Every labour experience is unique. Every woman should have the birthing experience they want. Mothers today are offered a variety of birth types to choose from.
Delivery type
There are few main types of delivery:
- natural vaginal delivery (spontaneous)
- medicated vaginal delivery (epidural)
- assisted vaginal delivery (vacuum, forceps)
- vaginal birth after C-section (VBAC)
- surgical (caesarean section)
Signs of labour
There are several signs that labour might be starting, including:
- contractions or tightening
- a ‘show’ which is when the mucous plug comes out of the vagina
- backache
- an urge to go to the toilet, which is caused by your baby’s head pressing on your bowel
- your waters breaking or releasing (rupture of membranes)
Birthing process
- In first time moms- efface of the cervix starts first (thinning of the cervix walls ) before dilation (think of an elastic band- the thinner the band, the easier it is to stretch it)
- Effacement is thinning of the cervix from 0-100%
- Dilatation of the cervix is scored from 0-10cms
- Contraction and dilatation alone will not progress labour, it is crucial to encourage the baby to move
1st stage of labour
During the 1st stage of labour, contractions make your cervix gradually open (dilate). This is usually the longest stage of labour.
At the start of labour, your cervix starts to soften so it can open. This is called the latent phase and you may feel irregular contractions. It can take many hours, or even days, before you’re in established labour.
Established labour is when your cervix has dilated to about 4cm and regular contractions are opening your cervix.
If possible, stay upright and gently active. This helps your baby move down into your pelvis and helps your cervix to dilate.
Breathing exercises, massage, having a warm bath or shower may help ease pain during this early stage of labour.
Positions
Movement can improve your comfort and can help the baby engage. If the baby does not engage, the contraction alone won’t help dilate and thin the cervix. Babies like to move and rotate with movement. If you want the baby to move, move the Mama!
Keeping active during labour can distract you from any discomfort you may be feeling. It could also shorten the length of time your labour takes:
- walking- the gravity and movement will encourage baby`s movement down the birth passage
- hands and knees/ elbows-knees- create more space for the baby, this position will take the pressure off your spine and pelvic floor. It is also great for women who suffer with haemorrhoids or vulvar varicosity. Try to add gentle pelvic tilts.
- ”stork”- walk like a stork to open the inlet of the pelvis, visualise where the baby is and try to move in down the pelvis, keep your knees below the hips level and you lift them
- pelvis movements- sitting on a birthing ball (with legs out, try gentle posterior/anterior tilt during occasional contractions, it will help to open the inlet of the pelvis. Never bounce on the ball (it negatively impacts on your pelvic floor, your cervix and ligaments. Movement on the ball should be really gentle, intuitive and connected with your breath.
Breathing
Breathing is movement. Your pelvic floor moves in the rhythm of your breath and your diaphragm. Using breathing techniques can help calm your nerves (before and after labour) and control the pain. You can practise all the way through pregnancy to ensure you’re comfortable using them when labour starts. It is especially important if your general mobility is restricted (for variety of reasons) to remember that the breath can be a very powerful tool:
- diaphragmatic breathing (you can read about it here: https://mnaphysiotherapy.com/360-breathing-technique-breath-for-healthyhappy-pelvic-floor/ and watch the video here: https://www.instagram.com/p/CRN46pZA3fz/
- humming/vocalizing (as if you were calling your baby: uuuuu, haaaa, ooo, aaaaa, open your lips slightly and relax the jaw to help release your pelvic floor, do not be embarrassed, allow yourself to experience and feel it
The further the labour progresses, the shorter the breaks between contractions . Try to rest between contractions.
Pelvis compression
The rhombus of Michaelis, also known as the Michaelis-Raute or the quadrilateral of Michaelis, is a rhombus-shaped contour (also referred to as kite-shaped or diamond shaped) that is sometimes visible on the lower human back. It plays a key role in physiological birth.
Your birth partner can compress and massage it during contractions. Your birth partner can use a scarf (not elastic one) if his hands get tired during compression and massage. Warm compress can also be used to ease pain.
Another technique that your partner can try is massage of the sacrum bone, using circular movements.
There are certain positions that help to make compression and massage easier. For example, leaning forward on a birth ball or sitting on a chair turned back to front, will make it easier for your birth partner to put steady pressure on your lower back or rub your back and pelvis.
Massage and compression may ease pain and reduce anxiety in the first stage of labour. It may help you to cope with your contractions by making them feel less intense and more manageable.
How to massage
Many women feel contractions strongly in their lower back, so lower back massage may help.
In early labour, your partner can use the flat of his hand to stroke down the side of your spine, from shoulder to bottom. He then uses the other hand to stroke down the other side of your spine, maintaining a rhythmic movement, with one hand constantly in contact with you. These long, slow strokes can be very soothing.
Make sure that he is massaging you using the whole of his hand and not just the heel. His fingers need to be in contact with your body as he tries to respond to the tensions he finds there.
In advanced labour, your birth partner can use the heel of his hand to press firmly over the base of your spine. He will need to apply quite a lot of pressure to counteract strong contractions so gently leaning in with his body weight is one way to conserve his energy. Or he can use his thumbs to make circles over the dimples in your bottom. Tell him what you find most helpful.
TENS – electrostimulation
The word ‘TENS’ stands for transcutaneous electrical nerve stimulation. This involves passing a gentle electrical current through flat pads on your back or ankles. There are two possible application depending of what you are trying to achieve:
- around ankles, 2-3 fingers above ankles on both sides when your waters broke and your aim is to induce contractions
- as soon as possible, during first contractions (place it at The rhombus of Michaelis). If your birth partner wants to compress your pelvis, then he will only compress your hip bones laterally avoiding pads
The small electric current stimulates the body to produce endorphins. Endorphins are natural painkillers. I particularly like this machine and often recommend it to my patients: https://www.motherandbaby.ie/perfect-mamatens.html
Squeezy balls/ spikey balls
Squeezing the ball (rather than partner`s hand) can reduce and manage the pain during contractions.
Empower yourself
Every woman is different. Our bodies are different, our babies are different and no two births are the same. Labour often requires strength and stamina, so it’s important to prepare your body for it. It is always a good idea to work with women`s health physiotherapist in preparation for childbirth.
Not sure what to expect on the first visit to a women`s health physiotherapist? Click here: https://mnaphysiotherapy.com/what-happens-at-the-first-womens-health-physiotherapy-appointment/
