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How to Support a Laboring Woman FAQ


Doula

This Frequently Asked Questions (FAQ) article is composed of facts from medical journals, studies, childbirth books, other childbirth resources, and from personal opinion. If you have anything to add, or have a question about anything, please feel free to write me.
A birth plan is a written tool to help your desires for labor and birth be known. I find them to be wonderful in helping to express your desires for your birth. Read the Birthing Planning FAQ by Sabrina Cuddy, AAHCC. Or read some sample birth plans in books such as The Birth Book by Dr. William Sears and Martha Sears or Good Birth, Safe Birth by Diana Korte and Roberta Scaer. The Birth Partner by Penny Simkin, PT, CD(DONA) is a great book for partners, it even has a handy reference for labor. (Click here for more options.)
I would recommend that you read plenty about birth from other women. That is why Childbirth.org has a collection of over 100 Birth Stories for your reading pleasure. When you are done giving birth consider submitting your story for other women to read and enjoy!
The * means this is a tip for dad or alternate support persons. This # indicates a tip for mom.

Robin Elise Weiss, ICCE, CD(DONA), NACA, BCCE
pregnancy.guide@about.com
http://pregnancy.about.com/
Last Updated: February 25, 1997

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Table of Contents:

General Support in Labor
After the Birth Support
Who Provides Labor Support
Labor Support for Back Labor
Early Labor Support
Long Labor Support
Active Labor Support
Labor Support During Complications
Transition Labor Support
Informed Consent
*Pushing Labor Support
*Doula's Top Ten

*

General Support in Labor

Labor and birth are very demanding of everyone involved. The laboring mother needs physical, emotional, and mental (informational) support before, during and after labor. Having someone with the laboring woman at all times, keeping her well informed, reminding her to change position and urinate frequently, encouraging her, reminding her of why she is doing this, and many other jobs are needed in labor.

Who Provides Labor Support

This labor support can be done by the father of the baby, the woman's sister, friend, mother, childbirth educator, or a doula (professional labor support). It can also be a job that is shared, because there is plenty to go around. Medical studies have shown that having a doula present provides the following benefits:

50% reduction in cesarean rate
60% reduction in epidural requests
40% reduction in the use of pitocin
25% shorter labor
30% reduction in use of analgesia
40% reduction in forceps use
increased maternal satisfaction

Mothering the Mother, Klaus, Kennell, & Klaus, 1993.

Early Labor Support

This is an exciting time! You might be wondering if you are really in labor or if this is a false start. If you know this is it you can be excited, nervous, afraid, or all of the above. Here is what you need in this stage of labor.

#Relax, go with the flow
#Tune in to your body
#Don't pay attention before you need to
#Try to go about your normal day if during the day
#If it's at night, SLEEP if at all possible
#Alternate activity with periods of rest
#A favorite game is to try and make the contractions stop
#Take a bath
#Take a walk
#Watch a good movie
#Pack your bag for the hospital or birth center
#Ready your home for your homebirth
#Alert everyone involved that you are in labor, even if you don't need them

*Encourage her to rest, eat, walk, whatever she feels like doing
*Rub her back, her feet
*Give her verbal encouragement
*Help her to time contractions

Active Labor Support

Active labor is generally noticed when mom is getting very serious about her contractions. Her contractions maybe 3-5 minutes apart and lasting 60-90 seconds. The cervix continues to thin and open, and the baby moves down.

#Relax, do not fight the contractions
#Breathe (Not necessarily any special way), deep abdominal breathing usually works very well in keeping you calm
#Find a position that is comfortable for you
#Maintain your mobility as long as possible, this helps speed labor by using gravity to bring the baby down, and helps you with pain

*Make sure she is not hiding tension
*Remind her to urinate every hour
*Remind her to drink and eat to comfort
*Aromatherapy
*Remind her to change positions often
*Encourage her verbally
*Assist her with massage, mental relaxation, or other things that work for you
*Maintain a peaceful environment

Transition Labor Support

This is the hardest but shortest part of labor. The cervix finishes opening during this phase of the first stage. This is the point when she may ask to go home, promising to return and finish tomorrow, she may shake, be nauseated, or vomit. These things do not always happen but are perfectly normal if they do. Contractions are 2-3 minutes apart, and generally last 90 seconds. Remember the pain is not any worse, just closer together.

#Relax, go with the flow
#Move around and get comfortable, you may need to change position with every contraction or you may not want to move
#Listen to your body
#Hang in there it's almost over!

