Pre Labour: 0-4cms (all covered in our birth preparation workshop)

This is when the neck of the womb (cervix), is getting thinner. Think of a very strong muscle that is slowly getting stretchy and thin.

How does labour start? Many ways! Waters can break (and gush, or leak), or you can have niggling back pain or a stomach ache that comes and goes. All this and a lot more is NORMAL.

It is common for babies to wriggle around a lot and then go strangely quiet; the calm before the storm. Tightenings (contractions) can come on quite strongly at night and die down by day, and this can happen for several nights. NORMAL!

As much as possible, get on as normal with your daily life, ignoring the sensations you are experiencing until they utterly demand your attention.

Then you will be in true labour, which is when the cervix is starting to stretching open. This is known as dilation. Hospitals expect you to be at least 4cms dilated before they will admit you. So relax as much as you can, and listen to what your body wants. Rest is vital at this stage, rather than trying to stay upright to get labour going. The more you relax, the more oxytocin you produce, which makes your labour stronger and more effective. This means LESS contractions are needed for your baby to be born.

First Stage: 4cms-full dilation

Early First Stage

Ignore your contractions as long as you can by resting as much as possible if you are tired, or getting on with your daily life if you feel energised. When this is not possible start with some of the tips and positions that follow.

You can go for a walk, buy some flowers, do some gentle yoga, make some brownies, watch funny and uplifting films. Do things that are connected to your baby's arrival, but don't exhaust yourself with chatter and errands.

Labour requires a few distraction techniques that usually run in this order:

Welcome labour, ignore labour, start moving and breathing through contractions, massage/tens machine, shower on lower back (have a stool to rest on), bath, go to hospital or call the midwife to come.

WAIT UNTIL YOU HAVE 3 CONTRACTIONS IN 1O MINUTES LASTING 40 SECONDS OR MORE BEFORE CALLING THE HOSPITAL/MIDWIFE.

Useful Yoga Practices

Full yogic breathing - Ujayii breathing - ocean breath, to sustain and focus, draw attention within, lower blood pressure and maintain calm. Breathe out into a contraction and focus on the exhale and then continue breathing as feels comfortable; find a rhythm. If in doubt breathe out! The out breath is the antidote to pain. If massive contractions and you can't help but hold your breath, use sound to help you exhale. Breathe into your partner's hands. Your partner puts their hands on your lower back; you breathe 'down your back' and 'into your partner's hands'.

Massage Techniques

The woman should be sitting or leaning forwards and upright, though this can be done with her lying on her side.

During contractions:

Start with partners palm on the sacrum. Massage from side to side, or clockwise circles, or put pressure on either side of the sacrum with palms, or use your whole body weight to press palm into sacrum.

Between contractions:

Inhale - hands up arms to shoulders.
Exhale - hands down to hips, put pressure on sacrum, or move down thighs and shake off.
Inhale - hands up the sides of the back, then Exhale - down the woman's arms: shake off.
Try different variations of the above to find what suits you.
Birth partner breathes loudly and slowly; gives cue to woman.

When contraction begins:

Let the woman guide the breathing and just after it 'peaks', the partner starts to breathe more slowly and loudly, giving cue to woman.

Labouring positions:

½ squat and rock - one foot flat, other tucked under. To move through contractions and give openness in groin.
Cat – helps you move through contractions.
Rest upright and forwards between contractions, on a ball or a mound of cushions. Always keep upper body higher than the lower end to let gravity do its job.
Funny walks - when you get a contraction, hang on your partner’s neck
Hip rotations - against a wall, on a ball, in cat.

It's not unusual for labour to slow down if anything makes you anxious, distracts or disturbs you e.g. disruption of moving to the hospital, not being able to use the pool as you'd hoped, having to answer questions, change of midwife as shifts end.

Do what you can to create a nice environment

Keep the lighting low and the room warm.

Bring pillows, cushions, music (don't forget a portable CD player as they may not have a socket near you), candles; anything that makes you feel relaxed. If you have a ball pump at home, bring it.

Your partner can politely help to ensure that chatting is kept to a minimum so you can concentrate on staying focused during contractions and resting in between them. All questions a midwife asks should be directed to the birthing partner, not the birthing woman. Have a BIRTH PLAN with this requirement in.

