As I wrote yesterday, Hannah and I love the Bradley method. It empowers mothers to deliver their baby naturally, without medications, but it takes commitment and preparation; the expectant mother is an athlete preparing for a big event, and the husband is her coach, prepared to guide and encourage her through a most demanding task, and ready to take care of all extraneous aspects of the delivery to allow his wife to concentrate on labor.
The climax of labor is birthing the baby. Especially in a hospital setting, husband and wife need to be sure of what they want to accomplish, in case the hospital staff is unfamiliar with the concept of natural, unmedicated birth. The very first thing Hannah and I did was write up a birth plan and have our OBGYN sign it (he did not have a problem with it). We then brought this birth plan with us to the hospital during labor and left in plain sight for all nurses to see.
Also important is being thoroughly familiar with the role of both husband and wife during each stage of labor; the husband must also be able to understand all stages of labor and tend proactively to his wife’s needs. He needs to be a prepared, active coach.
What helps a lot is a cheat sheet, a quick guide to help husband and wife recall all the important things to know and do during labor.
Here’s our labor cheat sheet.
Informed Consent: Questions to Ask Before Anything Is Done
Use your BRAIN. It’s always a good idea to bring your brain everywhere you go, but when dealing with medical decisions, you also want to remember your B.R.A.I.N., an acronym for benefits, risks, alternatives, intuition, nothing.
- Is this an emergency? Or do we have time to think and talk about it?
- What is the benefit of doing this (undergoing this procedure)?
- What are the risks?
- If we do this, what other procedures or treatments might ensue?
- Do we have alternatives? What else can we try first or instead of this?
- Can we have a moment alone to discuss this, please (intuition)?
- What would happen if we didn’t do this at all (do nothing)?
Remember, doctors and nurses are there to help, but they might not share your mindset of a natural birthing experience; they might also think about legal issues, encouraging procedures to avoid malpractice lawsuits; or they might push treatments and procedures for purely financial gain; labor and maternity care is, in fact, a highly profitable business for hospitals.
What to Bring to the Hospital
Ok, now the fun stuff. If you are not giving birth at home, what do you bring to the hospital or birthing center to help you during labor? You will want to create a quiet, hushed “bedroom” atmosphere, which will help the expectant mother relax. Here’s what Hannah and I have packed, since our little boy is due any day now:
- husband: comfortable clothing, crocks, swim trunks and flip flops (to help mother labor in the shower), toothpaste and toothbrush, #1 Dad shirt and hat;
- wife: bathing suit, flip flops, change of clothes, bathrobe, slippers, toothpaste and toothbrush, a few nursing pads;
- baby: outfit, hat, socks, burp rags, little blankets;
- food: organic power bars, lots of water, unpasteurized orange juice and honey (to replenish wife when she gets hungry during contractions), plastic spoons;
- a portable desk fan, to help overcome nausea during transition;
- iPod and iPad with a sound station; we found a used Sony one that sounds great for $65;
- Optional: an oil diffuser and essential oils to overcome that nasty hospital room smell;
- Washcloths (and lavender oil) to wipe perspiration from the mother’s brow
Am I in Labor?
Contractions: true labor is different from Braxton Hicks contractions. Labor contractions have the following characteristics:
- they are longer, stronger, and closer together;
- they are accompanied by abdominal discomfort or pain;
- they rarely exceed one minute in early labor;
- they are often accompanied by increasing back ache and restlessness;
- they are not reduced by the mother’s activity; they might actually increase with activity.
In contrast, false labor contractions have the following characteristics:
- tend to stay at about the same length;
- are usually not painful; if painful, the pain stays at the same level;
- may last 30 seconds to four minutes;
- are affected by changes in the mother’s activity.
During true labor, bloody show is often present before and during early labor. Intestinal symptoms are frequent soft bowel movements, often mistaken for digestive upset. Changes in the cervix show with progressive effacement or thinning, progressive dilation.
- time: 7-8 hours;
- contractions: 8 1/2 minutes apart (can vary), with duration of 30 seconds;
- mother’s behavior: happy, excited;
- cervical dilation: 0-3 centimeters.
