Labor Tips from a Labor & Delivery Nurse

I wrote this post a day or two before I delivered our little boy but didn't get to posting it until now. At that time I was all nerves and butterflies for the big event and originally wrote the little intro below for the post. A little outdated now, but I thought it was sweet to look back on how I felt at that time so I decided to keep it in.

"I can't believe that I could deliver any day now! Part of me (the very uncomfortable part) is so ready for him to come and part of me (the fearful part) wishes the delivery day would never come. I thought with being a part of hundreds of births I wouldn't be as nervous as I am. I thought somehow I would be completely calm, in control and unafraid. But that is definitely not the case. A few weeks ago I was absolutely terrified! And then something happened this weekend. It finally sank in that the time to deliver is here and most of the fear turned into great excitement! Instead of imagining what the pain will be like, I imaging my boy's little toes. Instead of fearing the complications that could happen, I dream about the physical features he might have. And amazingly enough, I'm actually excited to deliver."

That excitement never left me. Between contractions I was absolutely giddy like a child on Christmas Eve. We were so blessed with a smooth delivery and a healthy baby. It was all that we hoped for and having worked in Labor & Delivery as a nurse, I know so much of a birth is really chance and so we are so very grateful. We will save Asher's birth story for another post.

So here are few tips of the trade to help those of you who are delivering soon!

So often a woman a comes into the hospital with a plan. Sometimes she plans on it being just like her mother's deliveries. Sometimes she plans on it being just like it is "supposed" to be in the movies or how her friends had their deliveries. But most often that ideal plan usually comes from hours of research and advice columns. While it is always a good idea to become educated and prepared in the events of life since it allows you to have a foundation with which you can make good decisions, labor is not one of those events in life that abides by a prepared plan. No matter how much detail you write down, what color paper you use or even how much preparation you do during pregnancy, birth is unpredictable. So the best piece of advice I have is to know that you may never know what kind of delivery you will have nor will you always be in control of the type of labor you will have. If things don't go the way you imagined or planned, it doesn't mean you were inadequate in any way, it is just the nature of labor. There are so many variables and so many of them are not in your control. So try to prepare yourself for the unexpected and try to cultivate flexibility in your preparation, imaginings and hopes. The most important thing is a healthy mom and a healthy baby. And every hospital will have that goal as their top priority.

From what I have seen and also from the advice of many physicians here are a few things you can do during your pregnancy that can help you have a better delivery:

• Yoga and flexibility training: We have seen this allow the baby to turn into position easier and women tend push better
• Sitting on a birthing ball: We have seen this open the pelvis, allow the baby to drop, and relieve pain/pressure
• Cardiovascular exercise: Before third trimester and walking during third trimester help build endurance for the trial of labor

If all is healthy in the pregnancy, ask your doctor if you can have intermittent monitoring during labor. Usually they have to put in special orders for it. Intermittent monitoring gives you a break from all the cords which monitor your contractions and the baby's heart rate. The breaks allow you more freedom to move around, walk the halls, take a shower etc.

If this is your first baby, try to labor at home for a while before going into the hospital if your water bag is still intact when contractions start. The exceptions to this would be if you are GBS positive (you will need antibiotics during labor and should go in right away to begin the treatment) or have any other complications with your pregnancy. If you labor at home until your contractions have established a good pattern, you will be able to enjoy the comforts of home while your pain builds. There is little chance with a first baby that you will deliver at home (first babies take a long time) so wait to go into the hospital until your contractions are 5 min apart for more than an hour. Make sure that when you are timing the contractions your bladder is empty and you are really well hydrated. If not, your contractions might fool you into thinking that you are in an established pattern when you are not. Then as soon as you get your IV at the hospital your contractions will space out and the discussion of starting Pitocin will begin.

If your water breaks either before contractions start or while you are laboring at home it is best to go into the hospital unless your doctor has given you permission to do otherwise. Once your water is broken you are more at risk for infection as well as other complications so it is best to be monitored carefully. When your water breaks make sure and note what color the fluid is. We describe it as clear, light green or pea soup colored. It is really important for the nurses to know this information.

