Labor – My Radiant Beginnings

Category Archives for "Labor"

Acupressure – A Home Birth Story

Recently, I had an opportunity to attend an acupressure workshop for birth workers. I was on the fence originally, as I had missed the early registration deadline and had already been away from my family attending another training for five days not so long before this, but something kept nudging me to go. When I read all the information, saw the fee was 100% refundable if the workshop was missed for a birth (this is HUGE for midwives), it was local (equally as important when clients are in range to deliver), and my husband encouraged me to go knowing it would help me and my clients (this helped alleviate “mom guilt”), I was IN!

The workshop itself was informative, and I loved that we were hands-on practicing right then and there.  My only issue is that I wasn’t experiencing any of the ailments the day of the workshop that we were learning, except for a neck issue from my car accident back in June. That being said, I have to be honest, I’m a bit of a skeptic by nature; so, without experiencing first-hand drastic relief or improvement, I wasn’t sure what I’d actually walk away with. I was appreciative for the presentation and for the documents provided so that we could practice and use as indicated for ourselves and our clients.

It was probably about a week following the workshop that my next client went into labor. This would be her second child, and first out-of-hospital birth. She was about 6cm dilated when I arrived but I wasn’t loving how the baby’s head was applied against the cervix. That’s when I decided to give my new tool a try.

Fortunately, in preparation for the birth, I had scanned in the handouts to be accessed from my phone. I scrolled through to find the points that were most indicated for a posterior or asynclitic baby (fancy term that basically means the head is cocked funny or not well tucked-chin to chest). We had already gotten mom’s vitals and listened to baby, and since everyone was doing really well, we proceeded with a circuit of 3 positions for mom while dad supported, and we held some acupressure points.

She started out on her hands and knees, which on its own is a fantastic position for helping baby’s position, for 10 minutes, then got onto her bed and did four contractions lying on her left side and four contractions lying on her right side (the opposite leg is bent and supported with a pillow folded just in front of mom’s belly/baby).

Afterwards she got up to use the restroom while I charted a couple things and told her she can do anything that seemed comfortable and encouraged her to listen to her body. Literally within minutes her contraction pattern intensified. (Note: a less than ideal presentation can cause ineffective contractions or longer labors.) She decided to get into a warm bath for comfort and just changed positions as she desired, mostly kneeling.

At this point, we were helping with her comfort, hydration, and listening to baby’s heart rate as she navigated transition. I could tell something had changed and asked what she was feeling with the contractions now. She no longer felt the pain above her pubic bone, she just said it was different and had more pressure.

Deciding to empty her bladder one more time, she was helped out of the tub and onto the toilet. It was in this position that she realized how low baby was, that this was happening now, and that she had the sensation to bear down with the next contraction.

She declined the offer to be helped back into the bathtub, so we readied ourselves and supplies to do the delivery where she was. With her first push, the tight and bulging bag of water was visible, and minutes later she was holding her daughter in her arms with the most incredible look of amazement and disbelief on her face.

In total, it had been about two hours from the start of the acupressure points and positioning circuit to the time she had birthed her daughter! While I obviously couldn’t promise the same timing and speed for everyone, to me it is evidence that it worked!

Most notable to me was the obvious shift that took place in the contractions after our attempt to use the acupressure and positioning to help move baby into a more optimal position for labor and birth. I realize it won’t always be a necessary tool for each birth, but I am thrilled to add it to my toolkit!

Past the Estimated Due Date (EDD)

You’ve reached your estimated date of delivery. Now what?

Last fall, one of my clients reached out about waiting. This was her third pregnancy, but she had already delivered by this point during her previous pregnancies. She stated she didn’t understand why this time was different. She understood there wasn’t a rush; however, there was a fear about the possibility of needing medical intervention to get the ball rolling.

Pregnancy is a process. While not everyone’s experiences are the same, I think most women would agree they learned something about themselves during their own journeys.

Some women are pleasantly surprised to find they go into labor unexpectedly days or weeks before the BIG EDD! Others of us know, from day one, that is not likely to happen for us, due to our own previous experiences or a family history of holding onto those babies for days or weeks longer!

From my own experience, I understand completely! During my third pregnancy, I was working a corporate job and couldn’t wait for the day after my due date to arrive so that when I was asked again “When are you due?” I could smile and respond “Yesterday,” just to see the looks on people’s faces. Priceless. Interestingly, most people aren’t used to that response, especially in work environments, for numerous reason (scheduled deliveries, people taking leave at or prior to that time, etc…).

