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The Complete Guide to

the Lamaze Method
Beverly Savage and Diana Simkin
Photographs by Mary Motley Kalergis
Illustrations by
Dana Burns and
Laura Hartman
Ballantine Books New York
To Herb, who did so much for me and for everyone.
To my husband, David, with love.
Copynghl @) 1987 br Beverl}' Savage and Diana Simkin
PhOlograpfls cop)'right @ 1986 b)' Mary Motley Kalergis
IIIu5{fauoru on pages 70, 71, 113-23, 147. 149. 1 S9, 181. 219. 297, and 353-63
cop)'righl @ 1987 by Laura Maestro
llIustratioruon pages 74. 77, 78, 80, 81, 84. 85,153.156,230.261,272,277,
and 29S copyright @ 1987 by Dana Burns
All righu reserved under International and Pan.American Copyright Conventions.
Published In the Uniled States b)' Ballantine Books, a division of Random House,
Inc., New York, and simultaneously in Canada by Random House of Canada
Lmlted. Toronto.
Libra!")' of Congress Catalog Card Number 85.90884
ISBN OH).)1210.9
(...over de,.ign by Richard Aquan and Gc."Orgia Morrissey
Book d e ~ l g n by Beth Tondreau
Manufactured In Ihe U nilcd StaIC$ Q( Ametlca
Flnl Edmon Februar)' 1987
10 9
The Lamaze Metbod
Before Lamaze
How Lamaze Began
Using Lamaze for Natural
The Lamaze Teacher
The Lamaze Class
The Future of Lamaze
Choosing Your Doctor or
A Critical Choice
Selecting a Doctor
Changing Doctors
HOII/e, Hospital. or Birt/)
The Importance of Your
Birth Centers
Hospital Binh
Understanding Labor
Knowing Your Body
The Physical Process of Sinh
The First Stage of Labor
The Second Srage of Labor
The Third Stage of Labor
The Lamaze Breathing
Breathing for Childbirth
Techniques Common to All
the Breathing Panerns
The Lamaze Breathing
TIps on Practicing
The Lamaze Labor Chan
ExeroJe 'If/d Rel<Jxtltion
Durillg Pregll,lf/cy
126 Your Baby
The Lamaze Relaxation Chan:
136 The Inl1uence of Ld)o)'cr
( IIAPT[,R 16
The Placcma
POJ/pllrllll1l 330
8mb Repar/J 381
AI Ihe Hospital III Lnc mpltc.ucd Births 382
Your Phymal Recovery III Births Aided by PnoCio 402
The LIst ,\lolllb 13B
Being Home lP
Forceps Delivenes '04
BrcastFceding 342 A Breech Baby Delivered by
If '\\'u \X'ork 119
Your Emotional and Marital
Ceurcan 410
Tasks for the wt \Vceks 142
Adjustment 341
CC1arean 415
II 'four Baby Is Bret."Ch 152
Exercise 351 A Slillbirth 418
II You Your Due Dale 160
Barbituates. Amnestics, and Some Final Suggestions 364 Second Births '22
Inhalants 247
Local Anesthetics 254
Regional Anesthetics
I 5 .
General Anesthesia 265
The Secolld Baby 365
LIbor Begins 16
Medication Chart 266
Physical Changes
EMI, Lab", 16'
Labor Again 368
Back Labor I"
Vaginal Birth After a
The Birth Questiolmalre 429
Premature RuplUte of thc
I 2
Cesarean (VBAC) 3' I
Membranf:S 182
Labor Begins
373 sou ReES
InduLed Labor
Variat;ollS 011 Norma!
AI the Hospital or Birth
Labor alld
Delil'ery 270 Postpartum
How to Prepare an Older
r.lIAPT ER 9
Forceps 271
Child for the Birth of a
/lrlil,t Llbor and
Vacuum ExtraCtion 276
37' DEX
Cesarean Section
Active Labor
Gelling IU the Hmpltal or
Bmh Ccnu:r
AI the
194 Being a Partnel'
Lab(mnp: at the Hmpitai
T r"o)lIIon
Wh)' Should I Attend the
About Childbirth
Allending Lamazl.:
rHA"'lIR 10 The Final Strcllh
At the: J Impual
If A riSe
( .rOWllln,w;:
St:clOg Your Baby
The Pll'llpanUnl Pt.f!od
The: PartOl'(\ (;UIJt.
to Labor 12H

(QI//ollj III
To Dr. Ben Pa$cario (or reviewing and eduing OUf manuscript and for
answering our many questions.
To Drs. Adam Romolf, Daniel Clement, Don Sloan, Thomas Kerenyi,
Jane Galasso. Jane Hall, and James Onolmi for generousl}, giving us
their tlmc and knowledge.
To EIISaberh Bing for sharing her experiences as a founder of ASPOl
To Rober< Moran, direcror o( ASPO/ Lamaze, and his staff (or reo
spondlng prompriy and helpfully ro all our queries.
To Paul Placek, Ruth Lubie, Anne Rose,joan Solomon Wise, Patricia
Sh,mm, and Barbara Sellars for being knowledgeable and available ro us.
To Dr_ Dand Kritchman for research and sound guidance.
To Aibel for his thoughtful intelligence and cooperation.
To Amta ,-,<lise for her flexibility, organization, and uncomplaining
ToJoeile Ddbourgo (or her enrhusiasm (or rhis book and her skill in
gUiding us.
To Mary Flynn for ht'f availability and warmth.
To Nellie Sabin for her tho roughness and organizational skills.
To Melanic Jackson for her conSlant support and commitment to us.
To Conccna Glntoli for her willingness and help.
To Nanc), Dahan for allowing us the peace of mlOd to write this book.
To all our and clients, who shared Their birth experiences, gavc
suggestions. and fueled Our enthusiasm, especially Christie Smith.
To our famllu:s for special support and encouragemem.
And last. but not ICCBt, to the hundreds of women who wrOte us and
filll'd out our
We give our sinceresT thanks .
n 1982, I took my first Lamaze class with Diana and was Immediately
impressed by both her candor and her thoroughness. Dialld an
ASPO-cerdfied Lamaze instructor who has been leaching (he method
since J 976 She has anend<.d many births and heard the accounts of
hundreds of others. I felt lucky indeed to have the beneht uf Diana's
expertise as 1 neared the birth of my first child.
Six weeks later my daughter, Elizabeth, was born. However, it was
only afrer rhar I realized whar a good reacher I had had. Although I had
been skeptical at first, the Lamaze techniques worked beautifully. The
exercises were designed to alleviate pain in labor and help women
achieve drug-free childbinh, and this is exactly what they did for me.
The birth of my daughter was a wonderful experience, and I wanted the
world to know how strongly I believed in natural childbirth and how
help(ul Lamaze had been.
I approached Diana with the idea of writing a book on Lamaze, and
she was very enthusiastic about the opportunity to bring her teaching to
a wider audience. As we worked together, however, we realized that
there were many other good reasons for this book.
Diana and I share the deep belief that natural childbirth is superior for
bOlh mother and baby and that the Lamaze method is the best prepara-
tion for this goal. \Vle 3re convinced that Lamaze works and that this
training is one of the most important preparations a couple can make for
the birth of their baby. Wle want eveq10ne to have access to [he tech-
niques and information that are part of Lamaze.
Almost tWO million women scudy the Lamaze method every year.
Today Lamaze is a household word, btl( twemy-five )Iears ago, it was a
radical departure from common childbirth practices. Doctors and hospI-
tals originally fought against change, but through the determinauon of
a few pioneers and the fervent)' of its practitioners. intervention-free,
fnmily-ccOlcred care has now been Incorporatcd tOto modern obstetncs
\Vle have wriHen this book because we believe the method badly needs
/ lltrodlldi(m I."
updating. ObstetricS has undergone a revolution In (he past fifteen years,
transformed from the stepchild of the medICal profession to a respected
htghtcch specialty The cesarean rate has increased fivefold, and donors
are In(Ceaslngly practicing defensive mediCine under the continual threat
of malpractice. Lamaze teachers have traditionall)' Incorporated changes
In their class material, but the popular literature has lagged way behind.
\\'e want to correct this deficiency and to instruct women in how to use
the Lamaze techniques as effectively as possible.
\\" e also want to make a case for using the Lamaze method to have
narural chIldbirth. We are appalled that much of the childbirth experi-
ence seems to have revened back to where it started. Sedatives have
been replaced by Demerol, and spina Is have been replaced by epidurals.
Women are no longer hue they are still numb from the
waist down and their babies are still being delivered by forceps. Today
women are encouraged by their doctors, hospitals, and even some child
birth educators to prepare for medication and "not be a martyr." This
conditioning does not acknowledge that for most women the thrill of
narural childbirth far outweighs the pain of labor and that a baby is given
the best possible start in life if binh is untainted by drugs, anesthesia, or
We have found that almost everyone finds the Lamaze techniques
helpfuL Even those women who have had the hardest time giving birth
concede that they couldn't have gonen as far as they did without Lamaze.
This is the strength of the method; it enables women to have natural
childbinh and helps those who don't to require lesser amounts of medi
cation and decreased intervention.
In order to present accurate information, we did extensive research
and read professional journals, studies, texts, and Other books about
birth. We also interviewed many mothers, fathers, doctors, midwives,
and Other childbirth educators. While Diana's expertise provides the
backbone for thiS book, we also tried to draw upon the wisdom and
experience of as many Other people as possible.
We hope you will read this book soon after you become pregnant.
Your delivery may seem very far away, but it's never (00 soon to begin
your preparations. We will help you to decide where to have your baby,
how to evaluate your doctor or midwife, and how to locate an excellent
Lamaze teacher. The focus of {his book, however, is on birth, with
complete information about rhe last month of pregnancy through the
postpartum period. This is nOt a book about pregnancy; information
about nutrition, fetal development, and the:: expcrlence of pregnancy will
have to be found elsewhere.
The information here is meant to complement your Lamaze cJa .... es.
not to replace them. By reading this book early you can get a head Start
on learning the exercises, relaxation techniques, and br<'"athlOg panerns.
But only an instructor can give you personal anemion, correct any
difficulties, and answer your questions. Seek out an excellem Instructor
and attend Lamaze class as welL
Another purpose of writing this book was to provide reassurance.
There's no getting around ie Having a baby is frightening and juS[ about
every woman needs support and information. While useful generaliza-
tions can be made about labor and delivery, it is also tcue that there is
simply no such thing as an average binh. One woman can have a short,
pain.free labor while anOther may require a cesarean section after many
hours of hard work. Two women may have labors of Similar length and
intensity, bur one ends up feeling exhilarated and enthusiastic, the other
disillusioned and resemful. Each experience is as unique as the woman
herself. Both circumstances and perceptions vary tremendously.
To help us describe this wide range of experience, as well as [Q bring
you both the theory and the reality of childbirth, we have included the
words of hundreds of women and meir panners. These you will find
throughout {he book, particularly in chapter 16, which is composed of
comprehensive labor reports. The source of the majority of this material
was a questionnaire we created and distributed at the suggestion of our
editor,Joelle Delbourgo. ( It is reproduced in the back of this book, on
page 429.)
In 1984, we placed an ad in P(lrmls magazine. asking women to send
for a questionnaire about childbirth. It read:
Was your birth experience memorable. or was H something you
want to forget? \VIe are a childbirth educator and a mother writing a
book on the relationship between natural childbirth and current ob-
stetrical pra((ice. \X1e'd like to hear about your experience. Please send
for our questionnaire.
\Vle didn't specifically mention Lamaze because we wanted to hear
from women who used other types of childbirth preparation and dis
cover the percentage of women who studied each method. \Vie also kept
the description of our book as neutral as possible because we wanted to
l ulroduaioll
karn all cYPC<\ l,f hlrth eXpl'rten(t;'s, thc positlvC as well as the
\'\'c cxpt.."'C{t-J that perha.ps twO hundred would reply; when th('
P'."'Sl "m(t:' (ailed w ,1sk us to (()m(' to pl(k up (lur mail, we assumed the
tx",x was gentng full. InstC'Jd. there was an m;ulbag waiting for us,
p<1ckC'l..i with long letters a.nd requests flu rhe qu('stionn3lre. In all, we
n .... more than three thous.md responses to rhe ad, and from these,
nearly one thouswd women (;\Od most of rhelr partners) filled out five
long pages of detailed questions.
Our request touched a ner.e, and women seized the opportunity to
talk about one of life's most important expertences. \'{Ie were over-
whelmed. to say the least, but we quickly became absorbed in the hun-
dreds of different and fascinating birth stories, \V/e heard from women
h"tng in trailer parks and on army bases. from small tOwns as well as from
the biggest cities. Many included comments about more than one birth.
Answers were (rammed into the spaces provided and often spilled onco
the backs of t.he pages and ontO added sheets. Some generous women
even Included phOtographs of their births and their babies. \Vie laughed
and cned as we read. The women and men who wrOte to us were funny,
courageous, exuberant, and extremely canny about current birth prac-
tices. \\'e selected hundreds of (heir comments and descriptions for
mclusion in this book; to our great regret, we had to put aside thousands
of Others because there simply wasn't room.
The majority of the women who filled out our questionnaire had
studied the Lamaze technique, and they described (heir (eachers and the
method in glowing terms. This overwhelmingly positive response fueled
our enthusiasm for the book. A large percentage studied Lamaze in
order to expenence natural childbirth, and many of them succeeded. \Y/e
were pleased and surprised at the range of choices available throughout
the coumry and the number of women who had the opportunity to
deliver at home, In alternative birthing centers, and in delivery chairs or
beds. We were amazed and appalled to learn that doctors were still
msisung on enemas and full pubic shaves-practices we thought had
long been abandoned.
As expected, there was unequivocal praise for {he partners' support,
and Over and over again we read, "I couldn't have done it without him. "
The descnpuons of the highlight of the birth expenence brought tears
of lOY to our eyes and made us want to get pregnant ourselves.
I n order to have a great birth expertence, we think you need as much
preparatlun as poSSible, a good doctor or mIdwife, the strong emotional
of your partner, and motivation. Wt:. hope our he"lk will help
you achlcve all of these. We also hop<: that during labor. vou will rcHccr
on the words of the women in Our book and feel less alone
\Vle wish you an absolulCly fabulous labor, an easy delivery. and a
gorgeous, healthy baby who sleeps through the night from the nrst day

If are like most pregnant women, you \\'ill buy or borrow several books on
pregnanq' and childblnh and browse through them all. You ma}' dip Imo each
one at different places or read [hem cover (Q cover in one siuing.
We've designed this book so that it works best if you read It systematically from
beginning (0 end. Each chapter builds on the information in preceding ones, in
chronological order. so that the mformation will make the most sense if you read
(he chapwcs in sequence. \V.le encourage your partner to read the entire book, lOO,
but if time or inclination prevents this, he can simply read the partner's chapter.
\\' e \"C organized the material so that there is a minimal amount of repetition.
If you browse through {he book at random, you may think a particular rapic has
been glossed O\'er. when in fact, a more thorough discussion may be elsewhere.
There has been some crossreferencing within the text, but if you need more
mformation on a specific subject, you should check the index. Rather than con-
tinually redefiOlng medical terms, we have included a glossary. It's located at the
back of ,he book beginning on page 441.
Certain other information is summarized in chan or list form. For example, you
will find a review of labor at the end of chapter 5, a description of drugs used
during childbinh at the end of chapter II, and suggestions for packing your
Lamaze bag in chapter 7 As you near your due date, you may want to review
the sum manes or cut out some of the charts (such as "The Parmer's Guide to
Labor) and pack them into your Lamaze bag.
have tried to prestnt detailed and up-to..date information as much as possi-
ble. but medical practice varies widely from location to location, and in general,
the field of obsu::trics is quickly changing. This book will help clarify the issues
and present current thlOking. but It should never be used as a substitute for talking
to }'our doctor or midwife about the specific nature of his or her practice.
Lastly, a nOtt on gender. Some may accuse us of sexism, because throughout
the book we refer to mmhers as Jhe and docrors and babies as he. Since the mmher
is always female. we: use the pronoun he for everyone elsc. This is nm meam as
a slight to female obstttrlcians, but Simply as a means of preveming confusion.
The repeated use of he fJr Shf for every reference to the doctOr or baby is cumber-
some. A neutral pronoun would be ideal, but has yet to be invented .

Hou' to Use This Book XIV


The Lamaze
oe of the most profound changes that has taken place in the ewen
tieth century concerns the manner in which women give birth.
Today women are knowledgeable about the processes and procedures
of childbirth. They prepare themselves mentally and physically ahead of
time, and they expect [0 exercise a certain amount of control. \'(Iomen
The Lwwu ,\1ethod
on(c a(ceptcd all bnds o( mcdlCaricm and inccrvl'ncion; they now aSSume
that these measurcs will be taken only I( medlCall}' necessaq' llusbands,
(lno..' banished f(I lonely waiting rooms, now play an a(uve role In a
Joyful (debration o( li(e. . . .
The Lamaze method helps women in every stage ot chIldbIrth, (rom
prcgnancy to the postpartum period. You probabl)' know (hat Lamaze
involves certain kinds o( breathing patterns. but {here IS marc to Lamaze
than learning how to pant-blow {hrough a contracrion. Lamaze's goal IS
to enable women to experience narural childbirth. To accomplish that,
Lamaze teaches }TOU what to expect from labor, how to cope with pain,
what options are available if complications occur, and how to achieve
your (antasy birch, whatever that may be. Lamaze expecrs you to play an
active role in the management of your labor and delivery, to work hard,
and to be JJJIJltd in giving binh, nO[ de/trued
The Lamaze theory is founded on several principles. The first is that
educarion dispels fear. The Lamaze rechnique educates couples about the
realities of labor and delivery so that they will have an idea of what to
expecr. Couples are taught relaxarion rechniques, which are used to
counteract muscular tension, the narural response to pain. In addition,
the Lamaze method reaches a series of breathing exercises designed to
dIStract a laboring woman's mind from pain. These breathing techniques
work on a sensory principle called the gate theory, When attention is
focused on one specific thing. such as breathing or a focal point, the
transmIssion of pain signals is blocked. The theory is that the brain is
capable of receiving only one kind of stimulation, and pain messages are
stopped by rhe gare"
There are many pitfalls in [he road to a good birth experience: long
labors, Intrusive hospital procedures, unsympathetic doctors, and a natu-
ral fear of giving binh. But in almost every case, the Lamaze method is
helpful. The strength of the method is thar it enables many women to
have natural childbirth and helps (hose who can't to use minimal
amounts of medication and accept minimal Intervention,
Thtny ago,. obstetric wards were filled with women whose only
posItive about birth was to emerge with a healthy baby.
was often painful and lonely and usually heavily medicated, Elec-
tive InductiOns were performed rourl"nel. and
.' many women knew in
Prt'paralio1J for Birlh

"Was so glad we had taken the classes. I really fclt my husband and I were as ready
as we could possibly be."
.. I felt I had been well prepared and had control of what was happening around
me and to me."
"It helped, but I was still scared in labor."'
"1 fclt wonderful-ready (Q have anOther one!"
"Although I didn't follow all of the prescribed breathing, it was still wonder-
ful. "

"A laboring woman is in no position to have to make an uneducated choice or
decision, For people who want to participate as a couple and want to minimize
medication and medical intervention, Lamaze is the way to go!"
"At first, I felt uneasy about natural childbirth, thinktng I could never withsrand
the pain. But once I got to the hospital and calmed down and started me
techniques, J realized how wonderful this experience could be .. MY daughter IS
now almos( a )Iear old, and hardl)' a day goes by that I do not thlOk of when she
was born and what a truly wonderful experience it was to have given birth to her
the natural way."



T H f L , " ,.,
, Million
. r h d bo h her or not it would really work.
'1 was somewhat skeptICal belore an a ut w et ..
After labor and delivery. I became 3 firm supporter of Lamaze.
'My main cflOcism of Lamaze is the way it gives you the idea is
mind over matter and that everything will work the way )IOU want It to If you do
your homework. This is facile to the point of being damaging. I could never have
had a natural birth, but part of my sense of guilt and failure are the
Lamaze mystique says, . Anyone can,' and I can't. The labor was long and dlfficult,
and the cesarean was a colossal disappointment, but I was glad that I had the
courage to Stay awake for me surgery and (hat my husband had the courage to
Stay with me. Perhaps Lamaze training helped give us the strength for that."
"I am usually a very nervous person when it comes to new experiences. Thanks
to Lamaze preparation, I was calm and relaxed. Without the breathing techniques,
I probably would have been one of the screaming women in the next room. I was
prepared, and I knew what to expect."
.. Although nothing can prepare you for the pain, I think I was ahead by knowing
how to work with (he contraCtions."
"God bless Lamaze!"
"} felt misled, to some extent, by my Lamaze inSlructlon, which had emphasized
(he ease of natUral childblnh. This was complicated by my perfecrionistic desire
to 'do it right, ' to be In contr.ol, and to match the success smries I had heard about
or seen (mother does breathing flawlessly, pushes a few times, and delivers a baby

Preparaliotl lor Birl/)

1 .. 7 E
with a smile on her face and no SWeat, palO, or tears). I lUII able to use the Lamaze
technique and stay in cont rol of the pain for the most pan, but I hadn't expected
labor to be so painful and wished someone had told me it could be. I was surprised
{hat it was so difficult. "
"The Lamaze method is wonderful. It gOt us involved and prepared us in a very
positive way for the great and scary unknown. I have heard complaints from
mothers that the actual labor and birth was far harder than they had been led to
believe, but I don' t think that criticism is valid. We were nOt mid it would be easy
or painless. If all of us went away confident that we could lick it (even if we later
discovered we couldn't completely), well, it waylaid most of our fears and stress,
and at least we went through a ponioo of our labor fairly calm. That can only help,
especially since facing childbinh for the first time is terrifying. For those of us who
experience less than textbook-perfect childbirths--I had a cesarean after five
hours in transition--or who couldn't continue the Lamaze techniques, an unpre-
pared childbirth would have been that much more horrific, physically and emo-
tionally. Both my husband and I feel that Lamaze made the birth of our son the
most beautiful experience of our lives."

advance exacdy the day their babies would be born. Childbinh itself was
nOt particularly joyful, and it was merely a means to an end.
Consider this typical scenario: A woman in labor was dropped off at
(he hospital by her husband. After being admined and sent (0 the labor
floor, the morher-to-be was put into a hospital gown, gl\,en an enema,
and subjected m a complete pubic sha\'e. She might have been given :1
pill to hold under her tOngue. This was Pitocin, known in this form as
buccal-Pitocin, and it stimulated labor contractions. As labor intensified,
sht..' was given scopolamine, a drug nicknamed " twilight sleep" for its
lendenC)' to induce a hallucinogenic haze. She was confined to a bed,
Tbe L,lIJoJu \ltJbod

for.:.:t.'d (l..lUSt:' J. bedpan, hooked up to an and her hands were
often rc:stratncd to pre"ent her from harming herself. \X/hen she was
fully dilatcd. she was wheeled to (he delivery room and tied down again.
Her doctor performed an episiotomy and then delivered the baby by
forceps. The baby was taken immediately to the hospital nursery without
being seen or touched by his mmher.
The next da)' this woman probably thanked the doctor profusely be
cause scopolamine is an amnestic and she didn't remember anything. In
the 1950s, most women expected to be unconscious during childbirth.
The average hospital stay was about five days. Breastfeeding was dis-
couraged, and babies spent most of {heir time in the hospital nursery.
All of that began to change, however, one summers day in 1951 when
an unknown French doctor named Fernand Lamaze attended the Inter-
national Congress of Obstetricians and Surgeons in Russia. Lamaze had
heard about a new method of pain control used by laboring women
called psychoprophylaxis, literally meaning "mind prevention." In
Lemngrad he was able to witness a full labor and delivery during which
this technique was employed. His reaCtion was one of utter amazement.
"1 had, at the time, thirty years of experience as an obstetrician. I had
never been taught anything like this_ I had never seen it, nor had I ever
thought It could be possible. My emotional reaction was therefore all the
stronger. I made a clean sweep of all preconceived ideas and, now an
elderly schoolboy of sixry, I immediately began studying this new sci
When he recurned to Paris, Lamaze became a proselytizer for the
psychoprophylactic method of childbirth. Interestingly, his middlec1ass
patients were less than enthralled with his new approach and Lamaze's
practice shrank. This turned Out to be a blessing in disguise for it
afforded hlm (he time to refine the technique with [he patients at a local
metalworkers clinic where he was chief of obstetrics.
Today Lamaze's name is a household word. The psychoprophylactic
method of pam control is taught in every hamlet of North America and
Europe. Lamaze has become part of the fite of passage to parenthood
along with decorating the nursery and choosing names.
The Lamaze theory is founded on several principles: The first is [hat
-- ----
Preparation [or Birth
educatiun dispels fear DUring rhe 1940's Bntish obsu:uician Gnntly
Dick-Read wrotc about the fear-tension-pain syndrome In relation to
childbirth. He surmised that fear tension which created unneces-
sary pain which caused more fear, then more tension and so on in a
VICIOUS cycle. The Lamaze technique prevents this syndrome by prepar-
Ing couples for the realities of labor. In addition. Lamaze studenlS are
taught relaxation techniques which are used to counteract muscular ten-
sion, the natural response ro pain. The Lamaze method also includes a
senes of breathing exercises designed to help women cope with the pain
of labor.
Lamaze was popularized in the United States largely through the
efforts of two women, Marjorie Karmel and Elisabeth Bing. We met
with Mrs. Bing in her New York apartment and she shared with us her
memories of the early days of the Lamaze movement as well as those of
her deep friendship with Marjorie Karmel.
Both women had had their first children in 1955: Karmel had a
beautiful birth experience in Paris, using the Lamaze method with her
husband, a labor coach, and Dr. Lamaze in attendance; Bing, attended
only by her docror in a New York hospital, received a spinal anesthetic,
which left her with an e1even-day headache.
For the next few years Bing continued to (each preparation for child-
birth at Mount Sinai Hospital, using the Grandy Dick-Read method (the
earliest method of childbirth preparation and a precursor ro Lamaze and
Bradley) . Her own experience convinced her, however, that the method
was flawed, and she was casting about for a more effective technique.
Karmel had her second child in America, using the Lamaze method (an
induced labor), and in 1958 Htlfper 's 8112tll1r published her article, "A
New Method of Painless Childbirth."
Bing kept hearing of the Lamaze method but she couldn't find any-
thing to read about it. At last in 1958 a Cleveland docror, Isadore
Boostein, wrote the first book in English about the technique: P.lI1t1eJi
Childbirth Tbrollgb PJJcboprophy/.,.\/J. "juSt after getting the book, I had
a private patient come ro me to prepare for her second baby," Mrs. Bing
recounted to us. "1 told her 1 had JUSt received it and couldn't (each her
the method, but I tOld her to take the book and read It. She did and then
had her baby. A few days later, she called and said. ' It works! It
It works!' "
The following year, in 1959, Karmel"s book, Th.mA: }Oll. Dr. [."nJ:'(.
was published. It was immediately recommended to Bing. who read it
The LmlolU \1etbo(i <)
and was ven' impressed. "I wrote to the publisher for MarjOrie's add
. ress
and found she lived just across the park (Central 10 New York).
Her oldest son was a few months older than mme, Bing said, "and We
became great friends. ,.
The ('0.'0 women immediately began to organize a campaign to pro-
mote the Lamaze method in the United States. They geared their ap-
proach to dOCOfS because they felr that without medical suPPOrt the
techmque would go nowhere. They began educating people about the
Lamaze technique. using a French film, NaiJIJtll"e (birch), which had to
be 'imtlggled into the United S(3tes so thar it wouldn't be confiscated as
pornography. The film W:lS shown and fe\hown at Marjorie ,Karmel's
apartment. Hundreds of people saw it, some of them receptive, others
hostile. Many people were impressed with the film simply because they
weren'r used to seeing women give birth without forceps.
From the people who saw the film, a small group emerged-ten doc-
tors, plus Karmel, Bing, and Elly Rakowitz (a mother who successfully
used Lamaze}-to form the American Society for Psychoprophylaxis in
ObStetrics (ASPO). Dr. Benjamin Segal was its first president, and memo
bersnip was tnitially limited to doCtors, nurses, and physiotherapists,
those people who could moSt easily put Lamaze into practice. Elisabeth
Bing and Marjorie Karmel were nOt happy about this organizational
arrangement, but felt it was necessary if Lamaze was to be widely ac
cepted. A year later, in 1961, the organization was restructured into its
current form of three separarebut-equal divisions: one for doctors, one
for childbirth educators, and another for parents.
We define natural rhildbirth as birth that takes place without the influence
of drugs or anesthesia (except, of course, the local anesthetic for an
We believe that most women, given the proper emotional support, can
use the Lamaze method to have natural childbirth. Often there is confu-
sion about the difference between "natural" and "prepared" childbirth.
Prtpartd hildb,Ylh IS an ambiguous term because it t:an mean preparation
for JUSt about any type of bIrth experience, ranging from a scheduled
cesarean to homebirth.
We advocate natural childbirth because it IS the ideal way co have a
Preparation fur Birlb

" After the first meeting, I realized that I didn't know as much about labor and
delivery as I thought I did. I learned tttrytbmg that could happen and what we
could do to make it easier."

"Lamaze made my baby's birth the most memorable moment of my life."
"I didn't want to end up like my mother
in-Iaw, who was drugged so much she
didn't know she had a baby until the next day"
"Afterward I realized that the class was very helpful 10 preparing me for both back
labor and a cesarean, neither of which I thought could ever happen to me,
"The coping techniques gave me something to hold on to and me through
the worst parts of labor. Instead of going over the cJiff(as I felt I mtght), Lamaze
gave me the footholds to keep going and reach the tOp."
"Several times during labor I would think, ' \'<'hat would I have done without
Sara's class!' "
we would ha
"e been at sea. It really opened our eyes to
"Without maze
altcrnarives ...
.. As a labor and dehvcry nurse, I le.uned that couples
oO,1 their stated goals more often than couples \vlth "lternau .... e
... {Ota"lIIt<

Tbt' 1 . ItIl.lU \Iethod


L , I "li L\ \ " E F II RNA T II R .\ l t. .. I I. n [I I R 1 II
"/ n'ante<! to understand childbirrh berrer than [ had during the birrhs of my two
sons, where I drugged and anesrhetized and totally out of comrol and fright-
ened After thIS time, I was very pleased that I'd had a drug-free labor and
deliver), and was proud of myself, "
"/ felt that it was the thing to do,"
"To get a bener understanding of the delivery process."

'/ k La
tOO maze so that I could share the experience of labor and delivery with
m}' husband and so that I couJd playa more active role in the birth
"To have a birrh that was meamngful, unmedicated and sare and to ' I
h b
', ' II , IOVO ve my
us and 10 the enOre pregnancy and birth process."
"I wanted to be a participant, nOt JUSt a patient."

bab, y. Ever since ItS IOception ASPO/Lamaze has co 'd d f'
I nSI ere one 0 ItS
to be decreasing the need for medication during delivery.
We re Implying, however, that if you rake medication during labor,
can t have a wonderful birth exp,ericnce. Drugs and anesthesia have
t elf place d d' , ,
. ,an me !Catton IS sometimes the best solution to a problem
In labor. The Lamaze method teaches you to make an informed choice
PrepardtiQn jar flirtb

about yOUf options. If medication i<; nceded, you not allow guilt
and regret to overshadow the positive emotions of childblfth.
\V/e believe that a woman's ability [0 have natural childbirth is Influenced
by her motivation. Some women come to Lamaze class and say their goal
is to handle lahor until they can receive pain medication, whereas others
say they want to experience birth without any drugs or anesthesia. The
beauty of the Lamaze technique is that whatever your goal, you can use
and benefit from the training.
We were really impressed by the women who filled om our Question-
naires. Most of them said they wanted unmedicaccd births, and many of
them accomplished this goal. Those who did have drug-free births per-
ceived (heir babies to be especially alert immediately after birth and
attributed this to the absence of medication or aneSthesia. They also
expressed great pride in giving their babies the best possible start In life.
But interestingly enough, these mothers also expressed genuine under-
standing and compassion for women who did receive drugs and anesthe-
One of the biggest recent changes in the Lamaze technique is its
overdue recognidon that childbinh can be palOful. The earlier attitude
stemmed in part from Dr. Lamaze's name for his method:
Jam dOl/leur, " which means literally, "childbirth without pain." Because
labor is a narural body process, just like digestion or breathing, he
couldn't believe that it had to be so intensely painful. Lamaze found that
women approached binh frightened by old wives' tales and general
misinformation, but that after proper training and education, many of
them could use the breathing techniques {Q avoid pain. Childbirth with-
out pain is possible in some cases, but not in most, and usually not for
first-time mothers. Lamaze no longer claims to be a technique to achieve
painless childbirth, but rather an effectlve method for coping with the
Childbirth educators do women a disservice when they avoid the word
pmll and substitute discol1dorl. Granted, there is a fine line
educating people and frightening (hem, but we don't think anyone, Will
be surprised to hear that labor is painful. Besides, pain really can { be
measured; it boils down [0 :\ matter of perception. A demonstrated low
or high threshold for pam has little (Q do with the way a woman handles
labor; it's attitude and support that count.
M0St are afraid of pain of childbirth. Pain IS a part of giving
birth. but H Jl)t'sn't have to dehne the expenence. l\farathon runners or
weight their bodies to the limit, expenencing pain and fa.
tigue, and their effons are somethtng to be admired. \'(Ihy can '( we have
the same sort (If respect for women in labor? Labor pains are more
productl\'e than any other kind because at their end lies a new life, not
just a new statistic.
Lamaze works beautifully because it constitutes only one-third of the
time in labor. You spend onethird of your rime breathmg through
pain and the remaining twothirds relaxing. [f you're motivated and you
can relax, labor should go well because the breathing gives you some.
thing to do, altering your perception of the pain's imensity. Every physi.
cal dIScipline uses special breathing, and labor should be no exception.
After doing Lamaze breathing for several hours, many women reach a
kind of rranscendem state that removes them from rhe physical experi.
ence. ThIS is analogous to the kind of high, dreamy feeling long-diStance
runners often achieve. It's a beautiful sensation, and it should be your
Lamaze works best under ideal conditions. You're obviously going to
feel a lot more relaxed if you're in a comfortable posirion, if you can
move about freely, if people are helpful, and if your partner is with you.
Your ability to use Lamaze is bound to be compromised if you're im.
mobilized by an intravenous and a fetal monitor and you're worried
because your doctOr hasn't shown up yet. If, for whatever reasons, the
breathing techniques aren 'r enough and you need pain relief, that's okay.
At least your Lamaze course will have familiarized you with different
types of medication and their effectS (see chapter II). If things go well,
Lamaze will enable you to have natural childbirth. If things don't go as
smoothly as you hoped, Lamaze should nonetheless provide you with
some measure of relief, as wel1 as preparation for the unexpected.
We hope that couples can learn the Lamaze method by reading our book.
BU[ we also believe that a book is no substitute for a good [Cacher.
Ideally you will usc this book to complement what you learn in class. As
one woman said in response to our questionnaire, ., No maHer how much
1 read, I wanted an Instructor (0 give me Individualized attt:ntion."
You may think you can get by without going to class and learn the
Preparatioll for Hirth


T H F. L /to M /to Z I: T F. /to ( I I

"The day she 'delivered' Bert the Muppet from a dryer pipe kept us laughing
during many tense moments."
"She had a marvelous positive attitude and seemed genuinely concerned about
each couple. But I think her positive attitude went a bit too far and that she did
not present a realistic picture of the pain involved. "
"She wanted to help all of us, but she was a mouthpiece for hospital policy, as
if there was no other way to do it."
. . d . I I' k d ,he fact ,hat she dIdo', suess
"She was extremely posltlve an supportive. 1 e
a 'right' or 'wrong' way, but encouraged us to feel that what would be most
comfortable would be the best."'
d La . their delivery. She was very
"She had several children and had use maze 111 . h
honest about what had worked for her. All of us were firSH.lmers, and er success
was encouraging."
. R N She was knowledgeable, approachable, and enthuSt
"Our Instructor was an . .
astic. "
k' d IDvin and supporuve. I could a:sk her
"\Vle had (WO instrucrors. One was 111 'bo h and personal. The o.ther was
. d h Id have an answer t I Sh
anythtng, an s e wou h 0 anuhospitlll it was frighteOiOS. e
extremely knowledgeable. but s e was s
L _ __
- J'ht' LIIIIlIU \fe/hod
r -----




often made remarks that made me uncomfortable, as if my child's birth would be
rUined by having a medical person available."
"Her biggest strength was her faith in the Lamaze method. She didn't tell us that
this would be painless childbinh, but instead told us that through Lamaze we
would learn to gain control of the pain and have it work for us instead of ctgctinst
"She gave me so mllt"b of a positive outlook that I had no open mind for anything
but a beaullful, easy narural childbirth-which I did nOl have at all."
"Really tOps. She knew her material and covered it in a friendly and informative
manner-and she had had four children using the Lamaze method!"
"'\('e had four instructOrs, who took rums leading the class. I appreciated the
vartery of leadership offered, and r felt that was a strength of the class."
"My instructor has been a nurse for at least twenty years. She was very informative
and stressed that every woman is different; you can't all expect the same experi-
ences ...

Lamaze techOlques from our book, but iI'S not the same. We know it's
a lot of trouble to rush home from work, gulp down dinner and then
runoff I ' ,
to c ass, espeCIally in the third tnmeSler, but you won't learn the
method nearly as well without some expert instruction. A teacher can
Preptlraliou for Birth
demonstrate the right rhythms for the oreathlng panern\ and .,;an offer
corrections if you're breathing too slowly or reo fast She's alse there (0
answer any questions either of you may have
The women who filled out our questionnaire overwhelmingly found
their Lamaze teachers to be knowledgeable, helpful, and enthusiastic.
Many women could not point Out a slOgle weakness in their instructor.
We discovered, however, that people have different expectations about
what a teacher should do. Some complalOed because their teachers
glossed over possible complications, while others were dissatisfied be-
cause pain was not discussed. Many were pleased to have a pregnant
instructOr or one who was a mother herself.
How Lamaze Teachers Are Certified
All Lamaze teachers are certified by the ASPO/Lamaze organization
(which is accredited by the Council for Noncollegiare Continuing Edu-
cation), and they must satisfy rigorous standards before becoming teach-
ers. To qualify, a person must be a registered nurse or hold a
baccalaureate diploma. Then. the candidate is interviewed by a three-
member committee, one of whom is a certified ASPO teacher. If the
committee approves the candidate, she then pays a nonrefundable fee,
fills out an application, and begins the training. ThiS consistS of taking
an exam in four subjects-the physiology of pregnancy. the psychopro-
phylactic method, community relations, and instruCtional methods-
observing five complete births and submining detailed birth reporrs
about each one, and then observing tWO full series of Lamaze classes.
At that point, the candidate is required to attend a twenty-six-hour
seminar taught by faculty from the national ASPO/l.arnaze office.
Then, within sixty days, she must submit an original syllabus for her
own six- or eight-week Lamaze course. If the syllabus is satisfactOry, the
candidate practice-teaches one series of classes. The next step is a test
on instructional methods. If she passes and the supervising teacher
recommends her, she then becomes a certified Lamaze instructOr with
the ICllers ACCE (ASPOCertified Childbirth Educator) following her
name. The entire program usually takes from eighteen months to twO
years to complete. This is the primaf1' way Lamaze teachers are
although in some cases a teacher may be certified by a chapter With the
approval of the national organization or by completing a UOlvcrSIt)'
The Llm.i:.t' .\Iethod
How to Select a Lamaze Teacher
What can you do to find one of these wellqualified teachers? Well, it's
not difficult. You can call the ASPO/Lamazc national office at (703)
'5247802 and inquire about instructors in your area. The mailing ad
dress is 1840 Wilson Boulevard, Suite 204, Arlington, Virginia 22201.
Your donor or midwife or friends can probably recommend a good
teacher h's advisable to speak to a prospective instructor either by
phone Or In person, and it may also be helpful to speak to graduates of
her classes.
When you query prospective instructors, you should be looking for
enthusiasm, candor, accessibility. and for someone who will prepare
you for variations of normal labor and delivery. Questions to ask in-
Is tbe HlJlruelor ASPO/Lamau ctrli,fied?
If there is any question, call the organization for verification.
Hou' large r(!ill Ibe dOH be?
CLass size usually ranges from five to ten couples. A larger class is
Hoft, man)' JeJJiom a,.e beld?
The course usually runs about six weeks. Be suspicious of any course
that claims it can teach you about childbirth in two or three sessions.
Hou' Long iJ eaeh JeHion?
In general, one class should last from one and a half to two hours.
t U'l"hal are your feelings abOUI cbildb,rlh?
Look for an answer that seems consistent with your beliefs.
Is an early-bird daH al'ailable?
There are several pitfalls in this selection process of which you should
be aware:
First of all, make sure that any course you sign up for, especially if it
is taught through your hospital , is really a Lamaze course, taughr by an
ASPO/Lamazecertified instructOr. The ASPO/Lamaze organization reo
celves many complaints from people about hospital "Lamaze" classes.
Hospitals frequently run programs that consist of a hospital tour and a
talk by a labor nurse. This is billed as a preparedchildbirth course, and
while the tcrm Lamaze may be bandied about, it is nm a Lamaze course,
To avoid this deception, make your own check to see if the instructOr
is certified.
PreparaliQn for Birlh
. -.- \ .....

, '" , .
, JoI..
.' 4,

classes tend to be large and are usually taught by a labor and
who works at the hospital. She therefore very familiar
with the poliCies of the institution and is unlikely to encourage rebellion
against her employer. She may prepare you to face the standard hospital
procedures, not to exercise your fights. Although your hospital teacher
may be trained and certified by ASPO/Lamaze, she doesn't have the
freedom of expression that a private teacher does. We believe private
teachers are best because there's no question that their allegiance lies
with the client, In addition, private classes are usually smaller, so you are
able to receive more individualized Instruction.
Private Lamaze classes, most commonly held in the homes of instruc-
tors, are often slightly more expensive than those offered by hospitals.
We know this is a consideration for many people, but we encourage you
to spend the extra money. Women who filled out our questionnaire
repeated over and over that a good instructor made a tremendous differ-
ence in reducing their fear and helping them cope with the stresses of
Second, it is vital that your Lamaze instruaor be both botlnl and
knowledgeable about medical procedures. Lamaze teachers are discover-
ing that couples today have a great many questions and concerns about
the use of technology during labor and delivery. Instructors must inform
their classes about all the newest moniwring and appliances, such as
fetal-scalp sampling. This is important because it touches on the malprac-
tice issue. It's critical that your Lamaze teachcr tell the whole story about
these devices and that she not be one-sided in her presentation. Lamaze
takes a position of advocacy for new parents, and there are always several
sides to every story.
Third, be especially cautious if the Lamaze instructor is your doctor's
wife or works in his office. \'X/hile there's nothing inherently wrong in
an obstetrician's wife being a Lamaze instructor, it's much more difficult
for her to be objective about the way her husband practices. For exam-
ple, if he does a lot of forceps deliveries, she's likely to tell you this is
a very good way to have a baby. Lamaze instructors are not doctors'
adversaries, but thcy should feel free to exert a healthy independence.
This freedom is sometimes hard to achieve because just about every
Lamaze teacher depends on doctOrs for referrals, The dependency is
certainly exacerbated, however, if the instructor is married to the source
of her referrals or depends on him for her weekly paycheck The doctor
may feel that by sponsoring Lamaze training he is offering comprehen-
sive care, but you arc acmally being deprived of a choice.
The LWMU .\Ie/hod
Lamaze courses usually Starr at the beginning of the eighth moneh of
pregnancy The reason for this timing is that )Iou'li enter lahor with the
breathing and rela.xation techniques fresh in your mind. Ie's to your
advantage If the Lamaze series includes an early-bird session to discuss
exercise and nutrition during pregnancy. as well as how to choose a
docror or midwife (see chapter 2), which is one of the most imponam
decisions you will make while yOll are pregnant. I f an early-bird session
is not a standard pare of the course, you will have to research these issues
on your own.
Some courses require that you sign up well ahead of time, often
months in advance, so start researching your options early.
Classes provide a format for expressing ideas and fears about giving
birth. You don't have to speak in class if you don't care to, but you'll
probably be surpnsed how much you end up contributing to class discus-
sion. Even if you don't want to talk about your personal experience,
you'll enjo), JUSt being in the company of other very-pregnant women
and their partners. Many people who filled out our questionnaire re-
marked how much they liked the camaraderie classes provided.
We have noticed rhat men tend nOt to read about pregnancy or child-
birth during their wives' pregnancies, so they often pick up the bulk of
rhelr knowledge in Lamaze class. Also, by attending the classes, the
imminence of your baby's birth may become more real to your husband.
In 1985 ASPO/Lamaze celebrated its silver anniversary. The occasion
seemed [he perfea time to ask its executive director, Robert Moran,
what the next twenty-five years held in store. The organization is Slrong
at thiS time, with more than 6,100 teachers, and approximately 500
additional teachers being trained each year.
One trend Moran sees and doesn't like is the movemem of hospitals
into the childbirth-educauon business. "In the past, we could preny
much rest on our image as the good guys and we didn't have any
problem with business. Now, hospitals want co capture the obstetric
market from the earliest possible point," he said, "Hospitals are trying
to be comprehensive, saying, 'Look, we have an entire package: child-
birth baby care, labor, and delivery, and I[' S all here.' There
Prepuratiou jor Birth

"Since it was difficult to keep from laughing while practicing in class and at home,
I thought Lamaze would nOt be much help-we were nOt seriOUS enough about
it. I was amazed at how the practice sessions came back to me when I needed
thern. "
"I would have liked a more personal class. There were twenty couples in ours."
"{ was afraid while taking the class. The film made me even more afraid, and I
was ready to chicken out at any moment . After giving binh, however, I was so
glad I had taken the class and had had a natural delivery."

"It was a hospital-sponsored class, so all they taught us was what they wanted us
to know so that it would be easier on them."
"Lamaze classes made the last tWO momhs of my pregnancy an active time. We
. . . I b h! ml' husband much closer
enjoyed learning and praCtlClOg our exercises. t roug
to what was happening to me."
I though they showed us
" I found out later that it wasn't actually a aze c ass,
a few breathing techniques."
I I I was familiar with all the materials before
" \Vle enjoyed the classes tremendous),' , .- hour nrSt child, we felt
b f r positive experience" l(
taking the classes, ut a ter au 'selves for the birth experience.
the classes were an impoe[3nt pae[ of preparing h b h"
entail), up for t e Ie[ .
We needed the involvement to get m 4"ontmur,1

Tbt LW1,I::e \fetbod


T ilE l .\ M -\Z[ C L\.I. ..
. At nrst, the classes confirmed my worst fears about childbirth. As rhe classes
progressed. I began [0 relax mOfe because I knew I would have a lot of help and
suppon (rom nurses, doctors, and husband. After birth, I was thankful I had
attended classes. "
"Since the hospital gave the course, they told us exactly the hospital policies and
procedures, which did help. However, I resented their assumption that medica-
tion would be needed."

is concern mat couples are not receiving good preparation (or childbirth
in hospital COurses. We've been using a little slogan for the past few
}'ears, ' All childblnh teachers are not created equal,' and it's quite true."
ASPO/ Lamaze is pleased with the growing cooperation among
health-care professionals. "We're happy to see [he marernal child health
team growing to include midwives, nurse practitioners, and, of course,
our instructors," said Moran. "And the doctors are really beginning to
share information with all these people. We think this is all to the good,
helping provide healthier babies and mothers and better birrh experi-
ences for everyone."
We couldn' t agree more and rhink Me. Moran has succincrly stared the
goals of Lamaze training: a healthy baby and mother and a memorable
birth experience.
22 Preparation for Birth
Choosing Your
Doctor or Midwife
bab '-!o-be, and !hose dreams are
very couple fanmslzes t , Clr of It's understandably
onC of the most pleasunl e parts . ' realm of rooing babies
If awn), from [he Imaginary .
difficult (0 pu )ourse I ld of labor and delivery
In order to begin thinking abou[ the rea wor
-- - --------------(:-j:- ,O- O-fi"g ) 'our Dodor or ,\'idu'l/t
n"y\\', \'our baby\ birth mar ':it-'em remote, but In JUSt a short time
It be real than you can imagine. If you want to have Some
measure of control o\'er rour birth experience, )'OU and )Iour husband
mUSf plan ahead
If you wan( narural childbirth, choosing an obstetncian or midwife will
be the most Imponant decision of your pregnanc)" The quality of a
couple's birth experience is primarily determined b)' three factors: your
labor, rour attirude. and the person who attends you, You don't have
much control o\'er the first variable, but )IOU can improve your memal
approach and rou can ha\'e a supportive obsretriCian or midwife, Many
women say they wam a fabulous birth experience but are quite casual
about finding the person who can make it possible. The likelihood of a
cesarean or forceps delivery can acrually be determined when you select
the person who will help you deliver your baby.
The Lamaze method is an active one. There will be many importam
decISIons and you will need a doctor or midwife who is receptive to the
idea of your involvemem. To find the proper person, you should educate
yourself about l'our options,
It seems only logical that upon beginning any new endeavor, whether
i(s buying a car or building a greenhouse, you would want to do some
research into the available choices. Yet, most couples attend their first
I.amaze class in the eighth month of pregnancy, completely unaware of
many current obstetrical practices and their choices regarding these
practices. Lamaze classes often become consciousness-raising sessions, in
which standard hospital procedures surrounding childbirth are dis-
cussed. Consequently, many students don't know to ask about these
issues until a few weeks before delivery. A t that point, those who find
their doctOr's responses to be inflexible or vague usually wish they had
brought up these tOpics months ago.
Midwifery and natural childbirth go hand in hand, and you will have
an excellent chance of having a natural birth if you are able to use a
midwife. Because midwifery is poorly undecs[Qod, we have devOted a
special section to it at the end of this chapter. We know, however, (har
98 percent of you will be attended b)' a doctor. Therefore, this chapter
concentrates on helping you find the beSt possible doccor.
From the outset, got to understand there's no such thing as
perf<:nion, Don t expecr to find the perfect doctor or to have the perfect
birth expertence There are always variables, such as (augue or faltering
contraclions or an odd presentation, that can prevent you (rom achieving
2-1 Preparation for Blrtb

" In the office, the doctor had somewhat of a patronizing attirude. In the hospital,
we realized how imporWlt the chOIce of a doctor is, He was in control, and the
nurses basically did what he wanted done."
"My doctor said that women need to start telling doctOrs what they want and
fighting for it before the doctors will change But first, we need to educate the
"He was nOt supportive of my decision to try for a natural.bir-:h took it for
granted that I would require suong painkillers (which I dldn t).
"The one thing I've learned, especially after having second baby. is that you
need support. You need a deeply committed doctor.

. I d I thought I had made it
"\Vle had discussed my goals fairly extenslvra/ely,.an be I ft alone unless there
tural and gene y Just e
clear that I wante to go na a1k d and tried to take control
B t my doctor w e 10
was a medical emergency, u . 1 became very angry and mid him
immediately. He wanted to speed thlOgs up. 'own pace, but his attitude really
so. After that he pretty much let me go at m}'
d a doctor who liked to see himself as a midwife
"1 was lucky enough {Q have.foun . 1 couldn'( have asked for a better
. . dId perineal massage.
-very nonintervennonlst,
birth experience.

. \ 'ollr Dodor or \'"/uije


A CR TIt .\L effOrt E
"Mr mformed sources were limited. I asked everyone I knew about obstetricians
and got a few names. But none were enthusiastically recommended. I was sur
prised how many women told me. 'I can'c recommend my obstetrician. I was not
h,ppr' .
"I knew what I was looking for in a doctOr. I wanted a woman obstetrician who
had had a child of her own. I felt I could be most relaxed with someone who
would know' about pregnancy I labor. and delivery from the inside and the Out
"I got exactly what I wanted in medical care. My donor was caring and
patient and supportive. He didn't insist on prepping and didn't push any medi
"He turned down the lights, spoke softly, did not use stirrups until the last few
srirches, and gave me my son as soon as he was delivered. 1 even pulled him out
after the shoulders were delivered."
"1 felt totally let down because he went back to his office when 1 was fully dilated
and forgot about me. He called the hospital three hours later and then ordered
X rays. When he showed uP. he decided to do a forceps delivery without any
anesthetic, It was traumatic and painful."
'The doctor let us do everything our way,"

A C P I I t ( II
"My doctOr was more attentive than I ever would have guessed. He was with me
constantly, even held one leg while I pushed for forty-five minutes He was very
10 tune to where I was, and he was just great'"
"I was very happy with my doctor. He always had time [Q answer questions and
treated me like a well-informed, intelligent IOdividual who was in charge of her

your fantasy, But that doesn't mean you shouldn' l try for everything you
A doctOr's attitude can have a tremendous impact on your birth expe-
rience, It's the difference between a doctor who is supportlve during
labor and one who arrives once you're fully dilated. If you plan on a
natural delivery, you've got to choose someone who understands the
risks of medical intervention during childbirth. If you don't want a
cesarean, you've got to find someone who performs them with great
Although it's never tOO late to start a dialogue wnh your doCtor,
your bargaining position is much stronger in the first of preg-
nancy than in the third. Don't save all the hard quesuons unul last
minute. Your ninth month of pregnanc), is nOt the time to realIZe that
you and your obstetrician have different ideas about childbirth. Al-
though the idea of interviewing a doctor ahead of time may ,make
nervouS, it's the best way to find out how he practices. If you reunwlll-
ing to ask }Iour doCtor a few hard ques[lons. before you reram
there's no real way of knowing If this IS rhe fight doctor for you. It IS
possible to fall into the hands of a great obstetrician b}' chance. but
why leave it to luck? . .. h
FindlOg a doctor is like hiring any profeSSional, for example, an arc )-

CbOOJinC loll,. Doclor or .\fidu.'lfe

You will be looking for someone who is
[e(l, contr3(Wr, or accountant.
competem but shares rour philosophy You want a person you. can talk
to com(,xrably and is to your needs and deSires . It's
Imp<)ftam to remember, however, that you are the one In comrol, the
one who is making the chOICe.
Getting Recommendations
In order to get the kind of doctOr you want, you must actively seek
recommendations and then interview those doctors who sound promis-
Ing. \VIe realize it would be more enjoyable to think up baby names or
plan a nursery at this time, but in order to have a chance at the birth
expenence you would like, you mUSt take control now. Soliciting recom-
mendations is nOt difficult. We suggest start with friends or neigh-
bors who've recently had babies. Be sure to get as many details of labor
and delivery as you can and ask specific questions about the doctor's
Involvement, so that you'll have an idea of how he practices. Also, you
could ,"quire about me amount of time spent with the doctor during
office visits, because mis seems to be an area in which women frequently
feel shortchanged. And you may want to ask your friend's husband,
assuming he participated in me birth, about their doctOr.
Take these recommendations with a grain of salt and keep in mind that
different women need different things from their doctors. Sometimes a
husband and wife have divergent ideas about rhe obstetrician, and it
might be wonhwhile to hear both opinions.
Another source of recommendations may be your internist or family
doctor Dont feel guilty about pressing your doctOr far information'
It'S part of his job to recommend specialistS. If you happen to know
nurses, ask them for names or for an Introduction to a labor and deliv-
ery nurse, who will cen310Iy have preferences among local obstetri-
There arc [wo organizations that can help you find a doctor.
Both train and certify chtldblfth educators. The first is ASPO/Lamaze
stands for the Amencan Socicey (or Psychaprophylaxis in Obstct-
(5), and you can usually find 115 local lISting in [he phone book If
contact {he nanonal ASPO/Lam3.1-C office The 0 h .. nOt,
or Childbirth Ed . A' . [ er group IS ehe ICEA,
borh listings. ucallon SSOCI3uon. See page 435 for
The Interview
The next and hardest step is Interviewing the doctors from your list of
hopefuls. When making an appoimment, be sure to say exanly why you
are calling so that the recepllonist or nurse will schedule enough time
(or the visit. Some doctors will charge for the consultation, whereas
others will give their time freely . To find out, simply ask about the
doctOr's policy concerning interview appointments when you call. 1
there is no precedent, we advise offering to pay so that it doesn't appear
you're just window-shopping.
Many women report that they were glad husbands wenf with
them to interview prospective doctors. You are 10 this together, so your
husband's opinion does matter. In addition, he may pick up on things
you overlooked. The fact that the [wo of you are spending your time on
a consultation also shows that you are serious. To help you find the right
doclor, we've developed a list of questions you may want to ask. We
don't expect you to storm into the office, clutching our questionnaire like
a list of demands, but we do encourage you to ask every question you
want. I n general, we hope you won't be scoring doctors on their number
of correct answers, but will be looking instead for an overall feeling of
flexibility as well as a commirmem to narural childbirth. The imerview
should help you discern the doctor's attirude and style of practice. We
realize that some of you will be going {Q general practitioners and
family.practice specialistS instead of obsreuicians. but you should screen
them as closely as you would an obstetrician.
In order to make your interviewing easier, we're also providing what
we consider to be appropriate answers to these questions. Agato, don't
take them toO literally. There are any number of good responses to most
of the questions, and an interview is not a test, but a chance to meet and
evaluate someone you may be working with for nine momhs.
The following questionnaire comains technical terms and presents
siruations that we will discuss in much greater detail later. If you are
unfamiliar with a term, refer either to the glossary in the back of {he book
or to the appropriate chapter.
Qlltstious Abollt tbe Pl'lIclire
1. \'\fhat is your hospital affiliation? ...
Obviolldy you'll want 10 know where )'our baby Will be born. If your doctOr has pmlieges
at more than onc hospiml. )'Oll mlghl ask which one he prefers and why The answer may gl\e
CboOJing Your Doaor or .\Jidwije
, " For the doctor might prefer A inMcad of ho.spital
Yl.lU to ormation. \:. , .
II nalivc blrthlOg room and the nursl'S are well versed In Lamaze techmques.
J:\ an a t.'(
,See chapter \, Home, Hospital, or Birth Center.")
2. \\'har is the fee and rhe payment schedule? .
Fees \-an from doctor to doc[(lr and bern'ceo cities and rural areas In general, CIty obstetricians
eml more. $t)mc d(Ktots charge a flat fee. no matlcr what type of pregnancy you have, while others
will chuge extra if you are high-risk or if you have a cesarean. Payment schedules and insurance
differ trom dOC[Of (0 doctor. Do nOt make the mistake of believing that the most
expensive obstetrician is the best. DoctOrs' fees are not an indIcation of skill.
3. \,\' ho covers for you in case of illness or vacation?
This question IS applicable only to 5010 pracritioners, because members of a group practice
always cover for each Other. At rour first visit, an obstetrician should be able to tell you when
yacatlons are scheduled, so that you'll know if his plans conflict with your due date.
Can I meet your backup?
There's no reason )'ourdoctOr can't arrange to have you meet or talk to the person who replaces
him in case of emergenq' Even if the chance of your getting the backup doctor is slim, you don't
'Q,'ant to run the risk of being with someone you haven't met.
5. How many times will I see you?
The standard schedule is usually a momhly visit unril the eighth month, then a Visit every Other
week unol the ninth month, when you are examined weekly. Of course, there are variations-
for example. If you are late or have a special medical problem-but normally you should be seen
about twelve urnes in all, not couming postpartum checkups.
6, How long does an average appoint.ment last?
A good answer might be: "As much time as necessary, depending on your physical condition
and the quesuons you have." You want to know that the doctor will have the interest, and
therefore the ume, to diSCUSS any of your concerns.
Questions Aboul LAbor
1. What are your feelings about natural childbirth?
II is essential that the answer to this question not contain any jokes or be accompanied by
grimaces or other strange body language. If a doctor anemptS to make a humorous remark about
childbirth in tht fields. you know you're not siuing in from of your fmure obstetrician. There are
lots of acceptable answers to this one, bUt a really good doctor might say, "The less medication
the benC"r, and then ask how lOU feel about natural childbirth
2. How do you view the role of the partner?
Look for an answer mdicating some enthusiasm for the father's active participation. At the
delivery, the doctor's atmude will influence your husband's experience as well as your own.
What percentage of your mothers receive drugs or anesthesia for labor and delivery?
If more than SO percem of a doctor's patients receive meditation, find (Jut why. Some doctors
PreparaJioll for Dirtb
consider natural childbinh to be a delivery in which a woman 1\ awake and O(lperanve bUI numh
from thl down so that can't feel the pulling out her babv. If most of a doctor"s
receive some kind of medication, this could indicate a lack of ((lmmnmem I( true natural
4. \'hat medications do you normally use and under what circumstances?
When asked, many doclOrs respond that they use medication "when indicated This is mean-
ingless, so press on. Some doctors give medication as soon as a patient asks for it, others routinely
give it at a cenain point of dilation, still others would rather nOt give it at all. There's a world
of difference here, and it's imponant to get a spe<:ific answer
If a doctOr says you won't have to feel a thing and that he uses "twilight sleep' (scopola-
mine), leave right away and forget about the rest of the interview (For more on medication, see
chapter 11.)
5. How much time do you usually spend with a woman in labor?
Obviously you can't expect a doctor to tell you exactly how many mtnutes he'U be with you
at the hospital, but from the answer to this question you should be able to glean whether he'lI
be on the golf course, in the hospital, or actually in your room as you labor. What you don't want
is a doctOr who will arrive just in time to catch the baby. You're paying him to be with you for
the "jUSt in case," and that's where he should be.
6, What is your policy concerning such routines as the intravenous, enema. and pubic
These procedures are totally up to the individual doctor's discretion. Most doctors have
modified or omitted the enema and the sha.ve, but many still insist on the use of me intra\'enous
This is a point you may be able to negotiate, but there are lots of caring .mJ skillful doctors who
insist on the IV "just in case." (See chapter 3 for a discussion of hospital routines.)
7. What percentage of your patients receive Pitocin? .'
We're against the routine use ofPitocin to speed up labor A skillful doctor mlSht say he relies
on pitOcin as a last alternative, for example, when twelve hours have elapsed since the water has
broken and there are no signs of contractions or if earl}' labor drags on and on. A doctor who
uses it with SO percent of his patients is probably manipulating labor to fit hiS schedule.
8_ How do you feel about fetal monitoring? .
Fetal monitors are invaluable for high-risk pregnancies, but unfortunately tnsist
that every patient be monitored continuously throughout labor. During your tntervtew, :.
determine how and when a doctor uses an internal or external fetal monitor. (For more on e
monitors, see chapter 9).
9. 00 )'OU use fetal-scalp sampling?
Fetal-scalp sampling is now considered the most check on ::;:5
rately measures oxygen suppl)' to the bah)" Scalp sampling IS not pe 0
is worth asking about.
\'(fluu is )'our cesarean rate? d ors have rates as high as
The national cesarean rote more than 20 and some oct
Choosi"g ) 'OIU' Doctor or Uidu,i!f
A d('l(tor .. hould hav(, ;l cesarean ratc of approximately. 10 to 15
....'I'(t'nI Tim i\ appa mg , 'I h I k
,- . . h h k 'h' Some doctors. (or example, 'pCCI3 IZC 10 Ig l'rlS' women
'T(l'nt If II higher t an I ai, v. , .
I" h (I (\ important (0 interpret the donor s answer (orrc.ctly, B. c
with (1( rrertcnSlon, S I - .
. d. h ales bener babIes and the relld of unnecessary suffertng with
01 a ('I(tl'f \\ () equ
ll'uream. (F('If rnMI.: on sec chapter 12.\
II. Do yOU perform cesareans routinel}' for women who have had a previous cesarean
Thl're used 10 be a saying, "Once a cesarean, alwa)'s a cesarean," and unfortunatel), man}'
doclOn still practice by that outmoded axiom. More and more, however, arc adopting a wait-and-
see attitude. and a doctOr familiar wid, (he latest studies will generally let )'ou attempt a normal
deli\'cr,', dependlng on the reason for your previous cesarean.
11. If a cesarean IS necessary, may my partner be with me for the operation?
Once men gamed entrance to the delivery room, the next logical step was into the obstetrical
operating room. where cesareans are performed. Unfortunately, there are still man)' hospitals Ihat
do not permit fathers to witness the (esarean births of their children. While it may be the hospital's
poliq to exclude fathers from cesarean births. exceptions can sometimes be made in advance if
you are IOsistent. A caring doctor can tell you how to go about getting the necessary clearance.
13. If a woman's water breaks before labor begins, what do you do?
\\?hat you're tl")'lOg to avoid is a doctor who will insist that your baby be born twenty-four hours
after the membranes have ruptured, regardless of the progress of labor. Some doctors may try to
Kare you about the dangers of infection, but If you stay at home and use commonsense precautions,
there shouldn't be a problem. Obviously, it's nOt ideal to have your water break and then have
nothing happen, but--except for certain unusual situations-this shouldn', he treated as an emer-
gency. Think twice if a doctor says he would put you in the hospital immediately and induce labor.
On the other hand, if the doctor mentions the possibility of using natural methods to get labor
started, you should be encouraged. (For more on induced labor, see chapter 8.)
14, \\fhat is your policy regarding a woman who is past her due date?
Here )'ou are looking for Aexibiliry and a basic trust in nature, Any doctor who routinely
labor on or before the due date should be avoided. Bear in mind that a due date falls within
a twent),-eight-day range, and any date withm that period should be considered normal. (See
chapter 7 for marc on (he Significance of your due date.)
Questiom About Dtlit'l!ry
1. \Vhere do most of your deliveries take place?
flat on your back on a delivery table is the worst POSSible posilion (or delivery defying
lhe law of pumng you at a mcchaOical dlliadvantagc for and possibly
with the blood supplr to the babr Any doctor who doesn'l insist on usmg the delivery room and
Preparation jor Birtb
will UM: a binhing rooro promising. (Sec <napier Chr -,\lng a Bmh Sue.) Any mention
of sitting up, \quatting, or side lying IS cncoura.'ung Lc)ok for a doctor who takes your
and chain.' of position into consideration
2. llow do you feci about episiotomies?
All American doctors acc trained to do cpislOinmics. and only an exccplinnal doctor will
consider nOt performing one. A doctor who is Aexiblc regarding the will a1most
certainly be Rexible about OIher procedures. Most midwives never perform episiotomies rou-
tinely and believe they arc necessary only in unusual situations. (For morc on episiOtomies.
chapter 9.)
3. What arc your feelings about the leboyer buth method?
progressive doctors are now doing a modified Leboyer delivery, which means a1lowing
the cord to StOP pulsating before it is CUI and dimming the lightS. It to be a rare doctor who
allows the Leboyer bath, but if you feel strongly about this, ask how it could be arranged_
4. How much time do couples usually spend with their baby immediately after the binh,
assuming (here are no problems?
There is no reason that you can't all be together for an hour or so after the binh, if everything
goes well. You have certainly earned the reward of seeing and holding a healthy bab.,... and your
doctor can make it possible.
An Alternative to the Interview
If you don't have the disposition to interview doctOrs, and
d h
. othet way to determine if an obstemCian IS reall y
oes t ere IS one
to natural childbirth-by talking to.women than your
friends) who have been his or her patients. ThiS concept 15 to
providing references, and you shouldn't bave any obtaJOlOg tbe
names of a few recent patients. \Vle got tbis idea from fnend, a dOCto.r,
who warned us tbat many obstetricians can sound as If tbey beheve In
Lamaze but practice very
Other Considerations
SOL 0 R f a dOClOr who works alone, although we. realize it
\Vle pre er l ' difficult lO nnd this type of obstetriCian. \X'e
IS becommg tncreastng } b' 11 is designed for the conve-
don't like the concept of a gro.u
d ecaust: frees However tbere are tv.'D
niencc of doctors, and personahze care su ,

Choosing }"our Doctor or ,\fidU'i/e H

Sometimes u's hard to know when someone's purting onc over on you, panicu-
lar/y If that someone is a doctor. \Y.'e hope you'll interview )'our doctor using our
qut.'srionnam:, bur evcn with that, you could still be snowed by a warm smile and
a rush of rt:assunng cliches. There's nothing we can do about the smi le, but we
!la\"c composed 3 list of expressions that should send up a red flag of danger. If
rou nnd a doctor you like and he makes onc or rwa of these remarks, don't be
alarmed. If, howc\er, rhe doctor lOsses off more than tWO, he is probabl}1 a real
smoorhic, and )'ou should beware. Here afC our favorite red flags, in no particular
order of vagueness or overuse:
"I only use medication when I think it's necessary."
'Lamaze, sehlamaze. Whatever you do is fine with me,"
"You'rt: the only one who ever asked me (haL"
Of course )'ou wam an episiotomy. Don ' t you wam to be nice and tight for your
"11s for your sakty
Lt:r's (ross tha, bridge when we come to Il."
"Don, worry about a thing, I'll take ure of evcrythinj.;'

PrtJldnlliQI/ for BirO)

Rt F .\(
"We can't take chances."
,. I don't think your husband should be with you for delivery because it might ruin
your sex life. Do you want him thinking about the birth every time you have .sex?"
"It's a hospital rule,"
"There's no reason for women to suffer ..
"Don'( worry, 1 only do it when I have to,
"The episioromy won't hurt the way I do 1."
"You have 10 think of your baby,"
"You should have faith in me. After an, I'm the doctor."

adv3m3 cs: Your appolOtments ,ue n('ver canceled becau.se ?f a
d' have (0 wor'l' about your delivery cOlnCldlOg "uh
er\'. an you on t
your doctOr's vaGuion, h b h
"up often 4l. n .JPproJch to chlldbirt, ur t ere
octors an a /l.rv . h . f u
d 1 I
, d,,'ersltl' Within the practlce". T erelare. I
, 0 b' l greu c,l 0 . h
(,I C, . 'oli(\ \ thai you meet all the dOCtl'lrS dUring t e
,hoose .\ It 11 c .. C

Choosing ) 'ou r DOdO,. or ,U,dlt',jt

l,f ,'\,)ur visitS to discuss the kind of birth C'xperience you WJnt,
Childbirth I.-an be appwachcd With ml)r(' confiJ('n(c and control if )'OU
knllW nactly ''''ho will be dehn?ring your JnJ If you've gotten to
lnll\\' that person durins the past nine months, If there arc no competent
S1..11l) practitioners where you live, we suggest finding a group compatible
wnh rL)Ur philosophy and as small as possible Two or three partners is
manageable; or six can be o,-erwhelming,
Another factor you may want to thlOk about in selecting your doctor is
hiS age. This is a fuzzy issue because there are pros and cons for both
older and younger doctOrs. Some women like young doctors because
they are often less patronizing and more approachable, They also tend
to get more emotionally involved because they have fewer patients and
because they are ofren experiencing the excitemem of having babies
themselves. On the orner hand, young doctors are sometimes more apt
to rely on machines and surgical imervention, because that's the way
they've been taught. They also lack the wisdom brought by experience.
A ulIrry-five-year-old doctOr would probably do a cesarean instead of a
mid-forceps delivery, wherea5 his fif[)'-)Iear-old counterpart would be
more skilled in the use of forceps. Older doctors are more experienced
and therefore often calmer, having learned that most labors proceed
uneventfully. But age can bring burnout and a lack of patience in dealing
with the day-tO-day concerns of normal pregnancies.
\);7e don't think a dOCtor's gender is related to the way he or she practices,
but we know this is one preference some people feel strongly about.
\X'ith more and more women going to medical school these days-ie's
expected that by the year 2000, 20 percent of all doctors will be women
-you may well be interviewing a woman obstetrician. You can't as-
sume, however, that she'll be terflfic Just because of her sex. Although
she is like you 10 some ways, she has also had the same technological
tralOtOg as her male counterpart. And, the fact that she IS a woman
doesnt mean she'll necessaril}, practice like a midwife. In general, you
have to scruunize a female doCtor as closely as you would a male.
You may find a doctor who answers all of your questions beauufully but
for some reason rubs you the wrong way. Unless there are no mher
36 PreplIraliQIl for Blrtb

"Unfortunately, I got the only doctOr In the office that I didn', like. He was
arrogant and cold. I was very disappointed
"I don't think he even knew what my name was. The pnmary dOCtor knew me,
but he wasn't {he one to deliver me."
"The obstetrician induced me because he was gomg on vacation and didn't want
me to have the baby while he was gone, The baby was five weeks early."
"Even though he wasn't 'on call,' he came 10 for my delivery as we had agreed.
"There were four doctors in the group. It was like a factory."
"} wanted a doctor in solo practice and that's what 1 chose, My told
me that if you go with a group, you invariably get the guy you hke and I
f I h doctor always has hiS nose
believe that. In a group, consistency a care IS ost, t e - b
in your file, seeing what happened last ume. \'(Iith onl)' 10 c arge
o looked and I'OU develop a real close relationship.
nOt 109 gets over
On> docmr can', possibly deliver ba-
"It made ;ore se
::: me, if my doctor gets a lot of
bies 365 II '
h e someix:xJy who's not exhausted in the deliverr
vacation, tern c! at east AV

(bOOJillg ) "0111" Doctor or )fidw.Ji!


