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MoonDragon's Pregnancy Information
How Your Baby Grows
Labor & Delivery
WHAT YOU NEED TO KNOW TO PREPARE FOR AND MANAGE YOUR HOMEBIRTH EXPERIENCE
GETTING READY FOR YOUR BIRTH INDEX:
Preparing for Labor
THE STAGES OF LABOR INDEX:
PREPARING FOR LABOR
Preparing yourself for labor and delivery will help you feel more relaxed and composed once the process actually begins. Be sure to do the following well in advance of your due date:
- Find out if your insurance plan will pay for your midwife and homebirth where you plan to deliver.
- Make arrangements at work for your maternity leave.
- Ask your midwife when you should call her if you think you're in labor.
- Obtain a phone numbers for your emergency back-up plan in the event that a transfer to your nearby hospital may need to be activated.
- Establish who will attend your homebirth, and have those phone numbers ready to be called once labor has been started.
- Map out the quickest route to your home, anticipating any possible delays due to construction, detours, weather conditions, or heavy traffic. Give this map to your midwife well in advance of your due date. Most midwives will plan at least one home visit sometime during your prenatal care. This will help to prevent her from getting lost on her way to assist you.
- If you have other children or pets, establish a plan for their care while you are in labor and giving birth.
- Decide what birth supplies you might need for you and your baby. Most midwives will give you a list of birth supplies that she will expect you to have prepared for your labor, birth and postpartum care.
- Contact your midwife to see what personal items you will need to prepare for yourself. You'll probably want a comfortable gown or robe, toiletries, glasses or contacts lenses, sanitary napkins, nursing supplies, writing utensils, a camera with film and batteries, and important phone numbers. You will also need clothes for yourself and your baby for after the birth.
MoonDragon's Pregnancy Information: Writing A Birth Plan
CALLING YOUR MIDWIFE
When you finally think you are in labor or if your water breaks, call your midwife and let her know what's happening. Keep in mind her traveling time and distance as well as any weather and/or traffic issues when deciding when to call her. Myself, I prefer to be called right away so I can gather my supplies and hit the road. Discuss with your midwife when she wants to be called.
When your midwife arrives at your home, you will be asked questions about the length and strength of your contractions and whether your membranes have ruptured (water has broken). You'll be asked to undress and put on a clean, comfortable nightgown, and you'll be given an internal exam to determine how far your cervix has dilated. Your temperature, blood pressure, and pulse will be monitored along with your baby's heartbeat, and a urine sample will be taken to test for protein and sugar. You will not shaved or very rarely given an enema. These are considered unnecessary procedures.
The Stages of Labor
The average labor lasts 19.4 hours for a first pregnancy and may be shorter for subsequent pregnancies. However, each labor is different for each birth, even when it involves that same mother. At home there are no set guidelines for time limitations. Each woman and each labor is viewed as a unique experience and as long as both the mother and the baby are doing well, there are no reasons to be concerned about long labors.
Labor has three stages:
STAGE ONE begins with the onset of labor and continues through full cervical dilatation.
STAGE TWO is the delivery of the infant.
STAGE THREE is the delivery of the placenta.
PAIN MANAGEMENT
Most of your pain management comes from within yourself. You do not need dangerous drugs and other medical interventions to give birth. Fear and tension produce pain which produces more fear and more tension, thus more pain. When you are relaxed and working with your labor, assured and have one-on-one labor support with tools and methods that are available to you, you will find that your labor goes easier, faster and the birth experience becomes emotionally fulfilling for you and your baby. Your baby is born aware, awake, and connecting with you and your partner without the serious side effects that can result in major life threatening complications effecting your baby. Many of these side effect complications are associated with use of labor drugs. You will be taught breathing and focusing methods by your midwife or a homebirth childbirth educator. You also may have the option of hiring a doula for labor support assistance. These methods are the optimal choices for your and your baby's safety and well-being. Not only do they allow you to become a participating member of your birth experience, but they also allow you to make decisions and changes depending upon your comfort needs, both physically and emotionally.
weeks before labor. Blood-tinged mucous, or "show," is often a sign that your cervix is beginning to dilate. The cervix will then thin and soften, dilating to 10 centimeters by the end of the first stage. Your membranes will rupture in the first stage of labor, releasing the amniotic fluid that surrounded the baby in the uterus. If you think your membranes have ruptured, call your midwife immediately.
