The roadmap of labor
I have created a visual guide to labor progress using the metaphor of a road map. It shows key labor landmarks and appropriate activities and measures for comfort as labor progresses (see Figure 1 above).
Parents can use it during labor as a reminder of where they are in the process and what to do. Teachers can use it as a tool for organized discussion of normal labor progress and as a backdrop for discussing laboring women’s emotional reactions, and how partners or doulas may assist. Health professionals can use it to help parents identify where they are in labor, adjust their expectations and try appropriate comfort measures.
Normal labor pathway
The roadmap portrays three pathways. The main brick road represents unmedicated labor and shows helpful actions, positions, and comforting techniques to use as labor progresses. The twists and turns in the brick road indicate that any normal labor does not progress in a straight line; the large turns between 3-6 centimeters and 8-10 centimeters indicate large emotional adjustments for the laboring woman, and present an opportunity to discuss emotional support and comfort measures for the partner or doula to use. After 10 centimeters, the woman’s renewed energy and confidence are represented by the second wind sign. Along with discussion of emotional support and comfort measures, the teacher can offer perspective and practical advice for partners and doulas, to use both when the woman is coping well and when she feels challenged or distressed.
The roadmap provides a clear and effective way to teach about normal labor. It keeps the discussion focused purely on the physiological and psychological processes, without inserting discussions of pros and cons of interventions, complications, or usual policies and hospital practices that alter labor.
Once parents have a solid understanding of normal labor, the teacher can explain usual care practices and possible options for monitoring maternal and fetal well being during labor. She can also discuss labor variations or complications and treatments with medical (including pain medications), surgical or technological procedures. With this approach, parents are better equipped to discuss risks, benefits and alternatives, because they can distinguish situations and conditions that are more likely to benefit from the intervention from those in which the intervention is optional, unnecessary, or harmful.
Planned and spontaneous rituals
The normal labor road suggests measures to use for distraction, comfort, and progress. Distraction is desirable for as long as it helps. The Relax, Breathe, Focus sign reminds parents to use this pre-planned ritual for dealing with intensifying contractions when distraction is no longer possible. Parents need to rehearse these rituals in childbirth class (i.e. slow breathing, tension release, and constructive mental focus) and use them in early labor. They set the stage for the spontaneous rituals that emerge later in labor (as women enter active labor), when they realize they cannot control the contractions or continue their planned ritual, and give up their attempts to do so, though sometimes after a stressful struggle. Spontaneous rituals replace the planned ones. They are not planned in advance – they are almost instinctual – and almost always involve rhythmic activity through the contractions – breathing, moaning, swaying, stroking, rocking, or even letting rhythmic thoughts or phrases repeat like a mantra.
The three Rs
The spontaneous rituals usually involve the three Rs: relaxation (at least between contractions), rhythm, which is the most important, and ritual, the repetition of the same rhythmic activity for many contractions. In order to give herself over to spontaneous instinctual behavior, the woman needs to feel emotionally safe, uninhibited, accepted unconditionally by partner and staff, and to be mobile in order to find comfort.
The motto ‘Rhythm is everything’ means that if a woman has rhythm during contractions, she is coping, even though she may vocalize and find it difficult. The rhythmic ritual keeps her from feeling totally overwhelmed. The goal is to keep her rhythm during contractions in the first stage. Once in second stage, however, rhythm is no longer the key. The woman becomes alert and her spirits are lifted. An involuntary urge to push usually takes over and guides her behavior.
The role of the partner in labor
The partner helps throughout labor, comforting the mother with food and drink, distraction, massage and pressure, assistance with positioning, and constant companionship. Sometimes, a doula also accompanies them, providing continuing guidance, perspective, encouragement, and expertise with hands-on comfort measures, positions, and other techniques gained from her training and experience.
The role of an effective birth partner includes being in the woman’s rhythm – focusing on her and matching the rhythm of her vocalizations, breathing or movements – by swaying, stroking, moving hand or head, murmuring softly in her same rhythm. Then, if she has difficulty keeping her rhythm, and tenses, cries out or struggles – as frequently occurs in active labor or transition – her partner helps her get her rhythm back, by asking her to focus her eyes on their face or hand and follow their rhythmic movements. This is the take-charge routine, and is only used if the woman has lost her rhythm, is fearful, or feels she cannot go on. Partners who know about this are less likely to feel helpless, useless or frightened. Simple directions, given firmly, confidently, and kindly (‘look at me,’ or ‘look at my hand’), rhythmic hand or head movements, and ‘rhythm talk’ with each breath (murmuring, ‘Keep your rhythm, stay with me, that’s the way…‘) are immensely effective in helping the woman carry on through demanding contractions.
