Prelabor signs

Some signs that labor may begin in the next few days or weeks include:

*baby drops lower into the pelvis.
*low backache, different from the normal late-pregnancy tiredness.
*increased urination and bowel movements, perhaps accompanied by abdominal cramps and diarrhea.
*sudden burst of energy (nesting instinct).
*increased vaginal discharge of egg-white consistency.

Changing Positions During Labor

Changing positions during labor is very important. Even if you are confined to the bed - moving around - changing sides you lay on - or sitting up will help to dilate and efface the cervix. Gravity will also aid in bringing the birth about quicker. If you can walk around or sit in a chair this will greatly help. If not, moving around in the bed - even if you have to use a bed-pan can help to bring about the birth quicker.

How do I know I´m in labor?

Signs that indicate that this is likely "real" labor:

*contractions become progressively more regular, intense and last longer.
*intensified by walking.
*don´t stop when lying down or changing activity.
*contractions are accompanied by a "show" of blood-tinged mucus.
*accompanied by effacement and/or dilation.

Remember that labor may start and stop before finally continuing all the way to birth...don´t be discouraged. Any work done at this time is work that doesn´t have to be done later!

Avoid hyperventilation

The fast panting style of breathing should be avoided except in the case of a mother needing to temporarily avoid pushing.

If fast breathing is necessary, periodically take a cleansing, deep breath slowly released.

If you do hyperventilate, immediately slow down your breathing. You can also re-breathe your own air by tightly cupping your hands around your nose and mouth, or using a surgical mask or paper bag.

Bloody Show

The bloody show is often present at the onset of true labor. This happens when the cervix dilates and effaces - often the mucus plug has already passed. When the "show" is brownish - this is usually false labor. True bloody show will be pinkish and the birth could be only 24 hours to several days from happening.

Let people know how you are doing

Don´t just assume that all pain in childbirth is unavoidable. Be sure to let your caregivers know what is going on with you. They may well have suggestions for you that can ease your discomforts without medication. If you let them know you are having pain in your back, for example, they can help you change positions so as to minimize that. It might also give them clues as to baby´s position that will be helpful to know to allow you to work with your body most efficiently.

consider water

Water greatly reduces the perception of pain
during labor...consider the shower, tub or
jacuzzi while in active labor. It can also
help you relax enough that labor often moves
along more quickly.

Timing Contractions

When true contractions hit - it´s important to time them. They may start out at 15 to 20 minutes apart - they will gradually get closer together and grow in intensity. You time them from the beginning of one to the beginning of the next. Also, time the duration of each contraction, i.e. - 30 seconds, 60 seconds. The contractions will start out small and will get longer and stronger as the birth approaches.

Use technology wisely

For the vast majority of women giving birth is not a medical crisis; it is a normal, biological event. It will proceed perfectly well of it´s own accord.

Technology, used wisely can predict and rectify potention problems. Misused, it can often *become* the problem, starting off a domino of events leading to an increased likelihood of surgical birth.

Learn ahead of time about both the benefits and the risks of various tests and technology, then make an informed decision about which you will submit to.

Natural oxytocin

Use techniques that make your body release oxytocin, the hormone causes contractions. Nipple stimulation or sexual contact (including intercourse if your water has not broken) are natural means of releasing oxytocin and may speed up a stalled labor.

When to go to the hospital

For most women the best bet is to stay at home for as long as possible. Early arrival at the hospital may cause labor to slow, opening the door for questionable interventions.

Ask your doctor at a prenatal visit when he or she would like you to go in, but for most women a good rule of thumb for first-time mothers is to go when contractions are 5 minutes or less apart, last at least one minute, and are strong enough that you need to focus solely on them.

Before heading to the hospital

Grab a light snack before arriving at the hospital. It´s a known fact that once you are admitted you will not be allowed to eat until after the birth of the baby. Better to eat something light before you arrive.

True Contractions

True contractions will grow stronger and closer together. They will increase in intensity when changing positions. Braxton Hicks contractions will go away when changing positions and will not be regular. True contractions may be accompanied by lower back pain that radiates to the lower abdomen and possibly down the legs. Diarrhea may accompany the contractions as well as bloody show.

Keep you bladder emptied

Remember to empty your bladder every hour (more often if you feel the need) during labor. A full bladder makes contractions more painful!

Get to the hospital in a hurry if...

The following symptoms indicate a potential problem and mean you should get to the hospital immediately:

*sudden gush of a large amount of blood
*sudden intense pain in the uterus that feels
different from a contraction
*persistent faint feeling
*your intuition tells you something is wrong.

