Labour
Page Contents:
Stages of Labour, Written by Jenny Blyth
Labour, Written by, Jane Palmer, Midwife - Australia
Hydration Blends and Electrolyte Solutions, Written by Danielle Bishoff- Australia
Wonderful Oxytocin, Written by, Claire Hall, Midwife - Australia
Putting a Time Limit on Birth, Written by, Claire Hall, Midwife – Australia
STAGES OF LABOUR
Written by Jenny Blyth
The information below is an outline of basic strategies to help deal with energetic, physical, and emotional states experienced in labor. There is already a wealth of information about the dynamics and mechanics of labour in many birth books, and there is also a wealth of specialized information on homeopathics, herbs, and bodywork for labour and birth. This information seeks only to complement what has already been written and what you have already established or practiced in preparation for your birth.
PRE-LABOUR
Pre-labour body sensations can range from general aching and discomfort over several days, to specific pre-menstrual type aching and cramping in your pelvis. These sensations can also come and go in the weeks or days leading to labour, and often accompany the tightening of your uterus. With the build up to labour, however, the tightenings and associated cramping and aching tend to be more rhythmic and intensify over time. Your waters may or may not have broken. If they have, there may be a slow leak or strong gush with each early contraction. Your body replenishes this fluid over time. Usually bowel motions are regular and loose at this stage. You may have a ‘show’ which is the loss of your mucous plug (which accumulates in the cervix and protects the baby in the uterus). This may be clear mucous or tinged with blood and indicates that the cervix is beginning the opening process.
Your contractions are now rhythmic, regular and labour is requiring a great deal of your attention. Contractions can be very close together from early in the labour or more minutes apart the whole way through. Often, however, they start around 15 minutes apart, gradually intensifying and becoming closer together towards the end of first stage, sometimes with only a few minutes break in between and sometimes a few right after each other. Early contractions usually last around 20-30 seconds and the most intense contractions later can last nearly 1-2 minutes. Throughout the course of your labor, you will feel ‘shifts’ which may be subtle or may be obvious. You may feel a slight difference in pressure or know with clarity that a certain contraction brought your baby’s head into a different position. Whether or not you have a prelabour or go straight into first stage, everything in the prelabour list still applies.
The pushing urge in your body has been slowly building and is becoming stronger. Your baby is on the way out, and traveling through your vagina towards your perineum. Sometimes this is all over in 2 or 3 pushes, and sometimes second stage takes several hours. Second stage can be quite relaxed, shorter and more comfortable than first stage or it can be wild and fast or more difficult and uncomfortable than first sage. Sometimes it can feel your baby is coming out too fast and sometimes it can feel too slow or you can feel stuck. Even though second stage of labor is a different physical dynamic to first stage, all the points in the first stage of labour still apply.
Your baby is now born, and you have welcomed him/her. If all is well you have gathered yourself as best you can energetically, and now anticipate the birth of your placenta, unless the placenta has birthed spontaneously within the first few minutes.
Birth is the strongest force a woman normally experiences. If there is harmony with this force, your body and mind will enter into a different state, one that surrenders totally to natural forces. The face loses self-consciousness. It is a quiet state, gentle and profound. Sometimes I think the ease of a birth has to do with complete surrender to nature, an acceptance of being part of something greater than the individual self, like a beautiful spring, or the first heavy rains, or the sounds and rhythms of the sea.
Labour and birth are a matter of believing and trusting and listening to your instincts – a matter of getting close enough to yourself and to the information you are receiving from your body. You must rely on yourself. You cannot rely on anyone else, be they a coach, a teacher, a partner, etc. They are not receiving the stimulus or information you are receiving. I do not mean to de-emphasize the importance of support people during labour. I simply do not think they can do it for you because they cannot. Their support and love are invaluable and make it possible for more than just yourself to share in this most beautiful act of love, the joyful bringing forth of life.
Tune into labour. Unfold your inherent birth knowledge. Use any time dimension except the present. Accept each contraction, one at a time, just as you accept the rising sun each morning, without question, one day at a time.
A factor in labour is the intense sensation. This is beyond the expectations of anyone who has never given birth. This intense sensation is simply part of the whole, and when there is no fear, it simply is. It is nothing more, nothing to be afraid of, and nothing to waste your time and energy fighting against.
Common discomforts during labor and some techniques for helping:
Website: www.birthwork.com
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LABOUR
Jane Palmer, Midwife - Australia
(20th January 2000)
As the birth approaches a woman’s body begins to prepare for the labour. Signs that women may experience prior to labour include: Show (pink mucous discharge from the vagina), engagement of the baby’s head, more frequent Braxton Hicks contractions, a change in baby’s movements as they run out of space, weight loss of up to 1 kg, low pelvic pressure due to baby’s position, some diarrhoea and nesting behaviour (some women experience a surge in energy just prior to the birth). Once conditions are right labour will commence. The hormone oxytocin is responsible for the strong, regular contractions of labour. Oxytocin release is triggered by a centre in the brain and it causes the uterus to contract. Labour contractions feel very different to Braxton Hicks contractions that women experience during their pregnancy. The most important difference is that labour contractions come regularly. Each one starts gradually, builds to a peak and then fades away. Typically when labour begins contractions are short in length, around 20 to 30 seconds long. As labour progresses, contractions become gradually longer and stronger. Contractions need to be around 60 seconds long to dilate or open the cervix. Labour contractions can last up to 90 seconds. When a women gets true labour contractions they take all of her concentration and she is unable to talk through them. In about 10 to 15% of labours the waters will break first, before any contractions have occurred. In the remainder of labours, the waters will break towards the end of the first stage or in the second stage of labour (Robertson, 1999).
When should I go to the hospital?
