A Doula`s Guide to the Final 6 Weeks of Pregnancy
Contents
1. Also try to sit in ways that help to open up your pelvis see example on the left If labor is moving slowly There s no need to rush early labor Try to stay calm and relaxed and take good care of yourself If it s night time try to get some rest so you have more energy for active labor in the morning To help you rest take a warm bath might slow contractions a little then lie down lying on your left side is best If it s daytime and you want to move labor along you can be active go for walks etc or consult with caregiver about the idea of using natural augmentation such as nipple stimulation orgasm or acupressure What should support people do o Encourage mom to alternate rest distracting activities and labor enhancing activities o Encourage mom to eat drink and go to the bathroom at least once an hour Good foods during labor are bananas nonfat yogurt cooked cereal eggs graham crackers toast smoothies made with nonfat milk and non acidic fruit noodles or rice Focus on easily digested carbohydrates Avoid fatty foods and acidic foods Drink as much as possible drink mostly water and unsweetened tea since sweet drinks can cause nausea o Time contractions occasionally every few hours or when things seem to change significantly Time five contractions in a row and record when the contraction began how long it lasted and how long it had been since the start of the last one Active Labor What s H2. position see diagram just above of mom with head on pillow and rests there or sways her hips back and forth during contractions Alternate between pelvic tilts and open knee chest for 25 30 minutes When mom returns to a more upright position often the baby will move into a better position and the signs of back labor will fade Transition What s Happening Cervix dilates to 10 cm Contractions 2 3 minutes apart 60 90 seconds long Intense Mom may be discouraged scared angry May be trembling hot cold nauseous How long will it last 10 minutes to 2 5 hours Average is 1 1 5 hours in first time moms Breathing Techniques Hee hee breathing or hee hee blow Counted hee hee blow where partner tells mom how many hee hees to do before each blow Partners breathe with her Comfort Techniques Any of the techniques and positions from active labor Follow her cues What should support people do Stay very close to mom establish eye contact Give short and simple directions don t ask a lot of questions Speak calmly This is the most intense part of labor for many moms and mom needs lots of support and reassurance Second Stage Birth What s Happening Cervix has dilated baby has descended and is ready to be delivered Contractions continue 3 5 minutes apart lasting 45 90 seconds Contractions may be accompanied by a strong urge to push May feel like a need to have a bowel movement Mom s vocalizations may change to deep grunts o
3. 80 of the time you will go into labor on your own in the next 24 hours e Braxton Hicks Contractions Also called pre labor or false labor contractions oO Some women never experience these some women may have them for weeks before labor begins Pre labor contractions don t progress they may be irregular or may stay same length strength and frequency May last for a short time or for several hours Some women even start to develop a pattern with contractions every 6 7 minutes for 2 3 hours which then stop again Discomfort is mostly felt in the front of the abdomen as muscles tighten up May feel like your belly is a basketball Contractions may stop if you walk change position or change activity eat drink or empty bladder False Labor doesn t mean they don t hurt and it also doesn t mean that they re not doing anything Although the contractions aren t dilating your cervix yet they are helping you to progress in other ways moving the cervix to an anterior position ripening and effacing the cervix Positive Signs of Labor Labor has begun e Gush of amniotic fluid from vagina e Progressing contractions Get longer stronger and or closer together with time Are usually described as very strong or painful felt in the abdomen back or both May start in the back and radiate around to front Usually increase if you walk e Dilation of cervix seen in vaginal exam Early L
4. mother s milk has come in e Dehydration if you pinch the baby s skin it stays pinched up wrinkled crepe paper like skin dry mouth dark yellow urine sunken fontanel e Fever higher than 100 4 degrees F rectally or above 99 5 degrees F axillary under arm e Jaundice whites of the eyes are turning yellow skin below the nipple line turning yellow e White patches on the tongue or inside the mouth e Umbilical cord problems Any redness around the cord foul odor or pus bright red bleeding that makes a quarter sized spot on a teeshirt or diaper e Circumcision issues bright red bleeding swelling foul discharge unable to urinate e Vomiting forcefully or more frequently than usual more than spitting up e Feeding problems repeatedly refuses feedings for more than 6 to 8 hours e excessively or uncharacteristically fussy or irritable unusually lethargic or sleepy e Problems with breathing signs such as blue lips struggling to breathe flaring nostrils or deep indentations of the chest when breathing Breastfeeding Hints Good positions cradle hold football hold side lying See www breastfeeding com for illustrations Make sure baby s chest is lying flat against your chest baby s body is aligned ears line up with shoulders and hips baby s chin and nose are up against breast Signs of a good latch look baby shouldn t be just latched on to the nipple but has some of the areola in his mouth lips a
