A Simple Guide

to the

Hard Parts of Birth

Lindsey A. VanAlstyne
MOTHERRISINGBIRTH.COM
A Simple Guide to the Hard Parts of Birth
COPYRIGHT 2018 | Lindsey A. VanAlstyne | Mother Rising
All Rights Reserved

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The publication of this information does not constitute the practice

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 Table of Contents
Can I Do It? 4
Labor 101: The Stages of Labor 5
Stage One, Part One: Early Labor 6
Signs of Early Labor 6
The Secret to Coping Through Early Labor 7
Stage One, Part Two: Active Labor 10
Signs of Active Labor Are When Contractions… 10
Cervical Dilation: Warning! 11
Coping through Active Labor 12
Common Questions About Active Labor 13
Stage One, Part Three: Transition 17
Signs of Transition Are When Contractions… 17
Coping Through Transition 18
Why Labor at Home? 25
How to Labor at Home 29
Stage Two: Pushing and Birth of the Baby 32
How Do You Know When to Push? 32
What If You Don’t Feel the Urge to Push? 33
How Long Will It Take to Push out My Baby? 34
Will I Poop in Front of Everybody? 35
How to Prevent Tearing 36
Rethink Squatting 36
Rethink Perineal Massage 38
You Can Do It! 43

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 Can I Do It?
Hi! My name is Lindsey and I am the childbirth educator and doula
behind Mother Rising. You likely found my website and this simple
guide because you’re asking yourself a common, yet really tough,
question:

can i do it ?
Maybe you’re pregnant right now and delivery is very soon. Or maybe
you’re just in the beginning stages of pregnancy, dipping your toe in
to see what exactly it is that you’ve gotten yourself into.

Or perhaps you’re not pregnant quite yet, but devouring every piece
of information you can to prepare for what’s to come.

Wherever you’re at in the motherhood journey: Welcome! I’m so glad

you’re here!

I hope that through this ebook you learn more about the hard parts of
birth, the stuff that nobody really wants to talk about. I hope you find
the courage to roll up your sleeves and dig in - birth is sometimes a
little bit messy!

Not only do I hope you learn more about the nitty gritty of birth, but I
encourage you to learn more about yourself too. Becoming a mother
is one of the most transformative journeys that you will ever make.
The mother you are becoming is not the same person you are today!

I’m so glad that you’ve allowed Mother Rising to be a part of your

journey, encouraging you every step of the way. Hold on, mama,
because the best is yet to come.

MOTHERRISINGBIRTH.COM
 Labor 101:
The Stages of Labor
Before we dive into the hard parts of birth, it’s important to get a bird’s eye
view of labor. Once we know what generally happens at birth and how
things progress, it’s easier to dive in and dissect the more complex pieces.

To do this, we will discuss the stages of labor. Labor and delivery are broken
down into three distinct stages.

Stage One is what we typically think of when we hear the word ‘labor.’ This
first stage is when a woman has contractions that dilate her cervix to 10cm
(give or take - it’s not like we have a ruler up there, you know?), preparing
her for the second stage, pushing.

Stage Two is pushing and birth of the baby.

Stage Three is the delivery of the placenta. (The placenta gets its own
stage. Cool, right?)

important note
When you’re in labor, what I’m explaining to you it won’t really matter.
You won’t be pondering what stage of labor you’re in. You won’t be
thinking about labor much, really. Instead, you will BE labor. You will be
so in your experience, and out of your thinking mind, that none of this
will be relevant anymore. However, it is helpful to learn this information
ahead of time (especially for birth partners) to give you a general idea of
what to expect, how to cope, and how to process things later.

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 Stage One, Part One:
Early Labor
You're nearing the end of pregnancy and you're not sure if you're finally in
labor. Trouble is, early labor symptoms are very similar to end of pregnancy
symptoms and therefore can be quite confusing and frustrating! Just
remember, hindsight is always 20/20. Sometimes we don’t know where
we’ve been until we look back. That's where all of this information comes in
handy, so I'll be more specific for you.

Signs of Early Labor

• Loose stools
• Contractions that don’t go away or space out after drinking
water, resting, and/or showering
• Contractions start FEELING different than Braxton Hicks (often
in early labor, contractions migrate to a different location)
• Contractions get stronger, longer, and closer together
• Early labor contractions are typically around 30 seconds long
• Contractions are more than 5-7 minutes apart and/or irregular,
such as every 5, then 7, then 4, then 10 minutes apart
• It is easy to keep walking and talking during contractions
• Bloody show or mucus plug
• Baby “dropping” or moving down lower in the pelvis
• Cervical dilation
• Water breaks

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 Stage One, Part One:
Early Labor
Now let me stop you right there.
Just because you have one or even a couple of the signs of early
labor above, it doesn’t mean that you’re in early labor. For example,
say you have a vaginal exam when you’re 39 weeks pregnant and
you find out you’re 5cm dilated, and the exam causes a bunch of
braxton hicks contractions. Does that mean you’re in early labor?
No. Does that mean you’re going to have your baby very soon? No.
Well, yes, obviously because you’re full-term, but not necessarily
right this second, and it might not even be today.
Always remember that your vagina is not a crystal ball.

