We're really excited to see you soon!

Prior to labor, please review this article about Labor Tips For Dads and Birth Partners, which recommends you practice timing contractions using an app. Revisit our blog for updates and ideas closer to your due date. If you are considering an induction of labor, please review these helpful reminders.

Start timing contractions using one of these recommended apps when you have noticed that the contractions are getting stronger/longer and closer together. If it is overnight, don't time contractions unless the intensity increases, and take a loooong bath and go back to bed (you may take several warm baths throughout early labor even if your waters break). Avoid the shower until you are at the hospital; taking a bath will relax your muscles better and allow us to time contractions better than if you are tense out of the tub.

While in bed resting, lay on your side and use lots of pillows between your knees and ankles and try to at least sleep between contractions (you may doze off but wake at peak of contraction). If pressure is felt in the lower back area, side-lying with pillows is fine but occasionally switching to a hands/knees-butt-in-the-air position can be very beneficial. Also, alternate between a heating pad and an ice pack every 20 minutes or so (place cloth between skin and pad/pack) if back pressure is present. 

Sleep as much as you possibly can; conservation of energy is key since fatigue is the enemy of most labors. Labor will progress on its own and staying relaxed makes contractions more comfortable and allows you to sleep at least in between contractions.

Drink water, urinate once an hour (sit on toilet for at least 5 minutes every visit), eat fruit, and rest lots. If you have back pain, apply heat for 20 minutes and then switch to an ice pack for 20 minutes more - this confuses the nerves and disrupts the signals being sent to your brain.
 

5-1-1

When contractions are 5 minutes apart, about a minute long, and have been in this pattern for at least 1 hour, you likely will be around 3cm or so. Labor may fade or pick up around this point so stay in communication with your doula via text or voice and together, you will determine when is the best time to join you. Read these guidelines from Lamaze for early labor.

Be sure to call your primary doula when you need help/advice or wish to talk with her. (She may not wake if you text her.) If you call her and she doesn't answer, please leave a message, and call her again in 15 minutes. If she doesn't call you back within 15 minutes, please call your back-up/secondary doula.

Most expecting parents head to their birthing facility when they progress from early labor (0-6cm) to active labor. Traditionally the 5-1-1 rule is used. More recent recommendations are 4-1-1 (four minutes apart) or even 3-1-1 (three minutes apart). However, listen to your body and trust your instincts. If you feel it is time to go to your birthing center, follow that instinct. More info on what to expect for the different labor stages can be read here.

What to do if your water breaks

If your bag of waters release, note the color and smell (collect on a pad, if necessary). Any green, brown or black is a sign of infection or meconium. If you see this, call your doula and create an action plan together. Remind her the result of your Group Beta Strep culture.

If the water is clear and smells clean (maybe like hay/straw), rest-up and conserve energy. Stay hydrated and urinate once every hour or two. Your contractions will likely start soon and create a regular pattern, so take it easy and maybe a warm bath (no showering!) to help you relax and soothe muscles.

We know it is very exciting for labor to start this way but please consider sleeping while you can or at least between contractions. Fatigue is the enemy of many labors!

Usually contractions will start within a few hours of your bag breaking but it may take longer. Rest while you can. If you stay moving, contractions may seem more intense and this can be tiring. Allow the contractions to increase naturally while you are sleeping/resting on your side.

If you've tested positive for Group Beta Strep, typically, the recommended course of action when a premature membrane rupture occurs is to induce labor within 12-24 hours. Discuss this ahead of time with your medical care provider.

Eating and Drinking In Labor

We encourage you to eat light, healthy, and easily digestible meals during early labor. We recommend salads, smoothies, soups, etc.

Typically, women aren't interested in eating too much during active labor but yet it is important for energy boosts. Recommended snacks are fruit pieces, honey sticks, applesauce, popsicles, etc.

In the 1940's, Dr. Mendelson reported that during general anesthesia, there was an increased risk of the stomach contents entering the lungs and potentially could lead to severe lung disease or death. Since the 1940s, obstetrical anesthesia has changed considerably, with better general anesthetic techniques and a greater use of regional anesthesia. Cochrane reviewed 3,130 women during labor in 5 studies and determined women should be free to eat and drink in labour, or not, as they wish. Read more here. 

Labor Positions to Try

You will probably feel a contraction when you move into a new position and it likely will be the most uncomfortable one of the series. As you settle into a new position and find your rhythm, the second and third contractions should be easier than the first one. If you are still as uncomfortable and feel the need to move into a new position, please do so! However, if you can maintain a new position for at least 5-6 contractions (or approximately 30-45 minutes), then you are helping baby to work into a good position while evenly dilating your cervix. Here are a few positions to try out.

Pushing and Delivery Positions

For pushing and delivery, upright positioning helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the squatting and kneeling/hands-knees positions (Gupta et al. 2012).