- time: 3-5 hours;
- contractions: 3 to 5 minutes apart (can vary), with duration of 60 seconds;
- mother’s behavior: “this is hard work, but I can do it!”;
- cervical dilation: 3-7 centimeters.
- time: 15 to 90 minutes (hopefully 15 );
- contractions: 2 to 3 minutes apart, with duration of 60 to 90 seconds;
- mother’s behavior: confused, scared, often wants to give up;
- cervical dilation: 7-10 centimeters.
- time: 30 minutes to 2 hours;
- contractions: 3 to 5 minutes apart, with duration of 60 seconds;
- mother’s behavior: “what a relief!”;
- cervical dilation: 10 centimeters.
Four Things Measured During Exams
- Dilation of the cervix, measured in centimeters, from 0 to 10;
- Effacement of the cervix, measured in percentages, from 0% to 100%;
- Station of the baby: how high or low the baby is in relation to the ischial spines. A minus (-) sign means the baby is above the ischial spines; a plus (+) sign means the baby is below them;
- Presentation of the baby. Posterior (OP) presentation means that the baby’s occipital bone (back of the head) faces the mother’s back. Referred to as “sunny side up,” it creates back labor, which is very painful. Anterior (LOA) presentation means that the baby’s occipital bone faces the mother’s front; it’s the common and best position for baby and mother.
Possible drawbacks associated with (frequent) vaginal exams:
- they could cause the water to break prematurely;
- they can increase the chances of infection;
- they can result in misleading information.
- Don’t pay attention too soon;
- Face your labor calmly;
- Go back home if you arrive at the hospital too early (or don’t check in; walk outside the hospital);
- Relax all muscles during contractions:
- Walk during labor;
- Drink lots of water (or eat ice chips);
- Keep your lips moist during contractions (abdominal mouth-breathing makes for dry lips);
- Eat if you are hungry;
- Sleep if you are sleepy;
- Stay active during early first stage;
- take a warm bath or shower;
- Avoid medications (unless it’s an emergency);
- Husband/coach to encourage wife enthusiastically;
- Use natural techniques to speed labor (squatting, sitting on exercise ball, pelvis rock);
- Push only when the urge is irresistible;
- Use positive pushing techniques;
- Use effective pushing positions (squatting, sitting upright on bed).
Contractions are timed from the start of one to the start of another.
A first-stage contraction is like a wave building up in intensity, staying hard for a while, then subsiding. The peak is usually reached by 30 seconds.
Mother’s first-stage checklist:
- sleep imitation;
- eyes closed with a relaxed face;
- abdominal breathing.
Husband’s (coach) checklist:
- quiet room, soft music, diffused lighting, “bedroom atmosphere” recreation;
- check mother’s position (never on her back);
- check her relaxation (gently check muscles from forehead down);
- time contractions;
- guide her breathing;
- rub her back (especially the “saddle area”);
- talk to her (soft “love talk” or talk of the new baby)
Six First Stage Needs
- Darkness and solitude
- Physical and mental relaxation
- Quiet room
- Physical comfort
- Controlled breathing
- Closed eyes and appearance of sleep
Three Types of Relaxation
- Physical: relax all muscles from head to toe, under the guide of your husband/coach;
- Mental: think of beautiful things (memories, upcoming baby);
- Emotional: feel the beauty of the birthing experience and the awesome role you play in it.
What the Husband Should Say during Labor
- Isn’t my wife doing great?
- I love you.
- Welcome each contraction with a relaxing breath.
- That’s it. That’s the way. Just like that. Do it again just like that.
- With each relaxing breath you take, you are filling up our baby with oxygen.
- That was a powerful contraction! You handled that perfectly!
- Wow, honey, that was great! I’m so proud of you!
- You are working hard, thank you. You are doing a wonderful job.
- I love you so much. I can’t wait to hold our baby!
- Each contraction is opening the way for our baby! He (she) can’t wait to see us!
- Now that the contraction is over, relax completely.
- Visualize the contraction melting away your cervix.
- Open, release, let go, float it with. That’s the way. Good job.
