 4 cm, possibly more.  You might be feeling slight pressure over your pubic bone if your baby is low and well engaged. This is great as the pressure of the baby’s head over your cervix helps it to dilate.  Your uterus has established a good rhythm of regular surges that are doing the work of opening the cervix and nudging the baby down.

What might you feel?

By this stage you would normally be experiencing regular surges lasting at least 60 – 90 seconds and coming at regular intervals of at least every 5 minutes or less. You will find that you need to breathe through the surges to stay focused and talking during surges is hard and feels unnecessary. You become quieter and more serious, more inwardly focused – deep down you know that this is real labor. You might also be experiencing backache if your baby is in a position that exerts pressure over your sacrum.

What should you do?

If you are having a hospital birth, this would be a good time to go or at least be ready to leave, depending on how far the journey is and what road conditions are like. If you are at home, call your midwife and make sure you have everything ready. You might think about getting into your tub at some time during this stage.

Most important is to consciously relax using your breath - long, full, deep breathing through surges and easy breathing between surges. Remember that the spaces between the surges are every bit as important as the surges themselves – they are a time to rest and recover. Stay focused and present.

Use visualization techniques to “see” what is happening in your body while you “feel” it. Allow your instinctive brain to take over and let your body do what it knows how to do. Move your body, work with the sensations and use them as a feedback to know how to move and what positions feel good and “open.” Let go and surrender to the power of labor. Let go of how long it might take. Let go of what might happen and let what is happening happen. Be in your body. Connect with your baby.

If you are able to let go and let flow then active labor establishes a beautiful rhythm of strong surges that nudge the baby down and at the same time pulls the cervix up to its widest diameter. Once that happens you can follow those same instinctive urges to breathe or push your baby out into the world.

In order to allow labor to unfold in its own unique, individual, and variable way we need to trust:

  1. The process of labor
  2. Our bodies
  3. Our partner
  4. Our midwife/doula/doctor
  5. Our place of birth

We also need to let go of any ideas of what should happen and just allow whatever is happening to happen whilst understanding that the physiological changes are accompanied by changes in your behaviour, your attitude, your breathing, and your activity.

By listening, trusting, and responding to these changes you will instinctively know that things are moving along. You will know that it is time to call the midwife or get to the hospital.

 

Published in Birthing Assistance

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