Labor and Delivery Basics

Labor and Delivery Basics

by Dr. Peter J. D'Adamo with Catherine Whitney

I can assure you of one thing. No matter what your individual circumstances, good nutrition and regular exercise throughout your pregnancy will make your delivery far easier. Prepare for delivery the same way you would prepare for a strenuous athletic event.

• Pack more protein into your meals.
• Don't skimp on healthful complex carbohydrates, especially those found in vegetables and fruits, and blood type-friendly selections of grains and beans. These will increase your energy and balance your metabolism.
• Increase your consumption of vitamin C- and vitamin A-rich foods. These vitamins are essential for wound healing and tissue repair-especially for the genital and eliminative tissues, which will be so severely stressed during labor and delivery.
• Eat vitamin K-rich foods every day to improve circulation and blood-clotting factors.

Prepare Yourself: Prelabor Guidelines
As you approach the birth of your baby, typically around forty weeks, it's normal to feel equal measures of excitement and apprehension. If this is your first pregnancy, you're entering the great unknown. You may find your thoughts filled with worries about whether your baby is alright and dread about what you'll experience during labor.

If you've participated in childbirth classes and have a strong partnership with your doctor or midwife, some of that anxiety will be alleviated. And if you've adhered to your blood type plan, you can have some degree of confidence that you've done the best you can to assure a healthy baby.

The key now, as you prepare for labor, is to be as physically and mentally prepared as possible.

Consider enlisting the services of a doula. Doula (pronounced DOO-la) is a Greek word that, roughly translated, means "an experienced woman who helps other women." Doulas are specially trained women who provide pregnant women with nonmedical emotional and physical assistance from late pregnancy through labor and delivery, and into the first weeks of a newborn's life. In the past, it was common for female friends and family members of a woman in labor to gather at the birth and offer assistance. Today, doulas offer a way for women to gain this support before, during, and after labor. Studies have shown that in hospitals with high cesarean rates, a doula's presence lowers the chances of a cesarean. Women have shorter labors and need less chemical intervention to speed birth or reduce pain. Women's satisfaction with their birth experiences, postpartum psychological state, success in breast-feeding, and interactions with their newborns are improved.

Doulas don't replace Dad. In fact, they make Dad's role more effective. With a doula present to relieve some of the stress and burden, dads take fewer breaks, remain closer to the mother, touch her more, and give her more support.

There are several thousand doulas working in the United States, and their number and use are increasing. Most have undergone special doula training.

Advice from the Naturopath Midwife Cathy Rogers, N.D.: Hospital or Home Delivery?
The setting of the birth is an important decision. Many hospitals today are labor-friendly, so you'll want to check out the hospitals in your area and visit their maternity floors.

When you're deciding between home or hospital birth, the important factors are: a practitioner you can communicate with and whom you trust, and a setting that offers a sense of safety. Some women need the medical environment to feel safe — and it will be necessary if you have a high-risk pregnancy. Other women feel safest in their own homes. They equate hospitals with being sick. Talk it over with your mate and your doctor/midwife, and do your research.

Whatever you decide, remember that a meaningful birth experience is less about where and more about how completely you involve yourself in the birth.

The Stages of Labor: What to Expect
The first stage of labor is called cervical dilation. It is the longest period, normally lasting several hours to a day. During this stage the cervix will fully dilate to 10 centimeters.

In the second stage of labor, you will begin to voluntarily push the baby down the birth canal with contractions, which become very strong and can be painful. Each contraction lasts about 60 seconds. The contractions do, however, space out to about 2 to 3 minutes apart. The usual length of the second stage of labor for a first-time mother is about 2 hours. The second stage culminates in the birth of your baby.

The third stage comes after the birth and continues through the delivery of the placenta.

There is a fourth stage of labor, which is often ignored. The fourth stage begins after the birth of the baby and the delivery of the placenta, and lasts for about an hour. The fourth stage is a healing and mending time for the mother, and a time for her and her new child to begin to get acquainted. During this stage, the midwife or doctor will examine the placenta and the umbilical cord, look for episiotomy tears, and suture them and the episiotomy, if one was performed. The uterus will be firm or hard to the touch. This is the adjustment period to the stresses of labor. Many of the physiological changes that occurred in labor will stabilize within the first hour following the birth.