Can Labor be Slowed

or Stopped?
If you’re still unsure of when to go to the hospital, try to see if you
can slow or stop your labor. If you can do that, you should definitely
stay home. A bath, shower, nap, or even a walk are excellent
activities that can slow or stop a labor that’s not quite the real deal.
However, if you find everything remains the same or becomes even
stronger, it might be time to head to the hospital/birth center, or to
call your homebirth midwife.

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Stage One, Part One:
Early Labor
The Secret to Coping
through Early Labor
• Carry on with your normal life - a watched pot never boils!
• TAKE A NAP!
• Go for a hike or a walk
• Walk the mall or other indoor air-conditioned facility if it’s too
hot/cold outside.
• Swim
• Hang out with family
• Bake a cake for baby’s birthday
• Work on the baby’s room
• Start a baby book
• Write in your pregnancy journal
• Finish thank you notes
• Pack a hospital bag for birth and postpartum
• Finalize child or pet care plans for during labor
• Eat and drink freely and often
• Grocery shop
• Watch a movie
• Take a picture of your beautiful pregnant belly!
• Use this ebook and MotherRisingBirth.com at your discretion

important note
Please, please, please DO NOT post on social media that you
think you are in labor. If it turns out you are NOT in labor, you will
wish you had never mentioned it at all!

MOTHERRISINGBIRTH.COM
Stage One, Part One:
Early Labor

my best advice ever ?

If you get one thing from reading this, let this be it. Especially if
you’re a first time mom, the pain of labor isn’t usually what moms
find most difficult - it’s the exhaustion.

Labor pain isn’t the whole reason as to why most mothers get an
epidural, it’s because they are exhausted.

If you do one thing on the coping methods list above, let it be

“take a nap.” If you wake in the middle of the night with
contractions, PLEASE try and go back to sleep. If you can’t sleep,
just be still in your bed in the dark. Don’t turn on lights, let your
body and mind rest. Don’t wake your partner, you both need
your rest. You have a lot of work ahead of you!

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Stage One, Part Two:
Active Labor
Just like early labor, active labor is part of the first stage of the birth
process. Active labor comes after early labor but before transition.

Signs of Active Labor are

When Contractions…
• Get longer, stronger, and closer together
• Are an average length of around 60 seconds
• Are around 3-5 minutes apart
• Are timeable and predictable
• Require intense focus and concentration
• Necessitate the use of pain coping practices, such as
breathing techniques, shower, tub, massage, etc.
• Don’t space out, fizzle out, or completely go away during a
shower/bath, after a glass of water, or rest

And when you're experiencing…

• A need to settle in to the birth space, wherever that may be
• Feeling emotional, unsure about what’s ahead, or wondering
“if I can do it”
• Bloody show (light pink spotting and/or mucusy discharge)
• Cervical dilation (Active labor is defined by contractions that
have caused the cervix to dilate to at least 6cm)
• Diarrhea and/or vomiting
• Feeling shaky, and hot and/or cold
• The amniotic sac or “water” breaks

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 Stage One, Part Two:
Active Labor
Cervical Dilation:
WARNING!
Just as all women and pregnancies are different it will take a different
amount of time for each woman to arrive at 6cm, the textbook definition
of active labor. You will spend most of your time getting to 6cm. Usually.
Take heart, however, because once you hit 6cm, things typically start to
go faster.

At this point, we need to interrupt this discussion about active labor to

discuss a very important idea:

birth is not linear

We do not simply walk from Point A to Point B to have a baby. Birth is a
journey into the unknown. We can’t control it. We can’t predict it. Birth is
a journey of surrender. Of letting go.

For example, say it took you 6 hours to get to 6cm. Logically, you might
think that therefore it’ll take you 4 more hours to get to 10 cm, the
pushing stage.
STOP! Birth math does not exist! Any sort of calculating or future
predictions about birth are pointless and a waste of time.

Coping through this kind of journey can be quite frustrating, especially

for those wanting to plan and be in control of everything (I do this, too!!).
To have the best birth experience, no matter what happens, it’s
important to be present in THIS moment, instead of constantly looking
ahead.

MOTHERRISINGBIRTH.COM
 Stage One, Part Two:
Active Labor
Coping through Active Labor
One of the most simple ways of being present in birth (and in life) is by
noticing the breath – not changing it – but simply bringing the
awareness to the moment. I call this breath awareness.

Now that we know what NOT to do (try to control, plan, and predict
labor), let’s talk about how to cope through active labor. Talking about
coping techniques for active labor is the point in my childbirth class
where parents start to ask really good questions.

There are many ways to cope through active labor and it is very
important to stay in the present moment. Here are some ideas to get you
started:
• Massage
• Counter Pressure
• Tub and/or Shower
• Birth Ball
• Walking
• Swaying
• Squatting
• Resting
• Moaning
• Humming
• Singing
• Rocking
• Aromatherapy
• Birth Affirmations
• Sitting on the Toilet
• Eating and Drinking Freely
• Music

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 Stage One, Part Two:
Active Labor
Common Questions about
Active Labor
How long is labor for a first time mom?
Labor will vary from person to person. An average length of labor for a first
time mom is around 15-17 hours. However, many first time moms will have
labors much quicker or longer than that. Therefore, the answer to this
question matters little. Remember, #birthisnotlinear!

