2. When to go to the hospital? With a normal pregnancy, to have the fewest interventions, go to the hospital after you are showing a good collection of Active labor signs. Early labor signs can also be practice labor and can fade. Labor does not usually fade with Active labor signs. To help you determine where you are in labor and help you decide when to go to the hospital, use the 411 Rule: Contractions every 4 minutes Lasting 1 minute each For 1 hour

3. Natural Approaches to Pain Management Pain in Labor: - Natural part of the process - Intermittent - Out of your control - Pain/Fear/Tension Triangle

4. Core Strategies for Coping with Labor Pain: Breath Positions & Movement Partner Support Laboring in Water Visualization The Senses – Aromatherapy – Lighting – Music – -Heat & Cold

5. Breath Ensures oxygen for you, your muscles, your baby. Helps relax and focus you. Breathing deeply is physiologically relaxing: it signals to your brain that you are calm. OK to breath in and out through nose (more relaxing, least drying), in and out through mouth (faster oxygenation), or in through nose out through mouth (distracting). Specific breaths to practice: » Relaxation/oxygenation breathing » Cleansing breath

6. Positions & Movement There are two primary purposes of labor positions: 1)To help you manage the pain and 2)To open your pelvis and help your baby descend http://www.happyhealthychild.com/pregnancy-and-giving- birth/childbirth-labor-and- delivery.php?inf_contact_key=e8f33fc383e506bc5ecf9ac273bc654e 54b9e9ebd7125edcbc15357f056a674c

7. Standing Positions Side Lunge – changes shape in pelvis to give more room for baby to get in a better position – do 1-2 contractions to the left, and 1-2 to the right, then continue with whichever side feels better for 4-5 more contractions Slow dancing with partner or leaning on wall – Gravity advantage – Doula can do back massage/counter-pressure/hip squeeze – Easier to maintain than hands & knees

8. Squatting Positions helps open the pelvis gravity advantage Leaning Positions helps baby move into better position Reduces back pain Allows easy access for counter pressure or hip squeeze or back massage Over pillows on the bed, kneeling Over a birth ball Over pillows on the bed, standing Over the top of a bed headboard Hands & Knees

9. Sitting Positions Sitting on a birth ball Backward on a chair Sitting up in bed On the toilet Helps ease back pain Opens pelvis Resting position with gravity advantage Easy access for massage and counter pressure

10. Side Lying Positions Use if mom wants to rest or is in bed (even w/ an epidural) Shift in gravity just from moving from side- lying to semi-prone

11. Partner Support What do you need to do now to prepare yourself to be a great support person for mom in labor? Address and work through your fears, understand normal labor, learn the emotional signposts so you know what to look for. Partner- what are some ways you can help mom in labor? What is your “role” in labor? Give her a sip of water after every contraction in active labor. Encourage her to pee every hour. She can do this and so can you. Just having you there is helpful. Your fear will affect her. Verbal Encouragement Use massage and counter pressure/hip squeeze to help her relax.

12. Partner Support Verbal encouragement – Praise (You’re doing wonderfully. You are so strong. You are moving beautifully in rhythm with the surges. You are staying so relaxed.) – Encouragement (Each one is bringing the baby closer.) – Specific reminders (That’s right, breathe through it, in, out, good, good. Bring your voice down, that’s right. [If women are making high pitched sounds.])

13. Partner Support Counter-Pressure Hip Squeeze Massage Two major types: – Effleurage (light touch) – intended to release endorphins – Tissue massage (normal massage) » Unscented oils or lotions » Hand massage demo

14. Hydrotherapy How it helps: reduces muscle tension, pain and anxiety. It’s hard to stay tense when submerged in water. Deep water around body temp Stand in shower – water on back Shower sprayer on back or belly, or cup of water

15. The Senses The brain can only take so much stimulation…Interrupt some of the pain signals with pleasant stimuli Hot & Cold Packs Music Lighting Scents – Lavender - Relaxing but energizing at the same time. Wonderful for freshening up a birth room. I carry lavendar oil in my birth bag. – Sweet Orange – Invigorating. – Almond - Soothing, good for the beginning of labor – Clary Sage – Refreshing

16. Visualization Visualizations can be a powerful way to help you relax and focus in labor. Engage the mind body connection in a deep way. -Waves -Conveyor Belt -Counting Hypnobirthing Hypnobirthing technique is centered around practicing relaxation with a set of scripts, including the hallmark Rainbow Relaxation. You can then have these scripts playing in your birth room or read to you by a birth partner. - Partner read hypnobirthing script for homework

17. Ice Exercise