STAGE ONE - EARLY LABOR (Cervical Dilation From 0 cm to 5 cm)
- The blood-tinged mucous, or "show," that has been blocking the cervix during pregnancy is passed from the vagina. Bloody Show is often a sign that your cervix is beginning to dilate,and can occur as little as one hour before labor begins, or as much as three weeks before labor begins.
- Effacement occurs when the cervix begins to thin and soften as it is pulled up by the contracting uterine muscles. The cervix will dilate to about three centimeters in the early phase. (One centimeter is approximately one fingertip and 10 centimeters is 4 inches.)
- Rupture of the membranes occurs when the amniotic fluid that surrounded the baby in the uterus is released. This may occur before contractions begin, but will probably happen sometime during labor. If you think your membranes have ruptured, you should call your midwife immediately.
- Contractions will be mild to moderately strong, lasting 30 to 45 seconds. They may range from 5 to 20 minutes apart, gradually becoming more frequent toward the end of this stage.
- You may experience nausea, hiccups, leg cramps, backache, shakiness, the urge to push, exhaustion, confusion, anger, and irritability.
- This is the time that you would want to call your midwife and let her know that you are in labor. Once you have notified her, then either you need to get up, be active and get things prepared for her arrival, or go back to bed and get some needed rest and sleep, depending upon what time of the day or night that your labor begins.
STAGE ONE - ACTIVE LABOR (Cervical Dilatation From 5 cm to 8 cm)
Active labor lasts an average of two to three and a half hours, although many experts are noticing longer time periods for active labor. However, this may be due to the drugs given during labor in institutional settings. At home, long labors happen, but usually they are not difficult to work with because of added labor support and birthing assistance. It is not uncommon for normal women to have "plateaus" in dilation efforts during the active phase. Many times this may be due to some unresolved emotional issues that the woman needs to work through, or may be due to how the baby is sitting on the cervix. Extra emotional support, changing positions and activities often corrects this occurance.
Contractions are generally three to four minutes apart and last 40 to 60 seconds.
The cervix dilates to 8 centimeters.
You may experience increased back and leg pains, more bloody show, anxiety, and exhaustion. It is important to keep well hydrated and given adequate nutrition during labor to keep exhaustion from occuring. Rest is possible between contractions. Extra labor support is helpful.
STAGE ONE - TRANSITIONAL LABOR (Cervical Dilatation From 8 to 10 cm)
Contractions will be very strong, 60 to 90 seconds long, and two to three minutes apart.
The cervix dilates fully to 10 centimeters.
You may feel strong pressure in the lower back and perineum from the baby's head.
Bloody vaginal show will increase, and you may experience leg cramps, nausea, exhaustion, and an overwhelming urge to push.
The midwife will often do a quick dilation check at this point to make sure that you are not trying to push before you are completely dilated. If you attempt to push too soon, the cervix may swell and close up slightly, making labor longer. Injury may occur causing cervical tears, which are difficult to repair. Sometimes, if a woman has labored in the same position for awhile, she may have a slight cervical "lip" that has not finished dilating or effacing out. This is caused by inadequate or unequal pressure from the baby's head on the cervix. Often this "lip" can be eliminated by changing the position of the mother and/or applying slight cervical massage to move it up and over the baby's head, completing dilation and allowing the head to descend through the cervix.
STAGE TWO: FULL CERVICAL DILATION TO DELIVERY OF INFANT
The longest part of your labor is over! Stage Two begins when the cervix is fully dilated at 10 centimeters (about 4 inches). At this point, you will begin pushing.
- Stage Two lasts between 15 minutes and two hours or maybe more. This may be dependent upon whether this is a first time mother or a mother who has had several children, the size of the baby, the individual structure of the pelvis, and the position the mother is in during delivery.
