At the end of our pregnancy we start thinking about labor and how we can have it be shorter or easier. You might ask yourself, "Do any of the internet tips work?" As a mom of 10 and a birth doula I can say, "Yes they do."
Tip #1 Start With A Healthy You
Your birth will go better if you make sure you are healthy physically, mentally, and emotionally. Take time during pregnancy to exercise or walk a mile every day. Plus, drink plenty of water. Do you have some past issue to work through? Then, go see a therapist so that you feel free and ready to birth. It might be that you want to discuss fears or it might be that you have bigger issues. All of these are good reasons to go find a good listening ear. Ready Nest Counseling is a great therapist group that is specifically trained to work with pregnant or postpartum woman. One other area people don't talk alot about is body balancing. This does not mean just being fit. You could be a very fit person, but still have an imbalance in the ligaments and muscles around the uterus. Consider seeing a chiropractor ( ICPA certified) or a pelvic floor specialist. They will help your skeletal and musculature system come into balance. Focusing on these areas will remove potential stumbling blocks on labor.
Tip #2 Eat 6 Dates A Day The Last Month Of Pregnancy
Several studies have been done in regards to eating dates and how they affected their labor. The studies showed that eating dates may increase cervical ripening and more likely to go into labor on your own and not need an induction. Another small study showed less postpartum blood loss from the group that ate dates. These all sound like positive effects of eating a few dates every day. Why not try it and see what is does for you.
Tip #3 Make a Birth Plan
A birth plan is not something set in stone that everyone has to follow. It is a simple communication tool to help your support people understand what you wish to happen labor. Keep it simple and one page length. Share your birth plan with your care provider and bring it with you to your birth. In a study of pregnant women they found that women who had a birth plan were almost twice as likely to avoid a C-section. I like those odds! It all comes from a simple act or writing my desires out. Try it for yourself.
Tip #4 Take a Childbirth Class
A study was done in California and found that women who had attended a childbirth class were 25% more likely to have a vaginal birth compared to those who did not take a class. You have so many options for taking a class today. You can choose in person or online. You can choose a general class like Lamaze or something more specific like Hypnobabies. Any of these will help you increase your chance of having a vaginal birth. Look into one and sign up today!
Tip #5 Stay home Until You Are In Active labor
In recent years, the definition of active labor has changed to reflect current research. Active labor begins around six cm. If you are not 6 cm yet, you are not in active labor and should go home. Be ready to do alot of laboring at home. Early labor can last 24 hours (plus start and stop for days before it continues to birth) or more and that is very normal. That is not to say that hard work requiring significant coping doesn’t happen prior to six cm, but everyone understands that for healthy low-risk pregnant people, interventions are more likely to be avoided if they are admitted once they reach active labor. Learn about use your relaxation/distraction skills. Watch a movie, go for a walk, take a bath, listen to music, clean the house, etc. Wait at home and go to the hospital when contractions are 4 min apart for two hours lasting 1 and ½ minute each. This allows you to be less stressed, move around or sleep as desired, and eat or drink as often as you want in the comfort of your own home. Will I deliver my baby at home or in the car if I wait? First time mom's labor last about 16 hours. You will have time labor at home and still get to the hospital.
Tip #6 Having Your Water Break Does Not Mean Run To The Hospital
Only about 10% of pregnant people have their water break prior to contractions or labor. This is called PROM which stands for premature rupture of membranes. Current best practice shows that the outcomes for both the pregnant parent and the newborn are the same (APGAR scores, cesarean rates, infection, etc) if families wait for 24 plus hours for labor (expectant management) or choose to get labor started with an induction shortly after the water breaks (active management). Waiting for your own labor to start is an option and most people will go into labor within 24-48 hours. ACOG is now encouraging families to receive information and have the choice of waiting or getting things going medically. The risk of infection starts 24 hour after something has been in the vagina (vaginal exam, sex, etc) not 24 hours after membranes have ruptured. You can also monitor yourself for signs of infection by taking your temperature every hour and watch to see if it rises. If it rises, then let your doctor know.
