Practically preparing for labour and birth
New parents-to-be are often inundated with well-meaning advice, myths and old wives’ tales in the lead up to labour and birth. We are going to explore some of the ways in which you can prepare, both mentally and physically, and at the same time debunk some well-intended but not necessarily correct information.
Antenatal Classes
It's no surprise that given I run Antenatal Co. antenatal classes, this might be my first recommendation for preparing for labour. However, I do truly believe that a great antenatal class that presents parents-to-be with well-rounded, unbiased, up-to-date education is one of the best ways to prepare for labour and birth. No matter how you want to labour and birth, it's important to be well informed about all the different scenarios for labour and birth. Knowledge is power and being able to understand what is happening will give you the ability to make informed decisions and cope with change much easier in the moment if things go outside your ‘plan’.
It is also hugely beneficial for your birthing partner to be educated in the same way. Giving birth can be overwhelming so it's helpful to have your partner also understand what is going on and give them the knowledge to be able to advocate for you should you need it. They are generally more present, able to ask questions and make suggestions as to what you might want. It can be harder for your partner watching what is going on than it is for you going through it yourself, but if they are prepared and educated then that can make the whole experience less stressful or traumatic for them.
Meditation/Breathing
No matter how you are planning on labouring and birthing your baby, I highly recommend that meditation and breathing exercises are part of your ‘coping with labour toolkit’. It's easy to think that these things will just come naturally to you in the moment but deep, relaxed breathing and having a calm mind are much harder to do when you are uncomfortable than you might think. So to remain calm, comfortable and relaxed, you are going to need to practise them in advance.
During labour you want to be in a calm space so that all the lovely hormones going around your body can work for you. Oxytocin is well known as the ‘hormone of love’ and stimulates powerful contractions during your labour, opening your cervix and moving your baby down into the birth canal. Endorphins are calming and pain-relieving hormones that are produced and when you face stress or pain, are wonderful in helping you cope. In contrast, adrenaline is released in response to fear, extreme pain and stress - all valid feelings to have in labour - but we want to keep this hormone level as low as possible. High levels of adrenaline can cause labours to slow or even stop and may cause distress to the baby as well.
Physiologically there are a lot of changes to your respiratory system when you are pregnant. The two main ones are an increase in progesterone, which causes an increase in ventilation and can feel like you have shortness of breath. The other one is that the angle of your lower rib cage increases as your pregnancy progresses, this causes an increase in the work of breathing. Deep, relaxed breathing during labour is one of the most important tools used to help keep you in a calm, safe space and allow those oxytocin and endorphin hormones to work their magic in progressing your labour and get you closer to meeting your baby.
The same goes with meditation, birth affirmations and visualisation, all tools used to keep those oxytocin levels and endorphin levels high and you in a calm, centered, relaxed state throughout your whole labour and birth. These tools can be used in any birthing experience, no matter how your baby is born, and you can use them throughout your parenting journey too. There are many YouTube clips on how to breathe and meditate to help you have a calm, positive birth experience, however the trick is to practice them. Trying doing them just once a day, even when you go to bed at night or first thing in the morning to start your day. The key is consistency.
Get Organised
Being physically, as well as mentally, prepared to go into labour can help keep some of the anticipatory anxiety away. Packing your hospital bags is one of the jobs that needs to be done in preparation for birth and might take you a bit to get it organised. There are many lists online with suggestions as to what to pack so see what makes sense for you and also ask your lead maternity carer what they recommend. Ideally this bag would be packed by the time you are 36 weeks pregnant, with just the final few things to throw in on the day.
Your support person has a few things to be prepared for also. Firstly it’s important that they know how to use the baby capsule or car seat because it's not likely anyone will help you on the day. They need to know how to install it in the car correctly and how to strap the baby into the car seat safely. They also need to know where to go on d-day! Think about which is the best route to take to the hospital or birthing centre. Will they need to take a different route if it’s peak hour traffic? Where are they going to park when they get there? Where is the emergency entrance if you're in a massive hurry? Which floor is the maternity suite on? Lots of hospitals have online tours and some even run tours of the facility throughout the week that you could attend (Covid restrictions may apply). Make sure they also keep the car topped up, you do not want to have to stop for petrol while mum is in the throes of labour, she won't be happy!
There are also some key questions you need to ask your LMC before you go into labour and these can be discussed when you have your birth plan appointment, generally around 36 weeks. You will be asked to share your hopes and dreams for your labour and birth and what you have decided about things such as; will you give your baby Vitamin K at birth, do you want an epidural, are you going to breast or bottle feed and so on. It is also important that you ask them some questions too as every LMC works differently. For example, when would they like you to call them if you think you are in labour? Do they want to know the second you have your first contraction or not hear from you until you are in established labour? When will you go to the hospital and what does that process look like? Will they offer you an epidural or wait for you to ask for one? Do they do delayed cord clamping? That appointment is generally twice as long as a normal one so make sure you make the most of it.
Perineal Massage
Perineal massage can be done by you or your partner from around 35 weeks pregnant until your baby has been born. You pop a couple of lubricated fingers into your vagina and massage downwards and then around in a ‘u shape’, starting at the base of your vaginal opening closest to your perineum. Some protocols suggest that you do this once a week, others 3-4 times per week. Some for a few minutes and others up to 10 minutes each time. The idea is that you gently massage the muscles and tissues out like you would massage out any tight muscle. This brings blood flow to the perineum, enhancing circulation and stretching the tissues which helps them to widen for the baby to pass through.