5. A Doula s Guide to the Final 6 Weeks of Pregnancy Taking Care of Yourself and Preparing for Labor Nutrition Eating well can help to prepare your body for labor 6 weeks before due date make sure you re eating a variety of healthy foods Especially o Iron your baby is now storing the iron he needs for the first few months of life Red meat and leafy greens like spinach some lettuces kale are good sources Your baby is also storing up vitamin D for his early months which helps with bone development Check your prenatal vitamin you need 200 400 I U per day Protein good for strengthening muscles Eggs dairy nuts beans and meat Calcium at least 3 servings a day Vitamin C helps develop healthy tissues which is important preparation for birth Prenatal vitamins help to cover all the other bases o Drink lots of fluid at least 64 ounces a day Water is best O o0O00 0 In the last few days before your due date focus on carbohydrates these build up energy stores in your muscles Try bread crackers cereal corn pasta potatoes rice fresh fruit and some fresh vegetables Eat frequent light meals Eat some protein foods but avoid fatty foods that are hard to digest and spicy foods which might increase nausea in labor Exercise Certain exercises can help prepare your body for labor Kegel exercises Kegels exercise the muscles in your pelvic floor which surround your vagina and anus This helps avoid tears a
6. Problems with urination Burning or blood in urine inability to urinate e Very foul or fish like odor to vaginal discharge e Increased pain at site of episiotomy or tear e Swollen red hot painful area on the leg especially the calf e Sore reddened hot painful area on breast along with fever or flu like symptoms Signs of postpartum depression It is normal to experience baby blues in the first month or so you may find yourself often crying for no reason This is the influence of hormones and will soon resolve However if you have a history of depression in yourself or your family or if there are a lot of difficulties in your current life situation you may be more at risk for postpartum depression Share this list of symptoms with a support person so they can help keep an eye out for them If 3 weeks of more after the birth you are not able to sleep well even when baby is sleeping crying a lot unable to concentrate feeling guilt and inadequacy disinterested in baby or hyperconcerned about baby worrying about harming self or baby or having headaches chest pains you may be developing PPD Contact a counselor or Depression after Delivery Newborn Warning Signs If you see these in the first month call baby s doctor e Diarrhea unusually frequent and very watery stools blood or mucus in stools e Failure to urinate every six to eight hours or fewer than five wet diapers in 24 hours after day 4 or 5 when
7. abor What s Happening Cervix effaces thins out from 50 100 dilates to 4 cm Contractions 5 30 minutes apart Contractions last 15 to 45 seconds or longer Mom may want to focus during contractions but can walk or talk if desired Can usually relax between contractions and can carry on a conversation Early labor can last 2 24 hours or more Breathing techniques No special techniques needed to cope with contractions However many moms find it helps to begin breathing patterns which are useful in later labor Begin and end contractions with a deep cleansing breath use deep abdominal breathing thru contraction Comfort Techniques Alternate rest and relaxation distracting activities and labor enhancing activities Being active going for walks dancing shopping can help labor to progress but it s important not to exhaust yourself Try to be relaxed and treat this as a vacation day Start a fun project or work on a hobby that you normally don t have time to do Positions During labor it is always better to be upright standing or stting than lying down Gravity helps to bring your baby down in your pelvis the pressure of baby s head on your cervix can help your cervix to dilate more quickly It s good to be active especially in ways that help change and shift the shape of your pelvis like walking climbing stairs doing hula dance or belly dance motions It s easier for your baby to rotate and descend if you re moving
8. activities are free Go to www parenttrust org or call Family Help Line This doula guide was written by Janelle Durham MSW CD CCE 2008