Most women spend the early part of their labour at home. Advise as to when is the best time to come into hospital varies. The most important guide is the length and strength of the contractions. Remembering that contractions need to be around 60 seconds long before they efficiently dilate the cervix. It is less important to take note of the time between contractions. Contractions can be two minutes apart but be very mild in strength. You can contact the hospital and speak to a midwife if you are requiring guidance. You should contact the hospital if:
Labour has three stages simply known as first, second and third stage. During the first stage of labour the opening of the uterus, called the cervix, goes from being closed to fully open (or 10cm dilated). The strong, regular contractions cause the cervix to open. During the second stage of labour the baby descends down the birth canal and is born. Women during the second stage of labour assist the birth of the baby by pushing during the contractions. The third stage of labour begins after the baby is born and ends with the birth of the placenta and membranes (or after birth).
How long is labour?
It is impossible to anticipate the length of labour. Every woman and every labour is individual. In general women expecting their first baby will take longer than women expecting a subsequent baby (though this does not always hold true). For a first baby, the average length of the first stage of labour is 12 to 14 hours, the second stage 1 to 2 hours and the third stage 5 to 60 minutes. Women expecting a subsequent baby can expect the first stage to last around 6 to 8 hours and the second stage lasting from 5 to 60 minutes. Remember that these are only averages. Women can have quick labours and long labours and anything in between (Robertson, 1999).
What can I do to help my self through labour?
Informing yourself of your many options is really helpful. You can do this by reading, attending prenatal classes or speaking to others. One of the main things that research has found helpful is the presence of continuous support person. This person may be your partner, friend, relative or an experienced labour support person. It is important to feel comfortable in the environment you have chosen to give birth. You can make a labour room more comfortable by turning down the lights, closing the door, bringing some personal items and moving the furniture to suit your self. It is important to avoid dehydration in labour by drinking regularly. Eating small, light snacks in early labour is also helpful. Use up-right positions as these help stimulate the labour process and it is much easier to get comfortable (Robertson, 1999).
Reference:
Robertson, A. (1999). Preparing for birth: Mothers. Sydney: ACE Graphics.
Jane Palmer, Midwife - Australia
Website: www.pregnancy.com.au
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HYDRATION BLENDS AND ELECTROLYTE ORAL SOLUTIONS
Written by Danielle Bishoff - Australia
(Use fresh juices with no added sugar or preservatives)
Ginger, mint, honey, lemon blend:
Simmer grated ginger and mint for about 10 minutes, strain, and add honey and fresh squeezed lemon juice. Over ice or hot.
Juice and Tincture Blend:
Use one of the following as the base:
Pure orange juice
Pure lemonade
Cranberry Juice
Add the following to the base liquid:
2 Tablespoons liquid Calcium Magnesium
½ teaspoon sea salt
1 dropperful Raspberry leaf tincture
½ dropperful iron tincture (nettle or alfalfa) OR 1 teaspoon liquid iron
Honey to taste
Simple Blend:
1 pint of water
the juice of 1 whole lemon
2 Tablespoons liquid-Cal Mag
Sea-salt
Honey to taste
Raspberry Labor Tea:
In a glass or enamel pan (no metal), combine 1 ounce Raspberry Leaf with 1 pint of water. Steep for 20 minutes. Allow to cool. Then combine with:
2 Tablespoons Liquid Cal-Mag
¼ Teaspoon salt
Honey to taste
10 drops alfalfa tincture
10 drops lobelia tincture
½ dropper alfalfa OR 1 teaspoon liquid iron
Serve cold with premade raspberry ice cubes
Danielle Bishof - Australia
Email: mailto:sunshinecoast@homebirth.org.au
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WONDERFUL OXYTOCIN
Written by Claire Hall, Midwife - Australia
Oxytocin is a wonderful hormone that is released in the brain (from the pituitary gland) chiefly in response to social contact, but especially with skin-to-skin contact. It is also released during sexual intercourse(2) helping the male orgasm and ejection of sperm and the female orgasm which helps receive the sperm.(6) It helps men and women to bond together and form lasting relationships, making you want to cuddle, touch, be close and affectionate towards each another. Blood levels of oxytocin rise in response to touch, warmth, and remembering a positive relationship. Without oxytocin, animals don't recognize or remember their partner though they are able to recognize objects. Autistic children (who often have difficulty with social relationships) have lowered levels of this hormone.(3)
Oxytocin is produced in increasing amounts during pregnancy, when it acts to enhance nutrient absorption, reduce stress, and conserve energy by making Mum more sleepy.(6) It does not become active in the labour process until the balance of oestrogen and progesterone changes, just before the labour begins.(1) It plays a role in the onset of labour and acts upon the uterine muscle causing it to contract so that cervix opens and the baby can be pushed out. The peak of oxytocin levels during labour cause (in an undisturbed labour) powerful contractions that will birth the baby quickly and easily.(6) It continues this action after the birth to facilitate the birth of the placenta, and to keep the uterus contracted to control blood loss after the birth. This is aided by breast feeding, which causes further secretion of oxytocin.(1) Blood levels of oxytocin are high during labour and at their highest in the immediate period after birth, higher than at any other time in a woman’s life.(2) Oxytocin even appears in high levels in the baby’s circulation during labour, so that after birth, Mother and Baby fall in love with one another. It has been called the "love hormone" or the "cuddle hormone" or the "bonding hormone". It provides a sense of calm and well being and promotes those mothering feelings we experience after giving birth to a baby. For the baby, it invokes a strong desire to have contact with his Mother again.
