Labor is work. That’s the very definition. Sometimes, it can be difficult, daunting, physically demanding, soul-testing work.
It’s also a fitting way to describe the labor a mom-to-be will face. But some things can make that process a little smoother — more comfortable and relaxed, less stressful and anxious. Perhaps a little less work.
It starts before you get to the birthing room, by planning ahead and preparing your mind and body for the rigorous journey you and your baby will take to finally meet face to face.
Planning for labor, delivery and a hospital stay
Birth plans have been around for a while now. They’re useful to help women consider myriad answers to the question, “When you think about your ideal birth and hospital stay, what would that look like for you?”
When women started paying a lot of attention to birth plans as a tool to share their preferences, for example, for skin-to-skin contact with the baby, or designating the father as the one to cut the umbilical cord, hospitals listened. “The majority of places, including Sanford Women’s, have made what women desire pretty standard,” said Heather Spies, M.D., an obstetrician-gynecologist at Sanford Health.
Now, women receive a checklist — a birth plan wish list — that they can start with and then add to or subtract from to plan their experience. “It’s reassuring to patients because they see that we’ve already been doing those things,” Dr. Spies said. Delayed cord clamping, to allow more blood to flow from the placenta to the baby after delivery, is a fairly recent practice that now has become pretty standard.
“I think it’s good when people take an active role in thinking about their labor and planning ahead,” Dr. Spies said. Of course, not all things go according to plan. Kids tend to remind us continually of that, even from the very beginning of their lives. So while preferences are key to consider, keeping an open mind is also essential to a happy labor and delivery.
“If you get set in your mind exactly how you think your labor will go or how you want it to go, it sets you up for a feeling of failure even though it isn’t,” Dr. Spies said.
Specifics a birth plan can address
Just as every baby is unique, a birth plan can be customized to answer some basic questions:
- Who will be in the room with you?
- Do you prefer a natural, medication-free labor? Or do you want or are open to an epidural?
- Do you prefer intermittent monitoring of your baby in labor?
- What things sound good to you in labor? (birthing ball, whirlpool, walking, etc.)
- Do you have preferences on induction of labor or augmentation of labor?
- Do you have a preference on the position in which you give birth?
- Would you like a mirror to see your baby being born?
- Do you prefer delayed cord clamping?
- Do you have preferences on routine medications given to you or baby?
- Are you breast- or bottle-feeding? Are you OK with a pacifier being given to your baby?
- Do you want skin-to-skin after baby is born?
- Do you have preferences on baby care?
- Would you like the baby to “room in?”
- Do you have feelings on immunizations given in hospital?
- Do you want to avoid circumcision for a boy?
Things you can do now that will pay off in labor
From exercise to education, the choices you make during pregnancy can add up to an easier labor later.
- Exercise: For many women, it can be tempting to fall back on the old “eating for two” excuse. However, maintaining a healthy weight is not only important for the health of you and your baby, but those who stay in shape tend to have shorter labors. Staying fit also improves endurance, helping you better tolerate labor.
- Classes: Sometimes knowing what to expect is half the battle. Taking a childbirth class will help you better understand the stages of labor and what your body will be undergoing.
- Kegels: You’ll use a lot of muscles during labor, but strengthening one in particular might make a big difference for labor and in recovery as well. Kegels help strengthen the pelvic floor muscle. So first you have to recognize where and what that muscle does. Go to the bathroom and try to stop your flow of urine, but do it without contracting your abs, butt or thighs. You have just isolated the pelvic floor muscle.
Methods to ease labor
No longer do women have to labor in bed:
- Try different positions: Don’t be afraid to move. Standing up and moving helps the baby’s head to press on the cervix, increasing dilation. Plus, moving around, whether kneeling, squatting or standing, helps to widen the pelvis for when baby’s head is ready to pass through.
- Massage: For some distraction, have the support person can give a little massage during labor. Stimulating an area that is in pain can help soften the pain messages sent to the brain. Switch between a head massage in the first few hours to the lower back when contractions get tough later.
- Visualization: Practice this one ahead of time. Visualize the labor and childbirth. Practice visualizing somewhere you love to be, like on the lake with the warm sun on your face and a cool breeze. Picture the sand beneath your toes. Some might even envision their cervix opening like a blossoming flower when the contractions come. This can help in maintaining focus during contractions.