9. appening Cervix completely effaced dilates from 4 8 cm Contractions 3 5 minutes apart 40 70 seconds long more painful Active labor may last 30 minutes to 10 hours Change in Mom s mood During contractions mom is not able to walk or talk and is focused on contraction In between mom wants to focus on labor and does not want to be distracted When to go to the hospital Contractions are no more than five minutes apart lasting one minute with that pattern established for at least one hour and mom s mood has changed Breathing Techniques Deep abdominal breathing for as much of the contraction as is comfortable Over the peak of the contraction use hee hee breathing or hee hee blow Positions Again any position that s upright any hip swaying movement is good Also almost all women like to lean forward during labor this helps take the weight of baby off of your back Any of the positions shown above or any of these can be helpful for reducing pain Comfort Techniques for Active Labor Warm bath Touch Massage Effleurage light stroking on belly Counterpressure for back pain support person places the palm of his hand on her lower back and provides firm pressure during contractions Double Hip Squeeze Hot Cold Heating Pads on back or belly Ice Packs cool cloths on her forehead and back of neck Making noise Singing Moaning Sensory Distraction Music Aromatherapy Pictures Relaxation Techniques Touch Relaxation Vis
10. e on your back the better Sleep on your side During the day sit up straight in chairs sit backwards in a chair and lean your arms on the back stand or walk for part of the day lie belly down on a soft beanbag chair sit crosslegged on the floor do pelvic tilts Some people say the best activities are crawling on your hands and knees or scrubbing the floor on your hands and knees Emotional Preparation Fear can slow labor and increase pain so it s best to work out some of your fears before labor begins Spend some time thinking about or talking about what part of labor are you afraid of What s the worst thing that could happen during labor What scares you about birth and parenting Draw pictures or write it down talk about it or do whatever helps you explore and process these fears Also caring a new baby can be stressful so try to reduce other stresses before birth If you are struggling in your relationships with the baby s father or with your family work on this before the baby is born Figure out who you can reach out to for support if you re having a hard time with the baby talk to them about this before the baby is born Warning Signs in Pregnancy Call your doctor if you see any of these signs e Bleeding Bleeding especially bright red blood from your vagina at any time during pregnancy should be reported to caregiver immediately Headaches blurred vision swelling of arms hands or face pain right under y
11. hen you shift position but an on going dull ache that makes you restless and irritable Cramps Cramping in your belly that is mild to moderate in discomfort PMS symptoms crabby irritable Nesting Urge A sudden irresistible urge to clean or do projects to prepare for baby Frequent soft bowel movements diarrhea Flu like symptoms If you have these symptoms it doesn t necessarily mean labor is going to start right away It may be days or weeks before labor begins These symptoms are just a good reminder to make sure you have everything prepared for labor and birth and to make sure you know what other signs to be watching for Don t get overly excited just continue your normal routine get lots of rest eat and drink well and take care of yourself Preliminary Signs that labor may be about to begin e Bloody show During pregnancy cervix contains mucus which may be released in late pregnancy May be a thick plug of pinkish mucus which might come out when you use the toilet May be thin mucousy discharge on toilet paper If there is more blood than mucus call caregiver Note it s common to have a brownish bloody discharge within 24 hours of a vaginal exam or intercourse Don t mistake this for bloody show e Water breaks O O O Trickle or a gush If it s just a little mucousy fluid it may be mucous plug Pay attention to what time it breaks write down its color odor etc Call your doctor Usually
12. n and support for breastfeeding women Monthly group meetings and phone counseling 206 522 1336 www lalecheleague org Childbirth Education Association of Seattle s Breastfeeding Hotline 206 615 8078 Listings for lots of local resources www metrokc gov health breastfeeding Most hospitals have lactation consultants available call your hospital for information You can also contact your local Public Health office General Information and Referrals Children s Hospital Resource Line for basic health information 206 526 2500 Crisis Line 24 hour phone support and info for any personal family crisis 206 461 3222 Family Help Line Referral to support groups and crisis line between 9 am 11 pm 1 800 932 HOPE 4673 or 206 233 0139 Public Health Department home visits by nurses mother infant groups medical clinic family planning Medicaid and WIC program 206 296 4786 Family Resource Guide www pepsgroup org familyresources default htm Education and Support for New Parents PEPS Program for Early Parent Support Neighborhood support groups for new parents begin when babies are under 4 months and meet once a week for 4 months Also has drop in groups for families of children up to age 3 206 547 8570 www pepsgroup org Family Support Centers located throughout Seattle area offer support groups referral recreational activities for parents children classes on parenting child care and health screening Most
