Everything You Need to Know About Labor
Once a woman finds out she is pregnant, the most common question that follows is, “What is labor really like?” JustMommies got together with Liz Baker-Wade, a labor and delivery nurse, childbirth educator, and the Founder of Birth and Beyond in Santa Monica. Liz gave us the 411 on what to expect when going into labor.
JustMommies:This is definitely a hot topic. New parents of a ton of questions about labor. As a mom, what can I do to give myself an easier labor and a better experience overall?
Liz:One of the most important things is to understand how we labor women in our culture. In other cultures, women are up, they use motion and rhythm, they are in warm water… but in our culture, we tend to put women to bed early in labor. Does that help? Not really, because gravity helps move the baby through the pelvis. When we put a woman to bed- we increase the likelihood of a long labor, needing a lot of intervention. Lying down inhibits the process of natural labor. As long as you can be up, using motion, using rhythm, sitting on a birth ball, swaying, on all fours ~ the better.
JustMommies:Does labor really hurt?
Liz:Yes, labor hurts. It does. Now it’s an interesting thing, I’ve been taking care of laboring women for years. How each woman experiences labor, has a lot to do with her experience with pain. Some women have a long history with pain. They may have had chronic migraines, back pains, broken bones. They’ve sort of learned how to emotionally, physically and psychologically manage their pain. Therefore, they deal with pain in a different way than a woman who has never had a day’s pain in her life. A women who doesn’t deal with pain very often, might go into a panic mode. It’s the fear, combined with the pain, that makes labor seem so overwhelming and we have to talk that woman off the ledge and let her know that this is normal. We call it “discomfort” or “birthquakes”… but basically, labor pain hurts.
JustMommies:Let’s put labor into perspective. How does it feel?
Liz:For me, it was like really severe period cramps. Now in the beginning of labor, women often experience cramps and it’s no big deal. But when they start adding up- it gets a little bit more formidable, a little more intense. You realize that it may take all your concentration and focus to breathe through it. I think labor should be taken in 15 minute increments. Let’s do this and see how this goes, and then we’ll move on and see how you feel again in 15 minutes.
JustMommies:What would you say are the most popular birthing methods?
Liz:Some kind of prepared childbirth method. At Birth and Beyond, I teach a basic prepared childbirth class that includes relaxation, birth ball work and a massage technique for the dads to do to the mothers. It’s great. The Bradley method of husband-coached, natural childbirth is also very popular. Teachers of the Bradley Method believe that with adequate preparation and education, along with help from a supportive coach, most women can give birth naturally without drugs or surgery. HypnoBirthing is another popular birthing method. Parents actually work with tapes and audio. They are teaching themselves to get into a hypnotic, relaxed state to deal with the pain of labor.
JustMommies:What about water births?
Liz:Unfortunately, you will not find water births in a conventional, urban hospital… probably having to do with space, cleanliness, and liability. Personally, I would love every woman to be able to labor in warm, bubbly water. Water births are perfectly safe. They definitely have been associated with decreased pain because warm water is a muscle relaxant. Babies do not drown. They won’t take a big breath of water until they come to the surface. Isn’t that nice?
JustMommies:Walk us through the process of labor.
