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Labor and birth, of course, are a very physical challenge for an expectant mother. But, keep in mind, labor and birth is also a very emotionally charged event as well. Not only will the mother expend much energy during this time, but also her senses can be heightened. These perceptions, although sometimes overlooked, can add to or detract from her comfort and well-being, and therefore can even affect her progress. As her labor intensifies, her needs may change drastically from moment to moment. It will be up to her birthing support and her birthing attendants to help her maintain a calm, quiet, positive environment that will aid her throughout her birthing experience.
The following are some points to consider when preparing your birthing environment, whether it be at home for a homebirth or outside your home in a birth center or hospital environment. Keep in mind, if you are opting for a birthing environment outside of your own home, you may have greater difficulty achieving the type of environment you may desire for your birth due to medical routines and interventions. Either way, your midwife, your birthing support and/or a doula can help you add some of these considerations to your birth plan, and will also help you to achieve the environment you wish to have. These considerations apply whether you are birthing at home, in a birthing center, or a hospital.
OVERALL ENVIRONMENT
Privacy - This is a necessity. Consider whether you would like the door closed or open to your room, whether this be at home or hospital. The mother may feel the need to be unclothed at certain points in her labor and her privacy needs to be respected. If you are laboring in a hospital or birth center and the door is open, the door curtain can be closed. Window shades and curtains can be closed or open according to your choice. If you need to use the bathroom and wish total privacy, don't hesitate to say so.
Minimal Traffic - You may choose to have family or close friends with you while you labor. This is often fine unless it begins to interfere with your comfort or with the birthing team or medical staff's ability to perform their duties. It is usually best to keep company to a minimum as labor progresses, to aid in your concentration. Make plans ahead of time to have assigned tasks for any guests you have. This will help to keep them busy and out from "under foot". Your partner may occasionally need to be "relieved from duty" for a break once and awhile. Your family or friend under the supervision of your midwife and/or doula can help with rotations of duties, offering needed labor support. Children may be permitted in the room during labor, but it is best if someone is present to personally take care of each child and remove the child from the room when necessary.
Mobility - Remaining as mobile as you can greatly aids your progress in labor. Movement and gravity help to bring your baby down quicker than staying in bed. This is usually not an issue in a homebirth, but you need to keep this in mind when presented with interventions that will cause you to remain in bed for long periods in a hospital setting. You should try to keep interventive activities to a minimum when possible.
Personal Items - You should have around you small personal items that will make you more comfortable. If you plan a birthing center/hospital birth, you will have to bring these with you from home. Consider a favorite photo or other item to use as a focal point, music you have chosen to hear, a favorite pillow, robe, slippers, massage oils, aromatherapy oils, etc. Have these things out and available, or packed in your hospital birth bag before you go into labor so you don't have to worry about searching for them later.
Room Temperature - There is much that can be done to bring the temperature to your comfort. Ask to have the thermostat adjusted, if you are uncomfortable. Your midwife and/or doula can also use hot packs, cold packs, warmed blankets and towels, cool cloths, even an overhead warmer may be available, if you wish. As your labor increases with intensity, you may experience increase body heat from the energy you are expending. At home, you should have no problem with removing articles of clothing to cool down, but you may not have this option in a hospital/birthing center setting. Be sure to wear loose, comfortable clothing (such as a nightshirt or light nightgown) that can be easily removed, if necessary. If you become chilled, a warm shower or a bath will help to warm you. If warm, a large fan or an air conditioner will be helpful.
Creative Positioning - Midwives and doulas are trained to help you with positioning during labor. They can suggest many positions that will help you during different stages of labor or during back labor. There are also positions that can help you rest while upright, or even while using the shower. Your midwife or doula will make recommendations for you and you can decide for yourself if they are accomplishing their purpose. A position that feels right during early labor may not feel the same during intense labor. Changing positions occasionally helps keep tense muscles loose and prevent cramping from staying in one position for too long. Don't be afraid to experiment.
Music - You may decide to have tapes and CD's playing during your labor. Your midwife or doula may provide you with relaxation music. Keep in mind that as labor progresses, your state of mind may change also. Music that sounds great in early labor may not be appropriate later on when you need to actively concentrate and relax between contractions. If you are in a hospital/birthing center, you may consider using earphones for use during labor to prevent interference with someone else's labor.