Perhaps you are one of the frustrated momma’s who went into labor weeks early with your first, and now you are shocked and beside yourself for going past that special date. I believe this is the most frustrating position, because you could literally be pregnant a month longer than your previous experience! All I can say is, I’m so sorry! I do speak with those clients up front and throughout their pregnancy about this possibility, to help to keep the angst down as much as possible.

Let’s say you find yourself here, 40 weeks on the dot, without any reportable signs or symptoms of impending labor…now what?!?!

I like to take a 3 step approach, in order to address your mental outlook, your emotions and your physical needs.

First, most people like to have a plan in place. It helps them feel prepared and a little more in control. I know there is very little that can be controlled in life, let alone in pregnancy, but for myself I find that it helps to do what I can to help as much as I can. So, I review what things look like now that we’ve reached 40 weeks. For some, it may mean prenatal visits two times a week instead of weekly, though for others that doesn’t happen until 41 weeks. I recommend clients have a BPP (biophysical profile) done at 41 weeks. (Read about this in an upcoming post). We discuss a general overview of what to expect at those appointments, and any steps that can be taken between appointments to help ripen the cervix (supplements/activities). I also explain what happens if in fact we make it to 42 weeks, and the process of a medical induction. Personally, I feel exploring the upcoming two weeks at that time is more assuring because then my clients know what to expect. I also feel that discussing it all minimizes the likelihood of needing to go that far, versus not talking about it and everyone being frustrated, upset or confused if indeed we end up there. I educate in order to empower.

Second, I address the emotional component. It’s one thing to know in your head logically what is happening and what is to come, but that doesn’t address your feelings about it. This is a bit more difficult to quantify, because this is when my relationship with my clients comes more into play. One client may have fears about the “what ifs,” another may be anxious, while yet another may be actually angry about the wait. There are LOTS of emotions that come out in pregnancy and typically if you don’t see it early, you see it towards the later part.

I was taught and like to use the analogy about a piece of fruit. Fruit is best when it is ripe, and sometimes it feels as though that will come any day, and sometimes you keep checking back only to have to wait a little longer. Then, you have this window of time where you can enjoy the fruit at its peak, when it is at its best! If you happen to go past this time, the fruit turns rotten. While for fruit purposes you’d throw it out because it wouldn’t be so pleasant to enjoy it, when you turn the analogy back to an expectant mom who has crossed this ideal window emotionally in her pregnancy, this is the time she realizes she is ready and she’s willing to do anything (Endure Labor!!) to get this baby out! Why does this help? Because sometimes emotionally we are holding on a bit, perhaps fearful of labor, of pain or of the unknown.

Separately, I encourage my clients and build them up, ideally so that they leave with hope and uplifted spirit. I also encourage a date night, no matter when the last date night had been, so that they can get some uninterrupted time with their partner. This connection shouldn’t be taken for granted. Oftentimes, after a date day, labor is just around the corner. This is good for SO many reasons, but mostly the communication that takes place helps to unlock some things that were meant to be talked out before baby comes.

Lastly, we address your physical needs. Again, this is tailored to each client, but may include suggestions of getting some “you time,” a night out with friends or time alone to take a long bath or read. Overall, my recommendation is to have something planned each day. I’m not talking something big and crazy, I’m just talking one appointment to set for yourself – it could literally be a reminder on your phone to have lunch with a friend, not necessarily a massage appointment, but that works too!!!

With my first pregnancy, my mom scheduled a hair appointment on my due date, feeling pretty certain I would need the distraction. While I was a little bummed to still not have my baby in my arms, the appointment gave me something to look forward too and I felt really good about myself afterwards! The idea here is to have something to look forward to each day, even if it’s knocking another item off your “to-do” list that you wouldn’t mind cancelling, if in fact you were to go into labor.

Outdoor activities or anything out of the house is ideal since it may be a little while before you are venturing out after baby arrives. I am VERY careful to stress balance at this stage, which is why I recommend just the one thing or appointment a day. Balancing activity and rest towards the end of your pregnancy is key in setting yourself up for being as well-nourished and rested as possible before going into labor. Remember, it could happen any day and while we are trying to shift your focus temporarily from that, it is a reality that you need to be prepared for.

On average, first time moms go into labor 10 days following their expected date of delivery, or 41.3 weeks!  Remind yourself of that and take the above suggestions and adapt them to make them work best for you.

Many Blessings!