G II 0 (I I'
"1 chose a group practice because I wanted to know the physician that would be
anending the bltth. 1 was worried that if I used a single physician, he might be
III or on \'acation or tOtally exhausted when the baby chose to arrive."
"I used a group practice. They had me rOtate with all four doctors so that I would
know everyone. 1 had confidence in them all and had terrific care. I fe lt the
practice was very unified in philosophy and approach. I'd hate to have to depend
on only onc docror."
"1 had a backup doctor, who was totally against my using the birthing room and
made very sarcastic statements the moment he entered the room. I wi ll definitely
check Into the backup doctors next time so that this will not happen again."
"I dIdn't choose m)' obstetrician on the basis of single or group---I just stuck with
the single doctor I had. As it turned out, he was on vacation when 1 had the baby,
but I liked his backup even better. I liked seeing one doctor throughout who
knew me, even if he wasn't there for the big event."

obstetricians 10 your area, it would seem best to look for someone else.
A crlucal component in selecting a doctor is whether you like him. It's
essential that you feel comfonable when you are being examined, talk-
mg. and, mOSt Importantly, asking questions. Unless you've had a
chrontc disease. you've probably never visited a doctor almost fifteen
times In ten months. This frequency gives you an excellent chance to get
acquainted. but it also allows a mild dislike to grow into something much
more negative. Today many people seem to believe that a doctor can be
JR Preparation for Birth
either medically competent or emotionally supporttve but (hat they (:m't
have it both ways, We don't agree. and know many doctors who are OIce
people as well as skillful obstetricians,
Some women look for a fatherly type in an obstetrician. Othcn want
someone they can chat with easily. We think both of these priorities. are
fine. and It'S great if you can clearly identify your needs. There are,
however. women who expect toO much from this relationship and invari-
ably end up disappointed. To avoid this pitfall. we have drawn up a list
of what we feel you can reasonably expect of an obstetrician'
To answer your phone calls promptly;
To share all knowledge about your pregnancy;
To welcome your husband or partner at all office visits;
To be attentive to your feelings (but that doesn't mean being as
excited as you are about your pregnancy);
To be there while you labor
In general, you want your obstetrician to be. friendly and respectful,
but you don't want him to act like your best fflend take the .of
h b d You mus
t remember this is a profeSSIOnal relauonshlp.
your us an ' .
Suppose you've chosen a doctor. but for one reason or anmher (you re
moving or the tWO of you arc incompatible) you need {Q someo,ne
'd 'You're not married [0 your obstetnClan, you re
new on t espalL . . .
'I ' h,'m "or medical care. Umit the moment of delivery, It s
mere y seeing al ho
never too late {Q switch doctors. We know sever women w
changed doctors in their ninth month. and all of them were happy they
had done so. . OU to change doctors frivolously. Unless
\Y/e're not encouraging y .' mak-
, ft hould try negotiation ....
there is a true personahty can Ict, you s, h' Doctors aren '(
f f I
, I r about why you re not app).
ing yoursel per ect ) c ea . d' . fied Go to your
'I k ow why you [e Issatls .
mind re. aders and don t a n d k he receptionist to sched.ule
, . h I' of questions an as t
ncxt VISlt Wit a 1st d I that )'OU can present a untled
, B your husbnn a ong so
extra time. nng. " i ns of the doctor. Be willing to compro-
(ront as well as gam h relationship is perfect. Also. try
, h b anng 10 min t at n ,
mise somew at, e II \Women frequently rensC
',h what )'OU rea )' want.
W come to terms WI
--- -



CHA :'\ G I :-.; li 00(' TORS
"\\"'e moved out of state in my eighth month and had to find a new doctor. We
inqulfcd about birthing procedures at a few hospitals, {hen went to the hospital
we liked bes{ and asked them to recommend a younger doctor who was comforta-
ble With natural childbirth. We werc lucky because we immediately liked the
doctOr ther recommended."
"Much binerness is aimed dlrecdy at my doctor. I have sworn never to use him
again and have ver}' few good memories of the man. I should have known right
from the beginning that our relationship would be poor. At my first prenatal
checkup, I felt like I was JUSt another uterus. Things did not improve over time,
but I was afraid to change doctors mid-pregnancy. As It mrned out, he handled
my labor very poorly and ultimately did a cesarean. My daughter was born at
4:39 P.M., and to this day I believe that he took her then so that he could be home
In time for dinner. "
.. I decided to change doctors in my seventh month. It would have been easy JUSt
to continue and say. 'It's out of my hands,' but I was tired of feeling like a victim."
"He would laugh at me sometimes and say I was trying to undo what the medical
commuOIty had already achieved. He did nO[ do enemas or shave, but he insisted
on an IV and monitors. J now wish I had changed doctors, but I didn't."
"'X'hen we moved, I had to scout around for a new donor. When I spoke with
one doctor, who was quite young, about namral childbirth, hIS response was
some thong like, 'If you like pain, you'll like natural childbirth.' Needless to say,
I found someone else."

40 Pre/Jtlruti()tI jor Birth

,. ... '., Do
"The awkwardness of changing doctors was of surprisingly mlc concern to me.
I didn't know how 1 would deal with the goodbye explanation, but I knew I had
to be able to truSt completely whoever would be with me during labor and
delivery, I had done my reading and J had an inkling of the imensity of the
birthing experience. It made sense to try 10 decrease stress as much as possible
In preparation for that effort and [Q try to arrange to have competent, warm,
supportive people with me,
"As silly as it may sound, I thmk this deciSion lO change doctors was a water'5hed
for me. I grew up some. The 'obedient girl to authorities took a backseat 1 took
responsibility to make what effort 1 could for me to have a positive birthing
experience and for my baby to have a pleasant entrance.
"My delivery was problem-free. and my doctor was terrific If I have another
child, I would want her [Q be there again."
"There were four doctors in the group. They had a very good medICal reputation.
but I didn't particularly like the tWO I had met. If I had had a good pregnancy,
I might have been able to deal with their lack of sympathy and poor bedside
manner, because in my mind, medical competence was number one. But I was
getting all of one and norhing of the O[her, and I needed lots of number fwO.
"I felt one doctor had been in the business tOO long. He was very ple:lSant, but
also very egotistical. He'd answer yes or no to my questions, but he
any information. There was some concern for my constant nausea, but ,onll' trom
a strictly medical poim of view_ Appoimments were very shorr; I was IfI and out
in five minutes.
"I hesimted to change doctOrs for yet a third time. I was eager to someboch
who was just nght for me, but I had little confidence IfI my ability to
decisions. Luckily. someone I respected very much came along and Said not l'
that I should change doctors (l had heard that a lotl. but (hat she hld a suggestion
and handed me the name and number. It was a godsend, something handt.-.d to
.\ I 1- the blue All 1 had to do was make the phone call.
me on a 51 ver patter, out 0 .


C/J()osillg )'our Dodor or ,\Iidu'ije


e 11\ " L
r.; l.

'The consultation went \'cry, very well. I had a chance to speak about concerns
r had. and by rhe end of (he appointment I really felt good about,bein
I th,'n arranged tl.) meet my new doctor's assoCiate, and (hat meeting equally
well The)' were able to make pregnancy exciting and less scary. I,n lust one or
tWO ,",sits I had a 10( of my concerns cleared up, I was much happIer and much
more at ease.

their Idea of a good obstetrician in the middle of pregnancy because their
needs change or they didn't know what to look for in the first place. For
example, you might select a sucgicalltechnicai whiz and then feel disap-
pointed several months later because you're nOt being supported emo
Most pregnant women aren't in the mood for a confrontation with
their doctor, but we can't emphasize enough how important it is to have
an obstetrician you like and trust. If, after thinking the whole thing
through and discussing it with your husband, you're still unhappy.
change doctors. Don't worry about causing an upset. You have a profes
sional relationship that just isn't working out, and you must do what's
right for you. Your doctor will nOt be devastated-but you might be if
you have a bad binh experience with someone you neither like nor trust.
A letter is usually the best way to extricate yourself from (he relation.
ship. If you've paid the fee in advance, ask that the COSt of your visits be
prorated and mat your new obstetrician be sem your medical records.
Getting }'our money back shouldn't be difficult, because you can always
enlist the help of the state or county medical sociery, and your doctor
knows this. We recommend explaining the reasons for your dissatisfac.
tlon, even though [his can be painful. Perhaps if enough people tell a
doclOr why they aren't happy, he may try to change. Jf Il weren't for
couples who complained and asked for what they wanted fifteen years
ago, mothers would still be strapped to delivery (abies while thei r hus.
bands paced the floors of waiting rooms.
- -------
Prepartllir)1J for Birth
As mentioned before, you will have an excellent chance ) f having natu-
ral childbirth if you art: able to work wah a midwife . Midwives have an
inherent truSt in the natural process of birth and arc commined to a
policy of nonintervention. We've never heard of onc who arnved just
in dme [Q catch a baby, or offered an epidural in place of emotional
support, or routinely performed an episiotomy. In a normal bmh a good
midwife is always bener than an indiffert:nt obstetrician, provided there
is no medICal emergency.
There are twO basic types of midwives. You can have either a certified
nursemidwife (C.N.M.) or a lay midwife. The difference between a lay
midwife and a C.N.M. is formalized training. A lay midwife may have
gone to school, but her expertise IS based largely on practical experience,
and she can assist only at homebirths. A CN.M., on the Other hand, is
a registered nurse, trained as a midwife, and is certified by the American
College of NurseMidwives. She generally has a good deal of practical
experience and can deliver babies at home, in an alternativebirth cemer
or in a hospital. This type of midwife is sometimes in practice with an
obstetrician and usually handles prenatal visits and routtne delivenes.
There are approximately 2,500 C.N.M.'s practicing in the United States
today, and they assist in about 3 percem of all binhs, delivering about
100,000 babies a year"
\'(Iith a midwife, you receive more personalized prenatal care than you
would with most obstetricians. Checkups are not rushed, and you are
encouraged to ask questions and voice }'our concerns.
a great emphasis on teaching, especially nutritional counseling. In addi-
tion. you will probably get more emotional support preg
and labor. Midwives are concerned about your at every
stage. and they are renowned for staying at your bedSide, not at the
nurse's station, during your labor. .
Under a midwife's care you will be assured that everything done to
" " I A'fidwives advocate nOOintervention in obstemcs. and
you IS essentla . 1" d al
"d "C "II be more Iikell' to allow labor to procee ong
that means a mt wile WI .
" I Ira m,-dwife decides l'our labor needs to be snmulated.
ItS natura course.
you can be assured it's for your benefit, not hers.
Midwives cost approximately half as much as obt' g}'ns, and \\'ith a rou-
tine pregnancy and delivery you' ll get much more care for dolla.r. In
addition more and more IOsunlOceco
pames arecovenng

Anmh'er honus is that your family will be treated JS a woe. e
Cboosj"g Your Dodor or ,\Jidu',/e

j..- -'- -
CliO 0 SIN t. ,\ Min \\ I F l
"GI\,lng bmh IS a natural process that seem to be more In tunc with
than the medical profession. Also, being in control at the start will begin the
confidence necessary for child rearing. "
"I was extremely happy to have had the option of using a midwife for prenatal
care and birth because I feel that pregnancy and childbirth should not be treated
as medical emergencies. Unfortunately, medical training in this country deals with
trauma (very well) and is nO[ good with cooperative, educational, and preventa-
tive work with the diem. patient . My fears of medical emergency are alleviated
by the fact that my midwives practice at a large hospital. Being with women is
great. ,.
'Pregnancy is one of the most Insecure periods of my life, and I felt I needed to
be wuh other women, (Q be 'mmhered: I wanted as little interference as possible
and to be able to let thmgs proceed. narurally."
"I from a. of nurses and doctors, but I chose midwives for bOth of my
deilvenes. A midWife 10 private pracrice 10 a hospital-the best of bOth worlds."
My midwives have giv h .
caring than I Juld h en me muc mOre umc, information, and imelligem
ave gotten from the v .. ( ..
I will be mfo .d d . b h ' ast maJonty a obstetnclans. Because
rmc; urlng Irf ,I II have control b d '
no dlfficuluc;s will arise due to d . over my 0 y. and I m sure that
a OC(Qr s need to use technology."
I Ihmk I made Ihe nshl d' bo
cos IOn a Ul uSlOg a 'd r
birth, but rm not sure I'd k h group-ml wilcry practice for my
rna ere same (hoi, r h I

E _. . . . . ".""". " ..
-/4 Pn-Jltn.lllfJl/ for Bit'" --_ .

C I I O rj ,j t, A
.. "
the circumstances were quite unusual : I dilated beautifully to eight centimeters
and then stopped. 1 continued (Q have strong contractions, but after three morc
hours of labor I was still in tcansitlon, the cervix had begun to swell, and I had
regressed to five centimeters.
"If I had selected an obstetrician instead of the midwives, I know the outcome
would have been identical. The only difference would have been that I would
have been spared those extra three hours of labor_ I approached the birth of my
first child from a fairly radical viewpoint, bm now I think I'm morc aware of some
of the risks associated with childbirth and I'm morc inclined (0 try to find a doctOr
1 trust."

midwife will be instrumental in getting the three of you off to a good
start. She will allow generous time after birth for tmroductions and will
help you with breast-feeding. Midwives welcome your husband's in-
volvement, and you'll bmh be encouraged to get acquainted with your
baby (or as long as possible.
If you think you would like a midwife. we hope rou l.l use the ques-
tionnaire we developed for screening obstetricians. Obviously, some of
the questions are not applicable, but we think the interview can be useful
in dcterming how a particular midwife pranices.
There are dangers in having a midwife deliver your baby at home, and
it should never be considered unless 3 docwrand hospital are backing
her up. (See chapter 3 for more on home delivery) \Vle thlOk best
place to have a baby is in a binh center attached to ;i hospual, but
unforlunately there arC just a handful of these scattered.
. h n bl' mIdWives arc becomtng 10-
country. Alternative-blrt centers, TU .
creasto I f opular, but If compilcanon5 develop. must be {ram-
S) Ph' I \V/e fed the mldwlle pc-actlong 10 a
ferred dUring labor to:\ OSPUll. h deliver' room
hospital offers the best befween the high-tel.. )
and the more risk)' home cnviCI.:m

Choosing) 'ollr DodO,- or .'Iic/wijt-

If \,(1U J midwife and then dew' lop any sort of complication
durin"s pregnancy, )'ou' li probably be transferred to a care.
MllfCover, midwives are prohibited b)' law from performing cesareans
(lr dellvenes. For this reason many people prefer obstetricians,
who can promise continuity of care, come what may. Also. some couples
lust can't feel comfortable with a midwife-they may be from a family
of doctors, or they lust may be parricuiarly anxious about childbirth.
New York City has several successful midwifery programs. One that
has receIved national attemion began in 1977 at the North Central
Bronx Hospital. In five years of operation, the midwives lowered the
hospital's overall infant mortality rate so dramatically that it now Out-
ranks the average for rhe city's municipal and private voluntary hospitals,
This is remarkable because 30 percent of the patients at North Central
Bronx are considered high-risk-teenage mothers, Medicaid recipients .
and women with little prenatal care. Even with this population. the
midwives have a cesarean rate of only 9 percent. As you might expect,
the midwives have also greatly decreased the use of forceps. medication,
and anesthesia. They handle 87 .7 percent of all births at [he hospital, or
roughly 2,600 deliveries a year.
Selecting a doCtor or midwife is a decision only you can make, There
are many accomplished and compassionate doctors and there are also
hundreds of dedicated professional midwives practicing in the United
States tOday. There is no one choice for everyone. We hope you will take
the time to consider which alternative is best for you and to choose
carefully the person who will make your binh experience the best it
can be.
Preparuli(Jll for
Home, Hospital,
or Birth Center
hhough both home birth and birth centers are enjoying great
lariry tOday. approximately 98 percent of all couples choose a hospi-
tal delivery, This is because a hospital is perceived be safest place
by (women who filled out our questtonnatres repeatedly
to ave a h . I
d I
b I f) Mos[ doctors would argue strongly that a osplta IS
state t liS e Ie . .
the only safe place to have a baby, As more and more stud.les appear.
however, there is growing recognition that homeblrths and btrth centers
Home. Hospiltll, or Birth Cetlter
It rnat,\'.,\ If there IS proper scre<,'ning. expert carc, and hospital
:lre \;1 C;1 c:
t'lal:kup. .
The foundation of hospital birth is not as old or as solid as you might
think. "mnlY Caner was the first U.S. president to have been born 10 a
and today it's nOt unusual [0 meet a senior citizen who was born
at home. Before 1930, most women gave birch at home, but after World
\\'ar II. the national birthplace shifted from home to hospitaL In the span
of (wo generations, birth moved from the family circle imo the medical
\'(lhatever setting you choose, there is no guarantee of absolute safety.
Each option has benefits and hazards. If you select a hospital, you are
faced with the possibility of many types of medical intervention, includ-
Ing the use of intravenous, enema, pubic shave, fetal monitOring, labor
stimulation, and routine analgesia. In addition, you and your baby may
be exposed to bacteria that can cause infection. If you deliver Out of the
hospital, unexpected complications can become life-threatening because
precious minutes must be spent in transport to a hospital. Neither alter-
native is completely safe. Each one carries different risks, and you must
decide which ones you prefer to take.
Many observers believe that American obstetrics is being pulled in
opposite directions. On one side are the high-tech obstetricians, who
order IOterventions at an astounding pace. On the other side stand the
advocates, who trust a woman's ability to give birth. AI.
though It seems Ironic, the obstetrical technicians have helped to fuel the
alternative movement because they've made hospital births unanractive
to so many people. In a foreword to Home 8mb: A Prorllliomr's Guide 10
B",h OIllJld, 'h, HQ!pII.I, Dr. Phillip Stubblefield expJatns this impetus
for out-of.hospnal birth. 'It's harder to change an existing setting than
to create a new one. Couples having babies right now want a bener binh
they have no time to change the system except b .
to 5t. r H . ,y voting
u. ence, [he growing homebinh movement and the rapid
rat(, 0 establishment of out-of-hospital birth ceorers " 0
spending to . nc woman re-
our qucStlonnaire had a choice between a hospital with a 50
rare and a homcbinh. She decided to have her baby at
Most women howe .
, ver, never consldc:.'r alternative options and simply
assume they will go to the hospital. These women {Jften have a long-
"tanding rdationship with an obstetrician/gynecologist, and it 1\ taken
for gramed that he Will deliver the baby at the hmpitaL Although
choice of a birth site may not seem important, It will greatly InAuence
the quality of your birth experience. Before: deciding where you will
give birth, we strongly recommend investigating aU options.
There are many variables that will affect your decision: your health,
your feelings about previous births, your financial statuS, your husbands
attitude, your philosophy about childbirth, the facilities available to you,
and whether this is your first baby. Its impossible for us or anyone else
to tell you what to do. Only you can consider all the interrelated factOrs
and choose the place best suited to your needs and desires.
Its human nature to want to improve upon experience. The women
who filled out our questionnaires showed a strong desire to change each
subsequent birth for the better. For example, many of them were disap-
pointed because the hospital's one birthing room was in use; next time
they hoped it would be available. Some of them also mentioned they
would like to try an alternative-birth center inStead of the hospnal. Only
a few were interested in trying homebirth. but the ones who had ex-
perienced a home birth were adamant about never having anything else
It's very likely you'll have a great birth experience wherever you have
your baby if you have carefully selected your doctor or midwife. No
setting provides guarantees, so it's critical that you uuSt the who
attends you. Many people believe you have bener control 1f you .first
choose the person who will deliver the baby and then choose the birth-
place. But sometimes circumstances dictate these must be
revcrsed. For example, if you live in an area wlth twO hospttals, one a
modern, well-equipped teaching hospital with a high rate and
the other a small community one, dedicated to care,
you. d select the hospital first and then try to find a doctor you hke who
practices there. .... ..
Although a hospital is regarded as the best place to be tn
the hospital setting actually promotes unne<:essary
In 1976 Dr. Lewis Mehl conducted a comparison study of 1,04 women
who planned a homebirth with the same number of women \ .... ho
. I d I . The tWO groupS were welt m.atched, but Mehl oun
hosptta e tvenes. . h e-
.. d.ff . . the degree of obstetnc IOter .... entton eac r
a stnklng I ercnce 10 . f d I"
'. . I had more analgesin, oxytoClO, orceps e IV-
qUlred. The hosptta group. . that the birth attendants
cries, and episiotomies. It 1S Important to note
Home, Hospil.,I. or Birth Center
ham.i the ",1 tholt dltll'rl'Ilt.t.'.S l.\I1:l' ,tS i.l Cl'sult of
helng to thl' h,lsrltal. Thl' IllLrl'.lS(,i ltkl.hh()(lJ ,1t, Illl'Jh:.,l
In the h,l!Oplt:l1 nuy n'sult tCl11ll ;), lI"lWl.'r m(lH\ .HIl 'n tllC till.' {l'
nsrural (hildhlrth. ('r fn.101 nhlft.' n.\"hl" .,i\.:,hk' llf tr,llll
l'ln tht.: btrth .lttl'n,bnb fI."l tntl'C" ...tll,. ,,(\(.ll\ ...C IHllH..' ...'s-
sl\'d\ In thl hl"lsrtt.ll th.m hl"lnW, Tht.'rt:' Wlrl.' m' tilth.'renles
m wc,.'\}O:,ht. ol'wt"..lm m('irr ..lhty. or other
malllr octwt."'ell tht.' nt.'wlxlrns \If tht.' tWl'
In t'\alu3Hn}O:, the risks llf tht.' dltreft.nt blrrhpl.l(l'S. YllU shllulJ take into
'-llmIJt'nltl,"ln thl' Silt." ,lnJ qUillity l,f the hl1spit'.l1 th.l( wlluld provide
b.i.(kup (.Ire ,I birth (cntec or hllmc deliver)' . In lIomf
B,./b. Dr Stubbktield th;1t .111 hospitals .lre nl){ ;Iltke:
Theft: .!o!n.-"31 Cl..lntnt'!>t (h(' klOti Of t('dlOK.\I1), high-quality
l'An.: that can I:'t:.. Pf\."l\ .Jed 10 the beSt hospltJI seuins: and that whICh
can rr,',nJl..J In homl. but how much (llOlC'.\S1 IS there. really,
betwt."en a (are and wdl rC'.lined .1Od equipped
hl'mt.: Jdt\crv (,-am? If (he mother em he transported (0 3 hospit.ll
v,"uhm ll'1l where a (earn awaits c;.\p.lblc of performmg .10
(l.'''CC.lJl '!>e(Ulln. the ouh:omc of an at home
may lx hencr than If (hI..' were IJbormg In .1 small hosptml
"" hl rc It "" llUld talc half w hour h) a...,\crnble thc ce&.ut. ... ln section ream,
h(lttllrn Imt.' lln this questlon IS Yl)Uf Jbdity (() feel relaxed and
Ibsun:d. Lahtlf Will PfOl:Ct..j most smoothl" If you .lre at ease emotionally"
If a h('is(,t(tal would you the proper peace of mind, that's where you
if pJU really wam 3. homehlrth. but husband would be lOa
Ihl."n a blnh (l:'ntcr IS J happy cllmpcomise. Ie's good
(() ha\e I..hOh'::n,anJ Ivda}' thert.' arc soml.' new Jhcrnatives. The only
UUillll'n ",eo can t sanltivn I!I a htlml'birlh wHh on)}- your husband 10
.[{('oJ,In e }'LlU may hil\'c..I..-nrnpit.-(c faith In natuc.ll dliidbirrh.
)"our husband I) ancx!"l'cll"n(ld JI Jdlvl'nn.'t A pnlblcm l'Jsily
handlt.-d b\ a mIJ\l..tl. l.an furn IOh) J ..It rhl." h.lnlh of .1 noVlCC,
If \OU choo.se 10 J.dl\t.c un.;,Uh:ndlJ at hume. ynu Jrt.' !IetllOR rnuclclf up
f,)r thr n\kll"1t )1 all \IIUaUllns
,.,..,.'''';''./0' 8mh
.lIl hlfths In the 11.\IIon. Ore.'tnn, Whl'fC ht p'---.-' '. 1.1.1-"'''.1
r,lII..' lIf h\Uf (ll'Cll."nI The natllln.ll s hetlcVC(t to lOaClUr.l.tc1y
lllw. bn.lU\l' Iwolf..' deilvt.'f1cs .In ..' .lteg.tl In milny lid "I e-don an.
nlll .lh\ .IY'" fc.:pnrtl'ci
Illln1chlflh .. dtd not becoml' \(UCC hc .... 1USC they '9.CfC unsafe_ but
bl..'(.\U\l" hllSpH.11 hlrth ... Wl'rt.' ml1fC Tll mar-.:.;tc d hcmeblrth
propl'rly, .\ dr)(wr or mldwifl' musl "pcnlt hl un ill a woman-s bedside
p.ltlenliy ohsef\'m!{ thl' cour,c of hn laht1r In a he.spltal he or she can
rdr lOSlt ...ld on nursl.'\. n.:,idcnts, IOtnnS, and kul mpOIt('fS to ch.ut the:
progres\ of lahoe. By pc..'riormin1'! all ddl\'l'nn In a ho\ptt.t1 . 1 doc(\r (an
.llso man.lgc thc labors 01 tWO Of more wnml.'n 'ImuitaJ1c(lmly and (.10
s.we (oumlc'!>s hours to .lnd fCllm dlffefent k'l('ltions_ Home
hlrth IS often J long. Jrawn-llut Jtlalr lnd mo'!>! pr.ldlthlnefS simply

H 0 r: B I R T It
" wanted [0 be able to use my own kitchen, my bathroom, and to eat whenever
I WIshed. I felt very comfortable at home. I also wanted to get in my own bed
with my new baby It was special."
" 1 wanted to be in my own surroundings, have a happy, unmedicated birch, and
cart for my baby myself and not have her taken from me. I JUSt feel that hospitals
are for SICk people and unusual siruations, and that birth is a natural, normal
proces.. ...
"I a natural delivery. without interference because of someone else's
rouune or schedule I think homebirth is the safest way. "
'While I often tOyed with the idea of homebirth, I feel the risks are too great."
"J felt happ) and comfortable in my own setting. and had a lot of suppOrt and
help from famll),"
I had rn)' 6r)( 10 a hospnal, and (he fourth in a home setting. There is no
comparison. As long as qualified help is with you, and a hospital nearby JUSt in
you are In COntrol. We need to get away from assembly.line delivery."
Afh:r the birth It wa\ a wond!rful feeling (Q snugs Ie up wilh m (; '1 .
bed As long as the pregnancy normal, I'm convinced Ihal h 'b
y Our
natural. . orne Ir( IS sale and

------ -

H U,,!
"We had a homebirth. and il was the moSt meantngful thing I have ever done.
1 feel very fortunate to have birthed this way I don't advocate homebmh for
every woman, though I do belicve that marc women could successfully have their
babies at home and have an easier, more rewarding experience than in a hospital
I myself am not against hospital birth for others. Many women could not feel safe
outside this setting-but I could nO{ feel safe within It.
"I think society has brainwashed us inco believing that childbirth is a horrible,
dangerous condition that can be handled only in a hospital by medical personnel.
\Xlhile many problem pregnancies and births are beSt dealt wim in a hospital with
its technology. there are many more bIrths that would be beSt left alone, Too
many procedures are for the convenience of the doctor. Women need to know
that they needn't simply surrender their bodies to thetr doctors-mat the choice
is theirs."

risk must be considered by couples contemplating a hornebmh and it
should be weighed against the different sort of risks found in hospi
In general, home is where we feel most relaxed and secure A common
compliment is to say we feel "at home," or to describe an environmem
as homey or homelike, To give binh at home for many is simply to senl,e
for nothing less than the real thing-your own environment. There s
also a lot to be said for not having to be transporteJ dunng labor. and
when it's all over, for being able to f.lll J.slcep In your own bed, In
addition, homebirth represents ;l hol1stic philosophy olnd, ofren, J.
of life, It works best for people who have faith 10 the normal workIngs
of their bodies and who don'r fall prc)' to the "what if' memalny that
char;luerizcs much of Arnencan obstctrlL"S
According to (he women who filled out our the- deci-
'iion tt) have n home-birth was oftcn bl\'ied on the dt'Slre to be III charge
At home-birth the doctOr or
The Issue of control is a (ompe 109 one. J



Preparatio1J for flirt/)
Home, f/ospi,"I, or Birtb Ceuler
, h > Jt I'our invit3til)n, and therc's much less chance
IS III rOUf orne
l)t running up agalnsr aU(horir-arian .urirudes. . .
B b K
, Rothman discusses her decISion co have a home-
Author ar aea arz . .
'h d h lcuoole with the issues of social acceptance and responsl-
btrt an er s ,
I h
'ocal,o"e book JIl wbo,. U"omOl ,lilt! POlI'ff HI tbe Birthplace:
bi It)" In er pro\
There were some nsks I knew I could rake that werc torally acceptable
I was not held responsible, (or example, (or how I chose a
doctor Had I taken just the local doctor because I hated traveling on
the subllo'a},s, that would have been considered legitimate. And if hel
she screwed up, that wouldn't have been my fault , Back in 1973 I
could still ask to be drugged out of it completely and would not have
been held socially accountable for whatever risks that entailed. A
fnend of mine went to a doctor I know to be something of an idiot
and asked that she be knocked out when she gOt to the hospital and
not brought to until they had a clean. pre(erabl}, diapered baby to show
her And she got that. And that was sociali}' acceptable. A friend's
mOlher took diet pills all through her pregnancy twenty years ago
because the dOCtor prescribed them. The pills have since been raken
off me market (or everybody. not JUSt pregnant people .... But none
of these women are responsible, because they followed doctor's or.
The morai was that the more control I gave up, the more res pen-
slbdlt) I gave up for me consequences and the more socially acceptable
ffi)' beha\ior would be.
'h"\I'dpeb oPhle equate homebinh with a primitive SOrt of experience
C I lrt mthefield W" '
h H
s. e re not talking about that kind of thing
ere. orne-birth sho Id be II
u a we planned and carefull
evene In order to have a safe b' h h y
. let at orne yo h Id
(allow 109: u s ou
have the
An expenenced and qualified doc
attendant in case of -II . tor Or midWife, with a backup birth
I ness or emergency
A huspltal ready to acccpt yOu 10 C > '.
A reliable means of t _ asc of complications
A normal pregnancy to the hospital
A - Wit no unusual sym
)J)Cclai caretaker for orhe hOld _ proms as labor begins
- r <:: I rcn dunn I
e p with household dUI d _ g YOur abor Bnd delivery
- ICS unng th .
nod C Immediate POStpartum pe-
Preparation for Blrtb
Your doclor or midwife will bring certain supplies but will expect you
to have Others All preparations should be made well an advance of voue
due date.
A birth cemer can be a doctor's office, a building adjacent to a hospital,
or a facility all by itself. Officially. birth-center deliveries are categorized
as out-of-hospital births and they are the fastest-growing trend in the
obstetric business. Today there are more than 120 birth centers scaltered
around the nation, with at least 300 additional ones currendy planned.
Binh ceorers-sometimes called alternative-birth centers, or ABCs-
are popular because they are a compromise between home and hospllal
birth. Emergency supplies, such as IV or resuscitation equipment, are
hidden out of sight, and typically all that meets the eye is the homey
environment of bedrooms, a playroom. and a kitchen. Sinh centers
encourage narural childbirth, free of intervention, but they are equipped
to handle most emergencies short of cesarean section. Birth centers often
provide complete prenatal care and nutritional counseling as well as a
site for labor and delivery. Families return home within twelve to
twenty-four hours.
Care is provided by midwives or decrers. although some centers are
sraffed by both. Birth centers are designed for low-risk deliveries, and
approximately 25 re 30 percent of their prospective chenes deter-
mined to be unqualified. Multiple births, anemia, or
unusual presentation of the baby would prevent you from haVing blrth-
ceO[er delivery. During labor, another 15 percent of all wome.n are
transferred to a hospital because of complications, such as
undiagnosed cephalo-pelvic disproportion, severe meconium stammg,
or failure to progress.
Most childbirth experts believe birth cenlers re be extremely safe, but
there are very few studies re document this opinion. A study by.
L b
' eN M d,'rector of the Maternlt), Center Assoc"13t1on.
Watson U IC, . . .,
'B C N '- f Ph 0 attempted to compare the outcomes
and Amta ennetts, . .1' " '. " .
of mothers and babies at birth centers With Similar lOW-fisk mothers who
delivered at hospitals. This wasn', possible, however. because the), were
denied access to hospital dar-a.
Instead of a randomized controlled stud}', Ms, \'\'atson and Ms. Ben-

- ------ ----

B I R T II C f T E R
'\\'c: hve In J rural area, and the clinic was the dosest-thlrtyfive miles. Instead
of \ixry-fl\'c miles to the nearest hospitaL I preferred the non hospital sening, and
at 800, the delivery \Vas also much cheaper."
.. , thlOk the setting of 3. birth IS Important. and the birth center room was great.
Tht: C\Inams. rocking chair. dresser, lamp, walls, bassinet, and birch bed were all
coiof-coordm3tC'd in soft peach. No green tile walls and stainless-steel machines."
'The: hlrth cemer was an a hOSPital, near emergency equipmcm if needed. The
birthing mite very coz)' and comfortable. with an adjoining bathroom and a
tape Ca5\cne player Homelike, yet in the hospital."
"My husband would nm agree to a homchlrth so the h - I b- h
, " ,ospn3 In center was
the n('xt beSt thing. It s nice to know that if an}' medical help is need d f, If
or the bab)', It'S right there," e or yourse
"The didn't allow [he Leboyer bath but '
Ideal, Our fivc-and-a,half.year-"'Id d h' otherWise the birth ceorer was
--v aug ter attended h b' h
was darKened and very homey_ The b b t e let I and the room
flIU: a y never had to leave the room, which was
.. J rhlnk It s (he lIafc'it way. It"s 10 a ho I
splta I Id h
10 .Hft.:nd. )'l'( hmpJtal (arl' was only Sl'(;mds ave whoever I wamed

nc..'tt\ for a study d L
) hIe: Out{nml" of two thousand womc'f' who
gavl' hlrth at birth centers during the penoci from 1072 to Of [hi,
group, I percent had to be Iransfl'rred lO hospuals durmg labor" ')
percenl were delIVcred by cesarean ,ccuon; ') percent reqUired the use
of forceps or vacuum extraction. The death rat(.' for Infams, Including
those whose mothers were' transferred, was 4.0 per thousand live births
which compared favorably with those at many prestigious hospitals. .
For those who can safely use birth center,>, there is much to enjoy
Women in labor arc encouraged to walk around, to eat and drink lightly,
and to relax In a warm shower. Sibhngs arc permuted to be present, and
whole families are often assembled after the binh for a real celebration.
Some women dislike the early discharge. Hospaals can be impersonal
institutions, but they do provide service and an opportunity for rest,
which can't always be found at home.
We think birth centers are great and have summarized why they are
the perfect solution to the home*versus-hospltal dilemma-provided you
are eligible and have access to one. A birth center
Has an established backup arrangemem with a hospital The facility
is experienced in transferring women with complications, You don,
have to worry about calling an ambulance or relying on your own
Frequently provides prenatal care, so that when labor beginS, there
is comfort in the familiarit}' of the surroundings and personnel.
Has emergency equipmem if you need It.
CostS roughly half as much as a hospital birth, and many Insur-ance
programs are now reimbursing for btrth-center delivenes.
Encourages personalization of carc and choice of procedure. There
are no set routines.
Encourages the participation of whomever }'ou want at your side.
You are not limited 10 a Single support person, so If you want friends
or relatives 10 join yOll. ,hat's fine
Gives you an excellent chance of hn\'lng natural childbirth. You can
be relaxed because you know )'ou' re 10 a tiafe en\'lronment where
youre unlikel}, to encoumer unneedt'd imerventlon.
Many people believe blfth centers arc the wave of the and even
doctors arc bUlling them The National Assouatlon of Chtldbcanng
Centers (:1 trade organizat ion) is wrrcntiy considering a proposal to offer
some centcrs for franchise ownership. In [Cn thomJnd babies were
/JOlllt', lIo.lpit,tI. or Birth (olter
b h
t there 3re now enough centers to accommodate
born 10 In . .
as maoy twent)' thousand births annually. By providing an alternative
to hospitals birth ceorers are Indirectly pressunng them to be more
accommodating to the people they serve.
You $hould scrutinize a birth center as closely as you would a hospital.
Make sure that
It IS Slaffed with expenenced and accredited doctors and I or mid-
There is a hospital backup and proper transportation to get there,
should transfer be necessary.
t The facilities are clean and well maintained.
t There is professional prenatal care, and referrals to appropriate spe-
cialim when lOdicated.
There LS basic emergency equipment available, such as blood ex-
panders. resuscitation eqUIpment, and an infant warmer.
Hospital Procedures
and hinh centers have recently received much
media aneonan, the fact remains that most births roda 0 . h 0
l' Y ccur In a OSP1-
ta Many women areo t comfortable with the idea of homebirch, and for
one reason or another do nOt we a birth center Often I
(ectal d d h . women se eer a
n ,an t en without question follow him to the hospital If
you are hlgh-nsk or have an emergency co r . .
hospital IS the only place to be Th I during labor, the
treat iJU women as if they em IS that many hospitals
Hospitals tend to view a woman' I bo .
happen. and their actions are be as acclde.nt waiting to
lhlOklOg. Conunuous fetal rno", '. ,Y the what If" school of
m onng IS Justified j .
develops. An intravenous IS call dr.. ust In case fetal distress
e lor JUSt In case . .
emorrhagc occurs. Food and r"d " surgery IS reqUIred or
. Iqui s arc Withheld
Ct."'"Sart'an IS needed. A pubic sh ,_ In case an emergency
" ave IS performed t f 0\.
omy cop e Justifiably exJ>tct ho . I 0 aCI Itate an episiot-
splta 5 to be co d
an p. rep.ared for Intervention b h' ncerne for their safety
, Ut ospnais t d
venuon IS reqUIred by 311. en to assume that \fller-
Many couples don't realiz.e th h h
at t c Save lh
fOr, an the Imcavenous arc rcall _II _ I e enema, the fetal moni-
y a Optional d
__ procc ures, ordered by
Preparation jor Birt"

. -.\
"Our insurance covered only a hospital delivery. I would have preferred a more
gende atmosphere."
"I thought it was the safest, bUl it proved to be most Impersonal and lonely,"
"Have you ever been in a happier pan of the hospital? Have you heard the wheels
on the carriers bringing all the babies? !l's the neatest sound-here come the
babies. It was special, a wonderful time."
"I knew my husband and I could still malOtalO our support and relationship, with
the backup of professionals if something were needed. ,.
"I am a labor-room nurse and have seen how women, includtng myself. can be
manipulated and imimidatcd in a hospital. The medical community has a way
of doing things and turning your wishes around to suit their needs and prac-
"I was all set to butt heads the doctor and hospital staff about how I wanted
the birth [0 go, but I was pleasantly surprised to find the}' all wanted to cooperate
with me."
"It was most imponant to me to have great auending obstetricians; the sen:ing
was secondaq' ...

Home, HosP"I,JI, or Birth Ceuter



.. All went according to my wishes. The baby had a Leboyer bath and was not
separated from me. My four-year..old and my mother were allowed in righe after
the baby born."
"1 chose a large teaching hospital with a neonatal intensive care unit, where there
were expertenced personnel and adequate staffing for both myself and the child."
"The nurses are terrific and very helpful. 1 loved the hos it I d
rhey treated the bab)'." p a stay an the way
"The atmosphere was terrible, and the intrusion .
lack of privacy The dOClO b d d s were upsetting. I felt an awful
r a gere me and eve af b
ever present to correct me Th ' n ter Inh the nurses were
. e worst pan was h' fi
territory. 1 seemed to have no h" to ght for every inch of
affected only me." aut omy 10 maklOg decisions that ultimately

their particular dOCtor Th
h.' . ere are ve r .
t: are hospital policies-
standing orde on of tndlvidual dOCtors d St everythmg else is
ha rs concerning the care h ,an each doclOr leaves
ppens, however, is that e wams for hi .
Obviously the ho . I each hospital stand d 5 patients. What
, splta Will ,ar s of .
practices. similarly and h run mOSt smoothl f practice evolve.
t e staff d' Y I each b ..
can be ume-consumin F Desn t have to m k 0 stetflCtan
g. Or ex I a e exce .
up a fetal monitor and amp e, u's a lot e PUons, which
run It c ' aSler for
ctach it several times h OnllOuously !ha' a nUrse lO set
SOlata nltlSt
tared periodically. woman can walk a attach it and
about and b .
e moO!-
PreptlrllllOtl jor Birtb
It IS possible to receive md 'd I d _ IVI ua Ize care at a hospital. if you make
arrangcmcms 10 advance Y Ik . .' _. ou must ta to your onetor during an office
VISit and diSCUSS with him wh . at you Want (see chapter 8 (or a diSCUSSion
of the pros and cons of the b h . enema, pu Ie save, mtravenous, and fetal
mOOitorlng). If he agrees, he then your advocate for changing
standard and must leave orders concerning your particular
treatment with the staff. It's really quite simple. If a breakdown in com-
munication occurs, and a nurse attempts to give you, say, a pubic shave,
you say. "No, I'm Dr. Smith's patient and he left orders tbat I'm not to
be shaved." If the nurse is persistent, you must say no again and ask her
to recheck the orders or call the doctor.
We know we sound like firebrands, but the idea is that you do nm have
to allow unnecessary procedures. Obstetric departmentS have changed
dramatically in the last twenty years because people got angry and asked
for what they wanted. Women demanded that their husbands be allowed
to stay with them during labor and delivery and that their babies be
treated gently after birth. The recent addition of birthing rooms to
obstetric wards has had a profound influence on practice, bringing about
greater flexibility in delivery and more time for families to enjoy one
another after birth. Many labor nurses are no""' trained in Lamaze breath-
ing techniques and provide compassionate support to laboring couples.
These days, hospitals have become more flexible, but you still have to
know what you want and you must ask for it.
T h e Hosp ital Tour
Part of your preparation for birth should be a tOur of the hospital. Tours
tend to be regularly scheduled a couple of times each month. If you're
studying Lamaze at the hospital, the tour will probably be part of the
series. If your doctOr delivers at more than one hospital, you may want
to scrutinize each one before you choose. Some tOurs are excellent and
cover every possible point; others are not, and you must ask many
questions. To help you make an evaluation, we've put together a list of
things to look for and ask about:
1. Are the labor rooms private or semiprivate? Are any of them
equipped with birthing beds? _ . . ., .
2. Are women encouraged to be mobile dunng labor. It so, where
can they walk?
3. Co1n I have more than onc support person?
Home, Hospital, or Bi,.th Cellttr
, h siolo"ISI 3vJllablt' 31 all times? I( nm, how
4. Is there an anc.:S
e CI _)
UlCkly (an one be "ummont.'iJ
q, J 'e 'ospirol's fiscal dar beglll. so that I rna)' gauge the
I) \\'uen l..1C\ III 1\
. 1f mv arn\'sl and posslbl)' save some..' money?
time l . d d '
. , h . parare entrances (or the <l}'ume an cvcnlfi.g.
6. ,He I erc \e '
.. Where can we park) Is there a rwent),four-hour lot avaIlable?
Can we register 10 advance In order (Q save tIIne when we arrive
and prc\'ent being separated?
9. Are there anr birthine rooms? How many? \Xlhat is your policy
regardmg eligibility? Do rhey contain birching beds?
10. h a blrthlOg chair available?
II. \\'Ihat is the policy regarding fathers in rhe delivery room for
11. If the baby has any problems, will he be transferred, or can my
baby be treated here? Can my pediatrician be granted privileges,
or will the bab)' be treated by the staff physician?
13. \\'hat are the visiting hours for the father, mher guests, and sib-
14. \\'hat is your policy on rooming-in? Can I have me baby examined
and cared for in my room so that we never have to be separated?
15. If I want a pm'ate room, what are my chances of geuing one? Do
cesarean patients get private rooms for recovery?
16, Iff have a pm'ate room, can m)' husband spend the night with me?
17. Ho",' beds does a semiprivate room contain?
18. Are mere classes on breast-feeding and baby care?
The Delivery Rooms
A delivery room is reaU}' an 0 .
are rna ' d pe,ratlng room, and for that reason sterile
bactcrla and . It IS kept cold to inhibit the growth of
, w a enters except .
and gown It contains a bab ' you, must wear a surgICal cap
cmc.:rgenq eqUipment tha y wahrmer, as well as all the inStruments and
t mig t ever be ne d d I'
room and 11 IS brighth' lil TL , e e . t s usually a large
I ' lIere IS a mlrro h d
Over the delivery table and r altac _ e to One of the lights
, you can request th b
you on M:e your binh. at It e positioned so (hat
Most women are broughllO.h d I
e e Ivert. 0
J\(cownlOg. You Will spt:nd ' r am JU.Sl a'i. the baby's head
mOSt of YOur time h
10 t l: labur room You w'U 1.._ pus 109 10 yOur labor bed
, I transferred I h d .
)'OU n: only about thr(.:(: pu h. 0 t e chvcry room when
s (.:5 away fr
om actually giving birth. The
t t t t t t t t t t __ t __ t __ tj
TilE DELI\,lR R (I () M
.. I wanted to be in the delivery room and was relieved when we finally went and
everything was handy If needed."
.. At the time, I would have delivered on a roller coaster just to get It over with!
But I think I would have preferred {Q be in a more upright position:'
"The rush to the delivery room was a horrible expenence. My hands were
actually strapped down. I had to ask them to untie me so that I could hold my
"M y feet were tied, and I was consmntly told not {Q move my hands or they would
be tied, too. I hated it!"
"Had no problems. \Vlas propped up on a foam wedge, could see, and was as
comfortable as possible."
"Lying on your back {Q give birth is utter nonsense.
"It was more like a freezer than a delivery room.
. h I be bed to the gurney to the delivery
" The only problem was getttng from tea r, ood . "
d not 10 the m to mo\e.
table. I was vcr)' tired, in a 1m 0 pJln, an
"I fdt so helpless and vulnerable, lyang with my legs up hke that.
t t
t t t t t t t
t t
HOIllt'. HOfpiMI. Qr Birth (tllta
r can be quite frc.nzlcd and )Iour husband IS apt to
moment (l trans e . h
d \'our glasses. If )'OU wear tern.
forget the ("amen! an fib h
be the worst moment 0 a or as t (' one in which
Many women escn
" h d bulging but they were instructed. to smp pushmg
the babr s ea was ,
" be" d d and prepared for delivery" Changing beds can also
while 109 rape , .
h I t'
"me like this. Some urnes, the transfer IS directly from
seem earl e55 at a ..
the labor bed to the delivery table, bU[ someumes a gurney IS used,
necessitating twO uncomfortable switches. Most people would never
dream of moving an animal about [Q gIve birth, and it seems crazy to
subJect women ro this inhumane disruption when it's unnecessary.
The deli,'ery table is narrow and made of metal. The foOt of the table
has a retractable shelf. and when }IOU climb on, your feet will first be
placed on this shelf. After you are siroated, the stirrups are put into place,
your legs are placed in mem, and the shelf is rocked under the table. The
back of the table is sometimes adjustable-if it's not, you can request to
be propped up with pillows. You'll be asked to slide your buttocks down
to the end of the table (as you do during a gynecological exam). Your
stomach and legs will be draped with a sterile sheet, leaving open a small
square from which the baby will emerge.
For me final pushes, women frequently grip the handrails of the {able
to gain extra leverage. The table may also have leather straps attached
to handrails to secure your hands and prevent you from tOuching the
stenle field. Their presence is a reminder of the d I
h ays, not so ong ago,
w en. women were heavily medicated and Out of control. You shouldn't
permit your hands to be strapped d d
own, an you can assure your doctor
you can be trusted not to diSturb the d
Our husband can take pictures' .
nOt permitted because f h ' usmg a high-speed film-flashes are
o t e presence of 0 Y "
uncomfonable and vul bl xygen. ou may feel quite
nera e perched h'
console you to know that thO "h on t IS cold table, hut it may
. . IS IS t e way m .
give btnh today. OSt Women m the United States
Delivering in You l b
" r a Or Bed
The chOICe of the rOOm h
. wereYOua 11'
should diSCUSS in advance with Clua y gIVe birth is something you
women who responded to OUr Or midWife. Many of the
bmhlOg room because lhey wer: Were delighted with the

Prepflrtllioll /01' Birth
c to labor d I"
, e !Vcr, and recover in
the same bed. Many other women expressed .. with the deliv-
ery table. complaining about having to push uphill and being cold and
As an alternative, we suggest giving blnh In your labor bed 10 the
labor room. If your doctor has an immediate negative response to this
ideal don't acquiesce right away. Lots of babies have been born 10 labor
rooms. This is an issue that can be negotiated-you're not asking him
to do a cesarean in the back of a covered wagon, although he may rean
as if you were, Every labor room IS equipped wtth oxygen and a fetal
monitor, so you should have everything you need, and the delivery
room IS nearby in case a problem develops. Some doctOrs object because
the labor room is usually very small. and a few special accommodations
must be made, But if your labor is going smoOthly. there's really no
reason why you can't have the baby there. The actual issue is your
doctOr's comfort-he won't be able to sit on a stool with you conven-
iently displayed in stirrups before him. A classic excuse for transferring
you to the delivery room is that the lighting is better there. If you discuss
the idea in advance. offer to provide some extra lights. If your doctor
says that there's no instrument table in the room. ask him how many he
usually uses and whether there isn't enough room for them near .your
bed. Make it clear that if complications arise, you assume you wllI be
moved to the delivery room. If your doctor insists on using the delivery
room, you may be able to compromise by suggesting be
to deliver in your labor bed in the delivery room .. ThiS. solutton
mizes your disruption and discomfort while allOWing hlm the fam1liar
atmosphere of the delivery room.
The Hospital Birthing Room " "
" h" e the biggest thing to hit hospital obstemcs In years.
Irt 109 rooms ar . bo
P I h bad
ly and hospitals. are fast converung la r rooms
eopewant tem , . dl'
" b" h" ms The beauty of a blrthing room IS that labor. e IV-
IOto Irt 109 roo . dd'" h'
n all occur in the same place. In a mo.n to t IS
ery an recovery ca I k
." b' I ' rooms are designed to simulate a home 1 "e atmo-
conventence, Irt ling bed m and hving room.
here something like a crosS between a .
. I'k I find flowered sheets, plants, a teleVISIon, a rocking chalf.
au Ie}, to h 11 This is great. because it is an acknowledgment
and pictures on t e wa s,
" d comfort do matter.
{hat envIronment an
Home, HOJpittiJ. or Birth Cenle,.

>- --
"My sister used a hospital birthing room, but she still had a pubic shave, episiOt-
omy. IV. Internal fetal monitOr, a paracervical, and had her waters broken. I can't
!'ee v.'hy this had to happen. It certainly wasn't home st),le."
'I really wanted to use the birthing room, but chose not to when I felt something
was wrong. I was told I could not have 01lJ medication, and that scared me."
"The bmhlO8 bed was fantastic-IOO percent bener than the delivery table."
"I was very pleased that I did not have to use a delivery table or be moved from
room to room. The room was lit only by sunlight, and it was very private, with
JUSt my husband. the doctor, and one nurse presem."
"Thefiblfthing rooms are beautiful and new. I felt at home there, yet safe with
quail ed hOSpital personnel nearby."
-The h I h
OSplta as one lovely birthing room with b
elegant soft lamps The ,a rass bed, plush carpet,
1'- , .)' are very proud f ' d 0 0
hea.vil)._ But u's firS( come firs, serv d h k 0 It, an It IS advenised
, e-teytaeyo' h '
deliver and whisk you out quickly, I h u In w en you re ready to
.. 0 et t e next one use I[ I
Il at . . never got to use
T.he hospital birthing room was I 0
..... t. t:nloyed
pflvac}': Joved tht: rocker and the shower ,"
the atmosphere, space, and

Prl!pdraliotl lor Birth

"It was the grcatest M h b d h . y us an , IS sister, and the doctor were all on the double
bed w.lth at the end! The whole room was so comfortable, l"d hate to have
to deliver tn a cold delivery room."
., I loved it. Having everything in one room seems marc private and personal and
keeps you from being shuffled around."
"We had signed up for the hospital binhing room but were tOld mat Susan wasn'[
advanced enough to use it. They offered to move us to the birthing room when
her labor was almost over. Rather annoyed, we stayed in the labor room for
delivery. "

Ideally, birthing rooms stand for nonintervention and should be lim-
ited to normal labors. Birth in this setting is supposed to be a natural
event, and it's not the place for epidurals or forceps deliveries. It is a
misuse of birthing rooms when hospimls employ them as public-relations
gimmicks, heavily advertising their availability and convenience. The
net effect is that there is great demand for the one birthing room and
no one is able to spend an entire labor, delivery, and recovery there. h
bcco mes nmhing more than a decoratcd deliver), room, to which women
are transferred to have their babies. The solution is to have enough
birthing rooms for all women desiring natural childblf(h and louse the
regular labor and delivery rooms only for those specIal care.
Different hospitals have different standards of qualification for use of
I b
h m Normalll' a woman must be lo.\v-r.lsk with an une-
t lC Irt Ing roo . ' .
f I
and earll
' labor Usualll' no PUOCIO or anestheSIa
vent 11 pregnanc),.' .' .
. I 1
01 I or sp,nals ) on be used although" local anesthetic
lOe ue 109 epIC ura s '
for an episiotomy is permitted .

HtHIlt>. HQJpit.tl. 0" Both Centa 69
Birlhillg Bed
A distinctive feature of a birthing room is a special birthing bed which
can be used for both labo d d I" R '
. r an e Ivery, un by a moror, its tOp and
move, allowing for great flexibiliry of position, It has
a Justa e lOOt supports and the be f h b
d .. nom ate ed breaks away so that
your OCtar or midwife can sit facing you Women . .
SlUlOg squatting 0 J . ..' can deliver while
these beds be ' r
ylng on their Side. Not all birthing rooms have
, cause t ey are very ex . b ' f
to get one, you can inSlruct your ut I . lucky enough
of ways. an to POsition It 10 any number
Even though il can't be seen th
birthing rOOm. Hidden beh d' bere IS emergency equipment in the
In ca lnelS Or Curta . .
matenal, oxygen an episiolom k' lOS are resuscitation
' Y It, and perhaps b b
I necessary. there's more equip I a a y warmer. And
meO{ Case by becau
t e obstctrlcs floor. Sterile dr sc you arc right on
apes are not routin I d " "
rooms, and your husband will nm hey use 10 bIrthing
I kd
ave to wear a scrub . Th "
you can 00 own and see YOur b b . h SUIt. IS means
, . a y s ead as it em
[ouch It If you want. crgcs and you can
Preparation for Birtb
The Birthing Chair
Anmhcr option for delivery that has recently become available 1$ the
birthing chair. This is actually a revival of an anCient birthing stool. The
Greeks used a chalf with a crescent-shaped openmg, while sixteenth.
century Venetians sat on V-shaped stools. Today's model is a bit morc
functional, made of high-impact plastic with molded knee braces and
adjustable footrests. It can be raised, lowered, or tilted because it is
Frankly, we were dubious about the bIrthing chair until we sat in it
and were instructed in its usc. We realized then that the birthing chair
is only as effective as the person at its controls. Most of our negative
impressions were refuted by our saleswoman, who expertly demon-
strated its versatility.
\Vle still have certain reservations, however. The size of the leg restS
cannot be altered, and women with heavy thighs may find their flesh
spilling out somewhat uncomfortably. The plastic seat was also a bit rigid
because it's not padded. More importantly, a woman's autOnomy IS
limited because she cannot adjust her own position in the chalf; this must
be done for her.
The most frequent criticism of the chair IS that it prommes serious
Birlbillg Cbair
/-lome, J/oJpit.d, 0" Birth (enter



o This is not the buh of the lhalc, however, but of the
perinea (earl co' . _ .
pmhang terhmque. aided by gravlt)' require less forceful pushing
and a more controlled delivery than those III the IHhotomy pasHian. A
doctor be able to gUide a woman through J gentle delivery. and
she must be responsive to his instructions.
\X'e would prefer a blnhing bed ro a binhing chair, but the lauee might
be a practical addition to a bus)' obstetric department with only one or
tWO birthing rooms. In that case, the birthing chair would provide a
welcome ahernanve to the delivery room if the birthing rooms were
OCCUPied .

'" thought it gave good suppon for m}' back, legs, and arms."
"I Jo\.'ed II! I was a Imle Inumidated at firSt b th "d .
way I[ looked In the picture 1 had Y e I ea of It and I didn'llike the
bed, and J Went along h- btl( my doctor preferred it to the birthing
"It was a ImJe awkward [Q go from the bed .
[Q the chair, but nOt painful."

