Only women would find this interesting.

A little bird told me this story about perceptions of my research in helping people learn about childbirth through video games.  This story has been anonymized as much as possible.

I was speaking with my advisor after a group meeting with another professor on my future advancement and dissertation committee.

"I am going to present at the research event on campus this morning," my advisor began.  I nodded attentively.  "I showed my slides to the dean."  She continued:

"'These are interesting projects,' the dean said. 'Except this one, about childbirth. Perhaps you should leave it out.'

"'I'm not going to leave this out,' I told him, 'it's my student's work!'"

"'Well, maybe if you have time, you could mention it at the end.  It's just not very compelling.'

"I told him, 'No! I'm going to present my student's work.'

"'Maybe,' he said, 'if there are women in the audience, they might find it interesting.'"

We both had a good laugh.  I stooped to pick up my jaw from the floor.


And even now, I just do not know what to say.  This kind of gendered mindset is the reason we still have sexism and the reason fantastic essay-books such as Beyond Barbie and Mortal Kombat exist, to raise awareness and teach us that gender is not necessarily a good predictor of the success of certain games.

Anyway, I am not sure what I expect next.  At the poster session the same day, I stood in front of my poster and received positive feedback from nearly everybody that passed by.  I saw the dean amidst the scholars, usually with his back to me.  He had his back to the whole games group and both of us human-computer-interaction (HCI) students.  He never came over to see what we were about.

What bothers me most is that the dean fails to realize that what he said to my advisor was not only controversial, it was sexist, bigoted, and incorrect.  When I tested my childbirth video game, most of the participants were male, and overwhelmingly, the game was rated as pretty damn fun.  Moreover, these participants learned a bunch of new ways to help a woman in labor.

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.

Conclusion

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.


References

[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.

How many contractions are there?

There are only so many contractions in labor.  Would you like to do the math for first-time moms?  Great, because I would!

Early labor is widely variable, and can last anywhere between a few hours and a couple days.  Does this sound like a long time?  In early labor, contractions come and go with no particular pattern, and are generally not painful.  Sometimes labor can start and stop, allowing you to rest and sleep.  Women are encouraged to eat, rest, and do distracting things like watch movies, play cards, and go on short, mellow hikes.  The time between contractions can be anywhere between five and 20 minutes, and contractions last under a minute.  Let us assume, without loss of generality, an average of four contractions an hour and an average duration of early labor of 24 hours.

1st stage, early labor contractions: 4 contractions per hour × 24 hours = 96 mild contractions

Active labor, the second phase of the first stage of labor, has an average duration of 12 hours.  Contractions are more intense, and women often must summon their concentration through each contraction. Distraction is no longer an option, and women should be supported at all times by thoughtful caregivers.  At the onset of active labor, a woman's contractions are five minutes apart (60/5 = 12 contractions per hour), and by the end, they are around three minutes apart (60/3 = 20 contractions per hour).  The average of these is four minutes apart (60/4 = 15 contractions per hour).

1st stage, active labor contractions: 15 contractions per hour × 12 hours = 180 contractions

The final phase of the first stage of labor is transition.  This phase can last minutes or a few hours, but we can assume one hour (the longer end of average).  Contractions are up to two and a half minutes apart (60/2.5 = 24 contractions per hour).

1st stage, transition contractions: 24 contractions per hour × 1 hour = 24 intense contractions

The second stage of labor, or pushing, lasts between 10 minutes and three hours.  After three hours, the doctors start getting antsy to intervene (though some will let you continue pushing if progress is being made and the baby is not showing signs of distress).  Pushing contractions are different in frequency and quality from first-stage labor contractions, and many women find them easier to tolerate because, rather than working against them to relax, they work together with their bodies.  Let us assume an hour of pushing, with contractions every five minutes (60/5 = 12 contractions per hour).

2st stage contractions: 12 contractions per hour × 1 hour = 12 contractions

The third stage of labor, during which the placenta is delivered, lasts about 10 minutes.  Irregular, infrequent contractions can continue for hours or days.  Women tend to forget about the third stage of labor because baby's out, and these contractions are very mild compared to even active labor contractions.  But for the sake of completeness, we will factor these in.  Let us assume 10 minutes of contractions, five minutes apart.

3rd stage contractions:  10 minutes / 5 minutes apart = 2 contractions

The total average number of contractions throughout a first-time labor, then, is 96 + 180 + 24 + 12 + 2 = 314 contractions.  Think you can do that?  After every contraction passes, issue it a "good-bye" or cleansing breath, and tick down your counter.  That is one contraction that is never coming back, and you will never experience again.

Sources:
BabyCenter: The Stages of Labor