Recent Labor Support Experience (and why the system needs to change)

Scenario: Planned Hospital Birth with a Labor Support Person

Recently I was called to step in as a labor support person for a client when her Doula had to attend a mandatory engagement. While not super common, occasionally things come up and necessitate such an arrangement, and I am happy to have a support network I can call on, just as I am proud to support others within this community.

The Doula kept me informed of her assessments as the time was drawing near. Upon arrival, I asked to see the contraction app in order to get a picture of recent activity. Contractions were irregular, anywhere from 7-12 minutes apart. I was assured that at some point they were closer together, but knowing they had plans to transport to the hospital to join her OB for a planned VBAC, I knew we first needed to get an established active labor pattern going. As a midwife I am only comfortable attending women in labor when I can listen to fetal heart tones in order to ensure fetal wellbeing. The baby sounded great and mom was handling her labor well.

I suggested laboring in the bathtub with some Epsom salt in order to allow the contractions to regulate. She alternated positions from right side lying to left side lying every few contractions. Within minutes, contractions became more regular and were consistently 7.5 minutes apart. I monitored the baby’s heart rate regularly and we encouraged the mom to drink and take bites of fruit periodically. While the contractions never got closer than 6.5 minutes apart, I noticed the mom sounded “transition-y.” Difficult to describe or quantify, but in my experience there’s certain sounds a mom makes that tell you what point they are at in labor.

I gently assured her and reminded her that, although we had just met this afternoon, I am a midwife and that I could perform a vaginal exam in order to let her know her progress. Remember, upon arrival just after 1pm, contractions had been irregular and now it was about 2pm, after only 1 hour in the bathtub. I shared my thoughts about her contraction pattern versus how she was physically presenting. After the next contraction we helped her out of the tub and to the bed for an exam. The next contraction she experienced was intense; this was the first one out of the tub and she voiced how much better she had been able to cope with them while in the water. With consent and sterile technique I gently performed an internal exam and found her almost complete with only an anterior lip (cervix in the front) and baby at +2 station. I calmly explained what I found and gave her time to process while we started the steps of getting her ready for transport. It was only 2:40pm. She was a trooper!

I followed behind the client in my own vehicle, sterile gloves in my pocket just in case. We had discussed hospital arrival procedure and that I would park and run ahead to get a wheelchair so the mom could be dropped off at the front door and not have to walk much. I was blessed with a parking spot near the front entrance, which almost never happens, and ran ahead as planned to grab a wheelchair from the front. Empty. Nothing.

And, to top it off, because it was Saturday, there were no workers or volunteers at the desk or anywhere to be found. Knowing this mom was ready to deliver at any moment, I couldn’t aimlessly walk around trying to locate someone who could help. Instead I went back out to help support the laboring mother. We labored through a couple contractions while her mother parked the car, and didn’t make much progress before she met up with us and the three of us walked inside. Still nothing or no one to help.

The elevators were fairly close so we figured the best thing was to get there and up to Labor & Delivery. Once there, and it was a slow process, we finally found some help. We went from one to about five nurses and finally a wheelchair. We explained who she was, who her doctor was and what was going on. I was still supporting the mother and helped to ease her back into the wheelchair, which while it was welcome on one hand, was still difficult to do at this point. We quickly made it back to Labor and Delivery and they deduced based on her presentation that we could bypass triage and get a real room. I felt it prudent, because there were no less than seven nurses or staff buzzing about the room and the laboring mother, to let them know my assessment. Normally in this situation I would not advertise that I am a midwife, but I felt I really needed to let them know that I had done an exam and found her almost complete with baby +2.

On top of the myriad of questions they were already asking her, this new revelation threw them and now they assumed, though we were already very clear about who this laboring mother was, who her doctor was, etc., that we were a transport from a home birth situation.

No. That’s not what we said. Yes, I am a midwife. I am her labor support person who was helping her to labor at home until it was time to come to the hospital. She made quick progress and now we are here to meet her OB.

More questions. Multiple times I tried to help and answer what I could for her; however, and this is the tricky part, the hospital staff wants to hear from the patient directly. Now, don’t get me wrong, I get this to some extent. We aren’t talking about possible abuse questions or suspicious injuries, we have a woman in advanced stages of labor, trying her best to birth a human being and we’re getting chatty. STOP IT! I digress.

