WHAT IS ACTIVE LABOR?
Active labour is when things really get going! Labour is divided into three stages. Stage one — which lasts from the onset of labour until the cervix is fully dilated — is the longest stage of labour. During that time period, your labour will probably shift from not-so-bad to wow-that-is-intense! So childbirth educators and health professionals often talk about the three phases of labour that occur during the first stage (kind of confusing, huh?).
The first phase is latent labour. That’s when things are just getting started. You might lose your mucus plug, notice some bloody show and have some early contractions. During this time, your cervix thins out and begins to dilate.
The next phase of labour is active labour. You’ll know when your body shifts into active labour: your contractions will suddenly require more of your attention. If you could walk and talk through your contraction before, you probably can’t now. This is when things start getting intense — and when most moms opt for some kind of pain relief. Regular, strong contractions during active labour will cause your uterus to dilate from about 4 centimetres to 7 centimetres (10 centimetres is considered “complete” and ready to “push!”).
ACTIVE BIRTH – 8 BIG BENEFITS FOR MOTHER AND BABY
During an active birth, the mother-to-be is encouraged to move around freely and choose positions that feel comfortable to her. Though it may be a relatively common sight in a hospital birth ward, mothers having active births are unlikely to lie on their backs to birth their babies. Throughout history and across the world, women have been giving birth in upright positions. However, it’s believed to be King Louis XIV who made a massive impact on future generations of childbirth. He apparently insisted that his wives should lie down on a table, so he could get a better view of the birth. So, birthing on your back was born. That was until women eventually fought back from this painful, physiologically dysfunctional way of giving birth, which can result in the pelvis losing up to 30% of its capacity to open up for birth. The active birth movement started off as a way of giving women their power back. In a world where labour was controlled by medical professionals, the active birth movement encouraged women to take control of their births. Instead of being told what to do, women are encouraged to do whatever feels the most comfortable.
The term ‘active birth’ was coined by Janet Balaskas in the 1980s. As an antenatal teacher, Janet taught women relaxation techniques and breathing exercises to use during labour. Through research, Janet discovered that women in other cultures didn’t lie on their backs to give birth. In fact they squatted, knelt and stood, surrounded by supportive women. In Western society, most women still give birth on their backs. That said, the active birth movement is gaining in popularity, and many healthcare professionals are now aware of the benefits of giving birth in upright positions. For this reason, many birth centres now have a number of props in the rooms to allow women to move around and change position during labour. From birthing stools, balls and cushions to allow for comfortable sitting and kneeling positions, to ropes to assist with a squatting position. Many birth centres have water pools which allow women to labour and give birth in water. The water provides support and buoyancy which allows the women to change position easily in the pool.
8 BENEFITS OF AN ACTIVE BIRTH
There are a number of significant, research backed reasons to choose active birth, including:
- REDUCED RISK OF MEDICAL INTERVENTIONS
In 2012, a study found that upright positions during the second stage of labour was associated with a significant decrease in the use of interventions. The study also found that the pelvis opens up when the woman is in a squatting or hands and knee position, allowing more room for the baby to travel through.
- SHORTER LABOUR TIME
In 2009, a research review found that giving birth in an upright position was associated with a shorter first stage of labour. The study found that women who gave birth in an upright position had first stages that were approximately one hour shorter. The use of doulas have also been proven to result in a shorter labour. This is likely partly due to the fact that they support women to have active labours.
- LESS PAINFUL LABOUR
Women who give birth lying down are more likely to have epidurals, but those labouring in an upright position are more likely to cope with the pain. A 2009 study found that labouring in an upright position was associated with lower levels of pain during labour. Labouring on your back has been shown to result in a more painful labour.
- A MORE SATISFYING LABOUR
A study in 2009 found that women who laboured in an upright position felt more satisfied with their birth experience overall. Again, this finding is similar to those who use doulas.
- BETTER OXYGEN FLOW TO THE BABY
Being in an upright position allows for a better flow of blood to the baby. Lying down on your back can lead to a reduced flow of blood to the baby. Compressed blood and oxygen supply can cause fetal distress, resulting in further interventions.
- MAKES THE MOST OF GRAVITY
It makes sense to utilise gravity during labour. Pushing in an upright position allows gravity to do its job and help the baby travel down through the birth canal. Whereas, in a lying down position, you have gravity working against you.
- A WOMAN’S PARTNER WILL FEEL MORE INVOLVED
During an active labour, a birth partner feels like he or she is actively participating in supporting the mother-to-be. This creates a rewarding, bonding experience — teamwork — which can then sets the scene and filters through into parenthood.
- MAY RESULT IN LESS TRAUMA TO THE BABY
Because an active birth can result in fewer interventions, less likelihood of stress to the baby or a longer than necessary labour, your baby stands to experience a more trauma free birth. Of course, there are no guarantees, but active birth certainly helps to keep birth normal for both mother and baby.
HOW TO HAVE AN ACTIVE BIRTH SO, HOW CAN YOU ACHIEVE AN ACTIVE BIRTH?
Here are 5 tips:
CHOOSE A SUPPORTIVE HEALTHCARE PROVIDER
Speak to your healthcare provider early on about your desire to have an active birth. Ask questions about their experience in this area, and what steps they would take to help you realise this dream. If they seem unsupportive, look into other healthcare providers who may be better able to get on board with your vision. Here are 11 questions to ask an obgyn before hiring them.
DECIDE WHERE YOU WANT TO GIVE BIRTH
If you are having a low risk pregnancy, you should be able to choose where you give birth. You could give birth at your local hospital, at a nearby birth centre or in the comfort of your own home. Have a look at all of your options (even if you’re unsure about some), and ask the staff to show you the birth facilities. Many birth centres now have birthing stools, balls, ropes and pools as well as other props to encourage women to stay active during labour. Your local hospital may also have some of these props, so be sure to ask questions when you take a look round. If you choose to give birth at home, your household furniture will become your birthing props! You may also like to hire or buy a birthing pool for your home birth.