How do I time contractions?

Contractions are measured from the start of one to the start of the next. In a
nutshell, you simply calculate the minutes between the start of one
contraction to the start of the next and that tells you the length between
contractions.

Many laboring women have had success with taking note of how long the
contractions are, as that is a helpful indicator of the progression of labor. In
early labor, contractions average around 30 seconds. During active labor,
they increase in length to around 60 seconds. During transition, they may
be even longer at 90 seconds.

It's pretty popular with new parents-to-be to time contractions with a

contraction app, such as “Contraction Master,” as it makes timing
contractions simple and gives you one less thing to think about.

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 Stage One, Part Two:
Active Labor
Common Questions about
Active Labor
(continued)

You might find it helpful to time a few contractions every hour or when you
notice something has changed. If you’re really not sure, give yourself some
more time and see if the current pattern continues for an hour. If things are
progressing, remaining intense, and not going away for an hour, you might
want to head to the hospital!

For example, a mom might plan to time a few contractions once every hour
from 8-10am because she thinks she’s in labor, however, at 9:30 things
seem to have picked up so she times the contractions for a full 30 minutes.
Her contractions are now 3-4 minutes apart so she decides to go to the
hospital. She stops timing contractions once she makes the decision and
hops in the car.

important note
Please do not get caught up in the timing of contractions.
Because birth is not linear, it can be quite exciting to find
something to chart and obsess over. Many parents find
themselves timing contractions for hours upon hours.

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 Stage One, Part Two:
Active Labor
Common Questions about
Active Labor
(continued)

At what point should you go to the hospital or birth center?

Many women prefer to arrive at the hospital while they are still in active
labor but getting close to transition. I talk more about laboring at home later
in this guide.

A good rule of thumb is 411: When your contractions are 4 minutes apart,
lasting 1 minute each, and this has been going on for an hour, you might
want to start thinking about heading to your birth space.

However, as a doula, I look at much more than just the timing of

contractions. I pay attention to the laboring mom – her emotions, how she’s
moving her body, and how she’s interacting with her birth team. Some
signs I look for:
• If she is chit-chatting between contractions, in a great mood and
coping easily, she might want to labor at home longer.
• If she is moving slowly and contractions are close together, she
might want to consider going to the hospital.
• If she is having trouble answering questions because her
contractions are close together or because all her energy is
focused on coping with contractions, maybe it’s time to talk about
heading in.

You have probably heard, “You’ll just know.” Well, it happens! A few times
in my doula career, I have been heading to a client’s home to help them
decide if they wanted to head in, but while still on the road they've called
again to say they decided to go in because it became obvious that it was
time to go. They “just knew.” Sometimes, you just know. If you’re having a
gut feeling that it’s time to go, then listen to that voice! Go! Have a baby!

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 Stage One, Part Two:
Active Labor
Common Questions about
Active Labor
(continued)

If you're giving birth at home, when should your midwife to join you?
The advice above can be followed in any sort of birth, including a
homebirth. Instead of leaving to go to the hospital, that would be the time
to call your midwife to your home.

When will my water break?

Your water can break before labor, during labor, or during pushing. Your
water might not even break - a baby can be born in an intact amniotic sac!
This is quite rare, though. In my experience as a doula, the water typically
breaks during transition or pushing.

What should I do when my water breaks?

Over the years, my answer to this question has changed quite a bit. The
best response I can come up with to answer this question is to follow your
care provider’s advice. Many care providers wish you to “come in right
away” when your amniotic sac ruptures. Some care providers want you to
“come in within a couple hours.”

Every birth, every mom, every care provider is different. Have a

conversation with your care provider during a prenatal appointment to see
what they recommended for you and your baby.

MOTHERRISINGBIRTH.COM
 Stage One, Part Three:
Transition
The transition phase of labor is the shortest but most intense portion of
labor. Transition got its name because it is the part of labor where women
transition from Stage 1 to Stage 2. (Do you remember what Stage 2 is?
Pushing!) If you are experiencing these things, coupled with the signs
listed above, it’s likely you're experiencing transition!