During the second stage, rhythm is no longer important; now the partner encourages her bearing-down efforts and release of her pelvic floor, and also assists her with positions.
The motto “Rhythm is everything” means that if a woman has rhythm during contractions, she is coping, even though she may vocalize and find it difficult.
The detour for back pain
A second pathway, a rocky, rough road, represents the more difficult ‘back labor’, which may be more painful, longer, or more complicated than the normal labor pathway. Fetal malposition is one possible cause. The measures shown for back labor are twofold: reduce the back pain and alter the effects of gravity and pelvic shape to encourage the fetus’s movement into and through the pelvis. It helps a woman endure a prolonged or painful back labor if she and her partner use appropriate comfort measures, and if they know that dilation may be delayed while the baby’s head molds or rotates to fit through, or that changing gravity and pelvic shape may give the extra room that the baby needs to move into an optimal position.
The epidural highway
This third pathway represents a dramatically different road – smooth, angular, man- made, more comfortable – but it comes with extensive precautions and numerous procedures, monitors, and medications, which are necessary to keep the epidural safe. The woman adopts a passive role while the staff manage labor progress, and monitors the mother’s and fetus’s well being closely. The excellent pain relief and chance to sleep are the usual rewards. Discussion of how to work with an epidural in order to optimize the outcome is beyond the scope of the paper, but the basic principle is: treat the woman with an epidural as much as possible like a woman who does not have one! This essentially means,‘Keep her cool. Keep her moving. Keep her involved in the work of pushing her baby out. And don’t assume that if she has no pain, she has no distress! Do not leave her alone.’
The roadmap of labor provides a useful framework for teachers to explain the psychological and physiological processes of labor, and a variety of activities for comfort and labor progress for women and their partners to use. By focusing on the normal unaltered process, parents learn to separate the norm from the numerous interventions that alter the process, sometimes for the better, sometimes for the worse. The intention is to give them confidence that they can handle normal labor and to participate meaningfully in decision-making when interventions are suggested.
Descriptions of birth tend to vary among all mothers; anything from tumultuous, scary and crazy... to joyful, challenging and exciting.
Seldom do we describe a birth as sexy, right?!
Why don't we see birth as intimate and sexy? Is it the environment?
Imagine for a second the most romantic daydream you could ever have...
Got it? Ok, keep that image in mind.
It's BABY DAY. You're in a hospital room with cords strapped to you, beds that move every which way, and the smell of freshly bleached stained floors...
Not the scene we just envisioned from our best romantic dreams, right?
One thing we do know: Something special is happening.
A baby will be born and there will be an outpouring of love and ecstasy coming soon!!!
Too often, birth is portrayed as a scary and dreaded event in a woman's life. However, with the age of social media, I am grateful to see the birth experience demystified through photos and videos. There are many beautiful birth videos and photos of women in their glory, swaying to the beat of their own bodies, breathing baby down and keeping calmly to her affirmations. But let's face it ladies, not many of us feel this way during birth, although we would like to.
The unknown aspects of labor can be scary. Very scary! Fear of the unknown is the leading cause of anxiety and stress in labor, and quite frankly, in life! With many fear-based books out there for new moms, it comes as no surprise when fears arise before and during labor. Our society is ridden with fear facts about everything from what is in our water to when the world is going to end. We don't stand a chance listening to those voices that can flood our screens every day.
A bit of great news: It is said that it takes 10 positive thoughts to erase 1 negative thought. Imagine what negative aspects of pregnancy, childbirth and postpartum can do to the psyche of an already emotionally charged pregnant woman? What if we replaced those thoughts with positive ones about birth? Would we be as afraid of the process?
I personally believe in the power of love and fear to embrace the intimacy of birth. Love and fear play vitally important roles in our life, and for good reason. However, birth is one of those moments to decide love and only love. The most rewarding, easiest and quickest births have been with women who have chosen to invite the role of love to play out in their labor setting.
Fear and anxiety have no proper place in labor. Kick them to the curb. They may want to peek their head in every once in a while but you have the power to turn them away, just like you would a light switch. Click!