Quiet Conversation & Noise - Those with you during labor should keep conversation at a comfortable level. Birth partners, midwives, and/or doulas will need to offer verbal support and encouragement to you. Affirmations can be important to you at this time. If you use affirmations in your life, ask your midwife and/or doula to help you find an especially appropriate one for you. Televisions should be kept to a minimum, turned off, or placed in another room if it interferes with your labor concentration. Children can be removed by a friend or a family member if they become distracting. All conversation should be kept positive and calm.
Familiar Voice(s) - Your birth partner's voice may be the one you want to hear most often, or you may find your midwife or doula's voice may be the most comforting. Your needs may change as labor progresses.
Vocalization - It can become difficult to tolerate a contraction in complete silence as you breathe. This is not necessary, and making sounds can actually help you. Your midwife and/or doula can help you experiment with labor sounds. It is generally agreed that high-pitched sounds signify resistance and can actually prevent progress, while low sounds or groans, moans, or animal-like growling from deep in your throat can be beneficial to you, opening up the pelvic floor and assists with labor progress. You may feel like singing or repeating a meditation mantra over and over. Whatever feels right to you is fine as long as it is kept low and deep.
Negatives - If certain sounds do bother you, your midwife and/or doula will help to remedy the situation. You may be bothered by noises from other rooms, the television, children, visitors, or normal household or hospital sounds. The solution may be as simple as closing a door. Simply let your midwife or doula know.
Lighting - Rooms have a variety of lighting sources, and these can be dimmed or intensified as you wish. Even in the daytime, your midwife or doula can adjust the blinds, drapes or lights to give you lighting as restful as you desire for concentration and relaxation. At home, if you want soft candle light to labor by, this is an option. Keep candles safely out of danger, however. Soft lighting is preferable for the actual birth for the baby's sake.
Eye Contact - Focusing your eyes toward a person or focal point during contractions can help you cope and concentrate deeply on what is happening. Try keeping eye contact with your partner, your midwife, or your doula. If you have been practicing with a focal point such as a photo, have someone place it in a convenient spot for you to use. If you are going to be laboring in a hospital/birth center, you may wish to bring a familiar item from home to keep within your line of vision.
Visualization - This type of guided imagery can be extremely helpful to you during contractions or between them. Your midwife and/or doula can suggest appropriate images during contractions to help you visualize what is happening inside your body. She may also quietly talk to you in between contractions, guiding your imagery to a place that is particularly restful for you.
Negatives - Sometimes an untidy room can interfere with your comfort or concentration. Your midwife and/or doula can help by straightening up the room or simply by moving your personal items to a more convenient place for you or for the birthing staff.
Food - At home, you will not be restricted on food or fluids. In fact, you will be encouraged to eat lightly and drink fluids to keep your energy up. It is wise to keep foods and fluids light, such as soups, boullions, juices, herbal teas and such. Herbal teas can be made into ice chips and fruit juices can be frozen for popsicles. Sometimes laboring mothers will experience nausea or vomiting during intense labor. As labor intensifies, your digestion will be greatly slowed or stop until after the baby is born. You don't want a case of indigestion or heart burn while in intense labor. If you are giving birth in a hospital/birthing center, you most likely will not be allowed to eat once you are admitted. You will be allowed to have ice chips or fluids, according to your health care provider or midwife. You can, however, bring lollipops or popsicles (made at home from herbal tea or fruit juice, if desired) and ask your midwife and/or doula to keep them in a freezer for your use during labor. In most cases, a tray of food will be ordered for you after delivery, at any time of day. At home, your midwife or a family/friend can have a meal prepared for you for after the birth.
Dry Mouth - Ask your midwife or doula to keep you supplied with ice chips (either plain water or herbal tea made into ice cubes and crushed), or to give you a cold wet cloth for your face or mouth. Consider adding lip balm to labor list whether you are planning a homebirth or a packing list for the hospital.
Vomiting - Although everyone doesn't experience it, vomiting is a very normal part of labor. Be sure to have a toothbrush and mouthwash available afterwards. In the hospital, you will be provided with a toothbrush and possibly mouthwash.
