Choices in Labor

April 16, 2018

| Intuitive Birth

Having a baby is not as simple as showing up at the hospital and screaming your baby out (like in the movies). As a birthing person, you have many options about what kind of care you receive and how involved you want others to be in your birth.

 

 

We recently explored your choices in pregnancy. In this series, we’re diving in to the choices you have in labor, birth, and right after Baby is born.

 

This week, we will explore your choices in labor:

  • Hospital, home, birth center

  • Birthing space

  • Support team

  • IV fluids

  • Intermittent monitoring

  • Free movement

  • Eating & drinking during labor

  • Cervical exams

  • Augmentation

  • Pain Relief

 

Hospital, home, birth center

As a birthing woman, it is important that you are in an environment where YOU feel most comfortable. Our physiology is designed in a way where our hormones are in a dance. If our fight or flight response gets triggered, it disrupts the flow of oxytocin (the love hormone) and endorphins (the feel-good hormone).

 

Hospitals obviously have the most equipment and staff to deal with emergencies, but also come with caveats like less personalized care, more policies, and higher likelihood of augmented labor.

 

Home birth is a great option for low-risk mamas because you get very personal and gentle care in the comfort of your own space, but can sometimes be more expensive than hospitals (depending on your insurance) and obviously pose higher risks simply because you’re not as close to a medical team in case of emergency.

 

Birth centers are a wonderful middle ground. Some are connected to (or inside) a hospital while some are free-standing, meaning they have no affiliation with a hospital. Each one is a bit different but both will be more family-centered and gentle care than a hospital. They have midwives, big beds, big tubs, and things like birth stools.

 

 

Birthing Space

Feeling safe, secure, and comfortable is vital for a smooth labor. No matter where you choose to give birth, you can create your environment in a way that feels like home.

 

Some things you can do to set the mood:

  • Dim lighting

  • Play your music

  • Spray diluted essential oil around the room

  • Bring your birth ball

  • Wear your own clothes

  • Light candles or bring battery candles

  • Affirmation cards

 

 

Support Team

The people you have in your birthing space make a big impact in your comfort level and ability to focus. For instance, studies show that having a doula improves birth outcomes. Whoever you choose to have with you through this intense transformation, make sure it’s someone you trust to remain calm and confident in your ability to birth your baby. Bringing your support person to your childbirth class can be so helpful because you’ll have an opportunity to practice comfort measures and positions together. A great book for your support person is The Birth Partner.

 

 

IV Fluids

Intravenous (IV) fluids are common at hospitals. This means having a very thin tube inserted into a vein and being connected to a constant drip of fluid. It’s a common practice because it ensures that a laboring mama will be hydrated, but it does have some downsides like swelling and difficulty breastfeeding. If you choose to eat and drink during labor, it is not necessary to have an IV. You’ll just need to make sure you’re drinking water regularly or have someone offering it to you. An alternative to having an IV is a saline/hep lock. This basically means having the IV tube inserted but not being connected to anything. This option is a good middle ground and can make things a lot more efficient if you need to have pitocin or pain medication administered at some point in labor.

 

 

Intermittent Monitoring

Intermittent monitoring means checking in with the baby’s heart tones every 15 minutes or so instead of being hooked up to a machine receiving constant data. At a birth center or home birth, usually your midwife will use either a handheld doppler or fetoscope. Intermittent monitoring is a great option because you have much more freedom to move and be in water. And it is SO important to move during labor! You can always ask if your provider has waterproof monitoring devices so you don’t even have to get out of the tub or shower. Keep in mind, if you have an epidural you will most likely not be able to get out of bed and the baby may need to be monitored more.  

 

 

Free Movement

Moving the body is one of the best things we can do in labor to cope with sensations and keep progressing smoothly. It’s a beautifully complex process for a baby to descend from belly out into the world. As we change positions they are more able to rotate through the pelvis. And getting into a rhythmic movement allows the birthing person to release tension and go into the primal mind. (In my labor, I was moaning and swaying on hands and knees over a stack of pillows for hours.)

