Definitions
Contraction: is the wave-like squeezing motion of the uterus which moves the baby down the birth canal. They are measure from beginning of one contraction until the next starts. Dilation: is a process of the cervix opening to allow passage of the baby through the birth canal. Generally, early labor (the first stage) is considered 1-4 cm dilated (a pencil eraser to oreo); active labor is considered 4-7 cm; transition is 8-10 cm; fully dilated is 10 cm (a cheap roll of toilet paper). The more the babys head is applied to the cervix, the more it dilates. Effacement: is the thinning of the cervix where no effacement (0%) is a tight, bottle-neck, and 100% effacement means the cervix is paper thin and ready for labor. Station: this indicates where babys head is in relation to the ischial spines of the pelvis. (-3 is 3 cm above the spines, 0 is level with the spines, and +2 is 2 cm below the spines). The babys head is fully engaged starting at -1 station.
Stages of Labor
Before labor begins, make sure you are prepared to go to the birth center or your house is ready for home birth
Birth Center Necessities: Packed bag 2 changes of clothes for mom 2 sets of clothes for baby (newborn and 0-3 size) Car seat is installed Snacks, juice, Gatorade Rebozo, rice sock, essential oils, stones, candles
Home Birth Necessities: Plastic sheet under an old, fitted sheet Birthing tub/liner is clean and ready to be blown up Labor area is set up with candles, music, etc. Food and drinks are stocked Car seat is installed
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Lose mucus plug: the mucus plug serves as a barrier between your cervix and the outside world; it is blood-tinged mucus.
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Labor and Birth You could lose the plug weeks to hours before labor, you may not even notice it.
Nesting: this is a real burst of energy that happens days before the onset of labor to get everything in order. DONT OVER DO IT! Flu-like symptoms: you may experience diarrhea, nausea, and mild cramps. This is generally your body flushing out our system in preparation of labor. Let your midwife know if you have any fever associated with these things as it could indicate an infection that needs to be monitored. Contractions: you need to know the difference between prodromal labor (prelabor) and true labor (this is early and active labor). Prodromal labor can be very tiring but it is preparing the body before dilation begins; the contraction process softens and thins the cervix. This could last for several weeks before actual labor kicks in. o Only a portion of your uterus tightens and you generally wont experience back pressure o Last between 15-45 seconds without increasing intensity or spacing o Usually irregular o Changing position/activity stops contractions o Rest and try to create a nighttime ritual that is calming and lowers your anxiety level. True labor is the process in which the baby is engaged in the pelvis, with the head pressing down on the cervix. o Contractions may begin as a warm, menstrual cramp-like sensation that migrates, tightening around the entire uterus and around the back o The duration and intensity of contractions increases progressively o Changing position/activity doesnt stop them o Walking may increase intensity
Active labor: Once contractions are every 5 minutes, give or take, this is the time to call your midwife and either go to the birth center or have her drive to you. Baby is rotating to fit the widest part of its head with the widest part of your hips Emotionally, you may experience apprehension and uncertainty, a desire for companionship and physical touch, increased seriousness Physically, you will likely experience strong contractions every 2-5 minutes that last about 60 seconds. They require focus and deep breathing.
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Labor and Birth Guidelines for Comfort Measures and the Partner: Continuously, but genuinely encourage the laboring women. Praise her for the hard work she is doing. If the comfort measure isnt working for her, stop immediately. The laboring woman should always feel secure and affirmed with your presence. Remind her that she is loved. Tell her she is beautiful. Watch her body languageif she is tense when you are touching her, perhaps the action is bothersome, hurts, and/or she wants you to stop. Be proactive with wiping her brow, offering a sip of water or juice, and giving encouragement. Comfort Measures: o Clear your head of anything that doesnt welcome your baby and keep you relaxed What is a peaceful/calming thought to you: _____________________________________________________________________________________________________ o Walk, relax in shower/tub, lean on/sway with your partner or birth ball, focus and repeat a mantra that is encouraging to you, visualize your body opening Is there a visualization that reminds you to be open to your baby? _____________________________________________________________________________________________________ o Keep your mouth and jaw loose; make horse-lips as you exhale o Hum/moan/groan/sing/growl/moo in the lowest note possible to keep your throat and belly open o Breathe deeply; Inhale, expanding your belly and back; dont lift your shoulders when inhaling Exhale, pushing air out slowly through your mouth and using your pelvic muscles to squeeze out all air
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Rebozo Comfort Measures: Hip squeeze: wrap the middle of the rebozo snugly below the belly, around hips, and cross at either the back or side. Gently and firmly pull, while making sure the mother is comfortable. It can be knotted to hold in place. o The partner can stand behind or beside her and gather/hold the loose ends o Woman may be seated in a chair and partner kneels or stands in front of her, holding the rebozo ends (dont knot it in front of the belly)
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Supported Squat: With the partner standing in front of or sitting in a chair across from the laboring woman, the middle of the rebozo is wrapped around her back and under her arms as the partner holds the two loose ends. The woman can hang from the rebozo while the partner supports her. This allows her to go limp and loose while opening up in a squatting position.
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Reminders for Transition: DO NOT PANIC Take one contraction at a time Visualize opening and releasing your body and vagina Breathe all the way down through your vagina Any noise you make should be low Keep mouth and jaw loose with horse lips
For Partners: Keep her mouth moist Wipe her face with a washcloth Apply counterpressure, either with your hands or using the rebozo Praise her hard work and tell her you love her Breathe with her If she is starting to panic, focus her! Tell her firmly to look at your eyes so you can bring her back to the present and keep her grounded
Exercises to Practice at Home/Work/in the Car: Inhaling and expanding your belly/back; exhaling out of your mouth and pushing all the way through to your vagina Sing/hum songs in a low key, practice keep your throat open Practice rebozo techniques with your partner Visualize a comforting scene or image and relax with it as you bath or shower Write down affirmations that you can use as mantras during labor
Recommended Reading: Homebirth, Sheila Kitzinger Ina Mays Guide to Childbirth, Ina May Gaskin The Simple Guide to Having a Baby, Whalley, Simkin, Keppler
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