Signs of Transition Are When

Contractions…
• Are long, lasting around 90 seconds
• Get closer together, around 2-3 minutes apart
• Sometimes “double peak” (peak and then peak again)
• Are so long, strong, and close together, it feels like you’re
not getting a break.
• Increase when changing positions
• And are therefore more afraid to change positions

And when you're experiencing…

• Nausea or vomiting
• Crying
• Hot and sweaty, AND/OR cold and shaky
• Can’t find a comfortable position
• Looking for a way out
• Water breaking
• Discouragement and/or giving up
• Irrational thoughts and behavior
• Asking for pain medication

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 Stage One, Part Three:
Transition
Coping through Transition
Having an unmedicated childbirth is totally possible. You can do it!
However, many women receive epidurals during the transition phase of
labor because they can’t cope and/or their birth team is unable to help
them cope. The following are some amazing ideas to help you through
this intense portion of labor:

Change Positions
Change positions often. Paradoxically, this is one of the best pieces of
advice for transition AND also probably the toughest piece of advice to
follow. The thing is, during labor when you get in a position that is working
for you, or even if its not, it can be hard to change positions. Moving can
cause contractions and at that point you will be wanting them to go away,
or at least to be less intense, so your brain may tell you that not moving
would make the contractions better. However, in order to end the
contractions, labor ultimately needs to crank up, get more intense so that
you can push your baby out.
By changing positions, you might find a more comfortable position and it
also might speed up your labor – which is what we want, right?

pro tip
If you change positions and it feels AWFUL, try it for three more
contractions. If after three contractions it still isn’t working, try something
new. Sometimes, however, after three contractions you will find that it is
actually working for you. That first contraction after a position change can
be hard to cope through.

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 Stage One, Part Three:
Transition
Coping through Transition
(continued)
Here are some positions to try during the transition phase of labor for a
faster, more comfortable birth:
• Sitting on the bed, toilet, or birth ball
• Leaning into a partner, birth ball, bed, table, or wall
• Shower
• Bath
• Squatting

be brave!
At some point, women have to accept labor, that things aren’t going to go
away, and bravely embrace the sensations of birth because those are what
will bring baby and the end. Labor is such a mindtrip.

Here’s a rough idea of how I felt during my second birth, a homebirth:

Oh. My. Gosh. I was in so much pain. My contractions weren’t stopping.
They would double peak. I cried out for somebody to help me get up/save
me/whatever because I was in so much distress.

After that contraction was over, I did a little internal self-talk. “Lindsey, you
need to be brave. You need to get up and move.” And so I got up. And I
was brave. My baby was born not too long after that.

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 Stage One, Part Three:
Transition
Coping through Transition
(continued)

be encouraged!
A common signpost of being in transition is feeling like you can’t do it. You
might say… “I can’t do it.” Or, “If I have to do this for another minute, there’s
no way I can do this.” (Remember, birth math doesn’t exist!) “Someone
help me!” Or the more-common-than-you'd-think, “I need an epidural. No
really, someone get me an epidural.”

You know what? When my doula clients start saying these things I know
we are getting close to pushing AND that I need to increase my support
and encouragement. Encouragement during the transition phase of labor
is VITAL. If a woman does not have a team of support to rely on, she will
often turn to medication. This does not have to be!

The following are some suggestions for encouragement during that last
bit of intense labor:

• “You get to meet your baby soon”

• “Feeling this way means you’re progressing”
• “You’re getting closer to your baby”
• Using Penny Simkin’s “Take Charge Routine“
• Reminders that what she’s feeling is normal.

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 Stage One, Part Three:
Transition
Coping through Transition
(continued)
During transition, you may feel that something isn’t right. It seems like
things are hurting far worse than they should, or that you aren’t
progressing quickly enough. The cost is far outweighing the perceived
benefit. Reminders and encouragement are so helpful.

Personally, when I’m in labor I find it helpful for people to remind me that
things are progressing normally (because in fact things aren’t going
slowly). When you’re in labor it is hard to have an accurate sense of time.

Maintain Focus
During active labor, a mom might be more tolerant of external distractions
like bright lights, talking, the tv, and extra guests. However, during the
transition phase of labor things get more intense. Everything ramps up
which requires a whole other level of focus.

Unfortunately, instead of enforcing privacy and creating a birth space

conducive to focus, many women request epidurals to accommodate their
surroundings instead of requesting the surroundings to accommodate her.

mama!  this is your day!

Of all your days here on earth, this is your day to tell others how you want
things to go. Better yet, have your doula or “birth bouncer” (your partner,
nurse, etc.) enforce privacy for you.

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Stage One, Part Three:
Transition
Coping through Transition
(continued)

Stay Hydrated
Another important part of coping through the transition phase of labor is
to be hydrated. Staying hydrated during the transition phase of labor is
important especially if mom is vomiting. Dehydration is the enemy!

By staying hydrated you will help keep yourself and baby healthy, give
yourself energy and shorten your labor time. STAY HYDRATED!

My simple method of staying hydrated is by offering mom sips of ice water

using a bendy straw. To keep energized, diluted juices and electrolyte
drinks can also be used. Chewing on crushed ice is amazing between
contractions. I love using electrolyte cubes for labor!

Stop Complaining
It is really easy to complain during labor, especially transition. However, I
found relief when I chose to switch gears and stop complaining. Frankly,
nothing was helping anymore and once I decided there was nothing to be
done, I stopped whining about it. And instead of complaining and
whining, I focused my energy on to other things.

With my second birth I decided to get up and move. With my third birth I
decided to start squatting. By changing my tune I eased my suffering,
became more productive in labor and helped myself to progress. Who
knew, right?

