What Factors Influence the Progression of Childbirth?
Your body is perfectly designed to promote a healthy pregnancy and childbirth. For the majority of healthy women, childbirth progresses spontaneously without complications. However, there are steps you can take to promote this normal progression, and there are factors that can interfere with it.
What are the physical factors?
Many physical factors can promote the progression of labor.
Position of the baby
The position of your baby
might play a role. Most babies navigate best through the pelvis if they are head down, with their face toward your spine. This is called an anterior position. During the last weeks of pregnancy, try to promote this positioning of your baby.
- Avoid lying on your back.
- When relaxing, choose forward leaning positions such as sitting on a physical therapy ball with your legs apart.
- When resting or sleeping, lay on your side as far to your stomach as you comfortably can.
As contractions begin, choose positions of comfort. Freedom of movement and frequent position changes can help the baby choose optimal positions for birth. Upright positions allow you to use gravity to promote the downward movement of the baby.
You might find it very difficult to move during a contraction. That's okay - just relax as much as possible during the contraction, breathe slowly and deeply, and move when it is over. You might also find that changing to a new position makes the contraction more intense or painful. However, try to avoid switching again too soon - try several contractions in the new position, readjusting and regrouping - before deciding to abandon it. Alternate upright positions with positions of rest, such as sitting in a rocking chair or side-lying in bed.
How can emotions impact labor?
Your emotional wellbeing is very important during labor. Do what you can during pregnancy to address fears and concerns
so you can enter labor with confidence in yourself, your partner, your other birth attendants, and your midwife or doctor.
You can also use guided relaxation or meditation
at any time during labor to help you build images of safety and strength, or to identify fears that might need to be addressed.
Women in labor are often advised to let go and release control of labor to their bodies' own innate ability. In order to do this, you will need to feel safe with the environment and with your chosen care providers and support people. Because labor is a time when many women feel vulnerable, you should ask for understanding, support, and respect from those around you to help enhance your feelings of safety and strength.
What helps the natural progression of labor
The active participation of your partner, doula, labor nurse, midwife, or doctor is one way to promote the natural progression of labor. Research shows that the presence of a doula or other supportive person
is associated with many positive benefits during childbirth, including shorter labors, less use of pain medication or epidurals, fewer cesarean sections, and successful breastfeeding. Your midwife, doctor, or labor nurse may spend considerable time supporting you, but they might also have responsibilities for other laboring women as well. A doula, on the other hand, is likely to spend much of your labor with you.
Human touch can also help labor progress. This touch can take many forms: back and hip counter-pressure to help alleviate pain, massage to promote relaxation, acupressure to alleviate pain or promote effective contractions, or energy work such as Therapeutic Touch or Reiki to promote relaxation and pain relief.
It can even be as simple as holding someone's hand for support.
Many childbirth professionals promote the use of water therapy-immersion in a warm tub or warm shower-to cope with and shorten active
labor. In general, it is best to wait until labor is well established before entering the water or your contractions might become less strong or less frequent. (However this might not necessarily be a disadvantage, if you need a break from a long labor to rest and regroup.)
One of the pioneers in the natural childbirth movement, obstetrician Robert Bradley, compared the medicated and difficult childbirths of women in brightly lit, tiled delivery rooms with the relatively easy births of animals that chose dark, comfortable places of safety. Thus, his initial recommendation to promote the natural progress of labor was to choose a dark, quiet environment
Sound and scent
You might want to bring music
that you enjoy, find meaningful to you, or feel simply promotes feelings of relaxation.
You can also consider aromatherapy, which can contribute to feelings of wellbeing and thus influence your course of labor. Many birth professionals recommend the use of lavender during labor. You can try an infuser or make a small sachet. Check ahead of time for any hospital policies on "scent-free environments."
What effects can pain medication and epidurals have on the progression of childbirth?
Pain medication and regional anesthetics (such as epidural, intrathecal, or spinal anesthesia) bear special mention. Most midwives and physicians agree that the use of pain medication or regional anesthesia during early labor can slow labor progress
. A common midwifery text by Varney describes this very well, cautioning midwives about using IV pain medication too early in labor: "although you have made the woman extremely comfortable, you have lengthened the total labor by several hours (for which she would probably not thank you if she knew)."
Risks of epidurals
Most researchers have concluded that epidurals or other regional anesthesia may be associated with longer labors, longer pushing, increased risk of vacuum, forceps, and cesarean sections, as well as increased risk of other complications, such as low blood pressure (which might adversely affect the baby), fever, headache, and nerve damage. (It should be noted however that a newer research study challenges the association with longer labor lengths and increased cesarean sections.)
Situations where they may be beneficial
However, in some instances, pain medication or epidural anesthesia might help to promote labor progress.
What you should ask about medications
- Medication might help women who are very fearful and who have not been able to alleviate this anxiety with emotional support.
- Anesthesia might help the pelvic muscles relax when a woman cannot relax using breathing, relaxation, and supportive techniques.
- Epidurals might help women with an uncontrollable urge to push against an only partially dilated or swollen cervix to stop pushing, allowing the swelling of the cervix to subside and dilation to continue.
You should make a decision to use medications or interventions during labor carefully and take plenty of time to ask questions about this during your prenatal exams. Ask your midwife or physician for input if you are considering these choices. Informed consent for medications, or for other proposed labor interventions, means that you know the following:
- The name of the drug, procedure, or other intervention.
- The reason the drug, procedure, or intervention is being proposed (the benefits).
- The potential risks of the proposed therapy.
- What would happen if you did not use the proposed therapy, or if you waited.
- What alternatives exist to the proposed therapy.
Unless there is an emergency, it is always appropriate to ask questions, and to ask to be given time to talk privately with your partner as you make a decision. We've mentioned this before, but it is worth saying again: try not to make a decision about pain medication in the middle of a contraction!