A gentle birth, lack of intervention in the physiological processes, skin to skin contact and actions that maintain a quiet, calm atmosphere are vital for the optimal production of oxytocin, and thus enhancing bonding & the breastfeeding relationship. It is also a lactation stimulant, causing the expulsion of milk (let-down reflex) from the breast.(4,6)
References:
1. Bennett, VR; & Brown, LK.; (Ed) “Myles Textbook For Midwives”; Churchill Livingstone; London; 1993
2. Biancuzzo M.; “Breastfeeding the Newborn”; Second Edition; Mosby Inc; St Lois; 2003
3. www.007b.com/
4. www.drugs.com/cons/Syntocinon.html
5. Mattiesen AS, Ransjo-Arvidson AB, Nissen E, Uvanas-Moberg K; “Postpartum maternal oxytocin release by newbors: effects of infant hand massage and sucking”; Department of Statistics, Stockholm University, Sweden. Bith 2001 Mar; (1):13-9
6. Buckley SJ M.B., Ch.B;Dip.Obst; “Ecstatic Birth – Nature’s Hormonal Blueprint for Labour”; www.wonderfulbirth.com/default.asp?url=2307&
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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PUTTING A TIME LIMIT ON BIRTH
Written by Claire Hall, Midwife - Australia
Within the Medical Model, the first stage of labour is measured in terms of dilation of the cervix and descent of the Baby’s head. To assess these things, most Hospitals have a policy of performing a vaginal examination every 2 – 4 hours, depending on the Woman’s “progress”. As well as timing the first stage of labour, most Hospitals also place a “time limit” (normally 2 hrs) on second stage. If a labouring woman dilates at less than 1.0 cm per hour (and less than 2.0 cm per hour for a Woman having her second or more Baby) it is labelled a “protraction disorder.” If there is “no progress” in cervical dilation in 2 hours, it is labelled an “arrest disorder”. These criteria have been generally adhered to in the Medical Profession since the mid 1950’s, when Dr. Emanuel Friedman published a study of 500 labouring women. (Proposing his “Friedman’s Curve of Labour that puts a definite time limit on labour.) The study also outlined that the rate of a Baby’s descent into and through the pelvis should occur at no less than 1cm/hr. It is this assessment criteria that the Medical Profession uses to diagnose “abnormal” labours (in an otherwise uncomplicated labour that is just taking a little longer than normal) and prescribe intervention accordingly - administration of various drugs, (including synthetic oxytocin and prostaglandins), internal foetal monitoring or foetal scalp sampling, forceps delivery or vacuum extraction, caesarean section, episiotomy etc.
I once witnessed an interesting transaction between a labouring woman and hospital staff. After a complicated home birth that needed to be transferred to Hospital, (she later birthed a beautiful healthy baby with the help of a vacuum extraction) the Doctors and Midwives informed the woman that because her second stage was “protracted” (2hr 45min) then her uterus “would not” contract efficiently and she “would” haemorrhage unless she consented to administration of syntocinon. (She had informed medical staff that she would have the Syntocinon if she was bleeding and not “routinely”). They were amazed when her total blood loss was on the low side of “normal”. This is a clear indication that sticking to “numbers” and “time limits” (ie the Friedman’s curve) distracts medical staff from looking at the individual woman, baby and their individual situation.
It is the “Friedman norm” that is taught to most Medical & Midwifery students. From the time I commenced my Midwifery studies, I have been confused by the sometimes rigid adherence in following the Friedman Curve when my practice told me that rarely did a woman labour within the parameters. The "standard of practice" rigidly declares that women who go beyond the “time limit” are risking their own health and that of their Baby. This continues to this day, despite more recent studies from within the Medical Fraternity itself (that back up what the natural birthing movement have always maintained) that indicate Friedman’s “labour curve” does NOT describe the “typical” labour. Dr. Jun Zhang of the National Institute of Child Health and Human Development, in Bethesda, Maryland published a study reassessing the “labour curve” in women having their first baby. At the 2002 annual meeting of the Society for Maternal-Foetal Medicine he said . . .
"And the long-accepted Friedman curve may not be an accurate description of normal labor progression, according to a new analysis of data from 1,329 nulliparous women” [women having their first baby]… "Our curve is very different,"… pointing out that on his curve the average was 5.5 hours for progression from 4 cm to 10 cm, compared with 2.5 hours on the Friedman curve…"Our data suggest that most women enter active labor at different times, mostly between 3 cm and 5 cm dilation, and even in the active phase the speed of progression varies from person to person… And for foetal descent, it could take 3 hours to progress from station” (just 1cm) …"Therefore, the definition of protracted descent or arrested descent appears to be too stringent in current practice,"
In this study,labour lasting more than 2 hours without apparent change wasnot uncommon before 7 cm of dilation. Another survey of birth outcomes in America (published in J Obstet Gynecol Neonatal Nurs. 2004 Nov-Dec;33(6):713-22.) also suggests that the parameters to determine if a labour is “progressing satisfactorily” may need to be expanded to a “wider range of normal”. This study found that it was not uncommon for women having their first Baby to be in the first stage of labour for up to 26 hours and the second stage of labour up to 8 hours with no adverse effects to mother or infant. For women having their second or more baby, the first stage lasted for up to 23 hours and the second stage of labour for up to 4.5 hours with good birth outcomes.
Apart from the tendency of Medical Staff to intervene in your labour to keep it within a time limit, monitoring your dilation without good reason can have a dramatic effect on a labouring woman’s “head space”. If you are labouring well, and a “routine vaginal examination” to “check your progress” finds that “you are only 3 cm” or “stayed the same” since your last check, it can have a negative impact on your energy and resolve, as well as your belief that you can do it. Women in these situations are more likely to ask for pain relief, because they see no end – they are focused on the time it will take and not on the moment. I have seen many times a woman in good labour with strong contractions “make no progress” from 4 cm dilation in 3-4 hrs of labour, and then be completely dilated and pushing the Baby out in half an hour. (While the Hospital Staff were busy setting up for a Syntocinon drip).
