This article will suggest ways to help you avoid interventions during the birth. These interventions may include: episiotomy which is the surgical cutting of the perineum (the area between the vagina and the rectum) and forceps in labour. The suggestions are simple and appropriate for all low risk pregnancies.
Prenatal classes are an important resource if you are a first time parent or you want a refresher course before this birth. They provide you with up-to-date information on ways to cope at each stage. They also let you know the local practices with regard to birth planning and the actual birthing process. Knowing these things will help you be less anxious and the result is a more positive experience for all involved.
Prenatal classes will teach you the signs and symptoms of active labour. You will learn about the correct time to go to hospital. This is often said to be when contractions are no more than five minutes apart and are lasting at least a minute. There are many other signs and symptoms you will learn, that indicate you should go in for assessment. Basically, when you are mentally or physically uncomfortable with what is going on, you should seek attention.
Often, even when contractions seem to be advancing, a vaginal examination will reveal the cervix has not changed enough to diagnose active labour. This usually means there is still more time before admission to hospital. As this is a normal and usually a very safe part of labour, it is often best managed in the comfort of your own home. Medical intervention to make labour proceed faster is called induction of labour and is not usually thought to be in the best interest of mother or baby at this stage.
One of the most inappropriate places to be, for a healthy, pregnant woman
not in labour, is the labour and delivery suite.
Don’t feel badly if you are told to go home and return when things change. This is probably the best way to manage your labour. Some people do receive pain relief at this time to help them cope.
The role of a labour support person (often in addition to a birth partner) is to provide soothing comfort and encouragement during your labour. This person is usually female and a relative, friend or professional doula. The Greeks used the word 'doula' to describe a 'woman’s servant' or 'one who mothers the mother.' Today a doula is a woman with experience in childbirth, who uses this experience to provide support to a mother, before, during and after childbirth.
The presence of a labour support person has been shown to help achieve normal birth outcomes. These include shorter labour, less need for pain relief, fewer episiotomies and reduced need for forceps and caesareans. The labour support person can provide you with soft background music, a calm atmosphere, and a cold drink to sip. She is there to offer help to the washroom or massage whenever desired. She encourages relaxation such as showering and bathing. Another technique she uses is general positive feedback with good eye contact and frequent light touches.
Most people know the symptoms of anxiety - a racing heart beat, fast breathing, tremors and a heightened awareness, among others. These are caused by stress hormones called catecholamines. Anxiety associated with labour and pain can result in an increase in these hormones. When the level is high, the uterus contracts less effectively. Perhaps this is why a soothing labour support person can be so comforting when you are in labour.
As mentioned, high pain levels and the associated high level of catecholamines may interfere with the progress of labour. Some types of pain relief may also interfere with the progress. This is why pain relief should be used when needed, but not automatically. When pain relief is used, you still benefit from emotional and physical support.
Some types of epidural anesthetics cause a motor block or temporary paralysis of the muscles. This makes changing positions more difficult, but not impossible. Even if an epidural is used, it is still important that you keep changing position. Once the cervix is fully dilated, epidurals often result in a longer period of time before you begin pushing. If total block has not occurred, you should still be able to sense how to push and be able to push instinctively.
Movement of any form (walking, rocking or changing position) helps the progress of labour. Upright positions such as walking, standing, kneeling and squatting, have been shown to reduce the amount of continuous and intermittent pain experienced by labouring women. These positions may also help open the pelvis to allow the baby more room in the birth canal.
Even during the second or pushing stage of labour, you should continue to change position from time to time. Upright delivery positions can result in a shorter pushing stage, less use of forceps and fewer tears and episiotomies. There is no one correct position in which to give birth. When given the choice, a woman is likely to choose the position that is natural for her.
Sometimes a woman is encouraged to begin pushing before her body has signalled that the time to push has come. This is similar to trying to have a bowel movement when there is no urge to. Even once the cervix is fully dilated it may not be time to push for up to another hour.
If pushing is encouraged before the natural urge occurs, it is often coached pushing (since it is not instinctive at this time). Coached pushing may involve breath holding and bearing down for prolonged periods of time. Prolonged breath holding is associated with a higher use of forceps, more episiotomies and lower oxygen levels in baby.
Instinctive pushing is allowing you to decide for yourself the nature and type of pushing that should occur. You will start to push naturally after a contraction begins and will stop pushing before the contraction is over. Instinctive pushing may be accompanied by some of the breath escaping during the push and a shorter duration of each push. This type of pushing does not increase the time it takes to push the baby out and often results in a less traumatic delivery for mother and baby.
Some doctors and midwives recommend the use of daily massage of the perineum starting about six weeks before delivery. It is thought this may reduce tearing and the need for episiotomy at delivery. The massage is a gentle stretching of the tissues of the perineum. Women need to be highly motivated to stick with it, but are usually pleased they did. Instruction sheets may be available from your doctor.
The use of hot compresses, oils and perineal massage with the delivery of the baby’s head is also thought to reduce perineal trauma. No studies have been able to prove this. Studies have shown very clearly there is no indication for the routine use of an episiotomy. In general, a tear of this area heals better and is less painful than an episiotomy. It is best to discuss these delivery suggestions with your doctor before delivery.
Since labour and delivery are normal events, the goal should be to keep things as normal as possible. A woman in labour is a marvel to behold. If you can stay relaxed with helpful, supportive and comforting people around, you will keep positive memories of the miracle of childbirth.