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Labor and Birth

Definitions
Contraction: is the wave-like squeezing motion of the uterus which moves the baby down the birth canal. They are measure from beginning of one contraction until the next starts. Dilation: is a process of the cervix opening to allow passage of the baby through the birth canal. Generally, early labor (the first stage) is considered 1-4 cm dilated (a pencil eraser to oreo); active labor is considered 4-7 cm; transition is 8-10 cm; fully dilated is 10 cm (a cheap roll of toilet paper). The more the babys head is applied to the cervix, the more it dilates. Effacement: is the thinning of the cervix where no effacement (0%) is a tight, bottle-neck, and 100% effacement means the cervix is paper thin and ready for labor. Station: this indicates where babys head is in relation to the ischial spines of the pelvis. (-3 is 3 cm above the spines, 0 is level with the spines, and +2 is 2 cm below the spines). The babys head is fully engaged starting at -1 station.

Stages of Labor
Before labor begins, make sure you are prepared to go to the birth center or your house is ready for home birth

Birth Center Necessities: Packed bag 2 changes of clothes for mom 2 sets of clothes for baby (newborn and 0-3 size) Car seat is installed Snacks, juice, Gatorade Rebozo, rice sock, essential oils, stones, candles

Home Birth Necessities: Plastic sheet under an old, fitted sheet Birthing tub/liner is clean and ready to be blown up Labor area is set up with candles, music, etc. Food and drinks are stocked Car seat is installed

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Labor and Birth

Stage One: Early and Active Labor

Early Labor Emotionally, you may experience excitement, happiness, relief, and slight apprehension, among other things. Physically, you will possibly (and probably) experience menstrual-like cramping (to begin with), diarrhea, backache Stay hydrated with lots of fluids and eat easily digestible foods (try to avoid spicy and acidic foods!) Practice the relaxation techniques with your partner: gentle massage, rebozo eye cover/neck massage, rebozo stress-release and firm pressure along the body Early in the day: o Go about your daily activity (as long as it isnt too strenuous) and try not to focus on the contractions and imminent birth o The upright position and walking will help engage the babys head with the cervix o For every up and moving hour, take an hour of rest Late in the day/evening: o REST! o Take a relaxing bath or shower o Try to sleep! Water breaks: your bag of waters is the amniotic fluid that surrounds baby, acts as a protective cushion and bacterial defense, and aids in the growth of baby. Water breaking is generally rare before the onset of labor (about 10% of women experience premature rupture of membranes, PROM). It is slightly sweet smelling and pale straw yellow in color. Your body replaces these waters every 3-4 hours. If water breaks, DO NOT INSERT ANYTHING in the vagina! Note the COAT: Color, Odor, Amount, Time and let your midwife know o Especially take note if the color is anything but pale yellow. Brown, green, and other dark colors should be discussed with your midwife immediately. A gush of fluid is the fore waters and indicates labor is imminent; a slow trickle is hind waters and sometimes will stop and reseal itself

Lose mucus plug: the mucus plug serves as a barrier between your cervix and the outside world; it is blood-tinged mucus.
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Labor and Birth You could lose the plug weeks to hours before labor, you may not even notice it.

Nesting: this is a real burst of energy that happens days before the onset of labor to get everything in order. DONT OVER DO IT! Flu-like symptoms: you may experience diarrhea, nausea, and mild cramps. This is generally your body flushing out our system in preparation of labor. Let your midwife know if you have any fever associated with these things as it could indicate an infection that needs to be monitored. Contractions: you need to know the difference between prodromal labor (prelabor) and true labor (this is early and active labor). Prodromal labor can be very tiring but it is preparing the body before dilation begins; the contraction process softens and thins the cervix. This could last for several weeks before actual labor kicks in. o Only a portion of your uterus tightens and you generally wont experience back pressure o Last between 15-45 seconds without increasing intensity or spacing o Usually irregular o Changing position/activity stops contractions o Rest and try to create a nighttime ritual that is calming and lowers your anxiety level. True labor is the process in which the baby is engaged in the pelvis, with the head pressing down on the cervix. o Contractions may begin as a warm, menstrual cramp-like sensation that migrates, tightening around the entire uterus and around the back o The duration and intensity of contractions increases progressively o Changing position/activity doesnt stop them o Walking may increase intensity

Active labor: Once contractions are every 5 minutes, give or take, this is the time to call your midwife and either go to the birth center or have her drive to you. Baby is rotating to fit the widest part of its head with the widest part of your hips Emotionally, you may experience apprehension and uncertainty, a desire for companionship and physical touch, increased seriousness Physically, you will likely experience strong contractions every 2-5 minutes that last about 60 seconds. They require focus and deep breathing.

