Preparing for Labor & Delivery
Labor and delivery is one of the most physical and emotional experiences you will ever go through. The good news is that there is so much you can do to prepare so that you feel more in control, above and beyond what is typically taught in hospital prenatal classes. Equipping yourself with the correct knowledge and preparing your mindset can go a long way. I’m excited to bring you this post today and I had Amy pop in to share her experiences as well, since she used many of these tips.
For a brief review of breathing and how to push see our post HERE
Preparing for labor:
The Role of the Pelvic Floor in Labor
It is SO important to know how to work this area. How to contract, relax, and bulge it. Get familiar with working it PRIOR to labor and delivery. During the pushing phase you will want to use your abdominals to push down, while relaxing your pelvic floor. The Expecting and Empowered Pregnancy Guide has this all laid out for you so thank you know how to prep your body for your big event.
CONTRACTION Gaining some awareness of your pelvic floor can be powerful. It plays a major role in labor and delivery. To contract your pelvic floor, think about your pelvic floor as a diamond shaped muscle: Front to back (pubic bone to coccyx), and side to side (from sit bone to sit bone). To contract your pelvic floor, contract your rectum and pull it toward the back of your pubic bone.
RELAX
Practice letting the tension out of this area. Your muscles should be able to relax. To practice, place your hand on the outside of your pelvic floor or place a blanket/towel touching in that saddle region so you can feel your muscles come back down. Focus on bringing air into your lungs as you inhale. This should help the area to relax.
BULGE/BEAR DOWN
As you push your baby out you want to work WITH your contraction. When the contraction is occurring, you should lightly bulge your pelvic floor downward. Contracting your abdominals creates the pushing force to get your baby out. When your abdominals are pushing (you are bearing down) your pelvic floor needs to be bulging downward. This should feel like taking a poop. Let your pelvic tissue come downward toward your feet. This is the opposite of a pelvic floor contraction which is “upward” toward your head. You want to envision your pelvic floor opening up to the baby’s head— you do not want your baby’s head to meet the extra resistance of your pelvic floor contraction. If you are pushing against a contracted/tight pelvic floor—this is how vaginal muscle tears occur. Position is key for this- standing or on all fours is shown to reduce tearing of the perineum (vaginal muscles) and requires less stitching. We generally advocate for mamas to give birth in any position other than laying on their back with their legs up
Practice being in control of your pelvic floor throughout pregnancy. It will help you to be in control of your pelvic floor during the main event.
EXERCISES
There are many things you need to do to get your body ready for labor and delivery. It is a very physical task. Your muscles need to be strong and to really benefit from muscle strengthening, you need to start doing it at least 4-6 weeks before labor and delivery. The Pregnancy Guide walks you through the best ways to strengthen, but some things to consider are:
Endurance of leg muscles for squatting
Knowing how to use your pelvic floor
Having a strong core to be able to push the baby out
Knowing how to prepare for the postpartum period. The Expecting and Empowered Postpartum Guide seamlessly walks you through what to do- from day one through week 33 of your postpartum workouts. Strength is a key component for the everyday tasks of motherhood.
Perineal Massage
You can start perineal massage at 34 weeks. This can help prepare the area for labor because it increases blood flow and elasticity to the area. It can make for a more comfortable birth and reduce your chances of having an episiotomy and/or significant tearing.
If you don't feel comfortable or would rather not perform perineal massage on yourself, it is worth seeing a women’s health physical therapist that does internal work to help you stretch this area out.
To perform: You can perform independently or have a partner help (wink, wink). Lie down in a bath or use Slippery Stuff lubrication. Place your finger inside your vagina and stretch the back side of the vaginal wall from 3:00 to 9:00. You can stretch and hold. It should feel a bit uncomfortable like the sensation of opening your mouth wide and pulling your cheeks apart. You can also pinch and push the tissue between your vaginal opening and rectum to stretch and move tissue in this area. This is the most common area for tearing during labor and delivery. Perform for 5-10 minutes, 4 times per week starting at 34 weeks. If you are a high risk pregnancy consent your doctor.
Researching to Prepare Yourself
Learning through others stories good and bad prepares you for the miracle that is about to happen.
Also watch ‘positive birth videos’ on YouTube.
