The Stages of Labor
Understand your body, so you know how to work with it
Characterized by long 60-90 second contractions
Active Labor Strategy
While early labor contractions may be 35/45/50 seconds long, the active phase is identified by a change in the length of the contraction to 60 seconds or longer and comes with emotional changes as well. While a mom might smile for a picture, remain chatty and engaged with the world around her when she is in early labor, she will become more focused, turn inward, and shut out the world outside when active labor begins. This is when the contractions will take all of her focus and her birth team should begin implementing measures to help assist with deepening her relaxation and comfort.
Once the laboring mom shows emotional signs of active labor, the birth team should note the length of the contraction as well as the interval between them and begin paying particularly close attention to mother's needs. Is she warm enough? Does she have enough food? Did the lights get turned down? Are there candles, twinkle lights? Is the bathroom set up as a glowing sanctuary for her to retreat to at a moment's notice? Offer her a sip of fluids after every contraction. Offer her warm nourishing soup, energy bars, greek yogurt or honey sticks to keep her body well fueled to do the work of bringing her baby earthside. This is the time when she might like the ball to be rolled under her after each contraction. The rebozo can be hung over the partner's shoulders for slow dancing and squatting. Counter pressure and acupressure on her forehead, sacrum or between the thumb and forefinger are excellent at this time.
Benefits of Movement
Alternate between Active and Restful Positions.
hydrate after each contraction.
Help her Breathe Slowly and Gently, Elongating the Exhale.
Movement is your friend.
Movement helps the mother's body open more easily and helps the baby have more opportunities to move into a favorable position. The mother's free open movements may help the baby engage more quickly and evenly, providing her with a potentially shorter and more comfortable labor. Her movements stimulate the baby's head against her cervix, which release the hormones that help move labor forward. Mother's who are free to move in labor also often have an easier time breathing slowly and deeply, providing more oxygen to their uterus for efficiency, comfort and safety. When the mother is able to relax, breathe well, and move freely, her baby and placenta will be getting more oxygen as well, thus potentially reducing the incidence of fetal heart deceleration. With the more stable heart rate, the laboring mother is less likely to need interventions and may be more likely to avoid a surgical birth.
Mind-Body Connection in Active Labor
The mother instinctively will turn inward and perhaps closer her eyes, lean her head on her arms in a slightly forward position. We want to encourage this. Help her go into labor land. Be a buffer between her and any stimulation of her neo-cortex. Help her block out the sounds and people around her with a sleep mask, rebozo blindfold, noise canceling headphones or earbuds with birth affirmations or music. The music can be calming or invigorating. It can be nature sounds or the sounds of streams or rivers or rain. Have more than one playlist so that she has a lot of options to meet her needs in labor. Know how to activate them for her. Reduce the amount of things that she needs to think about. Buffer her with the rest of the birth team, answering questions that you are able to take over, interfacing with them when they offer checks or exams to ensure that they do not disrupt the flow of active labor. Let the birth team know when she is having a contraction in a soft, slow whisper, so that the tone is set for the whole room. Ask them to wait if possible with some routine procedures if you feel it may be difficult for the mom to integrate. Work around and negotiate with the care providers when you feel it may help the mom deepen her relaxation. Their job is so important, but hers is too. Her job is to send oxygen and blood to the uterus, placenta and baby. We do not want to disrupt that. If something stresses her out and she needs your help reorienting into labor land, then tell her to breathe out slowly with you and access her birth affirmations. Become familiar with them before labor, so that you are ready when the moment comes to encourage her and keep her calm, protecting her comfort and helping her to provide the baby with an easier exit, through deeply relaxed pelvic floor muscles, a mother who is able to go within and intuitively listen to her instincts, her baby and her body to move in ways that help the baby descend and help open her, and giving the baby lots of good oxygen, nutrients and removing waste. Help the mom remain undisturbed during the birth process.
Helpful Words to say to the Laboring Mom
Sway with the Contractions. Dip into them.
hydrate after each contraction.
That is one contraction that you will never have to do again.
This powerful contraction brings you closer to your baby.
Surrender to the process.
Release the tension so that you are letting your body open freely without any resistance.
Focus on your baby's movements and breathe deeply and slowly to send oxygen to your baby.
This will all be a memory soon.
You will not be in labor forever.
Enjoy the Space In between.
Get Ready to Cry when you Watch This Beautiful Birth
This mom tries a variety of comfort measures, and techniques to help her labor move forward, including water immersion, leaning on her partner, walking, counter pressure, squatting, hip squeeze, belly lifting, going up and down the stairs with her feet parallel which helps to open her pelvis wide for the baby to rotate and move into a good position, and more. She gets more focused as the labor moves forward and digs deep for that inner strength to push her baby out into her arms.