- Breathing: Nice long, deep breaths help relax the entire body and thus decrease discomfort. The more tense you are, the more pain you will feel.
Women are encouraged to take advantage of tools such as birthing balls or music, or whirlpool tubs if available, in birthing suites. “I think those absolutely contribute to a good atmosphere to help women relax,” said Dr. Spies. “Mindfulness and how you feel and how you can control your feelings during labor is very important.”
They can even bring in a favorite pillow or favorite pair of socks — “little things that can help them relax.”
As women approach this monumental task ahead, Dr. Spies wants to assure them that they won’t be alone in making decisions. “They’re going to have support throughout the whole process,” she said. “During active labor, they are one-on-one with the nurse the entire time.”
Answers to questions about water birth
Some Sanford Health locations offer the option of water birth for low-risk deliveries. Here are key things to know about water births.
Is it safe to deliver a baby in the tub? Research says yes. Multiple studies have found that giving birth in water is both safe and beneficial to certain mothers and babies. The prolonged stay in warm water combined with the absence of gravity on the mother’s perineum make the tissues more supple. This may have the effect of reducing the risk of pelvic floor tearing or trauma.
Can the baby drown? The answer is no. It’s important to note that in a water birth attended by certified nurse midwives, infants aren’t kept under water after birth. They are slowly brought to the surface by the mother or midwife. Many natural reflexes prevent the baby from breathing under water.
The four main reasons newborns do not take their first breath under water are:
- A mild lack of oxygen called hypoxia delays breathing.
- Fetal lungs are already filled with fluid.
- Infants have a dive reflex, holding their breath when submerged in water.
- The hormone prostaglandin E2 restricts the baby’s ability to breathe immediately after birth.
Which moms can deliver in water? While water can be beneficial for almost every mother in labor, some women can be excluded from delivering in the water under specific circumstances.
A water birth is not safe for everyone. Many reasons can prevent a woman from having a water birth, so she should discuss the option with her doctor if she’s interested. Here are some of the qualifications a woman must meet to deliver in water:
- Have a head-down baby.
- Be at least 37 weeks gestation.
- Have no medical risks, such as excessive vaginal bleeding, maternal fever, non-reassuring fetal heart rate, preeclampsia or thick meconium fluid (baby’s first bowel movement).
- Have only one baby in utero.
There are different medication options available to consider, if needed.
Intravenous medication, or a shot of medicine in the IV, can provide mild pain relief, generally providing some relief for about an hour. Most women who have this type of medication would say, “It takes the edge off.” Often women can rest a little after they have had a dose of IV medication.
Another option is an epidural. An epidural is a shot of medicine into the epidural space of the spine. A small tube left in the back can continuously provide medication until the baby arrives. An epidural can limit movement; often, a woman’s legs will be somewhat numb, and she won’t be able to move them like normal. But with this comes pain relief from the lower rib cage down to the toes. Usually with an epidural, women can feel only slight pressure with contractions.
The push is on
Eventually, all of those contractions lead to the cervix dilating and the baby descending into position. Once the cervix completely dilates, it’s typically time to start pushing if the woman is comfortable. As with labor, though, pushing can be a different experience for each woman.
“Like anything with medicine, we always take it on an individual basis with the patient,” said Dr. Spies. The decision of when to start pushing can vary depending on, for example, how strong and frequent the contractions are, whether it’s a first baby for the woman, how long the labor has been, the woman’s exhaustion level and how far the baby’s head has descended.
A recent study has reassured doctors and patients that whether a first-time mother with an epidural starts pushing immediately, or whether she takes a bit of a rest first, neither will more likely lead to the ultimate outcome of a caesarean section. The previous belief was that if women in that situation delayed pushing, it could help prevent C-sections.
Sanford Health’s C-section rate is already low compared to the national average, Dr. Spies said. “Part of the reason is because we have someone in the hospital 24/7, so we’re able to take our time and monitor labor very closely.”
Pregnancy classes available
Sanford Health offers a variety of classes to prepare new parents for labor, delivery and parenting.
- Podcast: Supporting natural birth through low intervention
- Busting the myths of midwives
- Your guide to contractions: What to expect in labor