13. nd episiotomy during birth and helps your body recover better after the birth restoring good bladder control and sexual tone To learn how when you go to the bathroom begin pee ing then tighten up your muscles to stop urine from flowing Those are the muscles you want to work with Once you ve learned to tighten them you shouldn t do this while urinating that s just a tool to help you learn To practice Kegels Just tighten up the muscles then relax You can either do 10 20 quick repeats with a quick tighten release or you can do slow elevator kegels where you count slowly from 1 5 tightening your muscles a little tighter with each count then count back down from 5 1 gradually relaxing the muscles It s best to do 100 kegels a day in late pregnancy It sounds like a lot but it s easy to do a few at a time off and on all day You can do them while talking on the phone or watching TV or driving or showering or whenever You can do this anytime anywhere and no one knows you re doing it Pelvic tilts These strengthen your stomach muscles which can help with back pain They also help the baby move to an ideal position for birth How to Get on your hands and knees Tighten up your stomach muscles and muscles in your bottom this will arch your back up like an angry cat at the same time tuck your tail like a scared dog Hold for a few seconds then relax back to a flat back don t let back sag down Repeat A
14. our ribcage Sudden unexplained weight gain Decreased fetal movements Signs of Labor before 37 weeks For example contractions of your uterus five or more in an hour Menstrual like cramps Dull ache in your lower back Pressure in your pelvis groin or thighs Increase change in vaginal discharge especially a gush of fluid When will your baby be born Your due date is only a guess at when your baby is born It is perfectly normal for your baby to come anytime from 2 weeks before your due date to 2 weeks after your due date I always tell my clients and students to be ready for the baby 2 weeks before the due date just in case but plan on the pregnancy going 2 weeks past the due date just in case If your baby is late try not to get too impatient Many women are tired of being pregnant and will hope for induction where a doctor uses medication to make labor begin However all methods of induction carry risks with them primarily longer and stronger contractions which are a more painful for mom and b harder for the baby to cope with may lead to fetal distress and a c section Use the extra days to take extra care of yourself and pamper yourself before you need to focus all your energy on caring for someone else s needs Signs that Labor May Begin Soon Has Begun Possible Signs that labor may begin in the next few days or weeks e Backache Not the type of backache you have in late pregnancy that changes w
15. r groans How long will it last Anywhere from a few minutes to three hours Typically 1 2 hours When should mom start pushing Check with nurse or doctor before starting to bear down Breathing Techniques and Bearing Down Caregivers will guide you But generally With each contraction take in a deep breath then bear down for five to seven seconds while exhaling or gently holding breath Then relax briefly take in a quick breath Then bear down again Bear down three or four times during each contraction In between contractions take nice deep breaths and rest Comfort Any of the ideas above A cold cloth on her forehead or neck is especially popular What should partners do Help support mom in chosen position Help guide pushing efforts and breathing Lots of encouragement and reassurance Reinforce caregivers suggestions D ag Third Stage Newborn Procedures Immediately after birth they may place the baby up on mom s belly or may take it over toa warming table depending on the condition of the baby and on hospital policy The doctor will deliver the placenta you may need to do a few more light pushes Then the doctor will examine your perineum and will repair any tears or episiotomy Hospital policies vary regarding immediate newborn care but most hospitals in the Seattle area will attempt to leave the baby in its parents arms for as much of the first hour as possible to allow for initial bonding and the fi
