9 steps to a better labour

Complete the sentence: Labour is...

a) fated — nothing I do can change its course b) something my caregivers and I can completely control

It’s a trick question, of course — the real answer lies somewhere in between. While sometimes things happen that are outside of your control, there are many things you can do — starting long before that first contraction — that can influence the course your labour ultimately takes. And what exactly is a “good” labour? Not only is it one that unfolds as smoothly as possible so you’ll be less apt to need interventions, it’s an experience you’ll feel good about after your baby arrives.

Here are your best bets for a better labour:

1. Get good information There are several reasons why learning about labour and birth ahead of time may improve the odds it will go well. For one thing, understanding the course labour typically takes can make the experience much less frightening. For instance, imagine what it would be like to reach the intense, back-to-back contractions in transition and not know this stage is usually brief and signals you’re nearing the home stretch. Solid information from trustworthy sources can also help counteract the scary, often inaccurate portrayals of labour and birth we’ve all seen in the movies.

Why is that important? Not only is anxiety known to increase pain, “being scared releases catecholamines (stress hormones) into your system, which can make labour dysfunctional,” explains Margaret Belliveau, a perinatal nurse educator with the Family Birthing Centre and Mother Baby Antenatal Program at St. Joseph’s Health Care London (Ont.). And, indeed, some studies suggest that women who attend prenatal classes report lower levels of pain, use less medication, and may even have shorter labours than expectant moms who don’t do this kind of preparation.

So where can you get credible information? Prenatal classes are an obvious place to start. A good course will not only educate you about the labour and birth process, but also give you a chance to practise some techniques that can help it along, like the slow dance couples can do, with mom hanging by her arms from her partner’s shoulders, to help move the baby down. You may need to shop around, though, since some classes just outline hospital routines and procedures.

However, while classes can be helpful, they’re not necessarily essential. Magazines like this one, books, DVDs and the Internet can also be useful sources. That said, “there’s a lot of junk out there, so you do need somebody to bounce it off,” says Helen McDonald, an associate professor in the midwifery education program at McMaster University in Hamilton. “Your physician, nurse-practitioner, midwife, doula and childbirth educator are all people who can help you sort out the trash from the not.”

2. Write a birth plan As you gather information, no doubt you’ll begin to form opinions about the kind of birth you want. Consider writing a birth plan that outlines details, including who you would like to be present, what kinds of coping techniques and pain-relief methods you’d like to try, and any interventions you’d prefer to avoid if possible. Not only does this exercise help you methodically think through your options, the finished product is a useful interview tool for choosing a caregiver who has a philosophy similar to your own, and for communicating your wishes to your care team. And at least one study suggests there’s a payoff: In a randomized trial, overall levels of satisfaction with their births were higher in women who’d drafted a birth plan than in those who had not.

3. Choose your caregiver with care The person you choose to care for you during your pregnancy and birth has more influence over the process than you might imagine. For starters, you want someone who will only intervene for good reason, for instance, who will give you a pep talk instead of agreeing when you ask to be induced because you’re fed up with being uncomfortable by week 38. (See the next section to find out how induction raises the risk of running into difficulties during labour.) Midwives may be more likely to offer this kind of care, but many family doctors and obstetricians do as well — the trick is finding someone you’re comfortable with. (It’s worth noting that midwifery care is linked with a significantly lower likelihood of interventions, such as induction, forceps, C-section, epidural and other pain medications; and in one Canadian survey, women were significantly more likely to rate their labour and birth experiences as very positive when their primary care provider was a midwife.)

After all, if stress can send labour off course, you want a caregiver who makes you feel calm and confident, and knows what to say when you hit a bump in the road. According to Penny Simkin, the author of The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth, labouring women are extremely suggestible, so even an offhand comment can have a huge psychological impact. For instance, if someone says, “Huh, only three centimetres?” you might get discouraged and want to give up, while a “Wow, you’re doing great!” could give you an energy boost when you’re starting to tire. As we’ve seen, emotions may alter body chemistry and, thus, the course of labour.

Sound airy-fairy? There’s actually solid evidence that a good relationship between a woman and her caregiver is more important to how she feels about her birth experience afterward than such things as how well her chosen pain-relief method worked or whether she ended up undergoing interventions she’d hoped to avoid. A systematic review of the best research on the subject concluded that a high-quality relationship with caregivers, good support from caregivers, and being involved in decision making were three of the factors that make the greatest contribution to birth satisfaction.

4. Hold off on the hospital Particularly for first-time moms, heading to hospital too early may put the brakes on labour, perhaps partly because they may be less likely to do some of the things that can keep labour ticking along, such as staying upright and changing position (see #8), once they hit the hospital room. But regardless of the reasons, “it’s very clear that women who are admitted to hospital in early labour have many more interventions than women who stay home longer,” says McDonald.

Staying home a little longer has other advantages: You have ready access to things that will increase your comfort and better prepare your body for labour. For instance, several studies suggest warm baths (which aren’t always available in hospital) reduce the need for pain medication and other interventions, boost birth satisfaction, and may even shorten labour. And, according to McDonald, distractions and diversions like DVDs and walks ease discomfort in early labour by focusing your mind elsewhere, giving your body’s endorphins (natural pain relievers) time to kick in. You’re also more likely to be able to catch a few zzz’s at home in early labour, when periodic rest breaks are crucial for keeping up your strength, says Belliveau. Additionally, food and drink (which your muscles need to function properly) are freely available at home, while many hospitals still limit labouring moms to ice chips.

