How to Prepare for an Unmedicated Delivery
Get the nitty-gritty on how to prepare if you will not get drugs or anesthesia during labor from moms who've been there and doctors who help their patients do it daily.
Aiming for an unmedicated or low-intervention labor and birth? As it turns out, ditching the drugs has advantages many pregnant women don’t even know about. Women who get an epidural (like the majority of those giving birth vaginally in the U.S.) have a greater incidence of risky interventions to get Baby out, such as vacuum extraction, delivery by forceps, and emergency C-section, according to a study in National Vital Statistics Reports. An epidural can also mean short-lived but unsavory side effects for Mom, including low blood pressure, headache, and fever. Not exactly the warm and fuzzy feelings you want in those first moments with your newborn!
Recovery can also be smoother for those who deliver without drugs or anesthesia. "These moms are up faster, feel better, and often experience less tearing and swelling," says Ryan Dickerson, M.D., an obstetrician in Baton Rouge. Women who skip the meds instinctively push, rather than exerting when they are told, which mean less pushing and less tearing, Dr. Dickerson explains. Other reasons moms with unmedicated births stay more intact: They generally don't need equipment to get Baby out and they get vaginal exams to see how far labor has progressed.
If you want to have an unmedicated delivery, tap into these strategies from experts and moms who made it through without meds. Even if you do opt for the epidural (remember, it's your choice!), you can stay calmer and more comfortable till the anesthesiologist arrives.
Preparing for Unmedicated Childbirth Throughout Pregnancy
Learn to Face Contractions
One of the secrets to an unmedicated birth is being able to relax in response to pain—a tall order, we know. When you're afraid of in the throes of agonizing contractions, your body's reaction is to stiffen, which tends to exacerbate discomfort, explains Heidi Rinehart, M.D., an obstetrician in Keene, New Hampshire. Fear increases tension, which ups the agony. "When you're tense, some muscles are tightening and trying to hold the baby in, while the muscles in your uterus are tightening to try to push the baby out," says Dr. Rinehart. "The muscles are fighting with each other, which makes it hurt more."
If you can stay (somewhat!) relaxed in the face of strong contractions, you'll have less resistance to opening up for the baby to come out. One trick? Try an exercise called The Grip. "It simulates contractions and allows you to up your pain threshold," says Julietta Appleton, certified childbirth educator, hypnotherapist, and labor doula in Bedford Corners, New York. Lie down on your side with a pillow between your knees, and if you're in your third trimester, with one supporting your belly too. Have your partner apply steady pressure to the muscle between your neck and shoulder for one minute. Focus on relaxing that muscle beneath your partner's gasp. Wait for the pressure to grow very strong before tapering off. The idea is to get used to relaxing your muscles rather than tensing them in response to pain. You are simulating pain so you can learn how to control your response to it. You can also try the space between your thumb and index finger, or an even more sensitive area, such as the Achilles tendon at the back of your ankle. At first the pain should be distracting and at worst very uncomfortable.
Know How to Squat
Contrary to what you see in most movie birthing scenes, you don't have to be lying in a hospital bed to have a baby. In fact, many women are more inclined to squat during labor. Squatting opens the pelvis and helps the baby get into the ideal birthing position (head down, face toward back, chin tucked in), explains Henry Dorn, M.D., an obstetrician in High Point, North Carolina. It's most effective if you've been practicing your squats throughout your pregnancy and building those muscles in your legs.
- RELATED: The Best Positions for Labor
It's safe to practice squatting throughout pregnancy as there's no evidence it can induce labor. "If your doctor tells you the baby is not in an optimal place in the last trimester," says Dr. Dorn, "try kneeling, sitting cross-legged, or perching on an exercise ball for as much of the day as possible." Or, open a door, hold onto the doorknobs on either side, and drop into a squat for one or two minutes with your knees wide apart. Pull yourself back up using the doorknobs.
Start an Exercise Routine
Like long distance running, childbirth calls for energy and stamina. "You increase your chances for success (of drug-free birth) by being very physically fit," Dr. Dickerson says. You'll want to consider the nine months of pregnancy your training period, and start preparing for labor early on by working out regularly, he says. Dr. Dickerson's prescription: 30 minutes of movement, seven days a week. Hit the elliptical machine or stationary bike and aim to get your heart rate up, or lace up your sneaks and walk whenever you can. (However, if you were not physically fit before becoming pregnant, check with your doctor to come up with a safe cardio plan for you.)
Flexibility, especially in your hips, will help you when it comes time to push, so stretching sessions are important, too. Shoot for 30 minutes of prenatal yoga one or two days a week. Cautionary word to the wise: Your body produces relaxin in pregnancy, which makes you naturally flexible, so be careful not to overstretch or work yourself too hard.
Exercise will also prevent you from gaining too much weight, which correlates with delivering a bigger baby. The larger the baby, the harder she'll be to get out, emphasizes Dr. Dickerson. Of course, following a healthy diet is also key. Pass the veggies, please!