Now is the point where she is poked and prodded, because apparently those 36 week labs she just had aren’t considered relevant any longer and because the hospital has little to no regard for midwives, they can’t take my word about her internal exam, they need to see for themselves. Her second exam takes place at the hospital and is done by a nurse. She calls her 9 cm and says baby is +1 station. Then when asked by another nurse about this, she adds that there is only cervix in the front. (THAT’S CALLED AN ANTERIOR LIP!) But they don’t like to agree with the midwife. (And station, while subjective, could have changed given the car ride and anxiety the mother was in transporting at this stage of labor and her long walk to the delivery unit.)

Her OB had not yet arrived because while she had called to let her know she had started labor that morning, they forgot to update her. That’s normal. When you are busy laboring, you aren’t thinking about everyone you should update. Instead, we had a hospitalist join the packed room in case the client/patient delivered prior to her OB’s arrival. At some point in this activity, I covered the mother with a light sheet because she wasn’t pushing yet, she was still laboring and I feel was waiting for her husband and then OB to arrive. Step in hospitalist/OB sub who moves the sheet and “needs” to check her again. WAIT, WHAT?!?!

This is the part that continues to baffle me. Why do you allow nurses to do an internal exam if you aren’t going to believe their assessments? Either they are qualified or they are not. Why is this woman or any woman violated repeatedly with little to no regard for consent, all for the sake of routine practice? She had 3 internal exams by 3 different people in a matter of 40 minutes. That is completely unnecessary!

Shortly after, the Doula I had been subbing for arrived and I graciously stepped aside to allow her to continue the role this laboring mother had hired her to perform. I was sad to miss out on the big moment, but I refused to add to the stress or crowd of the moment. By this point, the laboring mother had her husband, her mother, her original labor support person, and the hospital staff was no less than 4-6 people in the room because staff was still in and out. I didn’t want to be the point of contention and create an awkward moment where the soon-to-arrive OB states too many people are present and someone has to go. That would be rude of me; I had just met the couple that day. So, I politely excused myself and went to the waiting room because I knew the birth would be imminent. Roughly 15 minutes later I got the text that the baby had arrived and all was well. Sweet Bliss. Congratulations.

This momma triumphed in so many ways. She did it, and she did more than she originally planned. I hope she looks back on the experience with lots of happiness, joy and maybe even some surprising funny moments that make her laugh out loud.

But, I’m confused. This individual was under the care of an OB throughout her pregnancy. She did everything the system supports. Why, if this was the plan all along, was she questioned countless times by various staff, surrounded by more than a few people and forced to undergo multiple vaginal exams when she was basically complete? I just don’t get it.

The hospitals ask the same questions routinely, do they not? Doctors ask the same questions, do they not? Is there a way for one system to talk to the other prenatally? People register at hospitals prior to delivery, right? Is there some sort of bracelet or barcode the expectant mom could wear (or bring in) that would answer those same questions allowing them to labor as uninterrupted as possible?

Stop the madness. Labor is not the time to get super chatty with a woman who is literally working to bring a human being earth side.

Please tell me you have ideas or you have the ear of someone who can help to change policy or systems. One hospital at a time, that’s all it takes! (It could start with a nurse or charge nurse or OB or hospital administrator…it only takes a spark to light a fire!)

When A Home Birth Doesn’t Go As Planned – Part 4 (Cost)

For some, cost is the aspect of attempting an out-of-hospital birth that makes it the least appealing, and sometimes an all-out non-viable personal option. The short and quick of it is, payment is required in full prior to 37 weeks, or the point at which an out-of-hospital birth is possible. If you had paid for your delivery, and then went on to labor and needed to transport for any reason, you would also need to pay any associated hospital fees. Again, for some people, that does it.

Why should it not completely dissuade you?

Many people who choose to birth outside the hospital do have medical insurance. While this does not necessarily cover the costs of home birth (more to come in a future post), it is helpful in the event of a transport or emergency.  The medical insurance would cover the costs of the hospital according to your policy. So, even if the entire amount of your midwifery care has been out-of-pocket, the hospital bill may only be a fraction or percentage of total costs in regard to what you are responsible for after insurance adjustments and payments. Both will likely be applied to any deductibles.

What is the value of peace-of-mind?

Though impossible to quantify, I would argue that with the support of a healthy birth team, it is priceless. I cannot know upon meeting an individual what type of birth she will go on to have; however, if the couple is educated and supported throughout their journey and not filtered through a system or process, then they are set up for optimal success.

Personally, I would much rather be set up for success with a variety of tools available and know that I tried it all even if the outcome was different than my expectations than to save some money, become a number and lose my individuality.