In a recent 2017 Cochrane review and meta-analysis, Gupta et al. combined the results of 32 randomized, controlled trials that included more than 9,000 birthing people in hospital settings. In comparison with non-upright positions, people who were randomly assigned to upright positions in the second stage of labor were:

• 25% less likely to have a forceps or vacuum-assisted birth

• 25% less likely to have an episiotomy

• 54% less likely to have abnormal fetal heart rate patterns

• 20% more likely to have a second-degree tear; the absolute risk was 15.3% for people in upright positions vs. 12.7% for those in supine positions *

• 48% more likely to have estimated blood loss greater than 500 mL; the absolute risk was 6.5% for people in upright positions vs. 4.4% for those in supine positions **

* The lower risk of episiotomies with giving birth in upright positions was offset by a higher risk of second degree tears. However, since other researchers have found strong evidence that natural tears heal easier and are less traumatic to tissue than episiotomies (Jiang et al. 2017), a higher second degree tear rate in exchange for a lower episiotomy rate may be an acceptable trade-off for some people. Also, it may be possible to reduce the risk of perineal tears with upright positions by changing the methods used in the second stage of labor (e.g., directed vs. spontaneous pushing).

** Researchers found that people in the upright group were more likely to have an estimated blood loss greater than 500 mL. The authors questioned the accuracy of this finding because the blood loss was based on care provider estimates, which is not an accurate way of measuring blood loss. There were no differences in the need for blood transfusions between groups. Some researchers consider that, in well-nourished people, there is little impact from blood loss of 500 mL—an amount equal to a routine blood donation (Begley et al. 2015). However, in low-income countries where mothers may be poorly nourished and anemic, this amount of blood loss can be harmful.

However, despite these proposed benefits of pushing in an upright position, most women in the U.S. give birth either lying on their backs (57%) or in a semi-sitting/lying position with the head of the bed raised up (35%).

Physiological or “mother-led” pushing is when a birthing person follows their own instinctive urge to bear down at the peak of a contraction, starting some time after full dilation. This is common in home birth settings and becoming more popular in the hospital setting, as opposed to coached pushing, which can lead to overstrain, loss of breath, and perineal trauma. On the other hand, some people really benefit from verbal guidance at this stage.

Directed pushing may help you if you’ve had an epidural and don’t feel the urge to push. More info and tips to avoid directed pushing can be read here at Lamaze International.

Be sure to discuss your wishes and expectations with all members of your birth team. Women should push in any position they find comfortable – it is not necessary to be continuously upright or continuously lying down during the pushing phase. Learn more here.

Perineal Compresses

Vaginal births are often associated with some form of trauma to the genital tract, and tears that affect the anal sphincter or mucosa (third- and fourth-degree tears) can cause serious problems. Perineal trauma can occur spontaneously or result from a surgical incision (episiotomy). Different perineal techniques are being used to slow down the birth of the baby's head, and allow the perineum to stretch slowly to prevent injury. Massage, warm compresses and different perineal management techniques are widely used by midwives and birth attendants. Read the evidence here.

​The below video explains how to use warm compresses safely. Discuss this method with all of your care providers before labor begins. Talk to the nurse too (and later, the OB or midwife) about using warm compresses (washcloths) to support the perineum during the crowning phase. Compresses are used during contractions and many washcloths will be needed as well as an electric kettle. Purchase this and a few bundles of (pre-cut) cloths made from a soft material.

How might a TENS unit work to help manage pain?

TENS applied to the lower back during labor does seem to lower pain compared to placebo or routine care. One recent study that compared TENS to injectable opioids found that TENS relieved pain just as well as the injectable opioids, but without causing side effects for the mothers and babies. So far, researchers have not reported any bad side effects on mothers or babies from using TENS during labor; however, there has been limited research in this area.

Low-Intensity TENS and Gate Control Theory

When you use TENS at a low-intensity level, it is probably working through the Gate Control Theory. The Gate Control Theory says that there’s only a certain amount of stimuli that can get through to the brain. In other words, there is a “gate” that only lets so much sensory information through. So, with TENS, you’re kind of flooding the brain with this sensory buzzing feeling so that the brain can’t really perceive the sensation from labor contractions as much.

High-Intensity TENS and Diffuse Noxious Inhibitory Control

However, if you are using high-intensity TENS (with the intensity turned way up), researchers think it might work to relieve pain in a different way. The idea behind this other mechanism, which has a long name called Diffuse Noxious Inhibitory Control, is that by stimulating the body with another source of pain, you trigger the body to release its own natural pain relieving hormones called endorphins. In other words, you’re creating a painful sensation to encourage your body to release those endorphins, which act kind of like your own morphine supply.

Researchers also think that TENS during labor might work by decreasing anxiety, making you feel like you have more control over your labor, and by providing a distraction from labor contractions. Here is a link to purchase a TENS unit. The FDA has approved TENS for use post-surgery and for traumatic pain.