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Ten Tips to Change the Course of Your Birth

By Brittany Sharpe McCollum, CCE(BWI), CD(DONA)

 

A positive laboring experience has the potential to increase satisfaction with the overall birth process, deepen parent and infant bonding in the first few weeks, and set the stage for a healthy transition into the postpartum experience (Simkin).  One’s outlook on their birth, however, has less to do with how the process happens or whether it goes “according to plan” and more to do with how involved the laboring person feels in the decision making process and supported they feel in using their voice (Elmir).  Although prenatal preparation, such as nourishment and hydration, movement, and conscious decision making regarding providers and birth support, is an incredibly important component of a healthy birth, it is also important to remember that circumstances and choices made during the process can also help to keep the labor on a positive course. Here are a few tried and true suggestions for preparing for an empowered and healthy childbirth experience.

 

Keep it to yourself.

As the saying goes, “A watched pot never boils.”  Texting friends and family or posting contractions on social media is a quick way to invite anxiety and fear into a birthing space.  Unfortunately, many people – even those whom have given birth before – are not aware of the normal physiological process of labor, the myriad fluids that the body excretes, and the wide range of normal in length of time of labor.  This means that a flood of questions will need to be fielded (or ignored) if the first contraction is shared with too many people whom have too little info about the variations in healthy birth.

 

Distract yourself…

until you can’t be distracted any longer.  Paying too much attention to the pattern of contractions or the variations from one wave to the next only wears the laboring person out mentally and physically.  Think of early labor as the end of pregnancy and conserve mental energy, relax the thinking brain, and get last minute loose ends tied up instead.

 

Call your doula. 

A doula can offer suggestions and guidance for coping with labor even before they arrive in person.  The reassurance of this professional birth support can help decrease fear and anxiety in partners, friends, and family members so that they are able to offer the best support possible to the laboring person and the hands-on comfort techniques, position change suggestions, and encouragement can help create an environment of serenity, confidence, and progress.

 

Make an evidence-based decision when/if your water breaks.

Yes – your water may not break!  Or it might, at any point in labor.  If the amniotic sac releases before consistent contractions and after 37 weeks of pregnancy, it is given the name “Term PROM” (premature rupture of membranes with a baby greater than 37 weeks gestation).  Although the majority of people have their water break at some point during consistent contractions, about eight to ten percent of people have their water release first.  Unlike the movies, where the water breaks and hard labor begins immediately, research shows that between 77 and 95% of people will begin labor within 24 hours.  Nope, not necessarily 24 minutes.  And studies also suggest that inducing labor with PROM is just as valid a choice for most people as is waiting up to 72 hours for labor to begin on its own.  To read more about the research and extenuating circumstances, check out this thorough article at Evidence Based Birth.

 

Get in the tub…and then out of the tub.

In the vein of Michel Odent, the tub will either get your labor moving or slow your labor down. When used early on, immersing oneself in water can be a great way to relax and allow for some rest before things get more intense.  However, used for too long of a time in active labor, water immersion may keep things from progressing and slow the pace of contractions at a time that is not ideal.  The use of the tub in transition?  Go for it!  The relaxation at such an intense point of labor may help move the birthing person right into pushing.  And evidence shows that water immersion can have a significant effect on decreasing one’s perception of pain.  Bottom Line: The tub may be best used at the beginning and towards the end of the first stage of labor and can be a great tool for managing discomfort.

 

Know your rights. 

Know your rights.  Know your rights.  Know your rights.  It can’t be said enough.  No matter how one chooses to give birth or what the circumstances leading up to the decisions are, it is crucial that the laboring person be aware of their rights during labor so that they can remain as in control of the decision making and as involved in the process as possible.  Research shows that it’s not how someone gives birth or whether things went “as planned,” but how someone feels about how they give birth which is tied to their feelings of control over decisions made in labor (Listening to Mothers).  And without a solid knowledge of what one’s rights are (and whether they in fact line up with birth place policy), it can be quite challenging to…

 

Use your voice.

Birth place policies are set up to serve the mode of birthing that is least liable for the birth place and most common among its clients.  If a laboring person is doing something differently than the norm in that space, they must understand that staff may not be familiar with the evidence-based way of supporting those choices and clients (or their personal birth support team – friend, partner, family, doula) may have to do a fair amount of assistance in advocating for the birthing person’s wishes.  Practicing asking questions and stating one’s choices is an excellent activity in preparing for birth.