There are a number of studies published on perineal massage, most of the studies have flaws in their data analysis and have strong bias towards perineal massage being hugely beneficial so their conclusions are strongly swayed in that direction. Some show that there is some evidence to suggest that perineal massage during pregnancy might be associated with decreased rates of episiotomies, especially in first time mothers. Others showed not much difference at all. Overall there seemed to be little benefit or reduction in perineal damage, especially to women who had previously had a vaginal birth. Tools such as the EPI-NO, an instrument that is placed inside the vagina and then blown up to stretch the perineal tissues, currently has no research behind it to suggest that it is helpful in reducing perineal trauma and is not recommended.
The best way to reduce perineal tears is to discuss this with your LMC in your birth plan appointment. What is their episiotomy and 3rd/4th degree tear rate? In what situations do they see them occur? What measures or practices do they have in place to help prevent perineal damage? You might like to discuss putting a warm compress on your perineum during the second stage and the baby crowning, and also birthing positions. Calmly breathing the baby out and encouraging a slow delivery of the baby’s head, allows time for your muscles, tissues and skin to stretch slowly over the baby head as it comes out, and is much more likely to reduce the likelihood of perineal damage than doing perineal massage in pregnancy.
Overall, if you are pregnant and want to try perineal massage then there does not seem to be any harm in it, and it could potentially be beneficial.
Raspberry Leaf Tea
You can drink raspberry leaf tea any time in your pregnancy and during the postpartum period. There are claims that raspberry leaf tea can help women in the first trimester reduce nausea and vomiting. In the second and third trimester there is some research to suggest that it can help to strengthen the uterus, shorten labour, reduce the use of birthing interventions and prevent excessive postpartum bleeding.
There have only been a handful of studies on the benefits of raspberry leaf tea in relation to pregnancy, labour and birth outcomes since the first study was published in 1941. After reviewing the limited studies it was found that raspberry leaf tea may not actually shorten the first stage of labour as once thought but it may slightly shorten the second stage of labour and lower the rate of assisted deliveries. However concerns have been raised that raspberry leaf products can lead to miscarriage or premature labour and have some side effects such as diarrhoea and low blood sugar.
Currently there is nowhere near enough evidence to suggest how effective or safe raspberry leaf tea products are in pregnancy and there is no known safe amount of raspberry leaf tea to consume. Hopefully there will be studies carried out in the future to shed more light on this topic but at this stage it would be best to exercise caution with this product and, as always, consult your LMC.
Inducing Labour Naturally
If you are trying to get yourself into labour there are many old wives’ tales but many have little evidence to prove that they do actually work. Are there any that are worth trying?
Eating pineapple. At this stage there are no clinical research studies that have been conducted on humans, so there is no evidence that eating pineapple or drinking pineapple juice helps induce labour.
Drinking castor oil and eating hot curries use the theory that if you give yourself diarrhoea and upset the bowels this might put you into labour. However, other than sounding particularly unpleasant, it's not recommended as diarrhoea makes you dehydrated and it's not an ideal way to start your labour.
Sex is another one, however the probability of an overdue woman wanting to have sex is likely to be very low, as she will be tired and uncomfortable and sex the last thing on her mind! However researchers believe that, although there is no conclusive evidence at this stage, sexual activity could possibly affect labour induction through three ways. Firstly prostaglandins in semen near the cervix could help with cervical ‘ripening’, secondly an increase in oxytocin (one of the hormones that is responsible for contractions) from close skin-to-skin contact and possible nipple stimulation, and thirdly orgasm which stimulates uterine activity. If sex was going to induce labour, it’s likely that you would need all three to be effective. More research is needed in this area before it's claimed to be an effective means of inducing labour but as long as your waters haven’t broken and there are no other health concerns and you actually do want to give it a go, it is worth a try.
Dates. Researchers believe that eating dates can affect oxytocin receptors and help the uterine muscles respond better to your own oxytocin which can result in more effective uterine contractions. Studies have shown that eating 3 - 4 large medjool dates a day from 36 - 37 weeks pregnant can shorten the early phase of labour, decrease postpartum bleeding and the need for induction or augmentation of labour, have less chance of needing an assisted delivery and may also help shorten the second stage of labour, the pushing part, too. Sounds like a magical fruit and there is evidence behind this one but may not be recommended for people with diabetes and high risk pregnancies so again, discuss with your LMC before proceeding.
Finally a ‘stretch and sweep’ is something you might be offered by your LMC to try and get you into labour. In fact the World Health Organisation recommends that all pregnant women should be offered a stretch and sweep at or near term. It is a vaginal examination done with your consent, where your LMC puts a finger through your cervix and moves it around to gently separate the membranes from the lower part of the uterus. They do this in the hope that they will help soften and ripen the cervix and promote uterine activity to help you avoid a more formal medical induction later on. Some studies have shown that it can reduce the chances of needing a medical induction for post-dates and there is enough evidence that even the World Health Organisation recommends it, however it definitely won't work for everyone but it is worth a try if your LMC suggests it.
All of these natural induction methods are a bit like the chicken and the egg scenario and you will have friends who swear that eating that hot curry the night before they went into labour was the reason it happened. Who knows if they would have gone into labour that day anyway, regardless of the curry?
The anticipation of labour and birth can bring with it excitement and joy as well as some nerves and anxiety and this is all completely normal. Your life will literally change forever the day your baby is born so it makes perfect sense to feel the way you do. Be kind to yourself and do what you need to do to be in a positive mindset. Go to that antenatal class, practise your breathing, get organised and look after yourself. Get plenty of rest, keep hydrated and eat good nutritious food. You’ve got this!