 

 

Eating and drinking during Labor

Being that birthing a baby is a physically and emotionally intense event, and can be a long process, it make sense that your body needs nourishment. Many hospitals, however, have a policy restricting patients to clear liquid only during their stay. The main reason for this is a concern for vomiting/choking in the event of an emergency cesarean. There has been research on this and it shows that it is safe for low-risk mamas (including those who have an epidural) to eat and drink during labor. I recommend packing a lunch box to bring to the hospital!

 

 

Cervical Exams

You do not have to get your cervix checked. The main purpose of cervical exams in labor is to find out how soft, thin, and dilated the cervix is. This is also called effacement. When the cervix is fully effaced, it can dilate (open), and Baby can descend into the birth canal. Birthing people and care providers like to know how dilated the cervix is (1-10cm) because it gives an idea about when it’s okay to administer an epidural or begin pushing, as well as keep track of how labor is progressing. There’s a few things, though. First, labor is not linear. It can naturally slow down and speed up again. So dilation is not necessarily an accurate method to measure progression. Second, most birthing people do not like to have anything inserted into their vagina during labor. You can tune in with your body and you’ll know when you’re ready to push. (I didn’t have any cervical exams during labor but I was so aware as I transitioned through each phase of labor. When it was time to push, there was no stopping it.)

 

 

Augmentation

Augmentation is another word for speeding up labor. It’s normal for labor to slow down and speed up again on its own, and can even stall for long periods of time if a mother’s fight or flight response has been triggered. In some cases, especially in hospitals, care providers will suggest some form of augmentation to get labor moving faster.

 

Tools for augmentation include:

  • Pitocin (synthetic oxytocin), which is administered through an IV. This can bring on contractions that are stronger and closer together than the body would naturally create. The good thing about Pitocin is that you can turn the dosage up and down. Many women have been able to make it through this kind of labor without any pain medication, but often times there is a need for pain relief medication. With contractions surging so strong right after another, the baby may get less oxygen and become distressed. This is why the rates of forceps, vacuum, and cesarean delivery are higher when pitocin is used.

  • Cervidil - a time-release medicine inserted into the vagina that helps thin and soften the cervix and can be removed at any time)

  • Cytotec - also known as Misoprostol - a small pill that can be taken orally or inserted next to the cervix. It’s risky because it cannot be reduced once administered. It is not approved by the FDA for use in birth and occasionally leads to uterine rupture.

  • Amniotomy (artificial breaking of water) - (Did you know that babies can be born without the water breaking at all? I was born with the bag of water still intact!) Breaking a birthing person’s water can help labor to progress if it’s the right timing. But if the body isn’t ready, it won’t necessarily work. Once the water is ruptured, however, you have a time limit until another form of augmentation will be used (in order to avoid infection or not enough fluid for the baby). It’s important to avoid cervical exams after the water has broken because there is a higher risk of infection.

 

 

Pain Relief

There are both natural and synthetic options for managing pain. Sometimes a birthing person is not able to cope well or may just be too exhausted from a long labor. While some of the time, using pain medication can be just what’s needed, it does come with risks. Some risks include difficulty establishing breastfeeding, itching, headaches, nausea, blood pressure changes, and more. You or your support person can always work with the nurse or care provider to find the best option for you. If birthing at home, only natural pain relief options will be available.

 

Natural pain relief options:

  • Movement - check out Spinning Babies!

  • The 3 R’s - rhythm, relaxation, ritual

  • Counter pressure

  • Rebozo

  • Hypnobirthing - check out the Mongan Method

  • Hydrotherapy - being in water

  • TENS unit

  • Birthing ball or peanut ball

  • Essential oils

  • Massage and acupressure

 

Pain relief medication options:

  • Epidural - a very thin hollow tube is inserted into the back, right outside the membrane surrounding the spinal cord - mostly numb from the waist down - can affect ability in pushing stage

  • Nitrous Oxide - laughing gas - can be inhaled at will so no need for a needle

  • Opiates - Morphine, Stadol, Fentanyl, Nubain, Demerol

 

 

Have any questions or suggestions? Want to share your story?

Please share below!

 

Resources

Evidence on: IV Fluids during Labor

Evidence on: Fetal Monitoring

Book: Active Birth by Janet Balaskas

The 3 R’s - rhythm, relaxation, ritual (Watch the video)

Spinning Babies - easier birth with fetal positioning

 

 

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