Christian Doulas

Comfort Measures for Labor

 

Leave a laboring woman to find her best position to get through the intensity of childbearing, and she'll come up with some pretty creative ways to contort her body.

 

Here is an excellent site with illustrations of some of the more common positions that have helped many a laboring Mama  find comfort in labor.

 

And here is the first of twelve excellent you tube videos of a childbirth educator describing various labor coping techniques.

To check cervical dilation or not to check cervical dilation, that is the question.

There are many reasons why it would be beneficial or helpful or preferable to be able to check your

progress without having a vaginal exam. The most obvious is the discomfort of having someone (as I read on another blog) “search for my tonsils via my lady parts.” Also, vaginal exams increase the risk of infection if the water has broken — even when sterile gloves are used, there are bacteria on your body that get on the sterile gloves and then are given a free ride up to your cervix. Before sanitation (even simple hand-washing) was practiced by birth attendants, it was common for women to die of “childbed fever” due to germs being introduced directly into the uterus this way.
[As an aside, when you hear people decry modern homebirth because "women used to die all the time before they started having their babies in the hospital," you now know that the high maternal death rate was at least partially attributable to doctors' dirty hands infecting scores of women. It was common practice to teach medical students how to do vaginal exams by using cadavers -- dead women (who frequently were victims of childbed fever) -- and then to go down the hall to where women were laboring and without washing their hands, perform vaginal exams on them, directly introducing the germs from a dead person into the body of a living person.]
But another reason would be to assess where you are in your dilation so that you know when to go to the hospital (if you’re planning a hospital birth). A frequent concern of women is that they’ll go to the hospital (or call the midwife) too soon…. or else too late. In the first case, they may be turned away until they are dilated more; and in the second case, they may have a harrowing ride to the hospital with a white-knuckled husband fighting his way through traffic while she tries not to push.
On this thread at Midwifery and More, there are a few different ways mentioned, but the one I want to talk about most is one that Anne Frye wrote about in Holistic Midwifery, Vol. II, p. 376. Sarah Wallbaum mentioned it on our childbirth educators email list, and it intrigued me. Here’s how it works:
During a contraction and with mom on her back, determine how many finger breadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.
5 fb = no dilation
4 fb = 2 cm
3 fb = 4 cm
2 fb = 6 cm
1 fb = 8 cm
0 fm = complete
She said that she has practiced this for accuracy with a midwife, and has both found it to be fairly accurate, but that if a mom is very obese, it would be difficult to use. Even if it just gives a “ballpark figure” it just feels empowering to me to be able to know this information without having somebody else’s hand stuck up inside me. Remember also, that the World Health Organization’s guidelines for Safe Motherhood says that vaginal exams should be kept to a strict minimum, and in the first stage of labor once every four hours should be enough.

 

Rebozo

A rebozo is a long scarf used to provide comfort for a laboring Mama.  It is especially useful when a woman is experiencing back labor.  Here is a video of a Daddy helping his wife get through a contraction by using the rebozo.

Go Through Virtual Labor

Take this tour through a virtual labor.  It's a lot less painful than the real thing, and it's excellent practice at decision-making in a variety of laboring scenarios.

Stages and Phases of Labor

Stage 1: Labor 

  1. Early Labor Phase
  • 0-4 cm.
  • easy contractions.... can walk, talk, laugh through these
  • 5-20 minutes apart
  • 30-45 seconds long
  • low backache often present
  • possible bloody show
  • possible rupture of membranes
  • eat lightly or not at all
  • keep hydrated
  • longest phase of labor

REMEMBER: There are six ways your labor can progress. Do not put your hope in how many centimeters dilated you are.  Place your hope in God, who has created your body to give birth to this baby, and don't forget that if the dilation isn't steadily increasing, the labor may be progressing in one of the other five ways outlined by Penny Simkin in the very useful book, The Labor Progress Handbook:






(1) The cervix moves from a posterior to an anterior position







(2) The cervix ripens or softens







(3) The cervix effaces







(4) The cervix dilates







(5) The fetal head rotates, flexes, and molds







(6) The fetus descends and is born.