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 Stage One, Part Three:
Transition
Coping through Transition
(continued)

Try Something New

If you don’t know what to do to cope during transition, try something
completely new and possibly a bit scary. It worked for me!

During my third birth, a pitocin augmentation, I vocalized a lot. However,

I got to a point where I wanted to crawl out of my skin – nothing was
working anymore. My doula’s touch irritated me, my vocalizing was not
helping things, and I was at a loss. I became "That Lady" in labor. I’m cold…
so they put a blanket on me. I’m hot, get it off! Push on my back! No, stop!

And so, I decided to try something new.

Trying something new was scary, however, but it actually turned out to be
helpful. I decided that I needed a different approach and that I was not
coping well. I had the courage to change things up when nothing was
working anymore. So, I sat on the hospital bed and stopped vocalizing.
This was my big Aha! moment during my Pitocin experience.

Now, to the outside observer, it probably looked like I was feeling pretty
good, but it was still terrible. It didn’t get better, the contractions were still
hell. However, after doing a few contractions like this I felt a little bit less
out of control. My contractions spaced out the tiniest bit and I got to doze
between contractions.

MOTHERRISINGBIRTH.COM
 Stage One, Part Three:
Transition
Coping through Transition
(continued)

Let. It. Go.

My final piece of advice for coping through the transition phase of labor is
to let go. Channel your inner Elsa and just LET IT GO.

As a doula observing births and as a mom experiencing labor, I have found

that once we decide to stop fighting labor, but embrace and work with it,
our bodies relax and things progress. Let it happen. Let your body open.
Let your baby come down.

Ladies, YOU CAN DO THIS! Don’t let anybody tell you that transition is too
difficult to deal with without an epidural. (Sure, epidurals can be used
wisely and compassionately. Epidurals absolutely have their place… But
that’s a conversation for another time.)

You can absolutely, positively have a natural birth! You can make it
through transition without an epidural. By using the tips, tricks and
strategies above you will be well on your way to rocking an unmedicated
birth.

MOTHERRISINGBIRTH.COM
 Why Labor at Home?
Many women in my childbirth classes and those that hire me for doula
support often ask for tips on how to labor at home as long as possible. In
fact, one of the big reasons to hire a doula or take a childbirth class is to
facilitate laboring at home for the majority of their labor and arriving at the
hospital for transition and pushing. Before we get into the nitty gritty on
how to labor at home as long as possible, let’s discuss why laboring at
home is an option many pregnant women desire.

Encourage Oxytocin
One reason some women labor at home as long as possible is to keep their
labor as straightforward, smooth and short as possible. Hormonally
speaking, the further a woman is in her birth experience, the harder it is to
disrupt the flow of oxytocin (which causes contractions) and therefore her
labor pattern.

According to the hormonal blueprint of labor, if a woman heads to the

hospital in early or even sometimes in active labor, things might fizzle out.
Her contractions may stop and she’ll be sent home, frustrated and
exhausted. However, if a woman experiences long, hard contractions that
are close together before going to the hospital, odds are that the act of
leaving home, getting into the car and showing up at the hospital won’t
affect her labor or disrupt the release of oxytocin.

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 Why Labor at Home?
Less Pitocin
From what I've seen, women who labor at home for the majority of their
birth experience and “show up at the hospital and push a baby out” are
WAY less likely to need pitocin to augment or strengthen their labor.
Frankly, the labors of the women who do most of their work at home, are
strong and impossible to stop! By laboring at home and getting into a
good labor pattern before going to the hospital, pitocin is less likely a
possibility.

Unmedicated Birth
In my experience, women who labor at home as long as possible are WAY
less likely to need drugs or an epidural to get them through the rest of their
labor. Often, there’s just no time to get an epidural because things are
moving quickly once she arrives. Other times, she’s learned to cope
through her contractions while at home and continues coping just as well
even when she is admitted to the hospital. She’s got this!

Pain Coping
Many women who labor at home as long as possible do so because it is
easier for them to cope through their labor pains in the comfort of their
own homes. These women were more comfortable and less fearful at
home and therefore better able to cope through their intense contractions.

MOTHERRISINGBIRTH.COM
 Why Labor at Home?

Planning a VBAC
Another reason to labor at home as long as possible before heading to the
hospital is when attempting a VBAC (vaginal birth after cesarean). This
may seem like odd advice, however, even my local hospital midwives tell
their patients that “their best bet for a successful VBAC is to show up at 39
weeks ready to push.”

VBAC patients are monitored more closely and therefore have more
opportunity for interventions, which unfortunately increases the possibility
of other complications (this is called the cascade of interventions).

For example, many care providers require constant internal fetal

monitoring during a VBAC. Sounds reasonable, right? Well… with internal
monitoring comes breaking the amniotic sac and laboring in/near the bed.
By doing these two interventions, there is an increased risk of infection,
and increasing the likelihood of an epidural due to limiting options for pain
coping by limiting movement.

Therefore, under the thoughtful guidance of a trusted care provider,

laboring at home as long as possible may be a key component to
achieving your VBAC.

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 Why Labor at Home?

