Delivery

Early signs of labor
You may experience some signs to let you know labor is approaching. They may be noticeable several days or even weeks before your due date:

• Braxton Hicks, or false labor, contractions prepare the uterus for labor and may cause some effacement (thinning) and dilation (opening). During the last weeks of pregnancy, they may become stronger and more regular. Sometimes it is difficult to know if these are true or false labor contractions.
• Effacement and dilation may start before the beginning of labor. A vaginal exam may be done at a routine office visit to check for effacement and dilation.
• Mood swings are common during pregnancy.
• Leveling off or weight loss may be noticed in the last few days before labor begins. Some women lose as much as 1 to 3 pounds of water weight.
• Lightening or "baby dropping" is the moving of your baby's head into the pelvis. After your baby drops, your abdomen appears lower. It is easier to breathe and you may have less heartburn. As your baby moves down, you may feel pressure in your pelvic area, experience backaches and have to urinate more often.
• Loose bowel movements can happen 24-48 hours before labor begins to clean out the lower body for the delivery.
• Nesting is a spurt of energy some women may experience before labor begins. You may want to clean the house, do the wash, grocery shop, etc. Save this energy for labor.
• Vaginal secretions may increase to lubricate the birth canal before delivery.

Recognizing labor
You can recognize labor by uterine contractions occurring every 10 minutes or more frequently (six or more in 1 hour). These contractions may not hurt but can include:

• Menstrual-like cramps felt in the lower abdomen (may come and go or be constant)
• Dull, lower back ache felt below the waistline (may come and go or be constant)
• Pelvic pressure that feels like your baby is pushing down (pressure comes and goes)
• Abdominal cramping with or without diarrhea
• Ruptured membrane or a small leak or gush of fluid from the vagina
• Mucus plug, or thick mucus discharge, usually has a pink tinge

Call your doctor immediately if you have any of these signs of labor before your 37th week of pregnancy.

Medical care during labor and birth
The following are some of the more common medical procedures used during labor and delivery:

Delivering multiple pregnancies
Because premature labor and delivery present a serious risk, it is important to understand the warning signs for early labor. All of the following should immediately be reported to your doctor:

• Pelvic pressure
• Lower back pain
• Increased vaginal discharge
• Change in the frequency of false labor pains

Sometimes premature delivery can be delayed with bed rest and the use of certain medications if it is detected early. Each day gained provides your babies valuable fetal growth and development. Not all, but most, multiple pregnancies arrive early. An early delivery is mainly caused because the multiple babies stretch the womb quicker than a single child and the cervix may begin to loosen earlier than expected. The likelihood of premature delivery increases with each additional baby in a pregnancy. More than half of twins are born prematurely (before 37 weeks).

Delivery of multiples requires planning by the full medical team and full intensive care support following the birth. Cesarean section delivery is an option prepared in advance. If any complications are found with ultrasound, such as stressful heart rate or bad position, a Cesarean delivery is often the best way to ensure a satisfactory outcome. Twins may be delivered vaginally if the first twin is positioned correctly (head-first presentation). But if the twins are positioned differently or are otherwise interlocked, a Cesarean section is recommended. Almost all higher-order multiple pregnancies (triplets, quadruplets) are delivered via Cesarean section.

The coach's role
Knowing how to comfort mom during labor can help her, and you will feel like an active participant in the birth.

• Be calm and confident.
• Know what to expect physically and emotionally during labor and delivery.
• Ask questions if you are uncertain about anything.
• Be positive, supportive and encouraging.
• Help her to stay focused during relaxation, breathing and pushing.
• Keep the room the way she wants it (i.e., temperature, lights, door open or closed, TV on or off).
• Speak softly, touch gently and move slowly.
• Keep communication lines open with her.
• Identify mom's needs during labor. You are aware of her strengths and weaknesses and can help her cope.
• Communicate for mom with the nursing staff. You are aware of her needs. Be flexible and open to alternatives if needed.
• Don't become discouraged or give up if mom does not respond to your attempts to help her. Take a deep breath, relax and try again. It is not easy to be a coach.

What do I do if I am called upon to make a decision during labor?

• Relax and clear your mind.
• Think about the facts of the problem.
• Review the alternatives. Ask for more information if needed.
• Discuss with mom if possible.
• Make the best decision you can with the information and choices available to you.

What do I do if mom becomes discouraged?
Discouragement can happen anytime throughout labor. You can help keep a positive attitude by reminding mom:

• You want to be with her and she is doing the best job she can
• To take one contraction at a time instead of focusing on the entire labor
• Strong contractions are good and they help open the cervix
• Soon she will be holding her baby

What do I do if mom panics?
Panic can happen anytime during labor; however, it is more likely when mom is tired and contractions are becoming more intense. Recognize these signs: restlessness, inability to concentrate, moaning or crying out, thrashing in bed or holding her breath. To help mom gain control:

• Call her by name.
• Stand up next to her.
• Bring your face close to her. Get eye contact. Become her focal point.
• Say "I am here, and I can help."
• Use a firm tone of voice, giving very specific directions.
• Do the breathing with her.
• Get help from the nurse.

