Labor Support

Labor Support

This information also appears in audio form on episode 5 of the Transition to Parenthood Podcast.

Multiple research studies have found that continuous labor support reduces interventions, improves outcomes, and improves satisfaction with the birth. We will first talk about who provides labor support. Then we’ll address how to provide the best possible support by learning about childbirth, understanding what comforts the person who will be in labor, having tools to respond to each phase of labor, and understanding the importance of reducing fear during labor by helping her to feel safe and loved.

Who Provides Labor Support?

Throughout this website, I’ve referred to the role of the partner, or the support person. This may be just one person – often, but certainly not always, the father of the baby. Or many people may take on parts of the role. This may include a spouse or partner, other family members or friends, a doula, and medical caregivers, such as nurses, a midwife, or doctor. The person who will be giving birth chooses who is on their labor support team.

There are several qualities to look for – the most important is that they are someone that the birthing parent trusts and feels safe with. Labor progresses quicker and with less pain when the person in labor feels safe. Other helpful qualities are knowledge of maternity care, experience with supporting people through labor, trust of the birth process, love for and deep knowledge of the person in labor, love for the new baby, and the ability to stay calm through challenges and to be flexible to adapt to changing needs. No one person has to embody all of these qualities. But it is helpful if all those qualities are represented by someone on the team. Expectant parents should spend some time reflecting on this during pregnancy to be sure they have the people that they need.

Some parents choose to hire a doulaa professional in labor support. Doulas do not provide medical care. They offer emotional support, physical support like massage and assistance with positioning, suggestions for comfort techniques to try, information about what’s happening, and they help you to advocate for your own priorities during labor. To learn about doulas and all the ways they benefit the birth process and improve birth satisfaction, go to dona.org.

Now that we know who can provide labor support, let’s talk about what their role is.

Educating Yourself Prior to Birth

First, prior to labor, the support person should educate themselves about the labor process and maternity care, and they should stock up their toolbox with ideas for how to help. They can do this by listening to this podcast, reading Pregnancy, Childbirth and the Newborn or taking a local childbirth preparation class. Those resources will teach all the basics of labor support, but we also want to be able to customize to the unique comfort preferences of each laboring person.

Learn about what comforts this specific person

For partners, a good way to prepare for labor is to ask the pregnant person these questions:

  • What helps her feel better when she is in pain?
  • When she is exhausted, what gives her the energy to go on?
  • What soothes her when she is worried about something specific or just feeling anxious?
  • When she was sick as a child, what did her parents do for her (or what did she wish they had done)?

Knowing all these answers will help you create a Love Map that will not only help you in labor but will honestly help you throughout your relationship!

Knowing what has comforted someone in other tough times throughout their life provides such essential grounding in what will comfort them in labor. Whenever a birthing person hits a hurdle and is telling me “this is too hard”, I think back to these questions, and somewhere in there is the answer to what she needs now. And the answer is different for every person.

I have heard people say things like “all women in labor are like cats in labor – they like to be in a small, dark enclosed corner with as little interruption as possible.” That’s true for some, but NOT for all. I had one client who told me that when she was stressed out, she HAD to get out in the world with people around and bright light and do something active. She said being “trapped” in a dark, quiet room with nothing to do would be the worst possible thing for her.

Partners, it’s important not to assume that what comforts us will comfort someone else. Nor can we assume that if we hate something, they will too. I consider holding ice to be torture. But I had a client who was an athlete, and she was used to icing injuries to relieve pain. In labor, when she asked for an ice pack for her back, I was tempted to say “really?? Wouldn’t you rather have a heating pad?” Instead, I got an ice pack… when I put it on her, I expected to see her tense. Instead, she softened and relaxed. It was working for her. So, I held the ice pack there. There was one layer of towel between her back and the ice (never put ice directly on skin), and I had like six layers of towel between me and the ice! But I had to trust her cues that this was what she needed.

A basic rule of labor support is: if you do something and it causes her to soften and relax, keep doing it. If it causes her to tense up, stop doing it. And try something new on the next contraction. (Don’t try anything new in the middle of a contraction – that’s too overwhelming.)