Liz:The process of labor is a very individual thing. Everybody wants me to tell them what labor is going to be like and I always say the same thing year after year. The predictability about how labor feels to one woman, how it’s going to go, or how long or short it’s going to take is very poor. Some women experience distinct signs of labor, others do not. Signs that may indicate the beginning of labor include: lightening (the process of your baby settling or lowering into your pelvis), passing of the mucus plug, contractions, breaking of the bag of water, and effacement and dilation of the cervix. Generally, it’s a big waiting game, but going into a natural labor is the next step. Labor contractions usually cause discomfort and a dull ache in your back and lower abdomen, along with pressure in the pelvis. Here’s my rule of thumb, you may be in an early labor pattern for 24 hours. That means completely manageable labor. Your contractions are consistent, but they are not painful enough to make you stop talking, you are not teary, you are not having to breathe through it. Basically, you are able to function in your daily activities. Try to keep busy. Garden, go to lunch, take walks, bake something… there is no reason to go to the hospital unless you feel that you need help or you are having consistent, predictable contractions that are so painful, you cannot speak through them. If you are lucky enough to have a Doula coming to your home, you have that trained extra person who is going to be able to keep you at home longer. Why would you want to stay at home longer? Because once you get to the hospital, you have that cascading, effective intervention. Sometimes, it’s the fear of being in pain at home that brings the mother to the hospital too early. At the hospital, the nursing part of labor begins. We check the cervix to look at effacement, dilation and where the baby is in the pelvis. We take the mother’s vital signs, we obtain blood samples, urine samples and we put the baby on the monitor. Hospitals are very monitor centric. We are watching the baby and we take care of our moms in labor according to what the baby is telling us on the monitor and the mother’s contraction pattern. Ten centimeters is the golden ticket, but you can be ten centimeters and four hours away from pushing time. The baby needs to come through the pelvis and the baby’s head needs to mold and rotate down into the birth canal. Then it’s time to push.
JustMommies: During this process, can you eat… drink… and go to the bathroom?
Liz:If you are in your home laboring, you would eat and drink adequately. Once you get to the hospital, we cut you off from food, which is the complete antithesis of what the contracting uterus needs. Why do we do this? We are worried about liability. If we have to rush you off to a C-section, nausea and vomiting, etc. Therefore, once you are in the hospital, if you are in active labor (greater than four centimeters), if you are on pitosin, if you have an epidural… you are cut off from everything other than ice chips, and the occasional popsicle that your nurse slips you.
JustMommies:How does an epidural work?
Liz:Let me start by saying, I’m not anti-epidural, as I had one myself. The epidural is a wonderful form of pain relief, but it doesn’t come without its consequences and problems. So, it’s not to be taken lightly. The epidural is a vasodilator. That means it dilates the blood vessels and dilating the blood vessels also relaxes muscle. But what do I want the uterus to do in order to have adequate labor? I want the uterus to contract. So, if you have an epidural and you are wanting your patient to contract- then you are fighting against it. The epidural given in an early phase of labor almost guarantees a long, cascading effect of some kind of intervention. You are confined to bed, which now means that using gravity and motion and rhythm is out of the question. The patient is positioned in a way to open the spinal spaces, either leaning forward or laying on your back. The anesthesia that is put on the skin is lidocaine. Once the lidocaine takes effect, the doctor then inserts the epidural needle into the epidural space, not into the spine. A catheter is passed through the epidural needle, left in place and the needle is taken out and thrown away. It’s very important that moms understand there is no needle in your back for the duration. This whole process may sting a little, but most women say compared to the labor pains- bring it on! In my class, I try to discourage use of epidurals in the early phases of labor. Again, the earlier you have an epidural, the earlier that cascading effect of intervention happens. It’s like a train coming out of the station. This train (your labor) now has momentum and at least the epidural is not working so much against you.
JustMommies:How can you better prepare for labor?
Liz:Good nutrition and being in good physical condition. There is a lot of pregnancy yoga going on nowadays. Conditioning is important. The problem is, some people want to START getting in shape when they become pregnant and that’s not recommended… except for walking and light weights. You don’t want to start a hard, driving regime of exercise in your second trimester because you’ll be more prone to injury. I definitely recommend a good, prepared childbirth education class as well. Important questions to ask your teacher: How long have you been teaching? What are your philosophies? Where do you get your information? I would love a teacher who has spent time in labor and delivery. It’s also important to prepare for birth in your class (birth ball work, massage, relaxation techniques). It’s not enough to hand someone a piece of paper and tell them to practice at home. There are a lot of people out there, childbirth educators, doulas, nurses, who are waiting to help women have a good experience. Remember, labor is doable. One of the things we know for sure is that women keep having babies. If it were that horrible, we wouldn’t be having more children. Labor takes research, it takes some courage, it takes a sense of humor. You are leaking fluid, your breasts are filling up, your labor pain hurts… so if you can, dig deeply for a sense of humor. It will help. Plus, the big pay off at the end ~ you have a beautiful baby in your arms!
For more information on Liz Baker-Wade, check out www.birthandbeyond.net.