PreparatiQI/ /Qr E,rt/)

n important part of the Lamaze method is underslanding pregnancy,
labor, and delivery-learning llOU feel a certam W3)" under-
standing the terms yourdoctoror midwife uses, and familiarizing yourself
with the physical process of birth. In the past, much of the fear surround-
Ing childbirrh was generated by ignorance \'..:' omen had only the most
elementary knowledge about their bodies, ,lod once they became preg-
nnnt, they had nocla5ses to attend or bol"lks ll1 read. lnsteild. they relied on
, h dXIO[\ or frl111l friends and who (OUn-
Inf\)rmJ.uon treln) (('If l ' , , I 'w
, h oal and old wives to ('s. women (Cl'
,ded them WII perso _ .
L, I LorS Ihat \",ere difficult, cJther th<tn about those that
que""y he.u .\l>("1ul all
( ot
'compiitarions. Pregnane)' m},ths aboundcd-a baby
were casy or fce
h I t
'h cau'e, heartburn' srfclcllIng )lour hands over your head
J Olll air .
, d eo(aoglement-and it's no ", 'onder women appro, ached
childbirth with dread. Knowledge about birth can help you dlsungUish
(act (rom fiction in the stories you arc told II also helps [0 alleviate your
(ears and apprehensions about pregnane)' and birth.
Every field of srudy. whether it's Chinese cooklOg or car repair, has its
o\vn speCial vocabulary. Birth is no exception, and ir you understand its
terminology. the experience will seem less strange and imimidating. To
start. there are several parts of Ihe body you must be ramiliar with to
bener understand the workings or your body and share common lan-
guage with your doctOr or midwife (see illustration) . They are:
Intenwl Organs
Diophrogm __ '--r ___ _
Mucous Plug.
Vogino ----+
FRO!'\T \'E\'('
PreparatiQn for Birth

\ /
Coeey" (toilbone) / )" ""i--
/ Intestines
Umbilical Cord
Amniotic Sac
Pubic 80ne
'-....... _ Vagina
DIf,/phmRm A muscular shea h h
' d t I atcomroh rl'sp,rauon rhc:dlaphragm
IC\ un crneath the lu I'k
I - ngs, I e an opened upside-down umbrella. It
owers dUring inhalation and It relaxes hack to place on each exhala.
Pt'IUJ This bon
. y StruCture encloses and prou:us the pelvic organs--
rectum, vagina, bladder, and uterus. The back of the pelvis IS called
the Jel(rtlm, which is composed offtve fused liegments of the spine the
of the pelvis is the puhl( bont. The tOp of the pelvis is called the
Pt'it'IC mitt; the bottom is referred to as the Ptltic OUlltt The pregnancy
rdax.m causes the pelvic joints to soften, thereby allowing
the pelVIS to Widen. The rou)x, also known as the tailbone, is the very
last vertebra on the spine, located JUSt below the sacrum.
UrtnlJ. This muscular organ encloses the baby, the amniotic sac, the
amniotic fluid, and the placenta. In a nonpregnant Slate, it is the size
of a clenched fist.
Ctrn\;. The cervix, or neck of the uterus, can be seen and/or felt at
the very tOp of the vagina. It is oval in shape and a little more than
an inch in length. It has an openmg in the middle called the OJ, which
is the size of a very thin soda straw.
Mu(oUJ plug. This is a mass of capillaries and mucus that fills the cervix
during pregnancy. Its function is 10 seal the cervical opening and
thereby protect the baby from infection.
A ff1mO/IC jac. Forming a lining inside the uterus, the amniotic sac en-
closes the baby and the amniotic fluid. It is also known as the bag
of waters or membranes.
Amlllo/ir Jilad. This clear, odorless, sterile liquid surrounds the baby
and is completely replaced every few hours. The baby wtll swallow
the Auid, urinate into it, and be kept warm and protected by it.
P/rUm/fl. This organ beglOs to form tn the fourth week after conceptton
and grows to weigh aboul a pound at birth. Because mother and
bab}' have separate circulamf}' S}'Slems, the placenta is necessary to
transfer oxygen and nutrients from the mOlher to the baby and then
waste products back from the baby to the mother. Since almost
everything the mother ingests or inhales passes through II, [he pla-
centa has been described as a 'bloody sle\le."'
U b
'/' / d Th' ', (he vital cable that connectS the bab)' to the
til I 1m (or. IS I
placenta. It's a tWO-way lifeline, (omainmg three blood vessels.
gen and nurrients travel co the bab}' through (he vein, and waste
products are conducted to the placcnro through the two arteries. The
cord IS about three-quarters of an Inch 10 diameter, IS semitranspar_
ent and jell)'like in appearancc. and has an average length of twenty_
{wo inches.
Physiologically, the process of labor and delivery is quite simple and
straighaorward. The cervix opens to accommodate the widest diameter
of the baby's head, the bab)' descends into the vagina, and then the baby
is born. The placenta follows several minutes later. This process is di
vided imo three stages. The first stage is labor I the second stage is the
delivery of the baby, and the third stage is the expulsion of the placenta.
Chapters 8, 9, and 10 fully describe the physical and emotional aspects
of these stages. They will be easier to read, however, once you have a
general knowledge of the process of labor and delivery.
Dilation and Effacement
T ~ e first stage 0: labor begins with regular uterine contractions and ends
w en your cervix has effaced 100 d d'
Once your cervix has thO d d percent, an Ilated ten centimeters.
is completed This can t ~ n e n a s e lan
opehned fully, rhe first stage of labor
. meastreehours( f fi
or as long as thirty hours Th even or a rst labor)
, e average for fi b' h '
Normally the cervix is Ion h' karst 1ft IS twelve hours.
, g, t Ie ,and almoS{ cl d '
uterus from the vagina La . ose ,separating the
. . [e to pregnancy or durin I I b
ever. uteflne contractions pull d gear y a or. how
upwar on the ce' " .
out and Aauen or efface ElI rvlX, causing I{ to thlO
. '.' acement can only be d .
a an Internal examination add' etermlOed by means
,n ependlng on the h <
octOr or midwife you will be t Id ( anges leit by your
,u d Y , , a you are 25 50 75
cna, ce our cervix IS fully eff'd ...,. or 100 percent
ace once It IS com I I A
a tissue (see illustration). pete y at and thin as
Dilatlon occurs when the pull f h '
. ate uteflne co .
cervlca openlOg ro expand. Th' , ntractlons causes the
'" - - IS process IS so . h ' ,
o rhe pupil In your eye which . mew at lIke {he dtlarion
. ,opens Wide In h d k
maxl,mum amount of light to Cote L'k lear to allow the
d I riC effacem h
I au on can be determined only b' ent, t e extent of your
y an Internal exam' .
matlon. Progress is
76 Prep"re/lion for Bi,.th
measured in centimeters or "fingers," with twO centimeters equaling
one finger. Dilation is complete at ten cemimeters or five fingers (see
illustration). This is a very subjective measurement, however, since no
one introduces any instrumems into your vagina to get an exact reading.
You may be examined by a resident and tOld you are five centimeters
dilated. Then, half an hour later, you are checked by your doctOr and
told you are only four. There is no reason to be discouraged or worried.
Cervical checks arc not an exact science. \,('hether your baby is SlX
pounds or nine pounds, you will have [Q dilate to "ten centimeters"
before you will be permitted [Q start pushing. Even at full dilation the
baby is still high in your vagina. The baby can be seen only after you've
been pushing for a while and arc well inw the second stage of labor.
Effacement and dilation can occur separately or in unison. You can be
50 percent effaced and tWO centimetcrs dilated, or 100 percent effaced
and not dilated at all. In any case, you will probably be 100 percent
effaced by the time you dre about five centimeters dilated. Sometimes
dilation and effacement occur poor to labor, which IS lucky, since it can
decrease the length of labor. However, [his does not always happen.
Many women efface to SO or 100 pen:en[ and dilate to one or twO
L ndrrJl.",dillg Llbor
DiiJliOIl o/Ibe Cenix
10 em
tcnumc(crs prior to labor but
d I
" h ,H IS Tartt for a woman :'avil g I),er first
Wiatt past t tee cenumetcrs and k" I be
not lJ\: In a r
Early dilation and efface L._
' ment can uc exciting bur 5h4 uld (lor be used
to gauge t e accuracy of YOur due dale Y I bo
dl f
ou can tnt.J a r ar any
time, regar css 0 whethe '
_ r you were two centimeters dilated Or showed
no progress at all dUring your last check T' k_ d' d
, up. t) nOt to lscourage
If you re a week late and arc told. "Nothing's (hanl'!;cd from last week
Conversely: don't drop everything If )"OU discover rou have begun
efface or dilate. Cervical change is ooh' one mdicator of readiness (or
labor Unless you 3rc induced, labor begins when the baby is ready (Q
be born, and no one can accurately predict when ,hat will happen,
mciudIng your doctor or midwife,
Engagement and Station
To describe your readiness for labor. your doctor or midwife may use
tWO additional terms: mgagfmml and flJllO" Engagement occurs when
the baby's head moves deep into the pelvls. This event IS commonl}'
referred (0 as the bab}' dropping. If this 15 your first child, engagement
usually happens several weeks before your due date. If this is a subse-
quent pregnancy. it usua1ly doesn '( occur until labor begIns. Once the
baby is engaged, the upward pressure of the uterus on me diaphragm,
lungs. and stomach is somewhat relieved. and ir's easier to eat J. full me-J..!
or breathe deeply. On the orner hand. engagement puts extra pressure
on the nerves emerging from the lower back ;Uld bladder. cre-.1ting
soreness in the groin and thighs and .1 greater need [Q unnate.
Station refers to the baby's position in relauon to the pelvis l see Illustra-
tion). \'(lhen the baby's presenting part engasc), It rens at zero semon.
Anywhere above this point is a mInus station. anywhcre is a plus
station. The numbers range fr('Im onc to h,e. and each Ji,!l:1t IS t.'qulvaJem
to a centimeter. Minus five is the ,NY h)P (If the plu .. hve IS the
bottom of (he vagina (ccownIflSl. Thl..' of the b.lb)' IS to.
but not dependent up'-,n, et'f\leal daLmon. The trul..' 01 l.loor
cerVical dilation .lnd ellJlt.'Olt:nt JnJ thl: of tht" bJby
ROtilllOn ilnd
D 1 h
I I'"' l)f labM thl..' baby will more- dl..'e-pir In
unng Ill.' rs "'l"'I..' '
h Id I
n Jnywht'rl.. frl)m 90 {l"l 180 Jegf'f'ts
},ollr pdvlS lit." Oll .\ 'l.l tur
Pelvic Ql,ltiel
Within you, moving to a position that is either facedown or face-up.
This movement is called Internal rmation. In over 96 percent of all
bmhs the baby IS positioned head down. I n approximately 75 per-
cent of these cases, [he bab}' rOtates to a normal amerior position,
whICh means that he faces the mother's spine. In the remaining 25
percent the baby rotates so (hat he is facing [he mother's sromach
and ,he back of his head . h .
. _ resLS agalOs( er splOe. These babies are
said (Q be In a posterior presentation. (See illustrations.) Many babies
begin labor In a postenor ..
position or become posrerior as labor
progresses. Most of (hem r . h
eposlUon t emselves. however. before de-
The .Three Labor
the stage o( labo h -I
r 1'5 t c: ongeSl o' 'f
10(0 three phases: tarl) 1,1 I nc, it IS urther subdiVided
, 'J{Jr, Jail tabor a d - .
phases are uc,ed to dc.:stnbt: (h, ,n lrdl1JtllOt1. The different
t; progn:!ls of ( . I d
Itrenng qualJ(il's of the (e)n, , - crvlCa ilauon and the
raulCJn\ The 5
hnc), however; bear 10 mind tha I. _ Y crvl' only as gcneral guide-
_ 1 auor IS a proe . d
nor a pf(:nsc and predictahl. _ an an expcCltnce
t Sllcnu: '
Prepurulll)lI j()T Birth
Prese"ttlti(}m /rlr Birth
During rhis phase, regular contractions occur every five co (wemy min-
utes, last abom thirty to forty-five seconds each. and are usually fairly
mild. Women ofren compare these firsr comractiom (0 the feeling of
menstrual cramps or a low backache An average early labor takes eight
to nine hours, and during this time the cervix effaces to 100 percem and
dilates to about three cemimecers.
This may sound like a terribly long time (Q progress only a
third of the way through labor, bur you must remember thar having
a forty-five-second contraction ever), fifreen minutes is equivalent
[0 three minutes of discomfof( every hour. That leaves tifey-seven
minutes for resting, reading, wa[(hing television, or raking a walk
The time passes very quickly if you go back to sleep or carryon
with your normal activIties. B}' the end of (hiS phase, your comrac-
lions will probably las( a full and occur every four or
five minutes, and you'll be moving into ;1crive labor. ThiS IS (he (X-lint
at which many doctors want you to Colli them to fell (hem you are 10
labor-bu( this doesn't mean )ou lre rt!ad)' to go [0 tht! hospital or
birth centcr.
E I I Ix
'or each woman Many women ccahze the)' have
iU y .1 )r I' ' , _ ..
h h I I
Ixu )nl)' onc\.' ar\.' PJ.St tt and IOtO J,l.uH'.Jbor.
t roug a l. .'
Thl.'}' mny not an)" to (he l:0mrJ.(uom until (he Intt!n-
r woml.'n kno\\ ,mmt:'dIJtl.'iy (hat (hc\' af\.' In boor
\11)' In(f('ilSt,.\
(Utlt'n/.lIlding LJbor
or the ammotic sac hreaks, followed
, lua dIS ge
bc..-.cause the mm.Ous P .
. - uent contractions.
by sm:,". g and treq d I (rom strong regular uterine comrae_
'I' esults teen Y
Cervical d. anon r . ns are fairly mild and short, you should
'our contrac{to
[jom As ong as . h me even If this phase lasts a very long
( bl boul Slal'lIlg 0 ,
feel com ona e a 'd labors can be very shore. I f your early
h other han ,some
ume. n t e . f I I f II minute and quickly assume a pattern
contractions . I ' hould forget about movies and warm
f three-minute Imerva 5, ) OU 5 b ' C h
o d midwife right away. You may e 10 lor w at
baths and call your octor or
, ' h rt ned or condensed) labor, (For more on early
we call telescopIC 0 e
labor, see chap<er 8,)
. I bor contractions are three to four mmutes apart and last
unng active a , .
about sixty seconds each. Because these contractions are stronger,
longer, and closer together than the earlier ones, they dilate the cervix
more qUICkly. Active labor lasts an average of three to four hours, and
you will dilate to seven centimeters. As with all the other phases, a
normal acri\'e Laror can have many variations. You may dilate a respect-
able centimeter every hour, or you may move quickly to five centimeters
and remain there for a few hours until progress resumes further, or you
could race from three to eight centimeters in just one hour. (For more
on active labor, see chapter 9.)
This is tbe phase when there is no doubt you are in labor. Your
contractions are scrong and you will have to work hard to stay on top
of Ihem, Unless you are having Ihe baby al home, you should head for
the hospital or birth center. There's no need to rush. Even if you're eight
centimeters dilated, you probably still have about an hour or so of
transition and men another one to two hours of pushing before the baby
IS born.
Transition IS the last phase of the first stage of I b h '
. . a or, w en your cerviX
dilates from eight to ten centimeters It IS th d' ffi I h C
. e most 1 eu t p ase Jor
many women because the comractlons and reslS f hi I
d 6
are a roug y equa
urallon ( 0 10 90 seconds each) and because h
. It Comes w en you are
most tire ComractlOns can also OCCur lreeg I I ' ,
. u ar y, sometimes stnnglOS
t emselve.s together 10 double or triple form Th' h
d b
' IS paso can also be
accompanle y annoying chills sh' .. .
It [he moment when d . I'
are, Never agnln .
H2 Prepnrtlli(J1/ for Hirl/}
Transition usually docs nOt last long.. h h h d
....r t an an our. owcver. &.;In
somctlmt:s u consists of lUSt a few COntraction'). (For more un 'camillol
'iCC chapter 9.)
Although most women find transition the most pamful pan of labor
the fact that the end is near makes it setm excIting well. Once ';:)u are
fully dilated, the first stage of labor IS complete and you can begm to
The second stage of labor begins when the cervix IS fully dilated and
ends with the birth of the baby. It lastS an average of one hour for a first
labor. and 30 minutes or less for a subsequent delivery. During this
stage, your contractions will return to a more civilized rhythm, lasting
around sixty seconds each and spacing out to intervals of three or four
minutes. Now instead of relaxing and breathing. you will aCllvely push,
helping your baby descend through your open cervix. into your vaglOa,
and out into the world. You will push only during the contractions. and
rest between them.
As you push, the baby will descend lower and lower into your vagina.
Toward Ihe end, Ihe very lOP of Ihe baby's head will be VISible dunng
each contraction, but it will recede when the comracnon ends and the
force of your pushing stops. \,((hen the tOp of .the baby' s rem,ains
continually visible at the vagina, the bab}' is saJd to be crowntng. ): our
doctor or midwife will decide if an episiotomy is necessary. lhe
head is born, the baby will turn once more, back to the onglOaJ
side position, facing either your right or left hip. ThiS movement IS called
the external rOtation, and your baby will do this unaided (see I.llustra-
tion). Now his shoulders are lined up directly between your pubIC
Once Ihe
babl"s shoulders 3re born. your docmr or mldt\ Ife
an coccyx. . bTl
will literally catch the bab)' as the rest of hiS bl..""Kiy emerges. The urn I lea
cord is ClIt, and the second stage of labor has ended. (For more on
delivery. see chapter 10.)
J 1"\ ' to the expulsion of the plau:ma
This final stage of lah\")r IS devote so ) II I no more th.to thirty
I" . Dnd short U'iU.l y as
h . IS relative)' plun t:ss . . be; h' pl.Kenta is no longer needed
minutes. Now that the b.lhy IS rn. t t:
ROllllioll ,Old Deelll of Buby
H4 ____________ __
Exter"al RotatifJl1
U renne contractions conrinue, forcing dle placenta (Q detach and closing
off the placental site. The placenta will be expelled during a contraction.
along with a show of blood.
The placenta is examined to make sure it is intaCt and complete If any
portion of it or the amniotic membranes remains in the uterus, it can
cause hemorrhage. Nursing immediately after delivery encourages
proper expulsion of the placenta because your narural oxytocin is
released, creating efficient uterine contraCtions.

The Lamaze
Preptlralhm for Birlb
many levels, both physical and P\ychological. [0 dcucase the amount of
pain you perceive. By coordinating you b h h h
'. r reat Ing WI( (e comca([ions.
you will work with labor Instead of figh
tlng It.
Contractions arc often described as .. wave .. be h b Id peak
. s cause t cy UI.
and. fade much the real ones, and because they rise and fall, with
penods of calm In between. If you've ever Swum in the ocean (or
w3cched others), you know there are two techniques for dealing with the
W3:CS. The first one is indecision. The wave approaches and you freeze,
trymg to choose whether to duck or run for shore. Suddenly It'S tOO late,
and you are dragged under by the force of the wave. When you come
up for air, you're exhausted, Out of breath, and a little shaken. Then
there is only a shon break before the next one comes, and then another,
and another after that. It's frightening to contemplate, but this is proba-
bly analogous ro the feelings our mothers experienced during labor. as
they floundered through sensations that were incomprehensible and
The second technique for dealing with waves requires a little more
finesse, but is much less taxing and a lOt more enjoyable. By simply
diving through the wave, you emerge easily imo the safe, calm waters
on the other side. You are not in comrol of the wave, but you are able
[Q swim through iL You stay in the water for a while and dive through
wave after wave. Each time it takes a concerted effort [Q dive in and come
up on your feet. This technique is like using the Lamaze method-it
requi res concentration and timing, but the result can be exhilarating.
On a purely physical level, the Lamaze breathing keeps your body and
baby well oxygenated. \Vorking muscles produce waste products that, if
allowed [Q accumulate, can cause soreness and cramping. This is the last
thing you need on top of labor comractions. The oxygen you inhale will
help to metabolize these waste products.
Breathing will also help you ro relax. If }'OU doubt this, tr}' ro hold
breath and rela-x your bod}1 at the same time. Ir is an
task. Now breathe and let your bod}' go limp. It's easier. Just
." ,he flow of air you will experience a certalO degree of
y malOtalOlOg
relaxation. _ .
From a psychological standpolOt, the Lamaze breathing gives
c ete to do and serveS as a focus for your thoughts dunng
somet 109 can r de
. I abor requires great paSSivity because you must step asl
COntractions. LA Th' be ' difficult
and allow your body to do what_ is necessJr)'. IS .can ver) " I '
on your breathIng, you can acm e }
to accomplish, but by concentrating. ' '11
. b d As \IOU breathe the sensation of rhe contraction I
ilSSISI )'our 0 y. 1 '
The LI1I1"u Bred/bing

", ,' z [ B R E .-\ T II I N G
H ,','
'1 ft.d It is a very effective method. The palO is not as bad if you have a way of
gening through 1['''
'"I wish I had practiced the breathing exercises until they were second nature.
Looking back. I realize a person can't be roo prepared."
"It was well woITh the time spent breathing and practicing. I knew what to expect
and when to expect it, and the pain was minimized by the controlled breathing."
.. had a hard time understanding how the way I breathed would help me deal
9.lth the pam. Afterward, I was amazed at how it really did help."
'"h was like someone teaching you how to nde a bike it' .
rourself on the bike for the first lime." - s funny unul you find
'" have successfully used Lamaze breath,ng h '
h d
.. lOOt erpamf I' .
t e eotlS( s office. I used to be h d u Slrllat1ons, such as at
I; lot ea.ne but La h
Overcome all fear of pain. . 'maze as helped me to
"I'm amazed at (he power of the human bod M
a( umt:s, bur the relaxation and breathing h Contractions were very painful
ec nlques worked
wonders. "


HH ----
Prt-pllr.lliotl /f)r B,rlb
------ .

. .:-=.' '"
,.' , .. , ,
..: _.'.
---J"3. :':'_ )......,
decrease in intensity, 10 the same manne 'h t k d f d
r at ,ac groun a e
as you read an engrossing book. The pain of the (ontracuon IS there, but
because It IS not the object of your attention, you afC less consCIOus of
its presence. The Lamaze breathing will not decrease the amount of pain
you have, but it will aller your perception of it
The most natural response (Q a pain stimulus is to hold yOUf breath
and release it after the pain passes. The expression .. It took my breath
away" describes this Common reaCtIon. AnOther response IS muscular
tension. the tightening of the body in preparation for fight or flight.
During active labor, when strong contractions occur every three minutes
for several hours, you 'II be exhausted if you fight each contraction in this
manner, The ensuing fatigue will then decrease your ability to handle
stress and will lower your pain threshold, One could say that the Lamaze
method is really unnatural childbirth because breathing and relaxing in
response to pain is a very unnatural thing to do. Learning the Lamaze
method requires retraining and conscious effore.
During early labor. you will be reading. napping, taking walks. and
continuing with your normal routine. Try (Q ignore your contractions for
as long as you can. Your labor will seem very long if you drop everything
at the first contraction and concentrate solely on these sensations. At
some point, however, the sensation of your uterus will become the
strongest stimulus, and all Other distractions will fade.
You should start your first Lamaze breathing when you can no longer
walk. talk, or just relax through the contracuons, when other activities
can no longer divert your attention. . .
\'(/hile we can make generalizations. there's no telhng when thIS WIlt
be or exactly what techniques you will want to use when. If your labor
begins with strong. one-mtnute contractions from the very onset, you
might start with the modified paced breathing. On the hand, you
may use the slow paced breathing throughout }'our emlre and
never need any of the other patterns. The relaxation techniques b}'
themselves may be all you need for quite a long time, ther may w?rk
. ed' . 'on with a breathtng paftem. ): ou
bencr for you If us In conJuncu _
should experiment with what feels most comfortable for you and (rust
your Instincts . . "h b th'n" tOO soon
Many women (lre concerned aho
., h' he dreola,,' 8
"s true chat
.. f 'hnaque:; lor tear p .
and fcar they \vill " run out 0 ale labor -eern
. t )() early (an m' e )'our ;)
stamng your brcathlO8 l . build and rela.xJ.-
Jela)' bcglOnang tcOSIO
longer. Ilowever, I )IOU .' 'J t) and not worry about
tlon will suffer. You should Sl.ut when )l)\I nCt: l
. - - n There;lre always vi.lriariom that can be
how rllli will han e rrJo"t10 .
dem"J if needed. b h'" .. If
h h
'\S bing the Lamaze reat mg wrong. it
There IS no ring. II
. . . . h Th arc no magic patterns or perren numbers
!c..'l'!s right, j[ 1.\ n8 t. C .
. b' h ,. rna)' want [0 learn a foolproof techmque guaranteed [0
llt feat I OU .,
work but rhls does not exist. losfead, )Iou should consider (he breathmg
, be ools at your dISposal 10 be used when needed.
patterns 0
There are four breathing patterns: one for each of the three phases of
labor and one for pushing. Though each one is different , there are
certain componentS they all share.
The Cleansing Breath
The Lamaze breathing for a contraction always beginS and ends with a
deep sigh, called a c\emsing brealh. To do one, simply inhale deeply and
then release it gendy, slowly letting the air escape.
Cleansing breaths are helpful lO bOth you and your partner. The first
cleansing breath is a sign lO your partner that your contraction has
begun and he should begin timing; the second one tells him that [he
is over. Conserving energy is important, and always having
to say, I have another one coming" or "Okay Ih I' . "
I I a s It, wastes pre
Claus energy.
The cleansing breath is also your conditioned I
response to re ax com-
p. letely, SlOp whatever else you are doing and gel d d b h
rea y to a a reat -
Ing panern. It replaces your natural response I
o your breath. It s lIke a Silent VOice that sa "G .
ys, et ready now here s
anm er one. You can do it." The final cleans' b h '
mg reat closes the door
o.n eac contracuon, and the voice says "It'
s over now I'm doing all
right. One less contraction to go." ,
Timing Within the Contractions
During eaCh. c.omracrion your partner will I' h
Ime ( e Pass' d
He'lI Start timing as you take your cleanSing b h Ing secoo s.
" . . reat and will s
Fifteen seconds ... thirty seconds. fort fi ay to you,
. . y. ve seconds sixty
Preparation for Bir/h
seconds." Hc'lI know the contractl( - I
I b h
10 1\ nvu W l(.'O you take \'our sec')ntl
c can sing reat
You should practice the UmlO ( 6rl
g or <;(:con(h, eVen though aCf.Ual
contrac. Clons can vary in. length frum 3rl 10 12rl d A
st:cnn s. minute can
seem like ave. ry I.on. g time if you arc in paIn " 'II b
, anu you c encouraged
to hear that t.'me IS mdeed passing It IS also rc'" h
. - lust to ear your
parmer's vOIce and to feel his active assIStance:
The timing will help you to handle each COntraction more easdy. Your
contractions usually develop a rhythm, peaking at approximately the
same point each time. If your peak OCCurs at twenty seconds, you'll learn
that when your partner says, "Fifteen seconds," you must gear up for the
hardest part. Then once the contraction eases, and you hear, "Thirty
seconds," you know the worst is over and the rest is downhill
The Focal Point
Anmher way to reduce your perception of pain is (Q concentrate your
gaze on one point or image. Some women prefer an external focus: a tiny
spOt on the wall, a photOgraph of a beautiful place, or anmher child.
Sometimes it's helpful to close your eyes and concentrate on an Image
(riding a wave or feeling the contraction as heat), a color. or a sound
You should be mindful, however, that closing your eyes may intensify
the pain of the contraction; in order for this technique to be successful,
you must maimain a strong inner focus. Practice with your eyes open and
with them closed so that during labor you will be able to choose the
method that works best for you. Again, there is no right or wrong
One optional technique you may enjoy is called effleur-
age. This is a French word, meaning stroking or lIght massage. If you
bump your elbow, you autOmatically stroke it with your other hand.
Rubbing a sore body parr is a natural response, and an achmg uterus IS
, b bl' r Is good to rub )'our bell)" and
no exception. Even now It pro a } Ice .
, . h" forting motion once labor starts.
there's no reason to discontinue t IS com . h
. d ur abdomen or JUSt use a s Oft
You can rub a light Circle all aroun yo. ,k
hand or With two. Beuer } et, as
stroke underneath your belly wit one
Icuing him know (he correct
your partner to massage your bell)' or you,
The L,UlIIIU Bred/hing
( "ure.
I( ,
our bell," is sensitive, )'OU may prefer to eXert
amoum 0 pre.
'USI above ,'OUf pubic bone or have your partner massage
em pressure J .
. b" < I orrhlghs instead o( rour abdomen. You can use talcum
)our ac ... , lee . . .
powder, cornstarch. or a Iinle massage 011 to prevent skan Irntatlon.
In 1983 ASPO Lamaze standardIzed Ihe names for Ihe breathing
pauems (or labor. This dlfec[ive was in response to a need (or a commOn
professional language and a desire to eliminate regional differences in
usage These lerms had originally been 1efl 10 Ihe discrelion of individual
teachers, but names such as Jlo'l'-cbesl, .urt/erated, "derelerated, and palllblow
have now been replaced by Ihe lerms floll ',paml, modifiedpared, and pal
IlmeJ-paud. In addition, the guidelines for performing the breathing
patterns were made more flexible, allowing for greater individual varia-
nons on the pan of both srudents and teachers.
Other comfort measures were updated as well. A greater emphasis was
placed on teaching relaxation techniques, and effleurage, once confined
to abdominal stroking, was expanded to include back or suprapubic
pressure and leg, (001. and back massage. Though good Lamaze inSlruc-
[Drs had already incorporated many of these changes, they have now
been official I)' endorsed.
Slow-Paced Breathing for Early Labor
first breathing pattern is simple, and very relaxing to do. Find
focal POint. Take a deep cleanSing breath in and Out, and then
brealhe slowly and deep1 f h d .
,. y or t e uratlon of the minute contraction.
10 through your nose and Out through your mouth. Relax your
'h corndPlete1)', and leI each exhalation help you 10 let go even more
tt een ofthecont' k h .
OUt ractlon, fa e anot er deep cleansing breath in and
Dunng the contraction, your partner will tim h
mmute.: saymg "Ff _ e t e quadrants of the
Sixt'. ' I teen seconds '. thirty seconds ... fortyfive seconds
} conds, [he COntraction IS over" It will fe I h
efflturage, or light belly massage e SOot ing {Q do the
If you COUnt your breaths taken du' h
pmbabl}' take around ' nng t e minute, you'll find that you
SIX to mnt" (not count hi'
whICh is about half the ' ( 109 t t: c canslOg breaths),
palc 0 normal breathing Th
( 15 timang IS that a m -d . c reasoning behind
ore rapl rate will use too mu(:h energy and will
-- -
. - -
fail to be relaxing, but if the pace IS too slow It won t be rhythmical
enough LO hold your attention,
Try to makc the breaths in and OUl of almost cquallenglh. If you have
trouble, count slowly to youf'ielf as you inhale. 'One thou'and, twO
thousand, three thousand," and repeat the numhers as you exhale. It is
easy to breathe oul very slowly, but it is difficult to breathe m slowly
The timing is very individual Singers and yoga enthusia'ts are ofren
most comfortable with five breaths per minUte, and that is fine. The
breathing should be calming, so establish a pace that is relaxing for you.
The first few times you practice, your breathing Will be slightly fast. The
more you rehearse, however, the more confident you will be, and the
slower and more soOthing the breathing will become.
Feel free to breathe entirely through your nose, or in with your nose
and out through your lips. Comfort is more important than sryle, If you
have a cold or your nose is stuffed (a common condition called preg
nancy rhinitis), you will have to breathe through your mouth. If you find
your mouth gets tOO dry with this breathing, switch to allnose breathing.
Experiment a litde and see what feels most natural to you.
Don't worry about whether you are doing abdominal or chest breath
ing. The style you intuitively select will be the right one. the
purpose of the breathing is co relax you, not test your coordl.nanon.
You will continue this breathing pattern dunng the contractIons only
and use it for as long as it works for you. ThiS may be for only tWO
contractions or it may be for your entire labor.
Modified-Paced Breathing for Active Labor
contractions will become stronger,
As your labor progresses, your - th
, feel more pam as e contractlons
longer and closer tOgether. You rna} . '_ k
. .' , need a more active breathing pattern to eep up
intensify, and you rna} d' how )'OU v.'ill know when
. . I bo Y mal' won er nov.
with your acove a r. au _. be a problem. In labor
. h tern but chiS won t
to change to thiS breat mg pat , b hng patterns automatica1ly.
I fi d
,11 change reJI I
you will probab y n you V.I . d. (Urall)' when you have.1O
b eathtng a )ustS na
Think about how }Iour r _ , walk up a flight of St31rs
I hov.' It changes as } ou
work harder (han norma, , h ht your breathIng pace gets
or scrub a floor. \X/ithout consclousbect oug s more shallow. Mo{hticd-
. dd I brealh orne
faster I and each Ifl. IVI un I h "es You will accelerate the
. h e natura cane> .
paled breathlO8 mimiCS t es
" the comrac[Jon intensifies. and you will slow
pact' of your breat Iflg as
do,,'n as " fades . hi
fit and the contraction Wit your C eansmg
Find ,'our Toea polO .
. be b)' now it 15 3 conditioned respo. nse to breathe .and
breath. (Remem T,
h h on tract'
on ) Begin wieh breathing, then allow I( to
relax wit eae c .
. k ou reach the [hIT'l'.second mark. Once the peak of {he
qulC 'cn as }I
has passed
allow the breathing to slow down agam. At the
contraction ,
end of the contraction, take a deep cleansing breath and relax even more.
Your partner should still count off the quadrants of [he minuce and
cominue the belly, back, or foot massage. Feel (ree to inhale and exhale
through either your nose or your mouth.
The modified-paced breathing is faster and more shallow than the
slow-paced breathing for early labor. You will take about thirty breaths
per minU[c now, but this figure is an approximation-you are free to set
)'our own tempo. If this pattern of breathing seems difficult to grasp, try
to breathe to a song. A slow rendition of "Love and Marriage" or the
Beatles' "Yellow Submarine" are good ones, taking a breath in or out
on each nOte, This is the pace for your fastest acrivelabor breathing done
during the peak of the contraction.
To help you practice this breathing pattern, pretend you are going to
walk up and down a flight of stairs. Your partner is at your side and you
are ready to beglO. Take your cleansing breath and focus mentally on the
very tOP stair. Breathe slowly in and out, two or three times. You will
hear your parmer say. "Fifteen seconds," and you know you are about
halfway up the stairs. It is harder work now, so allow the breathing to
get (as.ter and lighter as you climb those last few stairs. At the very top,
you Will hear, "Thirty seconds," and you know that the hardest part is
over. Your breathing is still quick, but as you turn around and walk back
down the stairs, it will return to the easy pace Wh h h
. en you reae t e
nom ""P. take a deep dean b h d . .
slOg reat an rest. The COntraction IS
It can be difficult to practice the active breathing without any real
slimulus. You may feel th . b h
.h h" c rcat 109 seems too easy to be of any help
WtntlOgsgetto hT
t:xperiment b ' - 0 reassure yourself, you can conduct a small
t.hlgh to .. th
your pannfer squeeze your upper arm, calf, or
.... Sen53t10n 0 a com J
increase: the Intens f h' ractlon. Ie should gradually
ltv 0 IS squeeze so th h' - - .
thlrf)"5t'(ond markl I h . at IS gnp IS ttghtest at the
, ) Ow y, e should h . d .
s(:,l'onds. .... C IS gnp an cnd at sixty
Many women who try thiS eXc:rClse are amazed at h( .
they. are of the tight gnp and how well th b h- . 'W unconsCIOUS
". rear 109 works to decrease
their perception of patn. It is also ene' .
.' . ouraglOg to try thIS Simulation
without dOIng the breath 109 bccause th bl
. "' en you are a e to contrast the
amoun. t of discomfort with and without the b h A h
reat 109. not er experl
ment IS. to have partner squeeze your arm or leg quickly and as hard
as he did at the thtrryseeond mark This demonst at h .. h
. r es t at pam IS mue
more tolerable when it OCcurs gradually, as It does during normal labor
Parterned-Paced Breathing for Transition
This technique requires the most energy and concentration, so use it
only for the strongest contraCtions. The tempo is fast, light, shallow, and
even throughout the entire contraction. This breathing is done entirely
through the mouth, with lips and Jaw slack and relaxed.
Because transition contractions peak quickly, you only have time for
a quick cleansing breath. It is really more psychological than physical at
this point-a mental "On your mark, get set, go" preparation for the
contraction. The breathing for the contraction itself is done in one even
rhythm, breathing in and out three times, then taking a founh breath in
and blowing it out through pursed lips, as if [Q blow om a march. The
sequence goes like this: in/oul, in/out, in/out, in/ blow; in/out, in/out,
in/out, in/blow; and so on. The breathing is so shallow and light that
(here should be no sound on any of the exhalations except for the blow,
which is crisp and short, very staccatO, and will act as an accent, nOt as
a break or pause. A t the end of [he contraction, mke one or twO vcr)'
slow cleansing breaths to completely. Take advantage of what
ever short rest you get between contractions. .
This technique is the mOSt difficult one, so at )IOU should practICe
with a simulated contraction. of thirt), or forrybve As you be--
r , econds You Will be tempt
come more confident, practice lor OIner) s b th.
to make the sound of your bre.uhtng audible to your parmer, ut
f ' ur exhalauon but not of your
is unnccessar)'. You rna)' be aware 0 ) 0 _'" ..'.
hahng even 1t you can (
Inhalation. Don't worry about it-)'l1U are In
hear it. b k he can continue (he
h sband to rub your ac or
OU may want your u . I . ou vlsu.llize ),our cer\"lx
' be Interna as )'
c eurage. Your ocus ma) " . L.., external as ),ou stare
m "ters or It may lx.: .
opening (hose last t lfce ccnn t. ,
h P
h At this point, most women need direct
b ( ,( color In J P orog
. . .
at a I L 'h h' rmees and this is the ume you will most
eve (00[3(( wI[ t elf pa .
likely breathe through (he contracoo
together. . .
Your boch works VCf)' hard dUring labor, and by transltton .you are
ured The thinS you want co do is wHh your For
ld practice the transition breath 109 until each breath
thIS reason, ),ou
IS ieather light and completely effortless.. . .
Transition breathing lends itself to vaClations more easIly than other
types. This can be useful during labor, for varying the pattern can help
force }IOU to concentrate on your breathing. Practice the three breaths
and the blow, but once you've got it down, you can experiment a litde.
Try twO breaths and a blow, or five breaths and a blow. When the time
comes, you can change your rhythm for each contraction if yOll like.
Another variation of transition breathing is called pyramid brealbitlg.
ThiS pattern requires intense concentration, which some women find
P)' ramid breathing consists of breathing in and am once, then breath
ing in and blowing out through pursed lips. The next time, you in-
hale/exhale twice and then inhale/ blow; the third time you
mhale/exhale three times and then inhale/ blow, and so on until you
reach five in-and-out breaths followed by an in-breath and a blow. It
looks like this:
In/out. in/ blow
In/out, in/out, in/ blow
In/out, in/out. in/out, in/ blow
In/out, 1O/0Ut, in/out, in/out, in/blow
In/out. in/out, in/out. in/out, in/out, in/blow, and so on
If thiS variation seems ve I' d
B "ry camp lCate to you, you are correct, it is.
Ut many women like it for that ve .
Option Do . r I h ry reason, so we present It as another
" n [ ee you ave to learn it if you are too confused.
Breathing to Off
-- - set an Early Ur e to P
Usually, feeling the need to b<ar d gus h
the Signal that your c' Own (or have a bowel movement) is
1..._ ervlx IS completely d"1 d d
ucglO pushing. Sometime h " I ate an you are ready to
b<:f s, owever thiS urge
. ore you are fully dilated P . h" ' IS premature, occurring
swell. So always walt r us Ing now could cause your cervix co
Or YOur dOCtor Or m'd r
___ __ _ 1 Wl C to examine you first.
Prepflrtl/iQtI lor Bir//)
If you are tOl_d you are not completel d -I d
b h
' Y I ate ,you must do some very
active reat 109 to aVOId pushing.
To resist this strong feeling PUt you h d
' r an s over your nose and mouth
and blowout forcefully and quickly In mI' I h h I f
u up e 5 on ex a allons or as
long as the urge to push persists Keep your hands f
. .. over yOUf ace to
prevent hyperventilation. When the urge subsl-des
. , you can remove your
hands and return to your regular transition breathing. The desire to push
may last for just a few seconds at the peak of the comraction or through-
out the entire minute.
This breathing is an important technique, but one that will not make
much sense to you until you need it. Practice it anyway so that it will be
a familiar routine when the time comes.
Breathing for Pushing
During the pushing, or second stage of labor, you will bear down only
during the contraCtions; in between, you will rest. The type of breathing
you do for the contractions will depend on their length. If each contrac-
tion lasts a full sixty seconds, you will have time for an initial cleansing
breath and [hen for three or possibly four pushes before it is over_ If each
one is shoner, you will skip the cleansing breath and begin to push
immediately in order to take full advantage of the contraction's duration.
Each push will take ten to fifteen seconds. There are twO basic
techniques you can use during pushing: breathing in and then pushmg
as you continuously release your breath, or breathing in and then push-
ing while holding half a breath. . .
When you feel a contraction coming. you Will take your. cleansmg
breath in and out, then take another deep breath in and qUlckl)' blo\\-'
. w'h' le holding the rest you will completel), relax your
some a It out. wi' ..
. fi nd bear down as your partner countS, One ... tWO
pe VIC oar a . " h ., Quickly you
three four ... five ... SIX .. seven ... clg {. ..
. . . . . . ..' k other breath 10. let half of" out,
will release the remalOlOg air, fa e an f b een eight and ten.
d h
. P to the count a etW
hold the rest an pus agam. u h a third or fourth time.
. . ' 11 there you mal' even pus
I the contraction IS Stl b h ' u will relax your legs
"st of your last reat.) a
After you re ease ( e rc If 'me ,'ou feel any pressure
. ng breath ill JOy tI .
and fintsh with your c eansl . Trl' to work ),our chest and
I little morc air out. .
in your neck or ace, et a h es in }IOUr flce and pelVIS .
. I les and relax t e on h
upper abdomlO3 muse I breath in and out once t e
. 0 take IIDur C eansmg
Anorher techmque IS t
The LI1IMU BreJJtbillg
9f1 Prepardtirm -f.Q;:-;B;:-:------
f ~ r irlb
- ,
~ ~ j '
Tile LllmtlU Breathing 99
- ~


- ~
- 11 ...

epar4l1iou [or Birth
_ LeOI'n .. then to ,"halt: again a.oJ continuously exhale as you
(l10[radH1n II l:' .
rush. This )'l)U WI" rereal three or (our tlml'S. depending on the length
<)( r
(onrr;l(ion. and end wuh your cleanSing breath.
There arc marl' 'fight" wal's to bre.uhe as you push, and if will be
an individual and tnsrinCtlH' choice when you will exhale and when you
will hold }'our breath. It's possible you may nOt know how to push
bur it's unlikely }fOU would breathe incorrectly. Don 'r (ocus On
perfecung a specific breathing technique. Instead, practice different
sryles and keep In mind that when the time comes, your breathing will
probably be an adaptation all your own.
Man)' women don't do any special breathing at all, simply following
thelf natural desire to )Ielp, shaUl, or grunt as they push. If you're given
the freedom to assume a comfortable, efficient position and you're nm
IOhibued about vocalizing, (his informal approach may work the best.
The only breathing technique tha( should never be used is the Val salva
maneuver. which means pushlOg with a full held breath. h is commonly
taught In the delivery room by nurses and doctors, but it is a dangerous
and uncomfortable me (hod. In Nmt M011lbJ. Nmt LtJIofIJ, childbirth
educator Gail Brewer explains why: "This rechnique places severe strain
on your alread)' separated abdominal muscles, interferes with the return
of blood to your heart b}' raising the pressure in your blood vessels to
dangerous levels . " . and most significant for labor progress, causes the
muscles of your pelvic Roor to comra([, nOt relMJf, thus illhibitillg your
bab)'s descent,"
To understand the effect of the Val salva maneuver, take a deep breath
In and hold It for about five seconds, You will begin to feel the pressure
bUilding In ),our face and neck. If ),OU hold your breath and try ro push
at the same time, you will feel even greater pressure. Used during the
delavery, thiS technique will exhaus( you, making your face grow red
With effort and the veins In your neck nand out. It can even cause
capillanes In )'our face and eyes to break In addltlon h b
' , [ e nUrse may e
you to "Push, push, push, hold your breath, don't let any air
I.:!lcapc. whale instructing yo k .
u not to rna e any because [hat would
be: a Waste.:' of energy.
Dunn,&( (hiS yr 11 .
, )U WI tunc In to your parmer's encourag-
lOA voice and push 3') you fc:el the n<.'e.:'d You'll . b I
f . most enJo}1 giving In 1
I }IOU {J_n rdax, breathing and pushlnA Intuitively. Childbirth should be
comlJcrcd an <In, not an athlctlC (ompctJllon
LearnlOg how to l'i Imp h ' I
h _. un'lIlt, Uf It , a so IOhcrcntly lOadeqU1HI..'
c(au'll.: ,Q;lvlnA birth . I 'I .
on t l""JO) Irailllng, PrillllnnR pushlnR
without lahor i5 like trying to SWim withllul "'aler P L. h
.... nor loaotlr [ ere
Ie; no urge to push and no way adequately to prepare for the eff"on it
entail..,. Be reassured, however, that IS an IOstinctual aCf that
every woman can perform, prOVided that she IS alh,wcd [(. choose her
own position and that her pelVIC muscleo; have not been de-cldened by
Optimally, you should practice each breathing panern at least five urnes
every day with your partner and as often as possible by your5elf. You
can practice your cleansing breaths every time you feel the baby kick.
so you begin to condition yourself to breathe in response (0 a stimulus.
Do your slow breathing as you wait for a light 10 change or before you
drop off to sleep at night; practice the active breathing during a television
commerCial or on a crowded bus; try the transition breathing as you go
up a flight of stairs or ride your stationary bike.
When you practice the timing of the contraction, your panner can use
a walch with a second hand or a stopwatch. Within a few weeks. how-
ever he should develop the sense of the length of a minute and be able
to without the watCh. This is preferable because during labor hLS
attention should be on you, not on his watch.
Let your cleansing breath be the cue to your husband that your con-
, h s begun rather than having him tell you when {Q start. ThiS
traction a , . .
is what will happen during labor, so It IS a WJ.Y of eSl'.lbllshlOg the correct
habit. d d up in the heat of performance.
Ever)'one has the ten enc), to spec _ . 'II ak
d h twenty minutes WI t e
For example, a speech rehearse at ome
.1 s milar rush OC(urs
d I
. front of J.n au tence .. '"\ I
twelve minutes to elver 10 h f breathing pattern.
"f h is doubt J.oout t e remIX') 0 J
during la or, so I t ere . hi .. tde allowing yourself
it is generally better to practice ,1 hule on t e s 0"\\ S ,
the Icewa)' to speed up dUring nt where it's
. peJl:etul en\"lronmc
Don'( alwOl}'s an .1 . . _. "lur powers, of (onl:en-
relax Bright lights .\OJ loud noises ,,,,In Impf\.l\e)l
. h' d rela,,\tlon skills. .-
tration and your bn.:,tt Ing ,10 . I .' 'uil' )'oursdl (omtortJ.-
. . . )Os_ Dlln t a wa}' , d
Practl(C to different IX'sttll . - . I bor thl're. ) ou "hout
, .. "nll Ol('Ist l'll' llur a .
hi), In bed .. mee you rna} not. _. -0 tht'
, db ' ,(.lll(iaog up. I h
hl'lllmc..' ilC(USWme to. rl. . II ' 1."1 ln "our The brt"a.t inS
' k 1."1 ch,ltr .to'" }IOo!'> l .
ptlSltton, silting In .\ n.X lOt"
-- ----
will feel slightly ditferenl in differem postures, and since }fOU can o( pre-
dice what posiuons will feel best dunng labor, you s h o u l ~ be prepared
(or all of them. This also holds true (or when you practICe pushing.
The breathing patterns should be rehearsed to the pOIO.t where they
are second nature. Practice until the rhythms are so familiar they are
absolutely effortless {Q perform.
The following chart summarizes the information (rom chapters 4 and S
on labor and Lamaze breathing. No cwo labors are idenricai, and chere
are many variations on labor and delivery. This is meant only as a general
guide to the average labor. The chart can be used as a review once you
have finished reading this book or as a summary you can refer to during
effacement of
the CC"'IX and
dilation to 3
Regular 8-9 hours Excited
Dilation of
cervix 4-7
comractions that last
30--45 seconds and
occur every 5-20
minutes. Mild at
fim but gradually
becoming stronger
and more frequent.
contractions 3-4
minutes apart,
lasting for 60
Contractions are
longer, stronger,
and closer together
Prepuratit)tJ for Birth
3-4 hours
Become more
internally focused
Less verbal
Busy concentrating
on breathing and
Sioul Brratbmg: Relax, take a Time conlractions
slow I deep cleansing breath. Emphasize rela."(auon
Continue to breathe slowly and Verbal reassurance
rhythmically I in through the nose
and Out through the lips, 6--9
breaths per minute. Gently
massage abdomen. Partner times
quadrants to the minute, S3),jng
IS, 30, and 4Ssecond marks.
End with a deep cleansing
Modi}itd Bmlfbmg: Relax, take a
deep cleansing breath. Take twO
slow breaths to about the
ISsecond mark and then
accelerate breathing until the
45.second mark. Faster breathing
is done either all through the
nose or all through the mouth.
As peak passes, decelerate
breathing. End with deep
cleansing breath.
Time contractions
Check for rela.'(ation
Make comfortable
Massage back if needed
Protect concentration
Rest, relax, conserve energy
Read, nap, take walks, go [0
a movIe
Continue usual rouune
Eat lightly to keep up Strength
Cali dOCtor or midWIfe
Finish packing suitcase and
Lamaze bag
Go w hospual or birth center
Change position when nttde.J
The LllllldU Bre,Jlbing
Pl rRP{1SF
. Odatllln 8-10
I ""meters
Expulsion of
the bab).
Expulsion of
the placenta
Placc:ma I
I Comracnons and
, restS o( roughlr
equal duration,
60-90 seconds
long. Comractions
can be irregular,
peaking twice or
maintaining the
peak (or a number
of seconds.
I Contractions
become shorter and
further apart.
I Usually rerurn to
, pattern of
contractions, 60
seconds long and
3-4 minutes apart
continue bur are
brief and mild
PreparalirJII for Birl-;; --
I hour
1/2-2 hours
10-30 minutes
Lms o( sense of
Refreshed, having
found second wind
Possibly irritable
and confused
P"lltrtluJ BfI'IIIJ""g: Quick
cleansing breath to Slart. Breathe
through mouth, 3-4 breaths with
short, staccam blowout through
pursed hps as an accent.
Breathing should be shallow,
light, and rhythmical. Forceful
blowing out with hands over
nose and mouth for early urge to
push. Cleansing breath to finish
Brtalhmg for PUJhmg: Deep
cleansing breath to start. Take
anOther breath in, let half of it
out, then either hold breath or
blowout slowly for a coum of
8-10. Let out any air that is left,
take anOther deep breath in, and
repeat push as you hold breath
or let out slowly. Maintain pelvic
tilt and pelvic-Roar relaxation.
Help relax bt:twecn
Remember that thiS i!
I pan
Change position Maintain her sense of
her it will end.
Reassurc, encourage
Breathe together and
maintain eye contact
Set short-tcrm goals,
taking only one
contraction at a time
I Anything that you
feel better
Help with positioning so
she is nm Halon her
back. Should sit, squat,
or lie on side.
Count from 1 to 10 for
Push with each contraCtion
Try different pushing
I positions
Exercise and
During Pregnancy
E xerci_
and relaxation may seem unr
phYSical disciplines th ' elated, but [hey are bach
at can Improv If
Image. practiced throu h e se -awareness and body
t:dgc 10 labor i
p.regnancy, bOth can give you an extra
s cnucal because' "I I .
I[ WI permit your body
Preparatio" for Birth --
to restore Itself between Contract' h .
IOns, wile t: xefCise will provide
Birth IS more physical than YOU can ' , d
' II Imagine, an working with your
body now WI prepare you for the real work of labor
Before giving
birth, i you can learn how [0 isolate muscle h
. . groups, ow to breathe
through strenuous aCtiVity, and how to work w, h h . I .
t P YSlca sensations,
you II be very well prepared. We urge you to undertake the short exer-
cise program that Diana has drawn up and to practice the relaxation
techniques. We know they arc good-and you may enjoy them so much
that they'll become part of your postpartum routme.
Ten years ago, women who exercised during pregnancy were a small
minority. Doctors didn't recommend it , and women were concerned
that exercise could in some way harm the baby. There were no books
on the subject, and although pregnancy exercise classes were available
(Diana's being one of them), they were few and far between. Most
women sropped working out as soon as they realized they were pregnam
and resumed only after the baby was born.
Today it's a whole new world for pregnant women who want to keep
in shape. Pregnancy exercise classes are everywhere, as are books on the
subject. Mothers-tabe are now concerned with nOt getting enough exer-
cise, parenrs and peers expect them to work out, and obstetricians
mend exercise classes at the first checkup. The Lamaze movement IS
partially responsible for this change in attitudes because it has always
recognized pregnancy as a healthy, vital state that permits normal acnv-
ity. This shift has also occurred because women have spread the
about how invigorating and fun exercise regimens are and how ternhc
they felt after childbirth.
The Benefits of Exercise
I b make it less painful. or enable you
Exercise will not shorten your a or, _ aI I "n t directly affect
. h from the hospH . t WI no
to wear you r 01 Jeans orne bod h,ooer or triaaer
. ake your y t , ec
the amount of weight you gam, rn
labor. It will, however:
. d Relll\-dtioll During PregtldllC)
.... ernIe "" .

" never had :1 backache, I rarel}' was tired, I was strong. I never felt like a fat
pregnant lady, I had an Incredible amount of energy-and I ancibute all this to
ffi)' pregnancy exercise class."
''Through gerring In tune with my body. I got in rune with my baby. I felt so re
about myself and life!" g at
'Wh hid
. at e pe [0 push was that 1 was in great shape and had done Ke I
OIne monrhs ultglOlJJ/j ThiS helped me relax the h' I ge s or
109 ones 10 make way for a large bab .. sp meter muse es and surround
. Exercising throughout my pregnancy ke [m h .
I also felt 10 comrol of my bod I h Po Y P YStcal and emotional energy up.
o y-at oughltdd I klok 0
tn the mirror'" I nOt 00 1 e mme when I looked

" I can't Imagine not feeling good d .
lOt to do with it. h kept me in to pregnancy, and I think exercise has a
each d . UC wit myself and
3)' JUSt to be With me and bo . gave me a wonderful time
my un rn child."

find pregnancy to be one of the hardest tim .
y body. I have aches and pains s es dunng which to feel good about
Exercise not only tone,' m:e: tO
move at a snail's pace, and look
e p!. to make the nme months a hap e.s but also elevates my spirits and
py umc m my life."

Prep'lrtlli01l lor Birtb

, , ,



"Exercise made me feel th I 0 0
at was sull m c I f
completely out of shape. 1 became antra 0 my body, that I was nOt getting
second nature for my delive .. more aware of my breathing, and it was almost

" I enjoyed exercising with all the p regnant women be I Id
were even fatter than I!" cause cou seemherswho

Help you feel healthier and have more energy
Improve your circulation
many common complaints, such as leg cramps, lower back
pam, and constipation
Help maintain muscle (One so that you will carry the baby with more
grace and return to your former shape more easily
Teach you how (Q breathe and work at the same time, which will
prepare you for natural childbirth
Make you more aware of and confident about your body
It has never been scientifically proven that women with good physical
fitness fare better in labor than those in poor shape, but many women
who do exercise during pregnancy say that the preparation was at least
as helpful as the Lamaze classes themselves. We believe an exercise
regimen can o nly enhance your labor and delivery because fitness pro-
vides stamina for labor. This means you will hold up better during Jiang
labor and have more energy for pushing at the end. Pain is felt more
acutely if you are tired or run down, so the more stam
' you have, ,he
better you'll be able to cope. Being fit will also encourage gre-dler
comfort during birth because tt he eaSIer to chang'> pl)S1uo
labor or to squat or stand while pushlng. tn many ways w(lrklOg IS
similar to lab,,,; It's hard work, tt requ"es c,)ncentraUO
, tt help> ,t you
, ,
breathe (Un.'cdy, and it's not Jlways enjoyable. But like labor, it feels
wonderful \\:hcn you're done.
\);'e hope you'\'e been exercisang throughout pregnancy If
. ad I' you
haven't and are feeling we I, )'ou can egln t ay. (S not too late d
, an
the folk,wlog (CUune is a gentle one, geared to the last momh of p
nancy Just to be safe, check with your dOCIO! or midwife before starting
the exercises. Ask your husband {O join you and you can make It pan of
your regular Lamaze practice. You can start with the exercises rev'
, lew
the breathing techniques, then wind down with the relaxation exercise
at the end of this chapter. It should take about an hour, and you will reel
very good when you're finished.
________ -
The Exercise
This feels great I I
. . t a so tones and
Improve posture by strength . 'itrc(chcs the waist and 'b d
enmg the back muse! h n s, an help, to
es t at support the spme.
To Start:
Sit tall with yo -
ur spme long and straight
your shoulders relaxed and ope d'
h d n, an your
ea centered on top of your spine.
Stretch your right arm over your head and
bend to the left. Relax your head to the side
and let your left elbow drop toward the
floor. Feel the stretch along your entire
right side.
Try to maintain the length along your right
side as you unroll (0 the center position.
Six times to each side, alternating sides each time.
the In )"\..lur legs Impron"s rhe(in.:ularil1
. This ('xc-fcise will be espe
(I3liy helptul II ro
are prone 0 leg cramps or If \Y;lter rerentlon IS a problem
To St4rt:
$11 rall with r0ur legs str:lIght out in (ront of
\'Oll, hip width apan.
Prep<Jr/.Jlir,m lor Birlb
Keeping your heels in place. bend yOUf
knees and Rex your feet. Straighten yOUf
spine even longer.
Tighten your abel d
omen an the muscles on
t etopsofyo h" h
h ur t Ig S, point your feet and
steetc your legs Out straight.
Sixteen times
I'll 1/(, JIll
Tim .s a wontit . .'rful exc L
cOst: U\:caus '
'i.1nlC IIffil.' relaxing the 10 b (: II strengthens Ihe aM
wer ack Do It wilt: . c)mlnal rnusclo while at he.
never your 1001.cr k 1eels 3(h., or su:T
'/ 0 \Iarl:
LIC on the floor with your k
nees bent th
,o.lc5 of your feel on the fl bo"
oor a UI hlp
width apart
Tighten )'OUf abdominal muscles and think
of giving your baby a hug. Feel yOUf back
flatten agains( the Roor, your whole spine
long and straight. Make sure you keep r
Allow the abdomen 10 me and fill
with 3U
buttocks completely relaxed.

Eight urnes
[FG urn . d be m lete without just a few leg lifts. The first pan of thIS
N l new",-' (eglmen \\oul co P I h
l' . _ ' h' hs' (he second part (Ones (he outer t lIg s.
o;er(lS(' worb the mner (18 '
P.,rl I.-
Lie ()n your left side wnh both legs straight
and rour head on )'our bollom arm. Your
hod)" should be In one straight line.
Breathe normall), throughout.
Stretch both legs even longer, then raise
rOUf right leg to hip height
Leaving }'our tOP leg up, slowly raise and
lower yOur le(t leg. This should be done in
one smooth and even rhythm. Press your
lOner dllghs together each time they meet.
Total: t .
and re;:t urnes, then turn to your fight side
PrepfiraJio" !Qr Birtb
Part II:
Return to your left side and P'op If
up on onc arm. Bend your left I h
eg, t cn
check (Q see that your body and right leg
form one straight line.
Lengthen yOUf right leg, tighten your
buttocks, and slowly lift and lower the leg in
one smooth and even rhythm. Only lift your
leg three to five inches off the floor so that
you use yOUf thigh muscles ani) and not
yOUf hips or back.
Total: ten times, then turn to your fight side
and repeat with the other leg.
. d R"III \,lIioll During Prt!gu""CJ
Eserosf 1111 ~ .
" BOD)' (I!lCLtS , bod}' Here's one way of relieving It .
i PPf f\' . rhe shoulders and UpPl:f .
. - 'u/t:s Inll
d d
n of(c:n \t: _ acc also recommen e .
L h d a
:\ waml t.ar an
If) .\J.lrl:
Sit (all
Breathe norma"r throughout.
Shoulder C;rcles:
Circle yOUf shoulders forward, up, all the
way back and down to center. Reverse.
Eight nmes fO each direcrion.
Head Circles:
Elbau' Circles:
Place your tingenips on your shoulders and
circle your elbows forward, to (he side, and
behind you. Reverse direction. Eight times
[0 each direction.
Circle your head rorward, to the side,
around to the back, and to the other side.
Drop your chlO toward yOur chest and
direction. Four urnes each dircClion.
J IN Prep'trtl/iot/ jor Bir/b
Good posture is difficult to maintain as breast size Increases. Thl'i exercise will help
improve your posture, release tension in the upper back, and increase lOne and flexibility
in the waist and ribs.
To Sltlrl:
Sit with your legs crossed, your right hand
on your left knee, your left hand by yOUf
Tighten your belly musd.
ribs to the lert, looking 0
Inhale: h
Change sides, your left on t
k d loo
k over your right so
nee, an
Six times to each side,
, h ume
alternaung sldes eac
1 , t\ ,.
+- J .l..(.. n c 1': J. p".
) >=- J,. rz '<t"c...
(. ,
(J W f 11 )9' /0
I ui.
(I >, and relaxes {he ones 10 your lower
B.KK .IUS ., . ur abdominal mu' "
This exerCIse ) 0
To St.trJ: Nck with rO
knees bent and
Lc on roue h lioor hip width
the soles III roue feet on t e .
blhollc: . h
AJlo9. rour abdomen to nse and fill WI{
Tighten and tlanen roue abdominaJ muscles
and !ih ),our hips off {he floor Do nm
lightc:n )'our or arch )'our lower
back. ThlOk of tne lOPS of your thighs as the
POIOI, and your spine as a su-aight,
d1il8onalllOt:. Inhale.
Again. (18hl<:n )'Our abdommaJ muscles and
roll your spme, one \,<:rtcbra at a time, back
Ilj floor
Sn Urnes
J 2() PnpllrJlifUl jor iJlrtb
This exercise \[celches the hamstnng In ,hI.; ba, Ie!; f v m( legs and help'io you
practice consCIous breathing with tht, dis(omfrm "f a stretch '\jever bounce or (0(((:
yourself to go lower Use your bc<:athing and juSt thtnk .r lengthenmg your spme ,wer
your leg, not down [Q your knee.
To S'"rl:
Sit with onc leg straight in front of you and
the other knee bent, foot to the Inside of
your other thjgh. Relax your body over
your straight leg.

