Labor & Birth

First

Here are some reference handouts I will discuss in class:

While not comprehensive of all of the variation possible in birth, this one-page summary of the stages of labor and tips for coping with contractions may be useful as a review as birth draws near, a reference during labor, or to facilitate conversation about how you imagine each stage and what you could do or what would be helpful.
Deb’s Ultra-Simplified Guide to Labor

Worksheets:  What works best for me in Labor?
Optimizing Labor Physiology
Optimizing Labor Physiology for Partners

A written birth plan is not necessary for all people. It is important if you have specific wishes for how nurses and others interact with you during your birth. Your written preferences help to communicate what you believe will be most helpful to you in case you arrive in labor at a time when your are deeply focused on labor3ing, and they give your nurses and others a picture of the values and choices you prefer. Writing a birth plan is a great exercise in clarifying for yourself what matters most to you. This can help you understand the ways you can prepare for an experience you will consider positive. Including your doctor or midwife in the process by asking questions about your options and their insight is a very valuable tool for learning more about their style of care. If you’re wondering if you need a birth plan, read Should I Write A Birth Plan. To learn how to go about writing one, read How To Write A Birth Plan. To make the most of your birth plan during pregnancy, read Using A Birth Plan For Birth Preparation.

Options for labor management has a nice list of options you may want to communicate on a birth plan, and also some insight into what to consider as you are making your choices.

Here is a fillable birth plan template you are welcome to use.  It simply outlines the subjects that you may want to cover, though you can feel free to skip any areas that are not super important to you.

Here is a recap of many of the comfort measures and techniques we discussed in class.  You may want to print it out and take it along to your birth as a reference.
30 Comfort Measures to Ease Labor Pain

This pdf reviews the questions that you may need to ask in order to gather full information before giving yourconsent or refusal for recommended procedures.  You may want to consider printing this and bringing it with you to your prenatal appointments and/or birth to serve as a helpful guide if the need to make hard decisions arises.
Informed Consent

In class we talked about many actions or changes you can make physically, mentally, or emotionally/spiritually to help soften and open your body for birthing. Here is a summary of those body, mind and spirit tools for your reference.
Yes! Energy

Second

In this handout I introduce some of the hormones involved in birth and parenting – very informative for understanding how to facilitate the optimal function of labor, and a fascinating look into the biological drive behind parenting.
Meet Your Parenting Hormones

Writing your own relaxation script provides you with a wonderful, personalized tool to induce visualization and deep relaxation during birth.  It can be read to you, or you can simply recall the images in your own mind at times when the calming affects of visualization help you work through contractions or take a deeper more nourishing rest in between.  Share your script with your spouse, partner or doula so that they can offer the suggestion of the images most helpful to you during the midst of your labor.  Here are instructions for writing your own relaxation script.
Write Your Own Relaxation Script

The Surrender Quote: Letting Go Into Love

Here is a web site that will facilitate a deeper understanding of your baby’s position in the womb and the impact of his or her positions during birth.
SpinningBabies.com

An awareness of oxytocin is an important aspect of childbirth education.  Oxytocin is so implicit to the function of labor and birth, as well as in your relationship to each other and to your baby.  You want to know how to encourage an abundant release of natural oxytocin during your birth (not be mention throughout pregnancy!)  Love, caring, safety, non-judgement… these are all essential.  Nipple stimulation and foreplay are effective as well.  Blogs on Oxytocin abound!  People love to write about this hormone.  Here’s one I enjoyed, or you can also search for your own.  Each one reveals a bit more understanding.  I believe an understanding of Oxytocin is foundational to understanding birth.
The Big ‘O’ Isn’t Orgasm (This link is sometimes up, sometimes down.)

There is peripheral research on the effects of birth practices, such as induction and augmentation with Pitocin (synthetic oxytocin) and Cesarean birth, on oxytocin release.  This abstract reporting that vaginal vs Cesarean delivery, and age at first breastfeeding, impact the pulsatility of oxytocin and the release of prolactin during breastfeeding is one example http://www.ncbi.nlm.nih.gov/pubmed/8842644. This is the type of finding that is causing researchers to consider a link between synthetic oxytocin at birth and autism.  Autistic children sometimes have an altered oxytocin system. While this possible link between induction and autism has made it into popular press, there is no conclusive evidence for a causal link at this time.

Induction, or other procedures, are sometimes the best choice for your immediate physical health and safety, or for your baby’s!  When reading information about the potential long-term or subtle harm of this, or any, procedure I encourage you to allow it to inform your choices (for example, avoid unnecessary induction), but caution against allowing fear of the procedure to brew in your heart and mind.  If induction appears to be the best choice for you or your baby, make it with confidence!  First things first.  However an awareness of the possibility of long-term side effects informs our understanding of how to promote healing in the postpartum period when all are once again stable. Humans have a huge capacity for healing and an innate drive towards health.  If this, or any other unwanted procedure, becomes part of your birth story you are always welcome to contact me for insight into how to promote healing for yourself or your baby through skin-to-skin contact, alternative and complimentary medicine and more.
Primal Health Essays by Michel Odent, M.D.

This article provides lots of information on how epidurals can affect your body and your experience, as well as your baby, during labor and postpartum.  It also provides some guidance regarding how to make a personal decision to use or not use an epidural.
Epidurals, by Deb Rhizal

This is a link to DONA International’s position paper on birth doulas.  DONA International is the largest certifier of doulas.  This paper summarizes some of the research available on the impact of doula care during birth.
DONA Position Paper

In my experience immersion in a tub of water is incredibly helpful to many women during labor.  It is best to fill the tub high before entering so that the water covers must of your belly as soon as you get in.  Getting in when the level is lower and allowing the water to continue to fill is less effective.  Water should be around 98 degrees, and the best time to get in the tub is when labor is very active and mom feels like she needs to find a new technique or get some relief.