When a Home Birth Doesn’t Go As Planned – Part 3

Transport with a less than optimal outcome

Continuing the series on transport, I wanted to look at an example of a less-than-ideal situation. Mom and baby are healthy at the conclusion, so no need to worry there. Remember, my goal is to educate and empower, not to sugar-coat or to put the blinders on.

So, what does happen, when a family plans an out-of-hospital birth, but finds themselves transporting to a hospital for assistance?  How are they received and does that change their options and opportunities?

Similar to my previous post, this involves a first-time couple who were very excited to meet their baby. In this example, the mother’s water spontaneously ruptured prior to labor. (Her water broke before she was having contractions.) We applied our current protocol and let her rest for a little bit before coming in to the birth center to see if contractions would start on their own. We discussed baby’s movements to be sure the baby was okay, and discussed some things she may want to try at home to get things going.

The time came to meet up at the birth center to assess and make a plan. Mom and baby were doing well and while contractions had begun, they were not quite where we wanted them in order to make effective cervical change. I remained with them throughout our attempts to get stronger, more regular and effective contractions going.  Sometimes it would seem as though the uterus would respond and then with time not so much.

Looking at the overall picture, we discussed the situation and decided to go in to the hospital. At this point, we thought the uterus could use some Pitocin, and mom, if she decided to, could get an epidural to rest and relax as she continued her labor journey. We transported to the nearest hospital, not because it was an emergency, but because that is generally the right call when leaving a birth center and if specific back-up to a consulting physician isn’t available. (That was prior to the time of our current consulting physician and prior to the time of hospitalists, or OB/GYN doctors who are on premises to take any “walk-in” or transport patients.)

The mother had to go back alone for an individual separate triage time before being admitted. Once we were admitted, our nurse was noticeably open about her disapproval for the laboring couples desire for an out-of-hospital birth. It was really late at night (after hours) when we arrived, so the plan was to monitor and assess. The nurse was our only point of contact for a while and she communicated her assessments to the doctor. We were given time to rest and wait.

A couple hours passed and the nurse stated a favorable cervical check of 9cm! We were excited and ready to continue to labor the baby down while the entire team rested. Not so long afterwards, mind you it was only about 2 or 3 in the morning, the doctor came in to do a cervical check herself. One look at the parents (mom was short and dad was the size of a stereotypical linebacker) made the doctor call for an ultrasound. She began to palpate the mother’s abdomen and question me about the baby’s size. I assure her this is not a big baby.

All the same, she then does a cervical check and declares the mother is NOT 9cm, though she wouldn’t quantify her findings. She begins to talk of the complications of delivering a baby that is too big for a mother’s pelvis and works everybody up. The grandmother-to-be was in the room, the aunt-to-be was in the room and everyone was anxiously waiting to celebrate in the joy of the baby’s arrival. Now we have a doctor going against what previous internal assessments had been, by a nurse who was not new to nursing or to L&D, and was introducing this fear factor based on a snap judgment of the parents’ physical appearance.

They decided to proceed with a surgical birth (a cesarean) based on these factors alone. The ultrasound never came, but honestly, I don’t think it would have made a difference. Shortly after, they welcomed a 6lb 3oz baby girl at 40 weeks gestation with APGAR scores of 8 & 9 at the one-minute and five-minute intervals.

I did have a short moment with the couple and their family while the operating room was being prepped and I gave them time and understanding to discuss what was going on. I wanted to fight the snap assessment, but gave them non-biased causes, factors and things to consider from which to form their own opinion, but they were tired. They were tired, done and ready to meet their daughter. Without supportive and helpful information from the hospital workers or the encouragement to continue with their plan, they felt defeated and like they didn’t have a voice.  Rather than dwell on the negative, they chose to put their efforts and energy into the birth and the long-anticipated meeting of their daughter.

When A Home Birth Doesn’t Go As Planned – Part 2

Transport gone right

Thank you for joining me as we continue to look at transports. Today, I’d like to take a moment to look at a case when everything went well. I think it’s important to note that just because there may be need for a transport, doesn’t mean that everything is out the window! Remember, I’m not anti-hospital. I am glad they exist and that they are there to help us when they are needed. When the system works well, we can all benefit.

Let’s take a look at an example of when a transport was necessary.

First time mom laboring well at home but contractions are irregular. She’d had some prodromal labor the night before that stopped. We try various things to regulate contractions both in frequency and intensity, but she doesn’t seem to progress. The baby appears to be a little asynclitic (her head not flexed or tucked just the right way).

