The Joy of This

One thing that is helpful is to bring your favorite music, fragrances and massage lotions with you to the hospital. They’ll help you make the transition from home to hospital, which often causes a mom’s labor to slow down. Labor stalls because of the adrenaline effect. We get excited that we are finally going to have our baby, this is really happening, we get nervous, we’re leaving our cozy environment at home to go to our place of birth and we have a surge of adrenaline. Adrenaline is known to slow labor. In the hospital, Terbutaline, which is a drug used to slow or stop labor, is almost identical to our body’s natural hormone, adrenaline.

Likewise, Pitocen, which is the drug used to increase the power of our contractions, is almost identical to our body’s natural hormone, oxytocin, which keeps our labor strong and active.  So, when you need to ward off your adrenaline … soothing music, familiar scents and low lighting help reduce its effects. However, keep in mind if your labor starts to slow down after too much calm music, switching up the music with a good, strong beat can also help get your labor energized again.  Also, it’s good to remember, if you’ve stalled out, use of your breast pump in labor helps to increase your contractions if they’re slowing down.  Nipple stimulation releases oxytocin.

What’s the best way to breathe in labor? 

There is no one right way to breathe in labor. In fact, there are many ways to approach your breathing. However, what we have found is having a rhythm in our breathing is a key to coping well. One type of coping tool that I have seen work with a lot of moms is called “breath awareness” basically that’s a fancy term for focusing on your outward breath through a contraction (like your life depends on it). I often tells moms to “push out the pain with your breath.”  Or “make your outward breath stronger than the contraction.” If you can manage to stay on top of the contraction through your breath you’ll do just fine.

Can you tell me more about rhythmic breathing?

I’ll count in rhythm with the laboring mother’s inhalations and exhalations through a contraction. We’ll count to four. This way all mom needs to focus on is getting to four. That means we’ve just broken up her contraction into smaller bites of four seconds. Usually, I’ll count very slowly like this, “One and two and three and four…” keeping my eye contact strong, my head the same level as hers, nodding my head in unison with her breathing. A lot of moms respond really well to this. I will also pat on her leg or arm through the contraction in rhythm with her inward and outward breath and or have her pound on something in rhythm with her breathing. For example, in my second labor with my son, I clung to my husband and swayed back and forth in rhythm with my breathing while pounding on his back a beat that matched the pace of my exhalations.

What’s the best thing do to with my body in labor?

Whatever makes you feel the most comfortable.  Your body will tell you how to move and what positions to get in. However, you want to remember is to keep your body soft throughout your contractions. Which means, lower your shoulders, keep your jaw loose and your legs limp, and if you’re standing keep your hips wide and rocking. An open, soft body, especially at the top of your body, somehow allows the bottom of your body to stay soft and can help your cervix open faster and baby to descend quickly.

What should I do in between contractions?

Drink sips of clear liquid and or take small bites of easily digestible food, like non-acidic fruit. Did you know that woman in labor should drink about 4 ounces of fluids an hour?  Also, be sure to empty your bladder if you have the need- an empty bladder will lessen the pain of the contraction and give more room for baby to descend when pushing. However, once you’re in heavy labor, often none of that sounds appealing, that’s when it’s good to avoid thinking about the next contraction or the last one. I encourage mothers to let their bodies go limp and sink right into the tub, bed, ball, partner’s arms, etc. I remind the mom to let go in between contractions, breathe out any remaining tension from the last contraction and simply focus on her baby. I encourage her to shut her eyes and slow her  breathing down. Now is the time to go inward. Deep breaths in through the nose and out of the mouth. This is when I tell moms to “breathe all the way down to your baby, let your breath bring strength and life to your baby.” Sometimes we forget that our baby is going through labor with us, so this helps us stay connected and purposeful in our labor.

What if I make loud noises in labor?