Easing Your Labor
The exertion of labor has sometimes been compared to running a marathon race. Your state of fitness and the steps you take to keep your energy levels high will play a major role in how well you do during labor. Realistically, you can probably expect to have a longer labor if it is your first child. Some women begin experiencing mild contractions one to two days before the birth. Here are some tips:

• In the weeks and especially days before delivery, get plenty of rest. If you experience sleep disturbances, institute a relaxing routine before bedtime, such as a warm bath and a light snack to raise your blood sugar.
• Keep your nutrition levels high. You'll need those extra nutrients for the job ahead.
• During the first stage of labor, when contractions begin and the dilation of your cervix occurs, stay as active as possible. Distract yourself by engaging in regular activities. Delay the time you have to give your full attention to the contractions. (Cathy Rogers suggests that you not consider yourself in "active" labor until you can't talk through a contraction.) Walk around as much as possible, as walking helps the cervix dilate.
• If you're using breathing exercises, such as the Lamaze technique, start them when the contractions become intense enough that you have difficulty speaking.
• The first stage of labor can last many hours. Drink plenty of liquids and keep a light snack nearby. A strengthening broth of miso, vegetables, or chicken can be helpful in the early stages of labor. Ginger tea (okay now that you're in labor) can also help you avoid exhaustion.
• Be sure to discuss in advance with your doctor or midwife what the policy is about eating light foods or drinking liquids during labor.
• During the second stage of labor, when contractions are more intense and closer together, you'll be working harder to push the baby into the birth canal. Try to change positions frequently — at least every 30 minutes. This will reduce the pressure and keep you more flexible.

Safe Pain Control
In my experience, most of the anxiety women experience prior to and during labor is related to fears that the pain will be too great to handle, or they won't be able to stay focused or in control. There are many artificial painkillers available in hospitals today. Some are analgesics, which carry some risk since they affect your baby as well. Others, such as the epidural, are regional blocks. Before you hand yourself over to a medicalized childbirth, I urge you to investigate the many nonmedical pain-relief strategies that are available. Not only are they safe, they also allow you to be totally present for the birth experience.

Eight Natural Painkillers
1. Relaxation techniques. Visualization, meditation, and mild hypnosis can take the focus off your pain, relieve your anxiety, and make labor go a lot easier.
2. Movement. Changing position frequently enables the force of gravity to work with you, not against you. This decreases the feeling of pressure.
3. Massage. Prior to delivery, practice massage with your partner. In labor, light massage to your shoulders, scalp, legs, thighs, brow, face — wherever tension needs easing — can make you feel much better. Deeper massage can also be used at specific points. Counterpressure can be effective. This is pressure applied to areas of the body that are causing pain during labor.
4. Hydrotherapy. Water labor and birth can significantly increase your comfort and help you relax during labor. See below.
5. Acupressure. Acupressure is the stimulation of specific pressure points on the body to relieve pain.
6. Acupuncture. The insertion of tiny needles into nerve centers to block pain.
7. Doula. Studies show that doulas reduce a woman's need for pain medication by alleviating stress and the negative impact of high levels of stress hormones.
8. Homeopathy. The homeopathic remedy Gelsemium (in either the 6x or 30cc dilution or potency) can help to dilate the cervical opening. Homeopathic remedies are very gentle dilutions of a variety of plants, animals, and minerals. You can take two to three pellets of homeopathic Gelsemium under your tongue every 10 to 20 minutes.

Advice from the Naturopath Midwife Cathy Rogers, N.D.: Labor Baths and Showers
Water labor is gaining in popularity, for good reason. Contractions are less painful if you are in water. Water equalizes the pressure, relieving pain. It also allows you to change positions easily, which reduces the discomfort. Water puts you in a state of physiological relaxation.

Whether you are delivering at a hospital or at home, you can order a labor tub. There are a number of companies across the country that specialize in providing labor tubs. You can order the tub in advance, call their service when you are in labor, and the tub will be delivered. It has a hard plastic shell wrapped around a soft foam interior. A sturdy reusable liner wraps the whole tub and a disposable liner wraps it a second time. A circular foam pad is used as a base. Most services include setup, support, cleaning, takedown, and removal of the tub.

You can also use your own tub or ask for a hospital room with a private tub. If it's not deep enough to cover your belly, cover your belly with a wash cloth and continuously pour water over it.

If you only have access to a shower, sit on a towel-covered stool in the shower stall and direct the spray where it will help the most.

You can also use moist hot or cold compresses throughout labor — whichever is most comfortable. Use a washcloth and wring it well, then apply it to the brow, abdomen, lower back, or perineum. If you cover the hot washcloth with plastic, it will retain the heat longer.