The intimacy met in the laboring room can be unlike any other, if the stage is set properly. Lights dimmed, essential oil diffuser going, calming music, the sounds of oohs and ahhs...wait a minute, this sounds like a romantic evening we envisioned previously! We CAN equate birth to something so sensual because hey! We all know how the baby got there right?! ;)
As Ina May Gaskin says,
"The energy that gets the baby in, gets the baby out."
So if we set the scene for romance and sensuality, how do we prepare our mind, body and heart?
Typically, in the realm of natural labor preparation practices, once a couple satisfies the
3 S's (Safety, Support, Security), a positive experience ensues, regardless of the outcome. Or the setting!
With having the ability for couples to be themselves in their own rite, parents set the stage for positive change in the birth realm. This is where a doula can come in to help create that setting, in advance, so that mom can feel safe, supported, and secure.
The journey to safety, support and security can be a rocky one, but one well worth embarking on. In fact, it would be wise for parents to establish these systems firmly, well before the baby is born. Help from a doula can be highly beneficial. Why? Because when the unexpected happens, there are safety nets. We all need that in life. For finances, we have an emergency fund. For auto accidents, we have insurance policies.
In short, with a doula equipped to hold that space for the 3 S's, you have an insurance policy on the livelihood of your family. Then you have a sacred space for a positive experience and engagement for everyone involved in the birthing process, especially mom! This creates much less turmoil physically, emotionally, mentally, and spiritually!!!
When we pull out an insurance policy on our own well-being, we create Possibility. Choices. JOY even! We start from a place of worthiness, peace, and love. We are essentially doing our children a favor by ensuring that we put the gas mask on ourselves first before they even make it out of the womb. For the betterment of ourselves, we owe it to our children to set a standard for love, joy, and peace for ourselves.
The joy found in embracing labor is uncanny. Labor is happening for you, not TO you. The intensity of contractions have a purpose, not to harm you. Joy wants to meet you in that space. In choosing love and peace over anxiety and fear, we open doors to joy. With the proper tools in place, it is a completely obtainable reality.
My job is to empower you! I want you to know that you are going to ebb and flow through the highs and lows of pregnancy, labor, and beyond, just as waves on a shore. The grace you bestow upon your body, mind, heart, and soul are paramount pieces to success in your journey through motherhood. Don't let fear take a foothold in your life because someone or something told you so. Any of those thoughts are garbage and have no place in your birth plan.
So give yourself some grace and birth the way you would if you were to plan a date for a special someone because that special someone is YOU, my darling dearest mama! Dim those lights, light some candles, play some beautiful songs, and clear your head of the gunk. Let your mind and heart open to the date you will have with your baby.
And ahhhhh...Let the intimacy begin with you. Your love surpasses all.
It is so tempting to grab at all those BabyCenter Q&A's, What To Expect books, and advice from naysayers, but
Really, what is it all accomplishing?
A sense of doubt? Conspiracy? Fear? Uncertainty?
Let me give you a list of things.
Not a list of HOW-TO's
but rather a list of encouragement, of things to focus on.
At a later date, be prepared to switch up your list, as the test of time allows and calls for. But for now, let's keep it simple and fun.
1.) Focus on dear 'ol Y. O. U.
Address any cobwebs or unfinished business you may have in your life. You may be battling some unforeseen changes in your body and that's ok! Your old life may be flashing before your eyes. Trust that your life is not over but rather just beginning! Seek out a trusted counselor, mentor, life coach (me?), or a friend to walk through any struggles that could hinder you from becoming your best self through this process.
This is NOT a good time to: Work on BIG issues. Be gentle on yourself. Your body is changing all over the place. If you have had previous birth experience, it may be a good time to journal through your experience, good or bad, rehash your thoughts around birth and your new expectations this time around. Discover what this might look like for you through Birth Life Coaching.
This one is fun, yet takes some getting used to if you haven't tried it before. It's like a muscle, the more you use it, the stronger it gets. Make it simple!
Close your eyes and think about what you life will be like as you're pregnant. Are you joyful? What does your partner think? How are they supportive of you? Do your friends rally around you or is it time to reshape your tribe to fit your current and future needs? Is your family close to you? What do they do to make this journey more pleasant?
Do this for every stage of your journey: pregnancy, birth, newborn, and beyond. There are no rules here.
