One woman's path through doula training, childrearing, and a computer science Ph. D. program

Monday, November 1, 2010

Non-negotiable: Two things that will help you labor longer, better

The following items are (in my opinion) the top two non-negotiable things that will help a woman labor, especially if her goal is natural childbirth in a baby- and mom-friendly hospital.

Non-Negotiable Item 1.  Drinking in labor.

Eating in early labor is a given.  For many women, early labor comes on slowly and lasts an average of 12 hours.  Contractions are mellow and irregular.  Women and their partners are advised to rest, to walk, to eat, to smooch, and to enjoy this last bit of baby-free time in their lives.

In early labor, mom is preparing to run a marathon.  She is stretching her strongest muscle: the uterus.  Would you run a marathon on an empty stomach?  Of course not.  Eat.  Eat carbs.  Eat some protein.  Eat whatever sounds good to you.  If nothing sounds good to you, try some toast.

Eating in active labor is a bit harder.  If mom is at home, and she is hungry, she should eat.  At the hospital, eating may be restricted or downright forbidden.

Now, this is the non-negotiable part: After every contraction, take a sip of water.

Especially if it is your intention to have a hospital birth naturally, with no drugs and minimal interventions, drinking water is key.

In many Baby-Friendly™ birthing facility hospitals (such as the ones in my area), the standard procedure is, upon admission, to start a heparin lock, or hep-lock.  A hep-lock is a needle and a catheter with a lid on it.  The needle goes in the vein, and the rest of it is taped to the arm so that it stays put when mom moves around.  Depending on the obstetrician, the IV fluids are negotiable, and mom and her partner can ask that nothing is hooked up to the hep-lock until something is needed.

The doctors' argument for a hep-lock is that if there is an emergency situation later in labor (e.g., in transition) that the IV has already been started, as it can be more difficult to find the vein in a stressful situation.  Some activists argue that having a hep-lock started creates emergency situations: a doctor is more likely to intervene when the vein is open than if the extra work to start the IV still needs to be done.

Times that IV fluids are needed (and required) include, in order of severity, when mom is severely dehydrated and unable to drink, when mom requests an epidural, and when preparing for a Caesarean section [3].  Notice that I say that these are required cases of IV fluid use.  Some obstetricians give IV fluids routinely.  In routine cases, I suggest you argue for a hep-lock, or no intervention at all, if possible.

The reason I harp on routine use of IV fluids so much is fourfold.  First, the IV and associated IV pole hinders mobility.  It is harder to move around and change positions, harder to find comfortable positions, harder to engage in hydrotherapy (i.e., bath tub or shower), when wheeling around a pole.  Second, in many cases, when IV fluids are being administered, women become over-hydrated; if there is glucose in the IV, the baby often shows signs of hyperglycemia before birth followed by hypoglycemia after birth.  Third, in many cases, when IV fluids are being administered, women are prevented from eating and drinking, "just in case." I discuss this in the paragraphs that follow.  Fourth, and finally, an IV is an often-unnecessary intervention, so I disagree on principle.  Any intervention, especially an unnecessary one, adds to a passive maternal mindset, making her feel that labor is something that is done to her, against her control, rather than something that she is doing.

Back to drinking water.  Drinking during labor prevents dehydration, thereby helping to prevent routine use of IV fluids.

Although it is impossible to name the cause and the effect, the association exists: Women who were advised to eat and drink in labor had a lower rate of instrumental birth (13% for those that ate and drank, vs 24% for the women that did not) [1].  Some doctors do not allow women to eat or drink in labor for various reasons, such as aspiration in the possible case of surgery, but the aspiration myth has been debunked again and again [2].  We are just waiting for obstetricians to get on the bandwagon.

Non-Negotiable Item 2.  The "cleansing breath."

The "cleansing breath" (pictured to the right) is a breathing technique originally taught in Lamaze childbirth education classes [4].  It is also known as the "relaxation breath" and the "good-bye breath."  The basic idea is relaxation during (and between) contractions.  When she feels a contraction coming, the mother takes a deep breath, visualizing her entire body going limp when she exhales.  This prepares her body for the contraction ahead.  The contraction comes, taking her whole focus.  When she feels the contraction is leaving, she takes another deep breath and exhales, breathing away the contraction, and issuing it a much-needed farewell.  Keep in mind there are only about 314 contractions in one full first-time labor.  Each cleansing breath gives a welcoming hello and a parting good-bye to one of these 314.


Follow up the cleansing "good-bye" breath with a sip of water.  Eat, drink, and be mobile in labor.  In particular, drink to stay hydrated.  Birth partners, take note!  Offer a sip of water after every contraction.  Breathe to stay focused and relaxed at the onset of a contraction, and breathe to say good-bye after the contraction fades.

This discussion may have gotten you thinking about your own hospital's policy: What does your birthplace do routinely, and what leeway do you have with your birth plan? Check out this online list of questions to ask your obstetrician and hospital or birth center.  Strike up a conversation with your OB. And remember that the object of the game is to be well-informed and well-intentioned.


[1] Scheepers, H. C., Thans, M. C., de Jong, P. A., Essed, G. G., Le Cessie, S. and Kanhai, H. H. (2001), Eating and Drinking in Labor: The Influence of Caregiver Advice on Women's Behavior. Birth, 28: 119–123. doi: 10.1046/j.1523-536X.2001.00119.x

[2] Ludka, L. M. and Roberts, C. C. (1993), Eating and drinking in labor: A literature review. Journal of Nurse-Midwifery, 38(4): 199–207. doi: 10.1016/0091-2182(93)90003-Y

[3] Midwifery Today E-News. (1999), Heplock or IV?  Midwifery Today E-News, 1(37). September 1999.

[4] Hurprich, P. A. (1977), Assisting the couple through a Lamaze labor and delivery. MCN: The American Journal of Maternal/Child Nursing, 2(4): 245.

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