Imposing a time limit on labouring women is in my opinion, one of the biggest contributors to the high intervention rates in the Medical System. The higher the Medical Involvement in the running of the Birthing Unit, the more rigidly time limits are adhered to and the higher the intervention rates. Birthing Units (within a Hospital or independent of a Hospital) that are Midwifery led, generally are much more up to date with current research and less likely to impose such strict limits of “normal”. Of course, home birth is another option for women to be treated individually where less emphasis is placed on the clock.
Remember that when you are in labour – empower yourself by putting the clock away. Let your care giver monitor your safety, time etc. If you are worried about the time it is taking it is almost impossible to surrender to the process and be in the moment – essential for you to labour effectively.
Resources:
“Protraction and Arrest Disorders”;
www.birthsource.com/scripts/article.asp?articleid=120
Davis. A.J. ( MD); “The Friedman Curve: An Obsolete Approach to Labor Assessment” ; Journal Watch Women's Health February 19, 2003 http://womens-health.jwatch.org/cgi/content/full/2003/219/1
Cesario, S.K.; “Reevaluation of Friedman's Labor Curve: a pilot study” ; J Obstet Gynecol Neonatal Nurswww.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561659&dopt=Abstract. 2004 Nov-Dec;33(6):713-22;
Walsh, N.; “Definitions of labor protraction, arrest challenged (Reassessment of Friedman Curve)”; OB/GYN News, March 1, 2002, by Nancy Walsh.
Reeder, S., Martin, L., and Koniak-Griffin, D; “Maternity Nursing: Family, Newborn, and Women's Health Care”. (1997) Philadelphia: J.B. Lippincott Company.
Varney, H., Kriebs, J., and Gegor, C; “Varney's Midwifery: 4th Edition”; Jones and Bartlett Publishers. Sudbury, Massachusetts. 2004.
Zhang J, Troendle J.F., Yancey M.K.; “Reassessing the Labor Curve in Nulliparous Women” ; American Journal of Obstetrics and Gynecology. 2002;187(4):824-828.
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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Stages of Labour, Written by Jenny Blyth
Labour, Written by, Jane Palmer, Midwife - Australia
Hydration Blends and Electrolyte Solutions, Written by Danielle Bishoff- Australia
Wonderful Oxytocin, Written by, Claire Hall, Midwife - Australia
Putting a Time Limit on Birth, Written by, Claire Hall, Midwife – Australia
STAGES OF LABOUR
Written by Jenny Blyth
The information below is an outline of basic strategies to help deal with energetic, physical, and emotional states experienced in labor. There is already a wealth of information about the dynamics and mechanics of labour in many birth books, and there is also a wealth of specialized information on homeopathics, herbs, and bodywork for labour and birth. This information seeks only to complement what has already been written and what you have already established or practiced in preparation for your birth.
PRE-LABOUR
Pre-labour body sensations can range from general aching and discomfort over several days, to specific pre-menstrual type aching and cramping in your pelvis. These sensations can also come and go in the weeks or days leading to labour, and often accompany the tightening of your uterus. With the build up to labour, however, the tightenings and associated cramping and aching tend to be more rhythmic and intensify over time. Your waters may or may not have broken. If they have, there may be a slow leak or strong gush with each early contraction. Your body replenishes this fluid over time. Usually bowel motions are regular and loose at this stage. You may have a ‘show’ which is the loss of your mucous plug (which accumulates in the cervix and protects the baby in the uterus). This may be clear mucous or tinged with blood and indicates that the cervix is beginning the opening process.
- Conserve your energy. This is easier said than done, especially if this is your first baby or you are way past your due date. However, try to stay relaxed, rested, and go to bed at your usual time. Even if you think tonight is the night, staying up late won’t make things happen faster. It will just make you tired. However, it makes good sense to organize things for the birth if you haven’t already done so.
- Drink raspberry and nettle tea and eat and drink if your appetite is normal. Energize and feed your body.
- Notice how you are breathing and a have a little practice at calm, directed breath into any discomfort.
- Notice how you are physically. You might need a bath or hot water bottle or touch to help you relax, sleep, or deal with the discomfort. Put your energy into thinking about what you need to do next, rather than think about what should or shouldn’t be happening.
- Notice how you are emotionally, and if you’re not okay, then think about what might help. It could be a distraction, humour, touch, a change of scene, solitude, meditation, music, a walk, rest, or some practical household help.
- Check in with your baby and feel how your baby is doing.
- If you really need support at this stage, then ask for it.
Your contractions are now rhythmic, regular and labour is requiring a great deal of your attention. Contractions can be very close together from early in the labour or more minutes apart the whole way through. Often, however, they start around 15 minutes apart, gradually intensifying and becoming closer together towards the end of first stage, sometimes with only a few minutes break in between and sometimes a few right after each other. Early contractions usually last around 20-30 seconds and the most intense contractions later can last nearly 1-2 minutes. Throughout the course of your labor, you will feel ‘shifts’ which may be subtle or may be obvious. You may feel a slight difference in pressure or know with clarity that a certain contraction brought your baby’s head into a different position. Whether or not you have a prelabour or go straight into first stage, everything in the prelabour list still applies.
- Conserve your energy. However, if at some point you need to be more energetic because you have determined this will move the labour along and you are ready to do this, then this is fine. What is important is that you have the opportunity to gauge for yourself how different activity and positions affect and influence your labour. For some women, relaxing or lying down works best to facilitate labour, and for others activity and movement seem to be the key to progress. You can use this knowledge to your advantage in regulating the pace of your labour to suit your need to either rest or get on with it. It’s good to remind yourself, however, that you do have to go through the birth. At some point your determination and resolve will face this fact.
- Keep drinking fluids and if exhaustion starts to set in, hydration blends and easy to digest foods will boost your energy.
- Always, work with your breath.
- Notice how you are physically. If the labour is moving along quite quickly, what do you need to support you through the intensity? Touch, heat, water, help with breathing, or help with relaxing between contractions? If you are feeling stuck in the way your labour is progressing, then any sort of external change can sometimes help everything to shift. Changes of atmosphere, positioning, people, movement, or even rest can work well. Remember to pee. If you want to but can’t, try lifting your belly in a standing position to reduce pressure against your urethra and bladder.
