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The following information should be used in conjunction with childbirth classes. Re- member to take this book to your first class. Register for classes by your 4th month of pregnancy by calling 794- (BABY).
Before Labor Begins
The majority of babies are born between 38 and 42 weeks of pregnancy. However, only a very small percentage of babies are actually born on their due date!
The last weeks of pregnancy, you will notice both physical and emotional changes with your body. These changes tell you and your doctor/nurse- midwife that your body is preparing for labor.
A first baby usually descends into the mother’s pelvis two to four weeks before labor begins. This is called lighten- ing.* With second and subse- quent babies, lightening often takes place after labor has begun.
Your uterus is a strong muscle that surrounds the baby. During the last few months of preg- nancy, the uterus tightens and relaxes. These are called Braxton Hicks contractions. These contractions increase and occur more often in the last month of pregnancy. It is believed that Braxton Hicks contractions help to soften and thin out the cervix. Sometimes they are so strong women think that they are in labor. If the cervix does not dilate (open), they are called false labor con- tractions. Often, lying down on your side or taking a warm bath will cause them to ease up or go away. Another sign that your body is preparing for labor is that you may have an increased vaginal discharge. Just before going into labor, you may have diarrhea and/or flu-like feelings for one or two days. Backache, cramping, energy spurt or fatigue may also occur.
PREPARING FOR
LABOR AND DELIVERY
False Labor
- Little or no effacement* and dilation*(thinning and opening of the cervix) occurs.
- Membranes do not rupture.
- Contractions do not become longer, stronger or closer together.
- Contractions become irregular and stop when you walk, shower, change position or drink fluids.
True Labor*
- Effacement and dilation continue.
- Membranes may rupture.
- Contractions become longer, stronger and closer together. They usually occur at regular intervals.
- Contractions do not stop when you walk or change position.
There are some ways to tell true labor from false labor:
Uterine contractions begin at the top of the uterus (fundus) and continue down to the cervix. They cause the cervix to efface(thin) and dilate (open). During the first stage of labor, the cervix must dilate from 0 to 10 centimeters. This happens over a period of time with an average length of labor for a
first time mother (primigravida) being 14 hours (7 for multi- gravidas). The first stage of labor is further divided into early, active and transition phases. The contractions change in frequency and in strength during these phases. See chart on next page.
WHAT IS HAPPENING DURING LABOR
© Childbirth Graphics Ltd.
Cervical Effacement and Dilation
The second stage of labor begins when the cervix is 10 centimeters. The contractions are usually felt as an urge to push or wanting to have a bowel
movement.* Now the baby’s head and body can be pushed out through the vagina. This may take up to 2 hours or longer.
© Childbirth Graphics Ltd.
STAGE I
STAGE II
WHAT IS HAPPENING DURING LABOR
Illustrations above © Childbirth Graphics Ltd.
POSITIONS FOR LABOR
Pushing
Once your cervix is fully dilated (10 cm), the baby can enter the birth canal* (vagina). If you have had an urge to push before full dilation, it will be a relief to push now. You may feel a variety of sensations: pain; a burning, stretching sensation; backache; bowel pressure; or relief.
It is important to “listen” to your body now: Push when you have the urge. Have patience. It is not unusual to push for several hours. The semi-sitting position is used most often for pushing.
However, there are other posi- tions which may feel better or help to rotate the baby:
Side lying: Lying on your side, you or your support per- son can hold the top leg as you push. This position may increase the pelvis diameter since the tailbone(coccyx) moves slightly back. It is also used to slow down a rapid birth.
Squatting: Using a squat bar on the birthing bed, you can squat to allow gravity to aid your pushing. This position may also help the baby to rotate and descend onto the perineum. Hands and Knees: Used often when the baby is in a posterior position as it helps to rotate the baby’s head. It also helps to relieve back pressure.
Illustrations above © Childbirth Graphics Ltd.
LABOR GUIDE (Remember, every labor is unique.)