...which leads me to my next point

It’s okay to go to the hospital. If you need to go to the hospital, you should
go. If something isn’t feeling right, you should go. It’s okay to utilize your
support team and care provider. If you need medical advice, call your care
provider or a nurse.

If you are laboring at home as long as possible because you are fearful of
the hospital and/or staff, you are laboring at home for the wrong reasons.
Making decisions based on love – for yourself and your baby – instead of
fear, is the way to go.

If you don’t feel safe, comfortable, or do not trust your care provider or
hospital, choose a new one! It’s never too late to switch care providers!

If you need to brush up on how to talk with your care provider and make
decisions, check out this post!

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 How to Labor at Home
If you are hoping to labor at home as long as possible before heading to
the hospital, odds are your goal is to arrive at the hospital while in
transition, or right before transition. How can you prepare yourself for this?

Take a Good Childbirth Class

The foundation to laboring at home as long as possible is quality childbirth
education. If a laboring mom is ignorant of her body, pain coping, the labor
process, etc., how in the world is she going to navigate labor at home?
After completing a good childbirth class series you should have a solid
understanding of how labor progresses, how to cope and options in
childbirth.

Hire a Doula
The next layer to successfully laboring at home as long as possible before
heading to the hospital is to hire a doula. A doula has witnessed many
labors and is an invaluable asset when determining when to head to the
hospital. If I have a doula client that is unsure about whether to go to the
hospital or not sometimes I’ll just head on over to their home to check
things out myself. Usually in less than five minutes I will know if it’s time to
go or not. A doula is so helpful in this situation!

Be Prepared
Another way to successfully labor at home as long as possible is to be
100% ready to go at a moment’s notice. When laboring at home, parents
should not be packing a hospital bag - it should already be done. Phone
chargers, wallets, pillows, a towel to sit on, etc., should be in the car ready
to go, while mom is laboring inside at home. If the decision to go to the
hospital is made, everyone should be able to get in the car and go in just a
couple of minutes.

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 How to Labor at Home

Monitor Mama’s Mood

Even then, there are more things to take into consideration when the goal
is to labor at home as long as possible.

Sometimes, even when contractions are a solid 3-4 minutes apart, it might
not be time to head into the hospital. One way to know what to do is to
observe mom’s mood BETWEEN contractions. Normally, during a solid
active labor contraction a mom works hard at coping, breathing, etc., but
between contractions she’s in a good mood, talkative and generally her
normal self. However, when a laboring mom’s mood BETWEEN
contractions changes, that’s when I start paying attention.

It's probably time to head to the hospital/birth center or call the

midwife when the following start happening BETWEEN contractions,
especially if contractions are getting closer together:

• She closes her eyes and goes within

• Stops chatting with family, friends, or the birth team
• Annoyed at the chatter of birth companions
• Becomes irritable, agitated, and easily annoyed

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 How to Labor at Home

Slowing Down
Another thing to notice when determining when to go to the hospital is
how fast or slow the laboring mom is moving. In my experience, as a
woman progresses through labor she moves increasingly slower. If it takes
her forever to get out of the bed, get dressed, head downstairs, and climb
into the car, that’s a great sign.

If you are in labor but are able to continue texting and staying connected
via social media, it’s probably not time to head to the hospital. As lame as it
may sound, at my births… especially my second, I had considered posting
updates on social media via my phone. However, once things picked up
and got intense, I honestly did not have the ability and/or brain power to
stay connected. My phone was abandoned and I focused on my one task:

have a baby!

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 Stage Two:
Pushing and Birth
In my childbirth classes, on the night we talk about the pushing phase,
these common questions come up almost every single time.

How Do I Know When to Push?

There are a few answers to this question. The easiest answer is that you
push when your body just does it. I know that’s not too helpful for those
who have never pushed out a baby before, but pushing can be compared
to a sneeze or vomiting reflex. Pushing is an involuntary reflex. It can
actually be hard to NOT push, when your body is pushing. If you are
feeling the urge to push, it is likely time to push.

Often at this point a woman may agree to a cervical exam to ensure she is
fully dilated to 10cm. If she isn’t 10cm, she may be asked to pant, blow,
and/or change positions to push less or possibly stop pushing, which is
nearly impossible.

On the other hand, if a woman has an epidural, she will most likely not feel
the urge to push. In this case, she will know when to push when her nurse,
midwife or doctor says so. However, even with an epidural, many women
know that something has changed when they begin to feel a ton of
pressure in their pelvis, bottom, crotch, vagina, butt… whatever you want to
call it.

A lot of times with an epidural, mom will “labor down” before beginning
the pushing stage. Basically, this means they are giving the baby time to
come down on its own. Since it usually takes a lot longer to push out your
baby with an epidural, “laboring down” helps your body do some of the
early work so you don’t have to.

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 Stage Two:
Pushing and Birth
What if I Don’t Feel the Urge to Push?
If you have had a vaginal exam and are 10cm, but don’t feel like pushing or
bearing down, what’s a gal to do? If something isn’t working, try
something new! One of the first things to try to bring on the urge to push is
to change positions. If you have been lying down, try:
• standing up
• squatting
• getting into the tub
• walking
• hula-hooping
• lunges
You could also try sitting on a birthing ball. The pressure from the ball
could make that urge to push happen quite quickly!

