How Can I Have an Easier Birth?
We've all heard stories about women who had "easy" labors. (Okay I'm going to say that labor is almost never "easy", everything is relative, right?) Maybe they were only at the hospital a few hours before the baby was born, or say that they didn't have a lot of pain with contractions, or even that they didn't know they were in labor and had the baby at home or in the car accidentally! Why is it that for some women, labor seems to be faster and easier than it is for others? Of course there is no one reason why women's experiences vary so greatly, because each individual woman and baby is unique. But there are a few factors that studies have shown to help reduce the duration of labor, even in first-time mothers. Some of these factors include exercising regularly throughout pregnancy, waiting for the onset of natural labor, staying mobile and avoiding an epidural, and having continuous labor support such as a doula present for labor and birth. Let's look at why each of these factors may help your birth to be "easier" than it may have been otherwise.
It used to be commonly advised for women to "take it easy" and avoid all kinds of physical exertion during pregnancy. Pregnant women were spoken of as being "in a delicate condition", and some doctors today still recommend that a pregnant woman keep her heart rate below 140 bpm. While it's true that it's wise to be careful during pregnancy to avoid falls and other sudden drops, most pregnant women will see the most benefit from continuing to exercise at almost a similar level as before pregnancy. One study was designed to test the hypothesis that regular exercise aerobic was harmful during the latter half of pregnancy. Comparisons were made between the women who exercised to at least 50% of their pre-pregnancy routine, and the other women who discontinued their exercise program during pregnancy. The results were, in my opinion, amazing! The women who continued to exercise experienced several benefits:
* Active phase of labor (typically the most intense phase of was shorter on average by about 2 hours
* Cesarean rate of 6% vs. 30%
* Less use of forceps or vacuum- 6% vs. 20%
* Less clinical signs of fetal distress- 26% vs. 50%
The authors end with this statement :"These data negate the initial hypothesis and indicate that, in well-conditioned women who regularly perform aerobics or run, continuation of these exercise regimens has a beneficial effect on the course and outcome of labor."
Other studies have also suggested that babies who have been exposed to exercise regularly while in the womb tolerate labor contractions better, which may explain the reduced rate of fetal distress in the exercise group. Basically, exercise is all-around a great way to make labor and easier process for you AND your baby!
Wait for Labor to Begin on It's Own
Although there are valid reasons for induction, many women are induced without a clear medical indication. This can have an effect both on the length of labor, and the amount of pain associated with it. Even ACOG has just this week released a position paper that discourages induction before 41 weeks. However, it may take a while for these new recommendations to become common practice.
In this study induced labor lasted, on average, 5 hours longer than labor that started naturally. In the middle of labor, 5 hours can seem like forever! It may also be the difference between feeling like you can cope without drugs during labor, or not.
Many women also report that induced labor is more painful. It's difficult to study this objectively, or course, because the only women who can really compare are those who have experienced an induced birth and a non-induced one. However, there are many reasons why an induction would likely be harder than labor that starts on it's own. Oxytocin is what your body normally produces during labor. Oxytocin has also been called the "love hormone". When it's naturally produced by your body, it stimulates contractions and generally produces a relaxed, happy feeling. (It's also released during sex, for instance). In an induced labor, Pitocin is given intravenously in regular intervals to simulate the body's production of oxytocin during labor. Even though the two substances are chemically identical, there is evidence that pitocin works to stimulate contractions, but does not produce the lovey-dovey feeling that oxytocin does. This is likely one of the reasons why many women feel the pain associated with the contractions, but may have a harder time dealing with them, or report them as being harder and stronger than the contractions produced by the body's natural production of oxytocin.
conceptual model of how doulas help labor to progress- http://evidencebasedbirth.com/wp-content/uploads/2012/06/doula-conceptual-model.jpg
Stay Mobile Throughout Labor and Avoid an Epidural
These two go together because it's very hard to stay mobile with an epidural. You may have heard of a "walking epidural", but it seems to me that this kind of epidural is a bit like a unicorn. I have heard that they exist but haven't spoken to anyone who actually had one or had one that allowed them to "walk". Generally in this country we are very accustomed to seeing women immobile during labor. Why might it make labor easier to move around?
First of all, many women WANT to move around if given the opportunity. Babies often need to find just the right angle to get through the pelvis, and this might take some movement on mom and baby's part. Many women find that swaying, rocking, pacing, and even dancing are very helpful in relieving some of the pressure during contractions. There is also scientific evidence supporting staying out of bed, especially during early labor.
* This meta-analysis found that women reported more painful contractions when confined to the bed, and in general preferred other positions.
* This study found that women randomized to upright positions in early labor had an average reduction in labor time by about 1.5 hours for the first stage of labor.
Regarding epidurals and their effect on the length of labor, in a recently-published study aptly entitled, Second Stage of Labor and Epidural Use: A Larger Effect Than Previously Suggested, the authors found a large difference in the amount of time mothers pushed (the second stage) with and without and epidural. Although it was previously thought that an epidural may increase the time required to push the baby out by 1 hour, the researchers found that in their group of over 40,000 subjects, that for first-time mothers it may take an additional 3 hours longer in the pushing stage with an epidural, and 2 hours longer for a mother who had already given birth vaginally. This is significant because in many hospitals, it's common to consider a c-section after 2 hours of pushing! The authors note that many women may just need more time to push their baby out with an epidural. We can also learn that women without epidurals are generally push the baby out faster.
Have a Doula or other Continuous Support Person
Quite a few studies have been done that compare women's experience in labor with a continuous support person, and without. Some of these studies used nurses, family members who had been taken a short course in childbirth support, and, of course, doulas. The positive effects on a woman's labor of simply having a person there who will not leave her cannot be overstated. Consistently, women who are provided a doula report a higher satistfaction with their birth experience, less use of epidural analgesia, and lower cesarean rates. Some studies also showed an overall reduction in the length of labor. All of these combine to make labor more pleasant for the laboring mother, baby, and the rest of the birth team.
So even though labor is unpredictable and generally unavoidably painful (some people don't like this word, but I personally find it to be more realistic), there are some real things you can do to prepare for an easier birth. Regular exercise, staying mobile throughout labor, avoiding an epidural, and having a support person continuously by your side are real, evidence-based step that you can take to prepare for the least stressful birth for you and your baby!
I look at birth from the perspective that our bodies are wonderfully made, and if we really believe that and work with the birth process and nourish our bodies properly, they will function optimally, most of the time!