Heading To The Hospital

When to head to the hospital depends on the status of your pregnancy health, how far you are from the hospital and how close together your contracions are. You should have discussed with your doctor or midwife about when you should head to the hospital. As a rule of thumb, under normal circumstances, usually your doctor will suggest to wait until your contractions are about 5 minutes apart. This will vary according to whether or not your bag of waters has broken, if this is your 2nd or subsequent pregnancy, etc.

Getting A Good Night´s Rest Right Before Birth

The last month of pregnancy can be truly uncomfortable. Sometimes getting a good night´s rest seems impossible. Try taking a warm bath (if premitted) or shower to relax your muscles. Wear comfortable clothing and be sure the room temperature is just right. Place a pillow between your knees and thighs and try one at your feet and behind your back. Quit drinking liquids about an hour before bedtime to avoid adding to the already numerous nightly bathroom trips. And lastly, just think about how your baby will be born soon - and physically you will be able to sleep much better.

Prepare ahead of time

Have as much ready as possible ahead of time. Put a comfortable pillow in the car, and a plastic sheet in the event that your water has already broken when you go to the hospital. Have your route planned out. And don´t forget to pre-register; you won´t be in the mood for paperwork when you go to actually check in!

Stay active

Move around during labor, changing position frequently. This will help you cope with the contractions and will also keep your labor progressing.

Tips For Easing Back Labor

Back labor usually happens when a baby is posterior, with the back of the head pressing against the back of the pelvis. First thing you can do to relieve back pain is to change positions, walk around if you can. Have your coach apply heat or cold to the spot. Sometimes applying counterpressure helps to relieve the pain. Have your coach massage the area with a tennis ball - firmly. Though this may leave you a little sore - it helps at the time.

Cervix dilating

Before labor the cervix should remain closed. As labor approaches it will start to dilate. This process can happen over weeks or within hours.

Mucus Plug

The mucus plug can be passed some 3 weeks before actual labor hits - or it can pass the same day as delivery. The mucus plug will come out if the cervix has started to dilate and efface. It will look like a gelatinous mass - sometimes blood-tinged, sometimes clear or yellowish. It can resemble a mass of "stringy" mucus. Occasionally it is accompanied by a bloody discharge.

keep moving

Change positions often during labor. What feels
great at one point might not be good at all
at another. When you change positions, give the
new position a couple of contractions before
deciding if you like it or not.

Eat and drink during labor

Labor is an intensely demanding physical task and you must keep well-hydrated and keep your energy up. Eat lightly (yogurt or applesauce for example) during early labor (you won´t feel like it later) and drink honey-sweetened herbal tea or an electolyte-balancing solution. Remember to drink plenty of good old water as well!

Stay upright

Take advantage of the effects of gravity! Stay in an upright position as much as possible during labor. Standing, walking, squatting, kneeling, sitting in an upright chair or tailor-style on the floor are some good examples.

vocalize

Many women find it helpful to vocalize during
labor. A deep, gutteral, almost animalistic
sound is what you are after. (Shrill sounds
involve a closing of the throat and an
accompanying tightening of the vagina. They also
do not reduce pain like the deeper sounds.)

Do not be dissuaded by the cultural bias our
society has against such vocalization by women.
Imagine a man involved in doing heavy physical
labor or participating in a vigorous sporting
event...we expect to hear him grunt and otherwise
vocalize. You are doing every bit as much work
as him!

Signs of True Labor

True labor usually begins with contractions that intensify rather than ease up - more than 4 an hour. When you change positions or move around and the contraction gets stronger - it is the real thing. Pain, if any, starts in the lower back and can radiate down the groin and into the legs and feels like you need to have a bowel movement. The contractions will become more frequent and will increase in duration, though they may not be "text" book - i.e. - every 5 minutes. They may be 5 minutes, 8 minutes, 10 minutes, 4 minutes, etc. Bloody show or blood-tinged mucus will start during true labor. Membranes may rupture, though this only happens in about 15% of labors. The rupture may be a gush or a trickle.

Take responsibility

Remember that it is YOUR body, YOUR baby and it is YOUR responsibility to make the decisions that are best for you. Don´t just accept anyone else´s word for what that is. It is you who will live with the consequences of your decisions.

Make a trial run

To help ensure an uneventful trip to the hospital, make a practice trip before the big day. Find out alternate routes in case of heavy traffic, where to park both during the day and after hours, and which roads are the least bumpy.

Music

Find some music that you respond well to. Music can be very effective in helping you get and stay relaxed.