If after trying some position changes and you still feel no urge to push, you
could just do nothing. If you and the baby are fine, you could rest before
the big finale. I mean, not feeling the urge to push is in and of itself not a
problem or emergency.

If you are over it and ready to see your baby, try bearing down a little and
see how that feels. Sometimes women don’t feel an overwhelming urge to
push and bearing down a little during contractions help. This tiny push
may spur on the urge to push and you will be well on your way to baby.
(Someone who was in one of my classes said that with her last baby she
never felt the urge to push, but she decided to push anyways and her
baby practically fell out. lol!)

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 Stage Two:
Pushing and Birth
How Long will it Take to
Push Out My Baby?
Honestly, there is such a wide variation of "normal" in the lengths of time a
person spends in the pushing stage. For a first time mom, pushing may
take around 1.5–2 hours. However, there will be women who give birth
faster or slower than the average.

But if a first time mom has an epidural, the range of normal is even longer.
She could be pushing for 4-5 hours (or even more). On the other hand, it’s
not unheard of for a first time mom to push their babies out in 30
minutes or less. All that to say: your guess is as good as mine! To speed up
the pushing process, try an upright position and make sure you’re off your
back!

For my first baby, I had to push with everything I had! I was a bit surprised
at how much work it was. It took me 2.5 hours with my first. With my
second and third, however, I pushed them out in a matter of minutes. It
was shockingly different. They came so quickly!

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 Stage Two:
Pushing and Birth
Will I Poop in Front of Everybody?
Possibly. If you have ever looked at the anatomy of a pregnant woman,
you can see that to push your baby out, your baby’s head will be pushing
EVERYTHING that’s there out.

But get this: when I see poop during the pushing phase at birth, I get
excited because I know she is pushing correctly and making great
progress! To birth professionals, pooping during pushing a no big deal
type of thing (and even celebrated!), but to a pregnant mom this might be
giving you nightmares. In my experience, care providers wipe it away
before most people notice, including the birthing woman. And certainly no
mention of it is made later.

But, let’s talk more about pooping. What would this mean to you if that
happened? What would you tell yourself about yourself if you pooped
during pushing? Think about that for a moment.

What would your I AM statement be if you pooped when you pushed out
your baby? Now, take another moment and think about if that I am
statement is serving you. No?

Ok, then what would you like to tell yourself about yourself if you were
working really hard, pushing with all you had, bringing your baby down
and you pooped? Look at this potential situation with new eyes, eyes of
love and acceptance.

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
This common topic is worthy of it’s very own section because there are so
many factors that go into the pushing stage and so many possible causes
of tearing while pushing. The following are things to consider in order to
reduce the chance of tearing at birth.

Rethink Squatting
The first thing we need to talk about is squatting. When in the squatting
position, compared to being flat on the back, a woman’s pelvis will open
20-30% larger than it would otherwise. A greater outlet should make for an
easier birth. So of course, we should squat and push our babies out just
like in this video, right? Eh, maybe not.

Shocking fact: Squatting to push INCREASES tearing.

You see, according to this study (and many of the midwives I know),
pushing in the squatting position greatly increases the chance of tearing.
Squatting, using birth stools or even squatting with a squat bar, all lead to
more genital tract damage. Nobody talks about this! And many sources on
the internet will even say to squat during pushing to avoid tearing.

In a nutshell, if you are a typical sedentary civilized woman, you probably

should rethink squatting during pushing. Unless you’re like the 1970s
native Brazilian women in this video who SQUAT TO REST, your body
likely can’t handle squatting during birth. However, if you’re up to the
challenge, visit Katy Bowman and teach your body to squat. (Because I
bet you don’t know squat.)

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
(continued)

Consider Other Positions

Side-Lying, kneeling, and hands and knees are all lateral positions
associated with a reduced risk of perineal damage.

Midwife Thinking says, “I have noticed that when women are left to birth
instinctively they will often move from a squatting position – if they got into
one – into a hands-knees position just before the head crowns.”

(That’s exactly what I did for my births. At some point in all my labors I
squatted but Gabriel was born in the side-lying position, Eden was born in
the kneeling position, and Mercy was hands and knees.

So if you really want to squat in labor, go for it, maybe just move to hands
and knees before crowning.

important note
Talk to your care provider about the typical positions used during labors they
attend. In a hospital setting, you might find yourself in an uphill battle with
nurses and OBs to push in any position besides laying flat on your back, despite
research supporting mobility during the pushing stage. If you find yourself in
this position (no pun intended!), remember your B.R.A.I.N. and be your own
advocate for your needs during this important day!

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
(continued)

Rethink Perineal Massage

Have you ever heard about prenatal perineal massage? You know,
“massaging” the vulva, vagina, and perineum during pregnancy to pre-
stretch the perineum before birth?