- Notice how you are emotionally. It’s okay to express your feelings. You don’t have to be a saint when you’re birthing. You need to be a free, primal human being. You don’t have to like your labour, but you do have to somehow get through it. Sometimes you have to let go of the liking in order to do this, and it is possible to keep the loving intact without the liking. Try to discern between the negative and positive inner voices.
- It’s okay to ask for exactly what you need. This is a peak experience for you and your baby. Most people realize this and are willing to respect and serve you if they know what you do and don’t feel. You don’t get another chance with this particular birth with this particular baby. There are no replays.
- If you have support people, then apart from direct support of you, their tasks could include keeping candles lit , finding flowers, preparing food (you can never prepare too much), and making sure of a steady hot water supply. Either take the phone off the hook / turn off mobile or delegate someone to answer calls for you. “I found I could get through intense contractions best by keeping my eyes open and focusing on something red. During my first 2 labours it was a red flower, and during my third it was a candle directly in front of me. Orange/red is a very powerful colour to connect you with your birthing energy. It is the colour of life, renewal, energy and power. I also think candles and flowers are essential at births whether you have your eyes open or not. They remind us of the special sacred significance of birth. Candles help us connect to our ‘fire within’ and purify fear and negative influences and thoughts. Flowers are an exquisite expression of nature and remind us of our own flowering as we give birth.”
- Keep checking in with your baby on a regular basis. However your birth experience evolves for you, try staying connected with your baby and communicate every major turning point and decision along the way. Knowing you are journeying through this intensity together will help you stay with your courage and your body. If you are having trouble doing this, then you might ask someone to check your baby for you by listening to his/her heartbeat.
The pushing urge in your body has been slowly building and is becoming stronger. Your baby is on the way out, and traveling through your vagina towards your perineum. Sometimes this is all over in 2 or 3 pushes, and sometimes second stage takes several hours. Second stage can be quite relaxed, shorter and more comfortable than first stage or it can be wild and fast or more difficult and uncomfortable than first sage. Sometimes it can feel your baby is coming out too fast and sometimes it can feel too slow or you can feel stuck. Even though second stage of labor is a different physical dynamic to first stage, all the points in the first stage of labour still apply.
- You can direct your breath into any of the areas you feel under pressure or intense sensation or movement. Sometimes the pushing urge will overwhelm your breathing and take it away from you for a moment, and sometimes it might feel right to put some extra effort into the involuntary pushing urge. If you are able to mostly breathe through the contractions, your uterus will still continue to push the baby out while the soft tissues of your vagina are stretching and softening to your breathe. If the pushing urges are moving the baby down very quickly, and this feels overwhelming, then consciously pant a little as this sometimes helps slow things down and gives you time to adjust to the fact that your baby is being born now! Dropping to a hands and knees position sometimes slows down the emergence of the baby and many women do this instinctively.
- If you are feeling like you or the baby are stuck, then finding a more open position by changing your posture (e.g. throwing your pelvis forward and leaning back, or just kneeling a little more upright) can work well in ‘feeling stuck’ situations. You can also try changing your leg positions or standing. Do whatever you feel is facilitating and encouraging movement You will very likely need physical assistance with this, and remember that if you don’t like the position you are changing to, you can always return to where you were. It may be helpful at some point to push a little extra with the urges. If you are not sure how the baby is then ask for someone to check for you by listening to the baby’s heart. This is the only other was to find out anything about how the baby is apart from your own knowing.
- Emotionally and physically you may feel very ‘stretched’ as the baby comes close to being born. Sometimes touch guidance or warm towels on the perineum can feel very supportive, and you need to remind yourself and the baby that he/she is going to be born, resolve to be ready and to be as present as possible. Breathe into your perineum as your baby emerges.
Your baby is now born, and you have welcomed him/her. If all is well you have gathered yourself as best you can energetically, and now anticipate the birth of your placenta, unless the placenta has birthed spontaneously within the first few minutes.
- Usually it takes several minutes after a natural birth for the uterus to start rhythmic contractions again. These build in intensity until the placenta is birthed, and then usually continue after the placenta is out. The contractions are also stimulated by any breastfeeding in the moments and days after the birth. By the time you are ready to birth your placenta, the baby’s cord may or may not have been cut. If the cord has completely stopped pulsating, blood loss is not excessive, and you are feeling okay, then it usually means the placenta has separated. As soon as you feel ready you can use the energy of the next contraction to give a little push and birth the placenta. Usually it is sitting in the top of the vagina. Any guidance with the cord should be towards your anus as this is the angle of your vagina. Supporting your uterus above your pubic bone as you give a little push can feel so supportive and also encourage the placenta out. Some mothers feel a need or urgency to birth their placenta immediately and some mothers need to recover from the birth for a while first before they feel they have enough determination or energy to birth the placenta. This may seem daunting so soon after the birth of the baby, but remember, the placenta is much softer and smaller than the baby, and you will feel much better once your uterus is completely empty
- Be aware of your blood loss and how you are feeling. Make sure someone is with you at all times until well after the placenta is out. Keep warm. You can check on your uterus to see if it is contracted and at the right place in your belly. Ask for help to feel more comfortable and tell someone immediately if you are suddenly not feeling okay.
- Make sure to drink something that is warm and to replace fluids, such as a hydration blend.
- Showering can wait until you are absolutely settled and rested from the birth. Conserve your energy and respect the shock your body is experiencing after such a big experience, even though you might feel very well and happy. Be kind to yourself and the baby in the few hours after the birth. A lot is going on for both of you on a primal level.
- Seriously consider not making telephone calls or having visitors for some time, and your partner may need to know that you need him by your side till you are absolutely ready calls to be made. This is a profound time together with your new baby that can never be replicated.
