1. Be informed. During your childbirth classes you will learn a lotabout the anatomy and physiology of labor, especially how the uterus contracts and how your baby turns and bends as he or she navigates the winding road of your pelvic passages. Be sure you understand the importance of relaxation, the labor-stalling effects of fear, and how your hormones work and what you can do to help them work better.
2. Understand medical technology. Inform yourself before labor-day about the wise use of technology and medications during labor. While technology is often life-and laborsaving, it’s meant to help your labor progress, not interfere with it. A well-timed epidural, as discussed in month eight, can help an exhausted mother rest and get a second wind, accelerating labor in the long run. On the other hand, the wrong medication or the right one given at the wrong time can interfere with the progress of labor. If you need an intravenous, request a heparin-lock, which will allow you to be mobile, rather than tethered to a bedside I.V. pole. If you need electronic fetal monitoring, ask if it can be done intermittently. If for medical reasons you need continuous electronic fetal monitoring, request telemetry, which keeps you mobile.
3. Be fit. Here’s when those hours of pelvic tilts and tailor squats, daily walks, swimming, or stationary cycling really pay off. Pre-toned and pre- stretched muscles are likely to work better for you.
4. Be rested. It’s not only hard work that pushes a baby out; it’s efficient work. Fortunately, nature provides two breaks for laboring women. The first is during early labor, when contractions are not so difficult to deal with. The second type of break is continual — those little respites between contractions. Even when labor is at its most intense, there is time between the end of one contraction and the beginning of the next. If you are laboring at home, retreat into a quiet place, take the phone off the hook, and go to sleep, or at least get some rest. During early labor in the hospital, keep your environment restful.
5. Remember to rest between contractions, especially early in labor, when these breaks last five minutes or more. Click into the relaxation techniques you have rehearsed. Even during active labor, when breaks may last only two to three minutes, we have seen veteran mothers use their relaxation techniques so effectively that they are able to momentarily “zone out,” as if they are on another planet, and even snore between pushes in the second stage. Don’t spend your time between contractions worrying about what the next one will feel like. This will make the pain worse. Fear intensifies pain perception.
6. Think R, R, R. Between contractions think Rest, Relaxation, and Recumbency.
7. Be nourished. A hard-working uterus and the muscles around it need a lot of energy from food and hydration from drinks. Doctors used to discourage eating or drinking during labor in case the mother needed a general anesthesia for a cesarean delivery, relying instead on intravenous fluids to hydrate and provide energy. Since most mothers who end up with a surgical birth now elect to be awake and thus receive an epidural or spinal anesthetic, keeping an empty stomach during labor is not as important as it once was. In the unlikely event that general anesthesia is necessary for emergency delivery, the concern is that you might vomit while you are unconscious and then inhale your stomach contents into your lungs. For this reason, it is preferred that laboring women ingest small amounts of quickly digestible foods. Eating heavily is also likely to make you uncomfortable.
8. Be quiet. You don’t have to be like a mother cat and retreat to the closet to have your baby, but you must design a peaceful birthing environment for yourself. Birth attendants (partner, friends, nurses) need to respect your privacy during contractions, so you can concentrate on your work, and between contractions, so you can rest. This is where your mate comes in. Give him the job of peacekeeper, pledged to banish chattering, noisy, and interfering people from your labor room, and to protect the privacy and the dignity of this event.
9. Lighten up. Create your own labor-enhancing environment: dimmed lights, relaxing music, and whatever people and things you need to manage and progress in your labor. Laughter boost endorphins—stay light!
10. Be romantic. The hormones released during lovemaking also enhance labor; endorphins create pleasurable feelings during sex and also relax mother beautifully for birth. Nipple stimulation, by the mother, by her mate, or from water splashing on nipples during a soak in the tub, releases the contraction- intensifying hormone, oxytocin. A well timed kiss, a caressing cuddle, a sensual massage can all get your birthing hormones working for you. These labor- enhancing hormones also counteract anxiety that may cause your labor to slow rather than progress.
11. Be positive. A negative birthing environment is no help to a laboring mother. Banish negative people from the delivery room. You don’t want to hear someone else’s war stories, comments about how they couldn’t progress either, or their labor-strategy comparisons in which you are the clear loser.
12. Be comfortable. Pamper yourself with as many labor-enhancing amenities as you can think of—your favorite music, soft pillows and delicacies to nibble on. Take a shower, soak in the tub, and keep your masseur busy with the touches you need for peace and comfort. If your hospital offers them, take advantage of the new “birthing beds” that can be adjusted to support you in comfort and in your style of labor and delivery.
13. Be progressive. The top labor aid is a professional labor assistant. Several women whose births we attended brought along their own collection of 3×5 cards containing encouraging quips to relax and empower them. If you like this idea, collect memorable lines from birth books, verses from poems or scriptures, or humorous limericks. Hearing a lovely verse read by your lover may be just what you need to help you relax between contractions.
14. Be vocal. Reserve your etiquette for dinner parties; you needn’t be embarrassed about the sounds you make in labor. Many women find power and comfort in letting go with a yell, a prolonged moan or gutsy grunt when the going gets tough. These sometimes-involuntary gut sounds vocalize your release of tension and are a powerful way of mustering up inner energy to get through a really tough contraction. The low-pitched, long groan (gut sounds called “sounding”) are releasing and energizing. High-pitched, sharp sudden yells are body tensing and frightening. Be sure to prepare your partner for the sounds you are likely to make.
15. Be mobile. In order to take advantage of your body’s natural ability to guide you to the best positions for labor and delivery, however, you may have to first go through a bit of cultural deprogramming. In fact, studies show that women who are not culturally locked into the horizontal birthing mindset tend to assume any of eight different positions during the course of their labor, and most of these are upright, semi-upright, or moving.
16. Be upright. Most women, if left to their own devices, labor in an upright or semi-upright position. When you’re upright, gravity helps baby descend. When you try to labor on your back, not only does gravity pull the baby toward your back, but your uterus is now forced to push baby uphill. What’s worse, the uterus can now compress major blood vessels that run along the spine, reducing blood flow to the uterus and causing the contractions to become less efficient. When you are upright, your pelvic joints, relaxed by the hormones of pregnancy, are better able to shift and accommodate the little passenger with the large head and broad shoulders. Being upright also allows a more natural stretching of the birth-canal tissues making tears less likely.