Incompatible midwife? Don't underestimate the outcome of this on your labour. Your partner can tactfully take steps to speak to the senior midwife in charge and ask you to be re-assigned.

Focus

Time to go within and start disengaging from the outside world and all neocortex thinking; the analytical, 'thinking', processing part of the brain.

Time to connect with baby

Talking and explaining what is beginning to happen, comforting, soothing. Acknowledge and release fear thoughts and replace with trust/positive ones. Letting go of expectations, bringing humour in, affirm to your baby that you love and welcome them, and that you willingly step out of the way and are happy for her to choose the birth experience she needs. Also, feeling the anticipation and excitement, and allowing this joy to enter every cell of your body. Own your rapture!

Food & Drink

New evidence ('The Caesarean' by Dr. Michel Odent) says that eating should not be encouraged unless the mother wants to eat, as it increases sugar levels in the body which increases adrenaline. Birth is not an endurance sport. It is a NORMAL physiological process.

Neither is excessive liquid consumption recommended. There is a hormone produced in the brain during labour (Vasopressin ) which inhibits fluid loss, so Mum has what she needs inside her to stay hydrated unless she wants to drink.

WHATEVER THE WOMAN WANTS... SAY 'YES'!

Later First Stage

Breathing

As contractions strengthen, you may want to breathe more quickly and lightly, partner puts hands upper back just below shoulder blades – breathe into the pressure of his hands. If you start breathing TOO quickly, partner takes the lead and breathes loudly, it'll help the woman slow down.

Horse breath

If you find your jaw tensing up, you can exhale like a horse through flapping lips. Aim to make a sound, resonating the air between your lips.

Cooling the soup

When expansions come that are sharper to handle, breathe out with small out breaths through the mouth, as if you are cooling some soup or blowing candles out.

Golden Thread Breath

The purpose of this breath is to block the pain receptors in the brain, by re-focusing the mind on visualising a golden thread. Use your imagination with this. You can visualise a thin golden thread, a big fat golden ribbon, golden light spiralling from the mouth etc.

Lips barely apart, breathe in through nose and out through lips. Fine, long, thin breath; the longer the breath the farther out you follow it. The farther out it spins, the more focused the mind needs to be; the more focused the mind on the out breath, the more powerful the antidote to pain. SOUND: 'AHHH' AND 'OHHH' SOUNDS DOWN THE BODY.

Massage:

  1. Fingertips gently massage the cheeks between the jaw – very, very carefully, just to loosen the jaw.
  2. Gently stroke the inner thighs and buttocks. Pleasure receptors are less primitive than pain receptors, so they confuse the brain away from pain!
  3. Arm circles whilst sitting on birthing ball. Combine rhythm of breath with movement, to induce a state of relaxation between contractions.
  4. Another technique to use is wobbling the inner thigh during contractions.  Place a hand on either side of a thigh and wobble it like jelly. If your midwife is willing, partner please ask her to wobble the other thigh!
  5. If woman is tensing her shoulders, partner cups with palms and pushes down on her shoulders in exhale to encourage release.

Trust

Feeling as though she can trust those around her and what is happening is extremely important to a birthing woman. It is up to the partner to make sure this is possible.

Hot Towels

These are great for use during later Stage One labour. You need 1 bucket, 2 tea towels, and hot, but not scolding, water. Place towel in bucket of water, soak and wring dry then place on labouring woman's lower back/sacrum. Partner changes towels at the beginning of each contraction so that the hot one is in place for the peak of each contraction.

Postures

Use many of the postures of early first stage. Moving as you need and most importantly TAKING REST between contractions whenever possible. Conserve your energy. Supported standing: against a wall, or hang off partner's neck.

Helping the cervix to dilate:

If your cervix is taking a long time to dilate, try the following:

  1. Make a positive statement such as "I want my cervix to dilate fully now so I can let my baby through!"
  2. Partner: Look your woman in the eyes and say to her any of the following: You are marvellous! You are beautiful! You are SO powerful! I LOVE YOU! With her approval, keep repeating these statements. She may feel a noticeable opening in her cervix in response to such loving and empowering words.