Physical
Changes
STAGE I
Early Phase
0-4 cm dilated
Contractions: 5-20 min. intervals 30-45 sec. duration
Active Phase
4-8 cm dilated
Contractions: 3-5 min. intervals 40-60 sec. duration
Transition Phase
8-10 cm dilated
Contractions: 1-3 min. intervals 60-90 sec. duration
What To Do
Continue with usual activities, but sleep if tired. Relaxation – use breathing only if neces- sary. Empty bladder. Call doctor or nurse-midwife when necessary.
Relax, use focal point. Change positions, walk, use labor tub or shower, empty bladder. Concentrate on one contraction at a time. Partner: Offer comfort mea- sures like fluids, ice chips, face cloth, backrub effleurage. Offer encouragement. Low back pressure: pelvic rock. Get up on hands and knees. Lean over with contractions.
Continue relaxation tech- niques. Change positions. Blow out with urge to push. Partner: Stand-up and use eye contact – have her breathe with you. Be patient. Don't leave her. Encourage her— you’re almost to full dilation.
What Women
May Experience
May have bloody show and/or rupture of membranes. Contractions may feel like a backache, pelvic pressure, gas or cramps. Contractions become stronger, longer and closer together. May feel excited or anxious.
Stronger, more frequent contractions. Discomfort in back and/or legs. Becomes more serious, quiet and preoccupied with self. Discouragement – may doubt ability to cope. Low back pressure, nausea and/or vomiting.
Long, intense contractions, leg cramps, shaking, tremors. Feels exhausted, overwhelmed, and wants to give up. Difficulty concentrating, feeling of panic, nausea and/or vomiting. Contractions may have more than 1 peak and seem very long. Relaxation is hard.
Physical
Changes
STAGE II
Birth
Full dilation Pushing Contractions: 2 min. intervals 60-90 sec. duration
STAGE III
Delivery of
Placenta
Contractions: Less intense
What To Do
Assume gravity-aided position. Push towards vaginal opening. Relax perineum and go with the contraction. Relax in between contractions. When the head is crowning, push slowly; pant if necessary.
Hold baby. Doctor or nurse-midwife will repair episiotomy* or laceration if necessary. Medication used.
What Women
May Experience
Tired, but may have a burst of energy. Pressure on rectum and perineum. May feel like you have to have a bowel movement. May have uncontrollable urge to push. Bulging, splitting or stretching sensation. Intense backache.
Variety of feelings: relief, gratitude, disbelief, joy, exhaustion.
Problem
Leg Cramps
She panics
or thinks she
“can't go on”
You're tired –
doubting your
ability to help
What to do for the mother
Place the heel of her foot into your hand. Use your other hand to push the ball of her foot toward her head. Apply warm compresses. Try massage.
Stand up and tell her you're there to help. Hold on to her. Communicate that you care and that she has someone to hold on to. Put your face in front of hers and breathe with her. Tell her she can and will do her breathing. Be “present.” Stay calm. Tell her you love her.
Take a short break. A nurse will stay with her. Eat – you need nourishment. Use relaxation and breathing techniques to calm yourself. Have empathy(understanding), not sympathy (feeling sorry). Remember the nurse and doctor or nurse-midwife are there to help your partner.
Illustrations above © Childbirth Graphics Ltd.
Hydrotherapy
Many women find that being in warm water helps to relieve tension and pain. The warm water helps increase circula- tion/blood flow which may help to increase endorphin production, cervical dilation and reduce pain. You can either use the shower or get into our hydrotherapy tub, which is available on a first come basis.
Position Changes
As indicated earlier, changing your position can help ease the pain of the contractions. Every hour try a new position. See page 90 for recommended labor positions.
Touch and Massage
Many women like to be touched or massaged during labor. Some don’t. You may like massage during some of your labor, but not during other parts. Both you and your part- ner can massage different areas. You might find that effleurage (very light stroking) is helpful, or you may prefer a more force- ful touch, like a massage. Some women like to have just one part of their body massaged such as the foot or back. It is impor- tant to try different types. Use corn starch or lotion so that you don’t irritate your skin.
COMFORT MEASURES
FOR LABOR