- I’m here for you, honey. We’ll do this together.
- You are doing great!
- Welcome contractions. They are telling you the baby is coming soon. We’ve been waiting so long for this very moment. This is it!
- Flow with the intensity of the contraction, ride the wave, go with it, you are a labor athlete during your finals!
Transition is short, but it’s the toughest part of labor. The pressure is so intense, the contractions so strong and close together, that your wife will feel utterly confused and scared. She will want to give up. This requires special encouragement on your part:
- Yes, you can do this, honey. This is the hardest, but shortest part. It’s almost over. The baby is counting you. You can do this! [give her space, use the portable fan to overcame transition nausea]
- Yes, you can. You’re doing it right now. You are much stronger than you give yourself credit for. I know you can do this. The baby is coming. We’ll see him soon. You’ll hold him soon.
- Let’s just work only with this contraction. There’s only this contraction, and it’s almost over. You are almost done with it! Oh, our baby is coming so soon. You are doing it. You are a superstar!
- It’s ok to cry, if you want to. That’s it. Let go. Let go. Our baby is going to be so thankful for you!
In Case of Back Labor
- Conter-pressure in several places is usually most helpful. This requires help from the husband or coach, as it might need to be done for quite a long time;
- Take one contraction at a time;
- The husband should rub his wife’s back with a tennis ball;
- The most likely reason for the back pressure is the posterior position of the baby. What usually helps in this case is for the mother to try the pelvic rock;
- The husband should strongly encourage his wife to take one contraction at a time.
In Case of Long Labor
- Encourage your wife continually and enthusiastically;
- Encourage your wife to sleep between contractions;
- Try going for a walk; a change in environment can really make a difference;
- If you are stuck in early labor (less than 5 cm. in cervix dilation) consider going home and laboring in there, especially in your bathtub;
- Go to the bathroom often;
- Eat and drink often;
- Perform pelvic rocks;
- Try squatting for a while, as this position opens the outlet of the pelvis;
- If her water has broken yet, doctors encourage a warm shower, or better yet, a warm bath. The husband may want to jump in the tub with her;
- Be reassured that long labors most often lead to natural, normal, beautiful birth;
- Husband call call coach reinforcements;
- Remember that all things in nature happen for a reason. Going along with a natural process requires patience and adaptation.
It’s very important for the husband to coach his wife during second-stage contractions. As the contraction starts, say to your wife, ” Take a deep breath, release, take a second deep breath. Very good, now release that and take a third, deep breath; hold your breath, get into pushing position and bear down. Very good; only hold your breath for as long as comfortable. Good, now release the stale air, take another deep breath, hold and continue to push. (If contraction continues) Great, now take your last deep breath, hold, and push. Excellent job. Now let’s rest till your next contraction.”
Between contractions, offer your wife a drink of water, orange juice, or some ice chips. Massage her back, especially her “saddle area,” and wipe her brow with a cool wascloth. Remind her that she’s doing great and praise her for her efforts.
Tips for Mother
- Hold breath only as long as comfortable;
- Push only as long as comfortable;
- Push with the contraction. go with the urge you have; follow your body.
Positions for Pushing
- Alternate classic position
- Side position
- Squatting position
- Assisted squatting position
- Hands and knees
- Asymmetric position (on one knee)
- Standing (coach-supported)
In the very rare case of an emergency childbirth, keep these points in mind:
- Stay calm; there are doctors and nurses ready to help;
- Keep your hands clean and away from the birth canal;
- Watch your breathing;
- Make sure the baby’s breathing is good;
- Place baby’s face down across mother’s abdomen;
- Keep baby warm;
- Immediate breastfeeding will help expel the placenta and lower the risk of excessive bleeding, will keep the baby warm and nourished with essential immunities);
- Keep baby with mother as much as possible;
- Keep mother as comfortable as possible.
What Not to Do
- Do not hurry;
- Do not pull on the baby; let the baby be born naturally;
- Do not pull on the cord; let the placenta come out naturally after birth;
- Do not tie and cut the cord until both baby and the placenta have come out naturally;
- Do not take medications unless it’s a real emergency.