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Clinical Units Critical Info Special Groups Education Other Stuff
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True vs. False Labor |
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True Labor |
False Labor |
Contractions are usually • regular • get closer together • duration increases over time • become more painful • pain spreads • intensify if you walk & they do not go away |
Contractions are usually • irregular • don't get closer • duration stays the same • pain usually does not increase • pain stays in lower abdomen • stop if you walk or stop when you stop walking |
Bloody show |
No bloody show |
Drinking fluids has no affect |
Drinking fluids slows down contractions |
Water breaking |
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Her cervix may open some. The opening of the cervix is called dilation. It is common for mom to dilate a few centimeters then stay there for a couple of weeks. To deliver the baby, the cervix has to dilate to 10 centimeters (cm) or about the diameter of a softball. The doctor determines this by performing a pelvic exam. He also checks for the thinning of the cervix known as effacement. The magic numbers are 10 cm dilated and 100% effaced.
To protect the baby during pregnancy, the opening to the womb was plugged by mucous (i.e. like a glob of snot). As the cervix dilates, this plug will come out. It may be pink or light red. This is called the “bloody show.” It is a sign of true labor but may occur a day or more before labor begins. Mom will probably see this.
During pregnancy the baby lived in a fluid filled sack in the womb. This sack has to rupture for the baby to be born. When it does, the fluid flows out the birth canal. This is what mom means when she says “my water broke”. This is also a sign of true labor, but the mother may be well into labor before this happens.
Of course the primary sign of labor is contractions. The start of contractions signifies early labor which can last from a few hours to days. The contractions are usually mild and mom may not be sure they are happening. As labor progresses the contractions start occurring closer together (frequency) and lasting longer (duration).
Most of the time early labor is spent at home. Think of this as the pregame warm up. Your doctor will tell you when to go to the hospital, but commonly you wait until the contractions are 5 minutes apart.
Active labor averages 4-8 hours and is the early part of the game. The contractions are more intense and frequent. This is when you actively coach by helping her stay focused, relieve discomfort, change position, etc.
The contractions will continue until she reaches Transition. This is when the cervix becomes fully dilated and effaced. The baby has entered the birth canal (also known as engaged) and is about to be born. When she hits Transition, mom will feel the urge to push. This is pure instinct. She will just know; there is no better way to describe it.
When this happens you need to tell the doctor or midwife, even if they just examined her a few minutes ago. She should not push until the doctor or midwife tells her to. From transition to birth is usually less than an hour.
Most babies emerge face down, then make a half turn to get the shoulders out. Once the shoulders are clear, the rest of their body follows quickly. A vaginal birth is a bloody, messy event. Since your job is taking care of mom, you don't have to watch.
The doctor may perform an episiotomy which is a small incision to increase the size of the opening. However, the current trend is to allow a spontaneous tear instead. There are exercises mom can do to reduce the chances of a tear or episiotomy. These are found in the Healthy Living page.
To new parents, their baby is the most beautiful thing they have ever seen. Objectively, most newborns are ugly. They are scrawny, their skin is usually red or sometimes blue, their head may be cone- shaped or lopsided and most don't have eyebrows. All this is normal.
A just born baby's cry is also one of the sweetest sounds on earth. You want them to cry long and loud now, because for the rest of their life you will want them to be quiet. If your newborn doesn't cry right away, don't worry. It sometimes takes a few minutes to get started. They are still getting oxygenated blood through the umbilical cord.
The doctor will make an assessment using the APGAR scale at one minute and five minutes following birth. This scale is shown in the next chart. This is not a competition so don't get upset if your baby doesn't get a 10.
The event does not end with the birth of the baby. Mom still needs to deliver the placenta and the doctor needs to repair any episiotomy or tears. The baby needs a more thorough exam, some vaccinations and other medication.