ATTEND PRENATAL CLASSES
Prenatal classes often focus on active birth and discuss upright and active positions for labour and birth. Your prenatal classes are tailored to those in attendance, so make sure you speak up about your desire to have an active birth. There are also active birth classes you can attend to try out different positions and learn more about how to have an active birth. Read about why BellyBelly encourages women and their partners to attend non-hospital based birth classes here.
STAY ACTIVE DURING PREGNANCY
Labour is a marathon, and without any training it’s little wonder that some women end up lying on their backs in bed. Regular exercise throughout pregnancy can help to improve your stamina and general fitness so that you’ll be better able to cope during the birth.
GET YOUR PARTNER ON BOARD
Your partner has an active role to play in helping you to achieve your vision of what the birth should look like. In an active birth, your partner can help you to move position, and support your weight in certain positions. By holding you up and letting you rest on him, he can help to make the birth a little bit easier. Ask your partner to read up about positions in advance so that he can support you on the day.
ACTIVE LABOR PHASE
WHAT TO DO:
Now is time for you to head to the hospital or birth center. Your contractions will be stronger, longer and closer together. It is very important that you have plenty of support. It is also a good time to start your breathing techniques and try a few relaxation exercises between contractions.
You should switch positions often during this time. You might want to try walking or taking a warm bath. Continue to drink plenty of water and urinate periodically.
WHAT TO EXPECT:
Active labor will last about 3-5 hours
Your cervix will dilate from 4cm to 7cm
Contractions during this phase will last about 45-60 seconds with 3-5 minutes rest in between
Contractions will feel stronger and longer
This is usually the time to head to the hospital or birth center
Tips for the support person:
- Give the mother your undivided attention
- Offer her verbal reassurance and encouragement
- Massage her abdomen and lower back
- Keep track of the contractions (if she is being monitored, find out how the machine works)
- Go through the breathing techniques with her
- Help make her comfortable (prop pillows, get her water, apply touch)
- Remind her to change positions frequently (go with her on a walk or offer her a bath)
- Provide distractions from labor such as music, reading a book, or playing a simple card game
- Don’t think that there is something wrong if she is not responding to you
The active phase of labor usually lasts from two to three and a half hours (with, again, a wide range considered normal) as your cervix dilates to 7 centimeters. You’ll usually be in the hospital or birthing center by this phase (or if you’re delivering at home, your midwife should be with you by now).
HOW TO KNOW YOU’RE IN ACTIVE LABOR?
Your contractions will grow more concentrated and increasingly more intense (in other words, painful). As they become stronger and longer (typically lasting 40 to 60 seconds, with a distinct peak halfway through) and more frequent (coming every three to four minutes, though the pattern may not be regular).
You can expect to feel all of the following (though you won’t feel pain if you’ve had an epidural):
- Increasing pain and discomfort with contractions (you may not be able to talk through them now)
- Increasing backache
- Leg discomfort or heaviness
- Increasing bloody show
- Rupture of the membranes if they haven’t already (or your membranes might be ruptured artificially now)
WHAT THE HEALTHCARE STAFF WILL DO?
Assuming everything is progressing normally and safely, the hospital staff will leave you alone (or stay out of your way, but in your room), checking and monitoring you as needed, but also allowing you to work through your labor with your coach and other support people without interference.
You can expect them to:
- Take your blood pressure
- Time and monitor the strength of your contractions
- Evaluate the quantity and quality of bloody discharge
- Monitor your baby with a Doppler or fetal monitor
- Get an IV going if you’re going to want an epidural
- Possibly try to augment your labor if it’s progressing very slowly by the use of Picotin or by artificially rupturing the membranes (if they’re still intact)
WHAT YOU CAN DO DURING ACTIVE LABOR?
With fewer breaks in the action, there’s less opportunity to rest between contractions. Emotionally, you may feel restless and find it more difficult to relax, and your concentration may become more intense as you become absorbed in your labor efforts. Your confidence might waver along with your patience, or you may feel excited and encouraged. Whatever your feelings they’re normal — just get ready to start getting “active.” It’s all about your comfort now, so:
- Ask for help. Don’t hesitate to ask your coach for whatever you need to get and stay as comfortable as possible, whether it’s a back rub or a washcloth to cool your face. As much as your coach is going to want to help, he or she is going to have a hard time anticipating your needs — especially if this is his or her first time, too.
- Start your breathing exercises. If you’re planning on using them, start as soon as contractions become too strong to talk through. Didn’t plan ahead and practice? Ask the nurse or doula for some simple breathing suggestions. Remember to do whatever relaxes you and makes you feel more comfortable (if they aren’t working for you, don’t stick with them!).
- Ask for an epidural. If you’d like medication for labor pain relief, now’s a good time to ask for it. An epidural can be given as soon as you feel you need it.
- Use relaxation techniques. Especially if you’re having an unmedicated birth, relaxing between contractions will become increasingly difficult — but also increasingly important as your energy reserves are taxed.
- Stay hydrated. You might be offered light, clear beverages or ice chips frequently to replace fluid and keep your mouth moist.
- Ask for a snack. If you’re hungry and have your practitioner’s OK, have a light snack (a Popsicle, for example).
- Stay on the moveif you can. Walk around a bit (though you won’t be able to if you have an epidural) or change positions.
- Pee periodically. Continue to urinate regularly, too. You may not notice you need to because of the pelvic pressure, but a full bladder can keep you from making as much progress. (If you’ve been given an epidural, you’ll already be hooked up to a catheter.)