- Contractions will be two to five minutes apart, lasting 60 to 90 seconds.
- You will feel a strong urge to bear down. (Feels like you need to have a really big bowel movement.)
- The baby moves down the birth canal head first (usually).
- Crowning occurs when the baby's head can be seen in the vaginal opening.
- You may feel pressure and stinging in the birth canal as the baby is born.
- The baby's head will usually be delivered face-down (anterior position), and the shoulders will turn to allow the rest of the baby's body to emerge. A baby in a "posterior position" will have the head born "face up".
Once the head has emerged, your midwife will quickly check around the baby's neck for the umbilical cord. If one is present, most times it can be easily pulled loose and over the head or loosened so the body can slide through the coil(s) and out. A large baby may have problems with shoulders getting stuck under the pubic bone. Usually a "corkscrew manuever" will allow the shoulders to be freed and the rest of the body will slide right out without further problems.
STAGE THREE: DELIVERY OF INFANT TO DELIVERY OF PLACENTA
Stage Three is usually the shortest stage of labor, typically lasting 15 to 20 minutes. However it is not uncommon to have it last longer in a homebirth, since midwives tend to be patient about waiting for the mother's body to release the placenta when it is ready to do so. This waiting period allows the placenta to continue to oxygenate the baby until the baby's breathing is established. You may be prompted to hold your baby to your breast during this phase and begin nursing your baby. The baby's sucking on the mother's nipple will release oxytocic hormones into the mother's blood stream which will help in the contractions of the uterus and expulsion of the placenta. Your contractions will be much less painful and you may feel shaky and hungry.
Your midwife will watch for signs of placenta release which may include a slight gush of blood and lengthening of the cord at the vaginal opening. You may be asked to change positions into a squatting position over a bowl or other container used to catch the placenta. You may experience a few slight crampy contractions or may simply asked to push it out once the signs of placenta separation occurs. There is little discomfort for the mom with the delivery of the placenta.
This stage can be the most hazardous to the mom if separation (partial or full) has occurred and blood is being released. Hemorrhage is always a concern for your midwife at this stage. A missed separation can result in a significant blood loss for the mom. A hidden hemorrhage is when the placenta has released and has blocked the cervical opening with blood being backed up behind it. An obvious hemorrhage is when blood is actually seen flowing from the vaginal opening. Hemorrhage problems tend to be more common in women with anemia, poor nutritional habits, and unhealthy bodies and lifestyles. Nutrition is a very important factor that helps prevent excessive blood loss and to help the mom recover quickly from the birth experience.
If you had an episiotomy or a tear, it will be repaired once the placenta has been delivered.
Following the delivery of your baby, the umbilical cord will be cut, usually after the cord has stopped pulsating, and your uterus will be massaged to keep it firm. You will be given an internal exam, and your baby will be given an APGAR test to assess its health at birth. (APGAR stands for Appearance (color), Pulse (heartbeat), Grimace (reflex), Activity (muscle tone), and Respiration; a healthy baby should have a score of 7 or higher out of a possible 10.) Your baby may be given eye prophylaxis to prevent veneral infection, and the baby will be weighed, examined and possibly footprints and handprints will be taken (more for keepsakes then for identification purposes in a homebirth).
WHEN CHILDBIRTH DOESN'T GO AS EXPECTED
Most babies are born without any complications, but knowing what could go wrong can help you prepare. Your midwife will address any concerns or worries you may have about complications. 90% of all healthy women can birth their babies without problems of any kind. Another 5% may need some medical intervention, which most often can be handled in the home by your midwife. The remaining 5%, for whatever reason, may have to have medical assistance through other resources besides your midwife. Midwives today are trained to handle many potential problems. Most midwives are "protectors of normal birth" and are trained to provide preventive care for their clients. Most problems can be prevented with healthy nutrition, healthy lifestyles, and healthy outlooks on life, birth and parenting.