APGAR Scale for Newborn Infants |
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Sign |
2 |
1 |
0 |
A ppearance |
Totally Pink |
Body Pink, Hands & Feet Blue |
Blue, Pale |
P ulse |
100> |
Slow,<100 |
Absent |
G rimace Reflex Irritability |
Vigorous Crying |
Some Motion, Cry |
No Response |
A ctivity |
Active Motion |
Some Flexion |
Limp |
R espiratory Effort |
Good, Crying |
Slow, Irregular |
Absent |
Min 0, Max 10 Avg 7-10 after 5 minutes |
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After the Birth
After all the excitement winds down, the time will come for you to leave. Your baby is usually sleeping, your wife is trying to and it is time for you to make a few hundred phone calls then get some rest. Most friends and relatives will want to know the name, weight, length and health of your child. Some want to know their eye color and if they had hair. Both grandparents will probably want more details about the birth.
Being born is just as exhausting for the baby. Most newborns will sleep and sleep and sleep. They may or may not eat the first day. This is normal. They have some reserves to keep them going until mom's milk comes in.
The current trend is for a new mother to spend about 72 hours in the hospital. Even with a routine, normal labor and delivery both parents end up physically and emotionally exhausted. Many hospitals have reduced the size of their nursery with a policy called "rooming in." The baby stays in the same room as mom and she is responsible for baby care from the start. Considering that mom is exhausted and in pain, this doesn't work well the first day. Fortunately most hospitals realize this and pick up the slack.
The Playbook
All of these techniques serve the purpose of helping the mother to focus on something other than the discomfort of the contraction and wasting energy worrying about the next one. The names and specifics of each technique may vary. The key is using what works for mom.
To be effective all techniques require practice before the event. These are just not something most people routinely learn. You may even feel a little bit silly practicing them, but it is your job to help mom prepare for giving birth. Besides, the exercises and relaxation techniques apply to many other areas of life; try hitting a golf ball when you are tense. Some of the breathing techniques are common to the martial arts, shooting and flying high performance fighters; the breathing while pushing techniques is the same as used by pilots to fight G-forces during high speed maneuvers. Just remember that you encourage, remind and guide the athlete through all this, but you cannot make her do any of it.
Breathing Techniques . These techniques are used during the contraction.
Cleansing Breath. This starts and ends all breathing techniques and can be used to start or end relaxation techniques. Slowly inhale through your nose while concentrating on filling your lungs. Exhale through your mouth or nose at the same rate while concentrating on breathing out.
Slow Breathing. This is used early on when the discomfort from contractions is not too bad. You continue cleansing breaths throughout the contraction. The focus is on controlling the breathing in and out. The goal is a rate of 6-10 breaths per minute.
Patterned Paced Breathing. This is used when slow breathing does not work anymore. The focus changes from controlling the breathing to controlling the pattern. Mom can use a set pattern such as inhale then exhale in three blows while making a “hee” or “ha” sound. Example: inhale, hee, hee, haa, inhale, hee, hee, haa, …)or have you the coach change the pattern. Using the same example you can hold up a number of fingers to indicate the number of “hee”s before the “haa”
Breathing to Avoid Pushing. This is used when mom feels the urge to push but must not push. It is not used often or for long periods of time. During the contraction when she feels the strongest urge to push, mom should take small breaths in and out (pant like a dog) or blow out with her lips pursed like blowing out a candle.
Breathing for Birth. This is used when mom pushes. You can practice this but don't actually push during practice. This is just like lifting weights. Mom inhales at the beginning and blows out as she pushes. She takes a small breath and does it again. You will get several breaths with each contraction.
Focusing. The breathing techniques help mom focus her attention on something other than her discomfort. They are not the only techniques for this. Some women find it helpful to focus or concentrate on an object, picture, sound or movement such as rocking. Most labor rooms have rocking chairs for this. Generally the smaller the object the better the focus. Again the key is what works for mom.
Relaxation Techniques : These techniques are used between contractions.
Between contractions mom must rest and conserve her energy for the last part of the game. The objective is to relax. You can also use the same techniques to relax and relieve stress in other situations.
Progressive relaxation. You tense specific muscles then release the tension suddenly and allow the muscle to relax. You can start at your feet and work your way up or vary the pattern of muscles chosen. This can be combined with cleansing breaths. Tense the muscle as you inhale, then imagine the tension leaving the muscle as you exhale.
Massage or Touch. You can help reduce the tension in a muscle with light touch, stroking or massage. People tend to tense up different muscles during stressful situations. As coach you need to identify which muscles mom tenses and which techniques work best to relieve the stress. This requires some practice before hand by having mom tense different muscles and you observe how they are different. Then play “guess which muscle.” This can be combined with progressive relaxation. Even if you haven't practiced, you can massage when and where mom tells you to massage.
