Managing Labor – Tips to Make a Mammoth Task More Manageable

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The words “Labor Pains” evoke the mental image of women in distress and in need of rescue. The message is that labor is extraordinarily painful – while most women will experience “pain” in labor, some women have described their labor as “painless” in all cultures across the world. Surprising? But, it makes sense because pain thresholds are different for different women, but also that some of them are more prepared to “let go” and experience the pain of labor as a culmination of 9 months of pregnancy, and are more prepared for the whole experience. These women have “anticipated” the pain of labor, and we have had moms tell us that the pain of labor was “less” than they had anticipated!! Cool, isn’t it?

So, what can you do to make labor more manageable?

1) Early Labor:

Do not tell anyone except your labor partner (husband/mom/friend/sister/anyone that you have chosen) that you are in labor. This is especially important in India, where the mom-to-be is with her mom at the end of pregnancy, and there are tons of people around the house waiting for her labor to start!! Early labor or pre-labor pains can last for hours or days – they come and go; start and stop; increase and decrease; have rhythm for some time and then no rhythm – However, in each case they last for a very short period and are very easily managed. If you have learnt some breathing techniques use it; if not, do what comes naturally to you. The fact is that more the people who know about your labor, the more everyone thinks that something needs to happen – And, the shy hormone Oxytocin, which is needed to help labor move along, just runs away with all that prodding and watching done by everyone around you in labor!!

There is a reason why labor starts at night or in the early morning hours for most moms – A) the body is rested; and B) there is no one watching it!

So, what else can you do in early labor?

  • Take a shower, walk around a bit, have something warm to drink (or cold – if you do not like warm drinks, there is no set rule). Usually, these things will make you comfortable enough to go back to bed and rest. Yes, REST. In early labor, resting and relaxing are the 2 most important things that you can do. Sleep if you can. If the contractions are 10, 15 or 20 minutes apart, there is no reason that you cannot sleep in between, and then just breathe through 20 seconds of contractions!
  • If your back or your lower belly hurts, you can keep a hot water bag to the area and the warmth gives you enough relief to get some rest
  • If needed, ask your labor partner to give you a massage – back massage, foot massage, leg massages work great!
  • Keep the lights off! I cannot emphasize this enough. Keeping low light not only allows you to rest, but also does not over-stimulate your brain into thinking and over-anticipating the progress of your labor
  • Eat and drink normally.
  • You may find that each contraction sets of a need for you to visit the bathroom. This is okay. Go, then come back and rest.
  • If it is broad daylight, and you cannot rest anymore, go about your daily activities. Can you cook for yourself/your family? Yes. Can you go shopping to your neighborhood grocery store? Yes. Can you iron some clothes? Yes. Can you read, or watch TV, or play cards? Yes. Can you go back to bed, and rest? Absolutely, Yes. Can you walk, climb stairs, or do your exercises? If you feel comfortable, absolutely Yes. Can your husband take you out to lunch or to the mall? Yes. Do you HAVE TO walk or do exercises for labor to progress? NO. In early labor, doing too much will actually tire you out, and not leave enough energy for the hard part of labor.
  • Will you somehow miss the progress of labor if you rest and relax and go off to sleep? Absolutely NO! Your body is smart, and it signals you that things are moving into the next gear. You will know as the pain intensifies, pelvic pressure increases and you generally feel more uncomfortable! This is usually the time to go to your hospital or birth center. As a rule of thumb, by this time, your contractions are 4-5 minutes apart, 45-60 seconds long and strong enough that you have to stop doing whatever you are doing, and breathe through the contractions. You may be vocal or you may be silent, but usually by this time, you will not be able to carry a conversation at the peak of the contractions. Yes, by this time everyone in your house will know that you are in labor!

So, what has your early labor accomplished? By now, your cervix (the opening of the mouth of the uterus) has softened, come into a forward facing position, and opened out to some extent. Do not be surprised if you are a few centimeters dilated! Even if you are not much dilated, early labor still has so much meaning to the overall progress of labor – your baby may have come further down into your pelvis, she may have turned into a more optimal position, and your body’s hormones are primed to lead you into stronger, longer contractions, which will be needed to bring your baby out!

2) Active Labor & Transition:

If you are in the hospital, chances are that there will be lots of activity around you. Nurses walking in and out, Doctors wanting to check you internally. Electronic fetal monitors strapped onto you. Hopefully, you have managed to negotiate at least a few things with your care-provider during your pregnancy, and you will be able to do the things that help your labor to progress.

So, what are some of the things that can help you labor progress in this stage?