Tip #7 Every Hour PUSH And Move
While in labor moms should remember the acronym PUSH which stands for Position Urinate Snack Hydrate. This means a mom should drink something, go potty, eat something, and change position every hour. This will help keep her be more comfortable, keep her energy levels up, and give her body shifts to help with labor. In early labor mom will rest and stay calm. As contractions get closer together moms will need to use comfort skills and movement to deal with the contractions. Try belly dancing or slow dancing with a partner. Remember that being in an upright, forward, open labor position (UFO) knocks 82 minutes off your labor. Try to use your comfort measures to find a rhythm, ritual, and relaxation. Sometimes women feel like they can't control labor, but they want to. As you find a way to deal with every contraction (ritual) this you to feel in control of something during birth. Everything in nature has a natural rhythm. Birth is the same. Try to find your rhythm during labor and it will calm you. Maybe you tap the table, sway, or moan during the contractions. If you keep the pace slow and regular, it will help you be calm and manage the contractions. An irregular pace can be irritating and disrupting to the labor process. These principles work whether you are laboring at home or in the hospital.
Tip #8 Reducing Interventions Is Good
You have so many choices to make in pregnancy and birth. Become educated about your options. Every choice you make has consequences that are good and bad. You will have to decide what is best for your situation. Here are some examples. Choosing an I.V., heplock, or continual baby monitoring limits your movements and may cause you to feel uncomfortable which adds to your stress instead of calming you in labor. Choosing those things in labor means you just lost your freedom of movement in labor. Walking the halls and some labor positions are hard to get into with an I.V. Here’s another example. Choosing an epidural leads to needing an I.V., catheter, blood pressure cuff, pulse ox, and baby monitoring. All of these wires and the inability to move your legs majorly limits your positions and labor progress. Plus, choosing an epidural can lead to “epidural fever” and needing pitocin to speed up labor. You just increased your risk of needing a c-section. Researchers are now looking into if the relaxed uterine muscles due to an epidural cause the baby to get into a bad position therefore needing a c-section. If you want the best birth possible with the most options, ask your care provider or doula for other options before deciding. Use B.R.A.N.D. : Ask about the Benefits, Risks, Alternatives, Now/Not Now/Never, and Decision. What are the Benefits of what you suggested? What are the Risks of what you suggested? What are the Alternatives? Could we get results trying something else? What happens if we do it Now/Not Now/ Never? Can you give us a few minutes alone to decide? If they are talking to you, there is time for you to ask questions before deciding (even if you only take 2 minutes). This is your birth and your baby. Know your options and risk so you can choose what is best for your birth.
Tip #9 Intermittent Fetal Heart Rate Monitoring Is Appropriate For Low-risk Labors
Evidence has shown for years that continuous fetal monitoring for low-risk labors does not improve outcomes yet many people are not given the option of intermittent or occasional monitoring during their labors. ACOG recognizes that intermittent monitoring is appropriate for many people and should be offered. Discuss this option in advance of labor with your doctor or midwife. Continuous fetal monitoring for a low-risk labor can actually increase unnecessary interventions. With continuous monitoring, mom is asked to remain near or in the bed so the baby can be monitored and then she remains tethered to the monitoring responders and wires for 20 minutes or more every hour. This limits her movements and can possibly lead to needing an epidural or slowing labor down. Intermittent means that they monitor the baby every 4 hours or so. This gives the mom freedom to move around in labor to her comfort and to allow her labor to continue naturally.
Tip #10 Artificial rupture of membranes in labor is not necessary
ACOG now recognizes what research has demonstrated for years, that artificially breaking the water has little benefit to the labor and in fact may increase the risk of infection, cause a malpositioned baby, and possibly (in a very small number of births) create an emergency from a prolapsed cord or placental abruption. Membranes will release at the appropriate time and it is perfectly normal to labor with your bag or waters intact. It is not necessary to have your doctor or midwife break them. Current research and the new committee opinion supports this.