Focusing. This also works with relaxation and in this case closing her eyes will help because it removes distractions. Mom can listen to music and focus on the words, rhythm or instruments. She should concentrate on the music instead of using it as a background noise.
Meditation. This works the same way as focusing but without outside stimulus. Usually you focus on a single image in your mind or concentrate on a specific word, sound or phrase; thus, the stereotypical “ohm” for meditation. This requires more practice before labor to enter the relaxed meditative state. However, it can be very effective.
Visualization. This is basically a detailed day dream. You create a movie or picture in your mind. It could be a special place you build or decorate. It could be an action like driving a scenic road or imagining contractions as waves to be surfed. One visualization that may help mom during labor is to imagine her cervix is a flower bud that is opening. Since visualization can sometimes stimulate actions, only use this when in labor.
Showers. Often a warm shower or whirl pool will help with relaxation. If your hospital has these available, the coach should plan to get wet.
Counter Pressure. Firm pressure with the palms of your hands on her lower back help during back labor.
Timing Contractions
As coach one of your jobs is to time the contractions. You start the time when the contraction begins and stop the time when the next contraction starts—from the beginning of one to the beginning of the next. This gives you the frequency and is measured in minutes.
You also want a split time called the duration. This is the time from the start of the contraction to the end of the contraction and is measured in seconds.
Pre-season
Throughout the pregnancy, your primary job as the coach is to roll with the changes while providing encouragement and support in the best way you can. Here are some things you can do.
During the game, the role of the labor coach is to help the mother put all the preparation and planning into practice. As with most sporting events there is a lot of hurry up and wait.
Some things may not work as well as expected. As the one not in discomfort, making adjustments also falls to the coach. The play book section provides descriptions of different options or plays you can use.
Labor is divided into three stages, The first stage is what most people call labor. The second stage is actually pushing the baby out and the final stage is the delivery of the placenta after the baby is born. The first stage has three phases: early, active and transition. Most of the “coaching” occurs during the active labor phase. What follows are the general coaching actions during each stage and phase.
Early Labor (Stage 1, Phase 1)
Active Labor (Stage 1, Phase 2)
Transition (Stage 1, Phase 3)
Pushing & Delivery (Stage 2)
Delivery of the placenta (Stage 3)
Special Teams
Back Labor. This is when the baby is positioned with his face pointing toward her tummy. The back of his head presses against her spinal column and caused back pain.
Cesarean Delivery. This is a surgical procedure to remove the baby from the womb because a vaginal birth is not possible. You don't have control over any of the reasons for a C-delivery such as:
An emergency C-delivery is performed to save the life of the mother and/or the baby. It will involve general anesthesia and you will not be allowed into the room.
Other C-deliveries are planned either hours or days ahead of time. In this case mom will receive anesthesia that numbs everything from the chest down while she remains awake. You will be allowed to stay with her and she will need you. It is very unsettling to have half your body paralyzed. Her movement will be further restricted by IV tubing and monitoring devices.
Mom will need you to distract her, encourage her, praise her, and otherwise keep her head in the game. Techniques include jokes, stories, questions, and encouraging her to talk about pleasant memories. The same relaxation techniques used in active labor work here. Visualization works quite well because it is not interrupted by a contraction.
Post Game
The role of the labor coach does not end with the birth of your child. You have two more important duties for which you are uniquely qualified. The first is to watch mom for postpartum depression and the second is to introduce the bottle if or when you need to feed using that method.
There are two problems with identifying depression. The first is that you have to look at patterns of behavior or emotions for at least two weeks. The second is that the person suffering from depression is in the middle of the illness and may either not see the signs or deny that they are occurring. It is common for the mother to show some of these signs of depression soon after giving birth as her body readjusts to not being pregnant, she is getting less sleep and she feels overwhelmed.
These feelings are usually called the postpartum blues. Some women experience them for up to two weeks while others may not encounter them at all. If these continue 4-6 weeks following giving birth, she needs to discuss them with her doctor. The Guy's Guide to Postpartum Depression (provide link)discusses this in detail.
