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16 WAYS TO HELP LABOR PROGRESS
1. Be informed. During your childbirth classes you will learn a lot about the anatomy and physiology of labor, especially how the uterus contracts and how your baby turns and bends as he or she navigates the winding road of your pelvic passages. Be sure you understand the importance of relaxation, the labor-stalling effects of fear, and how your hormones work and what you can do to help them work better.
2. Understand medical technology. Inform yourself before labor-day about the wise use of technology and medications during labor. While technology is often life-and laborsaving, it's meant to help your labor progress, not interfere with it. A well-timed epidural, as discussed in month eight, can help an exhausted mother rest and get a second wind, accelerating labor in the long run. On the other hand, the wrong medication or the right one given at the wrong time can interfere with the progress of labor. If you need an intravenous, request a heparin-lock, which will allow you to be mobile, rather than tethered to a bedside I.V. pole. If you need electronic fetal monitoring, ask if it can be done intermittently. If for medical reasons you need continuous electronic fetal monitoring, request telemetry, which keeps you mobile.
3. Be fit. Here's when those hours of pelvic tilts and tailor squats, daily walks, swimming, or stationary cycling really pay off. Pre-toned and pre- stretched muscles are likely to work better for you.
4. Be rested. It's not only hard work that pushes a baby out; it's efficient work. Fortunately, nature provides two breaks for laboring women. The first is during early labor, when contractions are not so difficult to deal with. The second type of break is continual -- those little respites between contractions. Even when labor is at its most intense, there is time between the end of one contraction and the beginning of the next. If you are laboring at home, retreat into a quiet place, take the phone off the hook, and go to sleep, or at least get some rest. During early labor in the hospital, keep your environment restful.
5. Remember to rest between contractions, especially early in labor, when these breaks last five minutes or more. Click into the relaxation techniques you have rehearsed. Even during active labor, when breaks may last only two to three minutes, we have seen veteran mothers use their relaxation techniques so effectively that they are able to momentarily "zone out," as if they are on another planet, and even snore between pushes in the second stage. Don't spend your time between contractions worrying about what the next one will feel like. This will make the pain worse. Fear intensifies pain perception.
6. Think R, R, R. Between contractions think Rest, Relaxation, and Recumbency.
7. Be nourished. A hard-working uterus and the muscles around it need a lot of energy from food and hydration from drinks. Doctors used to discourage eating or drinking during labor in case the mother needed a general anesthesia for a cesarean delivery, relying instead on intravenous fluids to hydrate and provide energy. Since most mothers who end up with a surgical birth now elect to be awake and thus receive an epidural or spinal anesthetic, keeping an empty stomach during labor is not as important as it once was. In the unlikely event that general anesthesia is necessary for emergency delivery, the concern is that you might vomit while you are unconscious and then inhale your stomach contents into your lungs. For this reason, it is preferred that laboring women ingest small amounts of quickly digestible foods. Eating heavily is also likely to make you uncomfortable.
8. Be quiet. You don't have to be like a mother cat and retreat to the closet to have your baby, but you must design a peaceful birthing environment for yourself. Birth attendants (partner, friends, nurses) need to respect your privacy during contractions, so you can concentrate on your work, and between contractions, so you can rest. This is where your mate comes in. Give him the job of peacekeeper, pledged to banish chattering, noisy, and interfering people from your labor room, and to protect the privacy and the dignity of this event.
9. Lighten up. Create your own labor-enhancing environment: dimmed lights, relaxing music, and whatever people and things you need to manage and progress in your labor. Laughter boost endorphins—stay light!
10. Be romantic. The hormones released during lovemaking also enhance labor; endorphins create pleasurable feelings during sex and also relax mother beautifully for birth. Nipple stimulation, by the mother, by her mate, or from water splashing on nipples during a soak in the tub, releases the contraction- intensifying hormone, oxytocin. A well timed kiss, a caressing cuddle, a sensual massage can all get your birthing hormones working for you. These labor- enhancing hormones also counteract anxiety that may cause your labor to slow rather than progress.
11. Be positive. A negative birthing environment is no help to a laboring mother. Banish negative people from the delivery room. You don't want to hear someone else's war stories, comments about how they couldn't progress either, or their labor-strategy comparisons in which you are the clear loser.
12. Be comfortable. Pamper yourself with as many labor-enhancing amenities as you can think of—your favorite music, soft pillows and delicacies to nibble on. Take a shower, soak in the tub, and keep your masseur busy with the touches you need for peace and comfort. If your hospital offers them, take advantage of the new "birthing beds" that can be adjusted to support you in comfort and in your style of labor and delivery.
13. Be progressive. The top labor aid is a professional labor assistant. Several women whose births we attended brought along their own collection of 3x5 cards containing encouraging quips to relax and empower them. If you like this idea, collect memorable lines from birth books, verses from poems or scriptures, or humorous limericks. Hearing a lovely verse read by your lover may be just what you need to help you relax between contractions.
14. Be vocal. Reserve your etiquette for dinner parties; you needn't be embarrassed about the sounds you make in labor. Many women find power and comfort in letting go with a yell, a prolonged moan or gutsy grunt when the going gets tough. These sometimes-involuntary gut sounds vocalize your release of tension and are a powerful way of mustering up inner energy to get through a really tough contraction. The low-pitched, long groan (gut sounds called "sounding") are releasing and energizing. High-pitched, sharp sudden yells are body tensing and frightening. Be sure to prepare your partner for the sounds you are likely to make.