For another birth, I was the backup to the backup doula, meeting a stranger in early labor. Her mother was supposed to be with her, but could not travel to the US because of new immigration restrictions. So, I asked her… “when you were little and you were sick, what would your mother do for you?” She said “Oh, she would sit next to me and stroke my hair and say ‘I’m so sorry you feel so bad. No one should have to suffer like this.’” Now, this is totally different from my background – I’m from a military family in Wyoming – a “jump right back up on that horse” family. During labor, I fell into unconscious habits of what would help me if I were in pain. I was cheering her on, saying “you can do it.” And I could see it wasn’t working for her. She kept saying “I can’t bear it.” Finally, I remembered her story about her mom. And the next time she said “I can’t bear it”, I stroked her hair, looked her in the eye, and said ‘I’m so sorry you feel so bad. No one should ever have to suffer like this.’” And she looked at me and said “Yes.” And the rest of labor she coped better – because finally someone understood her.

What does support look like during labor?

I think about zones of support, where her need for support increases as labor progresses. In early labor, support is mostly about providing pleasant distractions. In active labor, it’s lots of hard work helping her manage the challenges. In transition, it will demand all your attention and emotional presence. During pushing, you cheer her on. And in third stage, it’s time to bond with this new baby. Because she will need you more and more as labor progresses, I encourage all support people to take care of themselves in early labor: eat, rest if you can, get the emotional support you need to be ready. And then, before she enters transition, again make sure you’ve eaten a meal, and make sure you’ve peed, because once she starts transition, she needs you by her side non-stop.

Early Labor

In the early labor zone, when things are just getting started, it’s nice to have your labor supporters nearby, but not absolutely essential. When I was in early labor with my second, we were packing our house for a move. (Never plan a move anywhere near your due date!) When a contraction would hit, I’d call out to friends in the other room, “Having a contraction.” They’d say “Do you want us to come?” I’d say “Nope, keep packing!” But just knowing they were there was helpful.

In early labor with my clients, we’ve gone out shopping, gone out to restaurants or the park, we’ve had their friends and family visit, we’ve watched movies – they’re pretty much in their normal state of awareness and able to chat and be social between contractions, so having pleasant distractions helps them not get too focused on worrying about labor.

At some point their needs shift.

I had one client where in early labor, we had a playdate in the park with four other families. We all took turns watching my client’s four year old and sitting with my client to keep her company. It was perfect for a few hours, but then she said “OK, we all need to go home now.” Back at her house, her husband and I swapped off between playing with their child and hanging out with her. In between contractions, we were chatting – talking about things like our favorite Star Trek episodes. During contractions, we rubbed her back and encouraged her to rock and breathe. And that was working. But then, as she shifted into active labor, it became hard to have her son there needing her attention, so he went off to Grandma’s house so the rest of us could focus on the labor and doing what she needed to do to cope.

Active Labor

By active labor zone, we hit that “can’t walk / can’t talk stage” where the laboring person is no longer chatting between contractions. During contractions, we’re working hard with comfort techniques. The support partner needs to be in the room during contractions, offering active support.

There are so many ways we can support a person in labor. First, pay attention to the environment. Remember her personal preferences – does she like music or quiet? Bright lights or dim? Warmth or cool? I think about all the ways I can make this the most comfortable possible environment for her, where she knows she is free to cope in whatever way works for her, without being judged.

If she’s coping OK – she’s working with her labor pain, I can tell by looking at her. If she’s relaxed (well, as relaxed as someone can be in active labor), and she’s got rhythm in her movements and breathing, and I’m not hearing fear in her voice, it’s fine to keep doing what we’re doing.

If she’s starting to have a hard time coping, I can tell. I’m going to see a lot of tension in her muscles – she may be gritting her teeth or clenching her fists. I don’t see any rhythm in her movements or breathing. Or if she looks or sounds anxious or scared, then I want to change something. I don’t change anything in the middle of a contraction – that’s stressful… I try not to ask her too many questions… that’s overwhelming in labor. But I start thinking ahead to what we may want to change.