Breastfeeding is the best thing for both mother and baby. While natural, breastfeeding is not easy. Both the mother and the baby must figure out how to do it efficiently. Sometimes feeding from the breast just does not work out and you end up using a bottle. Mom can still express or pump the breast milk to provide the nutritional advantage of breast milk.
Most babies will initially reject a rubber or silicon nipple when cuddled up next to mom's chest. After all which would you want a breast or a bottle. Thus, not being mom makes you the best person to introduce the bottle. The baby is willing to give it a try and once he figures out that this is food, he will usually accept the bottle.
Some Coaching Concerns
The first thing you need to do is ignore every movie and TV program you have ever seen. Hollywood adds drama by having babies delivered everywhere and uses dad for comic relief. Rarely are babies delivered in a car on the highway. That is why it always makes the news. Even then it usually happens with the second or later child. However, if your wife feels a very strong urge to push, it is time to call for an ambulance. This usually indicates that the baby is on the way.
A vaginal birth is a bloody, messy event. The site of blood causes anxiety in most people. A few people including me are weird and blood doesn't bother us. It is better to admit you are normal than try to be tough and pass out. For normal people the best thing is to not look and focus entirely on mom. Besides you are already paying the medical staff for everything else. Watching a few birth education films also helps you prepare for what will occur.
Watching the woman you love go through childbirth will be one of the hardest things you will do as a man. There will be a point when you can do nothing but be there. Emotionally you will have to suck it up and drive on.
You don't have to catch the baby or cut the umbilical cord. If you choose to do these things, the medical staff will not let you screw it up.
Finally, your emotions will be on a rollercoaster also. Don't feel guilty if you feel overwhelmed, not ready or not wanting to be a dad. These feelings are natural and will be replaced by your love for your child.
Other Stuff You May Hear About
Midwife
A midwife is a woman who specialized in delivering babies. Her focus will be on using natural childbirth techniques. Midwives are involved in the delivery of most of the babies in the world. In some countries such as Germany , their presence is required by law while the doctor is optional. In the U.S. certified nurse midwives have completed graduate level training and are certified by the American College of Nurse-Midwives. In U.S. most midwives practice with a physician as a back up. CNMs (Certified Nurse Midwife)are just as capable as a physician to handle low risk pregnancies and uncomplicated births.
Doula
This is a woman that has special training and experience in helping other women through the birth process. Her focus is on the mother while a midwife focuses on the entire birth and may have more than one patient. Think of her as a professional labor coach. Doulas complement the actions of the coach and medical staff. Most hospitals and medical practitioners keep lists of doulas in the area. Doulas of North America (www.dona.com) can also help you find one in your area.
The Bradley Method
This is a natural childbirth method developed by Dr. Robert A. Bradley. The key aspects of this method are extensive birth education, supervised practice of techniques and greater involvement of the labor coach. The Bradley Method is taught by certified instructors. (www.bradleybirth.com)
Lamaze
Lamaze is an organization that focuses on natural childbirth. They provide birth education classes, magazines and other support to expectant parents. Lamaze classes teach many of the techniques found in the playbook. Many birth education classes are referred to as Lamaze, but not all follow the standards of the organization.
Water Birth
This is a birthing technique in which the mother gives birth while her pelvis is underwater. The principle is that the baby has an easier transition from one fluid filled environment to another fluid filled environment. Immediately after the baby emerges the tub is drained. This birthing technique requires special equipment and staff training. NMCP does not offer a water birth.
VBAC (Vaginal Birth After C-Section)
A woman may have a vaginal birth after having a non emergency C-section in which the incision was made horizontally. In an emergency C-section the incision is made vertically because it is quicker; however, this weakens the uterine muscles making a future vaginal birth very difficult. Eligibility for a VBAC is best determined by your doctor.
The Game Plan
The idea of developing a labor plan has increased in popularity over the years. Some childbirth educators promote a written plan signed by both the doctor and the mother. Others view the plan as more of a theme to guide the birth. All plans help you ask the right questions and make decisions about the things you can control.
The Birth Plan for NMCP will help you develop your game plan based upon what is available and the policies of NMCP.
topLast Updated: 25-Jan-2006