15. Be mobile. In order to take advantage of your body's natural ability to guide you to the best positions for labor and delivery, however, you may have to first go through a bit of cultural deprogramming. In fact, studies show that women who are not culturally locked into the horizontal birthing mindset tend to assume any of eight different positions during the course of their labor, and most of these are upright, semi-upright, or moving.
16. Be upright. Most women, if left to their own devices, labor in an upright or semi-upright position. When you're upright, gravity helps baby descend. When you try to labor on your back, not only does gravity pull the baby toward your back, but your uterus is now forced to push baby uphill. What's worse, the uterus can now compress major blood vessels that run along the spine, reducing blood flow to the uterus and causing the contractions to become less efficient. When you are upright, your pelvic joints, relaxed by the hormones of pregnancy, are better able to shift and accommodate the little passenger with the large head and broad shoulders. Being upright also allows a more natural stretching of the birth-canal tissues making tears less likely.[/b]
EASY WAYS TO STAY WELL-NOURISHED DURING LABOR
Eat early. Eat to store up energy early in labor. When labor gets hard and heavy your stomach may not cooperate.
Eat often. Grazing (eating small, frequent meals or snacks) is much more friendlier to a squeamish tummy than a big meal.
Eat high-energy food. During early labor load your system with complex carbohydrates (grains and pasta) that are stomach-friendly and that will provide a slow, steady, release of energy over the hours of hard work to follow. In later labor, nibble on or drink simple carbohydrates that leave the stomach quickly and provide quick bursts of energy: fruits, juices, honey. Some mothers nibble on energy bars during labor.
Eat foods that are stomach-friendly. Some mothers experience nausea during labor and find eating and drinking unappetizing. Nevertheless, they need to eat. So bring along foods and drinks that were proven favorites during your early, nauseous months of pregnancy. Foods you tolerated then are the ones you are most likely to be able to digest now. Avoid fatty and fried foods, gassy foods, and carbonated beverages –there is enough work going on inside you without making the intestines labor, too.
Drink, drink, and drink. Avoid becoming dehydrated, which depletes your energy, upsets your body's physiology, and slows labor. Pre-load your tank with at least 8 ounces of water per hour in early labor, and sip between contractions. Be sure to bring at least two water bottles with your favorite fluid to the hospital; place them within easy reach at your bedside. Many mothers in our practice have used a time-tested recipe they call "laborade," which is a healthy version of the familiar drink of athletes. It provides carbohydrates, electrolytes, and minerals to help keep your body chemistry balanced.
1/3 cup lemon juice
1/3 cup honey
1/4 - 1/2 tsp. Salt
1/4 tsp. baking soda
1-2 calcium tablets, crushed,Add enough water to make one quart. You can add an additional eight ounces of water for a milder flavor, or you can flavor this blend with your favorite juice.
Consider intravenous "feedings." If you are too nauseated to eat or drink and your practitioner feels that you are becoming dehydrated, he or she may recommend giving you intravenous fluids. This can perk up a stalled labor or an exhausted mom. An additional benefit: more fluids mean more trips to the bathroom, which, because of the walking and squatting, are themselves, labor stimulators.[/b]
LABOR TESTED BIRTHING POSITIONS
1. Squatting. You may wonder why you should squat when you could be lying comfortably on your side in bed. Squatting benefits mother and baby. It widens the pelvic openings, relieves back pain, speeds the progress of labor, relaxes perineal muscles so that they are less likely to tear, improves oxygen supply to the baby, and even facilitates delivery of the placenta. If you have practiced squatting a lot during pregnancy, it will be easier during labor. If you try squatting down right now, you can probably feel where your upper leg bones, the femora, are attached to your pelvic bones. When you squat, the leg bones actually act like levers to widen your pelvic outlet by twenty to thirty percent. Squatting gives your baby a straighter route through a wider passage, creating the easiest path for moving baby through your pelvis. (Women who have short second stages will choose not to squat.)
2. Kneeling. Kneeling is helpful to ease overwhelming contractions, relieve back pain, or turn a posterior baby. It is also a position that helps you improvise, and can lead to the kneel-squat, kneeling on all fours, or the knee-chest position.
3. Sitting. The sitting position widens the pelvis, but not as much as squatting does. The most labor-efficient position is sit-squatting on a low stool. Alternatives are to sit astride a toilet seat, chair, or a birth ball you may have practiced on. If you must stay in bed because you've had a pain medication, you can sit astride the birthing bed.
4. Standing and leaning. Since your labor is likely to progress more quickly and efficiently if you walk a lot, you may find yourself upright during an intense contraction. Try stopping and leaning against the wall or your birth partner, or resting your head against pillows on a table.
5. Side-lying. Even though moving and being upright helps your labor progress, it is not humanly possible to be upright during your whole labor. Your hard-working body will need some rest, and if you don't get it, it may stop doing its job so well. Best to be upright, in varying positions, during active labor contractions, but to rest as much as possible during early labor and between contractions. Lie on your left side. Support your body with at least five pillows: one or two under your head, one supporting your top knee, one behind your back, and another under the belly.[/b]