Vocalizing in labor is a wonderful tool for coping. If you make noise during labor, as most of us do, remember to let the noise be low and loose. Typically it is best to avoid high-pitched, tight sounds, as these normally can keep your body tense. (There is always the exception to the rule, though). A good goal is to keep your jaw as loose and soft as possible and allow the sound to come from lower part of your throat – almost as if you’ve swallowed a large apple and it’s sitting in the back of your mouth. If you are already vocal person, it’s likely that you will be vocal through your labor so, don’t be afraid to use this wonderful coping tool. Just remember a low sound doesn’t mean it has to be a quiet sound. I yelled in my labor with my son, I mean threw my head back and yelled out like an animal bellowing, but my sounds were low and almost primitive – roars. They were not distressed sounds. I think it helps practicing making low grumbling noises from the back of your throat to get an idea of how that sounds so you’re ready to go there in labor.

What about being relaxed in labor? Is that even possible?

Yes, relaxation is a place of the mind, and our minds have a great impact on our body during labor. When we keep our mind free from fear our body will follow suite. Sometimes, though, we need a little help getting our bodies to stay relaxed. That’s when I very gently and respectfully touch a mom’s cheek and remind her to “soften here” or I lovingly place my finger tip on her furrowed brow and say “release here” or I rest my hands on her shoulders and say, “loosen here.”  Those words make so much more sense in labor than “relax.” Saying, “Just relax!” can really can frustrate a woman when she’s laboring. I encourage moms to discuss with their support team ways that already help them remain in a calm, peaceful place. We have found that often the tools that  help us stay peaceful in everyday stressful situations are the same tools that we will use to cope in labor. Is it touch? Is it words? Is it music? What do you already use to cope with pain or stress in your life? Make sure that your partner knows what tools you like best.

What else can my partner do to help me?

It’s not rocket science, simply be present. That’s the key. Support people should stay away from the phone, TV or computer (unless asked otherwise). They should remain close and connected to the laboring woman. They should watch her and respond to what they believe she may need. A strong touch, a loving word, a calm presence, eye contact, a hand to squeeze, a back to pound, a quiet presence of love and safety. Also, don’t wait for a the laboring mother to ask for things like a drink, place a drink in front of her mouth with a straw, and suggest she take a sip if she wants to (in between contractions). Offer her chap-stick if she’s been breathing forcefully. Suggest position changes if she’s been in one longer than 30 minutes. Also remember, the less questions we ask the laboring mom, the better. The last thing a woman in serious labor wants is someone to ask her, “Do you want the apple juice or the ginger ale?” Or “Hey babe, do you want Michael Jackson or do you want Reba?” Don’t interfere with a woman’s concentration once she has gone inward, simply be there to watch and cover her sacred space.

Is there anything about the pain of labor that I should be aware of? 

Keep in mind that coping techniques never fully remove the pain – they simply help you cope with the pain. The truth is when we think there is a way around the pain of labor rather than through it, we set ourselves up for disappointment. Thinking that we can escape the pain by just doing something right in labor can leave us feeling defeated during labor, which is not what we want.

I’m scared that I can’t do it.

I actually prefer working with moms that are afraid that they won’t be able to manage the pain of childbirth rather than a woman who thinks that she’s got it in the bag already. What I sometimes see with the over-confident mom is that she tends to get upset and angry with herself quickly if she doesn’t think she’s coping well and this can cause her to be overwhelmed by the pain (which she didn’t imagine would be as big as it is). This distraction can cause the rhythm of labor to be lost. The mother that has a healthy respect for the reality of the pain of labor tends to dig a little deeper in search of ways to cope with labor before hand. She often has a better understanding and acceptance of herself if she freaks out and tends to reach out and seek help from others in labor faster and gives herself room for loosing it in labor.

What do if I decide I want an epidural?

It’s a good idea to have a code word in place that you can use if you truly get to the point where you are laboring where you are no longer coping with the pain, but you are suffering. Penny Simkin, the founder of DONA, says it best, “No one wants a woman to suffer during labor. On the other hand, no supportive person wants a woman to have pain medication that she had hoped to avoid. A previously agreed-upon “code word” provides a safety net for a woman who is highly motivated to have an un-medicated birth. She says her code word only when she feels that she cannot go on without medical pain relief. The code word frees the woman to complain, vocalize, cry, and even to ask for medications, but her support team knows to continue their pep talks and encourage her to continue, and suggest some other coping techniques. However, if she says her code word, her team quits all efforts to help her continue without pain medications and turns to helping her get them.