 

  1. Active Labor Phase
  • 5-7 cm
  • starting to be hard to take
  • 2-4 minutes apart
  • 1 minute or more in length
  • more pain in abdomen
  • often at or going to birth location
  • partner is IMPORTANT in this phase
  • limited to ice chips in most cases
  • about 3-5 hours in many cases, but THIS VARIES
  • keep moving
  • urinate often
  1. Transitional Labor Phase
  • 8-10 cm.
  • no more meds
  • 1.5-3 minutes apart
  • 60+ seconds in length
  • STRONG
  • Backache
  • Nausea, vomiting, gas, hiccups
  • Sweats/chills/shakes
  • HARD TO RELAX... PARTNER IS VITAL!
  • Thigh and leg aches
  • Very easy to hyperventilate
  • Pelvic pressure
 

STAGES:  
1. Labor… early, active, transition

2. Delivery…. Pushing and delivery

3. Postpartum …both immediate and at home  
 
 

Stage 2: Pushing and Birth

  • 100% effaced
  • 100% dilated
  • STRONG urge to push
  • 2-5 minutes apart
  • 60 seconds long
  • may feel stretching, burning, pain sensation as baby’s head stretches the birth outlet
  • coach needs to listen to what doctor/birth attendant is saying and repeat to mother if she is not listening
  • count during pushes
  • support shoulders/legs during contractions
  • give strong emotional encouragement between contractions
 

Stage 3: Immediate Postpartum

  • cord is clamped
  • partner can cut cord if all is well
  • placenta delivered in 5-20 minutes
  • exam of placenta and abdomen
  • repair if needed
  • pitocin may be given to discourage hemorrhaging.

(with thanks to PAC for original list,
 

Use an online program to monitor contractions

Hit the space bar when a contraction begins and again when it ends.  The Contraction Master does the rest of thefiguring for you.  Created  by a dad who didn't like hauling a notebook and pencil around to record the length and frequency of his wife's contractions. 

What to know about pain medication in childbirth

Here is a very informative article about the use of narcotics to minimize pain in labor.

Fear in Labor and Childbirth

...definitely works against the dialation of the cervix and the body's preparations to give birth.  Here is a video made by a third-year nursing student presenting the latest research about how to minimize fear in women expecting their babies.

Labor Cubes for "clear liquids only" labor limitations

One very effective trick (in hospitals that insist that mothers labor on "clear liquids only") is to have the mother take along a zippy bag of "labor cubes" to the hospital, storing them in her room fridge. "Labor Cubes" are ice cubes made out of very strong raspberry leaf tea (perhaps one cup herb to one quart water, simmered down to half and strained) that is heavily sweetened with honey. If the laboring mother begins to fade, energy petering out or contractions waning due to lack of nutrition, she can chomp on these satisfying slushy cubes, which usually will perk her up and kick in some great contractions in a matter of minutes.

— Beth Barbeau
Excerpted from "Tricks of the Trade: Liquids Only," Midwifery Today, Issue 81

Studies support what midwives have always known: Walking or Being Upright Can Shorten Labor

Walking or Being Upright Can Shorten Labor Without Complication
A new Cochrane review finds that remaining upright or walking around during the first stage of labor may be associated with shorter labor and less use of epidural analgesia. Due to concerns in other studies about adverse effects on mothers and fetuses of supine position in labor, the authors recommend not lying on the back for extended periods.

Maternal positions and mobility during first stage labour

Plain language summary

Mothers' position during the first stage of labour
Women in the developed world and in health facilities in low-income countries usually lie in bed during the first stage of labour. Elsewhere, women progress through this first stage while upright, either standing, sitting, kneeling or walking around, although they may choose to lie down as their labour progresses. The attitudes and expectations of healthcare staff, women and their partners have shifted with regard to pain, pain relief and appropriate behaviour during labour and childbirth. A woman semi-reclining or lying down on the side or back during the first stage of labour may be more convenient for staff and can make it easier to monitor progression and check the baby. Fetal monitoring, epidurals for pain relief, and use of intravenous infusions also limit movement. Lying on the back (supine) puts the weight of the pregnant uterus on abdominal blood vessels and contractions may be less strong than when upright. Effective contractions help cervical dilatation and the descent of the baby.

