Someone Call the Doula! A Roadmap for Active Labor

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In most women, the signpost of active labor is the thought “This isn’t fun anymore.”

You will probably ride through the contractions of early labor thinking, this is not so bad, I can do this, all I needed to know about labor I learned in prenatal yoga class. I remember laboring at 10 o’clock at night in our living room, in hands and knees with my head on the couch during a contraction and thinking, I’ve got this labor thing in the bag. Meanwhile, fast-forward three hours later to what was supposed to be a peaceful stroll on the beach. I was in hands and knees in the sand on the Dog Beach of all places, the most filthy and poop-contaminated sand in the entire state of California, and telling Mike I couldn’t walk anymore and that he would have to carry me home. That was seven hours before Tusca was born.

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Many women panic once they realize how painful real labor can get. Many of these women go on to successfully give birth naturally. This is the point in labor when women need to call on the resources they have made available to themselves in advance. This is when you need to have your doula come over, when you can start using massage, counter-pressure, and hypno-birthing techniques, or when you can have your partner get a hot shower ready so you can hop in.

Sometimes positive words are all a mother needs to hear to keep going.

  • It sucks that you have to feel this pain
  • It’s hard to even know how intense it is until you feel it
  • It is a good sign, things must be progressing
  • You have to feel more pain before the baby can come out
  • You are strong, you can do this
  • This is the worst part of the contraction, it’s coming down now
  • Your body knows what it is doing
  • All you have to do is let go
  • I will be here with you every step of the way

Notes on What a Doula Can Do

Hitting A Wall 

A mother who is supported in labor will feel pain, but she will not suffer. There will be times when she will be obviously discouraged. I tell my clients that this will feel like “hitting a wall”, and that she will want to give up. Then something will change, and she will move on.

When you first feel what labor contractions are all about, you might find yourself “hitting the wall” psychologically. Many of us have a image in our heads before labor starts that birth is not actually painful unless you are a wimp or not in touch with your body. I have met a few women in my lifetime (maybe three, out of the few thousand births I have witnessed) who did describe birth as orgasmic. For the rest of us, birth is hard work, intense, painful by most descriptions and after a certain point quite overwhelming. The key thing to remember is that you are just as strong as I am, and I did it. I know you can do it.

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As a doula I knew when a mama was “hitting the wall” because I heard her say something like:

  • “I can’t do this anymore.”
  • “I didn’t know it would be like this.”
  • “This is so much worse than I thought it would be.”
  • “Help me!”
  • “Do something!”

This kind of language tells me that the mother needs a change of scenery or a change of pace. Getting into the shower is usually a really good game changer, at least for half an hour or so (or until the hot water heater runs out, don’t remember to check it ahead of time!) A lovely shower can buy the mother time until her labor changes again and she gets lost in Laborland and discovers her own way of coping (which she will).

One Doula’s Perspective About Hitting The Wall

Tools and Tricks of the Trade to Help You Scale the Wall

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Photo via Dance of Life Midwifery

Water

The birthing pool has been coined by many an adoring woman as the epidural for natural childbirth. Some girlfriends who have had the epidural during one labor and then the birth pool with another have said that they prefer the birth pool. One of the third greatest moments of my life (third to actually giving birth to my daughter and marrying the love of my life) was when my midwives finally allowed me to step into a perfectly warm, bouyant and well-cushioned birth pool during labor.  Ahhh water – gentle, soothing, calming, releasing the pressure of aching bones and invigorating frustrated spirits. It felt as I was being enveloped by loving arms that told me, “you can do this, you are safe now, just relax and enjoy.”

I truly believe that a well-timed soak into a warm birth pool has greatly enhanced many woman’s birthing experience, and possibly prevented many a stalled labor / traumatic birth / unnecessary intervention. Water birth is so lovingly gentle not only for the mama, but also for her little baby, whose transition to breathing is made softer by the gradual change in pressure and temperature. For mothers choosing natural childbirth, water may be essential for a calm and happy birth.

Note: Most midwives usually won’t let their patient get into the pool until they check them, because if it’s still early (less than 4 cm dilated) than getting into the pool can slow the labor down. You also want to save your “best tools” for when you really need them, for example during transition when nothing else is working. Research also shows that being submerged in water for longer than an hour can slow down labor.

Alternate Rest with Activity

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Photo via Birth of the Family

At some point, you may need to get back out of the water, and encourage the labor to get stronger. When contractions are about five minutes apart still but quite uncomfortable already, I like to alternate 30-minute periods of activity (walking, dancing, curb-walking, stair-climbing, squats, lunges) with hour-long periods of rest (getting into the shower, or lying down on one side while dad or doula provides counterpressure to the back).

Someone Call the Doula!

A good doula balances the good cop with the tough-lovin’ bad cop.

This is where a good doula comes in. She will help you relax as best as you can for periods of an hour, but afterwards that she will firmly encourage you to get up and get the labor going again.

Note for Mamas Desiring Out-of-hospital birth: Sometimes it is the daddy’s (your man) and loved one’s (your mom/friend/sister’s) tendency to want to protect you as a laboring mama from discomfort. They will want to rescue you from pain, but the only way they will be able to do that is to drive you to the hospital to get you an epidural. No one can honestly rescue you from the pain of labor and still empower to have the transforming natural birth experience that you dream of.

As a professional I can say that by getting you moving, even though it will bring contractions stronger and closer together, your doula and midwife are still on your side. Remember: the more up and active you are, the fewer minutes you will have to be in pain. You need someone experienced enough who has seen this first-hand, and so knows that causing you more discomfort in the moment will get you what you really need in the long run. You will not want to put yourself through more pain, even if it’s what you have to do to get your baby out.

Transition

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Photo via Mama Birth

Ah, transition, what can I say? Maybe all that needs to be said about it is that you will know once you get there. My experience with transition was begging Mike to call the midwives to come, because I was barfing my head off and was sure that I would need an IV. I have seen many wise women surrender during transition. They stopped speaking and started releasing primal moans. They went completely inward in search of their deepest reserves. And you know what . . . .

Even otherwise cool, calm and collected mamas lose control during transition!

This might involve yelling like an animal, hiding in the bathroom, asking for help, saying that you give up, crying your eyes out, or kicking everyone out of the room. Even a woman devoted to the idea of a natural childbirth may beg her midwife at this point for a Cesarean Section and/or hospital transfer. The thing is, that’s why many of us choose to give birth at home. We know we are human and in our weakest moment we will ask for rescue. So . . . we block our exit strategies in advance. Who wants to hop into a car and drive over railroad tracks in the middle of transition?

This is a moment when you must truly trust yourself, your partner and your birth team. There are women who trust themselves enough at this point that they could deliver their babies without anyone else’s assistance, and do. Most of us are very strong women, but we still need loving support.

It does not make you weak to need love and support.

While natural birth is a healthy and normal process, there will be some part of your psyche that believes that you are dying instead of giving birth. The intensity of labor may carry you outside your body, or might pull you deeper into your body than you ever knew possible. In these moments, you must trust yourself, your partner and your birth team unconditionally.

You will come out to the other side, and on the other side, you will be a mother.

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Art by Amanda Greavette

You can do this. If I could do it, then so can you.

NOTE: This article was written specifically with mamas planning home- and birth-center births in mind. Every labor is different, unpredictable and surprising. No two women have the same labor, and no woman has the same labor twice. The love and support I wish to express in writing this could not replace the face-to-face physical, emotional and spiritual support that a doula can provide. Please give yourself (and your partner) a most-important gift, and hire a doula for your birth!

As always, if you ever have any concerns, please contact your midwife.

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