Labor from Start to Finish

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Late Pregnancy: Handout #3

Labor team members General tips for the labor support person(s) • You do not have to be an expert: just staying Medical care provider (doctor or certified with mom means a lot. The nurse will assist and nurse midwife) instruct you as needed. • Provides care during the pregnancy to keep you • Feel free to ask questions, if needed. and baby healthy. • Stay relaxed, calm and positive. • Answers questions about pregnancy, labor and • Taking care of yourself helps you take better care delivery. of the mom in labor. Be sure to eat something • Follows your labor and birth and directs your nutritious and take breaks as needed. care; makes decisions regarding emergency interventions. Labor doula • Works with the hospital team members to meet • An optional, trained woman who provides the needs of you and your baby. continuous support throughout the labor and birth. • Provides medical management, if needed, as you • Hired and contracted independently by the deliver your baby. birthing family. • Numerous studies have shown benefits of Registered nurses and auxiliary personnel continuous labor support to mothers and babies. • Monitors the well-being of you and your baby. • Keeps the medical care provider informed of Friends and family changes in you and your baby’s condition and • Everyone is excited, but the safety of the mom progress of labor. and baby must come first. • Answers questions and provides information • Your job should be to assist the support person; about what is happening during labor and about give him/her a break when needed or bring in your plan of care. food and beverages. • Seeks to understand and support your goals and • Ask questions if you are not sure what is plans for labor and birth. happening. • Offers comfort measures; suggests ways to help • Make positive comments, talk quietly and allow you cope with labor pain and to promote progress mom to rest. in your labor. • Do not add tension; if you are nervous, leave and • Provides reassurance and encouragement to you calm down, then return. and your support person(s) throughout the birth • Leave quietly if asked by the nurse, whose first experience. responsibility is to care for the mom and baby. Support person(s) Everyone wants the birth to be a positive • Chosen by you; person(s) who will be your experience. If we work together as a team and are primary emotional support during labor and birth. sensitive to the needs of mom and baby, it will be a Your support person: good experience for all of us. – Responds to your needs to provide, as needed, things like encouragement, distraction, humor, comfort measure, praise etc.

Continued X12557bc (Rev. 11/11) ©AHC Labor from Start to Finish, Page 2

How you may feel Early labor “I’m so excited to be in labor!” • Cervix begins to thin (efface) and starts to • Happy, excited, full of energy, maybe a little open up (dilate) to 3 to 4 centimeters nervous and scared • Bag of waters (membranes) may break • Uterus hard and cramping with each • Mucus plug might come out contraction • Average time: 7 to 8 hours • May have backache that comes and goes • Contractions every 5 to 20 minutes, lasting 30 to 45 seconds

Active labor “This is hard work!” • Cervix thins partway and opens from • Must concentrate on handling contractions 4 to 5 centimeters to 7 to 8 centimeters • Serious, quieter, thinking about the “work” • Bag of waters (membranes) may break of labor; scared because labor is getting • Mucus plug might come out harder • More bloody show • Hot and tired; back could ache • Average time: 3 to 5 hours • May feel more pelvic pressure • Contractions 2 to 4 minutes apart, lasting • May become nauseated or vomit 60 seconds

Transition “I can’t do this!” • Discouraged and feeling in a panic because • Cervix opens 9 to 10 cm (sometimes called labor is such hard work “being complete”) • Hot and cold flashes; shivery and shaky; • Bag of waters (membranes) usually breaks if hiccoughs or burping it hasn’t already • Feel rectal pressure, “like you have to poop” • Average time: 30 to 90 minutes • Feel like contractions are one right after • Contractions 2 to 3 minutes apart, lasting the other 70 to 90 seconds

Pushing “This is hard work!” • May be nervous • Cervix completely open; baby pushed out of • You have new energy; better able to focus uterus and down the birth canal • Lots of pelvic pressure as baby presses down • Average time: 30 minutes to 2 hours • Contractions may be less painful • Contractions 3 to 5 minutes apart, lasting • You may feel more in control, as you can 60 seconds bring about the birth of baby • You may feel sleepy; rest between pushes if you can Delivery “My baby!” • Average time included in above • Proud, excited and relieved

Delivery of placenta • Average time: a few to 30 minutes • Contractions keep coming to help deliver placenta • Relief: “I can’t believe it’s over!”