*Remind her to take one contraction at a time
*Remind her this is almost over
*Help her find a comfortable position
*Water is especially helpful during transition. Try a shower, a tub, or cloths.
*Make sure she is not tensing with the contractions
*Remind her to breathe
*Lightly stroke her face or other part of the body if that feels good to her
*Slow dance with her
*Have her sit on the toilet, this is a great place if she is having trouble tensing her perineum

Pushing Labor Support

Wow! You are finally here! This stage starts with the complete dilation of your cervix and ends with the birth of your baby! Your contractions will probably space out to be about 4 minutes apart and last 60-90 seconds. Most women describe pushing contractions as different than labor contractions. Some women have a short period where they will not have any contractions, or their contractions are very light and no urge to push. Sheila Kitzinger calls this your "Rest and be thankful." phase. If you experience this do not panic, it is normal and labor will start again, get your rest!

The urge to push comes in several varieties: the overwhelming urge, the so-so urge, and the only at the peak of a contraction urge. Push to comfort, and do not begin pushing before you are ready, this can lead to an unnecessary cesarean for failure to progress or the belief that the baby is too large. Be patient.

#Push to comfort
#Find a position that is comfortable
#Squatting opens the pelvis by more than 10%
#Hold your breath as your feel comfortable, this will help with pain and provide extra force to push
#Remember that the baby is almost here

*Help her with positioning, she may need you to hold a leg or support her as she squats
*Encourage her verbally
*Remind her the baby is almost here
*She is working hard, offer her sips of water or juice
*Cool washcloths to the face and neck might feel really good to her
*Remind her to relax
*If she is making noise remind her to keep it low so that she doesn't tense her throat or bottom

After the Birth Labor

Your baby is born!!! Congratulations! This stage begins with the birth of your baby and ends with the expulsion of the placenta. It is called the third stage of labor. You will most likely be holding or nursing your baby at this point, but there are a few things to remember here as well.

#Continue to relax
#Nursing your baby will help the placenta come more quickly and your body heal
#Know that you did a GREAT job!

*Congratulations! You did a great job helping mom!
*Make sure mom has something to drink
*Take pictures, including some with you in there!
*Cut the cord if that is your job, and only when the birth plan indicates it
*Help mom begin nursing the baby

Labor Support for Back Labor

About 25% of women will experience back labor. The most common cause is a baby who is in the posterior (their spine against mom's spine) position. I want to point out that the best thing you can do is to encourage the baby to turn. Here are some helpful tips for back labors.

#Hang in there
#Rely on your support team to help you
#Continue to stay relaxed
#Adopt positions that encourage the baby to turn
#Hands and Knees
#One foot up on a chair and lean into it
#Pelvic rocking
#Remain upright, going to bed will not encourage the baby to turn
#Take a shower

*Use a tennis ball, rolling pin, soda can, or massager on her back
*Counter pressure on the back is very helpful, you may be asked to push for long periods very forcefully
*Encourage her to take one contraction at a time
*Encourage her to pelvic rock
*Use the double hip squeeze
*Remember that medication may take away the pain, but they will only mask not cure the problem, if you choose medication you might wait until after the posterior position has resolved itself before receiving it to lessen your chances of a cesarean

Long Labor Support

Long labors are hard, just as very short labors are. Remember that long labors end in the birth of a beautiful baby.

#Take one contraction at a time
#If you are less than 5 cms consider going home
#Urinate often
#Walking is really great
#Nipple stimulation can often help
#Rest when you can
#Continue eating or drinking to comfort
#Take a nice shower
#Squatting may help

*She may need extra encouragement that this is normal and she is doing a great job
*She may need help with positioning
*Remind her to urinate
*Remind her to eat or drink
*Help her stay relaxed during contractions
*Encourage her to change positions
*See if she will try pelvic rocking
*Talk to her, see if something is emotionally hindering her

Labor Support During Complications

Complication rarely occur, but support is just as important, if not more so. For detailed cesarean support, please refer to the Cesarean Section FAQ.

#Stay calm
#Stay informed, know all of your options

*Help keep her focused on her job
*Make sure she has all the information necessary to make an informed decision
*Maintain what measures of the original birth plan as possible
*Find support for yourself as well

Informed Consent

Informed consent should be obtained before any procedure or test during pregnancy, labor and birth. Here are some questions to keep in mind to make sure that you are getting informed consent.

Why do I need this drug or procedure?
Will my baby and I be healthier for taking it or having it done? Or is it routine?
What are its known side effects?
Will the benefits outweigh the side effects?
What is the risk to me or the baby if I don't take it or have it done?
Are there alternatives that can be tried before this procedure/drug?

You also have the right to privacy while you make your decision, just ask the person to leave while you discuss your options. You can call on your doula, or childbirth educator for help in gathering information. You do have the right to ask for a second opinion from someone who is not in practice with your doctor.

Doula's Top Ten

Here are the top ten doula tips for labor support:

10. Massage
9. Pelvic Rocking
8. Double Hip Squeeze
7. Positioning
6. WATER!!!!
5. Urinate Frequently
4. Effleurage
3. Eat and Drink to comfort
2. Heat and/or Cold packs, cloths

And the number one doula tip is....

1. Support and encouragement

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