Feel the
and along
, S -h ,pane
Slowly point your 100l. trt:!.. ,
e\'en longer OVt!f your leg.
This exert
," Increases in the muscles along (he spine and IS wonderful C
lor a
(If achr lower bad ..
To SlJrt:
Supptlrt weight on rOUt hands and
knees-hands directly under ),our shoulders,
knN'J shF(hdv apart and directl), under l'our
TI.':hlt'n rOUf abdominal muscles, do a pelvic
ulr, and round your spine. Let rOUf head
relax and your chm drop fO l'our chest.
Rt:G.irn lu thl' hand,and kn
Spine '1111 founded . posllion, the
I" ..
P,-p - -----
.lrd'W" 'fJr 8 I J' Irt}
Stretch your hips to your heels.
.\1rm11 straighten the sp. f
I h ne, celing
cngt cn as you streich K yOur balk
. ecp
muse C5 working to yOur belly
sUPPOrt the b b
your ack doesn't arch a Y. 50 that
r \
, l' I

Six times
r H . _ to do one exercise while pregnant, let it be YOUr
If y(lU re ani)' gOlflg . d A
d f
a pioneering California octor, rnold Kegel
Keoels. Name a rer ,
r . I ses wli' increase sexual pleasure and help you recOver
these simp e exerCi , ,
ldb h ore quickl u If }'OU ve never done Kegels before stan
(rom C I If{ m" I
now. ..
The Kegel exercises strengthen the pelVIC Roor muscle, which runs
(rom [he pubic bone to the coccyx and wraps in a figure eight around
the urethra, {he vagina and anus. This muscle can be thought of as a
hammock, supporting the pelvic organs: rectum, vagina, uterus, and
bladder. Good tone of the pelvic floor prevents urinary incontinence,
strengthens orgasms, and maintains good support for the pelvic organs.
And because healthy tissue is more elastic, it may prevem the need for
an episiotomy.
During pregnancy, [he baby's weight causes the pelvic floor to stretch
and weaken (like a sagging hammock with an extra person in it). Years
ago, urinary incontinence, uterine prolapse, and diminished sexual pleas-
ure were considered the unavoidable results of childbearing. Today we
know thiS isn't true, because the pelvic floor can retain strength and
elasticity with a little exercise, just like any other muscle.
To work the pelvic floor muscle, try to stop and start the flow of urine
as you sit on the toilet. It will be difficult to do this at first, but with
practice, your skill will improve. You can also perform Kegels while
making love, and both of you will be able to feel the pelvic floor muscle
squeezing the penis.
Try to do the Kegels in groups of five, working up to about twenty
groups a day. Even doing one hundred won't take more than ten min-
u,tes. Kegels are great because they can be done anywhere at any time;
sunply reminding yourself to do them is half the battle. The best way to
remember is to yourself to perform them while you are doing
some adler such as waiting for a traffic light, talking on the
phone, or waiting on line.
Kegels are the single mo '. .
St Important exerCIse you can perform dunng
pregnancy and throughom your life.
The Benefits of Good Posture
POsture is always a f
Impo II - matter a good health. Correct body alignment is
rtant at a times in a w . I"'
oman s IIC, but panicularly during preg-
Preparaliou for Birth
nancy, w. heo. a constantly shirring ceOi f
d b d
t:r 0 gravity and added (b
qually Istn ute ) weight can crcate I b k Ut une
. If Ower- ac ache, neck temion and
fatigue. you Want to look and (eel 11 -, _.
d I h b
. we , ImproVing and malOtalOing
goo postura a ItS IS esseOlial.
Dunng pregnancy, the. mOSl common postural mlslake is allowing the
belly to relax forward wtule leaning back wI,h 'h h Id
e 5 au ers as a counter-
balance. The result IS weakened abdominal mid I d
usc es an or osis an
exaggerated of the lower spine. To correct this tendency, to
lengthen your spme and balance your head and shoulders over, nm
behind, your hips.
Good posture is achieved by strengthening the muscles that support
the skeleton in alignment, nm by ljghtening muscles here and there to
make you look "straight." Proper posture doesn't mean walking like a
pregnant soldier or being frozen in one poSItion. Proper posture permits
you to move like a dancer, with ease and grace.
Even if you've always had bad posture, you can correct It while preg-
nant. This is an excellent time to work on poor habits because improve-
ments will be almost immediately apparent . Women commonly
experience heightened body awareness during pregnancy, and this sensi-
tivity makes it easier to remedy pOStural problems.
Here are three easy visualization exercises to help you improve your
posture, concentrating on different areas of your body. At first , do them
standing in front of a mirror so you'll be able to see as well as feel the
changes. Then, once rhe exercises become familiar, practice them as
often as you can, anywhere or anytime,
1. Stand tall and visualize the length of your spine, from your tailbone
up to the tOp of your neck. Imagine your head as lhe last pearl on
a string and each venebra of your spine as one pear.l on strand
Concentrate on teuing the pearls hang m one straight hne.
2. Tighten your lower belly muscles and give yourbbab)' 8
d I
" h 1 k . ng your uuoc an -nees
your pelvis to tilt forwar s Ig t Yt eepl
completely relaxed. Imagme your lailbone directly becween (not
behind) your legs. as if au were a puppet
3. Shrug your shoulders toward Now imagine
and someone were pulhng up the d II' r shoulders to drop
. b' I ' released an a 0'" you
the smngs emg gent). f he uppermost venebra.
k 11 resting on tOP a (
slowl)'. Fee your s u h d pper back to
, I I and your c est an u
Allow your neck to lec ong
Exercise III1tI RtJrl .\fIJ;01l During PregwUI(l
- I d (he fan that stress can have negative effects
'f ackno
e ge . h
o ... be" Th" reverse, that relaxauon can ave positive
hrs,cai well- Ing. c.::: d f
on II though not as widely accepte I Stress can raise
elfecrs ('qua }' true, , ' f .
. 'ood [hen relaxation. can lower It; 1 stress can Increase
one s bl pressure, '.
-' n then relaxation can slow tt down; If Stress can
the pace 0 resplrano , .
h h
. aJ balance within us then relaxation can restore the
upset [ e c emlC I.
I I S to
us (hat American culture 10 general resists the nOtion
ba ance. r seem . ,
f I
. as an Importam skill-perhaps because If s nor an active
o re axatlon
pursuit or onc with effectS that can be measured. We look forward to the
da), when a housewife does not feel guilty a few moments of
peace and when an executive can sit at her desk with her eyes closed and
nOt be considered strange.
The follOWing relaxation techniques will be extremely helpful for
you and your partner during pregnancy and labor, but please don't
assume that once your baby is born, relaxation has served its purpose.
Relaxation is a skill that will come in handy at other times as well,
such as before a big presentation, driving in traffic, or not being able
to get to sleep at night after an exhausting day. Both you and your
husband will find it a useful tool. Continue to pranice relaxation, bOth
an times of stress and in times of peace. The applications are almost
Relaxation is a learned art, not an inherited talent. The ability to relax
can be acquired with patience and practice, JUSt like any other skilL Do
not become discouraged if you find it difficult, for it is hard in the
beginning. But the more you do it, the easier it gets, the better you are
at It, and the more you will enjoy the feeling.
Included here are three different relaxation techniques: the progreso
sive relaxation, the full relaxation, and the neuromuscular relaxation.
Each exercise approaches the ability to relax from a slightly different
angle, and each one will be helpful in its own way. The progrt'fJitt
rtJoxattt:m IS. like an introduction. It IS an easy way to discover how [0
release tension from the body and requires the least amount of assistance
and knowledge from your panner. The full relaxallon is more loosely
Structured and allows fo '. _ .
r greatcr Imagmatlon and CreatlVHY _ It also ena-
bles you to expe . h d d
nence a muc eeper level of relaxatjon. It is base on
relaxation through sugg d .. h
. eSBon, an you Will dlscovcr images or rhoug {S
that WIll help you cope h I I
Wit yOur abor. The last technique neurofflUJ(/1 (,f
rtlo.\Ofta'l IS an act" . h 'd
' Ive one, to w Ich you learn to keep your body relaxc
Preparali'J11 jfJr Birlh

R ELAXAT 0...,
"The Lamaze was helpful, but what reall y worked ror me was the image
of the wave nSlng and falling."
"I walked up and down the hall for almost the entire labor When a contraction
came, I would stop, hold on to my husband, and do the slow controlled breathing.
I kept a mental image of how my muscles were working. I tried to stay relaxed
and to let them do what they were supposed to do."
"It was a very easy and fast labor. As long as I relaxed and stayed calm, it was
fine, but if I even tensed my toes, the pain seemed to multiply'
" I tried to relax my body completely and let the contIaCtJons simply wash over
me-almost as jf I could leave my body temporarily"
" 1 think the only way I was able to deal with twelve hours of back labor was by
relaxing completely during contractions. At first , I was startled and angry at. the
ain but once I was able to really relax, it was not difficult. contractions
, I 1" and worked on removmg any teOSlon
I tried to make my body go complete Y Imp . M doctor and all the nurses
in my fingers and toes. I seemed almost unconSCIOUS. I lbo,"
complimented me for adjusting so beauufuUy to a I cu tar

Obviously this IS the
.' tate of contraction.
even though one part IS 10 a s bo 0 e you have mastered the
" I elates to Itt f. nc I
exercise that most IfeCt y r be of images that he p )'Ou
. d established anum r , v , II
progressive relaxation an ' . d fun (0 prlcuce. IOU Vol
. '11 be qutte caS)' an
to relax, this last exerCIse WI
truly feci prepared.
___________ D 11< Prt!f!.tl"tln
. I R 11'\,,11011 uri" "
Exerote jOlt e,

- _ ez in a few minutes betv.'cen chores to practice
You can otten t
but it IS not a good idea to hurry through a relaxa_
a breathing pauern, . .
Th h
-h rechnique takes only ten to fifteen InlOutes, you
(Jon. aug eal
,'d r'me when \lOll and your parmer arc calm and when you
shou set asl e I _
W00'r feel rushed, The room should be comfortably warm and well
ventilated, rour clmhes should be loose and unconfimng, and your body
should be well supported by pillows,
B)' pCdcucing these techniques with your parmer, yOll both learn what
the feeling of relaxation is. You also learn about each other-where
tensions arc held, which strokes feel good, which words or images help
deepen rhe feeling of letting go. You will also learn which touches and
words [Q avoid, and this is equally important. You will become more
sensitive {Q each other and yOll will learn to trust and appreciate each
Q[her 10 a different way. \'(/ithom even being aware of it, you will
condition )'ourself to relax [0 the sound of your partner's voice and the
feel of hIS rouch,
If your parmer positively has neither the time nor the inclination to
practice with you, )'OU can do them by yourself or with a friend . It's
preferable to have your partner involved, but it's not essential.
The Progressive Rel axation
This technique for relaxation is a very simple one, All you do is tense
and then release each pan of your body, one part at a time slowly and
rhoughrfully You can m ' I h"
. ore east y sense [ e reelmg of relaxation by first
COntraeung muscles and then letting them go. By doing t his exercise you
will learn to be aware of h
eac separate muscle group and to be able to
distingUish between h h
w en t ese muscles are tensed and when they are
re axed.
Have partner ta1k yo h h h' ,
Th hUt roug. ( IS tenSion/relaxation exercise.
en places and let h' Y
bef h 1m try It. au can practice this relaxation
are rc tars 109 your breath
After a . k I.ng patterns Or at anOther time aitogc(her,
W(;e Or two you Will be bl
II' _ a e to practice this technique by
13 Y at flight If you h bl f ' '
with )'Our pa r' I ave trou e. alltng asleep). Time
r ner IS Imaed we kno
usc: your lime to 'h , W, so once thiS exercise is familiar,
gt( ('r to contCntrau: 0 h f II
\'Isualiz<ltlon rdax' h _ _ n t e neuromuscular and the u
. allon tee Instead
Begrn by setrlrng Yourself comf b. ,
your bed or couch A ona Iy In a semlrcclining position on
. rrange the pillo h d
ws so ( at every limb IS supporrc
PreptlrIJti(J1I /or Birth
, '" ,,' ,..... I
- .- --'
, I
-. 1IiIIIIro...
and there is no part of your body you have to h Id If H
o up yourse, a .... e
your partner read the follOWing suggestion, on(: at a time and cheCk It
see that you are complYing, HIS VOIce should be calm and soothing and
he should give you enough ume both (Q COntract and to completely
each muscle group. Encourage your partner to divide It IntO even smaller
muscle groups if he likes and to feel free to use Other images that come
to mand .
Contract each body part for five or six seconds before releasing it. You
will find that you will narurally want lO hold your breath as you tighten
each set of muscles, and you will begin to understand why the Lamaze
method uses conscious breathing techniques. Try to breathe slowly and
deeply all through this exercise-either your slow chest breathing or just
your usual rhythm. Have your parmer remind you to breath should you
Take a deep cleansing breath in and let It out with a deep sigh. Close
your eyes, take another deep sigh and breathe in and out,
yourself to exhale all your tensions wah the breath. Let yourself fall lOW
the pillows beneath you.
I. Tense your feet. Press your heels forward and spread your roes apart .
Feel the muscular tension in (he very tOpS of your feet. .
Now relax your feeL Let your toes hang loosely from your teet and
let your feet hang from your ankles. _ .
2. Tighten the muscles in your legs. Squeeze
and tighten the muscles on the topS of your t S an ar
n thou h there is tenSion 10 your legs.
legs and feel the UI'ghtloess
II ' and to be (omp ete )' sup
Allow your legs to open narura 1
the bed or Roar. , I S ze tightly as if )"ou have to
Aoor muse es. qUl'e .
3. Contract your pe VIC , ,ed Feel the peine
b h oom IS OC\.Upl .
uflnate desperately but teat r
hammock lift between )Iour legs I I' as If to allow )'ourself the
Now rela.x these muscles comp ete ,
luxury of urinating. h . nd [l'nsc y\.)Ur abd. omen ;lS
k ... htl)' wg
er a . k
4. Squeeze your buttoe's (Ie 'k' d how difficult It IS (\.) 'eep
. ,)ur lowc:r h.ll an . I' I b
well. Feci the teOSlon tn } l _ h. J t'\'cn;l Itt e If
> working ar '
8 when you .lrt;;
- - J J} /1,\ Ilifnl DurillS Prt'gu.J1I(l
F\fro'H' ,UUI n.t' j ,
buuocks and bell)' completel), and take a deep
Slov .. l)' release your
b ea
th to help )'OU relax even more.
cleansing r h b
n "our chest. Feci how { IS stops your reathing
5 Ttghtcn ( e muse ,. .
, I h se muscles and let [he air escape. Allow your breathing
Rea..xte .'.
d sense )
'OUf breastbone freely rlsang and fallmg with
to resume an
each breath.
6. Shrug your shoulders up [0 your ears as if you could wear them like
Slowl)' let them fall back down to )'our collarbone, like sand
smoothing our with a receding wave. Let them feel quite heavy,
7 Stiffen your arms like [he sleeves of a wet blouse left outside on an
iq' day. Clench your fingers into tight fists .
In your mind, bring the blouse indoors. Feel your arms soften to
the warmth of the imaginary room and unfurl your fingers. Notice
in passmg how your fingers will remain slightly bent even when
8, Lastly, tighten all the muscles in your face and neck, Pretend you are
earing something very sour, like a lemon drop or a very sour pickle,
Wnnkle your face in prOtest. Squeeze your eyes closed and deepen
the hnes in your forehead.
Allow all tension to drain from your face and feel relief pass over
It as if you JUSt heard very good news. Let all the small muscles around
your eyes relax and let your lower jaw hang loosely from your upper
Jaw- Smooth Out all the wrinkles in your forehead and let your face
grow smooth, calm, and free of expression.
Take a deep breath io, and let it Out with a slow sigh, Feel your whole
body relaxed and at peace.
The full Relaxation
Sa)'tng to yourself or be' Id "J
'II 109 to to _ USt relax" is usually [he very phrase
t at WI make you tense C d
- . ontracung an {hen releasing muscles using
t e progressive relaxa . d
h [Jon JUst cscrlbed is one helpful method to
ac leve muscular release An h h ' , I
. . or cr tee nlque IS to use specific menta
Images Or relaxation This IS c II d I"
relaxat ' h h" a e Vlsua IZatlon, guided relaxation, or
Ion ( roug Imagery Th' h'
cation heal d . IS tee mque is used for behavior modifi
,lOg, an Stress reduction through biofeedback. The prcmise
Preparalion for Birth
IS that the mind and body are Integrated If
. ' one a feting the other In an
on.gom8 process.
Animals can respond only to a concrete so d
. un or aUlon-to the tone
of a v,Dice, the nnglng of a bell or the rewa d r L
. ,r a a pat on (lie head or
food the dish. however. can respond to the abstract as we\!, The
merC Idea of somethIng can create a physical rcspon I '
. _ se_ magtne you are
eating a very sour lemon. Notice how saliva begins to form and how you
can feel .the in the Corners of your mouth. Or say to someone,
"I'm gOlOg to gIve you an injection now," and instantly his breathing
quickens, perspiration increases, and his heart begins to pound.
What visualization does is to use this ability physiologically to respond
to an idea in a positive way. Now dme your eyes and imagine yourself
on a beautiful beach on a warm day. Feel the sand sift through your
fingers , smell the fresh air, and listen to the rhythm of the waves lapping
at the shore. Do you feel how your body responds without your having
to think about "relaxing"?
Practicing this full relaxation is nOt a matter of becoming limp and
going into a "trance." Nor is it a prelude to hypnosis. Rather, it is an
opportunity to focus inwardly and to take the time to let the mind and
body be one. We so often feel one way but act another. do one thing
but think about something totally unrelated. We tc)' to look interested
even if we are bored, feign disinterest while keeptng alert; we fold the
laundry while thinking about what to make for dinner. The time spent
doing the following full relaxation is simply a time to focus your
and to do nothing--except allow yourself to rela.x. You can do thIS
, " If b '. f cable to have the assistance of your
VisualIzation yourse , U{ It S pre e
partner. d h'
Again begin by settling yourself comfortably on.yo
be ,c aIr, or
floor. You can be semireclining with pillows your head, arms.
I f
'd -th pIllows between your
and knees or you can lie on your e t SI e, WI Id I
'. T U and 'our parmer shou a ternate
knees or supporting your top leg. )' 0 , )S k I ,II' and allow time
h h laxation pea s 0\\
guiding each other throug t IS re I' can (ake ten minutes
'enced The re axauoO
for the images to e expert . d' n time and inclination.
f h
more de pen 109 a
or it can take hal an our or, )'our husband as you
, d h re will occur to you or
Images nOt mentlone e _ hem Unspoken images
h Id
t I free (0 IOcorporate ( .
sp,eak. and you s au ee II Th's I:; nne. 10 fa,ct. no, tWO
elax as we . 1
Will come to you as you r .' After each rela..xanon. diSCUSS
, ' II b exactly the samt: -
relaxations WI ever e . 'k d h' ost In the beginOing you
, h ' es I!OU It -e t t: m .
with your partner whtC Imag
. ' d Rt'II,\"lioll Durillg Prt'g,J./"ry
E.\t'nuf ,H' I
. I' cd here. After a few days or weeks both of
1St d'l
can usc ( c.; I drown repertoire, an you WI I be able to
\I h,,'e de\e1ope you
you WI "d d explore your own suggestions,
put thiS hook 3S1 e an .
d b
eath 10 then slowly let It go. Take anorher deep
Take a slow, eep r. .' I
d h
' feel your chest fill with air. Now s owly release
breath in, an [IS time
b h d Ilo
w l'our body to settle down even more comfortably
the reat an a
h bed flo
or underneath you. If you need to change YOur
omote or
" 0 right ahead Often changing the placement of your arms Or
poSiUOn, g . I .
legs will help you to relax even more. Sometimes, even nOises around
you can help }'DU rather than distract you. .
Concentrate your anemian on your breathmg and become aware of
the rhythm of your inhalations and exhalations. Feel the breath deeply
on the inside of your body. You can feel the rising and falling of your
chest as you breathe in and Out, and you can imagine your lungs deep
inside your ribcage inflating and deflating like balloons. Now take an
other deep breath in, and this time as you exhale. see if you can release
all tensions from your body out with the air. Breathe out all the tensions
from your body, and from your mind, with your exhalation .... Let your
legs relax heavily omo the floor or bed, let your head be supported by
the pillows beneath it, and allow your shoulders 10 drop as all your cares
melt away. You might even feel the bed or floor come up to support you
firmly, allowing you to let go even more.
As you breathe, you will feel your chest rising and falling, like the
waves at the ocean. The steady, ongoing rhythm of the inhalation and
exhalation continues without your even having to think about it. It
doesn't maner whether your breathing is slow or fast deep or shallow.
JUst let it be. As you breathe in, you take the you need and
release the carbon dlo ' d d h . d
XI e an at er waste products you don [ nee .
Breathe In what you n d I h .
. . ee '" re ease w at you don'r. Feel [he amaztng
elasllClry of your k d"
. S tn, expan JOg With each breath and then relaxing
back with each exhalation.
DUring pregnancy the h II
r ,ormone (3 ed relaxin causes the muscles and
Igamems of the body to f
be aw f so ten even more than usual, so that you may
are 0 an even greater ft ' b T . f
your body' b'l" eXI I Ity 10 your body right now and 0
s a I Ity to make grc d' .
YOur life As b ater a Justmems than at other times JO
. you reathc you m igh t b ' b
nSing and fall in I '0 egtn to e aware of your abdomen
g a ong With your ch d r d
responds to yo b h' CSt an to leel how your entire bo Y
ur reat mg.
________________ --
If you like, you might prclCnd th bod
at yOur y 15 I k b f
The scams run along the sides of yo bod h I (' a ag 0 sand.
the back of your neck, down yOur Y
, t C SO hies of your feet, In
. h ,an anyw ere else you would
like to put t em. But these seams are 0 1 I I
h I
n y OOse y sewn, and each tIme
you ex a e, sand escapes Out through these d h"
. . I seams, an eac time you
Iflhale, air rep aces the sand that you've lost E h I h
... . x a e OUt t e sand, and
It with the air you Inhale, until all the sand is gone, and your body
feels and full of air. [Pause to allow time for this image to be
Imagine yourself in a favorite place. It can be the beach on a Caribbean
island, a raft in a swimmmg pool with a cool drink in your hand. a warm
bubble bath, a walk in a pine forest, or a cozy room with a fireplace on
a cold wimer's day. Smell the smells of your surroundings and hear the
sounds. If you are at the seashore, you might hear the sound of the waves
and the cries of the seagulls. You might feel the warmth of the sun and
the coolness of the breeze and the texture of the sand sifting between
your fingers. Perhaps you will smile as you enJoy the calm and peace of
this place in your mind.
Now let JUSt a color remain. It may be the blue of the sky, the
whiteness of the sand, or perhaps no color at alL Allow the color to
become the color of a very deep and plush carpet. Imagine yourself at
the very tOp of a long staircase. As }IOU walk down the stairs, you find
that the carpet becomes deeper and softer. Step down to the first step
and feel how yielding it is beneath your fecL Perhaps you are barefoot
or perhaps you are wearing a pair of slippers. Now take your second
step. and a third step. and at each step down the you can feel
yourself becoming even more deeply relaxed. Conunue down me statr-
d h bo
ttom you are morc relaxed than you have
case, an now at t every
ever been before. .
The relaxation is almost over now, b\H know at any orne
can return to this feeling of veql deep calm. By closlfig an
. rna es of the past lew mmutes,
letting your thoughts wander to tel g I d
. r I' f taJ relaxation. Takc a s ow an
you can return to thiS Ice 109 0 to fl bed beneath
If to feel .he oor or
deep breath in and alow )'ourse d Take another
f h room arOun you.
you, and to become aware 0 t e arms and legs, along
I h
)' return to your
deep breath and fee teener dId On this last breath,
. f b . freshed an re axe .
with a fecltng 0 clng re r thoughts to the here
n and return you
slowly allow your eyes ro ope s and very slowly come up to the
and now. Stretch your arms and leg,
sitting position.
. d R [I\'aliotl During Pregntw(l'
E.n> reue ,Ol e j
The Neuromuscular Relaxarion
_ _ . laxation introduced l'OU to the feeling of muscular
The progressn e rC d h .
. I' (on relaxation deepenc t esc sensations and ideo.
release; [he \ ISU3 Iza I '..
_ be f ental images to help you. ThIS thICd technIque takes
uhed a num cO m .
. one step further teaching you how purposefully to tense
the re axauon '.
one body part while consciously relaxing the reS! of your body. Because
the uterus will be contracring durmg labor wh.tle you tr: to mainrain
rour mental and muscular relaxation, this most relates
to the skills you will need once labor beginS. It IS one thing to be able
to relax while comforrably settled in bed thinking about warm beaches
and cool breezes. It's another to maintain the relaxation while part of you
IS In pam.
Normally, pain is a message from your body to do something-re_
move your hand from the flame, take out the splinter, or fix a tooth.
Ordmarily it is a srimulus telling us something is wrong. We tense OUf
body insW1tly in preparation for aCtion-a necessary and healthy re-
sponse. Pain in labor, however, is an exception, the one rime when pain
is nOt a signal of distress and when muscular tension is an unhelpful
response rather than a helpful one. If you contract your whole body each
time a uterine contraction occurs, you will exhaust yourself after only a
very short lime. Only by letting the uterus work freely and actively by
IIself will you be able to free the cervix to open while at the same time
conserving energy throughout the rest of your body.
The neuromuscular exercise is not exactly comparable to childbirth,
for your parmer will nOt be asking you to tense your arms or legs during
Bur it is valuable preparation nonetheless because you are condi
{Ion 109 yourself to relax your body in response to a muscular conrraction
or a leg now, the uterus later), In this exercise, your partner will
as you to COntract an arm or leg and you will tighten that limb and relax
Ihe reS! of your bod h . II
y at t e same time, He will check your avera
relaxation before telling you to release the tensed limb, and he will
stroke It, a tactile aid to el . Y . I
r axatlon. au Will learn to isolate and contra
separate muscle groups so h d . '1
h h t at unng labor one group can work whl e
t e ot ers reS!. You will al b d '" f II
. so e con 1!I0nlOg yourself to let go 0 a
muscu ar tension to the wo d
pa .. r S (Otl/r(l(/ and relax to the sound of your
nner S VOice, and to the I f h '
You will fi d h ee 0 IS stroke on your body.
n t at 10 the beg" . . 1
one bod . IOnlOg It WI I be difficult to only conrrael
y part at a lime You b h' b
will Want to tense I r 109 will stop and your other lim 5
a SO, You Will understand why it is imporlant to
PreparatIOn for Birth
practice now to establish a new response d h .
the previous relaxation willi, aln ow your expencncec; from
. . "e p you.
The best position for practicing is one h' h
. an w IC you arc scmlreclining
Sit In bed or on your couch wilh your lcgs at hip hClght. Prop
behlOd your head and shoulders and underneath yo k N
. ur nees. ever put
a pill ow lOtO the small of your back for supporl I
-It on Y lficreases the
arch, Instead. add a second pillow under your knees.
This exercise really can't be done alone you'll need
, your parmer or
a friend to help you, Have your partner read the following instructions
and respond as best you can. When the exercise IS completed, change
places and have him be the one to try to stay relaxed. Besides being a
helpful skill to know, it may also make him a more sympathetic partner.
1. To begin, relax your body completely. Allow your limbs 10 be heavy,
tOtally relaxed, and easily maOlpulaled. Brealhe deeply and slowly
and focus on a mental image from the full relaxation to help you let
go even more.
Partner: Check each of your wife' s limbs to see that It l5 completely
relaxed. If you pick up her arm at the wrist, it should feel very heavy.
Feel how easily the elbow bends and how you can even swing the arm
gendy and easily in the shoulder socket. If you place Ihe elbow on
the Aoor and let go, her hand should drop to the floor with no
resistance. Now check her other arm, then make sure her legs are
relaxed. Put one hand under her knee and the other under her heeL
Check to see if her leg feels heavy and if YOll can easily bend her knee
(but keep her heel on the floor). Stroke your hand along the IOSlde
and oUlSide of her thigh and help her to relax to your touch.
check her other leg. Use a soOthing tOne of voice. and reass
f h leg Be patlem. t WI
that she need not help you to liter arm ,or . _. late her arms and
take time before she (an trust ),OU to gentl) maOlpu
legs while keeping them rel .. xed.
2, Contract your right arm. _ h "ht arm and hold it straaght
hould slliTen er rig
Partner: our WI e s . d h breathe and give her a
iT h fl Remln er 10
Out, inches 0 t e oar. bod N 'check to make sure her
moment to rela.x the rest of her f hI" fi ad: this difficult. remind he.r
legs and left arm remalO r .,. d h t \-e
)' few people do t IS
.' ) learn an [11
she is only just beglOntng {(
perfectly the first few times.
3. Relax you r right arOl .
_______ - - . I Rt'/,t\-.,tiotl 0111""8 Preg
E:l."t'IY/.\t' ,Wt .
k he
r arm as she relaxes It completely. Make Sure all
Parmer: tre e
tension is gone.
Contract rour left leg. . .
4 \' r "I"e should Rex her foot, coes to the cedmg and
Parmer: au
h mu
scles In her Ihlgh. She should not try to lift her leg off
tigtente .'
h fl
'fake sure her left leg IS completely stiff. Now check
( e OOf or . l'
her nght leg and both arms to see if they are still relaxed, and make
sure she is not holding her breath.
5. Relax )'our left leg.
Partner: Stroke her leg from her thigh all the way down to her toes
and see if you can bend her leg easily at the hip and knee joints. Tell
her what a great job she is doing.
6. Camraer your right arm and right leg.
Parmer: This is more difficult, so give her a moment to figure out
which IS right and which is left and to relax her left arm and leg
completely. Check her right side to see if these are contracted, then
check her left arm and leg to see if these limbs are relaxed.
1 Relax your right arm and leg.
Partner: Stroke first her arm and then her leg and check to see that
she has released all muscular tcnsion.
8. Practice this tension/ release exercise with bOth arms contracted, then
with hmh legs; with the right arm and leg contracted, and [hen with
the left arm and leg tensed. For the gteatest degree of difficulty, have
her contract opposite arms and legs. Finish each practice session with
a cleansing breath and with her whole body completely relaxed.
Easy way to release
tension from body and
learn 10 tell when
muscles are tense or
relaxed. During labor,
relaxing between
COntracuons allows the
body to replenish and
SUStatn itself
Tense and release each
part of your body, one
section at a time,
starting with your toes
and ending with the
muscles of your head
and neck.
Verbal instructions and
image suggestions.
Reminders to keep
breathing slowly and
PreparaJi01l for Birth
Dccpc:r level of
relaxation through
Imagery; allows for
g reater creativity and
visualization. During
labor, this technique
will promote relaxation
and the inward
focusing of auention by
means of suggestion
and imagery.
Learning to keep your
body relaxed even
though one part is 10 a
state of contraction.
During labor, you will
need to keep your
mind and body
(particularly the pelvic
floor) relaxed, even
though the uterus will
be working ha.rd.
a comfflflablc vcrbal exchange of
position and usc memal relaxation
Imagery, such waves, l
a btach a bubhle
bath, a ceflain wlor :-Ir
tcxrure, to promOiC
deeper relaxation.
Alternately tense and
release differem limbs
while keeping the rest
of your body relaxed.
Start with an arm or
Verbal instructions and
moking, checking for
full relaxation of limbs.
leg and work up to \
various combinations
(both arms, both legs,
right arm and leg, and \
so on).
. I ReJ.l.\""Jion During p,.egfl""(l
Exerose {ou
The Last
he last month of pregnane h
of feeling f b y IS not t e best-you're swollen and tired
at, lit nm sure yo ' II
rna)' be having difli I I . u re rea y ready to be a mOther. You
cu ty s eepmg because f . .
eg cramps and th a your Size, the baby's actiVIty,
, e conStant need t h ' h
month is when man 0 go to t e bathroom. The Oint
y women lose the d h
nam and when the. Ir goo umOr about being preg-
anXIety about hav h
you're late-and 109 a e.lthy baby reaches a peak,
mOre than 40
many of these feer . percent of first-time mothers arC-
Ings arc Intensified If h . .
. t IS IS your second or third chIld,

you will be worried about th
e enCCI the bab
your family life. new Y IS going to have on
If you haven't already been d .
riven crazy d
people telling you what 10 do ,., 11 unng.your pregnancy by
WI surely ha h
Some will advise you to buy yo . ppen In [ ese final weeks.
ur cnUre layette n 0 h .
you to prepare and freeze lots of . h" ow. t ers wIll insrruct
nouns 109 meal '
cook later. If you are working rna I _ S so you won I have to
, ny peop e will tell yo t d
ately. If you have already smpped at I U 0 s.top Imme 1-
, . ' east onc person will k h
you re gOing back, even though you've 0 I b h as w en
I b
. n y cen Orne three days. ThiS
a so seems to e the most hkely time to h h .
ear orror stones about fifty-
hour labors and emergency cesarean sections.
The last month can be trying but fortunatel II h d h
. . .' y,a t Isen sw en labor
beginS. Be pauent, remind yourself that pregnane d I f
y oes not ast orever
and do :vhat you most. In our opinion, this final month is
perfect time for IgnOring most of that well-intentioned advice and, if you
feel well enough, for you and your husband to have fun-go to the
movies, out to dinner, visit friends, in short, many of the things you
won't be as inclined to do as parents of an mfant.
As we've said before, a good doctor or midwife is essential for a good
birth experience. But if you're exhausted, even the most skillful practi-
tioner can '( help you find the energy to make it through a long labor.
If you go to the hospital worn out from unpacking boxes in your new
apartmem or from completing one more project at work, all your child-
birth preparation will be for naught. You mllS( be as well rested as
possible to maximize your chances of having narural childbinh.
I [ is difficult [Q strike a balance between pregnanc)' and the demands of a
job. How lo ng to work is a favorite topic of self-appointed
experts. Some will warn you not to work beyond )foUr fifth month, while
others will counsel you to stay on (he job until your water breaks.,Y,our
pregnancy may make your co. workers uncomfonable, so then opinIOns
. A d in the words of one of our
are nor always in }lour best Interest. n ..
. b b h . boutto explode. The deCl-
friends "They treat you hke a am (at IS .
, . k between you and )'our doctor
sian about how long to continue war '108 IS
Ifb essured by anyone else.
or midwife you shouldn't let yourse cpr -' h . I
, .., . h when deCiding ong to
There are lOts of cons1deratlo
S to "e
8 I d ,estimate their
. I 1 ommon y un e
remnin at work. ProfeSSIOns wornel L
The Llfl ,lfollih

l ____
. I d'ilicult time emotionally. There, a good deal of soul-search_
.. It s an ex(reme), I
"I did a 1m of nesnng-gerting everything cleaned and organized in the apart
"There's greater anxiety about the pain of labor now, but I feel my mind is open.
I can't wait for the arrival of the baby."
"!t's been the best month of all because I've learned so much, feel the best I've
felt smce the pregnanC)' began, and finally feel comfortable and knowledgeable
about my pregnancy. Everything is in place at home, and we are looking forward
to the baby."
"The whole process of being pregnant seems to be one of physical and emotional
realization that there really is a baby in there. And in the last month I find myself
I . ,
earnmg that I must focus on the baby as a separate being who will no longer be
a pan of me."
"Even though I've only be . h I h
. en In t e asr mom of pregnancy for two days, it seems
ilk. the longest mOnth."
"For the first time I Started feeling uncomfortable and bulky,"

140 Prep((I(lliou for Bi,.th

_, ;JIi::',."

TilE LA" M
"The nimh month becomes a COnten of patience. No more sleep, no more peace.
It's such a countdown, but you're really ready"
.. As they say, the ninth month is a trimester unto itself. Hungrier, heavier, slower
than I ever imagined myself to be. All my funny symptoms showed up-swollen
feet, tingling hands, quirky appetite and fatigue. The afternoon nap became a
"I'm looking forward to the birth while at the same time fearing iL Anxious about
the baby's health, and so forth, and need lots of support."

need for some time off before giving birth. The transiti?n
hood can be more difficult for these women, because 10 a. lUon to
adjusting to [he baby, they must also
We think you should plan to leave war adt prepare yourself and your
hat you can rest an
before your due ate so [ I . possible at least consider
If h' 's absolute y 1m ,
home for the baby. t IS 1 phs you could work at home
. . h final " 'eeks. er ap
working part-ume 10 t e da ' or modify your schedule so that
instead of going to your office rush hours.
you don't have to commute dunng 'b (he most important factor
.' h to leave your )0 , - h'
In determtntng w en II d our work IS not ex ausung
should be your health. If you are we an Y ster) you could stay unol
. d d' the last trlme, be he
(every woman is tire unng , I consideration should t
'f ,,'ant A cnUC3 d b dove
your ninth month I you d on a packe uS or
If I U have (Q stan - 'I he
effect of your commute.)O . e this gruehng pace unt! t
houldn' t contl
more than an hour, you s d
very cnd if you don't have to, ' and we should be able to 0
etenr as men
omen are just as comp

Tbt> L,sl ,\tonlb

arc differences between the two sexes and
,> W"lnt but [ t:ft: I
g "t " ot is onc of them. \'Qhen you arc pregnant
pregna . ' ,
b<:108 nIne k' h d and everything IS exaggerated-You'te
bod)' IS war -lOg ar.
. . . mer queasier, heavier. and you worry more. The
I >eplCr hungrier. 't'.ar h d"
s t: .'" ( en experience these c anges. an lt S POintless to
\";lst maJont) 0 worn
, I' egrettable that (he current superwoman movement
den) them, t S r "k '
men feel guilty If they don t wor unttl the firsl
makes pregnant wo
Midwife Elizabeth Davis has observed that women who work until
h )
' deliver almost always have overdue babies, In her book, A GlI/d,
I e f
10.Hldtl'lft'rj', she says, .. An invariable part 0 prepanng or parenting is
to the pregnancy and experiencing it with enjoyment. If a
woman has worked all along, she will take a couple of weeks to get ready
regardless of due date," Women frequently claim they'll be bored if Ihey
don't work until the last minute, but by clinging to their jobs they may
be trytng to avoid the scary and inevitable change to motherhood, Per,
haps yOli feel reluCtant to surrender your work identity, even for a shan
nme, or you may be afraid the office will self-destruct without you, bUI
try to keep your priorities in place, Having a healthy baby should be your
most important task right now.
If You're Not Working Outside Your Home
If you are pregnant with your first child and are at home, you are in an
ideal position to stay rested and fit. Don't leI yourself feel pressured 10
keep busy, Set aside leisure time and take advantage of it, Things will
never be like this again.
If you are not employed but do have other children, you do have a
full-time job; itjust doesn't pay anything, You need to slow down during
this last month, too, but it may be difficult. In some ways it is still more
socially acceptable to say, "I had a hard day at the office, leave me alone,"
Ihan 10 state, ''I'm exhausled, I need some time for myself," You deserve
special consideration even if you aren't bringing home a paycheck. You
are tared, you are pregnant, and you need your rest.
This can be a perfect time to do many of the things you won '( have rime
for once your baby is born-reading, shopping, cooking, seeing friends.
1-12 Prepara/iOlljor Bir/h

Right now is the time to choose your child's pediatrician. Although you may be
tired, in a month or so you'll be lugging around a bigger baby. a stroller. and a
bulging diaper bag, and even the smallen outing will seem like an enormous
affair. It's reassuring to begin labor knowing you have already selected your
baby's doctor, and should your infant need special attention after birth, you'll be
able to call on someone you already know and trUSt.
Before (he interview, try to determine what kind of doctor you would like. Is
it someone who will tell you what to do, Or someone who will give you the choices
and let you decide? A doctOr whose only concern is the baby, or someone who
views the family as a unit?
Getting recommendations should be easy. You can stan with your obstetrician
or midwife and then ask your family doctOr, your friends with children, or
Lamaze teacher. The pediatrician does not have to be affiliated with the
where you deliver. Some will extend privileges to your pediatri-
cian to perform the newborn exam. If not, the staff pediatrician will care for your
baby and your doctor can see you and your newborn in. hiS office
suggest you screen prospective pediatricians by to the a ce or an
, f I good Idea of whether you
informal chat. This meeting should give you a air y
can work together, d twelve questions concerning
d we've compose
To help you evaluate t e actOr, d ' e a standard talk to new
.' . e Many actors glv .
different areas of pedlatnc practlc '. d" I' e and office procedures. ThiS
, h'ld 'g feed 109, ISOP 10 , aI
parents regardtng c I rear
.' d ' u a sense of [he doctor's person -
stlons an give yo . . h h
will answer some a your que h can svmpathlZe Wit t e
, h Id be someone W 0 ,
ity, Ideally, your child s doctor s ou b b d who says, in effect, ''I'm here to
" f - for a new a y an
normal anXletLeS a canng
help you,"
, d 'hospital affihnno
. . ood hospital. or else ha\'e
1. \Vhat IS the actor s be lffiliated With a g d ncerns
a doctor . .. F d3"-to- ay co 1
It's very important t at. . h special fJClliUes. or 1 . I
'au with one wit {OlltOIllf<
arrangemems to connect)

Tbe L.tsl ,\lotltb





, PFtlt .-\TRll
1 ,\ N
. he fi but if }'our child becomes seriously ill, you rna)' Want a
J al rna) ne, .
oc ........ _ ' h hospital noted for its pediatric carc.
doCtor affiliated Wit a {OP
. ,
. Is thiS a solo or a group practice. .
The solo pediatrician is becoming extmct. There are mandy ditre;ent group,a.rrange.
metimes l'our baby can see the same ocror lor every VISit, even
however, an so
though it's a group practice.
3. What ace [he office hours? .
See if there are evening or weekend office hours, which are helpful for working parems
and for emergenCIes.
4. \X' ill (be donor make house calls?
5. \X"hat is the fee schedule?
6. How do )'OU like the office?
You'll wan! a location that isn't too far away and that has convenient parking. Check
also to see if }'OU like the atmosphere of the waiung room and of the doctor's office. See
If there are toys and books available and if the waiting room is chi ldproofed.
7. Are special provisions made foe sick children?
Sometimes sick children are segregated in the waiting room or are asked to come in
through a separate entrance A special location or special hours for normal checkups is
8. How are phone calls handled?
Find out If the dOCtor has a special call-m time each day, and if nor, how phone
calls are handled Are there nurses who can answer common questions over the
9. How long do office visits usually last?
You do nOt Want to be whisked in and OUt of the office in five minutes nor see the
doctor for two mmutes and then the nurses for twenty, Nor do you want to for hours
with a small child before se' h d If h . .. d .
. emg t e OCtor. t e wailing room IS generally crowde ,It
could mean that appolfltments are not bemS handled efficiently-although one child with
a medical emergc:ncy can throw off the most careful scheduling.

144 Prepllrlll;otl for Birt/)

p, "
10. What is the doctor's philosophy?

. " ( I \ '"


You will want to be in agreement on such tOpICS as child n .. -aring, breast-feeding, \
dlscipiane, workmg mothers, and the like. Find out the doctor's attitude on scheduled-
versus-demand feedings, when to mtroduce solid foods, and other points you care about.
If you are a vegetarian and your doctor think.s this commutes child abuse, keep looking,
If you want to nurse and the doctor is a mother herself, ask if she breast-fed her baby,
II. Is [he doctor willing to talk about behavioral and social issues as well as medical
Caring for a baby is more than JUSt keeping him healthy, and an experienced dOCtor
should be able to talk with you about the whole context of child rearing.
12_ Are you comforcable with this doctor? _.'
If you can discuss things freely, Ifhe or she really seems to enlo.,' children, If you feel
ase and are not afraid to call the doctor with your Quesuons----even 10 the middle of
M . - ho'c
the night-these are good signs, You need a doctor whose presence IS reassunng, W ")
auitude is not scary or abrasive to you, and whom you can truS[.

Tht' L.ul " olltb

' pl"ined more aboU{ fatigue and were gener.
, n-eatJ lorn "
have an), J5mtA. l. b t this time of their lives.
I' enchuS13StlC a ou, _ r . .
a Y lSS . '"need )'OU to take It easy berore g iVing birth
l( we still haven t con\ I , . '
. doing IhlS for Ihe good of your chdd . The lasl
. Jer chat rOll are .' .
COnsl f . is the time babies gaUl most of {helf weight, and
rnmeS(Cf 0 pregnanq d .
. I h have the energy to prepare an enJOY meals. Even
i(s essenn3 [ at )'OU . "
. h b d nlakes you a beauliful dlOner, you re nO! gOlOg to reel
I( rour us an
like eating it if )'ou're exhausted.
During [he ninth month, you'll probably hear some jokes about the
nesring syndrome, which is rhe preparation couples make to prepare
Iheir home (neSt) for Ihe baby. This is a basic, praclical urge, bUI il can
be carried to comic extremes. Men and women usually express this
instinct differently and with varying intensity. Your husband, for exam-
ple, rna)' finally get around 10 building Ihose bookshelves in the den,
"'hile )'OU may become preoccupied wilh Ihe neamess of your hall closet.
Of len IhlS behavior peaks juSt prior 10 labor wilh a sudden desire 10
scrub Ihe bathroom Ii Ie or buy OUI Ihe baby department.
Whatever srrange ideas you have about cleanliness and order, keep in
mind two things: (a) Babies don't know or care if their room is ready
or nOl; and (b) your number-one priority righl now should be 10 Stay
well reSted and ready for labor. There's no point in sanding woodwork
jf that means you'll be too tired to practice your Lamaze techniques or
that you could possibly go into labor desperate for a good nighl's sleep.
Hints for Better Sleeping
One of the biggest complaintS women have in their last month is that
they have great difficulty getting to sleep and remaining in that state.
Anxiety, an inability to gee comfortable, leg cramps, and a frequent need
to Urinate all contribute to somerhing less than a restful night.
There's very lietle you can do about your many nocturnal nips (Q the
bathroom, except to limit the amOUnt you drink in [he late evening, In
Ihe final weeks of pregn h b b' h .
. ancy, tea y s ead engages, putting exrra
pressure on. and creating a need (or more frequent elimina-
tIon. A positive thinker might believe this wakefulness is good prepara-
146 PreparatlQII /01' Birth
ti on for the many night feedings that lie ahead b
Ut most women C mSlder
it simp y annoying.
One di fficult y in waking frequentl y is that you can't always get back
to sleep nght away. For maximum comfort , we suggest arranging pillows
under your stomach and legs to suPPOrt your weight more evenly and
ease {he pull on your back (see drawing). You might use several small
pillows or a regular-s ized bed pillow. The only problem wi lh pillow
propping is that when you turn over, you may be required to wake up
fully JUSt to rearrange the pillows.
Sleep Positions
Tbt' L.ut .\folllb ] ../7
To help you get to sleep, we suggest warm milk or cocoa, Wine If that
\"ou sleepy. a warm bath, or the progressive rela..xarion exerc'
. . Ises
In chapter 6. Tr)' nOI 10 go to bed on a full stomach; you'll sleep be
. .
If rou\'e had a (ew hours to digest dinner. If your back IS hurting Or leg
<ramps are bothersome, do some stretching right before bed or be
, uer
Slill. do an exerCISe routine (see chapter 6) during the day.
Traveling for the Last Time
This final month may be your last opportunity for quite a while to enjoy
a romantic Interlude with your husband or a last-minute family visit. The
advisabilitv of travel depends on how much traveling is involved and
how anxio'us }'OU are about leaving home. It's not worth trekking to the
beach If )'oU will spend ever)' minute waiting to feel the twinge of a
contraction, But the same trip can be relaxing if you know that you'll
have ample rime to rerurn home if labor begins. Perhaps all you need
is the name of a local obstetrician and the rOute [0 the nearest hospital
JUSt 10 case ..
You shouldn't be worried about taking shon trips. Although some
babies are born in cabs, this usually happens to fourth- or fifth-time
mothers. Most women take eight or nine hours to reach the first three
Centimeters of dilation during their first pregnancy. Doctors generally
advise nm traveling If you're past your due date or if there has been any
cervical progress in terms of effacement or dilation. Obviously, it
wouldn't be prudent (ago away if you have a history of premature labor.
are carrying twins, Or have high blood pressure.
If you Want (0 fly anywhere during your ninth momh, you should
check wJ[h your dOCIor Or midwife first . Then call all the airlines that
!ltrvlce your route because their policies vary gready. For example,
one domestic airline alIa s I ' .
w you fO rrave unrestflned until seven days
btfore your due dale h .
, yet anal Cr requires a donor's letter for travel
III the: two weeks of h. . h .
{ e nlnt month-and after that point, you re
not permutc:d on boa d S . I'
r orne air lOes reserve the right to refuse a
pa'isf.:'ngcr whn merdy ap I
d . pears too C osc [0 her due date, At no lime
unng pregnancy $hould A
cabinS. you Y 10 small planes with unpn:ssurized
lot fllTI/) - -
Going anywhcrt by car is obviously a lot simpl"r nd h I
. ... arc no y prt: . .:au
tlon you should fa C IS to get Out and move abo h I
Uf once In l W I e (0 avoid
leg cramps: If you re not driving, you might consider stretching our
full-length In the so that YOU can keep your fect up and change
position more easily.
You should have been wearing your seatbelt all these monrhs. Some
women think they can harm their babies by using the belt, but [his isn't
true. If your car has a lap belt inStead of the more up-to-date shoulder
strap, you should adjust the belt snugly and as far below [he uterine
bulge as possible (sec drawing). Although il may seem odd [0 [lghten
the belt, this will decrease forward mmion and mjury if you are in an
Whether you should continue to drive until the day you deliver
seems to be an open question. Some doctors want women to StOp driV-
ing as the due date approaches, others are so casual about driving (hat
the subject never comes up. Obviously city women have an advantage
here because they can take public transportation. whereas rural women
may have no choice because they can't go anywhere without getting in
a car. A good general rule may be [Q let someone else do the dnvmg
when possible.
lI"e,II';IIg (I Sed/bell
'fbt" L.ul .llollih
Packing Your Lamaze Bag
Your suirc3se will (ontJ.!n whatever l'DU will want for your hospital stay
(see next s(..'C[Jon). Your wmaze bag will hold (he Hems you may need
(or labor You will probabl)' onl)' use one or twO of the things In the ba
but s!Oce rou can never predict which ones they will be, go ahead an
take it all
Books. cards, radio
Objen (or a focal point
LIp gloss
Cornstarch, baby powder, or
Large safet), pins
Food and dnnk for partner
Pillows, small ones and
Freezer or cold pack, hOt-water
Tennis balls or rolling pin
Camera, film
Change and necessary phone
Preparation for Birth
To pass (he time in earl), labor
For concentration and anemicn
Dr)' lips
Refresh face
For effleurage or backrubs
To preserve dignity in hospital
Energy and dry mouth
To assure his continuous
energy and presence
Hospitals never have enough
Cold feet
Back labor
To provide counterpressure for
To help you push in the labor
To remember the happiness
To celebrate
To announce the good news
Packing Your S u i t c ~
Ir 's possible to JUSt walk into (he hospital or birth cemer and deliver your
baby Wlfhout lugging along a suitcase, particularly if your parrnc:r can gc
home later and bring back whatever necessities you lack Most women
are happi er, however, knowing that their own clothes, makeup, and
toothbrush are close at hand. The fOllOwing is a list of items to consider:
Nursing bras, nursing pads
Toothbrush, toOthpaste
Shampoo, conditioner, brush, comb. and any other toilet articles you
might want
Makeup, manicure ku
A few dollars for miscellaneous items
Radio or tape recorder
Travel clock or watch
Scented soap, Other luxuries
Address book, telephone numbers, stationery, announcementS
NOtebook and pen for questions (and answers)
Reading material
Loose clOthes to wear home
An outfit for the baby to wear home
Most women spend less time in their own nightgowns and new hath
robes than they expected because of the risk of bloodstains. Generally
it's easiest to relax in your hospital gown and then add a pretty bathrobe
for visitors.
Hospitals may not provide everything you will need-a local anesthetic
spray, for example, for episiotomy stitches, or self-sticking sanHary nap-
kins if you've had a cesarean. Don't wait for the nurses to offer you things.
since they may never indicate what is available; ask for what ),OU wane.
Sometimes you may have to ask your doctor (Q leave orders for }IOU
Check our local parking lots, eating places. and public transportation
in advance. The less energy you or your partner have to spend on frantic
searches during or afrer deliveql the beuer.
Tbe LIIJI \Ionlb
Be \In the !t.x1h)ut f(1r items of sentimental value that rou can II co eel
such as the daily newspaper, a (I.)pr of your newborn's footprints 0 ' I r YOUr
JD l:lracelcrs Some hospitals have a.fC\utine for taktng pICtures of b b
. a leoS'
If thiS imcr('sr..-. you. hnd out how It works '
Checkups During the Last Month
The type 01 checkup, rou ... .11 be ha\'ing during your las! month of
pregnancy wlil depend on the manner of practice of your dOctor Or
midwife. FirsHlme morhers are generally seen once a week at {his point
and then mjce a week if they go past their due dates. Some doctors
routinely perform internal exams throughout pregnancy. others do them
only in [he final month,
From your examinarions, {he doctor or midwife should be able to
derermme (he position of the baby. If the baby's breech, rhere are certain
measures you may '9.'ant to take (see the section on breech in this chap-
ler). If the babys poStenor, however, there's very little you can do
except hope thai he turns, although Ihe chances of this happening de-
crease as you get nearer to your due dare. It's very likely any cervical
effacement and dilation will be nOted as well as the baby's Station. And
your unne, blood pressure, and weight will be checked as they have
been dunng previous visits.
Now IS the time when many doctOrs and midwives really begin to talk
about labor, addreSSing such lopics as when you should call them, how
to recognize earl}' labor, and when to go to the hospital. These lasr visits
are a good time to clear up any questions you may have about hospital
polaCies or your dOCtOr's particular practice. Often during the final
Lamaze classes important issues can be idemified thar you havenr yet
thQught about or discussed If your parmer hasn't accompanied you to
any office VISItS, you should In"Sl !hal he do so now. You'll both feci
more comfortable dunng labor if he's at least met the doCtor or midwife
B), now, m-ost bab,(:s Will have.: the vertex position (head oown),
but a few apprO)omateiy 3 to 4 per{(:m, are brcech, whllh means {hey
Outhxk:!o, or fect first If your bahy ie;; 10 a hreech pre.:scn
lion wh<:n you Into labor, you'rt: likely to have a cesarean, cspt.'(nlily
J 52 Pnpr.,llf)" ji"r iJlt'lh
if thiS is your first birth. Fifteen years 3g0, breech babies L _tlOety
delivered vaginally. Today 75 percent of all breech l-,al les are delivt-....
by cesarean because of the Increased safety of the operanon. Srudles have
also shown Improved lOrant OUtcome with cesarean delivery
There is no known cause for the vast majomy 01 breeche1. A small
perce mage are. related to ?inhs; a uterus nrctched JUt from
many pregnancies; excessive ammotlc flUid; an abnormal posiunn of ,he
placenta, such as placenta previa; and congenital and utenne abnormali.
es Women who have had a prevIOUs breech birth have an mcreased II .
chance of having one again, although no one is quite sure why.
Types of Breech Presentation
There are three basic variations of the breech position (see illustrations):

Frank bru(h. This IS the most common breech presentation, and u
IS considered the safest [Q deliver vagmally, The baby's legs are
straight up and pressed against his or her cheR
ill{omplflt bruch (also known as single or double footling). In thiS
position one or both of the baby' s legs may drop down IOto the
vagina. This category also includes a baby o;l,'ho comes out knee
Complete bruch. The baby has hIS legs crossed almost wlor fashion.

'- -


.., .. r.
"---.. ., '

fbc' l..tll \fOllth

'k' ot Breech Birth
The ",
' 'a .reatly increased rISk for the haby, The mOrt.lit,
Brt't,(h bin S LJrq . '. . )
. h" \'e rimes higher than for vertex vagmal dellvertes and
nHe IS tour to . . _ I
hrcech babies ha\'e a much InCidence Impair.
,c'-cause It IS posSIble for the baby s body to slip throu8'
menr. IS vc n
an Incompletely dilated cervix, bur not his head. Doctors and midwives
are most (earful of this occurrence, particularly if a woman is having her
nrst child and there is uncertainty about the size of her pelvis.
In hIS excellent book Tb, Preglldlll)' Book for Tod,,)' 's Womall, Dr.
Howard Shapiro describes a doctor's worst fear: "There is no obstetrical
situation which is more frantic and desperately tragic than the inability
to successfully and atraumatically deliver the head of a baby in the breech
position. Time IS crucial in (hese circumstances since a delay of four or
more mmUles is likely {O result in permanent brain damage due to lack
of ox}'gen received by the fetus. At this stage, the point of no return has
been reached, because it is {Oo late to perform a cesarean secrion." If
there IS an}' delay in the after-coming head, most doctors will assist the
deliver}' with Piper forceps, an instrumem that is especially designed for
this purpose.
Breech deliveries also have a greater chance of cord prolapse, a dan.
gerous condition in which the baby's oxygen supply can be compro.
mlSed. A University of Michigan Hospital study found a 5 percent
Incidence of prolapsed cord with complete breech, a 15.7 percent with
double footling, and 14.5 with single footling. There was no incidence
of prolapsed cord in 345 women with frank breech presentations.
Ways [0 Turn a Breech Baby
If )'our baby IS breech, there is a good likelihood he will turn by himself,
which would enable you to avoid a cesarean. There are techniques,
however, to coax the baby IOto the normal vertex position,
EXfl:rnal VerSIOn is one mel hod of lurnlng a breech baby, although It IS
not pt:rformcd or c.:ven recommended by every donor or midwife, Dur-
Ing procedure the baby is externally manipulated IOtO (he normal
VCflcx posiuon, Two doctors who pl:rform th<.:m rouClncly are: Or.
Thoma, Kl:rcnyi, dinic.:al prufessor of obstctrJc.:s al Mount Sinai Medical
Pnpi/rtl/irm Ifn' Hirlb
School on New York and former ch f f
Ie 0 pennatol 'I
MeJical Center; and Dr. Da ' I CI ogy at l'< OUnt Sinal
nle emcnt dtr(:t f
mediCine at Saint Lukc's Roosev _\ H _. or I") maternal fetal
. ,f; t ospltal Ccorn. also 10 New York
and professor of OhSlctClcS and ' . I
g)ncco ug), at Columbia Univer-
Both doc mrs havc had great success w-th I
_ I externa verslon\ for their
own patients as well as for women whose doc d ' .
tors or ml Wives don t do
them. Dr Clement feels the technique gOt a bad n d' h 60
ame urmg t e 19 s
when case reports appeared describing placental and d 'd I
. cor accl ems. n
attempting to perform a version, the location of the placenta was un.
known, and X were the only way to confirm the baby's posItion.
As Dr. It, obstetrics today has become either "straightfor-
ward natural childbirth or cesarean section. There is still something to
be said for the obstetrical maneuvers in between. which can make a big
difference." External version is one such technique. He feels the opti.
mum time to attempt the version is around the thirry.founh week of
pregnancy because the amount of amniotic flUId decreases as pregnancy
progresses. Roughly 20 percent of all babIes are breech at thlrtyfour
weeks, but at forty weeks, only 3 to -\ percent are still in that position
Dr. Kerenyi believes (hat if left alone, most babies will evenrually rum
themselves around and that he is simply giving narure a helping hand.
Dr. Clement likes to do his version a bit later, around the thirty-fifth or
thirty-sixth week, so that in case a problem arises and delivery is war-
ranted, the baby will be more marure. (He's being extremely cautious,
since he has never induced labor or created a placenta problem by
performing a version.)
Versions are done wherever there is an ultrasound machine-either
at the doctOr's office or at a hospital. The sonogram will show the
. . . I d f entl)' the umblltcal cord, It the
preCIse pOSHlon, [he p acenta an requ
d (
C_ ths) a bICornate (double)
sonogram reveals fibrol s ucOign gro" " __-
ced the ante nor (front) \\all ot the
uterus, a very large placenta anacli to ..
h h
e the verslOn will not be pt'r-
uterus or an abnormality wit t e letus.
, ' h L_ 'fe or it wouldn't be hkely to
formed because It would elt er uc: unsa . h b b'
I d (o[thcumetheyare.t e l)
work. If conditlons are favor-.lb e, an moS _ It ThIS mJ\' ieel
. d f an In-uten) somersau .
wtll be firmll' prodde to per orm c" ed and there ,hould
i - -hould never uc us .
uncomfortable. but un ue lorle
nL'ver be pnln. . d' -dwJ) thrllugh the ,pr(lCe-
Of d I
d WIll he on< ml
ten a seeon u [rasoun _ Th f lal heartbeat WIll J.bo
d b b
' C\\' poSlfIOn. e e
lire to aseertalO the a Y s n
The! 1..0/ ,\'o,lIb
1;\"tf,.,J,J! 1 'c' niofl
\ -



Pr('plIrtltifJU !lJr Birth
' '

" ,). . ..
, i

. ,



EXT F. R N 1\ l V E. R S 1 ()
" I knew at thlrtyflve weeks Ihal the baby was b h I h d d
reee, a one some reading
about breeches and therefore I was prepared to d .. h d
ISCUSS a versIOn Wit my ()(tor
when the position. I knew what the risks were, but given my
doctOr 5 I felt fairly comfortable about consenting to the procedure. My
husband went with me to that appointment and he encouraged me to try the
"The whole thing really went off without a hitch. There was no pain, and 1 can't
even say there was any discomfort. Other doctOrs In (he group came in to observe
what was going on, and my doctOr did a run01ng explanation as he turned the
baby. First. he looked at the baby on the ultrasound and then he moved him I
had one Braxton-Hicks contraction, and he Slopped and then brought the picrure
up on the ultrasound again before proceeding.
" It was very reassuring [Q see all of Benjamin's pans on the ultrasound. My
husband is extremely scientific, and this was better than gomg to a movie-he
found it fascinating .
.. After the baby was turned. I felt incredible pressure in the pelvic region
because his head was now in the proper place. For the first twenty-four hours, I
was really nervouS about him turning back and I tried to sleep 10 a semlupnght
positi on. But after a few days, 1 felt confident he was going to remalO vertex, and
he did."

be checked several times. If at any time the uterus startS to contract or
the baby seems to resist, he is simply eased back in(O the original posi-
tion. Approximate ly one-third of aU babies will resume the breech p0-
sition within (he next day or so; the other two-thirds will remalO
If your baby is breech, ask your doc lor or mIdWife about haVing an
external version. If you arC advised against the procedure but WJnt to
pursue it . you can call the ultrasound departme
oi your local h",pH.1
for a rcfeer,,\.
'[lIt' /.1$1 .\lo1l lb

Anllther way CO turn a breech baby before delivery is through exercise
\'<)u ,hould he In a pOsHlon that places the hips higher than the head fo;
fifteen minutes eycrr tWO hours or as often as possible for five days. ihls
can be .1(1 ..-omplished by Il
m8 on the floor on your back with your knees
bent and puning a few pillows under your hips . Or you can get on YOur
hands and knees ~ ' i ( h arms bent on rhe Roor and your hips 10 the air.
You can also use a rilted board or Ifoning board to get rhe same eft eet.
Although rhls can be a bit tedious, it seems to work and it's definitely
worth tTying.
Feelings of fear and anxiety are common during the last month of preg
nancy, and there is a belief among obstetricians and holistic practitioners
alike that this tcnsion can afi'en rhe baby's presentation. Acrively work
ing through these fears and/or simply experiencing tmal muscular relax
alion is another method to try to turn your infant.
Dr. Neil Nathan of the University of Minnesota School of Medicine
reported in the professional journal Ob. GYIl. NeulJ that he used relaxation
techniques for thirryfour women, all past thirryseven weeks gestation
and all with babies in the breech position. Studies indicate that only
about 5 percent of breech babies will usually turn past the thirty-sixth
week, but his success rate was 40 percent.
Dr. Lewis Mehl, a practilioner with the Holistic Psychotherapy and
Medical Group in Berkeley, California, has been using relaxation tech-
niques for rurning breech presentations since 1977. He sees about tWO
women each mooch and his success rate is roughly 90 percent. He takes
an interdisciplinary approach, using one or more techniques. including
visualization, biofeedback, hypnosis, and individual counseling.
There's also no harm 10 trying a remedy for rurning breech babies used
by practitioners of shiatsu, Japanese pressure.poim massage. First, you
must locate a POint known as Spleen 116 (see drawing), which is on the
Inside of the leg In the depression behind the shinbone, just above the
knob of the ankle. Then, place a small ball bearing or grain of brown
nce over this point and hold it in place with clear plastic tape. You can
change the tape whenever necessary. If (his doesn't work, you can exeC(
some hard pressure to the point, but only when you are a week or sO
158 Preparation for Birlb
"'- .o--.!...!
Spleell #6
Spleen #6 is localtd
behind the shinbone
and above the ankle.
bone of the tight leg
away from your due dare. It is believed that Spleen #6 IS extremely
sensitive and that. jf manipulated. it can trigger labor.
If the baby doesn't rum head down, you may not need a cesarean if you
meet a certain set of criteria. Most obsretricians evaluate the following
conditions before auempting a vaginal delivery:
:JJf baby'J pOJilioTl. If the bab}' is in the frank breech position. there
IS much less chance of prolapsed cord than if the baby is in (he Olher
twO breech positions.
The mother'; prt'rtollJ bErlh t'xpm"t'f/.ce. If the woman has given birth
before. her pelvis is known to be adequate in size.
The baby'1 tl'fjghl. Breech presenra(ion is most common among pre
mature babies, but vaginal delivery is considered unsafe for babies
under five and a half pounds because tiny infants are less able to
compensate for minor injuries. A large breech bab)', avec eight
pounds, is more difficult (Q deliver vaginally.
The baby'j dtlf dale. The baby's estimated age should be berween
thirty.six and forty-twO weeks.
Tht' b(lh), 'j (omhUof/. There can be no evidence of fetal dis(ccss ..
The progrt>I1 of '(Ibor A normal labor is imporrant, Stflce PltOO
should not be used.
The /..1,1 .l"lolllh I' 9
t TN ,/fI/lflY' t\'/,fl"lfll({ Today most young have neVer ('ven
;1 breech bJrth and wouldn't consider a vaginal delivery.
Emlr(iIIll b,l(t"P. You will need an operating room available
_ . Incase
a (t:'sarcan IS necessaq'
As an additional precaution, some obstetricians recommend haVing a
flat.plate X rJy taken. ThIS would show the position of the babys head
if the chin is lifted (military position), the cord could be wrapped around
[he baby"s neck. In this instance, normal delivery would be unsafe.
As we satd at the beginning of this chapter, there is an excellent possibil.
ity that if this is your first pregnancy, the baby will be late. More than
40 percent of all first babies arrive after their due dates, and only about
5 percent of all babIes are born on the day they are expected. Being late
should never be considered a medical emergency, unless there is a
sudden decrease in feral movement. Your due date is merely an estimate,
and having a baby on time actually means he can arrive anytime within
a twent}'-eight-day range-that is, two weeks before and two weeks after
}'our due date. (Your doctor may refer to your due date as your EDC,
meaning estimated date of confinement. but we prefer EDD. or es-
timated date of delivery).
Also try to keep in mind that the calculation of your due date is subjecI
to error because doctors use a standard approach that doesn't account for
indl\'ldual variations. Your due date is figured by taking the first day of
your last menstrual period, couming back three months. and then adding
seven days. ThIS method is precise if you satisfy three standards: (a) you
know exactly when your last period began; (b) you ovulated and con.
celved two weeks later, and (c) you have a twenty.eight.day cycle. Obvi.
ousl}" there are not many women who can meet all three criteria, and
therefore there are nm d
many pregnanCIes that can have an exact ue
date. Most couples cling to their due date because it's neat and tidy and
makes schedultng eas"e B b b" "
, .. I r. Ut a Jes arnve when it's right for them, not
IOU, and thIS tnablltty to pi b b
hood. an IS pro a Iy good preparation for parenr-
Although you shOUldn't b I
11 e OVer y concerned about your due date you
WI Want YOur calculations b h b ' '
po,sl"bl'. Th ' , a OUt t e aby s arrival to be as accurarc as
. .., IS preCISIOn . I b
IS Cfltlca ecause some dOCtors talk of induction
Preparation for Birth
as soon as your due date has passed You C(,Hamly don't Want 10 set
yourself up for an Induction by givlOg your dO(tor Incorrect mformatlon .
Unless you've had a sonogram between your eighth and twelfth week
of pregnancy I H'S very difficult to figure your baby's age Sono-
grams performed between the eighth and twelfth week an accuracy
range of plus or mmus five days. Between twelve and Sixteen weeks,
clear readings are difficult to Obtain because of the curled position of the
ferus. Between twentysix and thirty-two weeks, the accuracy range is
plus or minus elev.en days. After that point, the test is not useful for
determining gestational age.
Induction should be considered only if [he baby IS [ I
.' . . ru y postmarure, not
Jusr a little late. A. baby 10 elliS condition cannOt remain in the womb any
longer, because hIS food and oxygen supply is belOg compromised by an
aging The placenta is considered (Q be a timed organ, and at
approximately forty-two weeks it can begin to atrophy, causmg a post-
term baby co lose weight or suffer distress during labor. A poscmarure
baby appears wizened, skinny, and dry-skinned. This condition IS rela-
tively uncommon, however, occurring in less than 5 percent of all preg-
Many doctors are quick (Q induce as soon as a pregnancy reaches
forty-twO weeks. This is because studies have found postmarunry {Q be
a leading cause of death among babies born {Q first-time mothers, This
fear may be easing today, however, because sophisticated testing permits
the babys health to be more accurately gauged than 10 ,he past. A 1985
review of literature on postmaturity, published in rhE' Journal 0/ Stlru
Midwjftry, states that, "The routine induction carries a greater risk than
a prolonged pregnancy .... The majority of literature stares that the
routine induction of labor at 42 weeks does not improve perinatal out-
comes." Many practitioners believe {hat true postmatumy is r-are and
that what is more commonly seen after forty-twO weeks IS a miscalcula-
tion of the duc date. There are many inductions performed m [he name
ebb 'es delivered who are truly
of postmaturity, but [here are many lewer a I
postmature. .
f 13' ask you to hJve J tew tests
If you arc late, your doctor or ml WI en} .
to check the condidon of the fetal-placental unt[o
Th<, L.I,' \lollih
F(;'1411-. \fOI't'I1I(" I (011111 ing
One simple bur Jccurare test of fetal well-being is fetal -movement COunt
JOg. ACf!\'itr IS usually a sign of health, and (Duming fet al movements
can be a reassuring check on the baby. Normally, babies who are older
than thirty-twO weeks move an average of 282 times a day, although all
{hese motions are not felt by rhe mother. In general, a coum of at least
10 movements in ;1 twelve-hour period would signify that everything is
line with rhe baby. rf at any time there are less than that number of
movements or you deteCt a sudden drop in your baby's level of activity
call your doctor or midwife. I
The NOrlstress Test (NST)
One reliable check on your baby's condition is the nonstress test (N5T),
which monitors the fetal heartbeat in response to the baby's movement .
The NST has largely replaced estriol testing (measuring estrogen levels
10 blood or unne), Formerly thought to be an indicator of placental
well-being. estriol testing is now considered to be inaccurate.
Prior to the N5T, you may be asked to eat or you may be given orange
Juice {Q drink dUring the test in an attempt to increase the baby's blood
sugar and level of activiry. You will be hooked up to a fetal monitor and
Instructed to notify the docror each time you feel the baby move, A good,
reactive pattern is one in which the fetal heartbeat accelerates with move.
ment, mcreasing by fifteenbeatsper.minute for about thirty seconds.
This should occur fWO to three times within a twenty- to thirty.minute pe.
riod. With the NST, a reacrion is good. You will probably be told every-
thing seems fine and to go home. A nonreacrion could mean fetal distress
-or a sleeping baby _ Some obstetricians will ask you to have a nons tress
test as soon as your due date has passed. This practice is questionable
because It inflates medICal COSts and subjects expectamcQuples to unneces-
sary anxiety. We are against the nonstress test being given routinely or
Without reasonable medical cause. If there is a question about your baby's
agc, Or if you are mOre than five days past your due date it can be a use-
ful diagnostic tool. In addition to suspected cases of the non-
test IS recommended if there has been decreased fetal movement, in
hlgh-nsk women with hypertension, diabetes, or a history of stillborns.
Th . Itress Test
If your baby has not d , d .
emonstrate a reactive pattern in response to the
NST, your dOctor will probabl d " (51-)
y want (0 a an Immediate stress test ,
PreparatiQII lor Bi,-,h
also known as the Contract ion St
, . ress tCst (CST D
rhe baby !:i response to uterIne Cant . ' ). uring [his procedure
ractlons IS d '
an ,"(ravenous thai WIll feed yo P" reU)r cd. Y()u may have
u ItOCIn or Y II
late your nipples . Because comraer ' ou WI ut: asked to SOrnu
Ions can be Stirn I d b
cin or mpple stimulation, the test' k u ate y either Puo
IS now nOwn as
(est. Again, you'll be attached to a f I a COntraClion stress
. I . eta monitor reco d' h b '
heanbcat . r lere IS some Controver b ,r mg t t.' aby s
sy a Out whether a
stress test should be immediately d b nonreactive non
Owe y a stress I
study, Rayburn, Motley, and Zuspan reco d d . test. n a 1982
d h
rnmen e waiting a few hours
an t en repeaung the nonstress test instead f' d' .
. . 0 Imme lately glvmg th
more invaSive procedure. They found th' e
. at approximately two-thirds
of all nonreactive nonstress tests later became I
norma or were followed
by a normal stress test. They suggest that a
. nonreactive panern IS
often caused by a sleeptng baby who will perform II h
' qUite we once e
wakes up.
If you do have to undergo a stress test, your doctor will be watching
for a slowing down of the fetal hean rate dunng contractions. In this
case, a negative reaction-nOthing happens to the heart r3te during a
contraction-is good news. If deceleration pauerns appear, it could
mean that the placenta is aging or that there is a problem with the
position of the umbilical cord. If the fetal hean pattern IS alarming, your
doctor may want to take emergency measures. If you are receiving
Pimcin for the ST, the obstetrician may increase the dosage [Q Induce
labor. In extreme cases, an immediate cesarean would be performed.
If you have a stress test and the results are negative-that IS, all seems
well-be reassured and then get up and go home. Don't let yourself be
talked intO an induction. It may seem very convenient to just stay in the
hospital and let your doctor begin or continue the pitOcin until labor
really gets going. It may also seem particularly tempting if your favorite
doctor in the group has performed the stress test and be on caU (hat
. , . I . d f c_ pregnant You must remem
weekend, or If you re Simp)' tlfe 0 UC'lfig ._
. ' 0 intervention in an other
ber, however I that induction represents a mal r ,
. d I bo be difficult (see chapter 8)
\VIse normal pregnancy. Induce a rs can
tuml childbirth.
and greatly decrease your c ances or na <
Tenth Month
Most fi .
, rst-tlme mOthers get preu)' anxious once their due J3te has
passed . A t ,hIS point, )'ou're probably falrl), uncomforlJbk and )'ou're
'[h, Lotst lIolltb
.\' (0 be over. You're also probably very
. I' pregnanl _
ready klr t m en . 'e been lugging around tor OIne months
"t the person you \, .
eager to nll:t' status increase datiy, and H seems each time
Th> ph,)ne "lis about )'our h "Y'.
C h _ r U bump into someone w a says, au re sull
leave rour a
'" .
here. done about this situation and consequentl)1 not
It ... very easy to get un
. II ., (he unexpec(ed freedom. Women who are at
sleep verr we or enJO} . . .
. , I a ' e are bound to be upset because thiS waiting
home on mate rOlf) e' . .
od . n(o the (ime (he), WIll have la(er on w((h (he baby. It
perl IS cutting 1
h d use
'our da\'s construcrively because the longer you go past
is ar to . "
d d the
more frequently you will be havmg exammanons and
your ue ate,
nons tress tests. It seems that all you do is answer the phone and go for
You rna)' not be feeling (00 well physically ei(her, because you're so
ke),ed up about experiencing the firs< signs of labor. Any new symptoms,
whether It be a sruffed nose or a mild headache, are embellished in your
mind with (he hope that they'll really turn infO some(hing. You may be
feeling fille, but you'll mope around in a sorr of vague malaise, hoping
for something to materialize.
The beSt advice we can give you is to relax and try {Q get in tOuch
with how you really feel abou( having this baby. Midwife Elizabeth
Davis believes that "normal healthy women will, nine rimes out of ten,
have their physical factors in readiness at term unless psychology has
created chronic tension or inhibition." She has described some typical
Slruations that contribute to going past the due dare and beyond: (a) a
woman whos having her las( baby and is (horoughly nOSfalgic about it;
(b) a woman who is having her first baby and is frigh(ened of (he
responsibilities of parenting; (c) bOth parents being uncertain aboUl
their changing roles and this vacillarion prolonging (he pregnancy; and
(d) a woman who has felt obligared or mherwise compelled (0 work
right up to her due date and now may be taking some time to savor the
Becomlllg a mother for the firs< time can be a bold and frigh(ening
step. You'll begivlllg I ff d . .
, up a Ot 0 ree om 10 exchange for great responsl-
blh(y. If you're past yo d d d f .
ur ue ate an alrly anxious, you may want to
talk to friends who've h d hld
" a c I ren or your Lamaze teacher about your
feehngs. Sharing your a , h . . h
. nXlcty ran tUft, and you may gain some lnslg t
IntO your situauon To I h d
. re ax, cry ( e vlsualizacions in chapter 6 and 0
somee lOS you enjoy III I c
your as( lew days as a free agenr.
164 Preparalirm jor Hirlb
" who has been ten months pregnanr-or even a few days late-
Anyo c
'II forgi ve you for wondering if there iCjn't some way [(I gel thlOgs
WI ng Following is a list of natural alternatives that mlghr help trigger
movi .
C(lJ/(Ir oJ!. This is an old trick d
use to IOducc labo -, .
membranes have already ruptu d I r, espeoaliv It ,he
works, though no one kno re
t may taste awful, but It usually
ws exact y why Take w hi
castor oil o rally. followed by one tabl . h t 0 ta espoons of
.11 k espoon alf an hour later It
WI rna e you go to the bathroom so k
f fl
d rna e sure you dnnk pleney
o UI S so you don't get dehydrated.
Lot'emakmg. Ina May Gaskin the amh fS I
.. or 0 pmllla .HJdu ifiry IS a
great believer In erotic activit" as a means f d . I bo ..
. . 'J 0 In uemg a r
NIpple JIWIIlI"IIO',. This method can be used to su I . mu ate contractions
for a stress test, an induction, or dunng labor. It's common knowl-
that. breast-feeding causes the uterus w contract; nipple sumu-
latlon pnor to or during labor is simply an application of this
Dr. Benjamin Chayen, assistant professor of the DiviSion of Fetal
Maternal Medicine at the Thomas Jefferson Medical College in
Philadelphia, has conducted a great dea1 of research on nipple sumu
lation and has used it successfully in many different instances. H(:
presented some of his resul[5 at the ASPO/Lamaze annual confer-
ence in October 1985, and we spoke to him abom his work. One
of his most ioreresting findings is that nipple massage aCtivates the
production of the hormone prolactin, not oxytocin (as commonly
believed), to create uterine contractions.
In onc particular study. sixtyrwo high risk women were induced.
rhircy with electric breast pumps and thierytwo wnh Pltoon.
stimulation was as successful as Pitocin for induclOg labor and 10 lact
tOok much less time to esmblish strong, regularcomracrio
, (hereby
. f I bo A other difference was the
shorcemng the earlr phase 0 a r. n
. h . 43 ' percent of the women
cesarean-section rate 01 t e tWO groupS, .
. d h P' . were delivered bv cesare-J.n
whose labors were Induce Wit nOCin '.
. ) while only 26.6 percent 01
sec non (mosdy for failure to progress, . D Ch
. ., birth surglCall)'. r. ayen
the nipple-stimulation group gJ\e. - .. narurJ.i
. ffecll
because It IS J.
speculate5 rha.t prolac.tin IS more e 'fi I a' tl induce
... II), aru ClJ \\} L
hormone, while PiwCIO IS a tOta . h' _, mduce labor by
. . . ners claim t C) Lan
SbltllJfl IflllHlIgt Shiatsu praCUtlO
1'hr' LJJI "ollrh
prc..'SSlOg Splel'n #<1, il special point Just ahove the anklebone (
. _ sec [ne
Illustration l1n page 159). Even If your labor IS Induced wuh P'
. Ilonn
pressing on thiS point mar help establish a regular pattcrn of '
\\'e do not want you [Q have a medically induced labor if it IS nOt
essential. We believe that tOO many inducrions are performed, but this
phenomenon IS not created solel\' by a small group of trigger-happy
obstetricians. It's a complex medical problem, fueled by women puuing
tremendous pressure on their doctors to "do something" once a due date
has come and gone. It's also encouraged by doctors protecting them.
selves (rom litigation by ordering unnecessary tests, which should be
reassuring but often only further increase a mother's anxiety.
Being late is the one issue that really tests both a doctor's and a
mother's confidence In the natural scheme of things. This last month may
be one of the longest In your life. but there's no reason to try to hurry
things along without good cause. The more patient you are and (he more
you truSt in [he narural workings of your body. the better chance you
have of enjo),ing a healthy baby and an uncomplicated birth.
PreparaliOIJ for Birlh
Labor Begins
E ady labor is exciting and scar)'. It"s thrilling because you-'< walled
so long (Q see your baby. and that moment is now close at hand
As you feel labor beginning. )IOU arC filled with a sense of wonder about
YOur body, which is performing in a neW and powerful way But earl'
LJbor BegillJ