After delivery • Contractions keep coming to help the uterus • All of the above feelings tighten again • Exhausted • Surprise • Disappointment at after-birth discomfort • Talkative; need to review birth • Desire to see and hold baby

X12557bc (Rev. 11/11) ©AHC Continued Labor from Start to Finish, Page 3

What you can do What your support person can do Early labor

• Walk • Keep her mind off the contractions; encourage • Relax or rest if tired; drink and eat lightly; her to sleep if at night, encourage normal if at night, try to sleep if able activity during the day • Call your care provider and go to the place • Time a few contractions every hour you plan to give birth when you feel the need to be there or when instructed to go • Encourage light meals and fluids • Say to yourself, “My body knows what to • Call care provider as advised do, I am ready for this birth” • Calm and reassure mother with touch or • Try a warm shower verbal relaxation Active labor • Rest and relax, or walk and move about to keep • Encourage changes in activity, frequent urination, the labor moving; go to the bathroom often; use of relaxation and breathing techniques moan if it makes you feel better; try a shower, • Offer ice chips, clear liquids, cold washcloth cool cloths on your face, and/or back rubs • Time the contractions • Play music • Suggest water therapy • Say to yourself, “I am strong, my body can • Provide a relaxing atmosphere, positive do what it needs to do” • Use the breathing techniques that work attitude and reassuring voice for you • Encourage her and massage her as needed • See Pain Management in Labor handout Transition • Keep your body relaxed; change positions; • Be her “rock,” remain calm and confident focus on your breathing • Breathe with her to avoid pushing, using • Say to yourself, “Birth is close; I can do this; eye contact I won’t quit now” • Notify staff if she has an urge to push • Take one contraction at a time • Help her relax between contractions • Remember this is the shortest part of labor • Remind her she’s almost at the end and her baby will be here • See back page for more suggestions

Pushing • Relax body parts not used for pushing • Focus on pushing the baby down and out; rest between contractions • Encourage her to relax in between pushes; • Say to yourself, “I can push this baby out, offer ice chips, cold washcloth I am stronger than I will ever be” • Remind her to take deep breaths as contraction • Concentrate on relaxing your bottom (perineum) begins, and remind her of proper positioning to and opening it up to push out the baby relax legs and bottom when pushing • Find the most comfortable position (often • Support head and shoulders C-position) • Encourage her as she pushes; tell her she • You may close your eyes and rest between can do it contractions • Listen to your care providers for special directions

After delivery • Allow yourself to relax and enjoy this • Cut the cord, if you choose special time • Tell her what a good job she did

• Hold and feed your baby • Take pictures • Learn what you can from your care provider • Hold your baby and nurses; allow others to help with non-baby • Participate in infant care tasks so you can take care of your baby and rest • Offer mother comfort measures

What to do if she panics

There may be a time during labor when your • Ask for help. The nurse, midwife or doctor can partner hits an emotional low or panics. She may measure for dilatation, give you advice and show this by: suggestions, do some of the coaching, advise • Weeping or crying out. another position, and reassure you that your • Stating she cannot go on. partner is okay. • Looking or sounding as if she is in a great deal • Remind her of the baby. It is helpful to focus on of pain. the reason for the labor and remember it is pain • Becoming very tense and unable to relax. with a purpose.

A “take charge” routine may be helpful at this time. If your partner said before labor that she does not You need to do all you can until she regains her want pain medications and now changes the plan inner strength. Use any or all of the hints listed: and asks for them, respect her wishes. However, • Stand up. This action says without words that a request for medication may also be a request you are present and in charge. for additional support. With the techniques given • Remain calm. Your touch should be firm yet (see Pain Management in Labor and Affirmations confident. Keep your voice calm and your words handouts), you may be able to have her back in encouraging. control without medications. • Stay close to her and make eye contact. Instruct her to open her eyes and look at you. The important thing to remember is that what you • You can hold her head or shoulders, or hold her do is far more important than what you feel at the tightly in your arms. time. In other words, it’s okay if you feel anxious • Try a different position or breathing pattern. inside; your actions will show that you are helpful Breathe with her to keep her focused. and in control. • Encourage her with every breath and tell her she is doing a good job. You may have to speak louder to get her attention, but keep your tone calm and confident. • Talk to her between contractions and make suggestions such as: “When your next contraction starts, I want you to look at me.” • Repeat instructions frequently. She may not be able to follow what you are saying for more than a few seconds. • Don’t give up on her. This will be a very difficult time, but you will not be helpful if you decide she cannot handle it.

The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem.