Some Tips for First Time Mothers

Having professionals to support you through your labor can make a big difference.

There are women whose profession it is to be with laboring mothers.

With all due respect to husbands/ partners, a woman who has been trained to support women in childbirth is able to help you in ways a layman can't. Studies have shown that births with a doula present have fewer interventions.

And if you don't want to hire a professional, consider inviting a good friend, your sister or mother to the birth. A female friend or relative who you feel comfortable with can be a big boost, too. She can hold your hand, tell you how great you're doing and let your husband take a break.

There are hospitals that limit the number of people present to one or two so make sure you check hospital guidelines before.

Just make sure to set clear expectations before about what sort of role she is to play. When is she available (can you call her in the middle of the night)? Do you want her taking pictures? Would you like her to give you a massage? etc.

Early Labor

Because you have never experienced labor before, you may find it difficult to know if you are in labor. Before heading to the hospital, call your physician or midwife to discuss your labor symptoms.

More than one hospital trip

It is common for first time mothers to make more than one trip to the hospital. If you are in early labor and sent home, the following activities may be helpful:

• walking
• showering
• resting
• drinking fluids
• renting a video
• listening to music, etc.

Prodromal Labor

Some first-time mothers experience a prolonged period of early labor with minimal to no change in their cervical dilation. This condition is called "Prodromal Labor". If this occurs, it is especially important to alternate rest and activity to keep hydrated maintain your physical energy with light, high energy food.

Partners and families can be very helpful in keeping the mother distracted with activities and in keeping up her spirits. Periodic contact with your healthcare provider is also helpful.

Active Labor

Literature shows, and we have found, admitting a first time mother to the hospital when she is in active labor has a better outcome than admitting a first time mother to the hospital when she is in early labor. Admitting a first time mother during active labor helps her labor progress with minimal interventions and she has a higher occurrence of having a vaginal delivery. In active labor, the contractions are less than 5 minutes apart, lasting 45-60 seconds and the cervix is dilated 3 centimeters or more.

Induction

Although inducing labor may be needed for certain medical problems or prolonged pregnancies, induction for a first-time mother carries additional risk. Induction of labor for a first-time mother, (especially with a cervix that is nearly closed), doubles or triples the length of labor and possibility of a cesarean birth. However, in subsequent pregnancies, the chances for a cesarean delivery after induction are lower. 

Comfort and Pain Management

Pain is a natural part of labor and every woman is unique in the level of pain she can tolerate. Women also have varying success with the kind of activities or interventions that can help decrease their labor pain and increase their comfort. Outlined below are the three types of activities and interventions: comfort measures, medication, and regional anesthesia.

Comfort measures — There are several good approaches to pain relief that are effective throughout labor that everyone should try. Any of the following approaches with which you feel comfortable can be used during your labor:

• Walking
• Water therapy (e.g. shower or tub)
• Sitting or leaning on a birthing ball or rocking chair
• Keeping a restful environment in your labor room (quiet, low lighting, soothing music). Carefully select support people for a calm environment.Using various positions (all fours, sitting on toilet, kneeling, squatting, pelvic rock) and supporting with pillows if necessary.
• Massage/back rubs by support person
• Effleurage (light massage of abdomen)
• Having your partner or a support person rub a tennis ball over your lower back
• Applying warm or cold compresses
• Using relaxation/breathing techniques
• Prayers or religious ceremonies
• Guided meditation using calming imagery
• Utilizing several comfort techniques is an excellent way to involve first-time partners in supporting and working with you in the childbirth process.

Medication — For some women, as labor progresses and contractions become stronger or they get too tired to cope, comfort measures no longer provide enough relief. Pain medications are commonly used at that point, and your physician or midwife will explain the benefits of each type and will help you select the appropriate medication that is safe for you and your baby. You may want to discuss medications in advance of labor with your doctor or midwife. 

Medication may not totally eliminate labor pain, but can help ease it so you can better rest and cope with the discomfort. Continue to use comfort measures that help you relax as much as possible between contractions. Except in early labor, the most commonly used medications are short acting, minimizing the effect on the baby. For some women, no other medications are necessary to help cope with labor pains.

Regional Anesthesia (Epidural, Spinal or Intrathecal Medication) — If you reach a point in active labor that comfort measures and/or medication are no longer giving you adequate pain relief, your physician or midwife may order regional anesthesia to provide stronger pain relief. The anesthesiologist inserts a needle in your lower back to administer regional anesthesia. The goal of regional anesthesia, especially after your cervix is completely dilated, is to reach a balance between easing your feeling of pain and still feeling the urge to bear down to actively participate in delivering your baby. The various methods of regional anesthesia are discussed later in the section on medications. Talk to your physician or midwife in advance of labor about regional anesthesia, and tour the hospital in order to find out what types of regional anesthesia are available.

Episiotomy

Over the past ten years, there has been a national trend to avoid routine episiotomies (a cut in the perineum to enlarge the vaginal opening). Recent studies show that routine episiotomies have little or no medical benefit. What used to be a national episiotomy rate of 60 to 80 percent for first-time mothers has decreased to less than 13 percent. 

The main concern is that the episiotomy can increase the risk for extended tears to the rectum, especially for first-time mothers. This may lead to greater short and/or long term problems with bowel control (loss of gas or stool) later in life. Twenty years ago, it was thought that episiotomy might prevent these problems. We now know that this is not the case and that episiotomy actually appears to increase the rate of these problems. Since starting our comprehensive FPAD initiative, episiotomies have decreased 61 percent throughout Sutter hospitals, and rectal tears have decreased 44 percent.

For your first delivery, you are encouraged to discuss episiotomy with your physician or midwife (and their partners if they are part of a group practice) at one of your last prenatal appointments or when you are in early labor.

Close to 70 percent of women will have a natural tear with the birth of their first baby. Such tears usually involve less tissue and trauma than an episiotomy.

Pushing

Also known as the second stage of labor, pushing starts sometime after the cervix is completely dilated (10 centimeters).

• The importance of waiting

It is important to wait for the natural urge to bear down before starting active pushing. You are often encouraged to push by "holding your breath and push as hard and as long as you can." Research has suggested that a woman's spontaneous urge to push occurs three-to-five times during a contraction while the woman is exhaling and bearing down. 

• Pushing with an epidural

If you use an epidural, you may be encouraged to rest until you have the sensation to push. Women who receive epidural anesthesia for labor may have difficulty pushing, especially if the strength of the anesthetic numbs the sensation to bear down. The practice of "delayed pushing" is currently being studied in women using epidurals as an alternative to routine pushing at 10 centimeters.

There may be circumstances, such as having a strong regional anesthetic, or an arrest of labor, where you may not feel the urge to push. In event of such a circumstance, you will be assisted with pushing (see section on assisted delivery).

Other information/tips

Upright positioning (sitting, squatting, standing) allows gravity to help you push.

Allowing the baby's head to gradually stretch the tissue at the outlet of the vagina (perineum) will reduce the risk of a significant tear. Lying on your side is associated with fewer significant tears.

During second stage labor, your uterus pushes the baby down the birth canal (passive descent).

Perineal massage (gradual stretching of the vaginal and perineal tissues) from 36 weeks on has been associated with fewer perineal tears. Ask your doctor or midwife for information about perineal massage.

If your obstetrician or midwife is concerned about your or your baby's health, he or she may opt to shorten the second stage of labor by using a vacuum or forceps on the baby's head (performed by the obstetrician).

The breathing techniques used for pushing vary and depend upon what works best for you.