Lavender

If you are able to carry something with you that smells like lavender.it will help to clam and relax you during child-birth,making delivery a little easier.

Don´t watch the clock

The uterus works at it´s own pace. Remove all clocks from the room. Lulls in labor are normal, allowing you time to rest and recharge.

What to find out about your hospital

If you are planning a hospital birth, here are some of the things you will want to find out about the hospital ahead of time:
*Is there and LDR (labor-delivery-recovery) room?
*What is the level of emergency care, both obstetrical and newborn?
*Where is the night entrance?
*What degree of privacy can you expect?
*What facilities are available for your partner and/or labor support people (beds, etc.)?
*What are the visitation policies?
*Is there a board-certified lactation consultant on staff?
*Will the staff accept and work with your labor support person?
*What are the policies as to who may be present at the birth?
*What interventions (EFM, IV, etc.) are routine?
*How much freedom of movement will you be allowed?
*Is eating and drinking allowed?
*Is photography allowed?
*What are the options for the immediate postpartum period?
*How do you pre-register?
*What are the costs you can expect, and does the hospital participate in your insurance plan?
*Is there a hot tub available?

Is labor near?

These signs indicate that you will likely give birth soon:

*prelabor contractions (stronger than Braxton Hicks contractions).
*bloody show.
*leaking water.

Have you thought about a doula?

A doula (also known as a monitrice or labor assistant) is a woman knowledgeable in the normal course of labor and birth, whose role is to support the mother and father during the labor and birth. This support can take on many forms, depending on the needs of the family.

The doula does not replace the father, but rather frees him up to simply love the mother as well as deal with the changes he himself is undergoing as a new father.

Hypnobirthing

You may have heard of this "new" method for coping with labor. It is not actually new at all, and it is not actually even hypnosis in the sense that most of us usually think of it. It is really just a method of very deep relaxation, and it is extremely effective. See if there is a childbirth educator in your area that is familiar with it and see for yourself!

Doulas

Doulas decrease
the number of cesareans by 50%
length of labor by 25%
Pitocin use by 40%
use of narcotics by 30%
requests for epidurals by 60%
the need for froceps/vaccum extractor by 40%
the number of neonatl problems and the incidence of postpartum depression
Doulas increase
the level of maternal satisfaction with her birth experience
the partner`s confidence and participation level
the number of mothers breastfeeding their babies
the rate of successful breastfeeding at 3 months
the intensity of mother/infant bonding
maternal self-esteem

Kennell, John,M.D., et al. "Continous Emotional Support During Labor in a US Hospital," Journal of the American Medical Association 265:17, May,1,1991

Homemade Electrolyte Balancing Solution

It is important to keep well-nourished during labor. If you find that you are nauseated or for some other reason unable to eat, try this homemade version of the expensive electrolyte-balancing solutions such as Gatorade.

1 tsp. salt
1 tsp. baking soda
4 tsp. honey
lemon or lime juice to taste
1 qt. water

Consider dad´s role

We usually think of Dad as the "coach." In some cases he may be great at talking you through tough contractions and offering lots of verbal encouragement, but others may be better at offering quite support, such as hair stroking, offering water, etc., or even tending to the older children. Don´t assume that there is only one right way for dad to offer support.

Use a midwife

The obstetrician has an invaluable role in the management of high-risk or complicated pregnancies and deliveries. A midwife is not a lesser-trained OB; she is of an entirely different profession. Her training is in assisting mothers with normal pregnancies and labors. She also knows how to recognize potential problems that warrant an obstetrical consultation.

While an OB is highly trained in what to do when something goes wrong, the midwife knows that things usually go right, and her role is to facilitate the mother in her birth. She feels she has done her job best if, after the birth, you feel you didn´t need her.

Delivery of placenta with waterbirth

Childbirth practitioners are divided on the issue of delivery of the placenta in water. Physicians and midwives who allow women to deliver the placenta in the water report that it is safe and without side effects. Using this method, the umbilical cord is not cut or clamped until the placenta is out of the woman´s body. Doctors and midwives have observed that there is less bleeding and that the babies almost always start nursing immediatly after birth, which helps with the expulsion of the placenta. Some midwives state that the time allowed for the passage of the placenta increases slightly with birth in water. It is their general feeling that the water relaxes the uterus and that the contractions for birthing the placenta are less effective when a woman stays in the water after the baby´s birth. When some women stand up to get out of the tub, however, the placenta virtually falls out. -Barbara Harper, RN, "Gentle Birth Choices," Healing Arts Press, 1994