*** A little note, if this is your 2nd + baby go into the hospital as soon as labor starts. After your first, babies come very quickly and unless planning on it, you won't want to have it at home! ***

Being a nurse myself I feel it is important to let patient's know that they have the right to request a new nurse if the one assigned to them is making the experience less than agreeable. Having a baby, especially with the first is such a precious experience and you deserve to have someone at your side who can support you, validate you, comfort you and motivate you. It is never wrong to ask to speak with the charge nurse and request an assignment change  if the nurse you have is unkind or disrespectful.

It is extremely important to stay in a vertical position as much as is possible before you get your epidural. You can walk the halls, sway beside your bed, sit in a rocking chair or sit on a birthing ball. What matters is being upright. The vertical positioning will do two very important things: 1. It allows gravity to assist your contractions in pulling the baby down and 2. the vertical gravitational pull allows the baby to rotate so that he/she gets into the optimal position of facing toward your spine. If you are laying down in bed, the gravitational pull will pull the baby horizontally and make it much harder for the baby to rotate correctly as well as come down. Sometimes when the baby doesn't make the full rotation to face your back, it can cause the head to not be able to put equal or full pressure on the cervix so that you might not dilate fully. If this happens you have an increased risk going to a c-section due to not fully dilating.

Most doctors/hospitals will not allow you to get your epidural before you are dilated to 4cm. This is because it is best to wait to get an epidural until you are in the active stage of labor. Before the active stage you are not in true labor. For you to be in active labor you need to be dilated and have a well established contraction pattern. Your labor nurse will advise you if both of these two things are in a good position to make you ready to receive an epidural. The American Congress of Obstetricians and Gynecologists (ACOG) is our governing body and states that active labor is not until 6 cm for a woman who is having her first baby. It has been evidenced that your chances of getting a c-section go up drastically if you get your epidural before you are in active labor. My tip therefore is to definitely wait until 4 cm to get your epidural and if you can, then wait as long as possible to get your epidural. However, if this is not your first baby you do run the risk of running out of time to get your epidural since subsequent babies can come very quickly. So I would get your epidural when you are in active labor rather than trying to hold off longer with your first.

When you have your epidural and are stuck in bed, make sure your nurse rotates you from side to side every hour. This will help your baby to rotate into the correct position for delivery against the gravitational pull (as previously discussed above). One of my favorite aids for epiduralized patients we called peanut ball. These are much like a birthing ball but are shaped so that they fit between the legs. They open up the pelvis and really allow the baby to drop down and rotate. These are seriously miracle workers! They work so well. If your hospital doesn't provide them for you, you can click on the link to see how to buy one.

Once you are completely dilated, if the baby is not at a low state (2+ or more) you will want to labor down. Most doctors prefer that you labor down for just an hour so that you don't stall the labor curve. I have actually seen greater success laboring down longer if every hour you are making progress and the baby is coming down lower gradually. Your nurse should check you every hour at this point and see what you will benefit most from. Another unique tip I got from a patient. You can ask your anesthesiologist to turn down your epidural pump while you are laboring down. This will allow you to feel more pressure as the baby comes down and even some pain if you would like. The benefit of feeling pressure and pain (especially for your first delivery) is it makes your pushing much, much more effective. Pushing for a long time can cause distress for the baby, result in c-section and do more damage to your body. So it is ideal to be able to at least feel pressure when it comes time to push.

It is very common for women to get the shivers after and while they deliver. They can actually be quite extreme. While it has not been proven as to what causes these shivers, women experience them no matter what kind of delivery they have. Some doctors say it is related to the hormones released after delivery. Some say it is related to the adrenaline rush. And one doctor told me that it is a characteristic of mammals that we shiver after delivery to ward off predators. Whatever is the cause, they are harmless and don't mean that you are cold. They will pass in time. I found that even though the shivers are not related to your temperature, a warm blanket wrapped tightly around you and baby helps to suppress the nervous system and calm the shivers.

- If you have any questions or want some more resources/information, please comment below and I will do my best to help you find the best information -