What’s the most challenging thing you’ve ever done? Many mothers will say it was giving birth. Knowing that, you’ll want to prepare in every way you can to make your baby’s birth a little easier. Sylvia Brody’s* idea of a good birth was one where she felt in control, with as few medical interventions as possible. Categorized as high-risk for a premature baby due to her unicornate uterus (half a uterus), Brody was determined to give herself the best possible chance of a natural, full-term birth. And last February, at 36 weeks (just a week away from term), she gave birth vaginally and without pain medication to a healthy baby girl!
We’ve all heard stories of labours that were exhausting or that required all kinds of medical assistance. Some of us, like Sylvia Brody, might have additional fears due to medical conditions.
Nevertheless, there are things you can do to increase the odds that your labour will go smoothly from the first contraction to the final push that brings your baby into the world. Brody began with the basics that encourage a healthy mom and baby throughout pregnancy: eating well, getting plenty of rest and seeing her caregiver regularly. But she didn’t stop there: “I learned from a friend’s story of her disappointing birth that I needed to be really prepared.” But what can you actually do to boost your odds for an easier labour?
Of all the prenatal exercise classes out there, yoga has the largest following. Janet Balaskas, a British childbirth educator and author of Active Birth, explains why: “Yoga prepares the body to be upright in labour—standing, kneeling, hands and knees and squatting—and these positions keep the pelvis loose and open for easier positioning and descent of the baby.” Balaskas’ number-one rule for labour, all the way through to pushing, is “Don’t lie in bed!”
Yoga has other benefits. “Focusing on breathing was really helpful practice for labour,” says Kate Stewart, who attended yoga classes during her first pregnancy and is back with her second. Balaskas advises, “Concentrate on the exhale, and relax after, then stay relaxed for the inhale. Learn to breathe away the tension in your body and that will help you to breathe away the pain in labour.”
Sign up to get weekly email updates on your baby » “Regular massage helps women to breathe into areas of discomfort, relaxing tight muscles,” says Vancouver registered massage therapist Paula Jaspar, who sees mostly pregnant women in her practice. She adds that muscles made supple from regular massage relax more quickly following a contraction during labour, making the rest between contractions feel a little longer.
Is massage helpful in labour? Angela Verbrugge was so sure of it she hired Jaspar to be her doula. As it turned out, Verbrugge had intense back pain in labour. She says, “I was glad to have an expert massage therapist who knew how the muscles are connected and how to release tension.”
Other women turn to their partners for comforting touch. A partner can stroke the woman’s head, which may calm and relax her, allowing her body to get on with its work. According to research, firm touch such as holding hands (that’s all Brody wanted) or pressing firmly on the upper arms or thighs increases the production of oxytocin, encouraging labour to progress. If you’d like to learn more, consider signing up for a prenatal massage class.
Another route to relaxation is hypnosis—not the entertainment version, where uninhibited people might quack like ducks. This is the therapeutic form that requires the same deep relaxation or trance state experienced during meditation.
Shawn Gallagher, a certified hypnotherapist and retired midwife in Toronto, says hypnosis teaches women to relax deeply, causing them to be much less uncomfortable in labour. While many who come to Gallagher’s classes do so because they desire an unmedicated birth and are looking for an effective way to cope with labour, others come because they are highly anxious about the birth.
Michelle de Braux says, “Hypnosis was recommended by my doula. I was frightened of giving birth. Also, I knew wanting a non-medicated birth was a lofty ambition.” Did hypnosis help? “It was awesome,” de Braux enthuses. “We got through a challenging birth with no medication.
4. Optimal fetal positioning
The theory here is that our sedentary lifestyles, including slouching on the couch and riding in cars, allow gravity to encourage the heaviest part of the baby—the spine—to roll to the back of the mother’s body. Optimal fetal positioning (OFP) is a concept developed by New Zealand midwife Jean Sutton, which may help get baby into the best position—facing the mother’s back—before labour begins.