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Labor and Birth Guidelines for Comfort Measures and the Partner: Continuously, but genuinely encourage the laboring women. Praise her for the hard work she is doing. If the comfort measure isnt working for her, stop immediately. The laboring woman should always feel secure and affirmed with your presence. Remind her that she is loved. Tell her she is beautiful. Watch her body languageif she is tense when you are touching her, perhaps the action is bothersome, hurts, and/or she wants you to stop. Be proactive with wiping her brow, offering a sip of water or juice, and giving encouragement. Comfort Measures: o Clear your head of anything that doesnt welcome your baby and keep you relaxed What is a peaceful/calming thought to you: _____________________________________________________________________________________________________ o Walk, relax in shower/tub, lean on/sway with your partner or birth ball, focus and repeat a mantra that is encouraging to you, visualize your body opening Is there a visualization that reminds you to be open to your baby? _____________________________________________________________________________________________________ o Keep your mouth and jaw loose; make horse-lips as you exhale o Hum/moan/groan/sing/growl/moo in the lowest note possible to keep your throat and belly open o Breathe deeply; Inhale, expanding your belly and back; dont lift your shoulders when inhaling Exhale, pushing air out slowly through your mouth and using your pelvic muscles to squeeze out all air

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Labor and Birth

Rebozo Comfort Measures: Hip squeeze: wrap the middle of the rebozo snugly below the belly, around hips, and cross at either the back or side. Gently and firmly pull, while making sure the mother is comfortable. It can be knotted to hold in place. o The partner can stand behind or beside her and gather/hold the loose ends o Woman may be seated in a chair and partner kneels or stands in front of her, holding the rebozo ends (dont knot it in front of the belly)

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Labor and Birth

Vibration/Apple shaking: the woman is in hands and knees position (hips should be directly over knees); the partner kneels behind her and drapes the rebozo across her lower back and upper buttocks; pulling tautly on the loose ends, the partner gently/firmly/quickly moves the fabric back and forth to vibrate the area. This can be done between or during contractions, if the woman likes it.

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Labor and Birth

Supported Squat: With the partner standing in front of or sitting in a chair across from the laboring woman, the middle of the rebozo is wrapped around her back and under her arms as the partner holds the two loose ends. The woman can hang from the rebozo while the partner supports her. This allows her to go limp and loose while opening up in a squatting position.

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Labor and Birth

Transition: Physically, you will likely experience nausea and vomiting, hot flashes and/or chills, severe lower backache, and strong rectal pressure. Emotionally, you will likely feel irritable, a desire to give up, and perhaps a sense of panic. Contractions are very strong at this point, can last 60-90 seconds and are about 1-3 minutes apart. The baby is making its final turn in the birth canal towards moms back.

Reminders for Transition: DO NOT PANIC Take one contraction at a time Visualize opening and releasing your body and vagina Breathe all the way down through your vagina Any noise you make should be low Keep mouth and jaw loose with horse lips

For Partners: Keep her mouth moist Wipe her face with a washcloth Apply counterpressure, either with your hands or using the rebozo Praise her hard work and tell her you love her Breathe with her If she is starting to panic, focus her! Tell her firmly to look at your eyes so you can bring her back to the present and keep her grounded

Stage Two: Pushing and Birth

Pushing: The cervix is fully dilated and effaced; the baby is fully engaged in the pelvis Generally, resting phase occurs between transition and pushing. Could be 20 minutes long Contractions are 3-5 minutes apart, lasting about 60-90 seconds You will likely have an irresistible urge to bear down, feels like an extreme need to poop You will have strong rectal pressure You will likely experience a pins and needles feeling as the crown of the head stretches the vagina You will need to rest between contractions Pushing Positions: Semi-sitting Side-lying Squatting www.sacredbloom.com www.facebook.com/sacredbloom

Labor and Birth

Hands and knees Sitting on a toilet or birthing stool

Exercises to Practice at Home/Work/in the Car: Inhaling and expanding your belly/back; exhaling out of your mouth and pushing all the way through to your vagina Sing/hum songs in a low key, practice keep your throat open Practice rebozo techniques with your partner Visualize a comforting scene or image and relax with it as you bath or shower Write down affirmations that you can use as mantras during labor

Stage Three: Placenta Delivery

The placenta is generally delivered 5-20 minutes after the birth of the baby You can gently push You make likely experience some contractions with the placenta delivery; can be stronger if this is your second baby (or more) Emotionally, you may experience joy, fatigue, relief Latching the baby to the breast helps the uterus to contract and deliver

Recommended Reading: Homebirth, Sheila Kitzinger Ina Mays Guide to Childbirth, Ina May Gaskin The Simple Guide to Having a Baby, Whalley, Simkin, Keppler

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