 

Move your body.

Changing position and laboring and birthing upright have the potential not only to shorten the duration of labor but can also lead to more positive birth experiences (Dekker).  And here’s a not so little secret – upright birthing positions and movement in labor are possible even with pain medication!  Knowledgeable clinical staff and non-clinical support people can help, if assistance is needed, the laboring person into a variety of postures, both with and without pain medication, including but not limited to hands and knees, lunges, and seated positions.

 

Stay hydrated by mouth.  Although intravenous fluids have benefits when epidurals are given and when severe dehydration occurs, hydrating orally is an option supported by professional organizations worldwide.  “The American College of Nurse Midwives, World Health Organization, National Institute for Health and Care Excellence guidelines in the United Kingdom, and the Society of Obstetricians and Gynecologists guidelines in Canada all recommend that people be able to choose whether or not they want to eat and drink during labor” (Dekker).  Although IV fluids increase hydration, they also increase the birth weight of the baby which can lead to the appearance of excessive weight loss after birth and subsequent pressure to supplement human milk with formula.  Adequate fluid intake by mouth has been shown to be just as effective as IV fluids at shortening labor duration by about 30 minutes, while also helping to decrease tension in the throat and mouth and encourage feelings of normalcy in birth.

 

Understand the limitations of research.  Research is one part of the three components of evidence based decision making (the other two being client’s values and provider’s recommendation/experience).  Recently, a large study, called the ARRIVE study, looked at the effects of induction at 39 weeks on birth outcomes and called for the recommendation of induction at 39 weeks for healthy low risk pregnancies.  Henci Goer, medical analyst offers some fantastic insight into this research, discussing the limitations it has in regard to values and intentions of the laboring person in preparing for their birth.  Factors that may affect if this study applies to a specific person is whether they are planning for a medicalized birth, their desired use of pain medication, the prioritization of freedom of movement, and more.  An excellent infographic by Goer can be viewed at ARRIVE Study Infographic.

 

Let your intuition guide you.  No one knows the body and the baby better than the person experiencing the pregnancy and no one can speak for anyone else’s values or philosophies, which are a key component of true evidence based decision making.  Prenatal preparation and awareness of the importance of an active birth – as the laboring person defines it – offer a strong foundation for moving forward through labor and integrating the birth experience into a healthy and positive postpartum.

 

Sources:

Declercq, Eugene R. et al. Childbirth Connection. “Listening to Mothers III: Pregnancy and Birth.  Report of the Third National U.S. Survey of Women’s Childbearing Experiences.” May 2013. http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf.

 

Dekker, Rebecca.  “Evidence on: IV Fluids During Labor.” Evidence Based Birth. 24 May 2012; updated 31 May 2017, https://evidencebasedbirth.com/iv-fluids-during-labor/.

 

Dekker, Rebecca.  “Evidence on: Premature Rupture of Membranes.”  Evidence Based Birth. 20 November 2014; updated 10 July 2017, https://evidencebasedbirth.com/evidence-inducing-labor-water-breaks-term/.

 

Elmir, R. et. al. Women’s Perceptions and experiences of a traumatic birth: a meta-ethnography. Journal of Advanced Nursing, 2010 Oct; 66(10):2142-53.

Goer, Henci.  “Parsing the ARRIVE Trial: Should First-Time Parents Be Routinely Induced at 39 Weeks?” Lamaze. 14  Aug 2018,

https://www.lamaze.org/Connecting-the-Dots/parsing-the-arrive-trial-should-first-time-parents-be-routinely-induced-at-39-weeks

 

Odent, Michel. Childbirth and the Evolution of Homo Sapiens. Pinter & Martin Ltd; 2nd Revised ed. edition, 2014.

 

Simkin, P. Just another day in a woman’s life? Women’s long-term perceptions of their first birth experience. Part I. Birth, 1991 Dec; 18(4):203-10.

 

Simkin, Penny. Pain, Suffering, and Trauma in Labor and Prevention of Subsequent Posttraumatic Stress Disorder. Journal of Perinatal Education, 2011 Summer; 20(3): 166–176.