Why is a code word better than continuing to help her cope without medications when a woman (who had felt strongly about avoiding them) says she can’t go on, or vocalizes her pain loudly? It’s because some women cope better if they can express their pain than to have to act as if it doesn’t hurt. It also guides the team much more clearly than her behavior. As one woman said, “I shouted the pain down!” It’s really important for the nurse to know and understand the purpose of the code word, or she’ll feel the team is being cruel. If a supporter wonders if the woman forgot her code word, he or she can remind the woman, “You have a code word, you know.” One woman, when reminded, asked herself, “Am I suffering?” She decided she wasn’t, and went on to have a natural birth. Of course, a code word is unnecessary if the woman plans to use an epidural.” SOURCE

What things should be said to me in labor that will help me?

Well, that really depends on what you respond best to. However, I like to remind moms in labor that they are “stronger than this is hard.” I like to focus on what they’re accomplishing and how powerful their body is. And, when they are pushing, I prefer not to say “push harder” I like “push as strong as you are.” Sometimes little things like that can make a difference. During the pushing stage, your support person should remind you to keep your chin to your chest, gently supporting your head for you, reminding you to let your body make a “C” shape around you baby. This is when you should envision the power of your push taking the shape of a “J” down and out of your body. However, some of this may not apply if you are pushing on all fours and or squatting – which are wonderful positions to push in.  But I got a little distracted. Back to the question at hand, at some point you will likely say things like, “This hurts so bad.” That’s when it’s a good idea for your support team to respond with, “I know it does, labor is hard work, but you’re stronger than this is hard and you can do this.” Or when a mom says, “I can’t do this anymore.” I tell her, “But you are, we are watching you do it, and you’re doing beautifully.” I like to remind mom that the contractions are bringing her one step closer to holding her baby in her arms. Your support team should always appeal to your strength and not your weakness.

My mom/sister/friend wants to be with me while I labor/give birth.

Keep in mind that if your mom is going to be your support person in labor (or sister, etc) that sometimes it’s hard when we are emotionally involved with those who are laboring to see them go through the pain of labor and not get scared. When someone in the room get’s scared, the emotional atmosphere in the room changes, and the laboring mother responds to it poorly. It’s best to remember to have compassion towards the laboring mom, but not feel sorry for her or get scared by the intensity of her labor.

Also, this is not the time to have your friend in the room who has never seen a baby birthed naturally and wants to have a new experience to tweet about. Everyone who is present with you in the birth room should have a supporting role and or job to do (they would also do well to have seen some video clips of birth if they’ve never seen real birth before.) Your support team needs to be those who fully support your choices in labor. Your support people should have realistic expectations of what labor looks like and how long it can take. They are there to serve you. If they aren’t doing that, they do not need to be in the room with you. This is the time for you to be selfish and not distracted by those around you. Be very selective of who is present with you when you labor. Talk about this before hand with your family so that no one is surprised on labor day who is and who isn’t in the birth room with you.

What else can you recommend?

I like to tell moms and their support person to have a phrase that they can say to themselves or to the laboring mom to get through labor, like a mantra or a confession of faith. In both of my labors mine was, “My body is created to do this, I have nothing to fear.” Find something that works for you, words that inspire strength in your heart and mind. Sometimes you can write them down ahead of time and have your support person read them to you while you are in labor to give you a fresh perspective, or speak them over your body while you labor. Our words hold great power and connection to our bodies and what better time to use that power than in labor!

For other tips and suggestions on labor, please read these other topics I’ve written on:

How to Tell if it’s Labor and other Tips

Pushing and Beyond: Tips for the second stage of labor

The Birth of the Placenta: Tips for the third stage of labor