Relaxation
Practicing relaxation techniques while you are pregnant will make using them easier during labor. Labor is hard work. By relaxing your muscles you will have an easier and more comfortable labor. The only muscle that should be tense is the contracting uterus. Relaxation techniques should begin with distraction (light housework, watching TV, reading a book, packing a suitcase).

Benefits

• Helps you relax
• Reduces pain by releasing natural pain relievers
• Increases likelihood of shorter labor
• Helps conserve energy
• Reduces tension response to pain

Suggestions

Position yourself comfortably. Lie on your favorite side or sit in a comfortable chair. Support head, arms and legs with pillows.

• Get in comfortable surroundings, wearing loose clothing and take your shoes off.
• Play soothing, low-key music in the background and dim lights.
• Breathe slowly and deeply during relaxation. Don't hold your breath.
• If you have distracting thoughts, repeat a word or phrase to yourself to clear your mind.
• Each person relaxes in her own way. Practice will help you find what works best for you.
• Practice regularly until you can become relaxed and focused with several slow, deep breaths.

It is easy to become tense during labor without even knowing it. An important part of the coach's role is to help with relaxation. When relaxed, muscles are soft and heavy, joints looseen and arms and legs move easily from side to side. If mom is tense, the coach can:

• Massage; say to mom with your hands, "I care about you. I want to help you be more comfortable."
• Have mom take a deep sigh to help release tension.
• Have mom tense a body part (such as her fist) and then help her slowly relax its muscles to give herself feedback of tension/no tension from the different muscle groups in her body.

Breathing techniques and guided imagery will help maintain relaxation during the contraction. If the contractions cause tension, focus on relaxing from head to toe between contractions so mom is prepared for the next one.

Comfort measures for labor
Relaxation and breathing techniques will help you work with your labor. Other techniques you may also want to use are:

Medication choices for vaginal birth
Use of relaxation and breathing are all some women need to cope with labor; however, in some cases, it does not provide enough pain relief or relaxation. If you find you need medication or anesthesia, it is important you are aware of the choices available to you, including:

• Analgesics (narcotics)
• Regional anesthesia (local)
• Pudendal
• Epidural

Labor Breathing
Breathing is an unconscious activity that can be deepened and controlled through concentration. Our respiration patterns give us insight into how we are feeling. Notice how your breathing changes when you are tense versus when you are relaxed. Slow, deep breathing produces the best results. You can also benefit from labor breathing, which:

• Provides something to focus on
• Decreases awareness of pain
• Offers some control in the labor process
• Ensures your baby gets enough oxygen

The benefits of labor breathing include:

• Teches conscious controlled breathing during a contraction
• Conserves energy
• Focuses your attention away from the contraction
• Encourages you to work with the contractions
• Helps bring oxygen to the working muscles

Your labor breathing should make you feel comfortable, safe and relaxed. Several levels of breathing awareness can be used during labor. Choose the level of breathing that gives you the most comfort with the least amount of effort. There is no particular level for each phase of labor. Experiment and practice to discover what works best for you. Begin labor breathing with early contractions.

Breathing should be started in labor when you:

• Are no longer comfortable breathing normally during a contraction
• Are aware of increased tension
• Can no longer talk during a contraction

Combine breathing with relaxation. Determining a focal point will help you concentrate better. Choose a person or an object in the room as your focal point.

Between contractions:

• Breathe normally
• Change positions
• Use comfort measures
• Have your coach check for tension
• Relax

There are several breathing techniques. This is an example of one technique. Others may be discussed at childbirth classes.

Premature urge to push:
Many women have an early urge to push during labor. It is important not to push until the nurse or doctor directs you to. Using proper breathing techniques will help give you control.

Pushing
When your cervix is completely dilated, you can begin pushing or bearing down during each contraction. Your position should be comfortable during pushing. Select from semi-reclining, sitting up, side-lying or squatting position. Keep your mouth open slightly, relax your legs and pelvic floor muscles, and look toward your body.

It may help to think of pushing as if you are trying to empty your bladder forcefully or pushing your Kegel muscle out. Because pushing takes so much work, begin pushing only when your body tells you to push. Build the push smoothly with your contraction, pushing the hardest at the peak of the contraction. You may feel like you need to have a bowel movement. This is a normal sensation as your baby's head presses against your bottom.

As your baby moves down, you may experience a large pressure or burning sensation. Most women feel a strong desire to push. Do not push during practice. To assist in pushing, there are two methods of breathing.

 
For more information on Saint Francis' Family BirthPlace, call 877-231-BABY or e-mail sfmc@sfmc.net.