-.--........ r


'This is \X1hy dido '( 1 rest more and eat more before (his started? 1 had cleaned
the enore house and gone to bed one hour before labor started. 1 went to the
hospital and had ro he Rat on my back for the fetal moniror ro work. Thought
I was near delivery-but was only twO centimeters dilated! Progressed very
slowly until the)' let me sit up."
'"The only surpnses were good ones. I missed out entirely on {he first phase of
labor MI' doctor had said, 'Call me when the pains are five minutes apart,' but
they were never five minutes apart They sraned between twO and four minutes
apart, and that was tt. 1 kept thinking [hat at any time they would get further apart
so 1 could call my doctor' 1 got to the hospital at noon and delivered at 3:30 P.M."
"In the beginnmgI had contracuons that were very erratic. There would be a span
of twenty minutes and then rwo comracuons next to each other. Since my contrac-
tions weren't regular, we assumed it was false labor. h wasn't."
"I was scared and nervous, but very excited and happy. 1 felt my first labor pains
low In my pelvis. 1 talked and joked during contractions."
'The beglOOIng phase was extremely mild. In fact, I thought 1 was suffering from
mdigestion umil my water broke"
' Woke up at 3:00 A.M. wtth doarrhea and happily discovered 1 was in labor.
Contractions slowly gOt and closer together. J was comfortable, had
breakfau and lunch, even went shoPPing."

PreptlrtlllfJll !lJr Birth

"} don 't know what I was chinking, but I was totally surprised! Mr first contrac-
tions were mild, close together, and very irregular. I stayed up all nIght timing
contractions and wondering whcrher I should call the doctor or not.'
"Had no idea the comra([ions could be so painful so early. knowing they're only
to get worse. Back lahor was already starting."
"I was awakened at 6:30 A.M. by the rupture of my membranes. I knew thIS was
it. I was very excited and happy that we would have our baby soon. '.
"I had felt crampy all day bur didn't know I was in labot until the doctor, at my
regular clinic visit, told me I was four centimeters dilated: -
.. I had felt crummy all day, so when it started that evening. I thought I was getung
[he flu. I was a month away from my due date and almost positive J{ wasnt ume
for the baby."
"It was just little twinges-no more than a mild stomachache. "
"I had taken castor oil at lunch to hopefully start labot At around 3:00 P.".
had cramps, but I didn't realize I was in Iaborumil my 'show,' around 6:00 P.\1.
"1 had been three centimeters dilated for (wo weeks Labor began Wlm stomach
cramps. \Vitlun tWO nnd J half hours [he contracno
were five minutes J.pJrt

. . . .


Mr water broke at home, and mr pains went immediately (rom ten minutes apart
10 rhree mmures aparr When I gor to rhe hospiral , I had only dilared to rhree
(entimeters; forty-five minutes later, I had dilated to nine centimeters."
"When I lost the muCOUS plug, I announced to my husband that the process had
started Shared gfln, handshake, congratulations, and joint feeling of 'here we
go, not just for the process but for the beginning of parenting."
"The moment when my water broke was remarkable, I'll never forger thar feeling
of inevitability and 'There's no rurning hack now.' "

labor is also frighrening. because you've never felt a contraction before
and you don't know what lies ahead.
How Labor Begins
Sometimes it's only in retrospect that you realize when labor acmally
began. If your Water breaks and you have regular contractions, you ('an
be pretty sure this is the real thing. Btl[ for most women, labor stares as
discomfort an the lower abdomen or as a tightening of the uterus, a
feeling similar to a BraxtOn-Hicks comraction. h can also be heralded
by mild backache or cramps in the upper thighs. All of these signs may
be confused with the common discomforts of late pregnancy, making H
difficult to determine if you really are in labor. It is often only in retro-
spen that you will be able to pinpoim when labor began.
True early labor can start in an erratic manner, but usually a pattern
IS established. As we described 10 chapter 4, your initial contractions may
flO Prepllrllliol1!Qr Birlh
last thlCty to fOrly-five seco. ods and OCc h
ur anyw ere fro n
minutes apart. To determme the correct f m vc 10 Iw.enty
requency of yo
yOU must lime from th.c beginning of on h L._' ur COntractions,
e to t e l.x:glOnlOg of h
For example, contractions are four minut hie nexl.
.' es apart w en you have a .
mlOute contraction and a three-minute rest. one
These first contractions are generally mild d
,an women frequently
compare them to menstrual cramps. As time pas h h .
. ses, t e r ythm will
change, and the cOntractions will become longer s d
tronger, an c1mer
together. When thiS occurs, you will know that labo . call
r IS r y progress-
ing. For a .first an average early labor lasts eight or nine
hours. DUring thiS ume, the cervix will efface completely and dilate to
about three centimeters.
While you're ar home, it's hard to tell what phase you're In and how
quickly your cervix is dilating. Obviously. you can't examine yourself,
but you can get some idea based on the contractions. If they are mild,
ren minutes apan and lasting only thirty seconds, you can be pretty sure
there is not much progress being made. On the other hand, if your
contractions are at least sixty seconds in length, are occurring at least
every five minutes, and are strong enough to require Lamaze breathing,
there will be some effacement or dilation. Of course, there are excep-
tions to this paHern, bur in general progress can be gauged by the
strength, length, and frequency of your contractions.
Variations of Early Labor
The patterns of early labor are more diverse than the patterns that occur
later on. Most lahors begin as we've just described. There are, however
a few comm .. fl .' on vaCleues 0 early abor and they are easll)' recogOl
because they' re so disdncrive. They are
TeleJcopic I(lbor This labor begins with tntense, frequent contr3.ctions
rhat produce full dilation wirhin a hours. It's the kind of labor
that seems eas)' 10 retrospect because it's so short. But telescopiC
labor is ofrcn difficult because even these earl}' contractions require
your urmost concenrr.rion. There'S no chance to warm up to labor
and no idea at the time that it "'ill be over qUICkl)'
Prodromal labor. This technically means false labor, but it c.:an also
mean just a long warm-up phase, perhaps as long as eighreen hours.
ThIS rype of labor can be spenr ar home because disce,mtor! IS mint
mal. Conrr.coo
arC generally mild and Widell' sp.(ed Although
- ------
ldbor 8egl/l
n ..xfn..lm;tl latxlc I.m'l usually painful. its length and oS Can
wear ),OU (,)U[.
SlrIJtI" Idrf, /'lhor. This variation begins with a bang-wirh s,
..... _ rang
five minutes apart-and the contractions remain " tong
and frequem for hours, for the labor is of normal length. For [his
f}'pe of labor, )IOU need stamina because you will be doing a lOt r
brealhing for a long ,ime, It's a tough labor. but like all other
It, tOO. IS hOlte.
Starting the Lamaze Breathing
You should begin the slow chest breathing when your contractions are
strong enough to demand your full anention. You don'l have to start
your breathing if other distractions work. but if the breathing relaxes
you, by all means don't be afraid of starting too early. For some women,
early labor is the hardest part. If you begin with strong contractions or
Wllh .mmediale back labor, the pain can be startling, This migh, happen
rn the m,ddle of the night. and you may feel 'ired. lonely. and unable
to handle what's ahead. Even if your partner is wide awake and support-
ive, it can be hard nm to dwell on [he pain and fantasize about what you'll
do if It gets worse.
Try nO! 10 fall prey '0 these doubts, JuS! allow your body to ,ake over
and work automatically as the contraCtions intensify, If you surrender
and Ie, labor happen. you will find unknown resources for coping, One
axiom to remember is. "Take one contraction at a time." Fantasizing
about future pain will only undermine your present efforts, During each
contraction, concentrate exclusively on your breathing. and when (he
contraction has ended, don't think. just rest.
You will find that Lamaze breathing increases in effecriveness as
labor progresses, ThIS is because. like any,hing else. brea,hing
becomes easier with practice. Also. you get to know your contracrions
and you learn what to anticipate. You become more proficient and
relaxed because breathing becomes an automatic response that doesn't
require thought.
False Labor
- - - II ' k conlC.C- A precursor and component of false labor are Braxton- IC S
. and arc (ions. These arc: commonly referred to as warm-up COntraC[lOnS,
PreparflliOIl for Birth

usually painless. Most women dcsc 'b h
the feeling In your arm when YOur blood a Ilg. [COlng, almmt like
, h pressure IS lak D
contraction, t c utenne muscle bee en. urlng 'he
Qmes very hard B
occur all throughout pregnancy but . can
are mOre Strongl r I
approaches. The terms Braxlon-HlckJ a d (I lye t as the due date
n Ja it abor a e f
changeably, r 0 (en used Inter-
Labor is only considered real if you a h '
, re aVlng Contract" h
duce continual effacement and dilation of th . Ions ( a( pro-
., e cervlx_ You may b h
ing contraC(lons, but If they are not creat' ..fi . e av-
. . Ing slgm cant cervICal ch
you are expenenclng false labor. Approxima( I 2' ange,
' II ' e y ,percent of all
women w, expeClence a bou, of false labo bef
. . r are real early labor
beg,ns, ThIS can be maddening because the con,' k
, ractlons can eep you
awake and you can get tired, but no closer to del' e Th ' IV ry. ere s very
little good about false labor except that the contractions do flex and
strengthen the uterine muscle and they provide an opporrunlCY to prac-
tice your breathing.
We dislike the phrase /alIe labor, since it is a negative term that Implies
the body is somehow inefficient, but it is [he commonly accepted name.
The correct medical term. as we mentioned earler. is prodromal labor
meaning pre- or practice labor.
There are at least twO typical patterns of false labor. One is found
among women whose babies are large but not engaged. They experience
twinges as the baby drops into the pelvis. and these pains can be mistaken
for labor. Usually at this point there is some effacement, but not much
at the cervical opening, The best remedy for this situation is a hot bath
and some relaxation exercises.
Another son of false labor is more like the real (hing because there
are actual comra([ions, which cause some pulling discomfort. These
spasm like contractions tend to be irregular in length, which suggestS that
uterine movement is poorly synchronized. \X'omen with (hiS. type of false
labor should have a stiff drink to try to relax the uterus suffiCIently w swp
the inefficient contractions, d h I h
. ' h f I I borendsan (erea t 109
Its often hard to en a se a _ od
he with real labor [0 pr uce
egins, False labor is of,en lumpe lOge, r . 'h'
. h d "I 10 labor lor t Irt}-Sl\'
the childbirth horror stories we ve all . " "M ' mother was in
hours." "I had contractions for forty-eight hours.. .), Ion" bour of
omen experlcnle a eo
abor for three da}'s:' In most cases, w '1 I bo For cxJ.mple, a
f I I ount of rea a r_ .
a se labor and {hen a norma am ., .<n,),-four hours 1.1t
' 'b k n down Into \
t Ifty-six-hour labor might be ro e
-- --
l,.,bor Begills
. t' "Ions and twelve hours of the real thing. You may t
warm-up uJO r .. t . . IlIn
L _. st' nlluef of semantics because conrrac{tons are comractl'o
(illS IU .. ns
whe[her or not they produce dilation. \VIe know chat, but in defining
false labor, we <ire 3uempting co temper some of the mOre harrowing
birth scones )'ou\:e been wid.
False laborean be trUlr annoying. You may leave for the hospital, only
ro be sent home. You may have contraccions for a whole day and then
go to rour doctOr's office to find you haven't even dilated one centime.
ter. You will probably be bored, tired, and quite uncomfortable. The
palO of false labor mal' wear you down and cast doubts on your ability
co have narural childbirth.
The advice we have is (0 rest and then rest some more. Try not to
become dIScouraged; labor will happen. Take hot baths (if your Water
hasn't broken), drink wine, and turn off (he phone. Do your utmost to
nap or sleep through the night. Eat easily digested foods and drink plenty
of Juices and water. Think about how wonderful it will be when it's all
What to Do During Early La h or
You should cali your doctor or midwife when you know you are in labor.
This is a maner of courtesy as well as reassurance. Most docrors and
midwives want to know what's happening and prefer to schedule profes.
sional and personal engagements accordingly. Some women are inclined
to call their doctors as soon as they feel the first contraction. This isn't
necessary, but If you need to touch base, that's fine. If it's the middle of
the night, why nOt let your doctor or midwife get some sleep and call
in {he mornmg? As a general rule, doCtors or midwives want to hear
from you when contractions have been five minutes apart for at least an
hour or ten minutes apart for two hours.
For further reassurance, you might also call your Lamaze teacher. She
can answer your questions and suggest ways to make you more comfona-
ble. If you're feeling scared, she can also jUst talk to you. You shouldn't
feel strange about asking your instructOr for help. Her job isn't limircd
to mSlruction of the Lamaze she is there to offer support to
women 10 labor
If COntractions begin during the day, you may wam to go to the office
for an exa
lO3tion. If you've made even slight progress, you may want
174 Preparation for 8mb
to go w (he hospilal Or binh cent be' .
er, hevin h
comfonable lhere. If you're less tL. f g t at youn be mOre
nan Our cem .
well, and h. ave no special problems w h- k tmeters dilated, ft:ehng
et In yoush Id
The best time to be admiued is when _ ou return hnrne
'l d you are In active I bo .
centimeters 1 ate . Medication is U5U II - h a r, nve to six
. ' a I' Wit held ul I bo
estab\Jshed, so there s no reason to leave h . nu a r IS w.ell
'f orne JUSt to ge - I
Of course, I you are classified as high . kit palO re lef
d d 0
. f1S , ear y labor at ho
e. r If you are experiencing me IS not
. . any unusual symptoms such
as bleed 109 or acute pain, don't hesitate to go t L h - '
o tne ospual If h' -
not {he case, stay home. ' t IS IS
A hospital is no place to be in early labor Ho .
. . me IS more enjoyable
because there you can listen to music watch telev's' d d
, I lon, eat an rink
what you want, and use [he bathroom in privacy Yo I Ik . ucanasot3 on
the phone. any comfortable position, and exercise [mal control
over your environment. Your sense of time will also be different de-
pending on whether you're home or in the hospitaL Three hours
at home feels a lot different from three hours spent in a labor room.
There's nothing inheremly dangerous about spending early labor at
It's an unusual woman whose labor is so short that she barely has
enough time to get to the delivery room. In general, the longer you stay
at home. the more comral you have over your whole labor. If you arnve
at the hospital tOO soon-before labor is clearly established-you may
be sent away. Once you are admitted, your labor will be charted, which
means you have punched a time clock. If your labor fails to progress
satisfactorily, certain measures will be taken. To get labor moving. your
doctor may rupture your membranes or administer Pitocin to strengthen
your contraCtions. You may also be hooked up to a fetal monitOr, which
in turn may hamper your mobility. All of rhese interventions work
against your chances of having namral childbirth.
. . h' s to keep in mmd as you
While at home there are four Important t 109
ReJl. I f you wake up in the middle of the night with some mild
contractions, try to go back to sleep. Even if your water has broken,
\'ou should go back to bed after changing the ,hee
You may sleep
htfuliy, waking up for contractions, bUI you are Slill getting more
rest than if you were reading or ,'arching television. If labor beg.
while you arc at work or lOut of the house, return home and put )'ou
[.,bor Bt'gi1lS
, Th' m )st imponanr thing to do dUring early labor IS fes
kef up c.: l I,
, , I h' 'OU conserve energy for tht.;' hard parr.
tt s [ at )
'. v st keep up your strength. A lOt of people beltev
. arc not able to digest food, but recent research h
",'omen in .luuf as
' t) be untrue You know that gOing all day without ("' .... .J
S 0,,"'0 I IS l' . VV\J
makes }'OU feel weak and It unwise to ap-
proach a rigorous activit)' such as .dllldbirth WHhout no.urlshment.
Ob,.iously we're not recommendlOg that yOll eat an eight-Course
Chinese dinner, but you can eat light foods (hat are easily abo
sorbed, arc low in roughage, do nOt form a ball or e10[ in the
stomach (such as milk or soft bread), and do not rest in the stom.
ach for extended period, of time (such as fats), This would include
toast, honey, plain cookies, applesauce, brOth, and fruit. h's also
.mportant to keep well hydrated, so drink lots of fluids: herbal Or
decaffeinated tea, juices, and water. Even if you don't feel hungry,
you should make yourself eat something. Some women do throw
up during labor, but this is nOt the result of having eaten earlier.
Don't avoid eating juSt because this might happen to you. It's im-
ponant to keep your strength up.
Drmk. This is the one moment during pregnancy when you should
be encouraged to have a stiff drink. If you're experiencing false
labor, alcohol can relax (he uterus and stop contraCtions. Even if
you're nO( having false labor, a drink will help relax you, and that's
good. After months of abstention, you may feel odd about drinking,
but a few ounces of liquor will nOt harm your baby, who is fully
formed and hours from being born. It's preferable to relax with a
dnnk at home instead of with some Demerol at the hospital.
Sboweror batbe. Warm Water is always relaxing, and a shower is often
helpful when laoor gets stalled, (If your membranes have ruptured,
you should not bathe because of the possibility of infection,) A
French surgeon, Michel Odem, has recently been attracting a great
deal of publicity with his birth clinic in Pirhiviers. Dr. Odenr has
found that a bath helps women to become more instinctive and
relaxed, maklOg labor go more smoothly.
'bl attitude Although mmt dOCtors have at last adopted a more eXI e d
about 'prepPlOg" a woman for labor, some still require an enema an
a trtm of the pubic hair. You can do bOth these things while in early labor
. at [he at home, thus avoid 109 any disruption in your conccnrrallon
Preparatlfm lor Diy/h
Many wumen don't need an enema be h
cause t cy expec" J
'lust before or during early labor Othe d ' lence larrhea
. r!) on t Want One be
be a dehumantzing and uncomfortable p oc d I[ can
. r e Ufe under the best pf
circumstances. I you are constipated however . . '
, , Of worned about hav10g
a bowel movement on the delivery table you can b all
uy a sm Of chllds-
sized enema at the drugstore and use it before going to th h . I B
' kIf I' 'd f e ospHa, e
sure to nn otS 0 IqUI sa terward because enemas d h d
. afe e y rating.
As for pubiC shaves, they have proved to be useless IOn p ., f
, revenung 10 ee-
tion, so there s no reason you must have one. Some dOClOfS afe con-
cerned, however, about hair becoming caught 10 the stttches of an
episiotomy repair. Trimming your pubic half can be done at home,
preferably by your partner,
We know early labor is exciting, but you should nO! call your fam,ly
and friends to announce it has begun, The difficulty wHh sharing this
newS is that progress reports will then be expected, and this taSk will
distract you and your partner from the job at hand, It's also possible that
you may be experiencing false laoor, and then you'll feel obliged to call
everyone back and apologize for raising their hopes.
As we've mentioned, if your labor is progressing normally, you should
avoid going to the hospital toO early, See chapter 9 for a discussion of
the best time to go.
Women frequently describe back labor as the most difficult part of thelf
birth experiences. Back labor is caused by the baby resting in a posterior
position, which means the back of his head is pressing against your
sacrum (see the illustration on page 1St). \,(iith each contraction, the
baby's hard bone jabs against your hard bone, and you experience J
knifelike pain in the back, True back I.bor is reported to occur on about
25 percent of all birrhs, but the incidence in the responses to our ques-
tionnaire was higher, more like 30 or 40 percent. Some women expen-
eoce intermittent back pain during labor, but it"s nOt the continuoU) ache
of real back labor.
A baby born in a postertO
position emerges looking J( the whng,
Most babies (97 percent), however, are born in an anterior posouo
'h I f' h"oo If )'our bab)' ,ISSumes J
v IC) means [hcy come out acmg tell r.
' . . "k I h 'II n ',round during labor or ,\5
:;:tenor prescomtion, It IS It -e Y e WI mr 4
L.tbor 8 esim


"The pain did not radiate, it dId not throb. it was just There. My husband used
a roller on my back, whICh helped a great deal-as did being on all fours."
"Back labor feels like the baby doesn't have any room and decides to come
through your back."'
. Counterpressure from my husband helped, and the knowledge that I would
either die or deliver evenrually."
"We purrhree tenOls balls In a sock and my husband rubbed those along my lower
central back. No matter how hard he pushed, I wanted the pressure to be harder.
I needed someone on the order of Arnold Schwarzenegger to Jlalld on my back."
"J felt as if my back were being crushed by a truck. Massaging helped."

"Walking was the only thing I could do. I couldn't sit or lie down. I would press
my tailbone against the wall."
'J used a Tupperware roiling pin and filled it with ice to numb (he area."
'It was terrible. I could nOt get comfonable. counterpressure did not help, and
my husband wouldn't let me have an epidural. We really worked on our breath.
mg. and (hat gOt me through It. t.

178 Preparation for Birth

. ~

BAfK L ... flOR
"My entire spinal column ached, and J was nOt aUeued to deal with it. Once I
rufned on my side when no one was watching and was Infinitely more comforta-
ble. As soon as the labor nurse discovered my transgression, she scolded me like
a child and insisted I stay on my back, and in pain.
"Very painful. Almost no position offered comfort, although toward {he end
being on my hands and knees was best."
"Back labor fell as if my lower back were tied in a knoe I realized (hen how
important being able to relax was."
"The only way I was slightly comfortable was simng In a hO[ shower With (he
water hitting my lower back,"
"Elephants could have napped on my back and I wouldn't have felt ,hem at all.
The pressure was extremely intense. When the baby was finally delivered, I was
so relieved about my back that I forgO[ to ask If it was a boy or a glft.,

you push. But until this happens, )IOU will feel a sharp pain In your back
each time the uterus contracts, True back labor rna)' last for an hour or
two or for the entire labor. The pain often radiates around to the front.
making your stomach and back feel like one big sore spot.
The problem with back labor is that you don't have any moments that
are pain-free because you must cope wi,h a backache while recouPIng
from contractions. \'(Iomen who have expenenced back labor say there
are no discreet contractions, lUst greater or lesser degrees of pain In
addition, back labor can mean a longer labor because the baby's heaJ
Llbor BtgillJ

Ion du h1 ('nt('r the pelvis slightly detlexed, causing slow dila,
an asymmetric,\! fit olgolinst the cerVIX, e 10
Coping with Back Labor
Lamaze breathing is not as effective for back labor as it is for normal
labor, bec3use back labor is doubly pamful and therefore (wice as wear_
ing. Back labor has been the undoing of many women who planned on
natura] childbirth. Remember, however, that even if your baby begins
labor in the posterior position, it's veqr likely he will turn around.
Gewng 'hrough back labor ,akes a slightly different approach and a
greater commitment to rela.xation. The ability to relax between COntrac
tlons is cnrical because tension will only exacerbate the back pain. You'll
also be working harder during contractions because there's mOre pain
10 breathe ,hrough, and you1I really need 'he reSt periods.
There are ,hree good ,echniques for pain relief you should 'ry along
with your Lamaze breathing. They are
Hili or (oid Hot means a heating pad or hotwater boule, and cold
is a cold pack. To compare effectiveness, you can start with one and
swilCh to the other. You should also play around with the position-
Ing of the pad or pack, since the pain can shift, making it difficult to
hit luSt the right SPOt. Whether you prefer hot or cold is a mauer
of taste and of climate.
Cb,mgt oj PO.ctllO", The worSt thing you can do for back labor is to
lie Rat on your back. In that position, the entire weight of the baby's
head is pressed against your spine. Instead, any position {hat gets the
baby off your back is good. Try resting on your hands and knees,
standmg, lying on your side, or sitting while leaning forward over
a table or a pile of pillows. You can also experiment with sining on
a hard surface, such as the toilet or a wooden chair--or, in the
hOSpital, a metal tnstrument tray. Anyonc with a bad back will tell
)'OU that a soft surface can be torturc.
COll1l1trprmurt' People instinctively press on somc
8 that hurtS.
If )' OU siub a toc, your first Impulse is to rub it, so It'S no surprise
that you have the same reaction to a shooting pain in your back. To
apply counterpressure, your partner can usc hiS fist, tennis balls, (1
rolhng pin, or a folded-up towel . Don't worry about rubbing as hard
as you need to-II can't hurt the baby, and I( will only feci good.
Prl!plIrllfirnt jor Birth
for 'Ipplying
DUTm8 Baeb Labor


- .-
L "bor Bt'Sim
'fl.-'U have 1O t,."pl'rimcnt 10 find ;\ cnm(lrtablc ,\n<.l t,.'fTcniv" .
. .... amUunt
The Partner's Role
Back labor IS;l situation that can make or break your partner. It's a very
demanding sort of labor because there's a need for constant experimen_
tarion \\!ith breathing panerns and alcernative methods for pain relief.
Orten. as soon as one pOSition or pressure point will work, the pain shifts
and you'll be forced to find a different strategy, Your partner will be
completely ,"volved if you have back labor, working very hard to pro
vide physical suppOrt and a careful balance of encouragement and sym-
There is great disagreement even among obstetricians about what to do
if your water breaks before labor has starred-a condition known as
premature rupture of the membranes, or PROM. The controversy about
treatment centers on the risk of infection to the mother and her baby if
labor and delivery do not take place within a prescribed number of
hours. The dispute also touches on the risk-benefit ratio of many stan-
dard hospital pranices, such as internal exams, Pitocin stimulation of
labor. and fetal monitoring.
Some doctors and midwives believe that if the membranes rupture,
there is very little that should be done except to wait for labor to begin.
Until that happens, good hydration and impeccable standards of hygiene
are essential. This means no oral-genital contao, no tub baths, and drink-
109 lots of liquids to offsec the lost amniotic fluid, which is continually
bemg replenished. It also means periodic temperacure checks to monitor
for possible infection. All of these measures can be performed at home,
and if you are lucky. labor will begm soon-80 percem of all women go
IOto labor withm twenty-four hours of rupture of the membranes.
Ocher doctors, however, believe chat women wich ruptured mem-
branes should be hospHalizcd immedialely and given PitOcin to bring on
contractions. These obstetricians usually set a strict
limit for labor and delivery-that is, your bahy must be born wirhin
twentyfour huurs of your water breaking. If labor docsn', progreSS
PreptlrllliOIl /01' Birth
sufficiently to meet this standard a c
esarean will be f
reason staled for this urgency is a fe f per ormed. The
. ar 0 maternal or r \ f
Some doctOrs will extend deadline f d I' eta In e.;:rlon.
Or e Ivery to fo . h
and may allow you to wait awhile at h _ ny-elg I hour\
. orne, paUtcularly If
breaks dUring {he night. your Water
We believe in treacmg premature rupture of Ih b
, I 'bl Th' e rnem canes as con'ler
vatlve Y as passl e. IS means staying at h '\ '
, d' . orne unu labor IS well
eS[3bhshed an bemg alert for signs of infection If
, ' h . . your water breaks
you should IOSlst t at your doctor give nature a reaso bl h '
na e c ance to take
its course. A recent study has shown that the risk of In' ' f II '
.' leeuon a oWing
PROM lOcreases dramatically after the initial vagl'nal exa' d mlOation an
incrementally after each subsequent exam. This is because the ruptured
membranes have created an open passage into a formerly sterile uterine
environment, and with each check on cervical progress, normal vaginal
bacteria is pushed toward the uterus. Obviously, you will not reive an
internal exam at home, and by remaining there, you minimize the risk
of this kind of infection,
Statistics indicate that cesareans are three times as likely following an
induced labor, compared with a labor that beg,"s normally. If you go to
the hospital after your water breaks but before you experience conuac-
tions, you will be given Pitocin to induce labor If you stay home WHh
PROM and take good precautions, chances are excellent that you will
have a normal natural delivery.
There are three instances, however, when there can be no debate
about going immediately to the hospital with ruptured membranes:
1/ the tlmllio/ir fluid is slai1led lI'ilb brOlt'11 or grfmisb marter, it can mean
fetal distress. The dark material is meconium, me baby's first bowel
, h baby is in imminent danger;
movement. ThiS does not mean t at your .
, d' or he could be ,n a breech
he may have expenenced a temporary IstreSS, .
, , ' I ium because there IS great
position (breech babtes frequent y pass mecon d d
, h b ks) If the ammotlC uUI IS
pressure on their presenting part, t e uttO( .
' b undul}' ...orried because re-
colored with meconium yOU shou n t e .
, b b' - this situation are not compro-
cent studies have shown that most a les In Id " the mecomum,
, h h baby cou aspirate
mised. The fear, however, IS r at t, e . h h nces of respinlIOr)'
, b' h ncreaslng r e c a
Impeding breathing at Irt or If n\ I'Dur dcx:wr or
, . 'd nee 0 mecon
Infecrion. llowever, if [here IS eVI e ,. II ' throughout labor
, , ' h b \by care u )
mld.wlfc will want to mOOltor tel . . J 1'1u should go [0 tht.'
b J nol )t/ (IIgllgf
l d
t If )'0111' li 'l l/t' r brt'tlk' lllllilhe II) I - beouse )'ou coul
, " . can be dangeroUS .
hospital immediately. ThiS st[uatlO
d 'cur you OlU.5t J5Sum
d rolupse oes oc '
experience cord prolapse. I cor P
L.lhor BtgillS
a kncl..'-<:hcst p\)Slfwn with rOUf hips In the air ThiS conultlon nc<.:cSSltates
. t' th" hospital .md an emergenq' cesarean
a rapl trip l '-, ..
It tI't b.lhl /.f ", ,11/ IOIlIJlIdI POJlllOfJ. such as breech or transverse, a
(lrd IS again;] pOSSibility Someumes it's difficult to know if
rOUf membrJnes ha\"c rCJlly ruptured because there may be IUM a trickle
water. It could be urine that is being involuntarily released on accOunt
of the constant pressure of the baby's head on your bladder. If in doubt,
you can call rOUf doctor or midwife and describe your experience or go
to the office and be checked there.
PROM occurs in about 10 percent of all women at term, making it a
common labor variation. This is certainly one topic you'll want to discuss
with your doctor or midwife before your due date so that you'll know
what to do if your water breaks. Usually, membranes will rupture be
tween eight centimeters dilation and the delivery of the baby. If your
membranes rupture and labor doesn'r begin, try stimulating labor con
tractions by using the measures listed on page 165 and/or by walking
around at home, (Do not engage in lovemaking after your water has
broken.) Someumes one of these methods will work and sometimes a
combination will do the tnck. Sometimes nothing will help, but at least
you will have done all you can.
No one knows how many inductions are performed each year in the
United States, because they are done in a variety of ways and for a variety
of reasons. Inductions can be done manually in two ways: by breaking
the amniolic sac with a plascic hook (an amnioromy) or by stripping the
membranes dunng an Internal examination (separating the amniodc sac
from the lower utenne wall, usually done with a fingertip). They can also
done chemically, by administering Pitocin. This drug mimics the
effects of the body's natural hormone, oxytocin.
Of course, your membranes can rupture naturally before labor begins,
but you should never allow your doctor (Q break your water before labor
IS well established If this happens, you become a good candidate for
mduction by Pirocin or for a cesarean, because once {he amnioric sac is
broken, you and the baby are susceptible to Infection. Jf your doclOr
ruptured your membranes prematurely and labor failed to begin, he'd
probably Insist on putting you on Pitocin. Jf that failed to establish labor,
you'd hkdy have a cesarean, euher because you'd conrrac.:tc:d an infec,
tion or chancl.:'s were good that you would.
UN Preparlltio" [or Birth


"I was looking forward lO being Induced-I knew [ha[ by the end of [he day Id
have a baby in my arms. Now thal il has happened, Ilhlnk maybe I should have
gone against the doctOr's orders and let it happen naturally. "
"My water broke and [ never went into labor. After eighteen hours I was induced
with Pitocin. I was tOtally unprepared for labor to beglO with COntraCtIons three
minutes apart, and my contractions were peaking twice. I totally lost control! The
breathing was absolutely useless."
.. After tWO hours on PitOcin I had an epidural. The palOS were tOO much for me.
'" was opposed to it even when I gOt it. However, I was grateful when I sa'Q. my
daughter five hours later."
"[ had an induced labor, and on a sca1e of one to ten, the labor palO for me was
a thirty-six. There was no gradual buildup of contractions, and I never gOt those
' rest periods' they tell you about 10 class. Total labor and dehvery time was thrt:e
hours and forty-five minutes. This is tOO much like a record attempt an a sport at
which I am not well trained."
''!"ve had lWO normal deliveries, so I h3\'e a basIS for comparISon Inducllo
much more paInful. I can'l even begIn [a deSCribe [he paIn. I had back and
smmach labor."

[.I bor Bt>gim
. -- --'

Plwcin indUl.:rion should never performed because you're a few
days latt? or because rou want to deliver on 3 Certain date. In 1977 the
Food .nd Drug AdmlnlS"""on (FDA) recommended Ihal doclors
(rain fr(lm performing eleCtive inductions due to the risks associared
thiS procedure. This action more or less halted rhe practice of timing of
a bab(s birrh with a husband's business trip, an anlllversary, or a doctor's
\acation, although there are some practitioners who will still induce for
these reasons.
The risks of PilOcin induCtion are grealer for the baby than Ihe
mOl her. The), ,nclude:
Rf'JpfrJIM,),dJJlrt'JJ J)'lIdrome. If labor is induced before the baby is
fully developed and his lungs are still immature, respiratory prob.
lems commonly develop. \'(/ithout sophisticated testing, it's impossi-
ble for a doctor to assess the baby's maturity accurately and therefore
know when an induction would be absolutely safe.
Pel.tl diJlrt'JJ durmg /"bor If the dosage of Pitocin is too high, it
produces contractions that las[ toO long and prevent the uterus from
relaxing between them. The result of this overstimulated labor is
(ha[ the baby's oxygen supply can be compromised, causing possible
asphyxia and brain damage.
NtonatJ/joulldiu. The reasons for this are unclear. The incidence of
jaundice IS increased with smaller or premature babies.
Women consistently report (hat contractions produced by Pitocin are
sharper and more painful than natural ones and (herefore harder to
handle. An lOduced labor also starts abruptly, allowing a shorter warm-
up period and less lime 10 gel used to the feel of labor. By the lime
you've gotten the knack of how to breathe and relax with early contrac-
tions, you are headed into acrive labor.
There is no question that the use of Pitocin increases a woman's need
for medicaoon; there are numerous studies which have proved this
relationship. Obviously, an induced labor is to be avoided whenever
possible. There are, however, instances in which induCtions arc justified.
They Include:
If a woman has toxemia, diabetes, hypertension, or kidney disease
If the bab). IS truly postmature
If a positive Contraction st ress [CSt shows fetal heart dcccicrano . ns
If a woman's have been ruptured for more than twenty-
four hours and labor has not yet begun
JR6 Preparatio" for Birlh
If your labor muSt be Induced 1
,youwllgototh h
will be hooked up to an intraveno I .- e ospuaJ where you
us Ine with an h
Your labor must be continuously mo d atta( l'd Pitocln drip.
. . nHore by eith
external fetal monitor (the Internal er an Inlernal or an
. _ IS more common be
accurate) . ThIS IS one instance In wh- h came it is more
IC your dOCtor sho Id be
overseeing your labor, actually spend u. a.ctively
. mg a good deal r
room checkll1g the monitor and regulal d 0 time 111 your
log osage
The dosage you receive should be adm d b
. . 100Stere y an IOfus
calibrated 111 II1crements of miliunits per min I d.ffi 100 pump,
. d f p . . me. t s I cult to state an
Ideal osage 0 ItoCIO because women rea t d a
. c very lIIereody. One
woman may experience good strong contractions with tw 11
. . a mt lunm per
mtnute. whereas another might have no resul
al all . h
..., Wit twenty Your
dOClor will probably star! wilh a small dosage and grad II .
.. . ua y Increase it
by tWO mllhunlts every fifteen minutes until you have re I gu ar COntrac-
tions, roughly three minutes apart.
Whatever amount you are given, you should never experience contin-
uous contractions. This would be caused by too high a dose, and if this
occurs. your doctor should be nOtified immediately. The dnp should be
turned off. If the uterus is unable to relax sufficiently between contrac-
tions, your baby may nOl be able to get the necessary replenishment of
oxygen. Also, an overdose of Pitocin puts you at risk for placental
separation because the uterus is contracting so hard that the placenta can
become detached. \'Qomen who have had several children or previous
uterine surgery also risk uterine rupture if they receive an overdose of
Sometimes an initial dose of PitOcin may be all you need to trigger
your body's own produnion of oxytocin. If labor IS going well, you
should request that the drip be turned off to see if you can maintain the
contraCtions on your own. If this doesn't happen, the Pitocin can be
hooked back up again. .
An induced labor doesn't figure into many women 5 fantasies about
. . . M ! It mil)' not be the
bICth. but under cenaln Circumstances, it IS .
. . d' rill' have to rUin your expert-
easiest way to begin, but It oesn t necessa .. d
. ve you from a cesarean. an
ence. When properly handled." can even sa .
11 h a good blt,h expenence.
that 's no small ching today, You can so a\e
evf f . entS pitOcin,
en lone 0 ItS co.mpon h . SDnle conso
, ("ng bUlt eres
W/e know all of thIS sounds unappea I, h ormall.)nes. Your
II ' shorter t an n
In the faCt (hat induced labors are usua bab)' in J little while.
I b
ou Will see your
a Or may be pren)' intense. ut)
[,Ibor Bt'gim
Active Labor
and Transition
hen you are In active labor, you will know it. Yes, there are some
, 10
women who feel vague pains and then leave fOf the hospital
discover they are eight centimeters dilated, but they are rful y excep-
tional For mos[ women, active labor is powerful, recognizahl e, and
J 88 Preparatioll lor Birth
As we described in chapter 4, actIve labo II
r genera y oc :un between
fouf and seven centimeters of dilation and prod .
uccs f.OnlraCUCIfJ:l that are
stronger, long.er, more frequent, and mort: regular ,h, h
an ( lJ5C ex
e n e nced during early labor For a flrst pregnancy 'he 'v I h
. .. cragf' tngt
of this phase IS three to four hours although " can I'" I ..., a.'i Clng a.'i Icn
hours and sull be considered normal. Contractions are generally one
minute long. With rests of two to three minutes between each one.
Active labor will require your undivided attention, and you'll no
longer be able to walk, talk, or to be distracted through a comractton
Wome n in active labor have a tendency to become inwardly focused and
they are less observant of their surroundings than they were in early
labor. The repeti tive alternation of breathing and relaxing becomes
mesmeri zing, and everything fades as you focus on each contraCtIon.
Relaxation by itself may no longer be enough to help you cope with the
pain. but the combination of conscious relaxation and rhythmic breath-
ing will enable you to ride the wave of each contraction. Suddenly It will
become clear how the Lamaze technique works and why you have been
This is the rime that both you and your partner will begtO thinking about
leaving fo r [he hospital. As we' ve said before, most couples arrive there
too soon rather than tOO late. As long as you are comfortable. stay put
Trust that you will know when you'll want the security of medical
support. If you're perplexed abou, whe,her il"s ,ime, ,,'s probably no'.
If you need a more concre,e guideline, consider gOIng 10 {he hosp"al
when contractions have been abou( four minutes apart for at least an
As we keep "ressing, you should 'f)' 10 remain aI home as long as
you are physically and emotionally comfo

. Il"s really d,scouf"lglOg
'0 ge, ro ,he hospilnl and discover you'
dilaled 10 only ,)ne n,im

'cr. So metimes a laboring woman will feel fine .. home. bu' her p3r1'
ne r WIll be enrcrlniOlng fa",asies .bou' h" ' ing 10 deliver ,he b3by If
'hIS happens 10 you, reassure hIm ,ha' every,hlng's fine and ,,((emp' W
channel ,his nervollS energy inlO some,hlOS conslfUCIIVC. !Ike gOlOg w
"I . I h") lIal t-olrlh r.uht'f IhJ.o i;'lJflh<l.'oter
I" (1\ ' ()f t hl' information 10 t t l l ~ (haple
.\1'1' l e ~ t\l l ~ r
: {r/ll 'f L.,bor ,IIul Tr,UlJitio


"My labor was extreme I}' painful. I felt as if my insides were belOg (Orn our of
." could easily have rwent)' children! I've had worse pain from soccer and gymnas-
tiC mjunes.--
"I tried {Q convince myself that 1 was feeling pressure, and by power of sugges-
tion, I felt a (i{(le more comfonable. "
. I even loved the pain, because I knew if was getting me closer."
"The pain was conSl3.nt, with peaks and valleys but no real break between contrac-
tions. I was wraJiy unprepared for the Intensity of the pain; no thing I had read
and no one I had talked to had really prepared me for it."
"The pain was nO( outrageous to me. It 's only pain [don ' t understand that I can' t
"Not pam, but severe discomfort. I felt like my uterus was going to pick me up
and throw me OUt mt' wmdow!"
''I'm senSItive to pain, but thNe was no pain lhat I couldn 't bear fo r the lengt h
of time it lasted."

PreplJralifm lor Birth


"The best way for me to descnbe the feeling is no/afton. Your coach, nurse,
doctor can help, bm when you get nght down to it, laoor romethlOg )"ou have
to cope with, No one else can take the pain for a few minutes and give you a
"I t was worse than I expected, but not so bad I wouldn't do It again
"I kept thinking I wanted to freeze this moment as I was feeling Intense,lntense
pain. I was aware of a son of anthropoiogic connection with all women through
history-cenruries and millennia of childbinhing pain."

" I had a very easy, short labor, and me most painful thing was W31ung.
"M y mother always told me that you would forget all the pain when )'OU your
chi ld. Well, I still remember, but I'd do it again in B minute:
"Very painful, but it seemed as if I were in a daze, I could h .. ar everyone around
me and knew they ,,'ere Ihere, bUll wasn' t really aware of them, It feil as if I were
Standing on the outSide of myself, watching everything Ihat was gOing
" I t was very uncomfOrlable, but I never feil like screal1ung the war women do
in movies! I had a positive aniNde, and my husband's presence was terofie. Prayer
helped, tOO,"
. . . . . . . . .
I .,bol" .11/(/ Tr,ltl.fitio


P \ r '"
'I can honesdr sa}' ffi)' labor was not painful. If was wonderful! I enjoyed ever}'
minure of 1[, and as soon as the bab}' was born, I was sorry it was over. My sisters
hared their dell\'enes and they say I'm crazy because I liked mine so much."
'" thought labor was the most painful thing that I've ever been pm through in
m)' life. I rold my husband that being hit b}' a semitrailer would have hure less,
because yOll would at least be unconscious."
"It wasn't painful for me except when ffi}' daughter's head was crowning. I felt
I was being srrelChed more than possible, and it burned."
"I quickly realized J could nm escape the pain and let it come over me, each
conrraction, yielding [Q it and emerging OUt [he Other side. It could nO( be
fought. ..

the Slore Or walking the dog. (One couple we know had a real dis-
agret:mem about when to leave. The husband prevailed because he
headed for the door, saying, "I don't know about you, but I'm going
to the hospital")
Sometimes women feel frightened and confused as active labor takes
DR". Th"" 'he phase when COnlraClion, become qui,e painful and when
me novelty of being in labor has worn off. You'll know you have hit
aCtive labor when you ask yourself what you'll do if the pain gets worse.
Early labor can be fun; active labor is nOlo It has been described as a
'time of Shifllng gears, a time of giving in and letting go." Women often
n:quir<! much guidance at thiS point. The person who will provide that
Pre/JarllliQI/ ftn flirt/)

is your partner He will breathe with yo
f h h
' u, time COnlra(uons ...
your back, etc lings to drink answer th h ' mA:.S3R(;
. ' epone,cal\(hed
midWife, and be there JUSt to comfort you. OClor or
We presume that your suitcase and Lamaze b k
, ,ag arc pac ("<I (ree chap--
ter 7), but there Will be some last-minute things h
,suc as a toothbrush
chilled champagne, foo. d, and a cold pack '0 be 'h 0 . Y h .
, r wn In. ou 5 ould
also bnng along anythlOg that is proving useful to you at home, such as
a hot-water bottle, pillows, or a picture used as a foc I . Y
a POint. our
partner can doctor or midwife to say you will be leaVing soon
Actually, thiS eXit can be one of the longest you've ever experienced
because you will have to StOp each time you have a contractlon. '
The best way to get to the hospital is to have someone drive bOth of
you. If your partner doesn't have to watch the road, he can help with
your breathing or massage your back. This also means you will nOt have
to wait alone while he parks the car. Obviously, it's not always possible
to find someone to chauffeur you in the mIddle of the night, but in big
cities, you may be able to take a cab. Calling a taxi service is easier than
trying to hail a cab.
If your partner is driving, don't allow him to run all the red lights.
Each bump will intensify the pain, and the ride can seem excruciatingly
long. You will be convinced you are further along in your labor than you
are. If this is your first labor, the chances of your having ,the baby en
route are negligible. Try to get comfortable with some pillows In the
backseat or recline the passenger's seat if that's possible.


.. When we were gOlOg !O ,he hosP'''1. I was Slill dOlO8 fimphase bre,,,hm8
becau,e I needed my husband !O do ,he secondphase bre"hing. and he had !O
drive. So he JUSI kepI one hand on ,he wheel and ,he o,he
on m)" belly and ,alked
me through."

L.lbor ,1I1t1 Tr.msition

b,I,"ties once you arnve at the hospital: Should you
There acc tWO pas
, h )'our parmer or should he drop you at rhe door and
park t e car WI' .
- frhe car' Wle advocate going to the parking lot with hun
then ta e I..are 0 . ,
. d ,r If not he should drop you at the entrance, and you
It you can stan., .
h uld wait right there until he arnves. In any case, you should stay
:o;ether. so )'OU can go through the preliminary hospital routines as a
Most hospitals insist that you stop by rhe admitting department on
llour way to rhe obstetrics ward, even if you have If you're
tOO uncomfonable [Q wait while (orms are filled out, It can be done later,
either b), your parmer returning co rhe office or by a clerk coming up
to the labor room. The admissions office can be a booby trap in the
normal hospital process, because laboring women and their panners
often get separated there. This won' t happen co you if you are adamant
about sta}'ing together. Unfortunately, you may have w be adamam.
Once you arnve on the obsterrics floor, you will be shown to a labor
room, and there a nurse will go through the standard admissions proce.
dure. This usually mcludes a temperature check, a blood pressure read
mg. a unne sample, a shon medical history, and a few questions about
the progress of labor and what you've had to eat or drink. You will be
given a hospital gown to wear, and the nurse will check the baby's
heartbeat by hooking you up [0 an external fetal moniwr or by listening
with a stethoscope. You shouldn't be concerned about any of this; it 's
all routine fare for laboring women and none of it means there's any
thing wrong with you or your baby. (You can be detached from the fetal
monitor as soon as a pattern has been established .)
If you are having your baby at a teaching hospital and your donor'S
nOt already there, a resident will probably be the one to do the first
imernal exam. This is (Q make sure you're really in labor and it is
standard procedure, but if you are a private patient, you don't have to
permn It . We don't think there's anything inheremly wrong with a
resldem domg One cervical check for purposes of admission, especially
If wam to know your progress. 1 contractions have stopped or if
you re less than one centimeter dilated, you'll probably be seD[ home,
10 which case there 's no sense in having your doctor leave the office,
If you are 10 active labor, however, your doctor or midwife should be
at the hospital wuhm the hour, and any further checks should be per
formed by h,m Th 'I ., f
. ere s on y one mStancc 10 which you should re use
194 for Bir,h
a preliminary exam. by. a resident and tha" f
" S I your water brohn
The ri sk of m CCllon lOcreases greatly after th <
. e nrst vagmal exam and
since your doctor Will want to perform his own . h h '
. ...xam w en e arnves
it's prudent to walt.
Wc object to a resident making repeated checks becau'\e he IS watch.
Ing your labor on behalf of your doctor, who is someplace ehe. WIo: aho
object to repeated vaginal exams by a variety of people for purposes of
instructi on. At a teachlOg hospital, you will meet residents, interns,
medical students, and student nurses. They are all learning how to prac
tice medicine and they'll practice on you, if you let them.
Theoretically. unless your life is at stake, no one except your doctor
is permitted to tOuch you without your explicit permission. We're not
advising that you refuse the assistance of a resident, we're JUSt saying you
should know your rights and assert them when necessary.1f yourconcen
tration is being shattered or your breathing interrupted by hospital staff,
your partner should nicely but firmly ask them to leave. No one but your
doctor and a labor nurse has to be in your room. A laboring woman IS
under no obligation to be a good sport for the beneht of medical educa
The Pubic Shave, Enema, and IntravenouS
\'Qhile we're on the subject of assertiveness, we should mention that
there may be other moments during the admission process when you
must speak up abour what you want. Unfortunately, some hospitals will
still try to give you a pubic shave. an enema. and an intravenous. As
we've said before, the only hospital procedures you muSt undergo are
rhe ones you and your docror have decided upon, All docrors practice
differently, and rhis difference is reHeCied in ,he orders lefr for ,heir
palien", For example, rhe nurses know rhat Dr, Smith's palle
get an
IV ar five cemimerers, whereas Dr. Jones's don'r have one unless mey
are dehydrated.
All pam of rhe prep are unnecessary, bu' ,he pubIC shO'e has gor ro
be rhe maS[ useless of aiL Jr's an annoying and dehumanIZIng procedure
which causes gre.! d,scomfor< a weeks larer when ,he half beg,n> W
grow back, A pubiC shave was once ,houghr ro decrease ,he chance 01
infecrion, bur several sruches have disproved !hlS ,hear), One <lU'ly even
found ,he risk of ,nferllo
10 be grearer a shave b,,,.u,e 01 ,he
. . I .' I ... I \/ " 0'- ObJltlrtfJI LIfe'. C'\hteJ
mell encc of razor nicks. (.1( Pf,III1
,' ,llltl, .
hila j.,bQ" .1IIt! J"r.u
-k Z span and Edward Qutlligan. s. rates: "There is no evi.
b)' Frc: ertl U .
h h g
he perineum alters the inCidence of POStpanun..
dence { at s aVln '"
- b eakdown of the episiotomy." If }'our doctor demands the
infcc(lon or r - .
shJ\'e be done, ask him for a COP}' of the study which encourages thIs
archaic pC;lc[Jce.
\V/e were amazed at how many of (he women who filled OUt OUr
quesnonnaire had pubic shaves. Women who didn '{ get, full shaves re-
ceived a miniprep, 10 which just the area between the vagIna and rectum
(rhe episiOtomy site) was shaved. This is an improvement over a total
clip, but still unnecessary.
Enemas don't appeal to us, but many women wam them so that they
won't have [Q wOfry about having a bowel movement during delivery,
There is, however, no medical justification for requiring an enema. The
PrJrtt(al t\[.l1lual 011 ObJlelrical Care says, "There is no evidence that an
enema sumulates labor, despite the widely held belief. Unless 'he reCtulTl
is gread}, distended with hard or impacted tissues, the discomfort im-
posed by this procedure is nor warranted."
In many cases, women experience a slight diarrhea during early labor,
making an enema doubly unnecessary. You shouldn 'r really worry about
defecating while pushing because if it does happen, it's no big deal and
it's something everyone has seen before.
Using some gende persuasion, you should be able to avoid the pubic
shave and enema, but it may be a bit more difficult to negotiate regarding
the use of an IV_ Some doctors don', hook you up immediately to an IV,
but they will want one in place once active labor begins. If your doc{Qr
insists on thiS intervention for you, he will probably cite the two follow.
109 reasons:
It keeps a vein open in case of emergency. If you should hemorrhage
or go IntO shock after delivery, your veins can collapse, making it
more difficult to IOsert an IV and necessary medication.
It will keep you hydrated. Most hospitals don't allow food or drink
dunng labor (although they wiiJ allow a woman to suck on ice
chips). and that tends to make women dehydrated and fatigued.
paniculady those with long labors. This is why the IV consists of a
SOlution of dextrose and Water.
Using an IV to preVent dehydration seems almost contradicrory, If lloU
were JUSt allowed to drink, you wouldn't get dehydrated . The rationale
Prepllrali(m fo,- Hi,-,/)
for prohlhlUog the Imake of "quid, d I be uong a r tha f
arose and general anesthesia had to be ' t I an emergency
given, there woul'" he
asphyxiation from vom. iting, since it is tr h d' _ " a mk of
, . ue t at t\ d
the likehhood of vomiting under anesthe,i B _ UI 'i mUtase'S
, a. ut even If vou f f
dayS. th.ere s a chance you could vomit aspir ast or two
_ . f ate stomach seucuom and
die. ThiS IS, 10 act, {he more dangerous situ ( be '
. a Ion caust: stomach con
tents after. .asung are so acidic, chemical Irritau d . f - on an In ecHon can
occur, ThiS IS known as Mendelson's syndrome and hid " 15 t e ea mg cause
of anesthetic deaths In obstetrics and the fourth I d f " ea mg cause 0 all
deaths, We re not suggesting you eat full meals during labor,
Just that you. be allowed to prevent dehydration by drinking liquids. It
seems exceSSively conservative to withhold liquids from all women when
only a tiny percentage would require general anesthesia, especially since
this prohibition does nor tOtally eliminate risk.
You may feel reassured to have an IV in place, but most women find
it immobilizing. uncomfortable, and even painfuL It causes a subde
psychological change in the way you feel and the way you're treated by
the hospital staff. You go from being a healthy woman in labor to being
a patient on an IV. I t takes a lor of motivation to get out of bed and drag
,he thing behind you on a rolling pole_ An IV aauall)' makes" '00 hand)'
to administer medication. It promotes intervention just because it's
there, It takes so little effort to give you a dose of something with me
IV all set up_
In lieu of a routine IV, we prefer a wait-and-see attirude. An IV can
always be put in if you become dehydrated. If your docwr is particularly
insistent, he may have had a patient who actually did lOW shock
Although rationally he knows there is little chance thiS \\'111 happen, to
_11 _ - I on mI' As a compromise,
you, he may not be WI 109 to capltu ate ;N' -
_ I k Th- - a plilStlC catheter that is
you might suggest the Heparin DC '. IS IS - d
_ h d o-wa)' valve The tube IS tape
tnserted in a vein and {hen attac e {Q a tW . d '
_ all mbered but prepare lor
to your wrist and leaves you virtU }' unencu ' I
.' be ven through the \'3 ve .
a complication, since medlCa
can 8
H lock make
. ,ous or a epan
If yOll absolutely must have an lOeC'J,' en - 'd f he forearm IS the
, _ 'hi PO' Them" eo'
sure that It s put In a comlo
e s d I be ed as J backup.
. f h h d shoul on), u,
preferred location. The top 0 t e an, h' hospital a reslJent
. .. . . If lOu're Ina teaC Ing .
SlOce It IS a more sensitive aren- } want ,'our doctor
V Th re is no reason to '
IS most likely to insert your I , e -. I be qUite
, I of pracm c anl .
to do this. because a reSident gets DtS
.. t"UIt Llbor .I/It! Tr./lui/lOtI
Fetal Monitoring
T h ~ fe-tal monitOr is a machine that shows the baby's .heartbcat, YOur
ons and rhe relationship between rhe two. Until the beginnino
contract! . 0
of the 19"Os, the heartbeat was listened to (auscultated) with a feto-
scope. bur today elccrconic fetal monitors have replaced the human ear.
There are twO t}'pes of monitors: external (noninvasive) and internal
(invasive). Borh look like large boxes with dials. similar to a stereo
receiver, and rhe}' are wheeled aboll{ on metal stands aboUl as high as
rOUf bed. To use the external mouilor, twO straps will be placed around
}four stomach; they arc connected by two wires to the monitor. Some gel
will be rubbed on your abdomen to provide contact for rhe eiecrronic
leads. The upper strap will record your contractions, and the lower holds
an ultrasonic transducer to detect the baby's heart rate. Both your Con-
tractions and the fe[31 heartbeat will be recorded on graph paper, which
runs through the monitor. Some machines have a microphone, amplify-
ing the bab)'s heartbeat; it can be turned off if it's too distracting, There
will also be a small flashing light on the machine and sometimes a flashing
digital number, providing a computation of the baby's heartbeatS per
minute (normall), in the range of 120 to 160 bears per minute).
With the 1111"1101 monllor the lower strap is replaced with a long wire
that is attached directly to the baby's scalp by a clip or screw electrode.
In order to insert a fetal-scalp monitor, the cervix mUSt be dilated at least
two centimeters and the amniotic sac must be broken. The internal
fetal-heart monitOr is considered more accurate than the external, and
it is often used when Pitocin or an epidural is given. Sometimes a second
catheter is inserted into the uterine cavity to measure the contractions,
and this replaces the external upper strap.
The purpose of a fe[31 monitor is to determine how well the baby's
supply of oxygen is being maintained during labor_ Decreased blood
Row can OCcur if the mother is lying flat on her back, if there are
problems with the umbilical cord or the placenta, or if the dosage of
Pitocin IS too strong. Often the panerns revealed by the monitor will
mdicate the panicular problem. The three types of parterns are:
Type I ThiS pattern is a reverse Image of rhe conrraction. The fct,al
heart rate is at ItS slowest when the uterine contraction is at ItS
strongest. ThiS is a physiologic phenomenon, and a reassuring SIgn
of fetal well-being.
'fjPt" These patterns are called late decelerations and arc of nn
/98 Preptlrtil101J for Birlb
abnormal naturc_ Here the fetal h. c
tart rate 1x.gInS to drf (
slightly) close to the end of the uterine ( .. Th
. ontractlon IS OCcurs
because the baby s oxygen supply IS diminished bl be
,pom Y lause of
poor placental transfer. The baby doesn' , ha h f
. ve enoug 0 a reserve
for the fony to Sixty seconds dUring the COntracuon while the blood
supply IS diminished. This could be dangerous, and the baby'scondi-
tlon will be assessed, if pOSSible, with a fetalscalp sample
Type II J. These are varied decelerations that OCcur due to mtermit.
tent interruptions in the supply of oxygen and nutnents to the baby,
It may occur dUring a contraction if there is a cord wrapped once
or twice around the baby's neck, when downward pressure dunng
the contraction causes a brief interruption or a diminished supply of
oxygen. There will be a sudden drop in the fetal heart rate (to about
80 beats per minute), it will Stay there during the contraction, and
then it will recover once the contraction IS over_ A deceleration can
also occur between contractions if there is a compression of the cord
between the baby's body and limbs and the amniotic sac. If (his
happens, the mOther's position will be changed, she will be given
more fluids (usually intravenously) and oxygen through a mask. A
fetal.scalp sample may be taken, (QO.
With bOth Type II and Type 1lI patterns, the baby', condtlton will
determine the course of events. If fetal-scalp samples show sufficient
oxygen, nothing more will be done. If this is not the case, the bab)' will
need to be delivered quickly, either by forceps or by cesarean section,
One last element, especially of concern for high-risk patients, IS the
beat-to-beat variabiliry of the fetal heart rate in general. This can be
measured only by internal fetaJ monitoring. Normal circumstances indi-
cate a fetal heart rate that varies from five to ten beats from the baseline.
A rhythm that shows no variability could mean fetal distress.
A baby's heartbeat is normally in the range of 120 10 160 b<-ars per
minute. In addition to the late and varied deceleration patterns, distress
can also be indicated when the heartbeat goes above the normal rate
(tachycardia) or below (btadycatdia).
MonitOrs are controversial. Proponents of the machme artribute
lower infant mortality rates to their Vt.jdespread use. Opponents refute
this and link the use of monitorS 10 the escalating cesarean rate. Doc-
t I
, . . pted nll'diClI prac
ors calm that mOnitors n o ~ " constitute acce
, . I dpo' t [") do without them
consldcr It foolhardy from a lega stan In - \.
Many couples don't like the idea of tntervenltons dUflog labor, ye,
-if/ittf 1 "bor lind Tr.IIUilioll
they are afraid not (0 uulize the moniror, afraid that fetal distress could
go undetected.
A feral monitor IS not witham nsks. It's a gadget subject to malfunc.
tion and the error of human Interpretation. Studies have shown cesarean
rates [0 flse dramatically Immediately after monitors were introduced in
a hospital. but once people learned how to use the machines, the rates
dropped. Sometimes a monitor can give out many "false abnormal"
readings that show fetal distress but are really machine malfunctions.
Other common operational problems include: the electrode falling olf,
causing the babis heartbeat to disappear; the monitor picking up the
mOther's slower heartbeat instead of the baby's; the baby moving OUt of
range; and (he monitor picking up indiscriminate (racings from the
marher's movement or vibrations in the room, which interfere with an
accurate reading of the baby's heartbeat.
No one doubts the benefits of monitoring for high-risk women-
such as those with kidney disease, a history of stillborns, or high or low
blood pressure-but the benefits for low-risk women have nOt been
proved. In 1979 Dr. Stephen Thacker, of the Centers for Disease Con-
uol, and Dr. David Bama, of the federal Office of Technology Assess-
ment, reviewed rhe literature on fetal monitoring. Their conclusion
was that (here is no evidence to show that monitoring is of any benefit
in low-risk labors and that it carries substantial risks, including a
greater chance of cesarean section. They noted that the moni[Or lacks
the precision to distinguish normal from abnormal hean rates. This can
resulr in unnecessary cesareans as well as cases of real fetal distress
going undetected.
The external fetal monitor works best when you're lying down. No
woman in labor Wants to be immobilized, and the supine position can
be excruciating, espeCIally with back labor. Yet many women who filled
OU[ Our questionnaires reported being forced to lie in this position. If
you have complete freedom of movement, you'll feel more comfortable
and therefore be less likely to need medication. Also, if you can sit up
or walk, the force of gravity will aid your contractions and you will be
less likely to require PitoCln. We have also heard complaims that nurses
tend [0 focus on [he fetal monitOr rather [han on [he woman herself.
When nurses listened to the baby's heartbeat by fetoscope, there waS
certainly mare physical contact and perhaps more attention. Sometimes,
it almost seems [hat {he monitor has taken over [he labor and everyone,
including [he woman herself, is focused on the maclllnc.
We were surprised, however, [0 discover in reading the responses ro
Preparatiorl for Birth
our queStionnaires that there wer
e many coupl h
fetal monitor. The one great adva ta . es w 0 rc:ally liked the
n ge, cited agam and .
it was com orting to hear the bab h agam, was that
y s eartbeat thro h I
know that everything was all right Th ug OUI abor and
, e women also l'k d h .
partners announce the points when a . I avmg their
contractIon was be
ing, and fading. This can be a big helpwth h b . gmlllng, peak
I t e reathmg and . I
permits a woman and her partner to work " I[ certain Y
. .. as a team. The dlsadvan
of thIS technique IS that you bOth begin to I h . tage
r . re y on t e machme rather
than on your reeltngs to determine the strength f
f I b
0 contractions and the
progress 0 your a or.
There' s nothing inherently wrong with fetal .. .. mOOltOnng; I[ Just
shouldn't become the focus of your labor and It should ' . n [ prevent you
from assuming a comfonable position. We suggest that you have the
external monitOr on intermittently, perhaps for five or ten mmutes out
of every thirty or forty minmes. If the heartbeat is fine, theres no reason
you shouldn't be able to walk around or arrange yourself comfortably
in a chair or bed.
You have less mobilicy if an internal monitOr is used. This is because
it is nOt done routinely, but is usually required by a specific condition,
such as administration of PitOcin or anesthesia, demonstration of fetal
distress, or maternal diabetes. The internal monitOr carries a fISk of
infection-about 10 percent-for me mOther, and moSt people become
quite squeamish when they learn [he elenrode is attached to their baby's
scalp. It"s more accurate than the external monitor, however, and your
doctor may dismiss the idea of a cesarean if the internal monitor doesn't
reveal a difficulty. Contrary to popular belief, the use of the
monitor does nOt prevent mobility. The electrode can be detached trom
the wires leading to the machine and then taped to {he woman's inner
thigh if she wants to walk around.
If There Are Signs of Fetal Distress
If the external monitOr shows signs of fetal distress and JII possibility of
a mechanical problem has been eliminated (Ihey've already tried chang-
mac toes), there are three things that are done:
mg h'
You will be asked [0 lie on )'our Side. If OoC sidt' doesn't work. rou
wlil If)' Ihe other. The fetal distreSS could be caused b)' wrd com-
pression or b)' reduced blood Aow 10 Ihe uterU' b<'CJusc' )'"ur
4ftir't' L..,bor ,/lui TrllllSiliou
YL1U will be gin:'n some l.)'ygcn. This will give the baby a Jiul b
.. hh bk eooS(
and ohl'n t e can rate ac to ItS normal pancrn.
J(you an..' getting Pirocin, It will be turned olT, so that the UI
crus can
r(,st mon ..' completely between conuacnons.
If Ihe heartbeal Stabiltzes. nothing further need be done. If. however
the bab),'s heart rale IS still showing distress. you will probably
sWHched ro an Internal fetal monitor.
Fetal-Scalp Sampling
If the distress is Still present. a fetal-scalp sampling may be done. In Ihis
procedure, a small sample of blood is taken from the baby's head, and
itS pH is tested. This reading will indicate how much oxygen the baby
is receiving and whether il is safe to proceed with labor. The normal pH
of fetal scalp blood is above 7.25; readings berween 7.25 and 7.20
suggest that h)'poxia (oxygen deprivation) may be occurring; and a
reading of below 7.20 indicates that hypoxia is definitely present. If Ihe
scalp sampling delermlnes Ihe baby is in real distress, a cesarean or quick
forceps delivery will be done.
It can take an hour or more, what with all the tests and comings and
goings, to get senied in your labor room. Once this occurs, your contrac
dons may intensify or they may peree out. Both responses are normal
reaccions to a new environment. In either case, the thing to do is to close
the door, cover up the clock, and focus on each contraction, one at a
time. Your state of mind will depend a great deal on how much progress
you've achieved. If you 're barely one centimeter, natural childbinh may
be the furthest thmg from your mind, but if you've managed 10 dilate
to five cemimelers, you'lI probably feel quite positive. Whalever your
situation, now is the moment to dig in and get serious about having your
If your contractions have slowed down or stopped. you should gel OUI
of bed and walk around. Don'I lie in bed waiting for labor 10 pick up.
If you have an Intravenous. ask thac it be attached (Q a pole and drag the
pole around with you. As we said earlier, if your doctor wants you on
a fetal monitor, try to use it intermittently, so that you can walk around.
202 Preparalioll for Birlh

