Recently, a dear friend and client sent me a copy of her birth plan. It was so personal and insightful, and it inspired me to write this post. Only you know what will be comforting, relaxing, and helpful during labor because only you know what coping techniques you gravitate to during times of stress in your everyday life. Most of the time, what worked for you in your pre-pregnant state will be effective in labor, but occasionally the very things that you expect to be comforting will turn out to be irritating. This post is meant to provide some recommendations for coping during the stages of labor, to act as a jumping-off point for you as you create your birth plan. I’ve laid the information out within the “traditional” framework of the three labor stages, but I encourage everyone to read Whapio’s “Holistic Stages of Birth.” In my eyes, it illustrates the intricate and incredible process of labor, birth, and the immediate postpartum period. You can find it here: https://thematrona.com/the-holistic-stages-of-birth/
Stage 1: Early Labor
Discovering that labor has started brings a myriad of emotions: excitement, anxiety, nervousness, even fear. It may be tempting to try and finish any last minute prep or projects still hanging over your head, but now isn’t the time. The closer you get to the birth of your baby, the more energy your body will need. Early labor is best spent trying to sleep (or at the very least rest), eating small nutritious meals frequently, and drinking plenty of fluids. If sleeping seems impossible, read a book, play cards or a board game, watch a funny movie, or fold baby items.
Now is also the perfect time to start boosting your flow of oxytocin, the hormone of love that also stimulates labor progression. Kiss your partner, cuddle your other children, have a friend or your doula massage your back. Turn down the lights, put on your favorite playlist, and try to relax as much as possible.
Stage 1: Active Labor
The key to this stage is in the name: active. Walk, slow dance, try out different positions, but most of all, do what feels natural. Your body will guide you to move instinctually if you listen to its cues. As your contractions become stronger and more regular, you may find it hard to walk or talk during them, and the activities you were using to distract yourself during early labor may no longer work. This is a good sign that labor is progressing and you will naturally begin to turn your focus inward as your consciousness moves from the “thinking” beta brainwaves to the “feeling” alpha brainwaves.
If active labor is well-established (contractions are strong and regular) a warm bath or shower can provide soothing relief from tension and discomfort. If you and your partner or doula have incorporated “the three Rs” (relaxation, ritual, and rhythm) into your birth preparation, this is the time to employ them. To learn more about “the three Rs” and how to incorporate them into your birth plan, read this: https://www.pennysimkin.com/the-3-rs-in-childbirth-preparation-relaxation-rhythm-and-ritual/
Lastly, have someone remind you to empty your bladder about every 30 minutes. A full bladder can get in baby’s way and slow your labor progress. Sitting on the toilet can also help the pelvic floor to relax and allow the cervix to dilate more quickly!
Stage 1: Transition
As you enter transition, you are moving into the phase just before pushing. I like to think of this period as the peak of the mountain, the most intense physical, emotional, and spiritual test of labor. It is in this stage the the cervix reaches full dilation and in order to accomplish this, contractions are harder, more intense, closer together, and longer in duration. You may begin to feel like you are losing control or doubt your ability to get through this part. You may feel nauseous and could possibly vomit, which helps bring baby down (even though it’s not fun). Coping techniques that were effective in early and active labor may not be helping. Try to surrender to your body’s instinct and intuition. Vocalization is often helpful; focus on making deep sounds to open the throat like moans, groans, hums, or blowing raspberries (also called “horse lips”). A relaxed face equates to a relaxed birth canal.
Reactions in transition vary widely from woman to woman, so there really is no “right way” to navigate this stage. Some women seek the presence of others, needing to be witnessed and have their efforts validated, while others find that being touched or spoken to breaks their concentration and they may prefer to be left alone with the knowledge that help is nearby if needed. Others go even deeper inward, into the slow subconscious brainwaves of delta and theta, and may appear to be disconnected or even asleep. Maintaining a calm, peaceful birth environment is essential during this stage and interruptions should be kept to a minimum.