Increase Your Chances of a Drug-Free at the Hospital
If you want an unmedicated birth, you might want to stay home from the hospital as long as possible, especially if this is your first baby. That's because the best strategies for achieving a drug-free labor are often easier to put into action at home than in the hospital.
Most low-risk women are perfectly safe spending early labor at home. During early labor, which can take an average of eight hours or more for a first time mom, the cervix softens, thins, and eventually dilates. Doctors used to say that women should head to the hospital when they were in active labor, which was defined as starting at four centimeters. But studies indicate that this leads to too many unnecessary cesarean sections. Revised definitions take into account the fact that early labor often takes a whole lot longer than many providers have previously been willing to wait. In fact, the American College of Obstetricians and Gynecologists now says that for first-time moms, active labor begins when the cervix is dilated to about six centimeters.
When women head to the hospital during early labor, they may spend too many hours in bed with doctors, midwives, and nurses clocking their progress. They can expect long hours of fetal heart and contraction monitoring, lots of staff interruptions, and limited access to a tub or ability to move around. Many women are admitted early because that's what their doctors recommend, but many simply don't have enough at-home strategies, like the ones outlined below.
Move During Labor
When you begin labor, keep moving to stay comfortable. Walking, rocking, squatting, sitting, swaying, and switching sides while resting can help your body work with your contractions as gravity and mobility help baby move into the birth canal. Plus, movement eases tension and gives your mind something to focus on other than pain.
"Walk and stretch, sit on a birthing ball, and hop in and out of the birthing tub if it's available," says Dana Gossett, M.D., an Ob-Gyn at Northwestern Memorial Hospital in Chicago. And use a combo of gravity and hip movement to help the baby come down, advises Dr. Rinehart, who delivered two of her own three children without medication. "When you take the cork out of a wine bottle, you don't take it straight out, you jiggle it back and forth to get it to ease through," says Dr. Rinehart. "Movement of the hips, belly dancing, hula dancing, squatting, rocking, pelvic tilts, and such help maneuver the baby down and through to find the easiest path out of the mother," she says.
If you’re spending early labor at home, give your midwife, doctor, or hospital a call when your contractions are at least five minutes apart for an hour or more. Also call your doctor if contractions are getting progressively stronger and closer together no matter how you move. If they're five minutes apart while you're lying in bed but spaced further apart when you move to the tub or go for a walk, it's probably not time to go to the hospital yet.
Utilize Hot Water
Hot compresses, showers, and baths are a laboring woman's best friend. Hot water eases pain and allows muscles in the back, belly, legs, and perineum to relax while the uterus does its job. If you don't have a deep tub, a shower will work. Hot compresses on a sore back and belly are also miracle workers. Keep in mind that spending early labor in a tub is perfectly fine, but it may lengthen the time between contractions for a while. Many maternity units have birthing tubs or Jacuzzis on site, so don't hesitate to ask about spending active labor in hot water, too.
If your water has broken, check in with your provider before you dip into the tub. Many doctors consider it perfectly safe to bathe after your amniotic membranes have ruptured but others worry about the slim chance of infection.
Rhythmic breathing, meditation, self-hypnosis, and other relaxation techniques are excellent tools for all stages of labor, but they're easier to manage when you're not being interrupted. Once you're in the hospital, your nurse will frequently check your vital signs, hook up monitors, draw blood, start IVs, and do other interventions that may clash with your Zen. At home, you can light candles, close your eyes, follow your breath, meditate, and create an ambiance that promotes relaxation.
If your contractions are so strong that your relaxation techniques aren't cutting it, try moving to the tub or shower, change positions, or check in with your doctor or midwife about whether it's time to come to the hospital.
Some labors start with days of off-and-on contractions that wear moms out long before "real labor" even starts. Even after contractions get organized into a regular pattern, early labor takes an average of eight hours for a first-time mother and five or more for experienced moms. As much as you'd like labor to be over, there's usually no need to rush things. Keep yourself entertained, relaxed, hydrated, and nourished and plan on labor being a marathon, not a sprint. Be sure to let your midwife or doctor know if you're becoming exhausted. They'll help you decide on next steps whether that's at home or in the hospital.
If you're bleeding heavily, your baby's not moving, you feel ill or have any other concerns that your labor isn't progressing normally, then forget about staying home and go to the hospital where your provider can evaluate you and your baby. And, if you arrive at the hospital only to discover that everything's normal but you're still in early labor, think about heading back home. There's no shame in that and you may increase your chances for having the vaginal birth you hoped for.
Deciding on an Epidural
If you can't focus during contractions or relax between them, doctors agree it's probably a good idea to ask for pain meds, which at this point may help move things along. Your pelvic muscles can go into spasm mode if you aren't able to catch a breath between contractions, and then it's difficult for the baby to descend. An epidural, by relieving your pain, can let the pelvis do its job. Have an open mind: "If you reach the point where a [drug-free] labor is just not happening, you have to accept what's good for your child," Dr. Gossett. "The goal is a healthy baby."