You can listen to podcasts such as:
The Birth Hour
Birth, Baby and Love
Doing It At Home.
C-Section Strong Podcast
Sex
Yeah that’s right. Women who stay active in the third trimester are 20% less likely to tear! This might be something you want to keep on doing right up until the main event. ;)
Tips for the main event: Labor
Environment
Envisioning and planning your birthing environment is crucial to how you’ll cope with labor. For my c-sections, I spent the mornings getting settled in and organizing all my stuff. I would suggest doing this even more for your birth environment when you have to labor. Considerations for environment may include:
Putting your clothes and toiletries away (tooth brush at sink, soap in shower) during relaxation period between contraction
Having birthing playlists: quicker (during active labor) and relaxing music (rest between)
Battery operated candles in a dark room or Christmas lights
Aromatherapy
Comfortable room temperature
Affirmations up on the wall
Shut the doors
Curtains: open or closed
Have a “phones on silent” rule
Specific guidelines for support and/or staff
Your own pillow
Timing Your Contractions
I relied on my running watch during my first labor. I would take 10 enormous and slow breaths in and out, then look at my watch to see how much time had passed. Sometimes the contraction would be over before I was done and if not, the end was in sight.
I took each contraction one at a time without fear of the next. When I wasn’t having a contraction, I was able to relax and maybe even talk to my nurse and husband. I didn’t try to time the rest period, I just took the opportunity to have a break. Timing the contractions helped me feel in control of my experience.
With my second labor, I felt less need to time the contractions. I had the experience of one birth under my belt and felt more comfortable and confident with my birth plan and strategies that worked for me. Early on in labor I timed my contractions, but when things became tough…I focused on my breath to get me through.
My best suggestion would be to take your watch with you. See if that is a helpful strategy for you or if you’d rather focus on your breath to make it through each one. -Amy
Using upright labor positions
I remember the women's health class that first got me interested in these topics, including pregnancy and postpartum. Dr. Laura Krum (one very passionate individual) was telling story after story that involved women staying mobile during labor, and having a positive birth experience. She also shared stories of women who let the pain take control and did not want to move. Many of these outcomes were not what they were hoping for. After listening to her stories my major takeaway was: active upright labor is a concept you will want to think about. Here are some of the benefits of being upright and mobile in labor and delivery:
Reduced length of labor and easier time pushing
Reduced pain
More comfortable and in-control labor
Reduced interventions (forceps, vacuum) and therefore reduced damage to mother and babe
Partners are able to be more involved
Gravity is on your side to bring baby down to the cervix, which encourages it to dilate
More room in the pelvis for baby to fit
Baby gets better oxygenation
Lower risk of trauma to your lady parts
There is no right or wrong way to do this! We recommend whatever feels most comfortable to you. At the bottom of the post, there are some positions that you can practice at home prior to your delivery. Walking and keeping on the move is a great option, as well as a semi squat position with a bar or counter. This is how Amy brought her two beautiful babies into the world, and was also my plan before it got changed to C-sections. The squat position is great because it increases the pelvic outlet. Birthing in a squat or quadruped position has been shown to significantly reduce tearing. Feel free to make a note of your favorite positions, however your favorites may change while actually laboring.
Hip Squeeze
This is a great technique that you can use during the later stages of pregnancy and during labor. The pelvic bones begin to soften up and therefore are more moveable during these stages. You can have your partner, PT or midwife perform this. Have them squeeze the top of your pelvic bones together, which will cause the bottom of your pelvis or pelvic outlet to open up more. I have to say, from prior experience, patients tend to LOVE this move. It takes so much pressure off this area and we all know during the final stages of pregnancy, getting some of the load off is much welcomed.
Bath/Shower
Water can be very therapeutic. Warm water can ease labor pain by stimulating thermoreceptors, closing the gate to slower conducting pain fibers which reduces the perception of pain. It’s also a great method of increasing endorphins through relaxation.
Lord, thank you for the labor tubs. These magic water baths have helped me through the most intense phases of both my labors. I tell every woman I know to just TRY the bath during labor. I like to labor standing up and squatting for MOST of the time. But, when the pain escalates to a point where I’m searching for some relief, I get into the bathtub. This has worked like a charm both times and provides more relief that you can really imagine.
