Active labor is the part everyone thinks of when they think of having a baby. The part where movies and TV portray the birthing person lying in bed moaning for an epidural. I want to tell you a secret, you are stronger than TV or movies portray. Except in a very small percentage of cases (<5% depending on the source), you can birth your baby. If you choose, you can do it without pain medication, and if you mentally prepare ahead of time it will not be nearly as bad as you have seen on screen. Your baby grew inside of you, and your body knew how to do that part, your body can figure out how to bring your baby earthside too. You, your body, and your baby need to work together for labor to go smoothly, but you can help your body and baby move together.

Here are my tips for helping you deliver your baby.

Move positions every 20 minutes

Labor is not just about dilation, in fact dilation is a small part of the process. Really, dilation occurs because the muscle of the uterus contracts and collects at the top (fundus) of the uterus. The fundus will push your baby out once you are fully dilated, so it needs to be big and strong. Your baby also needs to move through the pelvis. This means the cervix moves to align with the vagina and get close to the vaginal opening (introitus). All of that contraction and movement of the uterus and your baby are helped if you move too. If you lie in a bed then your uterus and your baby have to do all the work. If you move on the outside too, then you can make that passage easier. When I say move every 20 minutes, I mean find a new position. If you have been lying on your side, then sit or squat next. If you have been standing leaning on a wall or your partner, then move to all fours. Keep changing your position to help your body and baby figure out how to progress. A good position should feel better within five contractions, but if you stay too long then your body will get used to the position and need more input, hence the need for another change in position 20 minutes later.

Drink a glass of water every hour

Your uterus is a muscle, and muscles need to be hydrated to contract strongly. Dehydration reduces productivity of muscle contraction by increasing the irritability of the muscle. In labor, this would mean less effective contractions and longer labor. Nobody wants that! Drinking a glass of water per hour keeps you well hydrated throughout.

Bathroom 1x/hour - return to a new position

When not in labor, I do not recommend going to the bathroom once per hour. On a normal day, urinating every hour meets criteria for urinary frequency, please check in with your local pelvic floor physical therapist. During labor, you want your uterus produce consistently productive contractions. A full bladder pushes on your uterus, and takes up space otherwise available to your baby who is trying to get low in your pelvis. This means a full bladder increases the pain of labor and causes difficulty progressing. These are clearly events to be avoided. By drinking every hour, you will be consistently producing urine. By urinating every hour, you can keep your bladder relatively empty. By choosing a new position when you return from the bathroom, you keep your uterus productive and labor progressing.

Eat!

Labor and delivery is a marathon event which requires adequate nutrition to keep your energy up. Fatigue will set in if labor gets long, which will only elongate labor. Of these recommendations, this is the only one likely to meet resistance from medical staff. For years, the concern has been that an increased risk of aspiration (stomach contents being vomited into the mouth and then going back down through the airway while under general anesthesia). When surgery is planned, fasting is common for 8 hours prior due to this risk. Since most labors end in vaginal delivery, most pregnant people are low risk, and most cesarean are not performed under general anesthesia this risk is very small. There have been no occurrences of aspiration in any research trials, but no studies have looked at this risk in high risk individuals, and studies have been too small to measure the frequency this rare outcome occurs. If you are high risk for needing a cesarean under general anesthesia, then further discussion with your provider can help you make the best choice for your unique circumstance. Otherwise, make plans to nourish your body by discussing your desire with your provider.

If you are birthing at home or a freestanding birth center you likely will be told their policy allows you to eat as you desire. If you are planning to birth at a hospital, then you should find out your hospital’s policy and be prepared with evidence to convince your provider to allow you to nourish your body. Don’t worry, I have done the research for you: (Lamaze.org, Evidence Based Birth including a handout to give your provider, 2017 systematic review and meta-analysis on safety, 2013 Cochrane review, The Society of Obstetricians and Gynecologists of Canada, NICE Clinical Guidance for the United Kingdom, The American College of Nurse-Midwives, The World Health Organization)

Plan to cope with pain, fatigue (mental and/or physical), and stress

We are all unique in what coping strategies we respond best to. Massage, music, aromatherapy, mantras, water, and movement are some examples of coping strategies that work well during labor. My recommendation is to prepare to try all of these options. Use what you know of yourself, assuming your responses will be similar to other stressful situations, but be prepared to be surprised. Knowing the three Rs may help you increase the effectiveness of any coping strategy you use. The three Rs are Rhythm, Repetition, and Ritual. The three Rs can help you focus inward and distract yourself from pain, both of which can help labor progress more easily.

I hope these tips help you have an easier labor, let me know what you think and if you have any questions.

Massage, music, aromatherapy, mantras, water