Pillow - At home, have plenty of pillows available for support and comfort. If you are in a hospital/birthing center setting, bring a bed pillow from home that smells like your familiar laundry detergent or fabric softener. Or consider bringing with you a favorite cologne to have nearby.
Aromatherapy - If you use aromatherapy in your life, bring with you cotton balls scented with a few drops of the essential oil that you feel will most benefit you. Lavender is most often suggested but certainly decide this for yourself. For a hospital birth, it is recommended that you don't bring the bottle with you, as the oil is very concentrated and would cause a major problem if spilled. Many midwives and doulas carry their favorite oils for labor purposes. Remember, though, that your senses will be greatly heightened, and you may choose not to confuse them with strong scents.
Food - Other people in the room should consider the laboring mother's situation. You may be very hungry or may not want to smell food at all. If your partner/guest needs to eat, it should be done outside the room, away from you.
Childbirth Smells - During your labor and delivery you may detect the smell of blood or feces or vomit. Be assured that these are all a normal part of labor, There is no need to be embarrassed, and your midwife and the birthing staff will take care of things quickly, maybe even before you realize it.
Clothing - At a homebirth, you should find a few comfortable, preferably old, nightgowns, lounging dresses, or large T shirts that you will not mind getting soiled, if this should happen. A cotton or cotton blend is preferable over nylon or other synthetic fabrics. A natural fabric will "breathe" better and be more comfortable during labor. In a hospital environment, it is probably best, but not necessary, if you wear hospital gowns during labor, as they are plentiful and always available. They can be worn two at a time, one to cover the front and one to cover the back. Your favorite comfortable nightgown or T-shirt can be saved for after the baby is born, when there is less chance that it will be soiled. Walking is wonderful for labor, and you may want to bring a robe for walking in the halls, although it is not necessary. Your birth partner should, of course, dress comfortably for what may be an extended period of time. Your midwife and/or doula can provide you with hospital slippers, or you may want to bring your own.
Showers - Your midwife and/or doula can provide you with soap and towels for the shower, if you wish. For a homebirth, you should have several available since you may want to be in and out of a warm shower or a birthing tub. For a hospital/birthing center, you can bring with you your favorite soap or shower supplies for after delivery. Using the shower during labor can be very beneficial, and you may be encouraged to do so. However, the hospital's towels are usually quite small and you will need a few of them at a time. Feel free to bring a large towel or two from home if you wish. Your midwife and/or doula can also bring you a heated blanket to dry with or cover yourself.
External Monitors - In a homebirth, your labor will be monitored periodically by your midwife using a fetascope or a doppler. This is all that is needed and has been found to be just as effective or more so than the electronic monitors found in a hospital setting. At the hospital, at some point you will probably be asked for monitor readings. Elastic straps will be placed around your abdomen, although these are not uncomfortable. The monitors use gel for conduction and the gel can be cold, but it rapidly warms to your body temperature. The biggest drawback with electronic monitors is you have to remain very still while they are being used, usually while laying down in a bed. This will interfere with your desire to move and be upright during your labor.
Exams - It is fairly certain that you will have at least one vaginal exam to determine your progress in dilation. Believe me, none of like these, especially during labor. If this is uncomfortable for you, try to concentrate on relaxing your pelvis. You can also use your favorite breathing pattern during this time or ask your midwife or doula for guidance.
Massage & Touch - For most women, touch is essential during labor. This may be in the form of massage, acupressure, stroking, effleurage, Reiki, or even holding someone's hand. Your midwife and/or doula can perform all of these for you, or can instruct your partner. There are methods of touch to comfort, to assure, to soothe, to counteract back labor, to help you relax. Your midwife has been trained in all of these and, with your permission, will use them as you need them.
These have been considerations for planning your physical labor environment, which also helps your emotional and mental state during labor. There are other aspects of labor and delivery for you to discuss with your midwife, birth partner, doula, or health care provider. The homebirth midwife or doula that accompanies you is not considered part of the medical staff, and will not be able to make medical decisions for you. She can, however, see that you have the necessary information to make your own decisions when something unforeseen arises. Spending time well before labor begins to discuss general medical preferences or choices will eliminate making difficult decisions under difficult conditions.
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