"I had to concentrate and wanted to be left alone. I didn't even want the bed to
be jarred. I felt exhauSted and wondered how long I could last.
"Contractions came hard and fast and were very regular It took a 1m of
nation and concentration to get through my breathing patterns. I didn't move or
talk or wam 10 be lOuched."
"I was permitted 10 take a long shower aboul halfway through my labor, whICh
helped a great deal to rela.x me and give me a second wind I hadn't slept for about

thirty-six hours."
"I was sent 10 Ihe hospital by my doctor, who didn'I show up himself for Iwelve
hours. I was unable to sleep in the hospital, with the IV, fecal monitor, and noise.
We were lired and angry."
.. I t was difficult for me 10 separate aClivephas
and lransllion because I went from
four to ten centimeters in less than tWO hours."
"The initial excilemenl wore off. I was lired and tried 10 nap belween contrac-
lions. The monilOr and periodic checks by Ihe nurse were uncomfortable. I was
awed by Ihe strenglh of Ihe contraclions and I realized I had 10 focus on Ihe
breathing and relax as much as possible."
.. Even Ihough IhlS labor was relall"el), short. I IhiOk some of ml distress came
from the feeling of nOl h,,"iOg contrOl o"er whal "., happening I felt ml bc>dv

. letin' J,lbor ,lIul '[r,tlhjtio

A I T I \'! l.\ 1\ n I\.
was a machine going through these contractions and I could not srop It or help
"I imagmed a rolier-coaster ride during contractions: up, up, peak, down, down."
"Both my husband and I were elated when the nurse checked me and said I was
eight centimeters dilated. Not thin)' minutes before, I had been 4 centimeters."

If labor has stalled, walking is a most effective way of bringing on
Some labors are harder to get moving than others. If your contractions
are still not as regular as they were at home, you might try some nipple
stimulation. This method is commonly used by midwives and is now
gaining acceptance among obstetricians. Your partner can massage your
breastS or you can do this yourself. You should also attempt to just relax,
because sometimes (he tension of being in a hospital can stall labor. Do
some deep-breathing exercises and ask your partner {Q give you a mas-
sage. If there's a shower available, take one. This is an excellent way to
release inhibitions and just unwind.
Sometimes contractions of similar intensity can seem more painful in
the hosp,tal than at home. This occurs because you may feel less in
control, or because a hospital can be a frightening place. If your comrac-
tlons suddenly seem much bigger and harder to handle, try to forestall
panic. Attempt to make yourself oblivious to the new surroundings and
adjust your breath 109 to whatever feels good. Your partner can sponge
you with (001 water, you ice chips, fix the bcd, or do whmcvcr yOU
find comforting.
204 PrepaTtiliou for lJirlb
The Presence of Your Doctor or MidWIfe
If a midw,fe is delivering your baby ,he ":,11 b bl c ..
. pro a Y lie ill your \lde
soon after you arrive at the hospital or birth ceme If c.
. ' r you nave a do({or
he ordinarily comes to the hospital after you have been d . d WC '
a mme nere
he will spend your is another mauer, and u's a subject should
have With him dUring an office visit. Women have very differ-
ent expectations of where thel( doctOr should be umil it is time to catch
the baby, ranging from being somewhere in the hospital to hovenng at
bedside, doing Lamaze breathing with her.
It's impossible {Q dictate correct behavior in this circumstance because
so much depends on what you want and what kind of labor you have.
If you're dilating slowly but normally and its the m,ddle of the night,
there doesn' ( seem to be any harm in your doctor catching a few winks
in [he lounge. But on the other hand, if you're having telescopic labor
and are sure you're dying, your doctor shouldn't be having a snack in
the cafeteria. Some women want to be left alone with their partners
during labor, others want as much medical supervision as possible. Ide-
ally, you should be able to tell your doctor how aVailable you want h,m
to be.
The Plateau Phenomenon
Sometimes at around five centimeters of dilation, progress seems [Q slow
down or StOp. This hesitance, which we call a plateau, can occur in active
labor or even in transition. A common scenario is strong contractions
and dilation to five centimeters. Two hours later, contractions have
maintained their intensity. but dilation rematns at five centimeters. An
hour later, no further progress has been made, and tWO hours after that,
dilation still rests at five centimeters.
This phenomenon is known as filii"" /. frog'''' and it has 10 be one
of the moSt discouraging patterns of labor. A 1980 Study done by Ihe
National Institute of Health on the great mcrease m cesareans cited
failure to progrcss as the single most important contributor \0 the rI"ng
cesarcan rate. Failure to progress IS frequently confused with cephalo-
pclvic disproportion, but that condition IS believed t" IXcur ,n only
about 2 percent of all deliveries. Somenmes a doctor w,lI perform a
ccsarean because of failure to progress and then sal' as ;\ kind ", ,,!ler'
Adin' /.,bo,. .wd Tn/milion

"By 2:00 P.M. I was six centimeters dilated. I went into (he office, and the dOctor
sent me to the hospital. Things slowed down when 1 got there."
" / Stayed at tWO fingers dilated for almost ten hours and then jumped to ten. After
that it was only another hour and a half until my daughter was born."
"/ was three centimeters dilated and two weeks late when 1 was finally induced.
After hours and hours of being on and off the Pitocin, 1 was still only 3 centimeters
dilated. At one point 1 said, '1 can't take this much longer.' My dOCtor had
examined me forty-five minutes earlier and then had gone off the floor, but 1
insisted that the resident examine me. He did and said, 'Oops! JUSt a rim left!'
Then / felt the need to go to the bathroom Ca classic symptom, 1 was later told),
and suddenly 1 was fully dilated and ready to start pushing."
"Cont raCtions slowed down once 1 gOt to the hospital. After two hours, my doctOr
suggested taking some castOr oil but thought it would be easier to send my
husband to the drugstore for it than dealing with the hospital staff. 1 guess the
reality of the castOr oil hit me, because by the time my husband gOt back, my
contractions were booming."

thought, "Oh, your pelvis was tOo small anyhow." However, most fail-
ure LO progress is simply that, a stalling Or failure of labor. and has
nothing to do with the size of your pelvis.
Generally, a plateau is a physical manifestation of a psychological
occurrence. It usually comes at a time when [here is no turning back,
206 Preparation for Birth
when cveryrhtn.8 must. be surrendered h
to t e labor h h
is about [0 begm. DUring this kind of I w en T e hard work
.' f p ateau, WOmen d h
often inSist on requent cervical checks b h.. an t elf partners
u( t IS IS mlsg d d be
lack 0 progress gc.tS everyone discou d UI t:. cause
rage, Ah(. the
uncomfortable, addmg new discomfo (h ,exams can.be
r w en you are alread be
(Ired and less tolerant. In addition if the h b y commg
, water as roken .
will increase the chance of infection ' examlOauons
In this situation, cervical checks are re d be queste cause women want
to know how much longer It will take aod how hi
. . k' " muc onger It Will hurr
ThIS thm 109 IS not gOlOg to help dilation' labo t k I . .
, .' r a es as ong as It takes.
and that s all there IS to It. You shouldn't be looking f 16
.,' or externa ven ca-
tion of Internal feehngs. What you should be dOIng s I I trying to et go.
labor stalls, you do what your Intuition tells you feels right,
ThiS maY ,mean removing monitOr and going for a walk, having a
snack, taking a shower, calling a friend, yelling out or having a good cry.
Surprisingly. loss of control can help, because tears produce a tremen-
dous release of tension, which will allow labor to proceed.
Last spring we attended a Lamaze workshop that was taught by veteran
instructor Anne Rose . She recounted anending the labor of a friend.
who was having her first child. This woman was admitted to the hospital
with litcie dilation, but once there, labor began to progress slowly, up
until the point of four centimeters. Then everything stOpped for several
hours. The doctor had left the room, talking about pitocin, when this
woman's husband noticed that her rear end was peeking through the gap
of her hospital gown. Impulsively, he leaned over and kissed it, saying,
"You 've always had the greatest behind." Wlell , that gesture seemed_tO
be the equivalent of a megadose of pitocin, because contractions 10-
creased in intensity, and about fifteen minutes later the woma.n had the
urge to push. Anne then ran out to get the doctor to do a cerVical exam.
He almost refused because he couldn't believe dilation could occur so
quickly. He was wrong, and the baby was born within the hour.
. < h h d 'as that even (hough her
Anne s explanation lor w at appene " _
fncod was fully prepared and tOtally committed to having her baby,
That Olle qUick kiSS made
there was a part of her {hat was una eta etgo. d, AI
her feel confident and comfortable enough to let things -
I h f en (an be one {altl\.. or one
though this swry is a Iiule unusua , [ ere t . Th d ffi It palt is
b' difference e t lU
moment in D labor thm can make a Ig _'. d h 'eels ri2ht
_ 0 b t 'ld\'lce IS to 0" at I' . ....
fisuring our Wh3{ works for you. ur es .
to you at that particular moment.
If/JI 't' r"bor ,,,ul Tr.I1ISitioll
Thi, '\ thl' parr L'Vl'f}'tlnC drt'ads, ilnd wC!'d be If Wt.' didn't tell
It (;\0 he h;\d . transition IS rhl.' shortest phase of labor
,lOl)ut dn hl)lJr and (onsisrin.g of roughly ten to twenty COlHra<::
tlL)ns. h's the ffi()sf difficult stage: of labor because it comes at rhl' end (8
w 10 .. wlll'n you're rhe most Hred. It's also the stage when
you arc the most runl'd 10 (0 your body. feeling every breath, eVeql
mO\'l'rncnt as the ccrYIX opens 1O its fullest extent. In Some ways it's
horrible, in SOOlt.' "'ol)'s it's greae
The difficult part about transition is that when your contractions are
rhe most Intense. the)' will lose their wavelike pattern and predicrabiliry.
It's not unusual [0 have a double or triple contraction or a very shan rest
period between contractions.
Not experiences rhlS, however, and for some the pace of
labor continues unaltered. TransHion can also include its own special son
of symptoms. which mal' make you feel pretty sick on tOp of it all. There
are SIX classic symptOms of rransition. Although you won't have all of
them, It'S good to know what they are, These feelings can be scary, but
you should understand they are a normal part of labor. signahng that
}'ou'rc very close to having your baby.
Irrt'l.Ilnli/l Some women can be grouchy all rhroughout labor, but
oftt'n a sudden ferociousness makes it very clear that transition has
begun This f<.:'cilOg is most frequently directed to the person closest
to )'OU, )'our parrner, and neither one of you should feel sensitive
afterward Many women we know have been nasry to their husbands
dUring transition, but men have never taken it personally,
\X/omen In transition commonly say thlOgs like, ''I'm never having
anOlhcr bab)'," or ''I've had it, let's go home," or "Don't cell me
what to do, I'm Ih<.:' one In labor, nm you." You may develop an
extn..'me wmltlvlty and announce that you don't wanl [Q be
touthed. Thl/) doesn't mean you're nOt relaxing properly, it JUSI
mt'ans you're 10 IranSHIon.
\I.1'IfI".1 Thl!'l a very common symptom of transition and (lne or the
worsl The bc!oI thlOg IS to just let go dnd throw up, hecausl' you'll
ft'cI b<:ttcr aflC..'rward Lelling go 11> whal you need to do, ;Ind
Illg up oftl.n Jltecliy to fuJI dilation. Evt:fy labor roOrn IS
cqulpped wllh baSins YOli Lan LISt' .
ChillI, Your hody "t.:'xhlbJtlng it claSSIC shock rC;lninn Whl'n }Itlll ACI
..JON Prep,n,llifJlI lor lJi,.,h

T R '" !'-. S J T 1 () N
.. All J knew was that it would eventually be over If I could just hang In there
After all, you certainly can't StOp and say, 'Excuse me, I'd like In leave now ..
"While in labor I kept thinking that anyone who docs thIS [Wice should be
committed. But sitting here two days later with the baby, I'd do II again."
.' I t was the most painful gomg through uanslUon while 10 the bathroom after an
enema, without a coach."
"I kept trying to figure out if I could kIll myself without humng me baby
"M y grandmother told me I would enrer 'me valley of the shadow of deam and
then suddenly return. She was exactly right. but it was complelei), worth It ,
"I thought 1O myself, 'ThiS can't go on forever.' It seemed like many hours. My
husband thought the time flew by-bur I ie" as if the clock had "oPIX'd!'
"During transition, I wanted the whole pharmacy in my Vl'ins. But later I was glJd
I was able 1O be <\wi.1kc to sec our babr being born,"
"It took a lot of dcternllmltlOn "nd conrentOltion <0 ge< Ih,,)ugh my brcalhing
pnttL'rns, I dido '( move or t.1lk or w;.\01 to be wu(hcd .11 JII. '

__ I


Idil'l; /.,bol" ,,,,d {,..wH/ion
the Your (eet feel like they're freezing. and )'Qur arms and
le,gs stan twitching uncontrollably, This can happen dUring transl.
tion as well as after the delivery. Have your partner get your socks
(rom rour Lamaze hag and ask the nurse for an extra blanket.
Blo(l,/) ibou ThiS is different from rhe loss of rhe mucous plug that
heralded rhe beglOning of labor. As rhe cervix stretches, tmy capil.
lanes can break. producing bright red bleeding. Don'r be alarmed
juSt be excited that labor is finally ending, '
B./(J'}{bf Even though the baby is nm posterior, backache is COm.
man dUring transition. Your partner should try all the tricks for
dealing with back labor-massaging, exerting counterpressure, Or
applying hot or cold packs. You may consider a stabbing backache
to be the final straw, but don't despair-it will be gone in a few
contractions .
Dt'Jlre for l1udi(fllion. This is often rhe time when, despite a prior
commitment to natural childbirth, you're ready for the entire pharo
macy. Although it's the most common time to ask for medication,
it is also the worst in terms of bmh the progress of your labor and
its effects on your baby (see chapter 11). Bear in mind that this is
the shortest phase of labor and that in just a few more minutes you
will be able to stan pushing.
In addition to all the things we have just described, you may also feel
an urge to push. As the baby descends, pressure is exerted againSt the
broad ligaments of the spine, triggering a reflex urge to bear down. This
shows great progress, but don 't push until you are examined. If dilation
is nOt yet complete, pressure from early pushing will cause the cervix to
swell, decreasing dilation. Often, you will spend the latter part of transi-
tion blowing to offset the strong desire to push. (To review this breath-
109 pattern, see page 95.) This can be very fruStrating, because you're
dealing with the most difficult part of your labor while trying to prevent
yourself from doing what feels right .
Loss of perspective is a sure sign of transition. At [his point. women
frequently ask for a cesarean so that they can be put Out of their misery.
They feel as if they have been in labor forever and can't make a connec-
tion between what's happening to their bodies and the coming of the
baby. Labor is regarded as a sadomasochistic conspiracy among {heir
partner, doctor or midwife (no one is sacred), and the hospital staff. This
is the time when every woman knows she can'l take any more pain. It 's
often hard to convince someone in transition that ie won't get worse.
210 Preparation for Birth
e [hat argument defies her experience of labor BU( 10 almm[
bccaus . . .
Case contractions do subside In frequency and intenSIty dunng the
every I
ulsion phase.
ex Transition is the time when some women are ready to throw In the
I Others however I take a perverse pleasure In thIS phase and enlOY
tOwe. 1
. k wing they are so close to the end
It, no
L.,bor .,,141 Tr.l1lsilion
any women regard pushing as the hardest, bue most rewarding
work they've ever done. Transition ends at last when the doc(Or
or midwife says, "Okay, you're fully dilated. You can push now. " Thi s
stage is a compl etely different experience from labor, and making (he
change from relaxat ion and conscious breathing to vigorous activity is
often difficult.
Even if you have a strong urge to push, you will be surprised by
the Immense elTon involved and the amount of energy nceded. For
some women, pushing is instinctive and delightful. For others it can
212 Preparation for Bi,",/)


.. Felt great when it was okay to push! There was an excitement and a relaxation
going into the delivery room where ' it' was finally going to happen."
" I hated everyone who kept telling me to push! push! I J,d. but they kept yelhng
for me to do it again and again. I couldn't wait for it to be over ,.
"I pushed on all fours for a while and then moved [0 the bed. All fours was easier.
Grunting really helped. The lower and deeper the grunt, the better the push. All
I could think of was geuing [hat baby out so that my perineum would stop burning
and stingi ng."
"My doctor instructed me to 'push as if you're having a bowel movement. I could
never make sense of using those muscles and I think it could be better explained. ..
"I felt as though I were the most powerful person in the world."
"I did not enjoy pushing. It did not reel good to me as many films, books. parents
have described it. I t was realll' hard work, though not painru\. I cned. I WJS tired
I specifically remember sal'ing, 'I want to go home! I can't do this" But I did it
beautifuill' . "
"The undeniable raCt is that it is up to l'0u JIOtIi to get the baby out. and <verv
ounce of your being comes tOgether to do it."



P l' , " I N ~ .
"j['s like yClu're t'mptying out all the pam."
"Squamng helped a lot. Also completely relaxing my muscles In that area. The
more I could relax and not worry about what I looked or sounded like, {he easier
It was.
"Between pushes I looked lOto the mirror and saw my baby's head crowning. It
was then that 1 knew he was really here."
" Our Lamaze teacher told us, 'Bulge your Kegel, push down and out.' The doctor
,Old I pushed great."
"Its hke holding your breath and trying to move a brick wall."
"I had two hours of pushing, which was very hard, but my husband would
practically push With me, and that made it easier. He would get so excited when
he could see the baby's head com 109 closer and closer that I got excited too!"
"My doctOr was very gentle and encouraging. He said, . Make up your mind,' and
that did It."
"All of a sudd<:n ~ ' O U don't have.: to concentrate on relaxing anymore. Ie fell good
lUSt (Q tense: up and push'"

Z 14 Prep,/riltifHl /1)" nift})

. 1
"I found that If 1 waited for the first fifteen seconds of the COntraction to Pa5S and
then pushed, it didn't hurt as much. I found my contraCtIons had a peak near (he
end when I could push extra hard. If I followed my natural deme about when
and how hard to push, H went easier."
"Once I used the right muscles to push, my son was born after (WO pushes
"I never got the 'urge' that other women have told me happened (0 (hem.
pushing hurt, and I wasn't enmely sure I wanted to have the baby If! had to keep
doing it-but the doctOr Jokingly told me that I'd be pregnant 'forever If I didn't
start to push."
"One nurse held her finger by the vagtnal opening and said to push agalfls
and this really helped."
"I never want to hear the word push again;"
"No matter what you learn in umaze, you don't reaUy know until you gIVe birth
-especially the pushing. 1 didn't get the hang of pushing unul the ,ery end. and
by then 1 was so tired I wasn't domg as well as I .anted."
"Contractions began to slow down once I had w push, and It wok me three hou"
with a Pitocin IV."
_ - - - - - - - - - - - - ~ - 1

- - ~ - - - - - - - - ~ ~ ~ - - ~


P 1..1 It I ...
'A countdown ro motherhood, , ' palOful, but a good palll that was going to end
10 something perfect."
"[ felt as though my baby had taken over; it knew what ro do, and the pushing
was involuntary."
"It felt great
[ remember burnlOg and feeling like [ would burst open, but, oh!,
I wanted ro push that baby out. [ would watch his head crown and see lots of black
hair. That was the greatest sight 10 the world,"
"It was great feeling the baby come sliding out and knowing that [ did it rotally
naturally. It was a real sense of accomplishment for me."
"The actual mamem of binh was the best! The real discomfort was over; I even
experienced an orgasm as her head was delivered."

be painful and exhausting, and not at all the relief they were expect
109, It all depends on the posiuon and size of the baby, the length of
labor. whether you've had anesthesia, your feelings abom birth, and
the amount of support you have. The less of an urge you have, (he
morc difficult pushing is; the greater your urge to push, the easier It is
to do,
There's no correlation between the length of labor and the amount of
omc it takes to push out [he baby. You c.:an have a long first stage and
a short !>econd slage, or vice versa. There's also no correlation between
the stages 1n terms of easc. In shoft, you lust have to be prepared for
PreptlratirJtl Birth
whatever kind of labor or delivery you might Th fi
f fif
geT t: rsttlme mother
spends an average 0 tyseven minutes p h . us 109 QUI her baby the
second.ume mother averages eighteen minutes,
. ' ,an natura Iy thai (an Oft.e
there is fear accompanying th" ,cage d I
Inhibit effecttve push 109, For those who are ambv I bo . . I a em a ut mother
hood, thIS IS the last chance to hold back For most h . . women, owever,
the fear IS on account of the physical act of expulslon Th . h . . . . ere I') a orror
of being ripped apan, of beIng Stretched so badly that you'll never be
the same. Every woman is bOthered by this fantastic nmion to some
extent, because it seems impossible that a sevenpound baby could
emerge from a normalsized vagina. Pregnancy seems unreal enough,
but the fact that babies are born this way defies comprehension The
experience has been likened to having built a boat in the basement and
then wondering how you will get it out.
To overcome this feeling, you muSt suspend your dIsbelief the way
you did when you were three months pregnant and saw a woman who
was ready to deliver. At {hat time you said with conviction, ''1'11 never
get that big," but of course, you did, The emergence of the baby from
the womb is perhaps the most amazing part of childbirth. and even
women who have just watched themselves giving birth have a hard time
believing what has just happened.
Once transition is over, contractions continue, but they occur less
frequently, and they don't last as long-more like the pace of aCtIve
labor. Your contractions may have piggybacked. but now they will prob-
e ' You rna)' reel like
a ly space out again to three (Q lOur mtnutes apart.
pushing or you may have no urge at all. Either way. you will be tn-
'h . ns Now that the task of
structed to bear down dunng t ese contraCUo . .
' " I d you must work with the
so temng and opening your cecvl..
IS camp ere ,
d Y
II push hard dUring. each
contractions to help (he baby descen. au WI . AI h h the phYSICal elfort
contraction, and when it stopS, so Will }IOU. t DUg . th
. oup your energy tor e
IS great, the rest periods will permit yOU to rec
next contraction. d pN'a
abo- h Vo'eaker or lSi! y-
Sometimes contractions become muc .' h Usuall)' (hev
. ' permISSion to pus . .
gether, even though you' re beIng given d h br"ak (J11
. or so an [IS "-
resume agam in. aoothe.! [\venty mtnutes \'1 \\ between Sl3g
. and
. t a naNra u
you a. second wtnd. ThiS can e IUS . \ 'our eyes for J few
.' y 1U might c ose )
nOt Ing need be done nght awa). l , be .. in "Olin. Many
. (ontnl((lons ((l e-
mmutt's or takL' a walk (0 encourage . . "ou Piwcin In 30
d . _. ' Id want to give - .
Octors or midWives. however, "ou. '. , '" the b.,by
J d 'Ise patient(; -- ..
c Ort to gct things going. Wie WOli 1I a \
hcard)t:a( remains Srrtlng. This pause Isn 't harmful. If it happens to You
cit"")nr worr\" .1botH ht)lding up the sho\"\'. You should be the center of
arremion. and your rhythms should determme the pace
The second stage of labor lasts long enough to permit ample time to
rind a comfortahle posirion and figure out how ro push effectivel)l.
The Physical Process
Babies must negotiate an almost ntnety-degree angle as they travel from
the uterus to the vagina. Go back to the illustration on page 84 and Study
the pathway your baby takes. Srudy how the vagina and uterus form an
almost mnety-degree angle. As you push, think to yourself "down and
forward" while slightly rounding your pelvis. Don't push toward the
rectum-it's the wrong direction. Instead, push vaginally as if you were
doing the opposite of a Kegel exercise.
As you push, the baby gently Stretches and opens the elastic walls of
your vagina. Dunng each contraction, the force of rhe uterus and your
expulsive efrons will combine to cause the baby to descend. At the end
of each cont.raction the pressure will Stop and your baby will retract a
bit. Thrs gentle back-and-forth motion of two steps forward and one Step
back eases your vagina open and your baby coward birth.
Positions for Pushing
Unless you use a birthing room, you will do almoSt all of your pushing
in the labor room and then move to the delivery room when the baby's
head crowns. If you are in the birthing room, you remain where you are.
Eirher way. you have great flexibility in finding comfortable posirions for
pushing. Try co get away from equating the postures for pushing with
the position for delivery. They can be quite different. For example, you
might squar for most of (he lime and then sir to give binh, or stand for
some of the time and then lie on your side for (he final pushes. Don't
be afraid to try a somewhat unorthodox position if (hat's whar feels right.
You can always switch back to a more conventional position for (he
actual delivery
There's no one perfect position for pushtng our your baby. Any '"'as 1-
Hon is fine except lithotomy (lytng on your back). There arC three
reasons for this: (a) you must push against (he force of gravity; (h) II
tenses the pelvic floor, creating [he need for an eplslOlomy while Incre'IS
21 H PreparalimJ for Birlb
POlitioll' for PlIshillg
109 the I
II . C lance of tCitrlng; and (c) the baby recel"es less o'l'!!en because
' tot e uterus presses on the "enJ ca'" and 30rl., Iwe' e'( the
le welsh f h
o y s . major blood vcs<,'ls
All .... . hospitals today arc eqUIpped Ie' place women In J ,em"e",,",n!!
POSltlOO I .' . . . , I I ' , bl 'Y uSIng pillowS or raISIng Ihe labor bt'<l or l e ,,,'f) to e 10
abl)U[ a angle- If the haby IS posterior, )'OU wlil Want to
assume any Pll\ltion-squauing, slde-IYlOg, standing-that takes the
weight of the baby's head (Iff your sptne. If )'ou seem to be pushlOg to
no 3'\'ail. try another position. If you can't figure one OUt, you merely
ha\'e ((l sal', ''!' m not comfortable, please help me find a belter position,"
Difficulty with push 109 doesnt necessarily mean your pelvis is too small
or th3t you're nOt pushing hard enough; you just may be more effective
in 3 different position.
Women commonly begin pushing in a semisitting posmon. This is one
of {he most adaptable postures because it's comfortable and )'OU can
move your legs easily. You can sit with your legs bem and your feet flat
on the bed, or with your knees open aod the sales of your feet together,
Another variation is to allow your legs and feet to be held by your
partner and the labor nurse. Or you can press your feet against your
partner's shoulders, which will improve your leverage. The only leg
position you should avoid is one in which you hold your knees against
your chest with your feet off the bed. This tenses your perineum and is
terribly uncomfortable. Unfortunately, this is a favorite among labor
nurses and doctors. Simply insist that your legs be allowed to remain on
the bed,
Most women throughout the world deliver their babies in a squatting
position, and many childbirth experts consider it the best one because
it opens the pelvis up most fully, To assume this position, you'll have to
be supported on either side, most likely by your husband and the labor
nurse. You could also squat unassisted for a while by leaning up against
a wallar the back of your bed, In his book Birth Reborn, Dr, Michel
Odent describes the reasons why women at his clinic in France deliver
In this position: "Most women at Pithiviers give birth in the supported
squatting posltions. By far the maS[ efficiem from a mechanical point of
view, since they maximize downward weight and minimize muscular
effort and oxygen consumption and facilitate relaxation of the perineal
muscles. -,
Two Other good positions are all-fours and side-lying, The aU-fourS is
recommended for back labor because it gets the weighr off your spine.
The side-lying requires someone to support your top leg, but its benefits
include minimizlOg stretch on the perineum and facilitating blood flow
to the placenta, especially if you lie on your left side. BOth positions also
make it easy for your partner to massage your back if the baby is poste-
rior. Whatever position you assume, you should relax your legs between
contractions. This will help prevent leg cramps.
220 Prepllrtttioll for Birth
HoW to Increase Your Effectiveness
- , croasc the east' and effectiveness of your pushmg
To 10 ....
Assume an upright position
Relax your perineum
Breathe accordmg to need
Comracr your upper abdommal muscles
Round your pelvis
Don't get hung up on "technique"
When you push, try to take advantage of the force of the COntraction
and push as fully and continuously as possible. Short sraccam pushes
don't seem to work nearly as well as ones that maintain continuous
pressure. If you are having trouble moving the baby, try m sustain each
push for a slightly longer period of time The breathing for pushing IS
described on page 97,
Vocalizing goes along with any great exenion, and pushing out a baby
is no exception. \V/e're not talking about bloodcurdling screams here,
just ordinary grunts, groans, and yelps. Tennis players, weight lifters.
and karate enthusiasts all make noises as they compete. Although your
doctor or labor nurse may tell you this effort wastes valuable energy, it
actually releases energy and is extremely helpful. Vocalization relaxes
the pelvic floor and is a perfectly natural response during (he second
Stage of labor.
I t seems that most American obstetricians and labor nurses do a great
deal of cheerleading during the expulsive phase. Sometimes husbands or
anybody else in the room join in, resulting in a rather freneuc atmo-
sphere nOt unlike that of an athletic event. Some \\,omen respond well
to this urging; others don't. It's a matter of choice. If having three people
scream, "Push, Push," helps you, that's fine. But if you find It rather
' "h tner ask them to stOP so
Con uSing and oversumulaung, ave your par
you can restOre your concentration. .
. en while they are trylOg
Dr, Odem doesn't believe in )'ellOg at worn II I
. "Words are usua Y Irre e-
10 deliver a baby. In Birtl; Reborn he wntes, " d'
. d I"k' ush or har er -('an
Vant at times like this and certaIn wor s- I e p. h'ldbirth
". a the \\'oma
10 c I
actually have negative ellccts. rten . I ' conflict with
. . rucuons may on )
exactly what she is feeling, and certain Inst a 'f I d speak it will be
hing rIo "
er experience. I tend not to say anyt . If the woman
I t the bab)' come,
something like, 'Good, ' ,goo ", e
secms gripped by the feM of failure, I nllght suggest, 'Don', hold baCk;
cry, shout if you want ro. ..
Elfec"\'e pushmg usualll' entails a bit of trial and error. You should
try different positions and different breathing panerns. Don't be dis.
mal'ed If \'OU don't get the hang of it right away. Some women take
twenty or thin)' minures before they can get comfortable and begin [0
push elfectiveil'. Idealil', you should have spoken to your dOctor before
delivery abom pushing positions and gotten his approval to experiment
a bie. As long as everything is progressing normally, your dOctor Or
midwife should permir you to discover the best position and technique
for you.
In her book, Tbt E\perienet q( Cbildbirth. Sheila Kitzinge r beautifully
describes the importance of sensitivity (Q contractions during the second
stage. "The important thing to remember is that one should listen to
contractions in order to remain sensitive and aware of their exact nature,
and be alerr to any change in their character. The urge to push varies
from comracuon to contraction. One pushes exactly when and as long
and as Strongly as each indicates. It is a little like the orchestra responding
to the conductOr's batOn. The contracting uterus is the conductor."
If There Are Problems
If pushmg should continue past two hours, your doctor or midwife may
begin to gel concerned about the baby's well-being and the reason for
such a long second stage. If this is your first baby, you will probably be
given a maximum of about two and a half hours to deliver him naturally.
After that point, your doctor will want to get the baby out. Three things
will be monitored to make sure it is safe to continue pushing:
The Jlrmglh 0/ the bab)'! hearlbeat. Even if you've only been pushing
for fifteen minutes, the baby's heartbeat will be checked. If there's
any sign of a serious drop, there may be a problem wi{h the placema
Or the umbilical cord. If this happens, your doctor or midwife will
decide whether a forceps or cesarean delivery is Indicated. This
choice will depend on the station of the baby.
Tbe (Ondilion o/Ihe mOiber. Maternal exhaustion can be a big problem
at this point and is perhaps the number one cause of forceps deliver-
ies . Your blood pressure and pulse will be taken to determine how
well you are holdmg up.
The dmmmi (l/ progreH bemg made. This means ascertaining the station
122 Preparation for Birth
and position of the baby. If the baby is descending, you ?:ill probably
be allowed to continue. If after two hours, however. (he bahy SlllI
isn't engaged, thIS could mean your pelvis IS roo small <cephalo-
pelvic disproportion, or CPD). It could also mean the umbIlical cord
IS exceptionally short or that the baby's chin is not properly flexed,
thereby obstructing his passage. In these cases, a cesarean would
probably be performed.
On {he other hand, some women, particularly those who have had
children before, can push out a baby In ten seconds flat. For these
women, the trick becomes not to push, especially until the doctor or
midwife arrives on the scene. Here the thing to do is [Q pant or blow
out hard for as long as you can. (See the correct breathing pattern for
olfsetting the urge to push on page 96.) This is difficult because the
uterus is working against this distraction, intent on expelling the baby.
If the baby is coming quickly and you are home, call your doctOr or
midwife or 911 and stay put. Don't ever allow anyone to instruct you
to hold your legs tOgether. This is a dangerous technique and can cause
brain damage.
Th' . h
IS IS t e moment when the baby no longer recedes into the vagina at
( ~ e end of each contraction, but remains visible, revealing a silver.dollar-
size swatch of hair. If you will be using a delivery room, this is when you
will probably be transferred.
Crowning can be extremely painful if no episiotOmy is performed. The
baby's head is stretching the perineum to its maximum degree, and there
is a burning sensation. You will be instructed to stop pushing; the doctor
or midwife will support {he perineum; and the force of the uterine
COntraction will ease the baby's head out. Once the baby's head has
emerged, there will be a tremendous feeling of release and relief and the
baby'S shoulders and body will immediately follow.
I f an episiotomy is performed, it is done at the moment of crowmng
If i, is done before this time, there will be exceSSIve bleeding. Though
the pressure of the baby's head against ,he perineum createsanumblng
sensation, a local anesthetic is always given before the epIsiotOmy IS
done. The injections are administered in a few locations In order to
numb the entire area and are felt as a sligh' burning sensauon. In thIS
way the perineum will already be anesthesized for the sutchlng
< ~
- -
\ '"
" .
\ ~
IS the second most co.mman in (he
linlred States today. following the (umng of the Umbt\tcill cord. Episiot.
omylx'Came an accepted part of childbirth dUTlng the 1920s and '30s,
rhe erJ when changed their place of birch from home to hospital.
Obstetricians arC trained to do episiotomies routinely, and it is per.
formed in 62 percent of all deliveries, with about 90 to 95 percent of
all firsHime mothers receiving them.
\'{' herher or not you have an episiotomy will depend more on your
choice of doctor or midwife than on any particular circumstance. Some
docw[s do them 100 percent of the time for first deliveries, some SO
percent, and some only 10 percent.
The depth of an incision or tCaf is measured in degrees, from the
shallowest (Q (he deepest. The first degree is the most superficial and
invohes onl)' the outer skin and the vaginal mucous membrane. A
first-degree tear reqUires one or two stitches or none at alL The second
degree will include [he submucosal tissue and the perineal muscle. An
episiotOm)' is a second-degree incision, requiring many stitches as each
layer is sewn. Third-degree tears (which can occur with or without an
epISIOtomy) continue IOtO the rectal sphincter muscle; a fourth-degree
tear extends into the anterior rectal wall as welL
There is no such thing as a small episiOtomy. Most are about one and
a half to two Inches long because [he incision has to be big enough so
that you don't tear past its end. The Cut can be one of tWO types:
Thf rlUd,oJ<ltfr"J IS made on a diagonal. It is usually performed be-
cause the penneum is particularly short or because this rypc is (he
doctOr's personal preference. The mediolateral is considered to be
less apt to tear IOtO the rectum, but it IS also more painful, more
prone to infection, and harder to repair. It also heals more slowly
because the muscle fibers must rejoin on the bias instead of in rhe
central body of the perineum .
Tbt ,,,,dJmt. or median, is the type most commonly done In the
United Slates. II is a st raight Cut, directly toward the rectum.
. a routine You should try to dissuade your doctor from per ormlOg . "
episiotom)" because It's an unpleasant part of chlldbinh [hat can spm [h.t:
web of intervenuon and complication. h's the reason for doing a pubiC
. h' h can shave. It necessitates the usc of sterile drapes during delivery, W IC
-- ._--
Prt'pllrlllifJII for Birtb


"I had a nine-pound baby the first time, so an epIsiotomy was necessary The
healing was so painful I was glad there wasn't time for one thiS ume! I did tear
a lirrie bit, but the healing was nowhere near as painful as that huge cut {he first
"It healed right away, but the doctor was wrong-l felt bOth the cut and the
stitches. "
"I tOre anyway, even with an episiOtomy. Very uncomfonable healing process. '
"I didn't have one, and afrer delivery needed anI}' one sutch."
"This was my biggest fear, but I never felt a thing."
"To me, the stitches were more painful than the labor."
"My doctor was washing me down for an episiotomy when my daughter went
flying into her arms. All 1 ended up needing was one stitch."
"The doctor insisted on doing a small one, JUSlIO give himself somelhing 10 do,
I think."
"The doctor did one that went off to the side and il waS p.llnfu) for Ihrt'e weeks" t'fl'ltmuiJ



"I asked the doctor to "'oid " If possible, and he did'"
.. At [he ume It was a great rehef to get the bab}1 OUC, bur it hurt for a long time
afterward ...
"I had no medication durmg labor /delivery. Postpartum, I needed Tylenol and
codeme for the episimom)' for three days. Felt a little silly needing it afterward."

. ----------i

ObstruC[ your view and prevent you from touching the baby as ,he
emerges. The IOcislon can become a site for infection, which may rcqulfC
you to take the precaution of cleansing yourself with a Betadinc solurion
aftcr unnation. The perineum will swell, itch, and hurt, requiring [he
of ICC packs, !aitz baths, anesthetic sprays, and perhaps even
It often compounds the pain of hemorrhoids. making if very diffi cult ro
Prl!ptlYfllirJ1l lor D,rlb
( I
elaxed and comfortable to any position after birth II If
eC r . a ens your
abilitY to reg
your strength, to take care of your baby and to make
with your husband
In 1981, U,S, government doctors David Banla and Stephen Thacker
conducted a reVieW of the medlcalliterarure concerning episiOtomy and
concluded that" the data on benefilS of epISiOtomy are very poor and
offer no convincing argument .the rouune use of that procc-
Moreover, there arc significant nsks associated with epiSiotomy ure, ...
that have not been adequately studied."
\Vle object srrenuously to the routine use of episiotomies. However,
there are some clear-cut instances in which episiotomies should be done.
They include the following:
When a woman is pushing uncontrollably and it's impossible to
guide the baby's head out slowly. The potential for tearing In this
instance is great, so an episiotomy is preferable. To avoid being cm,
you must have enough conuol to Stop pushing and to simply let me
force of the contraction ease [he baby out.
Some few women have tough perineums, With Iirde pliability or
elasticity. This may be the natural (ondiuon of the perineum or the
result of poor nutrition or lack of exercise. Tension in the pelvic
floor muscles can also cause a tight perineum. This be the reruh
of poor body position (especially if you are lying on your back) or
an inability to let go emOtionally as well as physically.
Forceps deliveries always require episiotOmies because [he norma]
vaginal opening isn't large enough to accommodate the instru,
If the baby is in distress and needs to be delivered quickly, an
episiotomy will be performed.
If the moeher's condition (toxemia or heart disease) necessitates 3
. . . f h' g an episiotom)' will
short second stage with a mlntmum 0 pus In ,
be necessary to enable speed)' deli\'ery of the bab)'
Your doctor may try to convince )'ou that epISiotomies are necessary,
UStng {he follow 109 arguments:
. etlrr 1.1/111 It'arlllg. Women who responded to l)Ur questil)nnalrt'
'/I 'tb I
expressed grc .. dissatISfaction with their epISioromlt's, but time and
lime agam they saId, "Well," was better Ihan I<"aring " In faC! there
IS a good chance thai you mal' not tear at all.
Ihal If IOU do. It'
likely to be ,1 sm;)11 tcar that docs not require repaIr (unlike a deep
inCiSiOn ).
All l'plsi;..)wmies cut through muscles, but tear:; often don ' t. [n
lune 198-4, 8""lJb ,\f{dl{uIJ(Ju,.,ltt/ published a study on rOUtine
-medlolateral episiotomy. In this research, a control group of firSI.
time mothers were delivered without episiotom}' unless it Was
deemed medICally essential: 21 percent did not tear, 25 percent had
a first-degree tear (which does not reqUire stitching because it heals
spontaneously), and 47 percent experienced a second-degree tear.
There were no third-degree tears. In this study, almost half (46
percent) of the women sustained less damage than they would have
with a standard episiotomy, and almost half of that group did nOt tear
at all. The remaining 47 percent with second-degree lacerations
no worse off than they would have been with an episiOtomy.
One Imerestlng result was the finding that only 8 percent underwent
episiOtomy for medical reasons, as compared with 89 percent in the
si); months prior to the study.
The tear )'OU do nOt want is a third- or fourthdegree one, which
extends imo the re((um. There is no guarantee that an episiommy
will prevent third-degree laceration, and in fact episiotomies them.
selves often tear and extend into rhe recrum.
/J 'J t.:Wtrto repatra dfan CUI thana)aggfd It'ar. Yes, it is easier to repair
a clean surgical incision rather than an irregular third- or fourth-
degree tear, but this does not hold true for a small tear. Also, there's
a good chance thar if you don't receive an episiotOmy, you won't
require an}' repair at all.
iI'.r good to Jell" you up Ilice and ligbl bt'Causf lhiJ will mha,,(' /lIll1rutxlIal
pltl1Jl1rt. No study has shown that a tighrly sewn perineum guaran-
tees sexual satisfaction to either party, and in fact, it can decrease
sexual pleasure because it can make intercourse very painful. The
Kegel exerCises (see page 124) are more effective than episiotomy
m regaining vaginal tone.
t A,t t-pmotomJ (an Jaft' YOllr baby/rom bfin8 brmll damaSI'd An episiot-
om)' IS nOt a ratIOnale for avoiding brain damage. The reasonmg
behind thIS notion IS that an episiotomy can shorten the second stage
of labor, thus saving the baby's head from pressure against the
penneum. The study In (he Bnw/) Mtdi({J1 jOllnwl stated that It
"produced no eVidence of " trauma to the baby's head, or greater
damage to the pelvic floor, when episiotomy was nOt performed,"
If your dOctor cites brain damage as a reason for episimomy dUTlng
Preparflli')IJ jor nirth
a normal delivery, he
probably dl\lrum na1ural chlldbmh ah(
/ 11/ eplrtoto1l1Y ({J1l /'runlt it/emit pm/ap., latfr HI I,ft There been
no proof that episiotOmy prevents future uterme prolapse :l condi-
tion in which the uterus falls IOta [he vagI03). Prolapse m4 \1 frt.:-
quently occurs III women who have had children or 10 women
whose pelvic muscles have been weakened by mid. or high-forceps
deliveries. In fact, most of these women have received eplSIQtomles
An e/uslO/(JI11Y If 11t(fHtlry if JOu hOlt 0 b,g hab.. No one has to stretch
your belly to accommodate a large baby, so why should anything be
done to your perineum? The difficulty In delivering a large baby has
more to do with {he size of your bony pelvis than the sofl tissues of
your vagina. Skilled doctors and midwives can and do deliver large
babies over Intact perineums.
If you do have an episiOtomy, you will be given a local anesthetic. such
as lidocaine. There is often a tingling, burning pressure mar is felt as the
baby is about to be born. This sensation can act like a narura! anesthetic,
but you should definitely have a shot of the real thmg, because )'OU WIll
need it for the repair. Even with the injection many women can feel the
stitching, and it will take about (wenty or thirty minutes to be sewn You
should do your Lamaze breathing and diStract yourself by holdIng ,he
How to Avoid an Episiotomy
an episioromy isn't simply a matter of askmg your doctor or
midwife not to do one. First and foremost, rou need to be in a proper
A medical student recendr tOld us, " I used to believe episiotO-
mies weren't always necessary, bur resrerdar I saw a woman rear very
badly." \'{then we asked abour the mother'S position, the student said,
"LithOtomy, of course." You cannot be on your bJck with vour legs
spread wide apart and expect not to tear. InstC'Jd, you must be sitting,
squauing, or lying on your side_ Your doctor or mIdWIfe should be
sktllful. and of course, there can't be any medical na-cs:;lty Lastly. deh\
eflog over an intact perineum is a teant effort, reqUiring pJuence and
. b d -d 'I'e y,)U must be Jble
... ration etween you and },our octor or ml " I' .
10 push or stop pushing on command, ,he bab)' '" lx' be"n
sIawI), and gentl)'_ You "'''' also need reassUCJnce 'hM ,he burning
_' 1
\l'llsacion Yl)lI wi II (eel IS norm.ll. and temporaq'- " ou must be convinced
that ;1 litlk extr.1 ctrl)rt now will save a lot o( pam and difficulty later
mldwi'"L's advocilte massage as a means o( relaxmg the perineum.
oil eln be wlukcd into the skin to increase elasticity, and the gentle
clOd stretching techniques are performed throughout the entire
second stage o( lahor
AnO[her method (0 avoid episiotomy is the Ritgen maneuver: A towel
is held o,cr the mOthers renum as upward pressure is exerted on the
baby's chin through the perineum. This action permits a careful and
deliberate delivery o( the baby's head.
Still anOther technique is "ironing the perineum," which means the
muscles arc slowly stretched by applying finger pressure against the
mside wall of the vagma during the final stages of labor. None of these
methods have been scientifically tested, however, (or efficacy. Many
practitioners manage to avoid episiotomy by doing nothing mOre than
supporting the baby's head as it is born,
ThIS is absolutely the best part, It's the moment when labor and delivery
are finally over and you can see your baby at last and know if it's a boy
or a girl. Normally, the sequence of events goes something like this: The
baby's head is born and the donor or midwife immediately suctions out
mucus with a bulb syringe. With one more push the shoulders are
delivered, and then the body, Somebody yells, "It's a boy!" or "It's a
girl!" and either you or your husband or both begin to weep, The baby
is checked OVCr and suctioned again, then he is placed on your chest with
the cord Still Intact. If his color is normal, you should be permitted to
hold the baby (or a while. At some point during the first few minutes,
he'll be footpnnted and tagged for identification so that there's no
possibilIty of mistaken identity later on in the nursery.
Cutting the Umbi li cal Cord
One variation In thiS scene is the timing of the cutting of the
cord, ApprOXImately one-fourth of all babIes are horn with the cord
, II'
wrapped around rhelr neck, Usually, rhe doctOr or midwife can simp
unloop it Ovt:r {he baby's head, but If the cord is tOO tight or wrapped
tWice, It will have to be cur right away. To do rhis, the cord will be
23-1 PYl'pdrtltiOIl jor Birth
clamped in tWO places and CUt in the mlddl I'
. e, [s a p ,I
r both partIes hecause the cord Contaln, n fi rU{'l'uure
. '" ' {) nerve bcrs.
If there IS no complIcation with the cord it' I"k I h
' S ley t al your baby will
be allowed to rest on your chest for a few minute. Lf
uc ore curtlOg ThiS
delayed clamping permits the baby to Continue to ' .
. _ receive oxygen and
helps the uterus contraCt, which aids the natural e I' . h
. . , _ xpu Sion ot c l' pla-
centa. Sometimes the father IS asked if he would like to cut the cord, and
we applaud any doctor or midwife who would make this lovely gesture.
Another school of thought on cord cutting is to wait about three
minutes to allow the cord to stop pulsating completely in order to permit
a complete transfer of the remaining placental blood to the baby. Recelv.
ing this additional blood has been shown to prevent anemia in later
infancy, but in order to be successfully implemented, the baby must be
held below the level of the uterus for the entire three-minute penod.
This prohibits the immediate skin[Oskin contact that is deSired by most
parents. Late-clamped babies have been shown to be more red, more
irritable, and more wakeful during their first few days of life. And these
babies also have a higher incidence of newborn jaundice from the extra
blood cells they have received. Late clamping is a controversial proce
dure that some people strongly support You should discuss it with your
pediatrician and obstetrician before delivery.
Feelings Immediately After Birth
No matter how many preparations you have made In advance, it is still
a shock aCtually to be holding your baby The room mIght be all set up
at home and all the baby clothes bought, but somehow it's still a surprise
when the fantasy becomes reality. You may have watched the entire
binh, but it's still hard to associate {he newborn in your arms with the
active being that was just inside you. For most first-time parems, the
pregnancy is one experience, being a parent is another.
How you feel after birth depends to :l great extent on the (,ourse of
eVents during your labor and delover)', But if every!hlng has gone well
and you've counted ten fingers and tcn tOes, }'Oll l\tIJ probabl)' "experl-
('nee the most incredible "high" of your life. Ten minutes earher
have been ready for a tubal IogauOn, but noW y<lu're alread), !honk
109 about the next time, You WIll fin all)' understand why women >J)' !hll
the pam of labor is worth the reward of birth.
TI Y a ' be exhaust\..J, but
1cre can be mixed emotions, toO. au m )
w' d' ' b rr)' )'OU'rl' nl1( prCllnant
I c awake; ecstaw.: thl1t labor IS over, lit so
81rtb :..;


I :\1 \1 E n I ATE L Y
"I (elr like the only who had ever given birth, I wasn't sure how Other
women got their babies, bU[ I was sure they hadn '{ done what I had."
"I was thniled and felt that I could stand up against a den of lions 10 protect my
"I felt pnde in accomplishment, and relief-and loneliness, My body was 'alone"
again_ .,
"Ecsrasy' All (he pain was immediately forgOtten. I wanted ro laugh and cry and
hug everyone In sight. My doctor came over and gave me a hug and a kiss, too."
"I felt distance toward the baby, nOt cIose to him right away,"
"Exhilarated! I felt as if I'd run a marathon and come in first. My baby is rhe
equivalent of a gold medal'"
"Absolute elation, and a love that filled my entire body. I wanted that momem
to last forever. The pictures show me being very tired, but I had lots of energy.
Very self-satisfied and in awe of my iiule miracle."
"Relieved I d,dn't feel that Interested in the baby, [ JUst wanted to sleep,"
ronl ilJllt'll

236 Prepllrll/;01] for Bi,.,b
1 I

Fl.ll,IN GI l'I'If.' I
. . , \ 'T
"I was exhausted physically and emotionally. In [he recovery room, I felt very
lonely and isolated, I didn't feel like I had a baby because I didn't get to see her,
I wish I could go back and make them let me hold her as SOOn as she was born,
I missed out on It because no one thought of me at that moment."
" H ungry, happy, and satisfied, Atthe same time, though, I felt as ,f I'd been run
over by a cement truck (or given birth to one!)."
"I felt like Mother Earth, I was overwhelmed by maternal love and felt I had
accomplished the greatest thing a person can ever do in life."
"I was amazed she was a girl. I wanted agirl very much and couldn't believe God
was so kind, And then [ was flooded with relief that she was healthy and looked
so st rong and aware."
.. I was so full of adrenalin I could have climbed a mountain
excited and madly in love with my daughter."
I was gtggly and
"For as long as I live, I'll never forget how it felt when she came slithenng out
of my body, It's a feeling that words can't express, and I thank God I didn' tgm",
up in my mother's era, when ther put you out and you missed all that."
" I
never felt as close to my husband iO our four years of marriage as I d,d then.

r --; -.