Birth is the strongest force a woman normally experiences. If there is harmony with this force, your body and mind will enter into a different state, one that surrenders totally to natural forces. The face loses self-consciousness. It is a quiet state, gentle and profound. Sometimes I think the ease of a birth has to do with complete surrender to nature, an acceptance of being part of something greater than the individual self, like a beautiful spring, or the first heavy rains, or the sounds and rhythms of the sea.
Labour and birth are a matter of believing and trusting and listening to your instincts – a matter of getting close enough to yourself and to the information you are receiving from your body. You must rely on yourself. You cannot rely on anyone else, be they a coach, a teacher, a partner, etc. They are not receiving the stimulus or information you are receiving. I do not mean to de-emphasize the importance of support people during labour. I simply do not think they can do it for you because they cannot. Their support and love are invaluable and make it possible for more than just yourself to share in this most beautiful act of love, the joyful bringing forth of life.
Tune into labour. Unfold your inherent birth knowledge. Use any time dimension except the present. Accept each contraction, one at a time, just as you accept the rising sun each morning, without question, one day at a time.
A factor in labour is the intense sensation. This is beyond the expectations of anyone who has never given birth. This intense sensation is simply part of the whole, and when there is no fear, it simply is. It is nothing more, nothing to be afraid of, and nothing to waste your time and energy fighting against.
Common discomforts during labor and some techniques for helping:
- Nausea and vomiting: chilling the nerves of the neck with a cold washcloth can be very helpful. Ice chips, particularly ice chips made from a hydration blend, can be soothing. Keep in mind that you may vomit during labour, so try to eat easily digested foods and avoid things like nuts and acidic foods. Remember, vomiting during labor is almost always a sign that things are progressing, and the opening of the throat often corresponds to the opening of the cervix.
- Backache: This is commonly caused by the uterus contracting and putting pressure on the broad ligament attached to the back and the baby’s head against your pelvis. This discomfort can be relieved or lessened by steady, constant back pressure, changing to hands and knees position, or applying heat.
- Leg cramps are caused by a calcium/magnesium imbalance. Flex the foot towards the knee until it goes away.
- Chills and shakes are caused by increased hormones in the body or muscle fatigue. They can be helped by vigorous skin massage, extra efforts of relaxation, covering with a sheet or being held in someone’s arms.
Website: www.birthwork.com
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LABOUR
Jane Palmer, Midwife - Australia
(20th January 2000)
As the birth approaches a woman’s body begins to prepare for the labour. Signs that women may experience prior to labour include: Show (pink mucous discharge from the vagina), engagement of the baby’s head, more frequent Braxton Hicks contractions, a change in baby’s movements as they run out of space, weight loss of up to 1 kg, low pelvic pressure due to baby’s position, some diarrhoea and nesting behaviour (some women experience a surge in energy just prior to the birth). Once conditions are right labour will commence. The hormone oxytocin is responsible for the strong, regular contractions of labour. Oxytocin release is triggered by a centre in the brain and it causes the uterus to contract. Labour contractions feel very different to Braxton Hicks contractions that women experience during their pregnancy. The most important difference is that labour contractions come regularly. Each one starts gradually, builds to a peak and then fades away. Typically when labour begins contractions are short in length, around 20 to 30 seconds long. As labour progresses, contractions become gradually longer and stronger. Contractions need to be around 60 seconds long to dilate or open the cervix. Labour contractions can last up to 90 seconds. When a women gets true labour contractions they take all of her concentration and she is unable to talk through them. In about 10 to 15% of labours the waters will break first, before any contractions have occurred. In the remainder of labours, the waters will break towards the end of the first stage or in the second stage of labour (Robertson, 1999).
When should I go to the hospital?
Most women spend the early part of their labour at home. Advise as to when is the best time to come into hospital varies. The most important guide is the length and strength of the contractions. Remembering that contractions need to be around 60 seconds long before they efficiently dilate the cervix. It is less important to take note of the time between contractions. Contractions can be two minutes apart but be very mild in strength. You can contact the hospital and speak to a midwife if you are requiring guidance. You should contact the hospital if:
- You are experiencing regular, strong contractions
- Your waters break
- You start bleeding
Labour has three stages simply known as first, second and third stage. During the first stage of labour the opening of the uterus, called the cervix, goes from being closed to fully open (or 10cm dilated). The strong, regular contractions cause the cervix to open. During the second stage of labour the baby descends down the birth canal and is born. Women during the second stage of labour assist the birth of the baby by pushing during the contractions. The third stage of labour begins after the baby is born and ends with the birth of the placenta and membranes (or after birth).
How long is labour?
It is impossible to anticipate the length of labour. Every woman and every labour is individual. In general women expecting their first baby will take longer than women expecting a subsequent baby (though this does not always hold true). For a first baby, the average length of the first stage of labour is 12 to 14 hours, the second stage 1 to 2 hours and the third stage 5 to 60 minutes. Women expecting a subsequent baby can expect the first stage to last around 6 to 8 hours and the second stage lasting from 5 to 60 minutes. Remember that these are only averages. Women can have quick labours and long labours and anything in between (Robertson, 1999).
What can I do to help my self through labour?
Informing yourself of your many options is really helpful. You can do this by reading, attending prenatal classes or speaking to others. One of the main things that research has found helpful is the presence of continuous support person. This person may be your partner, friend, relative or an experienced labour support person. It is important to feel comfortable in the environment you have chosen to give birth. You can make a labour room more comfortable by turning down the lights, closing the door, bringing some personal items and moving the furniture to suit your self. It is important to avoid dehydration in labour by drinking regularly. Eating small, light snacks in early labour is also helpful. Use up-right positions as these help stimulate the labour process and it is much easier to get comfortable (Robertson, 1999).