16. re flanged out fish lips listen don t hear smacking or clicking noises should hear swallowing after day 5 when mature milk has come in feel may hurt for first minute or so Should not hurt continuously Hunger cues rooting tongue thrusting sucking Full cues falls asleep pulls away from breast if he s been nursing less than five minutes he s not full and needs to be woken up or returned to the breast but if it s been a long nursing this shows he has had enough Feed on demand anytime baby shows hunger cues At least every three hours more is OK even every hour or hour and a half Should feed at least 10 minutes on first breast then as long as desired on second breast Next feeding start on the other side Nipple care After each nursing dry off nipple then express a little breast milk and rub it in to the nipple Leave nipples exposed to fresh air for a few minutes before closing bra whenever possible Don t use soap to clean nipples just use clean water For sore nipples Follow the nipple care recommendations religiously Nurse more often but for a shorter time each nursing Use labor breathing techniques to cope with pain Help for engorgement Take a hot shower or lay warm washcloths on your breasts for a few minutes to relieve soreness and hardness Nurse baby more often for shorter periods Seattle area resources Breastfeeding Support Lactation consultants La Leche League informatio
17. rst breastfeeding At the end of one hour some mandatory procedures are done with the infant including antibiotic eye ointment anda Vitamin K shot Typically the baby is also weighed and measured at this time and may be given its first bath Postpartum Recovery Lochia You will have vaginal bleeding for two to six weeks after the birth The early days are similar to a very heavy menstrual period though you may see large clots of blood It will taper off to a lighter flow the color will become browner or pink Sexuality Most doctors recommend waiting six weeks after birth or until lochia stops for resuming vaginal intercourse This allows your perineum to heal after birth Remember that ovulation may resume shortly after birth and you will be fertile two weeks before your first period so it is important to use birth control if you are not prepared for a possible pregnancy Care of the perineum You may experience soreness after the birth especially when going to the bathroom Try to drink a lot of water as this will dilute your urine and it will sting less when you pee After urinating use a spray bottle they will give this to you at the hospital to wash off your genitals with warm water then gently pat dry with toilet paper Postpartum Warning Signs If you see these in the first month call your doctor e Passage of a blood clot larger than a lemon Heavy bleeding soaks a maxi pad in an hour e Fever of 100 4 or higher e
18. t least 20 times a day Sit crosslegged Sit on the floor or elsewhere Indian style This helps open up and relax your hip joints which can help during delivery it also helps baby get in the best position aR BOS Help the Baby Move into the Best Position for Birth can lead to shorter less painful labor What position is best and why Ideally in labor baby is head down with his back along your belly and his face pointing toward your back This is called anterior Lots of babies as many as 25 or 1 in 4 are posterior instead looking toward your belly with his hard little head pressing against your lower back This causes back labor which is usually more painful than regular labor and labor also tends to last much longer as the baby is not in a good position to help your cervix dilate There are suggestions later on in the booklet for how to treat back labor however it s better if you can prevent having a posterior baby and back labor by trying the following methods in the last six weeks of pregnancy What to avoid The heaviest part of a baby is his back By the laws of gravity his body will rotate so the heaviest part is down closest to the ground If you spend the final weeks of pregnancy lying on your back leaning back in the car and reclining in the couch with your feet up your back will always be lowest and baby is more likely to be posterior What to do Try any of these the more you do them and the less you r
19. ualization Encouragement and Support What should support people do Remind mom to drink after each contraction and go to the bathroom once an hour Help with Comfort Techniques Establish Rituals by doing the same thing on each contraction for as long as that works then switching to new ritual Let her rest when she needs to but remind her that being physically active can help labor progress Try to phrase things as positive suggestions not criticisms Back Labor Can begin at any stage of labor Signs The most common sign is back pain during contractions the mom complains that she s having a lot of pain in her lower back Another very important sign to look for is contractions that couple there will be two or three contractions very close together then there s a long pause with no contractions then two or three contractions clustered together Why is it a problem Usually it s a sign that the baby is posterior see discussion about baby s position on page 2 of this booklet Generally labor is more painful it takes much longer to fully dilate to 10 cm and pushing can be slower and more difficult with a posterior baby What can support people do to help fix the problem As soon as I see any signs of coupling contractions or back pain I try the following techniques right away The mom gets on her hands and knees and does pelvic tilt exercises see description on first page Or mom gets in the open knee chest
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