The results of the review suggest that the first stage of labour may be approximately an hour shorter for women who are upright or walk around during the first stage of labour. The women’s body position did not affect the rate of interventions. The review authors identified 21 controlled studies from a number of countries that randomly assigned a total of 3706 women to upright or recumbent positions in the first stage of labour. Nine of the studies included only women who were giving birth to their first baby. The length of the second stage of labour and the numbers of women who achieved spontaneous vaginal deliveries or required assisted deliveries and augmentation were similar between groups, where reported. Use of opioid analgesia was no different, although women randomised to upright positions were less likely to have epidural analgesia. In those studies specifically examining position and mobility for women receiving epidural analgesia (five trials, 1176 women), an upright or recumbent position did not change the length of the first stage of labour (time from epidural insertion to complete cervical dilatation) or rates of spontaneous vaginal, assisted and caesarean delivery. Little information was given on maternal satisfaction or outcomes for babies.

Annemarie Lawrence1, Lucy Lewis2, G Justus Hofmeyr3, Therese Dowswell4, Cathy Styles5

1Institute of Women's and Children's Health (15), The Townsville Hospital, Douglas, Australia. 2The School of Women's and Infants' Health/The School of Paediatrics and Child Health, The University of Western Australia, Subiaco, Australia. 3Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, East London, South Africa. 4Cochrane Pregnancy and Childbirth Group, School of Reproductive and Developmental Medicine, Division of Perinatal and Reproductive Medicine, The University of Liverpool , Liverpool, UK. 5Institute of Women's and Children's Health, The Townsville Hospital, Douglas, Australia

Contact address: Annemarie Lawrence, Institute of Women's and Children's Health (15), The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland, 4810, Australia. annemarie_lawrence@health.

qld.gov.au. annielaw@bigpond.net.au. (Editorial group: Cochrane Pregnancy and Childbirth Group.)

Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: New)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD003934.pub2
This version first published online: 15 April 2009 in Issue 2, 2009. Last assessed as up-to-date: 30 December 2008. (Help document - Dates and Statuses explained).

This record should be cited as: Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub2.
--------------------------------------------------------------------------------


Abstract


Background
It is more common for women in the developed world, and those in low-income countries giving birth in health facilities, to labour in bed. There is no evidence that this is associated with any advantage for women or babies, although it may be more convenient for staff. Observational studies have suggested that if women lie on their backs during labour this may have adverse effects on uterine contractions and impede progress in labour.


Objectives
The purpose of the review is to assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies.


Search strategy
We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (November 2008).


Selection criteria
Randomised and quasi-randomised trials comparing women randomised to upright versus recumbent positions in the first stage of labour.


Data collection and analysis
We used methods described in the Cochrane Handbook for Systematic Reviews of Interventions for carrying out data collection, assessing study quality and analysing results. A minimum of two review authors independently assessed each study.


Main results
The review includes 21 studies with a total of 3706 women. Overall, the first stage of labour was approximately one hour shorter for women randomised to upright as opposed to recumbent positions (MD -0.99, 95% CI -1.60 to -0.39). Women randomised to upright positions were less likely to have epidural analgesia (RR 0.83 95% CI 0.72 to 0.96).There were no differences between groups for other outcomes including length of the second stage of labour, mode of delivery, or other outcomes related to the wellbeing of mothers and babies. For women who had epidural analgesia there were no differences between those randomised to upright versus recumbent positions for any of the outcomes examined in the review. Little information on maternal satisfaction was collected, and none of the studies compared different upright or recumbent positions.


Authors' conclusions
There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.


Effects of Chiropractic Care During Pregnancy on Labor

Chiropractic care during pregnancy has been shown to decrease the length of labor.


Chiropractic care can also decrease your chances of back labor.
The Webster's technique some chiropractors specialize in can help turn a breech baby.

The resounding answer is yes! In my previous article Chiropractic Care to Relieve Pregnancy Back Pain I examined the benefits of chiropractic care during pregnancy as it related to pain management. I would now like to take a look at the benefits that chiropractic care during pregnancy can have on a woman's labor.