Reference:
Robertson, A. (1999). Preparing for birth: Mothers. Sydney: ACE Graphics.
Jane Palmer, Midwife - Australia
Website: www.pregnancy.com.au
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HYDRATION BLENDS AND ELECTROLYTE ORAL SOLUTIONS
Written by Danielle Bishoff - Australia
(Use fresh juices with no added sugar or preservatives)
Ginger, mint, honey, lemon blend:
Simmer grated ginger and mint for about 10 minutes, strain, and add honey and fresh squeezed lemon juice. Over ice or hot.
Juice and Tincture Blend:
Use one of the following as the base:
Pure orange juice
Pure lemonade
Cranberry Juice
Add the following to the base liquid:
2 Tablespoons liquid Calcium Magnesium
½ teaspoon sea salt
1 dropperful Raspberry leaf tincture
½ dropperful iron tincture (nettle or alfalfa) OR 1 teaspoon liquid iron
Honey to taste
Simple Blend:
1 pint of water
the juice of 1 whole lemon
2 Tablespoons liquid-Cal Mag
Sea-salt
Honey to taste
Raspberry Labor Tea:
In a glass or enamel pan (no metal), combine 1 ounce Raspberry Leaf with 1 pint of water. Steep for 20 minutes. Allow to cool. Then combine with:
2 Tablespoons Liquid Cal-Mag
¼ Teaspoon salt
Honey to taste
10 drops alfalfa tincture
10 drops lobelia tincture
½ dropper alfalfa OR 1 teaspoon liquid iron
Serve cold with premade raspberry ice cubes
Danielle Bishof - Australia
Email: mailto:sunshinecoast@homebirth.org.au
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WONDERFUL OXYTOCIN
Written by Claire Hall, Midwife - Australia
Oxytocin is a wonderful hormone that is released in the brain (from the pituitary gland) chiefly in response to social contact, but especially with skin-to-skin contact. It is also released during sexual intercourse(2) helping the male orgasm and ejection of sperm and the female orgasm which helps receive the sperm.(6) It helps men and women to bond together and form lasting relationships, making you want to cuddle, touch, be close and affectionate towards each another. Blood levels of oxytocin rise in response to touch, warmth, and remembering a positive relationship. Without oxytocin, animals don't recognize or remember their partner though they are able to recognize objects. Autistic children (who often have difficulty with social relationships) have lowered levels of this hormone.(3)
Oxytocin is produced in increasing amounts during pregnancy, when it acts to enhance nutrient absorption, reduce stress, and conserve energy by making Mum more sleepy.(6) It does not become active in the labour process until the balance of oestrogen and progesterone changes, just before the labour begins.(1) It plays a role in the onset of labour and acts upon the uterine muscle causing it to contract so that cervix opens and the baby can be pushed out. The peak of oxytocin levels during labour cause (in an undisturbed labour) powerful contractions that will birth the baby quickly and easily.(6) It continues this action after the birth to facilitate the birth of the placenta, and to keep the uterus contracted to control blood loss after the birth. This is aided by breast feeding, which causes further secretion of oxytocin.(1) Blood levels of oxytocin are high during labour and at their highest in the immediate period after birth, higher than at any other time in a woman’s life.(2) Oxytocin even appears in high levels in the baby’s circulation during labour, so that after birth, Mother and Baby fall in love with one another. It has been called the "love hormone" or the "cuddle hormone" or the "bonding hormone". It provides a sense of calm and well being and promotes those mothering feelings we experience after giving birth to a baby. For the baby, it invokes a strong desire to have contact with his Mother again.
A gentle birth, lack of intervention in the physiological processes, skin to skin contact and actions that maintain a quiet, calm atmosphere are vital for the optimal production of oxytocin, and thus enhancing bonding & the breastfeeding relationship. It is also a lactation stimulant, causing the expulsion of milk (let-down reflex) from the breast.(4,6)
References:
1. Bennett, VR; & Brown, LK.; (Ed) “Myles Textbook For Midwives”; Churchill Livingstone; London; 1993
2. Biancuzzo M.; “Breastfeeding the Newborn”; Second Edition; Mosby Inc; St Lois; 2003
3. www.007b.com/
4. www.drugs.com/cons/Syntocinon.html
5. Mattiesen AS, Ransjo-Arvidson AB, Nissen E, Uvanas-Moberg K; “Postpartum maternal oxytocin release by newbors: effects of infant hand massage and sucking”; Department of Statistics, Stockholm University, Sweden. Bith 2001 Mar; (1):13-9
6. Buckley SJ M.B., Ch.B;Dip.Obst; “Ecstatic Birth – Nature’s Hormonal Blueprint for Labour”; www.wonderfulbirth.com/default.asp?url=2307&
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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PUTTING A TIME LIMIT ON BIRTH
Written by Claire Hall, Midwife - Australia
Within the Medical Model, the first stage of labour is measured in terms of dilation of the cervix and descent of the Baby’s head. To assess these things, most Hospitals have a policy of performing a vaginal examination every 2 – 4 hours, depending on the Woman’s “progress”. As well as timing the first stage of labour, most Hospitals also place a “time limit” (normally 2 hrs) on second stage. If a labouring woman dilates at less than 1.0 cm per hour (and less than 2.0 cm per hour for a Woman having her second or more Baby) it is labelled a “protraction disorder.” If there is “no progress” in cervical dilation in 2 hours, it is labelled an “arrest disorder”. These criteria have been generally adhered to in the Medical Profession since the mid 1950’s, when Dr. Emanuel Friedman published a study of 500 labouring women. (Proposing his “Friedman’s Curve of Labour that puts a definite time limit on labour.) The study also outlined that the rate of a Baby’s descent into and through the pelvis should occur at no less than 1cm/hr. It is this assessment criteria that the Medical Profession uses to diagnose “abnormal” labours (in an otherwise uncomplicated labour that is just taking a little longer than normal) and prescribe intervention accordingly - administration of various drugs, (including synthetic oxytocin and prostaglandins), internal foetal monitoring or foetal scalp sampling, forceps delivery or vacuum extraction, caesarean section, episiotomy etc.