NOT a good time to: Visualize what could go wrong AKA Irrationalize fears. Whenever we go through change, it is completely normal to wrestle through the "what if's". What if I eat deli meat and my baby becomes autistic? What if I get a back injury during an epidural? What if I go crazy before this is over? Try as best you can to keep those thoughts at bay. The more you focus on them, the more they can invade the personal happy space you're trying to create for your baby, who feels what you feel.
3.) Focus on HEALTH
This goes without saying that your physical being needs support, mostly by you. Think about, or better yet, visualize what that support group looks like, how it feels, and make a list of things you desire in terms of support to get to your health goals.
NOT a good time to: Exercise more. Continue on the workouts your body is used to, whether it be walking or power lifting. As your belly grows, you'll know when to scale it down.
4.) Tap in to your INTUITION
You may or may not have tapped into your wonderful beautiful friend call Intuition yet but trust me, this is one tool that will help you throughout your life from now on. More on this later...
NOT a good time to: Let your inner critic run wild. Do your best to stay positive! Let your intuition guide you to what you need to do today in order to get out of any funk you find yourself in.
5.) Remove what doesn't SPARK JOY
On the heels of Marie Kondo, LET GO OF THINGS THAT DON'T SPARK JOY! While you are still very mobile, although I can't say the same about energy, think about clearing out some space. You are working hard on a lot of new things and your living space can be one of those things. Remember to be gentle. This is not an overhaul on your life.
NOT a good time to: Begin a registry just yet. You're cleaning out your space. You've created something new and it also needs time to brew and make manifest. Don't rush your own process but making unnecessary steps towards your #pregnancygoals.
6.) Your emotional health
People don't lie about your emotions being a roller coaster during pregnancy. But how you handle it makes all the difference. Rather than spew out why it's not ok for your husband to fold laundry like that (*cue the Tidying Up with Marie Kondo music*), IT IS OK to feel those emotions first. As my friend, Maria Felipe says "You gotta feel it to heal it!" Recognize that ALL the emotions coming up. Because you are transitioning into a new dimension of your life, it is important. This is a new realm of existence that calls for a lot of change. Your emotions will carry you through those no matter how ugly it looks. Let those wide range of Inside Out emotions fly! Journal your experiences and allow your intuition to tell you what those emotions have for you in that moment. Free write what that gentle spirit wants you to hear today.
NOT a good time to: Judge yourself for being a basket case. Give yourself some grace, have a good cry, and pick up where you left off after you've filled the dustbin with millions of snot pillows. If you need some more encouragement and direction, feel free to connect with me to find some solutions!
7.) Connect with family and friends
I'll bet that your group of friends and family are amazing and so supportive of you having this baby! I wasn't so lucky however. If you are feeling less than stellar about your circle of people in your life, now would be a good time to start fresh. Go to the library, find a mom group, be-friend people at church, seek out a mentor, take a breastfeeding class... Work on these early as they will allow you to establish good relationships in a reasonable amount of time so that when baby arrives, you will feel confident in the tribe you've personally established for yourself and your growing family.
NOT a good time to: Throw out the friends that don't apply to your current life situation. If they phase out, what a good learning lesson to explore! We've all been there, my friend.
8.) Start reading a really good pregnancy book
This book may look like a week-by-week book that tells about your baby's growth or simply a book that addresses what goes on inside your body. Ask for recommendations from your tribe or jump over to my recommended books list HERE.
NOT a good time to: Make a birth plan. There will be plenty of time for that. TRUST, MY DEAREST!
9.) Plan a BABYMOON
What joy fills my heart when I see couples going to the beach, Disneyland, or the mountains with that adorable 2nd trimester baby bump! Planning for a baby can take a lot but don't discount your relationship with your partner. They are going through a lot right now too. Acknowledge how far your relationship has come thus far by celebrating the life you currently have with each other. It doesn't have to be glamorous but make it YOURS.
NOT a good time to: Move or remodel your home. Changing your space can be a huge overhaul for your already busy body. Plan to get away for a time, like for the babymoon so that when you come home, it is cozy for you to nest in.
10.) List and practice SELF-CARE
The latest buzz phrases going around are self-care and self-love. And for good reason!
"Find what feels good", says my favorite YouTube yoga guru Adriene Mishler. And practice at least 3 acts of self-love every day.
Some ideas are:
There you have it! Cheers to a wonderful 1st trimester journey.
What are you planning to focus on during your first 3 months?
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