We take breaks, allow her to rest and pace herself and try various positioning exercises to help the baby get into a more favorable position. We discuss the balance necessary to not completely exhaust herself in labor because, while delivery is an end to pregnancy, it is only the beginning to the parenting journey.

Keeping in mind that first-time moms push on average around 2 hours, and the work that breastfeeding takes, we decide to transport before there is a medical problem. Our thought and approach is that she needs an epidural and Pitocin. She’s been at this for a while and could use the full relaxation of an epidural and the uterus could stand some harder, more consistent contractions.

After consulting with our physician we decide to head in to the hospital but must use the on-call physician because our consulting doctor is unavailable. The nurses are supportive and a couple recognize me and are familiar with some of my midwife associates. They help to get us settled and work with us toward the desired vaginal delivery my client desires.

While the doctor was cautious and made us aware of time frames and the progress he was looking for, the staff stood strong and united. He broke her water and began Pitocin and she was given an epidural. The nurses worked with us to help change the mother’s position regularly, since she was unable to do so on her own after the epidural.

The mother was able to rest, regroup and prepare for the next stages and reflect on the hard work she had accomplished. The father was encouraged and supported, which allowed him to also rest and regroup in order to best support his partner. She met each milestone and we diligently continued our cadence throughout until it was time for second stage and she was able to push with those contractions she had been working so hard to get on her side.

Each push brought more determination and resolve for what was and was about to be. And then, just like that, her daughter was born. She was overcome with relief, pride, joy, elation and never doubted herself or the decisions that took place and brought her to where she was in that moment.

When A Home Birth Doesn’t Go As Planned – Part 1

Sometime the best laid plans don’t actually materialize.  What then?

You had good prenatal care, took care of yourself and the baby, participated in childbirth prep classes, followed the advice of your healthcare provider, had a birth plan and seemingly did everything in your control “right,” but something (could be a variety of things) causes you to need to transport to the hospital for the delivery of your baby.

Let me pause here to reiterate that there are no guarantees with birth.  You can only control so much.  I have journeyed with moms who have fit the above picture of being the model client and did everything within their power to have the birth they desired, only to have a different outcome.  And, I have met women who on paper seem to have lots of room for improvement, and whom I encourage one way but choose another, have the picture-perfect outcomes that dreams are made of. It’s not fair. It is frustrating.

Those who are against out-of-hospital birth would run rampant here and argue their point that birth is scary and needs to be in the hospital. That is not my impression or what I want your take-away to be. Midwifery is safe for low-risk women. While I have had to transport, I have not personally had an emergency transport situation.

So why would a low-risk, healthy mom need to be transported in labor and it not be considered an emergency?

Remember, there’s only so much you can control. You are in control of your nutrition, your exercise and your response to labor. You are not in control of your contractions or the response of the baby.

Ideally, with all the factors working together, a mom who is set up for success in her birth approach who has effective contractions and a baby who is tolerating labor well should be able to expect an uneventful birth without complications. However, if the latter two factors aren’t cooperating then something needs to change.

While there are some techniques a midwife can use to help regulate or strengthen contractions, there is a limit to that. We do NOT use Pitocin to stimulate or augment labor. When the natural remedies and holistic tips & tricks run out, we need to transport for back-up and support so that you and baby are monitored while your labor is augmented medically.

Perhaps the baby isn’t tolerating labor well and his/her heart rate has low or otherwise unfavorable decelerations. If a change in position doesn’t immediately resolve the issue, it is time to transport mom and baby. This is no one’s fault. You cannot control how your baby will respond to labor. Typically this doesn’t happen at the very beginning of labor. It may be a result of a longer labor or when other factors are present.

Finally, another reason for non-emergency transportation in labor would be for pain relief, or an epidural at the request of the mother. This is nothing to be disappointed by. The point is, you are listened to and heard and your voice matters throughout. You are in charge and call the shots. When you say go, it is not my place to talk you out of it. Please hear me, I have had women say “I can’t do this anymore” who are 9-10 cm and just need to hear that they can make it through, and they get a second wind and work through it and I support them every way imaginable. I have also supported women who say “I’m done, I want an epidural” and based on where their labor is at, it would be inappropriate to talk them out of it and stay. This is when it is invaluable to have had a close working relationship throughout the prenatal and early labor period. If a healthcare provider was just walking in, for shift change or on rounds to check on you and there was not an established history or positive rapport, it is more likely to get judgment calls based on reaction versus relationship.