Just as no two pregnancies are the same, no two deliveries will be exactly the same. You may find that nature needs a helping hand during your baby's delivery in one or more of the following forms:
Induction: Induction is usually not tried at home. However, if your midwife believes that continuing your pregnancy will incur more risks than inducing labor, she may artificially rupture your membranes or give you a tea of herbal or homeopathic formulas (sometimes combining with other methods) containing oxytocin-like properties. Oxytocin is a hormone naturally produced by the body during pregnancy. Some reasons for inducing labor may be an unhealthy uterine environment, preeclampsia (pregnancy-induced hypertension), fetal Rh affliction, diabetes,a chronic illness, or fetal death. Usually for these problems, the possibility of a homebirth would be considered to be too high risk to attempt. The woman would be referred to a medical practitioner which may be able to be of greater assistance under these circumstances.
Forceps or Vacuum Extraction: some midwives carry or may use a vacuum extraction device for a homebirth, but these are few. Most midwives feel very uncomfortable about using such interventive methods for deliveries. These methods have a host of complications and problems associated with their use and should only be used by a practitioner well trained and skilled using these invasive tools and techniques.
In the hospital, forceps deliveries and vacuum extractions are less common than they used to be, as most health care providers will use the Cesarean delivery method when the baby's head is not emerging from the birth canal. Some physicians still sees a role for forceps, though, as studies show that they pose no more risk to the mother and baby than a Cesarean when carried out properly by someone experienced in using forceps. A local anesthesia is usually given to the mother when forceps are used. A vacuum extractor may be used in place of forceps. The vacuum extractor uses a metal or plastic cup to suction the baby out of the birth canal.
Cesarean Birth: Cesarean sections (C-sections) are the most common major operation performed in the United States; as many as 25 to 60 percent of babies are delivered this way (the percentages tend to be higher in teaching hospitals than in local community hospitals). A woman may need to have a Cesarean delivery if the fetus is under stress; if there are problems with the placenta; if the baby is in an unusual position; if the labor is not progressing; if the baby's head cannot pass through the pelvis; or if the mother has an illness such as high blood pressure or herpes that would put the baby or herself at greater risk. Regardless of hospital percentages, the cesarean rate is much too high in the United States and should be reduced down to the 3 to 5% it should be. Most cesareans (for normal labors in healthy moms with healthy babies) seem to occur from the lack of patience on the part of institutional settings and their practitioners, the lack of labor support for mothers, misuse of drugs and technology, and the threat of lawsuits.
Breech Delivery: Most babies are in the breech position with the buttocks and feet pointed toward the pelvis until about the thirty-second week of pregnancy, when they turn upside down. Some babies, however, are still in this position at the onset of labor. Since the baby's buttocks are not as efficient as the head in dilating the cervix, the first stage of labor may be prolonged. The baby is usually delivered in the breech position until the legs and lower torso have emerged. In a homebirth setting, midwives have learned to be very patient with an expected breech. Dilation must be more than complete and extra care must be taken with the delivery of the head and shoulders.
If it becomes apparent that the homebirth is not progressing normally, you may be transferred to a hospital and prepped for a Cesarean delivery. Some hospitals will electively do Cesareans on breech deliveries when they know the head is high up in the abdomen. Most hospitals will not allow a woman in this situation to labor unless she is in very active labor and the baby is small.
Premature Birth: A birth is considered premature if labor begins at 37 weeks of pregnancy or less. A premature birth may occur if the membranes rupture prematurely or if the mother or fetus is having a problem. But rest assured that only 10 percent of pregnancies in the United States result in premature births, and most occur in women who are known to be at risk. Risk factors include smoking, alcohol or drug use, malnutrition, infection, stress, fetal abnormality, and genetic disposition. Other causes for a premature birth is incorrect due date calculations, misinterpretations of ultrasounds, and induction of labors and scheduling of cesarean deliveries before the due date.
Almost all babies will be born when they are ready since they are the ones that initiate labor. We must remember to be patient with them and allow them to decide when they are to be born... not our high tech gadgets and our calendars.
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