... I \1 I n I ,\ T r t, 'F T l I( B I R T II
"The midwife handed Bert the scissors to cut rhe baby's umbilical cord. This an
summed up (or me the last nine months of growing this child. He was no longer
of me. btl[ rather a person umD himself."
"M}' husband turned to me with tears in his eyes and said, 'Thank you. Thank
),ou so much!' ..
"The moment my daughter was born, she was placed on top of me. She just
looked at her father and me and moved her arms and legs , taking in the new
world. VX'e were scill connected by the umbilical cord. The most exhilarating
feeling came over me."
"The doctor placed Christopher on my rummy, where he took one look at me
and hord,d.' Then I knew everything was okay."
"The highlight of my birth experience was when I tentatively reached out and
tOuched my son for the first time."
.. I first felt sorry for our baby when J heard him cry at birth. J t must be a real
trauma being born! Then (here was excitement, a feeling of everything being
unreal, probably a little fear. and a sense of wonder. When I saw him, I knew him;
he looked familtar ..
"I couldn't believe she was actually there and nOt inside me any more. The lump
had become reality"

2lR PreptJrtllif)" ff)r lJirt/}


" \ was amazed at how large and alert the baby was, how good I felt and hnw
it was to finally look at the person I had known for nine mOnths,-
"When I first saw her, she looked exactly like my mother-m.law, and I thought,
'Oh, my God, after everything I went through, this is what I get?' But that mght,
in my room, she was the mOSt beautiful thing 1 had ever seen:'

.. Aaron was born with a cleft lip and palate. I bawled my eyes out for a minute.
Then my husband brought him to me, and we all fell in love with each Other as
a family. It was the most emotional moment of my life:'
"The baby was a girl , which my husband openly wanted and I secretly wanted.
so I was thrilled because of that. She had ten fingers, ten toes, all normal. whICh
is always a concern. She was just so beautiful, beyond words!"

anymore; you may want to hold the baby, but also want some time by
yourself to adjust to the fact that the work of pushing is done .
h's no wonder that your body may exhibit a typical shock reaction. h's
common for women to feel suddenly cold, with chattenng teeth and
uncontrollable trembling. This is normal and will subside after a time,
Ask for blankets and have your panner put {he socks from your Lamaze
bag on you r r eet.
YOur N b
y ew oro'S APpearaoce
0fU may be a liulc alarmed at fir5t by your bab.y" appearance Many
10 ants .
emerge ,n n rather limp ,nue and are bluISh gr.} ,n color Thi,


IS normal \\'Ithln hOW(,\'Cf , the lungs will fill with air a I
, __ . _ ,n{the
baby s skin will ht'(.l)me OX)gl'oilled and pink. Some babies l')
me OUt
sacamlng and kICk 109. wherL'J!'. others are qUiet and watchful so d .
' . k' ' on,
be C('Inn:rne It yours Isn r rna ' log any nOise
There are a number of mher po!islblc characteristics of rhe ne be
W cn
that may srarde you, Including'
A creamy ",hue skin covenns called urtJI.\ which looks like cold-
(rt.'rnl., hUI pn. 1fl'((S the baby's skIn during hiS nme months in water
A (oal of nne downy half, (ailed I.mflgo, that falls off within a few
The gennals will be swollen, and often the breasts will excrete
tiny drops of milk, called ll'it{ht'J' milk. Girl babIes can also produce
J amount of menstrual-like bleeding. These symptoms are all
caused by the morher 's hormones and are shore-lived.
Most bahies are born '\\'ith blue-gray eyes, which may later change
Many babies have misshapen or pointed heads due to the
moldmg of tht:lr skull bones during (he passage through [he
mmher 's pelVIS. You can see perfectly-shaped cesarean babies In
the nuneq', but It mar be several weeks before your baby's head
oc'Comes completel)' round"
The Apgar Evaluation
the flnt (ew minutes after birth, your baby will be watched
carefully b)' the nurscs In the delivery Or birthing room to make sure
he IS normally to the new environment. One minute after
hirth, and {hcn (our minutes later, your baby's healch will be evalu-
alcd five vital signs: color, heart ratc, reflex irritability, muscle rone,
and ThiS [<:SI known as an Apgar t'xum, named after Dr.
Virginia Apgar, an anesthesiologist (see chart). Each category can re-
(l"I\"e a maximum of two P<)IOIS. makmg ten POints the highest score,
Thl'rc 1\ u,uallr an ImprOVCml'OI bclwcen {hI! first and second score, A
tYPl{al '>oc- and riYl'nllnuu: Apgar would he 719 Although Apgar
1\ JX'rvaslVl:, It IS not a (omplt:tc1y reliable bt'caU"il'
It IS sunll'(tlvel)' d<:ll'rmlnt:J The or midwife who dclivcn
the nab}' glYl't rhl' rilling, and thl!rcfore iili HrMI
hiS own
If Ol ,x:dIOllfitlan l!ii prC:'Il'nl, h()Wl'Yl"r, he will lll'll'rrnlm' till" Ap,4.lr
Prt:p,.U',ltlfm jlH Birth
l. Response to catheter in
nostril (tested after
oropharynx is clear)
2. Tangential (oOt slap
)Iow (belt
Ov. 100

I Weak 'ry, e"OOQ sin n,l!: try
Some (If 'X, ell flexed
I c"(lrI:mltle1
No Responsc I Gnmace Cough or sneeze
No Response Gnmace 1 Crl' and wHhduwal
I of foo!
Blue, pale I Bod)" pmk Completd)" pmk
ExuemlUes blue
scores. This would happen under speCial circumstances, such as after a
cesarean or a difficult forceps delivery. Don't put tOO much store In these
numbers. It 's only a gross assessment of the baby's condinon. and 3 more
detailed examination will be performed later in the newborn
Eye Drops
The first hour after birth IS a time of amazing alertness fl)! your ,hilJ
He can hear perfecdy and will turn hiS head (Oward you as )"OU spcJk
A baby's eyes can focus on an object eight to in(hes JWJ)"; thiS
means your baby can see your face J.S rou hold hIm in lour arm' Fell
thiS reason. many parents .\sk to ddil\' the JdmiOlStC'JlIl1n llf slh"l'rniu"Jtl'
eye drops. The drops prc,en< bllndn.;; lJu,,,,1 hr ,he IrJn,ml"lon e,f
malern.1 gonorrhea ,\Od arc m,lOdJ'd b) bw In m,'" "JIll Th<) JI>,'
Iff"all' Ihe eyes, lolUSlO1t ,I ,)' pe of )nlunc(I\,\m. whllh "n IJ" f,ll.
day, The baby\ l')' e, benlnll' putT\' .\OJ fld, Jnd hI (3n', we J' \\.-11 ..,
he J"I a' hlf(h. I'M 'h" re."'IO. lupk' wmmonlr r<<1
t'l' ,ha' ,he' J,,'P'
he Rlvcn HI ,he nllm'rl' .1I<er ,he' ne"lxlln ",.m .. If,,r ,hn
" haJ
ade(llIlI(e 11m,' In <ill' dd" "f)' I" rel,m'" r,,,,m I') .IqualO'<'I1 \Ian)
Itn'l"II " If' 'h ml"lln llr
.' .1 \ nnw .11l
JlII.:.11 .lppI!C.ltlllll II lr)t nl

olOtmcnt Instead of the ~ d v e r nitrate drops because they are can d
~ 51 cred
less Irritating.
From reading our questionnaires, we were distressed to learn that par.
ents and babies are stili be 109 separated after birth. The hospital's ratio.
nale IS that the bab}"s body temperamre can be maintained ani}, in a
warmer. ThIS isn't true. A baby can be kept warm enough if he is held
close to hIS mOther or is well swaddled and nOt losing body heat through
an uncovered head. Some hospitals provide tiny caps to keep babies
We encourage you to savor this special postpartum rime and to make
It last as long as possible. [f the baby is healthy, this is the time to enjoy
the reward of all}'our hard work. It's also the beginning of your relation.
ship with your babl', and these first moments might make a difference.
Drs M. H. Klaus and). H. Kennel of Case Western Reserve Univer.
SH1' created a body of work on the emotional (ooneedon between a
mother and her newborn Immediately after birth. They called this pro-
cess bOlldmg. and although some of their claims for long-term results
have been called tnto question, their appealing idea has caught on. It is
mutuall)' satISfy 109 for both parents and baby to have this special time
to become acquainted. Romine separations have been eliminated, and
bonding has been incorporated in most hospitals.
Bonding is great, bur it's nor a prerequisite {Q a good future relation
ship. It's the optimal thing to do, but if you have a cesarean under
general anestheSia or if {he baby must be taken to the nursery. this
separation won't ImpaIr your ability to love your child. Some people will
nOt feel tnstantly comfortable or in love with their baby, and that's
normal. Some people are so swept away by labor and delivery that it's
difficult to ,witch the focus to the baby, and that's normal too. However
}'OU feel aftcr bIrth, be assured that just about every person is capable
of forming a strong attachment to his or her children.
Nursing After Delivery
NurSing immedJalely after delivery has become part of rhe bondIng
process. The: nipple: sflmulation and the skin.to.skin comact will help the
u(Crus COntrau and expel the: placema, and you can ,qCt a rrcmcnJous
PreptlrtlJirJ1} /01' llirJiJ
. arching your child performing this first Instinctual act. You high w
Id 't feci pressured to nurse immediately, howtver. If you're too hau n
'd the baby JUSt prefers to look around. You can try later 10 'he [Ire or
room or back In your own rOOm In a few hours, The more ecovery
r t ,hlOg " just to hold your baby and bask 10 the knowledge that importan
' ng has turned out well.
everyt I
In the past decade, procedures in the delivery room h be
ave en in-
fluenced by ,he work of the French obstetrician Frederick Leboyer.
Gone (we hope) IS the practice of welcoming the baby IOtO the world
by dangling him by the feet and slapping him on the bUllocks. InStead
delivery practices have been shaped by Dr. Leboyer, in accordance with
his techniques of "gentle birth": low lightS, delayed cord clamping, soft
voices, no routine suctioning. skint(}-skin contaCt, and a warm bath
Birth Withollt Violmet was published in France in 1974, and since that
time Leboyer's approach has been adapted by doctOrs and midwives
throughout this country.
His philosophy is to make birth as atraumanc as possible and to ease
the baby's transition from the mother to the outSide world, This means
re.creating an environment that closely simulates the intrauterine world:
a subdued atmosphere and [he continuation of physical contact with the
mother. Delayed cord clamping permitS the baby to begIn breathIng at
his own pace. The purpose of the bath is to return the baby to the familiar
sensation of being suspended in water. , .
The bath is usually the hardest part to arrange in a hospital because 01
. ' . ommonl}' done
concern abour possible heat loss. For thiS reason It IS most c
. b. . . b' h ters \VIe know of several
to Irthmg rooms and in alternative-- let cen .
. h h d I e"' room bUlIngeneral
ospltalsthatpermittheLeboyerba[ lOt e e 1\ .J '.
this can be difficult to get because delivery rooms are keptqulle coLld
. ho can arr'.lnge for J e } er
Your doctor or midwife IS {he person W I b h th [his
. ~ . gent e Irt 1;\ I
delivery, You should discuss JOY eSlre or J
person well before labor.
The dclive f
II IS ry 0 the placenll' is considered the thIrd <l.ge of l.bor, dnd
, usualll' pa I A' h 11
,In es>. Iter 'he bab)' is born, t e uteru' WI "lOlInu" ll'
CI.)mract, and tills shrinkmg will (J.ust:' the placenta to detach from lhe
utcrine w311. This process has been likened to a postage !itamp pechn
otf a deAated balloon. \\I!h one rinal push it will be expelled. The u t c r u ~
will continue to (ontlJ(t, sealing off the placemal site and shrinking until
it IS about the sizL' of a grapefruit.
Nonnalil'. the placenta appears anywhere between five and thlny
minutes after birth. Some doctors w3nt to speed up this delivery because
(hey are eager to begin the episiotomy repair. In order to accomplish
thiS, [he dOClor or nurse may try to push very hard on the top of your
stomach to iniciate a strong contraction, or may rug on the umbilical
cord. These tWO techmques are dangerous and should never be per-
formed_ They IOcrease the chance that a bit of the placema may break
off, remain an3ched, and thus cause hemorrhaging.
It's rare when the placenta does not emerge. If this happens, your
doctOr or midwife may have to reach into the uterus and extract the
placenta manually You will probably be offered a whiff of nitrous oxide
if manual extraction is necessary because it will hurt.
Giving a shot of Pitocin right after delivery of the placenta is quite
routine; however, many women are unaware [his is done. PitOcin really
isn't necessary unless your contractions are tOO weak to close off the
placemal site, whICh can occur after a very long labor or if your uterus
has been weakened bl' having many children. Two good ways to encour-
age natural expulsion of the placenta are putting the baby to the breast
(or anI' form of nipple Stimulation) or gendy massaging the abdomen.
Many doctors feel legally protected if they adminiSter Pitocin, and they
reason that there's no harm in giving it prophylactically. On the other
hand, Pitocin conrractions can be more painful, and it's another instance
when an Intervention is given "juSt in case."
Once the placema has been expelled, labor and delivery are finally
complete, and the postpartum period has officially started. Any perineal
tears or episiotOmy will be Stitched, and your legs and belly will be
washed, You will then be moved to the recovery room or allowed to
remain 10 the blnhmg room. In either location, your husband and baby
will usually be permitted to remain with you for an hour or so. Preg-
nancy is over. and parenthood has begun.
244 Prepardtiorl for Birtb
T' he ideal birth is an unmedicared one. Natural childbirth produces
healthier babies and allows new mothers peace of mind unattainable
me teate birth. Unfortunately, only about 10 percent of all
with a d' d '
women in the United States today experience labor and delivery without
drugs or anesthesia. We think this is deplorable because of the risks
associated with medication and because the quaJi'l' of the b"th expen-
ence can be compromised by unnecessary or poorly administered drugs.
Many women tOday abstain from smoking, drinking, ot taking drugs
during pregnancy and claim to be concerned about the effectS of medica-
~ o n on the baby. They should be, because nO drug has been proved to
e both free of risk and effective. As stated In the med".,1 textbo<,k
," ftiif"lio,'
Oh.rldrt,'J ,111,/ (,)lInldO,f!,J. by \Xlils(lO. Carrington, ilnd Ledger, "Many
druD's have hcen given to make labor and dehveQl less pamful b
t:'> Ut
untorrunJtely. all hJve disadvantages that limit their usefulness. The
'perfect' agent must prOVide relief from pain while It neither interferes
With the progress of labor nor i.\dds to the maternal or fetal risk. Such
an agent has not yet been discovered."
\X'e're not against the use of drugs or anesthesia during labor when
needed Obviously if there are complications, medication will be in-
dicated. \Xle are, however, adamantly opposed ro its romine use and its
prescription as a substituce for emotional support. There are several
interdependent reasons why thousands of women expect to have natural
childbIrth bu, end up wi,h some,hing quite different . They include 'he
H.lt ing 01 bJby r.m be 1 if) p{lIIJjul. and many women are nm prepared
for an}' sensation be}ond a mild menstrual cramp. They feel angry
and betrayed when labor gets tOugh, and chis reaccion undermines
their abiliry (0 cope. The normal reaction {Q something new and
overwhelming is to become frightened; this fear makes the pain
worse, whICh makes the fear increase, triggering the vicious cycle of
Do(/orJ are framed 10 relttt't'su./ff'r"'g, and (hat means giving pain relief.
The)' are not taught to sustain their padents emotionally, alchough
in childbuth, that's what's really needed. Many doctors can't accept
pain as a normal pan of birth and {hey feel obliged to offer women
drugs. If, every time an obstetrician was asked for medication, he
spent Just ten mlOutes talking to a woman and her partner, breathing
with them, or offering reinforcement for their eifons, the use of
medication dunng ,hildbinh would decline precipitously.
A u'oman m labor tluds (om/ant support, especially during transition,
She needs a sensitive doctOr or midwife, good nurses, and an excel
lent partner, If any of these components IS miSSlOg, her chances of
having natural childbirth are diminished. Encouragement during
trans1tlon IS critical because that's the time when a woman asks for
medICation-and she gets It, ThiS is a shame, because (hiS phase of
labor relatively shon and anything taken now will Impair her
ability to deliver naturally
Our lo(itl}'llctr/JlJ tlnd tl'ff/ promottJ drug life, Americans are not 3lCUS'
tomcd to <.:xpericncing paLn, and therefore H "ecms nrll to
take medll.;alion when somcthing huns. There's no pOInl in
Prepur,lliOIl jor Birth
holding pain relief from lerminallyill or bUI
c.:hilJbirth is tWft'rcnt It 15 nm an Illness, and it IS nnne
There arc four primary types of pain relief availabl . h
. . ,. . _ t: In r 3pnak
"Igula, whICh inhibit the reception of pam stimuli and 'h f
,I ere ore raise
,he P
ain threshold; loctli and rtglo,wl antJlhetm which in,er h
, ' ,rupt t e trans.
mission of palO Signals along nerve fibers; and gffltral atmthtll( which
produce unconciousness, All drugs pass through the placenta and affect
,he baby 10 some ex'ent, al'hough 'he specific effects depend on 'he
panicuiar drug, how it is given, the dosage, and when It IS administered
Medication is a subject that should be discussed with your doctor
ahead of ,ime, preferably at ,he beginning of your pregnancy, so 'hat you
know whether he truly suppOrtS natural childbinh, In any event, you
should discuss medication again, sometime near your due date, so that
you can find out what you might appropriately receive if there are
complications. Most donors have favorite drugs, and the choice will also
depend 10 a great ex,en' on ,he prac,ices of the hospItal. S,ill, you should
be informed about possible choices in the event that medication IS reo
Drugs used during labor or delivery include analgesics, tranquilizers,
barbituates, amnesties, and inhalants. They are administered either sin-
gly or in combination, to alleviate pain. By far, the most commonly given
medications are the analgesics.
Ana l gesics
drugs, also known as narcolICS, are ,aken during ,he firSl S1age "I
or. They can be administered through an inml\'enous or by an Intra-
muscular in.'. T <r . d be f I
. )cCIIO
. he eneClS at In,ravenous" mlOlSlcallon ,an e'
Within ' ' '
b mInu,es, bu, " WIll wear off more qUICkly ,han a Mr(OIl( 8"e
y Intf'\m I . . . t I , uscu nr In)CUlon. " ,akes 10 to I) mlnu,es or an aM ge,,( to
,ake effe .1. . . I II
. c, I "IS given Intramuscularly (drugs are [Jre Y gIven ora y
dUflng I I I .. t t 'h h .
. "" leeause ,he dlges
system has slowe< ,own," Il 1m
PIli" 'he I ' I. I. rug S Ul)S(lfpttOn) ,

r..f l n I ( :\ T I 0 N
. 'Before labor. I was absolute1r Opp\1scd to medicauon, thinking {hat women who
received it were' chicken.' Now I feel that you do what you have to do. 1 feel
fortunate ro have made It through labor and delivery without medication. 1 feel
proud. nO{ heroic."
'" 'O.'as all for medICation. I thought painkillers were the answer. Never again! I
felt maOlpulated and out of control."
I dldo'r want any medICation and didn't receive any. I feel this is best for mOther
and baby. However, I no longer feel that a drug-free delivery makes you a better
mOther or a stronger woman ...
"My husband and I talked about going drug-free a lor and really 'psyched'
ourselves up for u. I thmk that helped. If I had gone into labor feeling, 'Oh well,
if u hurtS, I'll take something," I probably would have."
"Once I starred having labor painS, I realized there was no way I could have
natural childbmh,"
'" wanted medication. but I was seven centimeters dilated when I gOt to (he
hospual, so I couldn't have any, It really wasn't all that bad, and I'm glad I didn't
take any.

2-1H PrepllrtlliOll jf)r BU"I/)

M tD CAT1 1
"Never fclt that I wamed to have medication before or dunng labor and delivery.
I knew that I wamed to be done with the job, but that medication wasn't a
solution. "
"I wanted a 'proper' entrance into the world for my daughter. To me, doped up
is not the way to be born. Secondly, I was totally selfish. I didn' t Want to mw
anything because I was 'out of it.' "
"The second she was here, I could enJoy her, enjoy the moment. Felt great, gOt
to my room, and sem my husband for pizza. It was such a truly wonderful
experience, Even twO hours after she was born I said labor was awful. but J W35
really glad I hadn't opted for medICation,"

By far the most popular narcotic of all is Demerol, but Nisenul and
are also sometimes prescribed during labor, Nisentil is fairly
Widely used because it is as effective. but shorter-aCting than Demerol.
It is given in doses of 40 to 60 milligrams (mg),
\VI e have devoted most of our discussion of narcotics to Demerol
because it so widely available and so popular as J method of pam relief
during labor, The use of Dernerol is so widespread that man)' pt.'1ple do
not fully consider its proper use, its risks, or its side effects. Deme
(meperidine is its generic name) is a depreSSll
oi the central nervous
system; it can be administered by an intramuscular inj!.'(Uon or (hroug
an intravenous line, It is normally gIVen in doses ranging from 2'5
milligrams, which last an),where from twO to four hours A ,h,'t 01 2)
m'll' J h . the -Jnt!.' dl):i""
I Igrams takes about I'; minutes to lake eutXt, w erei.Ui )
PUt into an IV line IS felt immediately. - . I
The good "bout Dcmcrolls that II Will rei .. , \'ou t,' et




t t t t t t t t t

'My labor ",as long and hard. \Xlhen my donor decided to stick with a va8lnal
deli,erj, the)' offered me some kind of drug, which [ took. [ was able to sleep
berween contractions and keep comrol."
"'X'hen [ finall), asked for relief from the pain and got a shOt, my attitude got
better. ,.
"The Oemerol relaxed me and allowed my cervix to dilate and my delivery to
go quickly. My goal was to deliver as easily and as safely as possible for both
m),self and the baby. [ had Oemerol bOth times, and both my children were alert
and active."
"[ WISh [had not fina ll y accepted the OemeroL It didn't do anythmg except make
me sleep a little and not push with every contraction."
'All Demerol did was make me vomit!"
"The medication took away what control I had and left the pain."
"The pains were JUSt as stron8 after I took some medication, but 10 between lhem
I could JUSt collapse. The pain was easier to bear, and time didn't make much

t t t t

t t

250 PreparaliQn for Birt h



t t


"Demcrol was not properly presented to me My doctor 'Old me It would help
the pam, but instead I was practically unconscious between contractions, which
seemed to lntensify and worsen,"
"If I'd known I was going to deliver so soon, I wouldn't have taken it."
"M y doctor said it slowed my contractions."
"The medication made me see double and slur my spe{!(h. It frightened me, but
1 was already into transition and I could nO( articulate this to anyone,"
"I had Demerol. I'd rather have done without it, but I now understand Its
usefulness, ,.
"Next time I will nOt use drugs unless it is absolutely necessary My son did not
begin breathing normally, and I attribute this (Q Nisentil."


you doze between contractions. It will not take away the pain. it will juSt
PUt you in a state in which you don't care about u so much. Women have
; eponed feeling slightly drunk under the InRuence of Demerol and
Os 109 their ability to speak and reacl at a normal speed The bad thong
about Oemerol is that it can prolong labor because it relaxes smooth
muscles, thus reducing the effectiveness of uterine contractions It can
also m k . f 11 a e you nauseated; approxImately tWO women out 0 len WI
vo . f
mtt rom the drug.
. \lft/iMI IOU
Demc?rol will ;lffen the baby's central nervous s),srem as well. Arrer
birth, breathing mar be depressed, the heartbeat slowed down (brad)"
cardia), body (cmpera(ure lowered (hyporhermla). and relaxation or the
smooch muscle may produce poor muscle (One and a dela)'ed Suckmg
reflex. These reacuons can occur because any drug taken by the mother
pas,es quickl)' to the bab)", brain and blood through the placenta, Be.
cause the babr is so small, he metabolizes and transrers back drugs to his
mother's bloodstream at a far slower rate (han he receives them, This is
an indisputable fact, and while you may be correnly lold that Demerol
won't harm your bahy, you should know it will affect him.
\X'e're not advocating a ban on Demerol. We're merely saying it
should be used intelligently and not prescribed as casually as it is today
by so many donors. There are twO c1earcut instances in which an analge-
sic can be a real boon to a troublesome labor. They are when:
You've been up ror {Wo days with false labor. Finally, you are in true
labor, admitted to the hospiral and only three cemimeters dilated.
The problem is now exhaustion and how you'll handle the demand-
109 pans of labor to come. Demerol rna}' give you the ability to doze
berween contraCtions and carch some needed sleep. I t can allow you
to recover rhe energ}f necessary for an unmedicated delivery .
You arrive ar the hospiral and you're three centimeters dilated.
Three hours later you've reached five centimeters. Three hours later
you're still five centimeters. The pain is becoming unbearable be
cause you know your contractions aren't doing anything. This situa-
tion is called a plateau, and it's not uncommon. It can have a physical
as well as a psychological basis. Before taking a drug you should try
walking, putting pressure on spleen #6, a shower, or a good cry. If
none of (hat helps, Demerol may help you to relax and allow labor
to progress_
The key to Demerol is tn the timing. It is not considered good medical
practice to give analgesics during early labor because of [he likelihood
[hat contractions Will be diminished in strength and frequency by (he
drug. On the other hand, medication should not be given near the time
of delivery because at (hat point an infant is at the greatest risk of
respirator}' distress. To be used most safely, Demerol should be taken
during active labor. The tricky pan is determining when active labor IS
taking place and how long it's going to last. Many women spend sever.al
hours in activc labor, but others dilate from four to nlnc centimeters In
252 Preparal;OIl for B;rlh
forty minutcs. Ir a woman takes Demerol d h
an I en :IilafC,; dl
mean that she may be too sleepy and unroc d ~ rap! v, ir an
r Ust If pU'ih OUt her b- ,b
without the help 0 lorceps, or that thc baby w-II h ' ._ V
. I ave trrolblt brea!i'ung
at birth.
We expect that your dOctor will attempt to coo d ' h . ~ .
. _ r matt t t: I.UmlOiStra_
(Ion of any drug with your anticipated time of del, v, B
rv ur as one
expert, Or_ Howard Sha
,_ states in Thi Prt-gnall(Y B'1Ok lor Today I
WomalJ, "Unfortunately, predicting the lime of birth is oftcn dtfficuh if
not impossible and occasionally a baby may be born with more than the
desired amount of medication in irs blOodstream." If this siruation oc-
curs, it can be remedied, according to Shapiro, by injecting a so-called
narcotiC antagonist, Narcan (naloxone hydrochlonde), into the blood
vessels of the umbilical cord_
Obviously, jt'S best to avoid an analgesic if you can. But this is difficuh,
because many obstetricians prescribe them at the first expression of pain
or discomfort, and women believe their doctor knows best. Many
women feel proud that the)1 made it through labor and delivery on only
a little Demerol. We feel that pride is justified and we're nOt trying to
make you feel guilty for taking an analgesic. We JUSt wan! you to rccog-
nize the risks of Demeral and to know you have a real choice concerning
its use.
Tranquilizers include: Valium, Vistaril, and Phenergan. Ther are used
either singly, or in combination with narcotics, i.e. Demerol and Phener-
gan, to decrease nausea and increase the effectiveness of the narcotic.
Tranquilizers may be given to a woman who is particularl)' tense, to help
her to relax her muscles and expenence less plin_ One drawbal:k IS that
tranquilizers can make )fOU feel so rela.xed you are unable to breathe
through contractions or actively participate in labor
Barbiturates arc rarely used during labor because the)' han: Ii depres
effect on the baby (which may last ror several days). Somt' comm('In
barbitu fateS are: Seconal or Nembutol. The), do not pC\,Widl' dire({ p,un
relief, but have a sedative effect whICh can proJUI.:e sleep.
The known amneMic is scopolamine, a (L'rebral depressan
Used in combination with a narcotic, scopolamine was the mOSt popular
drug (or <hildb"'h during 'he 1950s. I, was somCllmes referred '0 as
twilighr sleep because it induces a confused, excited state which is
remembered a5 a state of dreamless sleep. Side effens of scopolamine
include euphoria, amnesia, fatigue. restlessness, excitement, hallucina_
tions, and delirium.
Scopolamine does not eliminate pain, it just removes rhe memory of
j[. A labor passed under its influence often seems nightmarish in cetro-
speCL \'('omen given scopolamine often lose their ability to speak coher-
endy and they must be closely watched or restrained so that they don't
harm themselves.
Today scopolamine is rarely used in obstetric practice, alchough it is
not obsolete. This is one drug you should never take under any circum-
This type of analgesia is often available in the delivery room to increase
comfort during a painful delivery. It might be used during an episiOtomy
repair i( the local is nOt fully effective or if 'he placenta has 10 be
manually extracted. Inhalation anesthesia is most typically a combination
of oxygen (50 percent) and another gas (50 percent), such as nitrous
oxide. The mixture must contain at least 30 percent oxygen or the baby
could experience oxygen deprivation. The gas is inhaled through a mask
and is administered in small doses. It has no pronounced effects on eilher
mother or baby, since it is used for such a short period of time.
The Pudendal Block
This procedure blocks sensation to the external organs-vagina,
vulva, and perineum-making it useful for pain relief during delivery
but nOt for labor. There is controversy about whether it provides
quate palO rehef for a forceps delivery. It is administered by injection
next to (he pudendal nerves, located ncar (he ischial spines, on either
side of the vaglOa. It is easily administered by an obscctrician, and a
254 Prep(lralif)ll lor Birlb
dose of three to five milliliters of lidocaine or mcplvacaln(.' lasts ahout
an hour.
The main disadvantage to the pudendal block is thai It can Interfere
with the urge to push The most serious complication is the rare, acciden
tal injection Into a blood vessel. Symptoms would Include slurred
ech numbness In your tongue, Or a metallic taste.
spe , " ,
The timing of {he pudendal IS very Important because It should be
done after full dilation but before .active pushing. If there is a delay 10
. . g." there will be tOo much palO and trouble to make It wonhwhde. glvlO ,
The Perineal Block
The perineal block provides pain relief for the cutting and repair of me
episiotOmy. It consists of a series of injections of local anesthetic into the
perineum. Anesthesia can be complete, but often there are areas (espe-
cially in the deepest layers) that relain sensation.
Today there are four types of regional anesthetics available: epidurals,
spinals, saddle blocks, and paracervical', with epidurals belflg ,he moS!
popular. All numb sensation in specific areas, but (hey are administered
differently and have varying effects. The paracervical is the only one
given by an obstetrician; all the others are performed either by an
anesthesiologist or a nurse anesthetist (a nurse trained in the use of
anesthesia) .
Most hospitals maintain a staff of anesthesiologists. and the one on call
will usually be the one to anend you. However, you may request a
particular person if you know his repucation. A staff anesthesiologist rna,)'
be a stranger to you, but your obstetrician will probably know thiS
person from previous deliveries. , .
Should a regional anesthetic be necessar}', your obstetriCian and anes-
. I . . . .' h and make a recommenda-
eSlo oglst Will diSCUSS your chOICes wI( you
. .. d I d . n of loU and ),our bab)'.
liOn. ThiS Will be based on the me tCa can IUO
. . I d l'our expeCled orne
t e skill and preference of the anestheslo 08
(, an _."
. d "Of In this sltuano
If ,ou
o eliver),. You will obviousl}' be at an a , .
. . . d' nee with )'our doctor
nve discussed these considerations In a \a - h I' ta
, I nesthesla cross t e palen .
All of thc medications used (or reglona a 'fi d .... used the
.rh . . d b)' ,he ,peCI C .
elC cffc({ on the baby is derern
amount Jnd rhe rClute of administration, tht: metabolism r
. 0 the
mother. the flOltng o( adJ1ltnISrrat.lOll. and the general health of 111 b b
e a )'
In addition. thl' naby would be indirectly bue substanuvely affected b '
rhe medlc.lllon If It ImpaIrs the mOther's blood pressure or cireul Y
. . _ au On
The use of regional anesthesia IS usually contraindicated (or w '
with pn ..:\-iou:-. back bony ,of the spine, skin Infec.
tions near rhe site of the Intended inJection, a hls[Qcy of bleed,' ng b
pro .
lems. or low blood pressure. It is impractical if a speedy delive
ry IS
The Epidural
The epidural has been nicknamed the "Cadillac of anesthetics' because
it is considered to be the safest and most effective. The epidural can be
used dUring active labor and transition, pushing, and delivery by forceps
or cesarean section. It numbs but does not paralyze the lower half of a
woman's bod)" leaving her clear-headed but pain-free, Epidurals are not
available at all hospitals. however, particularly smaller ones, where there
are no round-the-clock anesthesiologists. To many people epidurals rep-
resent childbirth at its best-awake and aware, but numb from the waist
Epidurals can vary considerably in their effects, and this depends
largely on the amount of medication used. It also depends on the individ-
ual metabolism of the person receiving the anesthetic. The same dose
epidural can be given to five different women, and they will experience
five different degrees of pain relief.
Lou dOJ(, or segmmtal, epidurals can "take the edge oft' contractions,
but leave some sensation in the lower abdomen and perineum, A llal1'
darJ, or lumbar. epidural will completely anesthetize the region from the
lOp of the beU)' ro the tips of the roes, Obviously, the deeper the level
of anesthe::sia, the greater the potential for side effects. These include:
and slowed-down contractions, For this reason Pitocin is
frequently given In combination with the epidural. Epidurals arc
usuallr not be given until active labor is well established, with dila
lion to at least four or five centimeters. If contractions do weaken,
thc:n: a good chance: they will eStablish their former intensity after
about thirty minutes, but few docrors will walt for this to happen,
Ofr<:n PitfKln IS routinely added to the intravenous line once the
\:pldural is 10 pla(c.
156 Preptlr{/liQu for BJrlb


"I had an epidural an hour before my daughter was born. It turned a mght that
was fast becoming hysterical Into an event that I could participate 10 .
"The numbing effect of the spinal went up to my lungs, I felt I was suffocaung.
This was the worst feeling I've ever had."
"I thought I was only about SIX centimeters dilated and didn't think I could stand
transition, so I had an epidural. It turns OUt I was fully So here I was
completely numb for the pushing, I was a good pusher, so ,he docror didn't need
!O use forceps, but I couldn't feel anything, whICh was kind of strange, I should
have had the epidural an hour before. It was a waste at mat point'
"My husband and I are both pro-medication. He didn't want to see me sulfer, and
I wanted to enjoy [he birth, I would have the next one exactly (he same way if
I could. The epidural is the greatest thing since peanut butter. I would never fear
labor again,"
"After my son was born, I wanted to kiss the guy who invented regional anesthe-
sia, I thought it was the greatest thing in the world, It allowed me to enjoy the
birth, without pain,"
"My spine hurt for weeks,"
"I wcm through nine hours of excruCl,lIng pain, detenmned !O go 'nJIUrai' all
the way, I was IOrally unprep.r! for ,he waves of back pain ,hal each , ",lIIU(,{


.-- ------
t t t

t t
t t
R f .... 10:-'; \

, After nine hours I was on the edge of hysteria, and my husband Was
{r-amic With concern. \X'e deoded to go with an epidural-one of the smartest
moves I've e\'er made."
"I received an epidural after nine hours of induced labor, I seemed to be stuck
at seven cenumeters. About thiny minures after the epidural, I started dilating
"The palO I endured with back labor torally overwhelmed my breathing tech-
niques, leaving me scared and on the verge of losing control. Intellectually, I
know I made the right choice in going with the epidural, but I felt guilty afterward
because I didn't tOugh it out."
"When the epIdural wore off, it was like I couldn't even think straight, al\ I could
see was pain. Next time, I'll tie the anesthesiologist to my bed."
"Obviousl}" nOt everyone can go with no medication. H owever, those women
who have 'saddle blocks' for a normal delivery are missing an exciting moment.
B}' mat time, {he worSt is over."
"I had figured I would probably ask for the epidural. It was great nOt to hurt, but
I hated that I( slowed things down."
I had been up for over twcnry-four hours, the baby was (aceup, and I already
had the urge to push. I was rellevcd when I finally gm to five cemimercrs and

258 Preparalioll lor BIrth


could have tht, epidural, I was exhausted and fell asleep when it started work-
" I was nOt able to feel a sensation to push. [he fetal monitor tOld me when a
cont raction was beginning, and the nurse told me when It was time to push The
baby was delivered with forceps."
"Medication helped me enjoy the birth. h's no fun belOg in pain. The last ten
hours were spent laughing and enjoying the process. The epidural allowed me
to be more aware and understanding of my surroundings,"

.increased incidence of neonatal jaundice. It's unclear whether
thiS IS the result of the epidural, the Plroon, or a combination of
effeCts .
The increased use of forceps. For labors without epidural anestheSia.
the rate of the use of forceps is from -i to 21 percenr; for labors with
the standard lumbar epidurals. the rate of use is 65 to 75 percenr
Epidurals produce numbness, and therefore there is Iitue or no urge
to push. The epidural decreases the effectiveness of the muscles of
the pelvic Roar, preventing the baby from rowing naturall) \,\'hen
this occurs, the bab}' must be turned with forceps. A stud)" published
in the British ,Htd,r.tI/otlntJ1 10 19'"1 described the effe-.:ts oi lumbar
epidurals given to 486 women; instrumental deliwry {forceps lnd
vacuum extraction) was 6\'e times more C(lmmo
, lnd mJIp.."Isitil
of the fetal head was three times more common when o.1mpart.'J
with a control group of women who did not rC(elve epidur.i1s
The Incre.lsed risk of hypt"ltcnsion (lowered blcx
pressun.). Epldu-
' I 'h ch (an result in 10\\ ert.'J
ra s (a use your blood \lesse s (0 ul .ltC," I

\ Inf i,.11 if) II

bln(\(j l,n:,'UfC. This the amount of oxyocn d"t b ("> n . Uled
Ihrl"HlClht)UI yemr b..'ldy and .(0 the bahy As a. precautl on!TIa d . ny oe.
((lr\ will give.: you extra flUIds through the mlr;.1Vl'nOliS to mcrcasl'
your bkx'Xi volume.
If you do need an epIdural, )IOU should _ request that you be given a
segmental one. or onc with the lowest possible dosage. This mal' permit
you (0 retain some sensation in the lower perineum so that you can feel
the urge to push and so that rhe baby may rOtate naturally.
An epidural takes twenty minutes to administer and another ten to
rwenty minutes to completely take effect. If you request an epidural
during labor, your doctor will have to write orders for one, and you will
have to wait for the anesthesiologist to arrive. Your partner may be
asked ro leave the room while the epidural is being given, but he has the
right to stay if you want him to. The procedure is basically bloodless and
painless, so there's no reason why he can't stay to lend you moral sup
port. If )'ou don't already have an IV line in place, one will be inserted.
For the procedure, you will be asked to round your back by either
lying in a curled position or sitting bent over. Your back will be washed
with an antiseptic solution, and then you will be given a shm or twO of
a local anesthetic to numb the area in your back where the epidural will
be given. This spot is known as the epidural or extradural space. (It is
outside the last of the three membranes that cover the spinal cord and
juS! inside the bone and ligament of the vertebral column.) The local will
sung slightly, and then you will feel numb. Pressure is all that you will
feel as the epidural needle, bearing the catheter (tube) is injected. The
needle is withdrawn, but the long catheter is left in place and taped to
the outside of your back and shoulder. By leaving the catheter in place,
more anesthetic can be administered later if needed.
You will first receive a test dose of medication to determine if you are
allergIC to the particular drug being used. Then a full dose wdl be given.
Depending on the dose and the drug used, the pain relief should laS!
from fortyfive minutes to twO hours. The selection of the drug will
depend on anesthesiologist's preference, the latest studies, (he reason for
the epidural, and the projected length of labor.
You will be immobilized with an epidural because although you can
move your legs, they will seem heavy and weak and you won'r be able
to walk. You'll have to use a bedpan or have a catheter inscrtcu into your
Prep4r41ir,lll for Bulb

Spinol Cord
bladder to empty it, because a full bladder can Interfere with the descent
of the baby's head. If forceps are used when the bladder is full, damage
can occur, and the bladder can become infected.
Just like any Other substance you receive or ingest, an epidural anes-
thetic crosses the placenta. Previously it was believed that epidural anes-
thetics did nOt reach the baby. but more recent testing of the neonatal
blood after birth has found the anesthetic to be present. It is unclear what
effect, if any, epidurals have on babies. A 1985 review of tht" literature
on epidurals stated that the studies , .. ere far from consistent, although
they did suggest a mild transient effe([ on newborn beha,ior
Many women tOday rake prcpared.childbirth classes wJ(h the Idea that
rhc\" 1! have natural childbirth if it doesn't hurt tOO much. If labor gets
unbearably painful, they can always count on an epidural to bat! them
out. To some extent, this outlook becomes a selffulhlhng propheq
Ep. I ' h" nlnti :11"0 beC;,luse rhe)'
Ie urals arc enormously popular lor t IS n.:as
' ,. .
a h :ter them safe and eifel.
re encouraged by many obstetricians w 0 conSl
\fl't/ifdlioll ]61
tl\.e. Granted, an epidural can salvage a labor that IS doomed because of
, unbearable back labor, or irregular and gruesome COntractions I
lear, . t
(an also turn a cesarean mto a good birth experience because a woman
IS to meet her baby, and her husband is at her side
Epidurals, however. are much more than just a tiny inJection; they
spm a web of intervention that turns normal labor tnto a hlgh.tech
affair. Your baby's heartbeat will be conttouously monitored, YOU will
be hooked up to an Intravenous, and your blood pressure will be
checked frequently. And, as we said earlier, the chances of receiving
Pirocin and havlOg a forceps delivery 3re much greater than if YOU
didn't have the epIdural.
Many women request epidurals during transition, but this is the WOrst
time to receive one. You will have to hold still for the procedure during
your worst conrranions, and by the time it takes effect, you will be fully
dilated and tOO numb to push effeCtively. You might take a nap while
waiting for the anesthetic to wear off, bur ie's a rare doctor who will nO(
rush from one Stage of labor to the next. You will be forced to push
whether you feel like it or not.
To avoid this happening to you, you should ask for a cervical check
before receiving an epidural. Contractions can seem unbearable because
labor is progressing rapidly. You may gain some perspective, however,
If you learn you've just dilated four centimeters in thirty minures and are
finally at mne.
The Spinal
A spinal takes about three to six minutes to administer and lasts approxi-
matelyan hour and a half. It numbs and paralyzes the lower half of the
body, from the cheSt to the toes. The legs cannot be moved to change
poSItion, and the abdominal muscles will be immobilized for pushing.
Spmals have been replaced by epidurals for the pain of labor, but they
are still used today for forceps or cesarean deliveries.
Preparation for the splOai is the same as It is for the epidural. You will
be asked to round your back and i, will be washed and a local injection
will be adminIStered, A teSt dose will be gIven for allergic reaction and
to assure that the needle IS in ,he proper position. This will be followed
by a full dose. With a spmal, the injection IS made direclly into the spinal
canal and cerebrospmal AUld ,
( IS Important nor to cough or move dunng Ihe procedure In Of(
---- --------------
262 Preparatiotl lor Birth
at the anesthetic will not be moved h- h .
[ 18 er wHhm th
that were to happen your blood pressure could dro e sp.mal canal If
ur breathmg would be ImpalCed The I p pr(:(lpnously and
y. spma anCSlh I:>
nerves. blocking the passage of pain sensatio h. eftc athe, the
n to [ e )ram r\ k
effect. a warm tingling sensation will spread f h .. 1 H ta es
rom t e loel I( the abd(
men. .
Spinals have some advantages in comparison [d .
. .d . 0 epl urals. pamcularly
when time IS a consl erauon. They require less sk'il d .
. d d I to a mlOiSter less
anesthetiC IS nee e ,they take effect more quickly d h
. .' . ,an t ey arc faster
ID adminISter. Splnals also have a slightly higher succe .. k"
ss Or ta e rate:
95 percent versuS 93 percent for the epidural. Their primary drawback
is that .slde effects are greater than with the epidural
HypotenSIOn IS . the most common complication. There IS a widening
and loss of tone 10 the maternal veins due to the Interruption of the
sympathetic nerve impulses that control blood pressure. This is exacer-
bated if the woman lies on her back; she must lie on her left side. Spinals
can also cause difficulty with respiration because sensation to the Imer-
costal (rib) muscles is affected by the anestheSIa. Breathing may seem
labored o r shallow, and you may feel you can't breathe. You should be
sure to inform your doctor right away if you experience thIS reaction
In the most extreme case, you would be put on a respirator until the
anesthetic wears off. In most instances, however, you should be Cea5-
sured that if you can Still talk, you can still breathe
The most infamous complication of the spinal is the spinal headache,
caused by a loss of cerebrospinal fluid due to the IOjeC1.ion. In this
situation, the spinal fluid leaks out the hole made b}' the injection,
causing a change in spinal pressure and hence the headache. This used
to be a more common problem. but wday a finer-gauge needle IS
cteating a smaller hole. A stud)' of 9,2'7 splnals administered showed
an 18 percent mcidence of headache when a large l6gauge needle as
ed the headache rale
used; when a smaller 24-gauge needle su sutut .
dropped to 6 percent. . e ior
d .. ed to remalO supln
After receiving a spinal, women are a \ IS _ d h
d d ,eloPing a hea dC e
eight hours following delivery to a\'OI e\ h' ).;_
. _ . rual! ' helps prevent t t: l
IS some controversy about whether thiS ac} -
. -, the on I\' position to
Currence. but there's no question that It s. '_ I helpful.
. dlCilUOn loS J so
once you've gO( {he headache. aln Ole . _ . II . one or
h I" hnlte, )
Wit the knowledge {hat {he hea ac e '
two da)'s, '. I pr(lt.:t..Jure (J\lt"\.i
d ral IS sevcre,
If:l headache from a splOal or epl u ,
;l hlood pafl.:h (;In help, This is administered by an ancSlhcslOiog .
. lSI and
COnslsfs ("If an inJection of 10 to 15 milliliters of your own blond in I
. tOile
sHe of du.' puncture. The blood wlil then creare a seal OVl.'f the Ie k
a . A
saline solu(I(,," may also be substituted. The procedure IS not with
risks. so Its usc depends on tndividual CIrcumstances QUI
Which Anesthetic for Cesarean Section?
There are advantages and disadvantages to both epidurals and spina Is for
cesarean delivery. As we've said before, if you find yourself in a position
to choose, you'll probably be guided by the preference of the anesthesi.
ologist and the practice of the hospital. In addition to what we've already
told you, some of the things to consider are
Epidurals cause less of a drop in maternal blood pressure.
Because a catherer can be left in place, epidurals can easily be topped
off if anesthetic effect decreases.
A thicker gauge needle must be used to administer an epidural, and
if there is a puncrure in the dura, the headache that ensues can be
worse than a spinal headache. It is estimated, however, that this
complication occurs in only 1 to 2 percent of all cases.
The epidural can also result in spotty coverage, only affecting half
the body or leaving "windows," or small areas that are not anesthe-
The Saddle Bl ock
If a woman is given a spinal and then remains sitting for ten minutes, the
method of anesthesia becomes a saddle block. This is because the drug
settles to a lower body level than if it were administered while she was
lying down. A saddle block numbs the vagina, perineum, and upper
thighs. With the exception of the vagina, this is the area that would rest
on a saddle, hence the name.
This is an effective anesthetic for a forceps delivery or a painful seC-
ond stage. An advantage to the saddle block over a full spinal is that
some feeling 10 the abdomen remains so it does not completely impair
the ability to push. It does nOt seem to be a very popular method of
anesthesia. Since it can intetfere with the normal descent of the fetal
head, It should only be given if the baby is well engaged in rhe
mother's pelvis.
Prepnrnliotl for 8i,.I"
The Paracervlcal
Thisis the only reglOn.al anesthetic IS admmistered by the obslcfri.
cian, It relieves the pain but docs not affeCi the pam of
back labor or numb the vagma or The paraccrvical consists of
tWO injections. Inw the nerves .on either Side of the cc:rvix, so It IS usually
admlOistered no later (han .acuve labor, when there IS enough cerviX to
as a guide. The anestheuc effects can last anywhere from forty minutes use .
O hours depending on the particular medication used. tOtW ,
This type of regional anesthetic has largely been replaced by the
'd al because of a 25 to 30 percent risk of fetal bradycardia. ept ur
General anesthesia is most commonly used today for emergency cesar-
ean sections. If the baby is in distress or the mOther is hemorrhaging,
there won't be time for a spinal or epidural; with a general anesthesia,
a baby can be delivered in less than ten minutes. A general anesthetic
is also used for nonemergency cesareans if this is the anesthesiologist's
preference or if there are conrraindications for a regional anesthetic.
If you know in advance you will be having a general anesthetic, you
will probably be admitted a day early to the hospital and be prohibited
from eating or drinking anything for eight to twelve hours prior to
delivery. If you need an emergency cesarean, you will be given some
kind of antacid, such as sodium citrate, Maalox, or Tagemet, to neutral-
ize stomach contents.
The reason for these precautions is that the greatest risks of general
anesthesia are respiratory irritation or infection or death from the asplra-
. f" . Th I can occur whether you have
tlon 0 aCIdIC stomach secretIons. e atter
fasted or nOt and is called Mendelson's syndrome. It IS the leading cause
of anesthetic obstetrical deaths.
T h P e rocedure
Once yo .
Th u are an the delivery room, you will be given ox)'gen to breathe
e mask may smell unpleasant, and it may be uncomfortable to have
ybour nose and mourh covered, but it help if )1ou try to rela..\. and
normall y. Then a barbirurate will be injected inro your intr-3\"e-
noUS 1"
tne, and this will pur you to sleep In Just fifteen to tWcnry seconds.
A muscle relaxant will {hen follow, which will cause tcmpllrar
pa 1 .
1 fa YSIS
Now J. plastic (endotracheal) tube can be tnsenecl down your thro .
. .'.
the anesthetic gases acc administered through the tube causing u
. I ncon.
t;;ciousncss The tube also reduces the risk of inhaling stomach COnt
. . . cnts.
\\ 'hen rou awaken, rhe tube will be gone, but your duoat may be
(or a fe,\\' days.
. __ . - _.
Demerol, 1M or IV
Decrease perception of pain.
PromOte relaxation during
(Seconal, Nembutal) 1M, IV or oral pill
Induce sleep (rarely used
during labor),
(Phenergan, Valium, 1M or IV Reduce anxiety and/or nausea
Vistaril) during labor. (Is often used in
conjunction with Demeco!')
(mtrous oxide) Inhalation Pain relief during delivery.
(Kopolomine) IV or 1M Erase memory of experience.
266 Prepartllioll for Birlh
you may be confused, groggy, Or nauseated when you wake up and
OU may . have a poor sense of time. The may for," f(:w
Y a few dependmg on the amount of used and hours or
metabolism, Once the anesthesia wears off, there Will be a
ur own
yo turn of sensation, and you may need pam medication fight sudden re
. {he recovery room.
away In
Increases relaxation.
Can take the "edge off' contractions.
Effects can be counteracted with an antagonist
Can reduce fear and anxiety.
Has no effect on contractions.
Can increase relaxation.
Rapid onset of action; rapid recovery when
gas is discontinued.
Does not affect uterine contractions.
Eliminates memory of labor and deli\'c
No known adverse cfTeCl on newborn.
Can cause respiratory depression in newborn.
Can slow comractions
Often causes nausea and vomiting.
Safe dosages [00 low for effective pain relief
Sleepiness can reduce ability [0 cope with
contractions or push effectively
Has a depressant effect on baby
CannOt be coumeracted by .tn antagonist
Provides no direct pain relief.
Can cause maternal hn)olcnsion.
Does not provide tmal palO relief
Response IS unpredictable, rolnging from
euphoria to wild, irr,Ulonal beha\ll1r
(especially common re.tction in tht: pre)ernt'
of pain).
Does nOI relleH' polin so must bt: useJ With
other medlcJtions
Falher (".tnnal be
hIlS .t(tin- p.lrlicipJ.IWIl or
memory of experience

:lon5 anto
Numb vagina, vulva and
Nesacaine, Marcane)
area UI ,II'" l-......... _ dal nerves.
Perineal Block (same
Inje(non into per meum.
Numb perineum for episiotom
. . d Y
inCISion an repair.
as above)
(Marcane. Xylocaine,
Single injection or through
Pain relief during labor and/or
catheter placed in epidural
delivery. Anesthesia for
cesarean delivery.
Injection IntO spinal canal.
Anesthesia for vaginal dehvery.
Anesthesia for cesarean
Saddle Block Same
Numb vagina, perineum and
upper thighs.
Injection into vagina, into
Pain relief during labor.
tISsue on either side of cervix.
Gt"trJi AIlt.ffblJll1
Combination of Inhalation of anesthetic gases
Produce unconsciousness.
medications or IV medications.
268 Preparatio" for Birth
I .,'m
PrOVides pam rchef for normal delivery Or
episiotOmy repair; Relaxes perineum.
Provides pain relief for episiotomy repair.
Safest and most effective regional anesthesia.
Eliminates pain without affecting
Mother can still actively participate.
Requires less skill and is easier to administer
than epidural.
Provides excellent pain relief
Provides effective pain relief for pushing.
No effert on cont ractions.
Can be admintstered by obstetrician.
Fastest anesthetic for emergenc), ces..1..rea
difficult vaginal delivery.
Provides complete poin relief.
Not adequate pam rehef for fUfCCPO; deliverv
Often causes maternal hYPOIcnsion.
Often decreases strength and frequency of
Eliminates urge 10 push.
Increases likelihood of fetal malposinon and
need for forceps.
Anesthesia can be .. spou)' or ooly we OD
one side.
Can bome a spinal and cause headache.
Greater maternal side effects compared w
other regiorul anesthetics, especially
Possible spinal headache.
Can interfere with normal desctnt of baby
Can cause fetal bradycardiil
CannO[ be given past 8 an dilanoo.
Gre-lter risk of (ompli(Jtions for ooth mother
and child than regional ane5mem's lor
03.rural delivery).
pOSSible depression In newoorn
Father c",nnot be prt:'St'nt for
Mother 15 not awake.

Variations on
Normal Labor
and Delivery
sto rhink
o one wants to read thi s chapter because no woman want
about he r labo r deviating from [he no rm. r( yo ur pregnancy, has
been enj oyable and free of probl ems, [he possibility of complications
-- --
270 Prtjlllrtllifnl for Birtb
ems hard to accept. Often women who have be' h I
.. cn ea thy .
ontemplate something gOing awry. If thmgs have (an t even
. gone smoothl f
yOU think, why JinX my luck by Y so ar,
We' re not asking you to worry. We're only ho h '
f h
' db' h ' ping t at you II extend
the process 0 C 11 1ft preparation to include 'd
". a COnSI eration of for-
cepS and cesarean deliveries. ThiS SOrt of discussion sh Id be
. ou not consid-
ered fri ghtening, nor does It condone medicallnrerventl'o Kid
, n,
reduces fear , and talkIng about complications does not p od h
r ucetem
There are many th: cesarean rate has practically quadrupled
since 1970, but diSCUSSion Isn t one of them.
In 1983 the national cesarean rate was 20.3 percent and climbing. If
you don' t learn something about this method of delivery, you'll be
sticking your head in the sand. If there are five couples in your Lamaze
class, one o f them is likely to have a cesarean, and it could be you.
According to the responses to our questionnaire, most people deCided
to have the ir baby in a hospital. JUSt to be safe. For that same reason, you
should read (his chap(er-just to be safe, and [Q know the choices you
will have to make if a cesarean or forceps delivery becomes necessary.
Preparing fo r labor makes you bener able to make decisions, and prepar-
ing for compl icat io ns does the same thing. If you're IOformed. you are
able to panici pate more actively in your child's birth and better under-
stand {he e ntire exper ience, no maner what the circumstances.
The need fo r a fo rceps delivery is apparenr only during (he second stage
of labor, afte r you have di lated completely and are trying [Q push the
baby out.
. Fo rceps a re pai red metallic instrumenrs. frequently compared in de-
sign to salad tOngs; they are used for rotation and/or extraction of the
baby's head . The analogy to tOngs isn't really precise. however, because
the blades come apart , They are placed around the head indIVIdually and
then, once in place, they are joined tOgether.
The re have been mo re than six hundred types of forceps desisned., but
all of them are used primarily for cwO purposes: exerting traction (pull-
OUt the baby) and turning the baby's head to a bener posmo
Forceps delive ri es are classi fied according to the station and posItion ot
baby' s head whe n they are applied, nnd not acc"rdlng to the type of
InStrum d " k cot use ,as ),ou mig ht rhlO .
1 ',trilil
on Somlil l L.lbor .I fil l Del i l'er".)
T)'pes of Forceps Deliveries
The three varieties of forceps deliveries are
Lrm'-. or outlo. joraps. This IS the most common type of forceps
delive[,)', occurring JUSt before the baby's head crowns. The head,
however. is visible without opening rhe labia. This is the safest
method of forceps delivery, provided It is performed by a skilled
obstetrician .
lbdfor.-tpj. In [hiS situation, the baby's head is higher up in the
pelvis. ahhough H must be engaged for the procedure lO qualify
as a midforceps delivery. Any delivery requiring cmation of the
baby's head becomes a midforceps delivery, regardless of how
low the head is resting in rhe pelvis. It's sometimes difficult for an
obstetrician to peedin how difficult a midforceps delivery will
be; some are quite easy, whereas others can be traumatic for
mother or bab}. The risk of the deliver)' is greatly Increased if the
doctor has IOcorrecdy Judged the position or station of the babys
This operation has become extinct In the past fifteen
yean because of the increased safety of cesarean sections. A high-
forceps delivery is an outmoded and dangerous procedure. In this
dehvery, tbe bab)' s head is not engaged and may be Aoating high
In Ihe pelvls_ A cesarean section is vinuall)' always preferable to 3
high-forceps dcliveC)'
PrepaYl,lIlo1l for B/rlh

"It took longer to sew me up than for her to pop out! The forceps badly bruised
my daughters face.
"The doctor was very careful. My daughter never had any marks at all"
'The procedure looked too violent to my husband, and he felt the baby must be
experiencing pain from the use of the forceps. They caused a small red spm on
the baby's face, bur it is all gone now"
"I hated it! It was the most painful part of the whole birm. I think my doctOr was
in a hurry and just wanted to speed things up."
"The forceps were not painful, but there was a lor of Ar me time I didnt
care what [hey did as long as I could have the baby.
.. I " ' II et when ml' doctor got out the forceps, but was happy because
was tnltla Y ups h ed "
' d baby came out un arm -
they sped up the de Ivery an my

The Procedure f _ "nesthetic. Pudendals.
-' . the use 0 ,to IoU' _
Most forceps dchvencs reqUIre I' give
_ If there Isn t
, 'I h ones most common) . f
epidurals, and sptna s are t e .. offer you J. whiff 0
. the doctor rna)
enough time to give anest CSI3. . I OpeOlnl.t. an episio(-
, ' T n huge the vagina -
nitrous OXide (laughing gas). 0 e
-----------, ---:,1 I Llbor ,lIld Dt>lit en
1'"ri,lIl otlJ 011 or"'"

om}' always done, Other requirements ror delivery include an empt},
bladder (to ercate maximum room an the pelnc cavity). and ruptured
membranes (50 that rhe doctor will nm lose traction b}' having to place
the torccr' over the amniouc sac).
If the docfClr is doing a low-forceps delivery. you will be asked to push
as he pulls dunng each contr-.lction. His hands may shake and it will
appear that he's exerting a lor o( (orce. He is pulling hard, bur the whole
thlflg probably looks much scarier than It really is. In a couple o( pushes
the baby's head will emerge, and you'll be almost there. Sometimes
doctor will bring the head down with forceps and then let you
push out the baby yourself.
Indications for Forceps
\X'omen who have little or no medication during labor usually don't
need (orceps. For them, pushing is hard work, bur it also brings relief,
and usually after about an hour the baby is born, There are, however,
several reasons why (orceps are necessary. They include
Ftldl Jmrw. Forceps can be a godsend when (etal distress is detected
and the baby to be born quickly, In that case, you would
probably be given several whiffs o( oxygen to boost the baby's
supply and moved ro me delivery room immediately,
tht mo/her:r {tu'n txpulm t (jforl!. This use o( (orceps increases
epidurals more available and more popular. A woman
nh no sensauon In her pelvic floor has much less ability and desire
to Approximately 65 to 75 percem o( the women who receive
epIdurals for pain reLief also require the use o( (orceps, This rate
COntrasts With rhe use of (.0 . 4 . rceps In to 21 percent o( deliveries
without anesrhesia Orne r-
. . r reasons lor an Inablliey to push are exhaus-
tion after pushing for a I ' -
b .. . ong time, poor uteflne contractions or an
a normal posltlomng of the baby's head '
Thf nuJ for t':t;tra Irdriion I ,ff. d drJfi'
. 0 OJlItl a cor t 1m/I). Sometimes a short
cor or one that IS wrapped d h
aroun t e baby's neck or shoulders can
prevem the head from d d
. ed escen 109 naturally. This phenomenon is
m Icat when the head b
\'agma Th crowns ur repeatedly slips back into the
. ere may also be some fetal heart decelerauon . When this
OCCUrs, doctor Will need
rush. h. ., to use orceps. You may wonder if he's
t Ings, but 10 thiS case you need thiS 3SSlSIance. You could
o on or another hour and th h d
e ea would stdl be rctreanng after
Ci.lch push, The baby IS not In d
. I f anger. kH:causc th . d .
C!;.lStlC, )ut a orceps delivery IS . t cor IS qUHe
ncces,ary m order f h b b
be born without further stress. or tea 'i fO
/ mtd,c(11 problemJ of Ihe rr. II A
10 'Jfr woman wuh h d'
should avoid. the physical strain of ph. can Isease
us 109, Also a woman h
de tache re. tina should not raise her lot . I ' WII a
racranla pressure bl' S!
ously beanng down. tenu-
t , I pr.fflltllUre HI/a", The head of a prema b b
ture needs more pro-
tecuon than that of a (ull-term infant To rcd
. uce Stress to the head
(orceps may be used to shorten the delivery. '
T he Risks Involved
Naturally, there are risks involved with the use o( (orceps, and as with
any other medical intervention, you must weigh them against the ben-
eilts_ Forceps can lacerate the mOlher's cervix, vagina, or bladder. And
they can cause facial nerve damage in the infant as well as hemorrhage
withm the head. The risks o( complications are greater with high- and
mld-(orceps deliveries than with low ones. Often, with outlet (orceps the
baby sustains only temporary bruises or indentations where me metal
touched his head. To minimize these risks, it's very important that a
woman be (ully dilated and that the dOCtor be experienced. Unless
there's a true emergency, don't allow your baby to be delivered by an
intern or resident who is just learning how to do a (orceps delivery - As
we said earlier, you're under no obligation to be a good sport or to
provide educational opportunities (or young doctors.
Low-(orceps deliveries are considered safer. However, in Tbe Prig-
lUU1CY Book for Toddy'S \ylomafl, Dr, Howard Shapiro stales that many
doctors now believe that i( an easy outlet-forceps delivery cannot be
performed, a cesarean section should be done instead, because there is.
less risk o( maternal and infant traUma, Shapiro cites the research 01
Dr. Emanuel Friedman, who noted tWO infant deaths per one thousand
. hi ' deaths per one thousand
spontaneous deliveries, compare wlt e e\ en
. d aths per one thousand
(ehveries with mid(orcepS and twenty-mne e C 'Id
. ed h d f 1 long labor hI ren
chvcries i( mid(orceps were uS at teen 0 -
h d much greater InCidence
who were delivered by mid(orceps a so a ,1 .
hreL'--the Impairments ('1(-
o hearing and speech disorders at age t d . h
and compare \\'u SIX
curred at a rate o( thirty-three per one t ous. I .. ' at
e horn by norma \ ae;1O
per one thousand among children'" 0 wer
Forceps Deliver),
A"Ol l n ~ -:---. , .
_ - .- C 'd d done somenmcs tt S il bH of [fUe grit or SUper
\X'hen all IS :0..11 an ' . .
. bles women to dehver \v(thour assistance. Often aliI{
willpower ( at enil : -.'
,. 0 ot the wordjorapJ co give ,I woman that extra ounce
rakes IS t e mt.:OO
- .
the bab)' out herself. A delivery-room nurse was
o l'nergr to P , .'
t d
,< -)'Iog "You see this all rhe time. with these blrthing_
n,.'cenr r quo e .... ,,,. ,
room. 'natur.ll.childbirch mothers-you juSt menuon forceps and they
get those babies born."
No woman can exercise (Olal contcol over her labor. Although you
may not have wanted a forceps delivery. there are urnes when it is
necessary To give yourself {he best shot at natural childbirth, don't
have epidural anesthesia. Take it easy during early labor so that you
can decrease me chance of exhaustion much later on, Assume a com-
fortable position for pushing (not on your back) and try using a mir-
ror or some visualization [Q give you that extra edge. Anmher
technique is to have the doctor or midwife place twO fingers just in-
side the vagina. This pressure will help you find exactly where to
push. Sometimes me transfer [Q the delivery room can make a differ-
ence because it's a change of scenery and it means you really are get-
ting closer to the end.
Vacuum extractors are suction pumps used in lieu of forceps. They have
been popular in Europe for many years, but have never achieved the
same status here because of (he risks associated with the metal cup that
was attached to the baby's head. The machines with the metal cup have
now been replaced by a more sophisticated device, which utilizes a cup
made of soft silicone rubber.
The indications for using extrac[Qrs are virtually the same as those for
Proper poSItion of the bab)'. NOl recommended for brow or face
No demonstrated CPD ( hi .
. cep a a-pelvIC disproportion).
Adequate dilation and effacement of the cervix
Ruptured membranes.
Engagemt:nt of the baby's hl:ad
Unlike .for(cPS, however, the extractor should n b d f
ot e usc or breC'h
deliveries or. when unusual amOUnts of lraCIIOO d
arc require .
The machme works on the principle of a vacuu h h
m, w IC u created by
pistOns m the ":'otor. The rubber cup Ilts on top of tht bahy's head, and
SU((lon IS applied only dunng a COntraction. The extractor cannm be
used if fetal-scalp sampling has been done because of a risk of excess
bleeding, One of the biggest advantages of the extractOr is that unlike
a forceps delivery, it's not always necessary to perform an episiotomy
Vacuum extractors have a bad name with many doctOrs because of the
high risk of scalp lacerations and hematomas (blood clots under the skin)
associated with the old metal cup. The original machines also had a long
VtlCUum Extrm'tor
. Ihere (rom (our (0 Ollllutcs-and therefore
st,W-up time--a
)" h
. of fetal distress. The mac incs m use today Can
were not suitJ em."
achieve a vacuum in thirty seconds.
The up-to-date exrractors are not available, \Vle
sentatives of the tWO major manufacturers, who said they
spo 'f W repr .. . .
had placed many machines In hospitals lateiy, but only on a tflal basIS.
Adyocates of (he vacuum extractor claim certato ad va mages to compari.
son with forceps: (3) A local anesthetic can often be used instead of a
regIOnal. thereb)' allowing the mother to push more effectively; (b) the
cervix doesn't have to be fully dilated for the cup to be applied; and (c)
the severity of injuries to mother and baby is less. One study stated that
extraction with the silicone cap was a safe substitute for mid forceps
deliveries because there was no risk of vaginal and cervical tears from
the metal blades of the forceps. It also cited reduced risk of hematoma
to the baby.
We spoke to Dr. James Ottolini of St. Louis, an obstetrician who has
performed more than one thousand deliveries with the extractor and is
considered an expert in its use. "The extractor is like any other ma-
chine," he said. "Extractors are only as good as the people who use them,
and that's a shame because there are many things they can do." Dr.
Onolini likes to use the extraCtor for the vaginal delivery of twins. The
second twin, who is generally smaller and less robust than the first can
be dehvered by suction in a matter of minutes. Dr. Ottolini said he
gets Apgar scores in the eight to ten range for the second
(win, an outCome that is considered quite good.
A.nOther of his unusual uses of the extractor is during a repeat cesarean
section. the baby is quite high and not engaged, and getting him
out can be hke bobbing for apples," Ottolini explained. The doctOr uses
the extractor to locate the h d d hi' . .
. _ ea an t en pul It 1Oto a more accessible
poSItIon "The effect f h
.. . Iveness ate extractOr enables me to make smaller
IOCISlons 10 the abdominal wall and in the uterus," he said.
The eXtraaor has all but I d" .
bel" . rep ace lorceps to Onolini's practice. He
leves ItS use during a delayed second stage can reduce the likelihood
o a cesarean "Often wh .
a 10 d' en a regional anesthetic is used, there can be
og secon stage with th h
108 If I b ' e mm er experiencing difficulty with push-
. can nng the baby . I .
Sure there' CPO ., .lOtO P ace With (he extractOr., I'll know for
sno S01[S cr
and letting h h' JUSt a matter of letting the epidural wear all
.. er pus the baby out herself
One of the extractor's b .' .
delivery thal II .est uses IS as a subsmute for low-forceps, a
nOrma y requires ..
an epISiotomy. The pull on the head can

be controlled beautifully. I use it gently aim Ik
, .. , ,O$t I C a shoehorn. With
the mother s cooperation It s a gentle, controlled delivery
Obviously, not every obstetnclan can match Dr 0 1- ',.
. . uo Inl iii expertise
and expeCience With the vacuum extractor As wIth f
,. orceps. an extractor
is best used by someone with considerable skill.
T h e Statistics
In the United States today, more than one out of every five babies will
be born by cesarean section. The national cesarean rale for 1983 was
20,3 percent of all deliveries, which represents almost a fourfold in-
crease from 1970, when the rate was juSt 5.5 percent. This incredible
jump has been described as a cesarean epidemic and is denounced by
radical feminists and conservative obstetricians alike.
This surge of cesarean deliveries has a 1m to do with the operation
becoming safer and with the hazards of midforceps and difficult breech
deliveries becoming better known. But there are also many unnecessary
cesareans being performed. It's sometimes difficult to determine when
a cesarean is truly needed because the issue of the baby's safety often
overlaps with the doctor's fear of malpractice or his desire for conve
The cesarean rate differs from state to state and from hospital to
hospital. One would think th.t large hospitals and teaching hospitals
perform the most cesareans. In the past, srudies have that the
bigger the hospital, the higher the rate. Cesarean dehvenes are. so
h h
. longer any direct correlanon
prevalent today, however, t at t ere IS no
. f ction The Massachusens
between hospital Size and rate a cesarean se '. .
Department of Public Health did a study in 1984 dlSProvtngd no-
. . I a ean rate The stu y loun
tlon that smaller hospitals have a ower ces r d
State cesarean rates in 1982 to range from 31.22 to 7.63 percent ".Ohd
. I . th greater 80smn area a
revealed that small community hosplta s tn e . aI he e the
f h
Massachusens hosplt s w r
t e highest rates. In fact, 0 t e ten f h e referral cen-
r d nl f twO a t em wee
most cesareans were penorme 0) _. I h of the study,
. . k The pnnopa aut or
tees specializing in hlghns cases. . b her findings was
.. ' klng thtng a out
etma Davis said that the most sm. be explained by
' . '1' g hospHals cannot .
t at the tremendous vanabl It}' amon
known risk factors. f h . g a cesarean depends
'd chance 0 av,n
utting the statistics aSl e, your


C E ARE A \l 0 Ell \' E R Y
h d
the bab)' from womb was an experience I couldn't
"Feeling [e cX1or' .
. -b I It "as so moving to see my child. I felr so many emottons_
begin to eSlrl e. ...
[ears, laughter, [he whole nine yards!"
I didn't understand, and still don't, is why they let me labor for twenty-two
hours ...
"\Vhen the cesarean became necessary, I was caught off guard and was totally
unprepared w make any decisions about what was happening. I didn '[ even
realize that there were deCisions (Q be made. I just went along with the doctor,
nurses, and policies"
"Once I accepted the (act (hat I had (0 have one, the entire experience was
fulfilling and not at all dISappointing. My husband was allowed to be with me the
whole ume, and then he was with OUf baby, which was wonderful. I felt very
supported by my husband and the staff,"
"The hospaal staff treated me like a piece of meat. I accepted the cesarean secrion,
but nOt their anuude."
I had to ask for everything bY - --
- I 101 mClSlon Instead of vertical spinal anesthesia
Instead of gl:neral. '
"ObVlou,ly I did not get what I
ninl:tel:n hour f I bo b wanted when I had a cesarean section after
u a r Ut at leas I h .
. (ave a tape recording of her first cry and

PrePdrllli-.'-1 /()r ;:;;;