I once witnessed an interesting transaction between a labouring woman and hospital staff. After a complicated home birth that needed to be transferred to Hospital, (she later birthed a beautiful healthy baby with the help of a vacuum extraction) the Doctors and Midwives informed the woman that because her second stage was “protracted” (2hr 45min) then her uterus “would not” contract efficiently and she “would” haemorrhage unless she consented to administration of syntocinon. (She had informed medical staff that she would have the Syntocinon if she was bleeding and not “routinely”). They were amazed when her total blood loss was on the low side of “normal”. This is a clear indication that sticking to “numbers” and “time limits” (ie the Friedman’s curve) distracts medical staff from looking at the individual woman, baby and their individual situation.
It is the “Friedman norm” that is taught to most Medical & Midwifery students. From the time I commenced my Midwifery studies, I have been confused by the sometimes rigid adherence in following the Friedman Curve when my practice told me that rarely did a woman labour within the parameters. The "standard of practice" rigidly declares that women who go beyond the “time limit” are risking their own health and that of their Baby. This continues to this day, despite more recent studies from within the Medical Fraternity itself (that back up what the natural birthing movement have always maintained) that indicate Friedman’s “labour curve” does NOT describe the “typical” labour. Dr. Jun Zhang of the National Institute of Child Health and Human Development, in Bethesda, Maryland published a study reassessing the “labour curve” in women having their first baby. At the 2002 annual meeting of the Society for Maternal-Foetal Medicine he said . . .
"And the long-accepted Friedman curve may not be an accurate description of normal labor progression, according to a new analysis of data from 1,329 nulliparous women” [women having their first baby]… "Our curve is very different,"… pointing out that on his curve the average was 5.5 hours for progression from 4 cm to 10 cm, compared with 2.5 hours on the Friedman curve…"Our data suggest that most women enter active labor at different times, mostly between 3 cm and 5 cm dilation, and even in the active phase the speed of progression varies from person to person… And for foetal descent, it could take 3 hours to progress from station” (just 1cm) …"Therefore, the definition of protracted descent or arrested descent appears to be too stringent in current practice,"
In this study,labour lasting more than 2 hours without apparent change wasnot uncommon before 7 cm of dilation. Another survey of birth outcomes in America (published in J Obstet Gynecol Neonatal Nurs. 2004 Nov-Dec;33(6):713-22.) also suggests that the parameters to determine if a labour is “progressing satisfactorily” may need to be expanded to a “wider range of normal”. This study found that it was not uncommon for women having their first Baby to be in the first stage of labour for up to 26 hours and the second stage of labour up to 8 hours with no adverse effects to mother or infant. For women having their second or more baby, the first stage lasted for up to 23 hours and the second stage of labour for up to 4.5 hours with good birth outcomes.
Apart from the tendency of Medical Staff to intervene in your labour to keep it within a time limit, monitoring your dilation without good reason can have a dramatic effect on a labouring woman’s “head space”. If you are labouring well, and a “routine vaginal examination” to “check your progress” finds that “you are only 3 cm” or “stayed the same” since your last check, it can have a negative impact on your energy and resolve, as well as your belief that you can do it. Women in these situations are more likely to ask for pain relief, because they see no end – they are focused on the time it will take and not on the moment. I have seen many times a woman in good labour with strong contractions “make no progress” from 4 cm dilation in 3-4 hrs of labour, and then be completely dilated and pushing the Baby out in half an hour. (While the Hospital Staff were busy setting up for a Syntocinon drip).
Imposing a time limit on labouring women is in my opinion, one of the biggest contributors to the high intervention rates in the Medical System. The higher the Medical Involvement in the running of the Birthing Unit, the more rigidly time limits are adhered to and the higher the intervention rates. Birthing Units (within a Hospital or independent of a Hospital) that are Midwifery led, generally are much more up to date with current research and less likely to impose such strict limits of “normal”. Of course, home birth is another option for women to be treated individually where less emphasis is placed on the clock.
Remember that when you are in labour – empower yourself by putting the clock away. Let your care giver monitor your safety, time etc. If you are worried about the time it is taking it is almost impossible to surrender to the process and be in the moment – essential for you to labour effectively.
Resources:
“Protraction and Arrest Disorders”;
www.birthsource.com/scripts/article.asp?articleid=120
Davis. A.J. ( MD); “The Friedman Curve: An Obsolete Approach to Labor Assessment” ; Journal Watch Women's Health February 19, 2003 http://womens-health.jwatch.org/cgi/content/full/2003/219/1
Cesario, S.K.; “Reevaluation of Friedman's Labor Curve: a pilot study” ; J Obstet Gynecol Neonatal Nurswww.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561659&dopt=Abstract. 2004 Nov-Dec;33(6):713-22;
Walsh, N.; “Definitions of labor protraction, arrest challenged (Reassessment of Friedman Curve)”; OB/GYN News, March 1, 2002, by Nancy Walsh.
Reeder, S., Martin, L., and Koniak-Griffin, D; “Maternity Nursing: Family, Newborn, and Women's Health Care”. (1997) Philadelphia: J.B. Lippincott Company.
Varney, H., Kriebs, J., and Gegor, C; “Varney's Midwifery: 4th Edition”; Jones and Bartlett Publishers. Sudbury, Massachusetts. 2004.
Zhang J, Troendle J.F., Yancey M.K.; “Reassessing the Labor Curve in Nulliparous Women” ; American Journal of Obstetrics and Gynecology. 2002;187(4):824-828.
Claire Hall, Midwife - Australia
Email: charisbirthsupport@bigpond.com
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