If the back of a baby’s head is turned to press against the mother’s tailbone, the mother experiences intense back pain in labour and often a slower labour as well. Sometimes these posterior babies require assistance with forceps or vacuum extraction to be born. Connie Banack’s first baby was posterior and was delivered by Caesarean—part of the reason she’s an advocate of the technique.
“Spend time every day sitting upright with a slightly forward lean, or kneel on the floor while leaning forward into the couch,” suggests Banack, a childbirth educator and mother of four. One study found that being on hands and knees 10 minutes twice a day from 37 weeks’ gestation to the onset of labour did not reduce the number of babies still in a posterior position at birth. Advocates of OFP argue that women should start earlier (34 weeks) and spend longer (30 minutes twice a day) in a forward position.
“Do your Kegels!” admonishes Skylar Hill-Jackson, director of Baby and Me Fitness in Toronto. “Pelvic floor exercises help many women avoid medical interventions.” She explains that the weight of the uterus creates continuous and increasing stress on the pelvic floor muscles, the hammock of muscles that support the uterus. Strengthening these muscles, by squeezing the walls of the vagina tightly together and holding for a count of as much as 20, may make pushing more efficient and prevent poor bladder control and hemorrhoids.
6. Perineal massage
Perineal massage gently stretches the tissue at the opening of the vagina. While studies are not conclusive about the value of perineal massage, some research suggests it reduces a woman’s chance of tearing when she pushes her baby into the world.
Registered massage therapist Paula Jaspar is an advocate. She argues that the perineum is made of muscle (it’s the hammock of muscles that support your growing uterus in pregnancy) and muscles need time to learn to be supple. Jaspar advises her clients to begin massaging the perineum as early as 12 weeks of pregnancy.
She explains how: Imagine the face of a clock at the opening of your vagina. The 12 points to the clitoris, the six to the anus. The area to be massaged is the lower half of the vagina, from three o’clock to nine o’clock. Women can do the massage themselves. Lubricate your thumb with olive oil. Place one thumb into the vagina to the first knuckle. Stretch the tissue at three o’clock, then four and all around the bottom of the clock, continuing to nine o’clock.
Just how far should you stretch? Jaspar says you’ll know, but describes the sensation as burning.
Another benefit of perineal massage is that it helps women learn to consciously relax the perineum, allowing for an easier passage of the baby. Massage increases the circulation of the perineal tissues, speeding healing after the birth.
Preparation for labour is very important, but there’s a lot you can do during the birth to make yourself more comfortable, decrease the likelihood of interventions and encourage your labour to progress. Here are some suggestions:
7. Hire a doula
Research has shown that when a woman receives continuous labour support from a doula she is less likely to require pain medication and other medical interventions.
“My doula made all the difference,” says Brody. “She was there when my strength and courage wavered.” Doulas are trained providers of labour support. They encourage a woman to focus and breathe, suggest positions to help labour progress and provide encouragement. “It helped to have a woman attend who had experience with birth. I appreciated her strong support for my decisions in labour,” says Brody. “Afterwards, because she witnessed the birth, I was able to debrief with her and feel I made the right decisions.”
To find a doubla, ask for referrals from your caregiver, childbirth educator, friends and colleagues. Or check the following websites:
Doulas of North America
Childbirth and Postpartum Professional Association
8. Labour at home as long as possible
At home you will be free to move about in your own comfortable surroundings and eat and drink what you need. Unless it is necessary to be in hospital for medical reasons, consider staying home until your contractions are a minute long and three to five minutes apart.
9. Think positively and stay focused
The more positive messages you give yourself about any task, the easier it is. It helps if others around you remind you of your strength and the wonderful reason for labour—your baby! Stephanie Fell says, “I believe in the power of mind over matter and practised visualizations in pregnancy. I was able to call on images such as flowers opening and waves ebbing during my labour and it helped me to focus and stay in control of the pain,” she explains.