I know this because during my first labor when my nurse kept suggesting it, I kept saying, “I don’t really like to be hot and I really am liking to move.” She said, “Amy, let’s just draw it…and if you don’t like it, we’ll have you hop right out.” THANK YOU Anna for being persistent and giving me the key to my natural births, because I wasn’t sold on how warm water would help until I experienced the relief myself.
During my second labor with Trey, I was quite literally falling asleep between contractions while in the bathtub. I had felt SO in control and empowered during that birth. When the contraction ramped up, I sat up and breathed through it. I would then return to my floating, zen rest period.
Both times, I continued in the bath until it was time to practically push. I can’t recommend it enough and would encourage every woman to try it. -Amy
TENS
If you are striving for a drug-free intervention-free birth this can be a great source of pain relief. I don't use a lot of modalities but during labor and delivery I was going to try this (before I knew I was going to have C-sections). It is a device to stimulate nerves for therapeutic purposes. You place the electrodes on your lower back and sacrum area. These units can be purchased on Amazon for $40. When you’re using TENS during labor, you might feel a buzzing, tingling, or prickling sensation wherever the pads are placed. A TENS unit lets the mama feel more in control of her pain, helps with anxiety and offers a distraction to the contractions. TENS can be used in combination with other non-drug and drug methods of pain relief – except with hydrotherapy, or water immersion. Mamas can adjust the intensity of the TENS unit as needed during contractions. In a large meta-analysis, most mamas that used TENS say they would use it in a future labor.
Hold a Warm Washcloth on Your Lady Parts
After 7 cm of dilation it is called the "ring of fire"! Writing this I am grateful for my C-Sections. OUCH. It is called the ring of fire because women often will feel ‘burning’ or ‘stinging’ in the later stages of birthing a baby. Warm compresses on the perineum can make it more pliable, which makes it easier for the large stretch that is about to happen.
Having a warm compress held to the perineum whilst you birth your baby can significantly reduce painful sensations, and also reduce the incidence of significant perineal trauma (third and fourth degree tears). You can have your partner, midwife, doula or nurse have a bowl of very warm water ready to ensure the compress stays warm.
MENTAL PREP
Affirmations
Positive affirmations will promote an overall more positive birthing experience. This may sound silly, but they work! They work in any birthing setting and you can use them any time or as often as you need to. This will help with having confidence in your body that YOU CAN DO THIS! Repeating positive affirmations to yourself can also help reduce any fear, anxieties or tension you may be holding on to. Here are some examples of positive affirmations I have found to work:
Just get through THIS contraction. Don't get too far ahead of yourself.
Just breathe this baby out of you.
I am MADE to do this, I can do this. So many women ahead of me have done this.
I am so close to meeting this baby. I am DOING it.
Before both of my births, I wrote a letter to myself and I HIGHLY suggest this. I think women often underestimate the power of encouraging THEMSELVES. -Amy
Support and Guests
The support you choose to have or not have during labor can make a big difference in your experience. It can be very similar to planning a wedding- people will want to help in any way they can but you need to set boundaries for what YOU are comfortable with. You want someone there who is able to respect your choices, encourage you and know when to offer help or give you space. Also be very assertive with who you want to come to the hospital after. Amy doesn't even tell me when she is in labor. At first I was hurt by this but I had to take a step back and realize- there is ONE GOAL here: happy, healthy mom and baby. Because of the size of my immediate family, I only allow them to visit all at once. It really is hard enough getting the rest I need and starting to breastfeed, without people coming in and out all day. Again, the priority is YOU and the baby.
Laboring Positions
Below are partner assisted labor positions and independent positions. Knowing and exploring ideas for laboring positions prior to birth may help you feel more prepared. Amy stood at a counter and was in a squat and semi-squat position during contractions. That is a great position, but a girl has got to have options…right? Again the worst position is laying down and pushing in that position because gravity is not assisting with the downward movement of the baby. Having an epidural changes your mobility but I would stay mobile prior to administration of epidural.
With an epidural try laying on your side with your top knee toward your chest. Use the side bar to hold onto and push down.
Without an epidural: quadruped is a great position to push in! There is less pressure on your pelvic floor than a squat position.
It is my greatest hope that this blog post was helpful for you! I know that you can do it mama, we’re over here cheering for you!