Time of Labor
The body's balance and ability to function properly can have a huge impact on its capacity to adapt to extra stresses placed upon it. The most common cause of Cesarean in the United States is "failure to progress". Any misalignment in the pelvic outlet could be a cause of slower descent of the fetus through the birth canal. Back pain could also decrease a mother's rang of motion making it more difficult for her to assume the upright, active positions that have been proven to make labor more efficient. Proper adjustments can make sure that the hips and pelvis are in proper alignment.
A study by Dr. Fallon in 1994 showed that "chiropractic adjustments effectively reduce the average amount of time spent in labor." The data she collected showed almost 25% reduction from the accepted average labor times in first time mothers who had regular chiropractic care during pregnancy, and 33% reduction from the norm in woman who had previously given birth.

Fetal Positioning
There is another aspect beyond just length of labor to consider. Another huge factor in labor progress and even pain levels is the proper positioning of the fetus. It has long been accepted that a breech baby (a baby presenting foot or buttock first instead of head first) is more difficult to deliver, often resulting in a Cesarean. It is also known that a posterior baby (a baby who, while head down, is facing forwards rather than face towards the mother's spine) creates the most painful labor conditions.
One of the biggest benefits to regular chiropractic care during pregnancy is that a properly balanced and open pelvis allows more room for the fetus to turn into a proper position to ease labor. In fact, many chiropractors have additional, specialized training in a technique to encourage a breech baby to turn called Webster's technique. According to the Journal of Manipulative and Physiological Therapeutics there is an 82% success rate in turning breech babies using the Webster's technique (July/August 2002). Another study showed that regular chiropractic care also reduces the chances of posterior labor, sometimes called back labor (Diakow, 1991).

Encouraging Labor
Tamie Dixon, doctor of Chiropractic and West Virginia State Coordinator wrote, "Pelvic bone adjustments have been found to stimulate part-due labors and non-progressive labors that are stalled due to pelvic outlet disproportion." I know this one from personal experience. With my daughter's birth, my second baby, I experienced off-and-on-again labor for a two days. I called my chiropractor at home the next morning and asked if he could come by on his way to the office and he came to my house. I received an adjustment at 7:30 and he left, and from then on my contractions really picked up. Brianna Joy was born at 12:15 after just a few hours! My labor never stalled or slowed down again.
Dr. Sears wrote in Parenting magazine "It is our personal theory that chiropractic care in pregnancy can help to avoid or relieve back pain and also prepare your back and pelvic structures for the stresses of labor and birth." And I have to agree with him.

What happens when you get an epidural

Here's an informative video.

 

And here is a doula trick to help the baby descend even after you are immobile:

 

Passive Pelvic Rock

 

Epidurals in the US are quickly reaching the 90% mark of usage among laboring women. Local anesthetic medication (similar to that used by dentists) is injected into the epidural space, an area immediately outside of a protective sac which surrounds the spinal cord. The spinal cord ends at the same level as the tip of the breastbone. Below the spinal nerves to the lower abdomen and legs descend in this sac before leaving. The fluid in the sac allows them to move out of the way of any needle, which penetrates the sac. The walls of the sac are formed by a thick membrane called the dura.

Nerves entering and leaving the spinal cord pass through the epidural space and are responsible for transmitting touch, temperature and pain sensations to the spinal cord and also to the brain. In the other direction, these nerves carry commands for movement from the brain. Epidural anesthesia moves up, down and around and is able to coat many large nerves to the legs, pelvis and abdomen. To what extent the sensations are blocked depends upon what dose is given.

Due to the relaxation of the muscles from the epidural, the descent of the baby may be compromised and the baby may descend ascynclitically or even occiput posterior. Either way, the mother may not be able to use her lower body to get into an all-fours position to perform the pelvic rock. When used in the all fours position, the pelvic rock allows the baby to fall out into the sling that the tummy muscles make and the rotating action of the pelvis causes the baby to turn approximately 85% of the time.

To perform a passive pelvic rock, position the mother comfortably, preferably on her left side (photo shows model on her right side). Standing behind her (see photo), cup your left hand over the iliac crest and place your right hand on the sacrum. Moving your arms in a bicycle-type motion, rotate the pelvic with the strength of your hands and arms. Depending on your individual strength, you may need to show another support person how to do this so they can take over when you are tired. Success in rotation of the baby depends on many factors, so it make take a while before results are seen.

 

How to make the best use of a birthing ball while in labor

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       Christian Doula

christiandoula@gmail.com


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