Pain Management at a Home Birth

Labor is intense and it’s hard work. What is available to help me get through it?

I’d love to address this from the perspective that you’ve already decided within yourself your reasons for choosing an unmedicated birth.  I do not feel it’s my place to talk you into or out of personal decisions. Remember, I had my first 3 births inside the hospital setting, with the use of an epidural. This is an area close to my heart and I hope to share that with you.

During a consultation, when I am asked about pain in labor, I like to use the following analogy. Let’s say someone was pinching the fool out of you. (I know, not nice, and contractions are not at all like someone pinching you, but stay with me for a moment.) Would you be better able to tolerate it if you could walk, move around, DO SOMETHING to get your mind off of it…OR would you handle it best if you were strapped in bed, hooked up to a bunch of monitors, lines and BP cuffs?

The answer is pretty obvious.

We are able to tolerate pain better if we aren’t sitting/lying in one position, only being able to concentrate on that one stimulus.

So, for starters, being home and in your own environment, where you are already typically your most comfortable and relaxed is the first component. The freedom of eating and drinking throughout labor, coupled with the ability to move as desired in this comfortable environment allows you to progress more smoothly.

Once active labor is established and your birth team is present, they are able to help facilitate changes as needed to vary your support. The use of water in labor, whether it’s using your shower or a bath/birth tub helps to alleviate some pain and make it more manageable. Does that mean you have to birth in the water? Of course not. Many people who do not plan to have a water birth enjoy the use of water at some point during their labor.

In addition to water, your support team provides touch, through massage or counter pressure in ways that you control so that it is truly a help to you and not an annoyance.

Aromatherapy with essential oils can be a part of your laboring environment either from a diffuser or added to a carrier oil for your massage. Many midwives carry special blends of herbs or homeopathy to help take the edge off, smooth transitions or to help calm or center the laboring mother.

Finally, and I don’t think this is quantifiable, the one-on-one support of the laboring mother with her support person (Doula, spouse or midwife) throughout those super intense contractions taken one at a time is invaluable. I have supported women during this time who say, “I can’t do this anymore,” and with the right encouragement, support, their trust and responses to what I am working with them to do, they are able to go on and deliver their babies without issue. It doesn’t mean it wasn’t difficult, but they did manage and they have a new respect and appreciation for their capabilities.

From First Heartbeat to First Cry

A midwife stays with you the whole way.

In my post Prenatal Care without Waiting Rooms I stated that one of the biggest pros of midwifery care for me was the difference in prenatal care I experienced as an expecting mom. I had my first three children using OBs in a conventional hospital setting and my last two births under the care of midwives at home. Second to the prenatal care, my next favorite aspect of midwifery care was the continuity of care. When you select your midwife, you are selecting your birth team.

Whether you desire to work with an OB or a midwife, you will likely spend a lot of time researching, calling, and asking friends for references as you select a care provider for your pregnancy. In the typical scenario, an OB you select will be in a group practice and you very likely do not have a choice in which provider will actually be on call and help to deliver your baby. That may not always be the case, but often it is. One of the only ways that doctors in a group office can work to avoid this disruption is to encourage or find medical cause to schedule an induction; then you are conveniently scheduled for this procedure on your OB’s scheduled hospital day.

Even if you are fortunate enough to go into labor on your own and your doctor is on call at that time, you will see him/her very little during your labor hospital stay. Upon arrival at the hospital you will have a nurse assigned to you (and others) and she/he will be your primary resource until shift change. For some women, this process works well.  Maybe labor progresses well, they have a nurse who loves their job, it was a slow day at the hospital and patient ratios are lower allowing the nurse to spend more time with the patients they do have, and the mother delivers before further interruption in their care by a shift change. I am happy for those women and their positive experiences.

What if any one of those things had been different?

Rather than listing a myriad of negative scenarios that could ensue, let’s assume you’ve heard your own stories and know that it is not always such a pleasant experience.

The crucial point is, you don’t pick your nurse(s) at the hospital!

All this work in choosing the best OB for you (or your insurance), and you see them twice during labor and delivery if things are going well:

  1. Once upon admission, after the nurses have done their assessments and asked a myriad of questions getting you into the system – while you’re laboring and trying to find “your happy place.”
  2. Second to catch your baby, after the nurses had you do some pushing without them to make sure you’re not going to take too long and that you’re pushing effectively – at least for most first-time moms.

