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FIRST STAGE OF LABOUR

Preparing for Birth
There is a fundamental difference between a maze and a labyrinth. Both are intricately patterned winding affairs but whereas a maze is designed to get you lost, misleading you with dead-ends and pointless passages, a labyrinth will always lead you to its end. It might seem the same, but with persistence and staying power you will not get lost in a labyrinth.

Modern birth is depicted as a maze. Without the help and intervention of the medical establishment, women are led to believe they will get lost or will not cope. Birth, though natural, is presented as something complex, designed to trip us up at every twist and turn. But this is a misrepresentation. Birth is more like a labyrinth than a maze. If you trust in the process and have patience, then you will get to the end with as much or as little help as you wish.

Having faith in the process of birth, and recognising that it will have a beginning, a middle and an end is good psychological preparation for the journey of labour.

Pre-labour
Although labour is a continuum, it is useful to think of it in stages just to have some sense of where you are throughout.

Knowing the difference between pre-labour and actual established labour can be difficult for first time mothers but it will save you an unnecessarily early trip to hospital and many hours of clock-watching which is likely to make you feel dispirited. Many an account of a 24 hour labour is because the measure included pre-labour and not just established labour.

Pre-labour is, in textbook terms, the first three centimetres of dilation. In second and subsequent labours this can and often does occur in the weeks leading up to birth. For the first time mother, it is characterised by contractions that are spaced a long way apart and which are erratic. It can take a very long time but is a manageable stage of labour. A good measure of whether it is established labour or not is if you can still carry on a fairly normal conversation between contractions- of you can do so easily, it is likely that you are in pre-labour.

Coping with Pre-Labour
Carry on as normal as much as you can. Obviously its good to make sure you have everything you need if you are planning to give birth at home or your bag ready and the petrol tank topped up if you are going to hospital, but other than that just keep on as normally as is possible.

If it is during the day then keep mobile. This will help the labour and the baby who will be moving into the best position for birth, if it is not there already. Don’t be surprised if established labour doesn’t kick in until nightfall, as most births do happen at night.

Established Labour
In textbook terms this is between 3 and 8/9 cm dilation. The contractions are every five minutes and last for between 30 and 45 seconds.

You will find conversations increasingly difficult and will feel compelled to focus on nothing but your labour.

Another way of telling that you are in established labour is that the shape of the belly changes- becoming box-like- with each contraction.

Coping with Established Labour
As the momentum of the labour builds you will increasingly need to turn inwards and start to anticipate contractions. If you are able to get into a rhythm of anticipating a contraction and moving or swaying or doing whatever feels comfortable as the contraction builds then you will be on top of it when it peaks.

It is helpful to know that a contraction builds in intensity and then peaks, but as soon as it peaks, it then stops- as though it has fallen off a cliff. This means that at the point at which you think that you might not be able to deal with the contraction, it is over.

Make sure that your environment is suitable for labour- respect your own need for minimum interference, privacy, low-lighting and quiet. If you are transferring to hospital then get your partner to take care of your birth notes and answer questions so that you can remain focussed.

Remember that as the contractions build so do your body’s own endorphins which are your natural pain killer. The focus in so many books and birth preparation classes is on the contraction- few people talk about the blissful period between contractions when there is no sensation at all, but just the lovely feeling as your body is flooded with hormones and endorphins. If you stay within your labour you will give yourself the chance to enjoy this period between contractions.

As labour builds trust that your mind and body are working in tandem. If you keep going- thinking of each contraction as one less that you have to do and one step closer to meeting your baby- then you will find yourself heartened as you cope with each one. Labour is not designed to trip you up. Countless women have laboured successfully to have enabled you too to labour- a long line of mother after mother after mother- and you have the capacity to labour well. Birth is not a maze, but a labyrinth-just a journey with twists and turns and difficult bits, but a journey all the same.

Be as active as possible- this will facilitate your labour making it shorter, less painful and safer for you and for the baby. Don’t worry about what positions you adopt but simply let your instincts lead you. If you are asked to do anything that restricts your capacity to move then see if there are alternatives or mobile versions so that you can continue to labour unimpeded.

Breathe- it sounds obvious but it is essential to remember to breathe…long deep breaths and use sound if you wish. There seems to be an indirect correlation between the amount of sound a woman makes and how much pain she is in. If you hold your breath- which is a common response to something that you anticipate being overwhelming- you can make it so. If you breathe, focussing in particular on the exhalation, then you will release tension and find your capacity to cope increases hugely.

Consider using water at the end of the first stage, when the contractions increase in intensity and the space between them reduces. Water will help you cope with this more difficult part, increase the relaxation between contractions, help to hold you up and so conserve your energy and will take the peak off each contraction. It will also speed up this final stage of labour and take you through transition
and stage 2.

Finally, remember that birth is partly physical and partly mental. Make sure you drink water or juice throughout labour and if you feel like it, have a snack to keep your strength up. Remain active as much as possible, moving as you feel you want to.
Allow yourself to mentally retreat, to be on another planet as Michel Odent puts it and enjoy the unique experience that this affords you. Many women find this experience, this losing yourself to the process, the most wonderful aspect of birth.
Have faith in your capacity to cope. As my midwife said to me before having my first baby, ‘You will not be sent more pain than you can handle’. You were designed to give birth and your body and mind work in wonderful synchrony in order for you to do so. You are your best guide, so respect your needs and instincts, and listen to what your body tells you. If you trust yourself whilst remaining open to possibility and to change, you will be well on the way to having a very positive birth experience.

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