Occasionally women don’t like the tub, and occasionally the relaxation seems to make labor slow down.  Both of these are the exception. If they occur simply get out, and consider using the tub again at a later point in labor.

Typically women settle into deep relaxation almost immediately after getting in the tub and find labor much more manageable.  Research shows that laboring in water does not increase your risk of infection, and is safe for GBS positive women.

This brief article explains some of the ways water works to benefit mom’s during labor.
Water Immersion and Pain Control in Labor

Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England has some fabulous sections on pain coping techniques. She explains different types of focused and non-focus attention, breathing, and reframing – and provides instructions for how to “test out” the techniques using a piece of ice to create a painful situation to practice through. Pam’s book also gives many suggestions for releasing fears and building your confidence for birth.

Ina May’s Guide to Childbirth by Ina May Gaskin is another fabulous book.  The first half is full or empowering birth stories that will broaden your ideas of how to cope and increase your confidence that women can do this!

When to cut the cord? Common practice is to clamp and cut the cord within seconds after birth.  Some parents and care providers are choosing to allow the cord to stop pulsing naturally on its own before clamping – usually within 2-20 minutes after birth.  If a baby is born depressed and does not breathe, common practice is to immediately clamp and cut the cord before resuscitation.  Medical obstetrical care providers have research-based reasons for this management, and are working to reduce brain injury and other potential complications.  There are others, within the obstetrical community and without, who question this practice on the basis that placental function and blood transfusion from the placenta to the baby are physiologically protective.  They dismiss much of the accepted research because all babies in the studies have their cords clamped and cut and there is not a control group of unclamped cord management.  They advocate for delayed cord management, especially in situations where the baby requires resuscitation.  Many parents feel most comfortable leaving decisions to the medical staff in a high stakes situation such as lack of breathing at birth.  Others have a strong desire to research the available evidence and discuss the management with their doctor or midwife.

There are also parents who prefer to leave the cord in tact for physiological reasons related to the baby’s energy body or due to spiritual beliefs.  Often referred to as “Lotus Birth,” the practice is to allow the placenta to dry and separate on it’s own a few days to a week after birth.  Some parents practice partial lotus birthing, cutting the cord after 12-24 hours.

If you feel strongly that your baby’s cord is left intact for any reason, you must educate yourself and then have extensive conversations with your doctor or midwife about carrying out your decision.  It may necessitate that you choose out-of-hospital birth or go through a process of informed refusal of care.

This article explains the physiological reasoning and techniques for delaying cord clamping, especially when resuscitation is necessary.
Basics of the Cord Clamping / Brain Damage Issue

Here is a link to one of several web sites dedicated to Lotus Birth.
Common Questions about Umbilical Nonseverance (Lotus Birth)

The Scientification of Love by Michel Odent is one of my favorite books to recommend to parents interested in physiology and research-informed decision making in birth.  The book claims to be about a review of the scientific understanding of how the ability to love develops.  As such, it’s not written distinctly to expectant parents.  That being true, within the covers you will find many discussions about the impact of epidurals, disruption of the labor process, separation of mothers and babies, and experiences of trauma around the time of birth; and their impact on life-long capacity for attachment, relationship and self-love.  The books discusses animal studies, ethnographic studies, and more.  The author sets out to make a strong case, which at times I find is short-sighted of the subtleties, resilience, and complexity of human socialization… but the information is provocative and fascinating all the same.

This article provides a detailed review of fetal monitoring, including information regarding reassuring, non-reassuring and ominous fetal heart rate patterns.  Clearly the interpretation of fetal heart rate patterns is a medical skill.  Some parents may feel comfortable entering their birth without detailed knowledge about what heart rate variations may mean for the safety of their baby knowing that they will rely on their nurse, midwife and/or doctor’s knowledge and skill.  Others may want to be informed so that they can actively participate in decisions during their birth.  Knowing the language and the possibilities helps parents have meaningful discussions with their care providers.  Some birth professionals believe that continuous fetal monitoring is over-used in the United States, and there is evidence that this over-use leads to a small number of unnecessary cesareans.  These trends are also discussed in the article.   Other draw-back of continuous fetal monitoring are the impediment of movement, and a negative impact on feelings of autonomy, strength, and confidence.  Given the physical and hormonal nature of birth these impacts can be significantly  detrimental to labor progress.  These draw-backs can be overcome or reduced through education and personal preparation, giving you the tools to keep active and remain confident.
Interpretation of the Electronic Fetal Heart Rate During Labor

This YouTube video shares a positive experience utilizing epidural pain relief.  Watching it and thinking about the contrasts in the experience of childbirth in comparison with the unmedicated birth we watched in class is helpful for making decisions about your wishes for pain management.  It also provides a glimpse at electronic fetal monitoring – both on the mother and the screen showing the contractions and heart rate.
YouTube – Perfect Labor and Delivery

Did you know fetus’s can hear ultrasound?  Ultrasound is also used to listen to the baby’s heart rate in labor.
Fetuses can hear ultrasound examinations

Here is a link to Lamaze International’s web page that outlines six evidence-based healthy birth practices:

  • Let labor begin on its own.
  • Walk, move around, and change positions throughout labor.
  • Bring a loved one, friend or doula for continuous support.
  • Avoid interventions that are not medically necessary.
  • Avoid giving birth on your back and follow your body’s urges to push.
  • Keep mother and baby together – It’s best for mother, baby, and breastfeeding.

Wondering what to take with you to the hospital?

Packing for the Hospital

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For Healthy, Happy, Families