Are there exceptions? Of course there are! These are generalities made for comparison of the common/usual experience.

How does this differ with midwifery care?

I’m glad you asked. Remember, you are typically spending about an hour for each prenatal appointment throughout your pregnancy with your midwife. If you have a question or concern at ANY time throughout your pregnancy you are given your primary healthcare provider’s direct contact information. That means you can call your midwife directly at 7:00 pm or on a weekend if you start bleeding/spotting! Not her answering service, not a nurse who will page a doctor to have him/her call you back; you will call your midwife directly.

Even if questions arise that aren’t an emergency, you still have direct contact information so that you can get the answers to your questions before your next appointment. Whether your midwife prefers email or text for such communication, she will let you know. You will be communicating directly with her, your primary healthcare provider.

Typically, home visits are scheduled around 37 weeks of pregnancy so that your birth team gets a practice run before the big day and can find your house, note any special circumstances such as entry or gate codes, review your birth plan and the roles of participants who plan to be present for the birth. All of this helps everyone to be on the same page and to anticipate the best way to help prepare for the birth of your baby. When labor begins, you will call and speak directly to your midwife.

For my clients, I am the first one to arrive to assess them in labor. Vital signs are taken, physical and emotional support given and birth set-up continues as needed. At the appropriate time, a second member of the birth team is called to assist with the birth. That means if it is early, you don’t have multiple people watching you; the person you have come to have a relationship with throughout your prenatal care is present and supporting you. There are no shift changes.

Your midwife also remains with you during your immediate postpartum period. Instead of having nurses take over, checking your vitals and helping with breastfeeding, your primary healthcare provider (midwife) will stay to do those things. The bond and information you’ve shared throughout your pregnancy is carried on and built upon instead of being interrupted. You are valued and treated as an individual versus just one of many. Your midwife is on call for you 24/7!

Hospital Birth: How can I know for sure that it’s time to head to labor and delivery?

So you’re having a hospital birth but would like to minimize your chance of intervention, being put “on the clock,” or sent back home!

What can you do to avoid this? When is it time to go to the hospital?

Regardless of your choice of delivery setting, if you are able to go into labor on your own (i.e. you don’t have a scheduled surgical birth), it is usually best to labor at home until you have moved from early labor to active/established labor.

The following applies only when you do not have reason to seek care immediately and you don’t have a history of rapid delivery

Ask yourself:

1) What are the contractions doing?

The first rule of thumb is to ignore them until you can’t ignore them any longer!

This may look different for different people.

  • Are you able to distract yourself?
  • Can you rest/sleep between contractions?
  • Can you work, do a project around the house, distract yourself with shopping, watch a movie, etc?

2) Is baby moving normally?

When is it time to go?

Regularity of contractions:

First-time moms: Contractions are 4/1/1

  • Contractions are no more than 4 minutes apart, each lasting 1 full minute* for at least 1 hour

Baby #2 or more: Contractions are 5/1/1

  • Contractions are no more than 5 minutes apart, each lasting 1 minute* for at least 1 hour; they are regular, not having one 5 minutes, then 6 minutes, back to 5 minutes and then 7-8 minutes apart.

*While some people round up on contraction length, there are others who only count the peak or how long the contraction is painful for…you need to time the contraction from the beginning of uterine tightening until the contraction is over.

TIP: Download an app on your phone! SO much simpler and user-friendly than pencil/paper!

Intensity of contractions

  • You’d rate contraction intensity as a 7 or higher on a pain scale of 0-10
    • With 10 being the WORST pain you’ve experienced and you’re on the cusp of sawing off an appendage. (but you DON’T ;-))
    • I’d say this is the most speculative as MANY first time moms originally report a 6 when I’m doing a labor assessment and then well after the baby is born and we are doing a recap, they laugh and say, “I didn’t know how intense it was going to be; looking back, I’d call that a 3!!”
  • You can no longer laugh, walk or in other ways distract yourself from the intensity of each contraction during the contraction

Remember, most first-time moms have between an 18 – 24 hour labor from first labor sign until delivery.  There are of course exceptions, but generally speaking, this means you have time.

Are you overwhelmed or confused by what to look for or do?

Having a labor support person, specifically a doula or other trained birth attendant, can be invaluable. They can be your first resource and have a few tips/tricks and tools to help with your comfort and progression. You may also want to consider enlisting the services of a monitrice (think, “doula+”), who can perform cervical checks and monitor vital signs of mom and baby.

Monitrice Services Learn More