Stage 2: Pushing & Your Baby’s Birth
This stage can be very different depending on your birth location as well as your care provider. Hospital providers often encourage mothers to push once they reach 10 centimeters dilation without considering whether they have an urge to push. It is also still very common to see “directed” or “coached” pushing, where the provider or other staff instruct mom to push with her chin to her chest while holding her breath for a specific amount of time (like to the count of ten). Women in this scenario are frequently either on their backs or in a semi-reclined position (lithotomy), and this is especially frequent practice for those with an epidural.
In recent years, more emphasis has been placed on mother-led pushing. This approach waits for the mother to feel the urge to push and encourages following her physiologic cues. In the case of an epidural, in the absence of any maternal or fetal distress, waiting for the baby’s head to appear at the perineum is an excellent alternative. Even with an epidural placed, some mothers do experience pressure that indicates readiness to push.
Keeping this in mind, consider waiting for the urge to push before actually doing so. It isn’t uncommon, especially in a birth with few interruptions, for the intense contractions of transition to space out considerably or even stop entirely before the pushing phase. Take this opportunity to rest and gather your strength for the final work of labor. In the hospital setting, this is a common time to see interventions being introduced due to the perception that labor has stalled. Again, if mom and baby are doing well, there’s no need to do more than watch and wait. Oxytocin is at its highest point now and works with your body to do most of the work of birthing for you. If you surrender to the process, you may not need to push much at all. When you do push, resist the urge to hold your breath. Instead, focus your exhales down into your bottom - it may feel like you need to have the biggest bowel movement of your life. That’s okay! You’re using the same muscles, so if you do poop, it’s normal and no one will (or should) care! If the sensations become too intense, especially during crowning, ask your provider or partner to apply gentle pressure to your perineum.
Once baby is born, place them directly onto your bare abdomen or chest and cover both of you with a blanket. Take a moment and relish the post-birth oxytocin high - you did it, mama! Your sweet babe is here!
Stage 3: The Placenta, The Umbilical Cord & “The Golden Hour”
With the exception of a true emergency, your baby should be placed on your abdomen or chest immediately after birth. Skin-to-skin is key to facilitating breastfeeding as well as helping your little one transition from womb to world. Being close to you helps them regulate their blood sugar, body temperature, heart rate, and breathing, and it provides comfort for them to smell your familiar smell and hear your voice in this strange new place. Even in the event of a cesarean birth, there should be no reason to keep you separate from your baby unless one or both of you need emergent care. All routine newborn assessments and treatments can be delayed for a few hours or performed with baby in your arms, so don’t allow non-emergent care to interfere with this crucial bonding time. Baby will likely only be alert for an hour or two, giving you a little window in which to initiate feeding and love on your little one. If you are separated from baby for any reason, don’t worry too much - your baby will still be strongly bonded to you and breastfeeding success is still very possible.
Unless there is concern about unusual placental attachment (accreta, increta, or percreta) or evidence of hemorrhage, passive management of birthing the placenta is not only appropriate, but can actually prevent hemorrhage or partial detachment. Often providers will apply traction to the cord in an effort to encourage the placenta to detach from the uterine wall, but this can lead to separation of the tissue, possible retained product, and an increased risk for bleeding. Physiologic birth of the placenta can take thirty minutes or more - continuing the flow of oxytocin through smelling and kissing your newborn as well as breastfeeding can help this process along. If you have chosen to keep your placenta for encapsulation or commemorative purposes, make sure you bring a cooler, ice, and ziplock bags for transport home.
Lastly, many hospitals are beginning to acknowledge that delayed cord clamping is both beneficial to the newborn and something many parents desire. Unfortunately, this process in the hospital setting is often abbreviated. Providers are eager to cut the cord to allow staff to weigh and measure baby, administer medications, and perform your postpartum assessments and care as well. Often, they wait thirty seconds to one minute or until the cord is no longer obviously pulsing. If you want to delay cutting longer, such as until the cord is white or begins to shrink (which can take up to an hour or more), you will likely need to be explicit about this. As I mentioned above, there is no routine care that cannot be delayed or performed with an intact cord.
I hope this information has been helpful! If you have further questions about any of the information in this post, please contact me: email@example.com.