10. Apply heat and cold
A hot-water bottle, heating pad or microwaveable bag applied to your lower belly or back may relieve some discomfort. A cold pack on your back may also ease back pain.
11. Stay mobile
Movement can help your labour progress and relieve discomfort. If your movement is restricted by medical procedures, try to negotiate with your caregiver. For instance, continuous electronic fetal monitoring of the baby’s heartbeat requires belts around a woman’s belly that are attached to a machine, confining her to a bed. Ask if continuous monitoring needs to be done for medical reasons. If not, intermittent monitoring will give you the freedom to walk, sit on a birth ball or soak in a tub.
Brody required an IV to deliver antibiotics to protect her baby from a potential group B streptococcus infection. She negotiated a hepron lock, keeping her vein open, but allowing her to be free from the IV tubing and pole between regular antibiotic doses. “Then I was able to walk up and down the hospital stairs to encourage my labour to progress,” she says.
Transcutaneous electrical nerve stimulation (TENS) is a popular tool in England for relieving labour pain and is increasingly being promoted by doulas in the United States. Early in labour, four electrodes are attached to the middle of the mother’s back, on either side of her spine. The mother holds the control unit and increases the electrical impulse during the contractions. TENS works by stimulating the body’s production of endorphins (natural pain killers) and reducing awareness of pain.
Julia Donovan rented a TENS machine for her birth from a medical supply store. Donovan used the TENS machine right through until pushing and believes that it, along with the emotional support of her husband, contributed to her coping without medication for her entire 33-hour labour. “It gave me something to focus on. I felt I had some control over my experience,” she says. Some women remove the unit earlier, and some report that it wasn’t helpful. TENS may be particularly useful to women experiencing back labour.
At home take long showers or baths to help you relax. Once in the hospital, the bathroom offers privacy, and the tub comfort. Balaskas recommends, “At about five to six centimeters’ dilation, when you might consider an epidural, try the birth pool instead for a half-hour.” Or take another long shower. Warm water promotes relaxation, and often women feel pleasantly sleepy in about 20 minutes. Research suggests that soaking in warm water increases the production of oxytocin, encouraging dilation. “I spent four or five hours in the bath at the hospital and needed no other pain relief until pushing,” says Stewart.
14. Try different upright positions
Brody, who had persistent back pain during labour, sat on a birth ball (a large inflated exercise ball) to give her posterior baby more space to rotate. “It was great because I could rock and loosen my hips.” Later on she knelt on the bed with her chest leaning on the ball, allowing her arms to be free of the need to support her.
A recent study found that having an epidural resulted in more babies being posterior at birth, not surprising when you consider that an epidural usually keeps a woman lying down, losing the advantage of gravity. But if you do need an epidural as Verbrugge did, Banack advises, “spend lots of time in the recovery position—lying on your left side with the bottom leg straight and the right leg bent and resting on a pillow in front of the bottom leg.” This position opens your pelvis to give room for the baby to rotate, and makes the best use of gravity.
15. Make noise!
Sighs and low sounds will help you let go of tension in your body. When you open your mouth and moan, you relax your birthing muscles, allowing them to open more easily. Guided by her doula and joined by her husband, Brody hummed through most of her active labour. She explains, “I was reminded by their low sound to keep bringing down the pitch. Humming kept me breathing and calmed me.”
Verbrugge made a different sound. “My doula encouraged me to breathe through loose ‘horse’ lips. Keeping my throat open and relaxed helped me get through the intensity of contractions and to open for the baby to descend.”
No one can predict exactly how your labour will go. But that doesn’t mean you should leave it to chance, says Balaskas. “Labour is a bit like climbing Everest,” she notes. “It requires preparation because our lifestyles today don’t naturally prepare us to give birth.” Using some of these strategies will help you cope as well as possible with whatever labour Mother Nature gives you. So take the time now to get ready—physically and mentally—for the big day.
*Name changed by request.
Originally posted in December 2005.