  • Walk, Move Around, Remain Active  – in this stage of labor, activity helps to progress labor along.
  • Assume positions that feel comfortable to you. Mostly you will find that lying down just makes the pain feel worse! Sitting on the toilet seat may be very comfortable. Or a birth ball or bean bag may help. Squatting may feel very comfortable, as may slow dancing with your labor partner. Try out different positions and postures or even exercises that you have learnt in prenatal yoga or Lamaze classes – You may be surprised to find out that you are managing the pain of contractions more easily than you anticipated!
  • Sway to a rhythm, keep your hips loose. Keep your lips loose too – Loose lips = loose hips!
  • Shower or take a bath in the tub – Nothing more relaxing than this. Getting into a tub, seems to give an “AHH” effect to most moms in labor! In water, you will find that you can manage your contractions far more easily. Even a simple bath using the humble bucket and mug, can give you much needed relaxation and rest.
  • Think of your contractions as a wave – It comes and goes. When it goes away, there is no pain. Can your partner give you a foot massage or a neck massage when there are no contractions? Absolutely. Can you rest on a Birth Ball leaning forward over some pillows? Yes. Can you play music or Hypnobirthing positive affirmation tracks? Superb choice. Can you eat and drink during the periods of rest? Excellent idea.
  • Keep the mood in the room as light as possible. This is really a responsibility of your entire birth team! The more everyone or even one person around you gets anxious, the more you will experience the pain of labor as acute and unbearable. As a mom you have to do enough work during labor, without having to bear the tension of others too!!
  • Will you sometimes ask “how much longer”? Of course, you will. Does anyone know the exact answer to that question? NO. The best thing you entire labor support team and especially your husband/partner can do is to reinforce that “You are marvelous”. “You are doing great.” “You are strong.” “You can do this.” “You are doing this.” “Every contraction is bringing you closer to seeing your baby.” While some moms will want absolute silence, so that they can focus during the contractions, most moms that I know love and want to hear those 1,2 or 3 positive affirmations over and over again during their labor.
  • Rest and Relaxation is important now as well. Often, the hard work of labor, combined with the hormones of labor will ensure that mom goes into a deep sleep/ or rest even in the minute or two between contractions. Dads will ask “Is it normal that she is sleeping soundly?” Yes, it is. The best we can do is to leave her alone and not disturb her. She will wake up and manage the next contraction better when it comes on again!
  • You may feel afraid at some point. Can I complete this? Your doula, midwife or labor partner can focus you with some eye contact, breathing with you and telling you that you are doing great. The hormones of fear make you go into a fight, flight or freeze mode and make the pains feel even more painful. In contrast, the hormones of labor are those which make labor and birth easier and less painful. This mind-body connection is very important to understand and once you surrender to your labor, without fear, you can usually manage it far more easily!

3) Pushing:

  • While this is a topic that I can write a whole blog post on, for now, I will just say that you will know when to push and how to push. Pushing is an instinctive, primitive process and there will come a time when you can do nothing but push. Follow your body’s cues. Rest between pushes. Yes, it will seem a monumental task at times. For some women, pushing can be as less as 20 minutes, and for others it will be hours before they see their baby. Be mentally prepared either way. Most women will not want to eat anything while they push. Drinks that give quick energy are absolutely essential for this phase, and even sipping on some water between pushes will help.
  • Change positions to harness the effect of gravity. Upright positions such as kneeling, squatting, using the toilet seat or birth stool, using a rope/saree/squat bar to do supported squatting, all fours position, low stool, or even being in the Birth Tub will help you to push more effectively, as compared to being on your back.
  • Many moms find that warm perineal compresses help to ease the burning pain of the final few pushes. Easing and breathing the baby out works really well.
  • Again, privacy and calm helps. Unfamiliar people coming and going out of your room. Voices telling or yelling at you to push, are usually not conducive to the hormones of labor.
  • Remember Oxytocin, the shy hormone? It is also the hormone of love and comes in its final surge with the final stretch of the perineum as the baby’s head crowns and the baby is born! The euphoric feeling surrounding birth, is so pleasant that the pain that is present, just seconds before, is often erased, or pushed into the background!
  • And, not only this, the same hormone allows for bonding and breastfeeding your baby!

Do prepare your mind and body to manage the pains of labor. Do not over-think or over-anticipate it. Do relax and do things that feel comfortable to you in labor. Do not over-analyse why it is going slowly, or when you will get to the next stage. If your labour is taking longer to establish than you hoped, don’t feel disappointed! Your body is working very hard – long early labor, short active labor, short early labor, longer active labor, and any combination of these are all normal variations of labor!

Remember, feeling anxiety or stress can slow or stall your labour – and that’s the last thing you want to do! Enjoy this very special time before your baby arrives, as much as you can. Remember that this extraordinary mixture of vulnerability and power that comes to you in labor and birth lasts with you for a lifetime!