So when should you head to hospital or call your midwife? Ask your caregiver for personalized advice. Unless you’re having worrisome symptoms, such as severe headache, chills or fever, or you suspect your water has broken (the fluid may gush or trickle), it’s usually OK to wait until contractions are at least five minutes apart. If you’re sent home because you’re not in active labour, don’t despair — just make sure you get clear instructions on when and why you should return.

5. Let labour start naturally Obviously, this doesn’t hold when there’s a compelling medical reason for a baby to be born before labour starts spontaneously. But this isn’t the case for many women who end up being induced. For instance, a caregiver might suggest bringing on labour early because she thinks the baby might be a little big (even though induction under these circumstances hasn’t been shown to benefit moms or babies), or because the caregiver has a policy of inducing at 40 weeks, despite guidelines from the Society of Obstetricians and Gynaecologists of Canada recommending that induction for postdates pregnancy not be offered until 41½ weeks. (To learn more about these issues, and how to reduce your chances of being induced, check out Todaysparent.com/induction.)

So what’s the big deal? It’s no accident that “let labour begin on its own” is number one on Lamaze International’s list of Healthy Birth Practices, all of which are backed by research, says Kathie Lindstrom, who, as perinatal program manager at Douglas College in New Westminster, BC, teaches medical, nursing and midwifery students about normal labour and birth. A growing body of evidence indicates that induction sharply raises the risk of a Caesarean (one recent study found it raised the odds by more than 50 percent for first-time moms), most often because the cervix simply doesn’t dilate or the contractions don’t push the baby downward.

6. Enlist extra support Research has repeatedly shown that women who receive continuous labour support from a doula are much more likely to escape the need for interventions than expectant moms who don`t get this kind of one-on-one care. A report from the Vancouver-based South Community Birth Program, which provides doulas to all of its clients, sums up the benefits this way: “Doula support reduces the overall Caesarean rate by 50 percent, the need for forceps by 40 percent, the length of labour by 25 percent, oxytocin use by 40 percent, pain medication use by 30 percent, and requests for epidurals by 60 percent.” Another plus? Compared to women who don’t receive continuous labour support like doula care, those who do are 33 percent less likely to report feeling dissatisfied with their labour and birth experience, or to rate it as negative.

None of this is to say that your nurses and your partner won’t be wonderfully helpful during labour. But the truth is that nurses must often run back and forth between two labouring women, and can’t offer continuous one-on-one support. And as wonderfully loving and supportive as your partner may be, he’s probably at least as nervous as you are, and equally inexperienced at knowing what to try if a swollen lip of cervix is keeping the baby from descending, or what to say to coax you out of bed when your contractions start flagging. Another plus? Having an extra person present — a professional doula, a relative or close friend — allows Dad to take periodic breaks without leaving you alone. (If you’d prefer your mother, sister or friend to a pro, she may find it helpful to attend prenatal classes along with you and your partner.)

7. Give continuous monitoring a miss Why would you want to have your caregivers keep only periodic tabs on your baby, rather than staying hooked up to the fetal monitor? As long as there’s no medical reason that requires continuous monitoring, there’s ample evidence that it doesn’t make any difference to babies’ well-being, but it does sharply increase the odds of receiving drugs that speed up labour, epidural use, instrumental delivery and Caesarean section. While many institutions still mandate the monitor be used for a specified time after admission to create a printout for the medical record, you can ask to have the device removed once the compulsory 20 or 30 minutes have passed.

8. Keep moving “We know that being mobile, upright, and changing positions can shorten labour by 30 percent,” Lindstrom points out. Among other things, movement stretches out stiff, tired muscles and helps gently rotate the baby into the right position while nudging him down the birth canal.

That doesn’t mean you have to pace the halls until the baby’s head is showing, just that it’s a good idea to try different things — walking, draping yourself over a large ball, rocking in a rocking chair, or even rolling from one side to another between contractions — to find out what helps most at each point in your labour. For instance, if you’re having back labour because your baby is still “sunny side up,” getting on your hands and knees can ease the pressure on your back while giving junior more room to manoeuvre.

That said, “if everything’s going as it should, it doesn’t matter whether a woman is standing on her head or lying on her side, as long as it’s working for her,” says Lindstrom. Of course, if your contractions start petering out, a walk might be just what the midwife ordered. Like the other steps to a better labour, walking won’t guarantee you’ll have an uncomplicated labour, but it can often get things moving in the right direction.

9. Use epidural wisely Continuous monitoring isn’t the only intervention that can lead to a cascade of others when it’s used indiscriminately. While epidurals can be extremely useful in certain circumstances (for instance, to get a much-needed rest in the middle of a long labour), research suggests they can also increase the length of the pushing phase and hike the odds of needing forceps, vacuum or C-section. According to some experts, however, these drawbacks can be minimized with strategies like delaying the epidural until you’re four or five centimetres dilated (thereby reducing the likelihood of Caesarean section), and asking for a low-dose version. It’s best to investigate all of the options available to you — medical and otherwise — before deciding how you’d like to deal with labour pain.