Tip #11 Drink and Eat In Labor
ACOG has stated that drinking during labor is preferable to IV hydration. Be prepared with lots of healthy beverages (coconut water, sports drinks, EmergenC, broths, juice) to consume during your labor. Bring along your water bottle to make drinking even easier. ACOG even alludes to the benefits of eating in labor, acknowledging that the risk of eating solid food in labor is almost non-existent and that in fact, eating can keep a person strong and energized. For low-risk labors that are not medicated, there is no reason to be receiving IV fluids. Evidence Based birth has a great article on the research. Food is restricted in labor due to anesthesiologists worrying that women could aspirate (throw up and breathe the food chunks into the lungs) in an emergency c-section. According to the research only 1 death occurred in 1.4 million births. That means your risk is very low of that happening to you. Being tired and worn down from not eating in labor actually increases your chance of need a c-section. Most hospitals will not give you food or drink in labor, so plan on bringing lots of snacks or sending your support team to get you food. Labor is a marathon. Keep your energy and strength up by eating in labor. Also, did you know that oxytocin makes you thirsty? During labor oxytocin is the hormone that drives contractions. Be prepared to feel thirsty and drink plenty of fluids in labor.
Tip #12 Don't Push On Your Back
In the movies when there is a birth scene the mom is always laying on her back in the bed. You are very familiar with this position and it gives the OB the best view. Have you every asked if this is a good position for mom and baby? Lamaze states that women should avoid giving birth on their back. You might ask why? Well they found that giving birth on your back is not the natural position women want to be in labor. Birthing on your back could decrease the fetal heart rate, lower oxygen supply to baby, increase the need for an episiotomy, and create more issues with how baby fits through the pelvis. There are a ton of other positions besides laying on your back to birth. Research them and try them at birth. What if you plan on getting an epidural? You still have many great options. A doula or nurse can help you get into productive positions that help your labor and birth progress. It might take a lot of work if the mom can't use her legs, but it will help the mom have a better birth to not be lying on her back, Side lying using a peanut ball is an excellent option for any mom.
Tip #13 Push Spontaneously With The Urge To Push
Research shows that people will spontaneously push to a count of six when left alone to do it on their own. So, why are we telling moms to hold their breath and push to a count of ten? Silly right? How do we know what is happening in her body? Mom's need to feel the urge and follow the instinct. Pushing with the urge to push for as long as feels good helps the baby to stay oxygenated. Try letting sound out during the push through vocalizations or noises. It can be very helpful. Did you know that being 10 cm dilated does not automatically mean that a person must start pushing? There is still more work that baby has to do once mom has reached 10 cm. The uterus is a strong, amazing muscle and can do lots of work to move the baby down and into the birth canal without much pushing effort on the part of the laboring person. This is called laboring down. Be patient and wait! It is normal to delay pushing until the baby moves down a bit lower and there is more of an urge to push. As the baby moves into the vagina, the urge to push will usually start to become more intense. That is a great time to start pushing! You might wonder how this is different in an epidural mom. In 2019 ACOG changed their recommendations for epidural moms and suggests that they start pushing as soon as they are fully dilated. The studies show that pushing as soon as they are dilated lowers the risk to mom and baby. With an epidural the mom might want a little more pushing guidance from her support team since she is numb and can not feel if her pushes are effective. Try asking for a mirror for mom to see how effective her pushes are or play tug of war with a rebozo. Both of these options can help the mom focus her pushing power.
Following these suggestions can help you to have the best birth possible and possibly avoid a c-section. Once you have a c-section, your options are severely limited for your next birth. It can be hard to find a care provider to support you for a VBAC (Vaginal Birth After Cesarean).