I think about physical comfort – might she need food? A drink of water? A restroom break? To change positions? If I know she likes touch, I think about massage. If we haven’t tried the bath or shower, I might suggest that. As we go through a few contractions, I’m thinking this through, so that when we’re in a break between contractions, I can suggest something new, or I can try cautiously adding it in on a contraction and see how she responds. If she relaxes and softens, and gets more rhythm, I know it’s working. If she tenses or loses rhythm, I know it’s not helpful and I back off.

I know that in the midst of providing labor support, it can be hard to remember everything you’ve learned about comfort techniques, so I’ve created a comfort techniques handout of options that you can print and carry with you or find online during labor.

Transition

In the transition zone, we may use any of the same comfort techniques that were helpful in active labor. However, everything is more intense. Where in early labor, you could offer support from another room in the house, and in active labor you just had to be in the same room during contractions, now it is best if you are within arm’s reach of her at all times for all of transition – which typically lasts 90 minutes or so. For some people in labor you’re hands-on and touching her the whole time. Others do not want you to touch them at all! But they want you in arm’s reach in case they need you.

In transition, people in labor are often physically overwhelmed – they may tremble, they may vomit, they may feel lost in the pain, and they’re emotionally overwhelmed. They need you to stay as calm as you possibly can – I think of this as being the anchor in the storm of her labor. Now, if it’s the first birth you’ve ever been at, it may be hard for you to stay calm yourself – tune in to the doula, the nurse, the midwife – someone who is experienced at labor support. “Borrow” some calm from them.

If she has a rhythm, do all you can to help her keep it. Touch in rhythm with her breathing, move in rhythm with her rocking, talk in rhythm with her. But if she has no rhythm at all and just isn’t coping, you may use the Take Charge Routine.

Move slowly and intently, use a calm, deep voice. Sit at her level, or below her. Give simple, concise directions for what to do: “OK, I’m here. Now breathe with me, OK? Just breathe – hee-hee-hee-hoooo. Hee-hee-hee-hooo. Good. Again. Hee-hee-hee-hoo. Good – breathe with me.”

Some people calm themselves by closing their eyes to shut out stimulation and if you insisted they open their eyes it would be stressful. So, if her eyes are closed and relaxed, let her be. But for most people, eye contact is helpful. If you see her scrunching her eyes in pain and/or frantically looking around her, then say “open your eyes, look at me, look at me… I’m here, it will be OK.”

In between contractions, encourage her. Acknowledge that labor is hard, so hard right now, but it’s not impossible – she can do it. Let her know that as soon as she begins to feel the next contraction, she can look at you, and you’ll be there for her.

Now, if she chose an epidural at some point during active labor or transition, she won’t be experiencing this level of physical pain. However, the emotional experience can still be very intense for her, so be sure to stay present and available for support. In the episode on pain medications, I’ll talk more about labor support after an epidural.

Second Stage

As she nears the end of transition and begins to move into readiness for second stage, you may notice the rhythm of her contractions change. The interval between them gets longer – you get a little more break between contractions, and they may feel less intense. She may get a burst of energy, and come out of the inward focus of transition and re-connect a bit. She may develop the urge to push. It often feels at first like the urge to have a bowel movement. Then there’s a lot of downward pressure and an undeniable urge to push. If her care provider is not in the room at this time, be sure to notify them of these signs so they can check on her progress.

If she is ten centimeters dilated, we’re ready to enter the pushing zone. For this stage, there will be professionals in the room to guide you – either a nurse, midwife, doctor, or multiple professionals. They will help to coach her on positions, breathing and pushing techniques. You can help to echo, reinforce, and support their recommendations. Your primary role at this time is emotional support – staying connected with her, encouraging her forward, letting her know that she can do it!