Once the mother reaches the final moments of dilation and is completing the opening phase she may have contractions that double peak, going up again in intensity before fading away. She may have 90 second long, powerful contractions. The laboring mom can help herself by welcoming the intensity, relaxing into it and deepening her breathing and concentration, which will help increase the blood flow to the uterus and baby and most likely make her more comfortable. The goal is to maximize her comfort in this stage. The hormones of this part of labor may make her feel vulnerable and open, but this is appropriate, because her body is literally opening and so is her heart and mind for this new little person. We are meant to feel open and vulnerable, but that can also feel overwhelming for some mothers. This stage may last for 20 minutes or even up to an hour. Some mothers will skip this or flow through with little to no panic. It is common for a laboring mom in this stage to feel cold, then hot and then cold again. She may shake. She may decide that she doesn't want to give birth and tells you that it will be up to you to birth the baby, because she's done. There are many strategies that may help with this time. Give her lots of encouragement. Help her to get in a position that assists in deepening her relaxation, because the more she lets go of the tension, the faster she will open and move through this stage and the more comfortable she will feel. The rebozo wrapped around her may provide comfort if it holds her arms tight like a hug with her partner or doula in front of her holding it closed. The knee press and rebozo back support can be an amazing technique to help a mother feel supported during this time. It also opens up the pelvis by keeping it neutral. This makes it easier for the baby to navigate and move down and through more quickly.
How Touch may help
We do not want to overstimulate the laboring mother's mind by touching her too fast or frequently during a contraction. In between contractions we may use light touch or deep massage, but we should always move in a downward motion, because the energy of labor is down and we should move slowly so that we do not overwhelm her. The sensations of labor are intense and are enough for a laboring mom to integrate on their own. They often take all of her focus. Each individual contraction may demand all of her attention and movement on her body may be too distracting from the task of turning inward, breathing, releasing tension. When a laboring mom tells her support team to "stop" what she really might mean is that she doesn't want that touch at that moment, but different touch might be welcome. Generally touch that involves any movement will be welcome in between most contractions, so long as it is slow, downward and she lines it generally before labor. This is why practice and feedback beforehand is key to implementing these comfort techniques. Practice light touch massage on her neck, down her back and shoulders. Don't do it too often in one spot, because the skin gets sensitive. Try deep massage of her hips, legs and feet, slowly exploring how the sensations feel to her body. If she likes it before labor, it might be welcome during labor. Sifting with the rebozo is a great technique to practice and bring into labor. Sift her back while she sits in the chair to relieve tension in her muscles and pelvis. When the contraction begins pull her into you with her knees against your body to provide support. FIRM STEADY SUPPORT is often welcome during labor. Belly sift between contractions and when the contraction begins, lift her belly and apply sacral pressure for counter pressure, acupressure and support. In general, massage and sifting are great for the space between contractions if she desires it, while firm steady lifting or pressure are great when the actual contraction is happening. Sway with her and move with her body while holding the firm steady pressure.
How the Rebozo may help
Helping baby move into the ideal position is important for all phases of labor. The visual below shows the baby settled in the pelvis. Note the pubic bone near the baby's ear. If the baby's head were on top of the pubic bone or even behind it the robozo could help the baby engage, by lifting and bringing the baby up and over the pubic bone and into the pelvis. When the mother lifts her belly with her hands or rebozo the baby may be brought over the pubic bone to rest within the pelvis, to more easily move down and out.
How Birth Affirmations may look
Birth affirmations are individual to each mom and can speak to what is in her heart and mind. She can write what is meaningful to her and place it in her birthing space. She should also place her birth affirmations where she will be able to visualize them daily, so that they can get into her psyche and become automatic for her mind to retrieve. They should come to her easily in labor. Birth partners and support team can read them to her, memorize them and help her with setting them up.
This mom wrote her own birth affirmations on lovely colored paper and created a unique affirmation that spoke to her heartfelt humor. She decorated them with hearts and stars. These types of birth affirmations can be taped around the home, framed, laminated or set on the table like you see here. There is no right or wrong way, so get creative or keep it simple. The most important thing is to have them in a visible location, where you can see them often. Place them on your bedroom walls, the mirror in the bathroom, the kitchen near the sink, the case for your phone, all around your desk and work space. Do whatever works for you and say them to your self when you practice your breathing and movements for a contraction rehearsal often.
This mom clipped her beautiful birth affirmations onto twinkly lights and had pictures of birds in nature to ground and center her. This is a wonderful way to incorporate both lighting, visualization and birth affirmations together. Think about a place in nature that comforts you, a place that makes you feel safe and secure, a place that relaxes you. Find a picture that captures it or represents it for you. Go there in your mind when you are in labor. It works really well for many women to help them visualize a safe calming oasis in nature so they can deepen their relaxation and go even more within themselves into labor land. Share this safe oasis in nature with your birth team and let them help you get lost in that safe space in your mind by describing it to you when you are in labor. Draw a picture of it your self with colored pencils if you would like and place that in your birth space.
Active Labor Explained
Once the mother's body has dilated to 10 cm she is now ready to move into the 2nd stage of labor!
She may start