Evidence shows that perineal massage during pregnancy will help a

first time mom decrease the chance of receiving an episiotomy. So, if you
think you’re at risk of receiving an episiotomy (however, from my
experience this is based mainly on who your care provider is) perineal
massage might help you there.

To be honest, I’m not sure how the one helps the other. Maybe the moms
who educated themselves on protecting the perineum were more active in
their pregnancies and the birth process leading to less episiotomies?
I don’t know…
Curious about how to do prenatal perineal massage? Here’s a great
tutorial. And remember, it’s not really a massage.

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
Rethink Perineal Massage
(continued)
Here’s what happens with perineal massage during the pushing stage…
The doctor/midwife/nurse sits at the bottom of the hospital bed on their
stool, all gowned up with gloves on, then they put their outstretched and
open hand towards the nurse. The nurse then squirts lubricating jelly on
their fingers and then go to town with a lot of “perineal massage.” They
take two lubricated fingers, place them in the vagina and push down and
to the sides over and over again. It looks so uncomfortable, almost painful.
If not painful, then by golly it’s gotta be totally distracting! Sometimes
these moms would have 30-60 minutes of this! Eventually, many women's
vulvas begin to swell due to this procedure. When watching this, I just
want to scream, “Leave them alone! You’re not helping!”

If questioned about this technique, I bet the doctors would say that they
were helping to prevent tearing… but ironically they’re always suturing
immediate postpartum! One doctor told me once that a second degree
tear is average for a first time mom. What???!!!

And what really makes me sad is that nurses will do this technique as well,
when it’s just the nurse and mom. Sometimes, while a woman is pushing
but before baby is crowning, women spend a good bit of time pushing
with the nurses and the doctors aren't called into the room until the baby
begins to crown. The nurses are learning this technique from doctors,
assuming it’s an evidence-based practice, but it's just not!

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
(continued)

Hands OFF!
The evidence says that perineal massage during pushing has little
effect. And that being “hands on” (aka actively slowing, holding,
stretching, pushing… basically being VERY involved in the crowning
process) shows an increase in tearing, episiotomy and postpartum
perineal pain. Instead of being “hands on” it’s suggested that “hands
poised” is a safer alternative.

The hands on approach to supporting a perineum is one of the biggest pet

peeves I have about hospital births. Over the years, I have seen this
approach used in hospitals by doctors, nurses and midwives. Honestly, at
the time I didn’t really know about the research saying that it wasn’t
helpful.. but EVERY TIME I saw this happening these internal alarm bells
would start to go off. It really bothered me to watch this technique.

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
(continued)

Warm Compresses
So far, we’ve learned that squatting and lying on our backs increases
tearing, but a side-lying, kneeling or hands and knees position decreases
tearing. We’ve also learned that perineal massage is mostly worthless and
maybe even causing more harm than good. So what else can we do to
prevent tearing during birth?

Warm compresses have been shown to help decrease the incidence of

tearing - wonderful news because warm compresses are SO SIMPLE.

Supplies Needed: Very warm water, (preferably soft) washcloths (here’s a

link to 24 pack of washcloths), and a crockpot to keep the water warm
(here’s a link to an inexpensive 3 quart one). You can get fancy with your
compresses and add a few pieces of ginger into the water to help reduce
inflammation.

Instructions: Once crowning begins, take the washcloth, submerse it in

the very warm water, wring it out, and then place on the perineum to
support the area while baby is crowning.

TIP: Make sure the water isn’t hot. Once it reaches the desired temperature
keep the crockpot on the warm setting. If it’s burning your hands when
wringing out the washcloths, it’s too hot for mom’s perineum.

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 Stage Two:
Pushing and Birth
How Do I Prevent Tearing?
Warm Compresses
(continued)

Using warm compresses to support the perineum is standard

protocol at out of hospital births. Accomplishing this task in a
hospital or birth center can be a little more complicated since you
don't have access to your own supplies.

Ask the nurse or birth assistant for a basin, fill it with warm water and
grab a stack of washcloths - 5 to 10 should be plenty. It takes about
two minutes to set up!

I’ve seen this done in the hospital once and it was the OB’s idea -
awesome! Mom was so grateful for the extra support.

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 You Can Do It!
Sometimes the hard parts of birth are hard because of fear of the
unknown. And sometimes they’re hard because it’s simply extremely
difficult work. From early labor through transition, and to eventually
pushing your sweet baby into this world, I hope that this Simple Guide has
been helpful to you in preparing yourself to rock your way through the
hardest parts of birth.

I wrote this eBook to demystify the birth process, offer new ideas about
pain coping, and to be an encouragement in the journey. I hope you feel
better prepared, inspired, and just a little bit more ready.

Please visit Mother Rising for more information as you get ready for your
big day, including topics such as:

• writing a birth plan

• finding your doula
• when to take a childbirth class
• learning the B.R.A.I.N. acronym to make decisions for
yourself and your baby
• preparing for a cesarean without expecting one
• giving birth without fear
• routine newborn procedures

You have a big task in front of you. It's hard work and it hurts.
But believe me when I say this: YOU CAN DO IT!

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