Third and Fourth Stage

After the birth of the baby, we enter third stage, which is the delivery of the placenta, but more importantly, is the meet-the-baby time. At this point, the role of the labor support team depends on what their relationship to the baby is. If the support partner is the other parent of the baby, they move in close to meet their child. If they are close family or friends, they also move in and connect, but remember that the primary goal of this time is that initial connection between the parents and the baby. For me as a doula, I step back at this time, remaining close by for any support that is needed, and working to create a space where no one interrupts the family in making these first connections. [Learn more about this “golden hour“.]

You can learn more about second and third stage labor support in the episode that focuses on those stages.

Reducing Fear / Increasing Oxytocin

Throughout all the stages of labor, the most important job of the labor support partner is to help the person in labor feel safe, loved, and protected.

I talked about the Fear-Tension-Pain triangle in my episode on Understanding Labor Pain… the more fear someone feels, the tenser they get. The more tension they hold, the more physical pain they experience. The more pain, the more fear, and we’re locked into a pretty awful cycle.

We want to do whatever we can to reduce fear and increase her sense of safety and increase her confidence. Not only will she hurt less, but her labor will then progress more quickly.

In order to really understand the impact of fear on labor, it helps to understand the role of hormones in the birth process.

Let’s meet the key hormones

You’re probably familiar with adrenaline – what is often called the fight or flight hormone. It helps to protect us from danger. If an individual ran into a tiger in the jungle, they would choose either to fight it or to run away.

But, do you know about oxytocin? It’s the “collect and protect” hormone. If a tiger is coming into our village, we gather everyone together, because we are safest together.

You may have heard about endorphins when people talk about the “runner’s high.” Endorphins are released when we experience stress or pain, and they help to relieve the pain just as effectively as morphine, but without any side effects.

What effect do these hormones have on labor?

Oxytocin increases contractions and helps labor to progress. (Oxytocin is often called the love hormone, because it increases when we feel loved, and is at its peak levels when we orgasm, when we give birth, and when we breastfeed. It’s all about making babies, birthing babies, and feeding babies.) Endorphins make us less sensitive to pain, can cause euphoria, and can cause feelings of love and dependency. So oxytocin speeds up labor, and endorphins relieve pain.

On the other hand, adrenaline slows down labor and increases labor pain. With adrenaline, your heart rate increases, your breathing speeds up and all your muscles tense up. All your energy goes to your limbs in case you need to fight or run away. You are more sensitive to pain – now, this is all useful if you’re at risk of injury because your body tells you what dangers to move away from. But, for childbirth, it’s really not helpful – it just means that labor hurts more!

As adrenaline increases, oxytocin production drops and labor slows down. (It’s hard for the cervix to open when someone feels scared…)

TTPcover

How can you tell what hormones are affecting someone?

We can tell someone is rushing on adrenaline if they act vigilant or panicky, breathe fast, have lots of muscle tension, focused eyes that dart around if they hear sounds, a high pitched voice, and no rhythm. If you’re seeing any of those signs, think about how you could reduce adrenaline triggers.

So, what causes adrenaline rushes?

  • Fear, anxiety, feeling abandoned.
  • Feeling watched or judged. Feeling trapped.
  • Feeling like you don’t understand what’s happening or have no control over your situation.
  • Bright lights, being hungry or thirsty or cold.

All these things increase stress hormones. Let’s try to reduce those in labor as much as we can!

We can also tell if someone is on an endorphin / oxytocin high. They seem open and trusting, their muscles are relaxed, their voices are low-pitched and husky, their eyes are sleepy, and they move rhythmically. What helps oxytocin and endorphins to flow? Having privacy, having support, feeling warm and cozy, eye contact, skin-to-skin contact, kissing, nipple stimulation, love making. Having the environment be the right temperature, the right amount of light, and the right amount of noise for her to feel comforted. Basically doing anything that helps someone feel loved and cared for.

[Learn more about hormones and labor.]

Takeaway

This is the most important takeaway about labor support: Any time you’re in doubt about what to do, just remember this: Anything that helps the laboring person to feel safe and loved will help her relax and gain her rhythm and will help the labor progress faster and hurt less.

Learn More about Labor Support