... D
some pictures from right after she was born. There are no words to teU how
disappointed I was, and for the first few months I was very depressed, I felt
deprived of my bonding experience and wondered what my poor, new, trembling
little baby must have thought . I wonder how different things might have been
with a vag mal delivery, without the aftermath of the pain and disappointment
from the cesarean."
"I was relieved. I was afraid of labor."
"I felt cheated, I kept apologizing to my husband, as If I were to blame,"
"Made the most of it and had a really good time! My husband was with me, the
staff were super-supporttve. There was a very warm and joyous atmosphere.
"I was absolutely devastated, I think my docwr lied to me to cover uPhfo: his
' h Th were many other women on ( e uoor
associate, who attended the Irt. ere . . M f 1 .
, b I rh only one With a vertical cut. y aIm}
who had cesarean sections, ut was e alive and well
and friends could not understand my feelings. since everyone was
at the end, but it's a tremendous sense of loss."
. d ami ,zed. It was the most terrifYing
"During the operation I was [(ed P }
and humiliating experience of my life.
d cation which I wanted to do
. I labor me I, ..
"I got to expenence ear Y I I'k 0 push J babr out
II ' fce s I'e t
1 will never know what It a([ua }



\' I It ,
I th sl
"a After rwentl,(our hours of labor, I Just wanted to be
"I ,hose gener-a :mes e .
asleep and have them deliver ml' child."
"1 think it was unnecessary. It was my doCtor's idea, and I was too tired to fight
" I don't feel guilty about any parr of m)' delivery. Fear of surgery is narural, bur
the guilt is totally unnecessary."

to a great extent on the individual cesarean fate of your doctor or
midwife. This is one of the mOs t imponam questions to ask a doctor
dunng a preliminary consultation, and juse about every obstetrician,
whelher his rate is high or low, will be proud to tell you. If 8 percent
of his deliveries are cesarean, the doctor will say that he doesn't believe
In intervention and that a patient, namral approach is best. If his rate is
25 percent, the doctOr will talk a lot about better babies and the benefits
of technology. Midwives can't perform cesareans, bur any midwife
shou.ld be able to give you the percentage of her patiencs who require
delivery. (Midwives, unlike obstetricians, screen their patients
10 advance to turn away women who are high risk, with increased
chances of having a cesarean.)
Reasons for Cesarean Delivery
In 1979, the Depa f H "
nmem 0 ealth, Education and Welfare contracted
r Helen Mariesktnd [0 I h " " '
. eva uate [ e riSIng cesarean rate. Her report,
re eased 10 1980 stat d h h " "
, e r at t erc IS no eVidence that supportS a correia
PrepllratiOl1 for Birtb
tion between lowered tnfant monaluy and h d
mor I try rat(:$ with the
in the rate 0 cesarean sections. In her -h [)
an I r MancsklOd IOtu
viewed morc t an onc hundred doCtors and f h
rom T eic (omments she
compil ed a list of the twelve factors (OntnhUl h
" 109 to ( e tremendous
IOcrease lO.ccsareans. The pnmary rcamns in orde f"1i
I r 0 sign. cance, were
the follOWing:
1. Threat of malpractice
2. The policy of performing repeat cesareans
3. The nature of current obstetrical traimng, which encourages cesar-
ean delivery (that is. for breech babies)
4. The belief that cesareans produce better babies
5. Changing and expanded mdications for cesareans, that is, tWinS and
In the same year, 1980, another federal agency, the National Insmute
of Health (NIH), also studied the grow 109 phenomenon of cesatean
birth_ The NIH convened a special task force of nineteen members .
which issued a 536-page report. One of their mOst Imponam findings
was [hat four diagnostic categories account for about 80 percent of all
cesareans, and about 80 to 90 percent of (he increase in the past fifteen
years. The categories are
Repeat cesareans
Fetal distress
Breech presentation
Some women will know in advance that they may need a cesarean, but
" d " I bo Y SImply cannot know before-
most receive the news urmg a r. au .
hand what kind of birth experience you are going to have. Even If you
Od ' gerl' I'OU should reVIew the
think you are an unlikel y can 1 ate lor sur _' .
" f h ses )'OU bener under
following conditions so that If one 0 t em an I
stand what is happening
o Y S Toe I A . I des failure to progress. aph.llo-
Dystocia is a ca" tchall category that mc u "/ progrJJ means (hat
" " d I . I CPD F.1I IIff 10 r
Pfll'1(dlJpropOrllofl (CPD), an re au\e 'd"l" This can occur be-
"I oduce 1 aUon.
COntractions either stop or 31 to pr . because of 3n odd
d unresponsive.
cause the uterus is stretche out an
a woman is tense, fearful, or exhausted. CPO
ll... _ _ .
h the
"'oman's peh'ls IS toO narrow to permn the baby to pass
means [at ...
This condition can do:"n dilation, but it IS most apparent
dUring expulsion, because pushlOg fads to move (he baby. ExceptIO rare
cases, CPD can't be accuratell' diagnosed umill.bor beginS, True CPD
is believed to occur In only abom 2 percent of all births. but it IS
(requently mislabeled and blamed (or failure to progress,
The cask force recommended {hat before performing a cesarean for
failure to progress, seve raj Other alternatives be tried. They include rest,
hydration. relaxation by sedation, walking around, and stimulation of
contractions with PitOcin. We certainly endorse any of these measures
In an attempt to avmd a cesarean. In addition to the task force's recom-
mendations, we would suggest nipple stimulation, massage, visualiza-
non, relaxanon {echniques, and changing body positions. Labor is
greatly inRuenced by a woman's state of mind and her energy level.
Fasting. exhaustion, tenSIOn, and laboring in the supine position can all
make dilation falter or stOp.
Perhaps me most controversial recommendation of the NIH Task Force
was that repeat cesareans nOt be performed routinely. It suggested that
women who had previously had a cesarean by means of a low transverse
cervical Incision (see page 295) be permitted [Q attempt a vaginal deliv-
ery for subsequent pregnancies, if the condition that necessitated the first
cesarean is not present. This recommendation has great potential for
redUCIng the escalating cesarean rate, because repeat operations account
for nearly one-third of cesareans performed. As more primary ones are
done, the likelihood for more secondary ones increases. Vaginal birth
after cesarean has recently attracted considerable publicity, but in prac-
tice approXimately 98 percent of the women in the United States with
a prevIOus cesarean now give birth by repeat cesarean.
Many peeople '--( h .
LX: levc t ere IS a meaningful correspondence between the
growing reliance on elect 'r I . . ,
- roOiC leta monltOIIng and the rising cesarean
rate The task (orce dd k d
I not rna e a Ireet correlation between these tWO
I.h:vclopmcntS b t d d h
, U I state t at probably no more than 1 percent of the
total cesan:an rate IS a b bl r
nIl uta c to Ictal rnonlloring. The study did not
deal with the Indlrect1t (h h '
c eo 0 t Iii tct.. nology, partICularly on dystOCia.
Scvcral.studK'S havt: dcmonSt' 'd h '
rate [at normal undergOing StreSS
Prt'/hiralif)fJ Im-Bit-Ill
and those who are compromised and truly d,s! d
rCS'e may ,ho h
abnormal pattern on the fetal monitor To d.ff W t C same
. .. I ereouate bet h
twa very different SHUations and thus aVOid ' wecn t ese
. unnecessary fetal
scalp sampling IS necessary. Unfortunately thO .'-
f f I
. .' IS test IS unavailable in
more than hal 0 a I American hospitals and . f
.. ' It IS 0 ten underutllized
even when H IS available.
Breech deliveries, the last major contrlbuung factor to th h h
e Ig cesarean
rate, are a controversial subject. Many doctors strongly believe that
breech babies should be delivered by cesarean because numerous studies
have shown {he outcomes of cesarean deliveries to be superior to vaginal
deliveries. However, a vaginal delivery of a breech baby is sometimes
possible (see chapter 7), This IS nOt a black-and-white ISsue, '0 It',
difficult to generalize. The deCision really hinges on your docmr and
what type of delivery he is comfonable performing, The cho,ce of vag,-
nal or cesarean delivery is complicated, and this is something that should
be discussed a[ length with your doctor or midWife.
An ac[ive case of genital herpes makes a woman a prime candidate for
a quick cesarean section. If vaginal delivery occurs, the infant has a 50
percent chance of contracting the virus during me passage through the
infected birth canal. If the baby getS herpes, he has a 60 to 90 percent
chance of either dying or sustaining damage to the central
system. If you have herpes, your doctor will determine whether It IS
, 'f II f I ' d by taking v,ral cuhures for
active by checkmg care u y or eSlons an
several consecutive weeks prior to delivery.
" hi out of every tWO hundred
A rare condition, occurrtng tn roug Y one I I'
. I partlall)' Of camp ete )
pregnancies placenta preVia means a p .tel: cd h n
. ' . .' db ' brt ht red ble 109 ( at IS pat -
covenng [he cervIx. It IS diagnose ) g d I be)! Vaginal
. h I mester or unng a
less, usually occurring dUIlng t east trI leteh' blocklOg
' ' -bl 'f h' I.cenra IS not comp
chvery IS sometimes POSSI e I [ l: P be performed
S a cesart'an must
[he cervical open 109, but 10 most case I hemorrhage There
' h' I:> materna
I[h placenta previa, t e pIIma) become by the
also (he possibility that the placentll C.ln ,uppl) or that the
off tht.. ox}'ge

baby's presenting part, [hm (u[ttns he bIrth (allal
b b
' dcsL'ent InW t
p will prevcm the a)':>
teeine hemorrhage caused by the complete or panial
This IS a rype 0 u ..
fthe P
lacenta from the uterine wall . Ie IS ,more rare and more
separation 0 . .
h plac
enta previa because It can pose an Immediate threat to
'l.cri(luS t an
the bab)"', oxygen supply, Its seventy depends on the degree of placental
t on beca
use QX)'gen and carbon dioxide can be adequately trans
, ,,-
{erred acroSS a semidetached placenta. Often chis condition begins be-
fore {he onset of labor, but it is not apparent until labor begins. Be aware
of any sudden onset of conrinuous and localized pain.
This occurs in 4 percent of all pregnancies. The condition is also known
as placental deficiency syndrome because of the placema's inability to
(unCtion efficiently. Postmarure babies actually lose weight and they
suffer from a diminished supply of oxygen, If you go past your due date,
rOUf doctor or midwife will probably perform a nons tress and perhaps
a stress test to assess (he condition of the fetal-placental unit. (See chapter
7 for more on these procedures.) If it seems that the placenta is aging
and therefore not providing proper food and oxygen, labor will be
induced. If induction does nOt stimulate effective labor, a cesarean will
be done,
Women carrying babies in the footling or incomplete breech posilion
have the greatest risk of cord prolapse. It can also occur when the
membranes have ruprured and the baby is nOt well engaged in the pelvis;
the cord slips down in the uterus and becomes prolapsed or wedged
between the baby and [he cervical opening. With each contraction, the
cord IS squeezed and the baby's oxygen supply is interrupted to some
extent. Sometimes the cord will actually slip Out of the cervix into the
vagIna. Cord prolapse is an extremely dangerous condition, requiring an
emergency cesarean.
In 40 to 50 percent of all twin births, one of the babies presents in the
breech position. Babies born in multiples are likely to assume odd posj
tIons IfthefirSttw' 'b h d "
In IS reec an thiS IS your first pregnancy, a cesarean
may be necessary, But if the first baby is vertex (head down) vaginal
deltvebl '
ry IS POSSI e if your doctor or midwife is willing.
Preparatifm for Birth
t\falprt'J0I1rt/lOfl means anything other th h
. _ an t to normal .
The most common vanation IS breech (h vertex position.
see c apter 7 , f II
lion of the varreties of breech and the St d d r or a u descrip+
an ar 5 lor normal d r
Another odd position is tranJltrlt Itt in h- h h e Ivery).
. w IC t e baby IS stretch d
acroSS the uterus at a onyfive+ to ninety-d I e
. . egree ang e to the mother's
spmal column. In t IS Instance, cesarean section' d' d
. IS a Vise ,because {he
shoulder usually enters the cerviX, blocking th '
. e passage lor {he rest of
the body. Babies also demonstrate a brOil' prtJtntalto'l. in which the
head is not tucked Into the chest, or a fare pmmtalum, in which the
head is extended and the face is forced to enter the binh canal first.
Some of these. necessitate a cesarean, but frequently they
are accompamed by comphcallons, such as failure to progress or fetal
This is a common complication of pregnancy and it does not necessarily
require a cesarean. After the membranes rupture, there is increased
chance of infection. To minimize risk, many doctors prefer delivery to
occur within twentyfour hours. If your water breaks and labor does om
start on its own, your doctor may insist on performing an induction, and
if [hat fails, a cesarean. We consider this to be an aggressive approach
and would prefer to allow labor to start narurally with scrupulous care
paid to hygiene in order to prevent infection. (For a complete discussion
of PROM, see chapter 8,)
, I ' dangerous and somewhat
Toxemia also known as preec ampsla, IS a
. ' _ . y time during pregnanc)'. but
mystenous condmon that can occur at an .
, ' d ' It 's heralded by a (flO
most commonly appears 10 the {hlr trimester. I .
'n the unne and edema
of symptOms' high blood pressure, protem I I
. . Th . unknown. but many peep e
(swelling from water retenno
). e cause IS be lied bl'
, ' Id ' a can often cootro
believe it is linked to diet. lvl1 [Qxem
. . If I f ntreated
r IS del1\'ery. e {U '
medication and bed rest. Its cure, oweve, I - which can
. _ d" known as ec ampSl3.
toxemia can progress IntO a con ilion d h If the disease does not
. coma or even eat .
cause materna convu Slons,' fli be induced or a
respond to more conservative measures. labor "I
cesarean will be performed.
. 1...., . must bl' (Jrefully nlnnltorCli unng pregnant)' 10
" d '[ w Also. daabetlc women an: apt to dcvelop
mJ.ke surt.' II (X"sn l
, b !xxn w dlabcuc mothers have an mcreased chance of
wxeml3. J les
'd" s s)'ndrome due to {he delayed m;.Huracion of Chelf
rt:splfawn ISlreS, "
d Ilb
,f{h ,(the baby goes III term (Th" doesn t appl), to those
an SCI, .

PCSIJu,,)ual dUring pregnancy.) For this
w()men w () '-' _ _ '
' doctors will deliver early by inducnon If possible, or by
reason. m .
, an The NIH Report on Cesarean Birth noted Improved treatment
lCsare .
for diabetic women and their babies, resulting in diabetic pregnancies
being closer to term and more mothers delivering vaginally.
birth occurs in approximately 75 percent of all diabetic
Hypertension alone does nO[ necessitate a cesarean. Excessive pressure
on the blood flowing to and through the uterus can impair the supply
of nutfiems and mq'gen to the baby because of (he associated narrowing
of the blood ,essels, I( )'our blood pressure remains high throughout
pregnancy, the baby may nO( be properly nourished and your doctor
mar want to induce labor. Some women develop gestational hyperten-
sion during pregnancy, but this condHion responds well to good nmri-
tion, medication. and rest.
The Risks Involved
En:n though cesareans have become much safer to perform in the past
fi([y years. they are sull major surgery, with risks for bOth mmher and
baby Ce:iarean births have a maternal mortaliry rate rwo (Q four times
greater than (hat for vaginal birth. If a woman has had an internal fetal
monitor prior to a cesarean, her chance of Intrauterine infection is 35 to
65 ' , (W' h
PUC4..:nt It out the monitor, the rate of Infection is 20 (Q 40
Tht:rl' IS also the pOSSibility of hemorrhage, infection of the
IOClSIIJn, and inJury to the bladder and urt:ter For the baby, jaundice is
thl.;' mmt common'o I, f ' d b
. l: mll1catlun a ter ccsarean delivery, followe Y
rl':iplrarory dmrc':S:i :iyndrumc (RDS). C<:sarean bablcs do not have AUlds
squt"l:'lc(i from thclr lu d
ngs unng normal deltvery and therefore expen-
l:'ncc grl.;'att:r difficult), bn:athing. Abo, baoll'!\ have RDS because
,he), arc delivered t,oo early, hcfore rht"ir lun . h .1
b b
gs ave 1ai lime to mature
fully. Cesarean a ICS {an also appear siwH'l\h f ' d I
. . 1 tcr (: ivery because of
the drugs or anest eSla given to the mother du I ho
flng a r .md deli\'ery
The Operation
In many cases, the decision to do a cesarean is made dunng labor and
it IS made with your Involvement. Although there may be some urgency
(0 deliver the baby. there is usually enough time (Q discuss chotee of
anesthetic and incision and to understand what's happening to you. You
will be asked to sign a consent form for surgery and you will be given
a routine surgical prep-urinary catheter, intravenous, shave of the ab-
domen and upper pubic area, and cleansing of the abdomen With an
antiseptic. Most of [his will be done in the labor room. When you're
ready, you'll be wheeled to the operating room, whICh IS usually located
on [he same floor.
Recently. hospitals have begun to permit fathers (Q be present in the
operating room during cesareans when regional anesthetic IS used. ThiS
is a privilege that most parents want but many hospitals are reluctam [Q
grant. It has become a battie analogous to the one fought the late
sixttes. which won fathers admission (Q the delivery room .. \'\ e re confi-
dent though that the forces of reason and economiCS Will [Oumph agam:
and ;000 all 'hospitals will allow couples to be together (or the birth ot
{heir children. . . W
If your hospital allows fa{hers {Q be present dUring cesare hans,
. h You will be dr.lpeJ. so e won t
encourage your husband {Q e WI{ you. . It' have
- f he doesn t want w_ )OU
have to actually see the oper-.lttOn I h e the JOY of
' h . lk (0 \"ou Jnd you can 5 ar
regl,'onal anesrhenc, e can, t.\ .' Id h' b b ' rioht .liter birth.
' II I be .ble to ho t < J 1
dehvery together. e WI J so '. husbJfld to
I h
h,-piul will not pcmm }our
If you need a cesarean ;lOl t eo l!i " ._ '1 ' hI n()SSibiliry the
d - There 'i al1\.1)) J S Ig t -
be present, at least ask your l)(tor. m (or future (hangl.'
fuel the momentu
of your may
A N, EST H E S 1 A '1 _ , betwecn gena',ll .lnd rt.'
' II b' ,!fered .1 l: lllllt.: . j .
II time.: permits, you WI l' l . I n'sthetll t(lU;n an
. . ulu rd:ll1n.l J l,
anesthesia. Thl.' most [Xl[l, ,
, I I ,bor .",,1 Odit"o,
. 1 \or"IoI-'
1-,11";,1110/11 ell
11 for a complete descriprio n), and we would
e ,dural (see c lapter _ _ . I Th
r h. It IOstead of bemg pur ( 0 s eep. erc are several
cnCQUr,lge you to ave - I h '
-dural compared with genera ancs( eSla:
Jlhanrages 0 an ept
. ake and able to see the baby seconds afte r birth.
). ou are aw
You're not grogg}1 (or several hours and you wo n't be nauseated as
}IOU might following general anesthesia:. .
You won't have a sore rhroar because I[ ISO t necessary to msen a
rube to maioraln an open airway.
Jr 's a safer procedure (or both you and the baby.
You will be able [Q hold and nurse your baby In the recovery
The only objection women sometimes have to receiving epidurals for
cesareans is that a slight tugging of the uterus can be felt as the baby is
lifted out. However, this is not painful, JUSt disconcerting. If you ' ve had
a long labor and need a cesarean, you may feel ready to end your misery
and just be pur to sleep. This is an underStandable reaerion, bur your
panner or dOCtor should gently persuade you to have the safer regional
anesthesia. Some women, however, are repulsed by the idea of remain
ing awake for surgery and won' t consider an epidural. This is a pe rsonal
choice and yet anOther matter that should be discussed in advance with
your doctor or midwife. Even though it may seem a bit negative to bring
up the subject of anesthesia during an office visit, it's a good idea. As one
of our friends said about her cesarean experience, "When it came ro
pIcking the anestheric, I felt like I'd been handed a menu, but I was in
no posltion to make a choice."
The great advantage to general anesthesia is the speed with which it
can be administered. If there is a true emergency, such as cord prolapse
or sudden fetal distress. there won't be time for explanation or discus
sion. Although these situations are terribly frightening. you are given an
opponuOiry to see your hospital in its finest hour as it responds to a
medical crisis. If necessary. you can be hooked up to an intravenous and
be given general anesthesia in five co ren minutes. Undoubtedly. you will
feel scared and your husband powerless as he waits outside the operating
rOOm. ~ t this moment, the only rhing to do is to place yourself in your
doctor shands WHh complete faith in his ability and concern for you.
Wlthln a few minutes. your baby will be born. and about an hour later
)' OU WIll wk ' h I
. a e up In t e recovery room to find that everything has {Ucnc(
Out all fight.
Preparalion for Birlb
. , . )urself delivering your bab\, b\, nalural chddbirth in a
If rou pICHI feu } (. . . .
. t the transfer ro the opcriltlllg room can be a )olt. Once
COl\' CO\ Ironmen , , .
c_ omes necessary. there IS no more talk of dimming the
a lOC'C ' .
I n
" Ihe champagne ready. Suddenly Ihe medICal team goes
lOW 3'UOO, fast.
Llsuall)' there IS quite a cast of characters 10 the operating room during
a cesarean: your obstetriCian, who will be performing the surgery; an
assisnng surgeon; the anesrhesiolog
; an attending pediatrician; and
\'anom nurses. The operating table IS narrow and uncomfortable, the
room IS cold. the hghrs are extremely bright, and the whole situation is
unfamiliar. The serting may be a little alarm 109, but you can (om fOr(
yourself Wllh Ihe thought that you are In the right place and that your
babr will be delivered soon. A cesarean does not provide a natural
delivery for your newborn, but if complications occur, this is no longer
a pnomy.
DurlOg the surgery. the anesthesiologiSt will Stand by your head. Right
before the anesthesia is administered, you will be given some oxygen to
give the baby a little boos(. As soon as the anesthesia has taken etten,
your doctOr will make the lOcision. Unless there is an emergency I he will
do a low transverse Incision, known as the bikini cut (its scar is low
enough to be hIdden by a bikini).
This type of incision has all but replaced the classical vertical one (sec
drawmg) because it is more aesthetically pleasing and has much less
chance of ruprunng in subsequent pregnancies. The classical incision is
still performed in about 5 percent of all deliveries, and in those instances
a's done because of extreme emergency, unusual position of the baby,
or because placenta previa preventS the use of a bikini incision. An
(Kcasional doctOr will do a low venical incision, known as a semiclassical,
but thiS t)'pe is also more prone to ruptUre than (he low transverse
IOCISlon. It's not likely that you1I be dictating {he type of incision your
doctor should perform, but there may be some room for discussion about
thiS chOIce either d' iii .
uflog an 0 ce ViSit or JUSt prior [Q surgery.
YOur Baby Is Born
W IIhin five m h b
lOutes. t e aby will be out. He will be thoroughly su(-
"oned and qUICkly e I d '
va uace lOr Apgar scoring, If your husband is there.
Itt; /
.... law Ce""cal (Blk'n, Cull
Cesarean Incision
he should be able to hold the baby at this point. Then the placenta IS
manually extracted, and the layers of muscle and skin are sntched. The
sewing.up process takes time, approximately fortyfive minUles to an
hour. The inner layers are sewn with absorbable thread, whereas me
outer ones will be done either with absorbable thread or with stitches
or staples that will later be removed.
Recovery at the Hospital
11 be k the recovery room. If ),ou
Soon after the operation. you WI ta 'en to . d . '
'II b d out of consCIousness an Yo on {
had a general anesthesia, you e In an . h d "dural
, If you ve a an epl
really be aware of what's gOIng on., _' cquainced
.' be a good time {Q l,}C"l..ome a
Or other regional anesthesia, It can, be db)' ad\'ance
. . - mal' have to arrange
With your baby, ThIS first meeting h .
outinel)' whISk
many ospU<I 5 r
special permission, however, calise h Cr)' where (hey are
d I
room {Q t e nurs ,
cesarean babies our of the e Iveq . "r diffi.(Ul
b d have great, '
kept for observation. Cesarean ales 0. b b)' is doing well. the
. d but If your a
lies than vaginall)' delivere ones, have him in the reco\"-
pediatridan should be able ro arrange for )'OU IO
__________ \ r ,I L"bo" dud Deliury
I '"ridtjom Oil 0"""
. "Ieepy and unresponsive. your husband CRn spend
, . room II yt)U rc s
(n . . . h h bab)' either in the nursery or In your room. There's
1 ' urne wI[ r e
scm l 'h" -esarean should prevent }'our husband (ro m seeing
of! n.':lson \\ ) ) our l
and holdmg h" chtld. . ,
. com can be a good place {(l try nursmg. ) a u should
The [ccovell r . .
11 . . 'our stomach to proteCt It from lntl e ki cking feet. Or
pur a pi 0\\ 0\ er ) ... '
h t
he football hold (see IIlum.non ) to . vold resting the
you mig ( use
bab}' on "our abdomen.
\\:'hile ~ ' o u ' r e in the recover}' room, you will probably be offered some
Demecol for relaxation. Some women feel a bit shaky and disoriented
after a cesarean, bur that doesn 't mean they need a narcotic. D emerol
at this time IS not medically indicated, so this depends entirel y on how
you feel. You should feel free to say no thanks.
The amount of time you spend in recovery will depend on the type
of anesthesia you received and on your conditi on. You may be nauseated
or vomiting if you had general anesthesia. If you' re in good shape,
however, you could be in your own room within a few hours.
The first forry-eight hours after the surgery are not going to be any fun.
If at all possible. get a private room. You will be very tired, especially
if you had a long labor, and your incision will feel excruciatingly tender.
Getting Out of bed will be painful. and just five minutes on the phone
will exhaust )'ou. For all these reasons, we suggest either having your
husband scay with you cominually for the first twenty-four to thirty-six
hours or hlflng a private-duty nurse. This is worth [he money because
)'ou'll greatly appreciate a professional sponge bath and experienced
hands helping to rurn you In bed. The staff may forget to tell you about
turning, but it is important that you not lie frozen in one position. Since
movement will be painful. you'll appreciate help.
You'll also need help when you're required to stand and walk a few
steps aboU[ twelve hours after surgery. Moving about helps prevent
thromboSIS (blood clots in the arteries). and it will hasten your general
recovery and give you a great feeling of accomplishment. You may not
be hap,p), about walking, but you have no choice. Try using the Lamaze
breathing again, and remember, your stitches are quite strong; you are
not gOlOg to come apart.
Som'time afte 1 d he
r surgery you WI I have the catheter removed, an t
mtrav.enous should Come Out a day Or two later. If you received nonsol u-
blc stitches the 11 b If
' y WI e removed around the fifth or sixth day. yOU
PreparatiQ'l jor Bil'/h
Nun;lI!; Afler Cesarellll
Pi llows used to Cover inCision
Pillows used to support baby (football hold)
I I L ,bor ,HId Delil'rry
I '(tricl/iollS Oil !'" om'" '
' h ')' ma)' come oU{ sooner bc'(ausc ther promote bet(
han: star l: s, f 1.: er
Sible stitches acc simply absorbcJ.
he Ing ..... o U .
Gas pain IS a common problem following any surgery and
O(cur!i because {he digestive S}'SfCm has been The best remed},
(or 8
:'. is walking about and gelting Pam medication may
funhcr slow down intestinal functlontng. so It s better to avoid it if
you're having (rouble with gas. A suppository or little enema may also
relieve gas rams.
You will be pur on a liquid diet (or two or three days until {he doctor
IS convinced that your intestines can handle food. Drink lOIs of liquids,
beyond thirst, for this will help your recovery.
h is important that you do some deep breathing or coughing on a
regular baSIS ro avoid Ruid building up in your lungs, which could lead
to pneumonia. Deep breathing is especially important if you had general
anesthesia. Stan this exercise right away for maximum benefit. As an
added bonus, it should help with gas pains.
If rou dId not come ro the hospital prepared for a possible cesarean,
}'Oll may need to send your partner oU( for stick-on sanitary napkins so
}'OU won't have to wear a belt. Forget the bikini underwear, which will
cur fight across your incision, and switch to something bigger for the
next few weeks.
The pain (rom )'our surgery will manifest itself in unexpected ways.
Your Incision is tender for a while, but you also have several layers of
stitChes IOside that hurt in different places. The nerves in your skin have
been CUt, so yOll will feel numb until the nerve connections grow back.
(ThIS takestime but will happen.) Your pubic hair will be uncomfortable
when it StarlS [0 grow back. These aches and pains all cake time to
Do nm expect to feel the way your friends who have just had
vag mal births feel, and do nm expect to be "all better" in six weeks,
The average hospical scay following a cesarean is twice as long as one
after a normal delivery: 6.2 days versus 3.1 days. Toward the end of this
time you will Stan feeling much better and there's no reason you
shouldn't have your b b . h ' . ..
fIi a y Wit you as much as pOSSible, Nursmg IS more
I cult after a cesarea b h . f
n, ut ( ere arc many women who manage 1( , I
your 5tomach IS JUSt too Ie d h Id
n er to ave anything resting on it you shOll
try the football hold .'
' as we Just suggested, or nursmg while lying down,
propp<: on one arm AI
d . so, you may need patnkillers during the first few
ar>, so ask for them Th ' f
d I .' ere s no reason (Q be uncomfortable a rcr
e Ivery To minimize rh d '
- e rugs eneCl on the baby, rake rhem right after
ou nurse, We urge you to accept pain rer .f b
ie 1t
milk isn't 10 an only trace amounts w'lI polm your
makes sense that nurSing will proceed I appear to the (oIO$tcum. It
mOSt smoothly If you' re nO[ in
An estimated 30 percent of cesarean mOl he 'II f
, . rs WI run ever$ of at least
100A degrees. ThIS IS not a serious medICal p bl b
, ro em, Ut nevertheless
women with even slagh.t . fevers are often separat d r h .
, e rom t elf babies
because of a slIm pOSSIbIlity that the bablcs could bee f d
orne 10 eete with
a disease that could contaminate the nursery We th k th I .
.. m
unduly conservative and a senous overreaction to a comm . .
on Situation.
There are who agree with us, among them Dr. Audrey
Naylor, a pediatriCian and lactation specialist at Mercy Hospital in San
Diego, California. She believes that only in "very rare circumsrances"
should a baby be caken from a nursing mOther and that those circum-
stances would include an active case of tuberculosis or hepatitis.
,. I n developing nations, where Infectious diseases pose a serious prob
lem, studies have shown (hat when a nursing mother and baby are
separated, there has been a significant increase in newborn infecuons,"
Dr. Naylor said. "When the mother and baby are allowed to remaIn
together, there has been a decline in newborn infections, and this has
been demonstrated even in very crowded clinics where mothers are
sometimes forced to share a bed," She feels, however, that more caurion
should be taken with mothers who are botdefeedtng, because those
babies do not benefit from the antibodies contawed in breast milk.
This is one hospital regulation we encourage you to fight. Losing your
baby, even though temporarily, can undermine your making
you angry and upset. Try to enlist the support of your pedlam,clan
. f If ' . the argument abom Infernoo
your doctOr or midwi e. you re given
f k (he babr with you and
contaminating the nursery, see I you can eep .' tdd
have your baby be given his daily barh and exam inlsoiJnon, Your,c I
h' I U might have If he IS not
stands a greater chance of getttng aD}'t 109) 0 . _,
, 'bod' ( 'our bod)' IS manutacrunng.
allowed to nurse and receive the anti )
Recovery at Home
. when ),ou get home from (he
I laving a cesarean means havlOg he P h e man)' things
. :i this T ere ar
hospHal. There's no way .\roum . - up and down SUlrs.
rft n" or gOIng
shouldn't be doing at first, suc as I I I:'
and if you do, you'll Jel:1Y your recovery b.y weeks. If your husband can't
tJke off from work, someone should be with. you for at least the first full
week. You will be totally preoccupIed taking care of your baby and
regiunins your strength. _ Dishes, cooking. can be per.
formed by a surrogate. patd or otherwise. unnl you re back on your feel.
You will be extremel)f tired, and routine chores will be exhausting.
W'alking around the block or emen31OIOg for an hour will send you to
bed for a nap.
You have a longer road to recovery than the new mothers who have had
vaglOa! deliveries. Your big challenge during your hospital sray is simply
getting to the point where you can stand up straight. As you begin to
feel better, however, you should try to help your body recover from
both pregnancy and surgery bl' doing the following exercises. [n a few
weeks you will once again be able to lie on your stomach and get Out
of bed like a normal person.
Take (hings one step at a time, following the progression below. Each
day add one new exercise to the ones you are already doing, keeping
10 mind that as a postoperative patient you need to conserve your energy.
Numerous short periods of exercise during the day (four five-minute
sessions) are bener than one long, tiring one (twenty minutes all at one
For the first week, do these exercises lying in bed. After that, move
to firm surface, such as the floor, and add the pregnancy exercises,
are gentle. Once you have had your postpartum checkup, you can
beg," the postnatal exercises in chapter 14 (see page 351).
Fool Circles
Circle one foot to the right (Wenty times and then to the left twemy
times. Repeat wi(h orher foot.
Fool Pumpi"K
Flex and point your foot fi'
b k f twenty- ve times as if you were pumping the
ra es 0 a car Repeat with the Other foOt.
Peh'ic Tilt
Lie on your back with k
COnt your nees bent and your feet on the bed. Exhale,
ract YOur abdominal I
bed_ R . musc es, and lauen your lower back into the
epeat ten limes.
Prepllrtllio'l /01' flirt"
Knee BeNds
Lie Aat on the bed, legs straIght. Sltdc one heel I h
S h
a ong t e bed toward
Our hIps. tralg ten .your leg by sliding you h I
r ee away from yo
Alternate knees, ten times each leg. U
For cesarean mot.hers, disappointment is a natural component of the
postpartum expenence. \XI'omen who have had cesareans frequently ex.
presS feelings of failure because they feel they have flunked the ultimate
femininity test-giving birth, They can also become embittered because
they've been deprived of their fantasy Lamaze birth, a dream they
worked so hard to achieve. On tOP of that, they worry about letting
down their husbands and families . The icing on the whole sorry cake can
be strong feelings of self-hate, fueled by a sense of betraya! by a body
that didn't perform properly.
The worst part of all this is that every time you get worked up and
begin to feel really bad, you then feel guilry because you have a healthy
baby. The depression and sorrow never get fully expressed because cher
are always held in check by the guilt/ gratitude response. You can end
up in a terrible depression, which is really a case of normal JX)stparrum
depression compounded by a case of cesarean depression and simple
Negative feelings following a cesarean should be expressed and ac-
cepted. This expression is crucial or they're likely to surface dunng
a subsequent pregnancy. The}1 can even become transformed 10[0 resent-
ment toward the baby, who put you through all this. Westrongly recom-
. . . hich will proVIde a format and
mend JOInIng a cesarean support group) w
. f . ess your feelings. You can find
a sympathetic atmosphere or you to expr
d Framingham MassachusertS
one by writing to CoSEC at 22 Forest 0', ' .
d f
C eans/ Support Education
01701. This group's acronym scan s or esar h I
rean support group or . e p
and Concern, and it can refer you to a cesa , y\Y/CAs or
you establish one. You might also check women s ceO[ers, '
churches for a referral. . b rself but in {he
bl h
die more thlOgs I' ),ou ,
In time you will be a e to an ering from sur
b that }'OU are recov
very beginning you must remem er her down {he street
"'-th the new mot,
gery. Do nOt expect to 'eep up 1 'ho has never been
. I d expect an}'one '"
who had an easy delivery, am 0 not, -k I' P to you to set the
. . . h . s realiy II C. (IS U
In your posltlon to know'" 1\( It I . led shortcomings.
If r 'lny pen.e
boundaries and to forgive yourse 0'
Being a Partner
hIS chapter is for yo h U
( e parmer. For whatever reason, you may
not do a lot of research about pregnancy and childbinh, and you
may nOt look at the f h b h
. _ rest 0 t IS ook but we hope you will read [ IS
section. It will give y ' . ' . h
h _I ou an overview of the whole process of childblrt ,
l' P d<:flne what you h
as a partner can in advance and once [ at
rocess begins-and. If you have doubts gIve y( d
Juan, eaofho I k
yOU are to have thiS opportunity. W uc y
II wasn' t until the mid-1970s that men were permitted b h I
.' . . y OSplta S to
be with the ir wIves dUring chIldbirth. Bdore that ume h b d us an s were
banished {O a smokefilled waiting room or ordered to walt it out at
home. Although some of you may nOt want anything to do with natural
childbirth. you ' re lucky to have a choice about participating. Fifteen
years ago , men wefe created like imbeciles who were only capable of
chauffering the precious cargo to the hospital and then passing out the
cigars. T oday i{ is universally accepted {hat husbands and wives belong
togethe r during labor and that men have an important and unique coom
bu rion to make.
In (his chapte r , we di rect the majority of our comments to fathers and
refer most frequently [Q the partner as husband. That is because the great
maj orit y of Lamaze students are married couples. It seems unfairly re
strictive , however, to conSider husbands the only proper companions for
labor. Wo me n can be assisted by a husband, a boyfriend, a mother or
sister, a friend , o r a professional labor companion. The Lamaze method
is so sound that the parmer's role can be successfully assumed by anyone.
The term coach is often used to identify the primary Lamaze labor
compani on. T o us, comh suggests gung-ho athleticism, with an implica-
ti on that women should playa secondary role. \VIe therefore prefer the
. I flects the shared expenence
word partner, because It more accurate Y re
gether toward a common
of childbirth and the joint effort 0 wor 109 to
goaL . h h' can
f d r ng childblrt IS t a. tr
The best reason to be with your WI e u 1 . .
nce of your life. As you can
be the most exciting and profoun expene .' ers felt
. d our questionnaIre, partn
see from the responses we receive to .' result of
. Th f It closer to their Wives as a
JOY, amaze ment , and awe. e)' e . d touch their baby
sharing (he birth experience and had a chance to see an
immediately. birth is that your wife wantS yOU
The second best reason to be at th< . . g birth you'd reel
:t yOU were glvln .
( ere. If the roles were revers am .d Debe-
. 'd I ( her atyou
r SI
e. ... d
JUSt as apprehenSive and you " an f. ood bi rth experience an
. 'h mponc
" ,l g
ra 1 anzer has stud le u t e co .' . are ne(essarv to pfl.r
j partlClpatton .
ound {hat a husband's presence anl
B"i ,lg ,I
, ,

, ,
-- -
\\ H \
"ren <;t>Conds after OUf son was born, the doctor handed him to me, umbilical
cord still auached. I looked at my baby, and his eyes looked up at mine. I will
never (orget (hat first eye contact."
"The best and most wonderful moment was the actual delivery. It's the most
joyous thing I've ever experienced."
"I gave mr new son a Leboyer bath. My great reward was his sweet smile as I
immersed him in the warm water."
"Those first precious minutes .... She was beamiful and she stuck her tongue out
at me. h was one of the happiest morn ems of my life."
"I reahzed my father and my wife's father had never seen their children being
born, and all, I could think of was how unfortunate these twO grown men were.
I really feel It makes the man feel part of the birth to share this experience."
"I had a whole new respect for my wife watching her go rhrough labor and
delivery. I wouldn't have missed it for the world."
You read things about preg . b k d . I I' nancy In 00 S an magazines bur nmhing abso-
nothing, compares with witnessing the binh. I plan to be there for next
c 1 ,and every one after that!"
, , , , , , , +
L-- . ________ ---.:_----=-_-...:':..---.:+ ___ ' __ ' __ ' __ ' _--, I
]04 PreptJrllfiol1 lor 8'I"'/)
, , , , , , , , , , , ,
W" 't S II 'U , I A , , ,
.. After my daughter was born, I iuS! meltd I' b
, (! , ts nngmgtea
remembering who at it.was like seeing h. be' b - rl to my eyes Just
, er 109 orn It'l be d
parents' generation did not allow the father t __ ' _ y?n me how my
I wouldn't have missed." 0 partiCipate an thiS, an experience
+ +
, , , , , , , ,

duce a peak experience for the mmher Her abiliry lO feel joy and ecstasy
is directly related to her husband's involvement
Your job is to suppon your wife emotionally and physically You will
try to free her from distractions and to increase her comforr by massaging
her back or offering her sips of water. You' ll be doing whatever you can
to make labor enjoyable and endurable, Being there means that )'ou're
willing to share everyrhing with her, her pain as well as her joy. Labor
can get pretty intense. You won' t get any breaks for coffee, and it rna}'
be hard to find the time to go to the bathroom. If things go well,
however, it should be one of the greatest momentS of your life.
In the final months of pregnanc}', it is normal for you to feel or
. d d I 'e " the hospital en\'tron-
anxlOUS about many aspects of labor an e 1\ r), .
f h b b
' d the role you WIll play
ment {he pain of labor {he health 0 tea 1, an
" a' haunt you as weU as
Fears about fainting in the dehvery room ml ' I
!luous You can ree quite
worries about your being complete y super ' , d LamlZ
'ldb' h horror stOnes an
s ak}' as idiotic people recount C 1 Irt . . . Tn. not
f h '1
classes make you aware of some 0 t e t I a)' be more
d f it 's all over, ),ou m.
to worry. Complications are rare, an a , men have trouble
,our ,vile-many v. 0
em 1l1Sla{lC about Lamaze t an ) , h' h .. bands SJ,vo
, f b rth but t t:lr u.
forgetting the pain and exhaustion 0 I ,
. . d h ilin'" memory
cxpcnence as a romantiC an t fI t:'
, ,

- -
AllOl,,. C II I I ) B 1 !tTl-!
'I was afraid that It was gOing to be blpody and disgusting, but actually it was
heautlful "
"{ was worried that all wouldn't go according to plan for a natural childbirth."
"I feared an unknown complication over which we would have no control."
nOt gening my wife [0 the hospital 10 time."
"My major concerns were about the baby being scillborn or my wife dying in
ch,ldb",h, '
'I was afraid I would faint or throw up when my wife needed me the most."
"I was afraid I would forget how to do something and make my wife even more
" . fcared (cellog helpless In the face of anxiety and suffering."
The biggest fcar I had was of being imimldaccd b}. (he doctor/nurse/hospllal
rouune. The midw-r, d
I e encourage mc to help and was nOt fearful of my
usurping her authQrity.
t __


Participating In childbirth IS a scary id
ea to mOSt first-li f h
Many men enter as reluctam panicipams but me at ers .
. , ' emerge as enthralled ad
ca,es of shared chIldbIrth, You don', have '0 be 'I vo-
, I a parucu arly demonstra
rive or emottona man to SUPPOrt your wife d . lbo' -
"' ,unng a r-all kinds of
men do It, and all kinds of men are 'hrilled by 'he e S
xpenence. orne even
feel sorry for those who have missed 'he b"'hs of Ihe'lr h'ld 0
. c I ren. thers
become proselytizers for 'he Lamaze melhod Wha,eve f I'
.' '. . r your ee JOgs,
being with your Wife dUring 'he birth of your child wl'll
Increase your
mutual and .Iove. She. cannOt help but appreciate your presence,
and you certamly Will appreCiate her Willingness to work so hard for you
Visiting the Doctor or Midwife
Your chances of enjoying your child's birth are increased if you have
been emotionally involved in your wife's pregnancy. On a tangible level,
(his means accompanying her on some visirs to (he obStetrician or mid-
wife. Ideally, you should have participated in the seleaion of this person.
If you did nOt attend the Initial interview, you should meet the doctor
or midwife as soon as possible at a routine office visit. A bonus will be
the opportunity to hear a unique sound: your baby's heartbeat. Also, you
will feel more at ease during labor if you are familiar with the person
responsible for your wife's care.
It seems to be a rare expectant father who reads books on pregnancy and
birth. We commend you fOf reading this chapter and urge you nor to
, ' f h 'c t 'on Reading clears up
Watt until Lamaze class to gain urt er mlorma I .
, ' d 'des a point of reference to
misconceptions decreases anxiety. an pra
fi 'h h
' , f u shouldn '[ ms {e rest
YOur wife's pregnanq'. There s no reason }o d
f h
' h 'fc can recom
OtiS book or tackle any or efS )'our \\ I . h'
d" 'Lamaze course wit lour
\VIe assume that you will be aHcn Ing J be ded ro go
, men have to persua
or your partner. At the outsct. man} . - he course (lJSSe'S
to classes. but most of them actuall)' cnd up enIO)'mg t .
are great for several reasons:
,) help Jnd partlClpalt'
ou Ie nn 0" Il
You feel less nnxious, heCJUS
y .
In )'our child's birth
You participatt' in discussion. which clarify your expectations
alx1ut birrh
You meet other men 10 the same situation
You dc\elop a sensc of camaraderie with the other l-ouples at a time
when you sorely need it
y ('IU can ralk aoour your feelings and wornes tf you want
Practicing the Breathing PatteCllS
As the due date approaches, you should be diligently praCtIcing the
breathing patterns with wife; this is of critical importance_ Since
tension IS the normal reanion to pain, it takes a lot of conditioning to
change that reRex to one of relaxation. Even though we'd prefer to resist
sporrs metaphors, narural childbirth is analogous to a strenuous athletic
event: It requires stamina, proper attirude, and the confidence that comes
with training.
It seems that men are often more lax about practicing, although
women can be tOO, albeit for different and more complicated reasons.
We have analyzed men's feelings about nOt practicing and have come up
with four classic excuses for avoidance. They are
It's bener if you breathe b) yourself, and then, after you get the hang
of it, I'll do some with you.
You're doing JUSt great, you don't need my help. I'd probably JUSt
mess you up.
t Your pam threshold is Incredibly high. I don't think you're going
to need to do any breathing at all.
We dont have enough time now. I brought work home with me,
and then larer, if it's nOt tOO late, I want to repaint that rocking chair
for the baby's room.
All of (:xcuses are bogus, of course, because you can find {he time
and energy for you care about doing. If you really want {O
hdp your Wife during childbirth, you're going ro have ro prac{ice noW.
You've got (O learn the breathing techniques because she may forget
them. In addmon, you must become acquainted With her particular
rhythm In order to gUide her through the vicissitudes of labor By
practiCing now, you'l\ know whICh wunh and suggestion!) arc most
tffcctlve For examph:, if she needs to slow down, you'll know rh1.\t

. . . . .

"It's amazing how much I didn't know I learned a lot.
"Lamaze helped us both feel more confident, and it made me feel like, 'I(s my
baby. tOo!'"
"I didn't like going to [he classes, but the information was helpful."
"The classes forced us to take the nme out of our schedules to talk about things
we had been thinking about all along.'
"Lamaze taught us to rely upon ourselves to conrral the situation, rather than
letting the docror conuol it."
h ms It was like getting
"I felt foolish lying on {he Roor pracncing breat 109 ..
. F II b' sitting In the bathtub.
ready to go over NIagara as}
til but didn't dUring delivery
"The sight of blood had bothered me In the ms,
of all the other men in the I
"I liked the friendship and support . h' ('Inl\' one to teel that
h and I w;lSn t t t: <
exactly how I felt about e\'eryt

. hilt were nOl t'".lSik undeNl.x"ld
" w Ic(hniqu
' t
"Lamaze classes opcnc m) t:) _ J
{$"'t,"l. clJ
from books."

1 -------



Bong ,I P.,,.llId
r----- .-

A T T 10 :-.; () I N l. L ,\ \1\ I
"The classes helped prepare me for a siruation that for many years was considered
women's work."
"There was nothing to dislike. The camaraderie of the couples was great. The
patience and insight of the instructor were wonderfuL"
"I had dIStanced myself emotionally from the birth because I was scared about
what might or mIght not happen. The classes helped me keep in touch."

simply saying "slow down" doesn't work, but telling her to take deeper
breaths does the trick.
The last momh of pregnancy is not a particularly enjoyable time for
either parem-to-be. BOth of you are getting anxious and impatient, your
wtfe probably feels like a lethargic blimp, and your sex life is a thing of
the past. You can gain a lOt of points at this time by extending a little
sympathy. A foO( massage, a cup of tea in bed, an unexpected hug. or
drawing a hOt bath will assure her of your empathy and love. There's
no way you can really know what it feels like to be pregnam, but imagine
carrying around six five-pound bags of sugar twenty-four hours a day.
and )'oo'l! have some idea of the effort involved. We know all of you
are filled with goodwill, but it doesn't hurt to make a daily demonstration
of thai splrit.
There are lots of practical things you can do right now to prepare for
the baby and make things easier for your wife. If you've never been
domestically inclined, thiS is a good time to learn (0 make an omelet or
3 J() Prf'p"rllliOtl jor B,rJh
.;.::0 '
"". , . ,
run the washing machine, These skills will L,
"" appreCIated n b .
be invaluable in a ew weeks when thing h. ow, Ut will
S get eCUe You h Id
try (0 ,have a lutle fun at this point because in h S OU also
a mont Or so yo '
be gOing out (00 much. This is a good lime t h u won.t
ogo to t e mavi
friends. or do whatever you enjoy. es, VISI[
Labor Begins
You may have a vivid fantasy about the way labor will begIn, such as the
water breaking while rhe two of you are waiting on a movie line or fierce
contractions developing in the middle of the night and the baby emerg.
ing a few minutes later. Try to abandon this type of thinking and JUSt
relax. Many couples spend the final weeks as if rhey were waiting for a
bomb to explode. Ofren it is only in retrospect that you know when labor
began, and though early labor can be very exciting, me onset is nm
always announced with a flourish.
If labor begins during the night, you should make your wife a stiff
drink or some cocoa or draw a warm bath (unless her water has broken),
and you should both go back to bed. You may be tempted to start riming
contractions or packing the Lamaze bag, bur you should both conserve
energy for the hard part. If she's having mild contractions and doesn't
need to use her breathing, there's no reason for you to be up. (Your
" pie belflg
may have other ideas, but we don't see any POint 10 (WO peo
tired.) You should return [0 bed and sleep until you're truly needed, or
JUSt too excited to sleep. taI h
. . bo k pies go to the hospl muc
As we say many times In this o',mostCO
bo home and a([1ve labor
too SOon. Ideally you should spend ear y a rat , . I
' I tractions approximate Y
should be weI! established before you eave-co
dR' calm
c . C fi e to sixty secon s. emalO
(Our to five minutes apart, lasung lorry- v d of
fi . mothers spen an ave.""O
and tel! yourself, repeatedly, that rstume f b b' being bom at
, h I I bo The chances 0 )'our a }
elg t (0 nine hours in ear y a r. . " , au will encourage un-
home are slight and there's a strong POSSlblllf) Y
. '. . ' he hospital tOO soon. .
necessary Interventton b}'arnvlng
. . k' a1ks fixing light
h' teleVISIon, ta 109 w ,
arly labor is a time for warc Ing h' he call your doc. tor
.. h middleoftenlg,
mea s, and relaxing. Unless It s r e 'be h w things are gomg.
0 .'
Or midwife to say labor has begun an WC don t adVise
. 'f h needs to be secn. _,
scon your wife to the office I s e bl' ed 10 Issue Uyu3tCS.
' '11 then be 0 18
ea Ing anyone else because }IOU WI . )' this exciuog time
n Tr)' (0 eOJo
a task YOli won't have time for ater 0 . __
Beiflg ,I p.lrlflt'r

L" B 0 R

''I'll ne,'er forget the excitement, antICipation, and cogerherness I felt with my
wife dUring our drive {Q the hospital at sunrise."

lJ 2

together, making sure both of you maintain energy by eating and drink
ing, Though you may not feel you are doing anything important for your
wife. your presence and your support are more help {han you know.
You will both be working harder as labor progresses and i[5 intensity
Increases, You may be breathing with her and you should certainly begin
timing contractions as the pace picks up. (Time the intervals by clocking
from the beginning of one contraction to the beginning of the next. For
example, contractions are said to be five minutes apart when there is a
one-minute contraction. followed by a four-minute rest.)
The decision about when to go to the hospital can sometimes be a hard
one, but in general, allow your wife to decide, It's easy to get fidgety
and nervous waiting around, and you're likely to jump the gun. Only she
can determine how much stronger her contractions have become and
whether she thinks things are progressing, Although that doesn't sound
very sClemific, it's the best standard available, and you've just gOt to trust
her. If, on the mher hand, your wife is agitating ro leave as soon as
contractions begin, try [Q slow her down, but don't force her ro stay.
Some women are JUSt nm comfoctable laboring at home, and it's beuer
to gIve in than to fight. If you're really in dispute, call your Lamaze
teacher oc obstetncian.
AI the ho ' I 'I 'r "
splta , you WI I assumc yet another job, (hat of your WIIC oS
advocau: For [h f ' h no
' osc a you who are macrled to women who ave
"ouble speak r h d d I
)fig lor t emsclves, thiS role may seem slighdy re un an,
p ----
rt'pllratifJtJ if)Y 8irt/)
It'S nOt. The hospital can be a threatening en '
k b k
vlconmem where mdlvid I
needs can fa e a ac seat to efficiency, Worn I bo ua
r d r t:n In a r shouldn'[ be
expected to.en ror themselves as they normall d Th '
, , h' . Y 0, erelore it is up
[Q you to maintain p YSlcal and emotional COOl' , .'
anulty. to prOVide COm.
(ort, and to make SUfe no one dislUrbs your wife In 0 d
, , " r er to accomplish
rhls, y ~ u ve. got to stay by her Side, especially at such ernical points as
admiSSIOn, Internal exams, and transition.
We're not suggesting that anyone in a hospital will purposefully un-
dermine your wife's effons. We're merely saying that mnocuous re.
marks, such as, "First lahors take a long, long time" or "You're going
to get dred out if you keep up [har breathing," can shake her confidence
Hospitals, even the smallest ones, are noisy, busy places. and teaching
hospitals are the worst in terlTlS of impersonality and chaos. If your wife' s
breathing is repeatedly interrupted by a residem's questions or if her
concentration is shanered by a parade of people through the room, you
must imercede. It's your job (0 answer quesuons for her during a con-
(racrion. It's your job to make the room Quiet by closing [he door, and
if necessary, it's your job to limit personnel ro only the uuly essential
people-the doCtor and labor nurse,
(['s extremely common for labor ro falter or even Stall once a woman
gets to the hospital. This is because il's hard ro make a smooth transition
to a new place even in rhe best of circumsrances. You musl proVide the
, f ' 'h - t as well as run imerference
Ink rom the reassunng orne envlfonmen ,
, ' aI I ' your)' ob 10 remove the
with all (he obs{acles a hospH can presenr. t s
, 'r lax and focus on her labor
distractions and to encourage your Wile to re , ,
, II ' d and caIrn WIll dilate
It makes sense thar a woman who IS we tcame
much more quickly than one who is nor. h d
coffee or clear your ea ,
If you need co leave [he room ro gee some I I bo nurses
k place In genera. a r
you can ask the labor nurse (Q ta e your " Th' eans that
11 er ed 10 Lamaze, IS m
are terrific, and usually [hey are we v !I w suggestions
'f h' tern or wam some ne
I you forget a parricular breat Jng pat . i I" vcrwhelmed oe
r 'd If you re ,ee JOg 0
lOr back labor they will gut e )' OU, be (hat even [he
' k" help Just remem r
elpless don '( hesitate to as' or' sence
at replace }'oue pre
nicest, most competent nurse cann
Active Labor 'nla
.lf1 even keel
, ' I' b ~ (rYlng to mal - ' 'h
DUCIng active labor you wll Just t: 'b' hlnsincon)Unc(Il)o"-lt
'I I he hang of re,it
IY nny couples quickly deve op ( __ -------:1
the f<.,tal monitor, Jnd this (an work well. You see a (ontra<.:tion begin.
Jnd you Jlen your panncr before she even It. Later, you can
announce checontrJccion has peaked, and (his knowledge can help
her COpl..' with the rest of the contr3C[(Ons. If lahor is progressing OIcely
and the tWO of you arc working well cogether, [he fetal monitor can seem
like the greatest invention since the wheel. It is, however, a quirky piece
of technology with definite limitations.
The monitOr shouldn't control your labor. If your wife wants to walk
around, that's what she should do, and the monitor can be used intermit.
tcntly--on for ten minmes, then off for twenty. If she wants to change
positions in bed. this should also be encouraged, and the monitor can
be readJusted. She should be disconnected approximately every hour to
go to the bathroom. Don't panic if your baby's heartbeat suddenly
disappears; most likely the belt has slipped off or the baby has moved
out of range.
The Plareau Phenomenon
Most of the time, the pace of dilation accelerates as comractions increase
in intensity and frequency. Sometimes, however, cervical progress can
come to a halt, even though good. strong contractions cominue una
bated. We call this the plateau phenomenon, and though it usually
happens around five to six centimeters dilation, it can also occur as late
as eight or nine centimeters.
Contractions, even if they hurt, are usually bearable as long as they are
accomplishing something. Bue [he same contractions become unbearable
if they cause only pain and no dilation. If your wife reaches five centime-
ters dilation and remains at the same point for the next three hours, you
must Intervene in some way. No one knows for sure why these plateaus
occur, but tension often plays a large part. To help her relax you can
Restore calm and order [Q her environment. Turn down the lights,
get her Into a more comfortable position, and ask anyone else in the
room to speak quietiy or nOt at all .
Help her IOta a shower. Water can be very soOthing.
Change her surroundings. Sometimes a walk and a change of scenery
works wonders. Go visit the newborn nursery If it's ncarby.
A{knowlcdge her pain and reassure her that you are there ro help.
Try to make her feci less alone. Tell her, show her, that you love

___ A:.:.:,R.:.T-.:N::..:f.:...:',R
"I provided her with moral sUPpOrt and tried t 'h
a COmlOrt er as much as "hi
She was super. I must confess, I'd rather be the h h h POSSI e.
coa{ t an t c player ..
"My daughter said she wouldn't have made it without me Th d I
. e nurses sal was
of the best they'd seen. I think my presence kept my daughter from
betng nervous, which helped with labor."
,. All she wanted me to do was rub her back and nm leave her side. I did whatever
she asked, and later she said I was great. I'mglad she didn't knowwharl was really
thinking. "
''I'm nOt sure I helped at all. I was just there-but my wife says that's what
"She did not feel alone."
h I
d ' have known she had if I hadn' t
"I was the strong part of her that s e wou n (
been there."
I' h ucs if they could measure anxiery.
"Initially I was pretty calm. but for the ast 0 II 'Ie {Q gel up and let me
J would have been off the scale I v,anted to te my v.'I
lie down for a litrle while."

{hi and even the cheerlea
ll8. but m):,wlfc
"Anyone could have done the hrea n.g h'I's what 5he needed to do.
b me--W II.. 1 I
couldn't have yelled at anyone lit


"I needed my parmer as a buffer between the hospital staff and me and as an
advocate should any problem have arisen that required a sane decision."
"My husband pulled me through, He was awake when I was tired, he was
encouraging I wanted [0 give up, he breathed with me when I couldn't
think straight, and he was kind when I was irritable."
"He was beside me the whole time. He kept telling me to open InyeyfJ, forcing
me not [Q crawl inside and lock up with all the pain."

"My husband prOtected my right to rest between contractions by working out a
synem with the nurses. When the nurse came to check me, she'd look at my
husband from the doorway and he'd gesture whether or not I was asleep,"
, HIS love and support were manifested in his wuch, tone of voice, and caring for
me physically. He is very goosey about vomiting, yet held a basin for me in a most
calm and loving manner."
"My husband was very supportive, helpful, and sympathetic. In all honesty, I was
qUite surprised. He is nm usually an emOtional man, and I saw a tOtally different
side: of him, I don't think I ever loved him more than at that time."
'My husband was essential. I fell in love all over again, I can't imagine it without
him I leaned on him with each pain and felt his energy and support and love.
The smell of his shl t f b ' ."
r was com ortmg, La or was a very mumate expenence,


Remind her Ihal mU$! ride: ,h '
l: of the
to conlrol them, Tell her to allo h If comracllons, nOI tty
w er.,e 10 lei g .
Encourage her to take 25 mlllig f 0 0, to gIl, birth
0 emer I Of .
small amount can relax her when 0 h h . o. . len IUSI thiS
t er le( mque\ fall.
Active labor can seem unendlOg but you should be I ' h
. ' ..' a ert lOr t e signs
of tranSItiOn, which IS the last and hardest parr of dllatlo T ..
.' n, cansmon
means ternble crabblOess, a new and often irregular pauern to COntrac-
ti ons, an urge to defecate, chills, nausea, and a desire to call it quits. Most
women have a dread of this stage, and your wife may click on her denial
mechanism as it happens to her. It is imporlant to recognize transition
because its intensity can make a woman feel like she's dying and doubt
her ability [Q make it through one more contraction, Its your job to
assure her that (a) this intense pain is normal; (b) labor will not get any
worse; (cl this will probably last only a few more minu<es; and (d) she
is doing beautifully. This smge requires your most intense participation,
and this is the time when most men must establish eye-to-eye comaa and
breathe right along with their parmer.
Most men don't think tOO much about medication while they are taking
. . h' . ds that their wives plan or
maze classes, except to register In t elf mm . .
don't plan on having it. The problem is that either POlOt of view rna)'
have to be revised depending on the circumHances of tbe parncular
an epidural once she has
For example your wife may expect to get 'ki th
, " b . f I hor progresses qUiC }'. e
reached five centimeters dlla(Jon, lit I a ..' - -t's
. If fi d yourself In thIS SHuatlon, I
ocror might advise against 1(. you n. y '-II both ha\"e (0
critical that you know the Lamaze ou "h I I bor is f"J.Sier
la)' discover t at a
work harder than anocipated. ut }IOU n
and more thrilling than lloU _ever imagined. d avoiding all drugs.
r, hwe plnnne on
n (he other hand, y.our Wile rna) '. f h . '0 or worn down by
b b
. rensll)'0 t epal f
Ut e taken by surpnse at t e In . h'. terrific power 0
f Even If she as a
a. cng labor and ask for re Ie ' . ,hat transition contrac-
, . k 'Inoldva
" . " h
Imagmation, she is not gOiOg to no" , _ be in J, blOd It s e
'k You rc gOing ro
lions Or back labor really feel I e, _---------
Being" PJrtn(r

.. _-- --- ---

"My husband didn't tell me what to do, he showed me. Because I was a bI[
irascible. he had to breathe v.'ith me, I could not have remembered the techniques
had he not coached me. He rubbed my feet, hands, and the small of my back.
And most of all. he knev.' 1 scillioved him when I screamed, "Don't tOuch me!
Don't ever do this to me again!"
"When cransltion neared, my coach noticed a definite pattern with the contrac-
(ions. He would tell me when to speed up or slow down my breathing, Most
Importantly, he kept telling me, 'You' re doing great. ' . just a few more .. , I
know ),ou can.' "
"My husband was an angel. 1 couldn't have done ic without him. He coached and
praISed and breathed and massaged and was handy with a cold washcloth. He
suggested, 'five more minutes; over and over again,"


begs for medication during labor bue you know she truly wantS natural
childbirth. She may even have enlisted your support during pregnancy,
makmg you promise you will nm allow her to have anything. Although
lhlsseems like a hopeless situation, there are several things you cao do
dUring labor to help her to attain her goal:
T 1) 10 tbrt'rmmt if fear tJ makmg the pam Item wow', Fear is a natural
componcm of childbirth, but It is commonly overlooked by child-
birth educators, doctors, and couples themselves. Talk to your VJife,
attempting to determine her feelings about what she is experiencing-
If she is scared, acknowledge this and try to assuage her anxiety. If
"I ' k k can t ta e H if It gets any worse," bring her auenlion ba
to the present, reminding her how well she IS Joing.
Prtparlll;01J jor Birlh

- -.---:.:---:.--.--.--.-

"He was supportive, reassuring I H
. . ' coo. e kept h h d
wante to give In to an epidural or so L. ' IS ea when I lost mme. I
'Th b b mctumg, but he said 'N
we . e a y was born wit!1in an hour " ' o,you' redolng too

If/ork 011 leJJeIlmg tbe pam, Change positi . h
Ik on, getting er to Sit up or
wa. around the room just once. If you've been using cold packs
co hot or vice versa. If you haven't been paying much auen:
non to, the fetal moniror, use it to let your wife know when to begin
breathmg and when to relax. Work at esmblishing and maimaining
e.ye contact-this helps many women. On the other hand, if you're
Sick of staring at each Other, try some visualization. Pick OUI a
beautiful and encouraging image and describe it so vividly, she can't
help but relax. Try some back or fOOl massage. Ask the nurse for
suggestions .
t Take the nexi three (ontraCUom til r.J Ina/. Give her a shoft-term goal
and see if she can reesrablish control with just a few contracttons.
When that's accomplished, ask her 10 tr), three more. Tell her you
won't call for medication umil she's tried to breathe through just a
few more contractions. She rna)' hate this idea. but she'll do it if )'OU
insist .
t GN thf dorlor or mtdll"ijr to pi-r/orm J" tlffmlal t.\Jm. A p"Mticulari)'
difficult phase of labor can produce great cervical progress. It may
give your wife some inspirafion to learn she's Just dihHed (rom three
[0 eight centimeters in one hour, even though It was the worst hour
of her life. Also. if the doctor or midwife will just emphasize h.o\\
beautifull)' she is doing, this recognirion can pro\ide enough mO(1\,a
tion to make it to the final stretch.

'd' . , .' .' possible to know in .id-
e Icatlon IS a (Clck)' ISSUe, because It IS 1m . 'f d
v d . h ' she will react to tt I an
ance whether )'our wife will nee It or ow
when she..' gt.'ts it. \Vhile ,1 drug-fret..' hlrth IS Ideal, It IS also true that a bit
()( rehet at some poior helps many women keep gOIng and feel bener
Jbtlut their whole birth experience. If your prelabor plans about medica.
non begin to seem more and more inappropriate. then it's lime to
consider rour options (see rhe rnedIC3uon chart on page 266) . If your
wife does ne-ed medication. you should be sure to inquire what she is
being given and how much. You can also request that the drug be given
In rhe smallest dose possible In order to minimize fisk to the baby_
There's a big difference between 25 and 75 milligrams of Demerol, anu
you should hold out for the lesser dose. It's always possible to give more
medication if needed, but i(s very difficult [Q undo the effects of too
As transition moves along interminably, you should be alert for signals
that dilation is completed. The end of this stage is sometimes accom-
panted by a strong urge to push. \'Qhile this is very exciting progress, you
should nor permit your wife to begin bearing down until she has been
examtned by the doctOr or midwife. If she pushes against an incom-
pletely dilated cervix, swelling will occur, and dilation will actually
decrease. To offset the urge [Q push, you must instruct your parmer to
blow our forcefully" At this moment, she'll probably be so dazed you may
have to breathe along with her.
If you have your baby in a delivery room, you will be asked, some-
where near the end of transition, to change into a scrub suit and boories.
The scrub suit replaces your clOthing, but the boOties go over your shoes
with the strings tucked in. You'll also be given a kind of surgical shower
cap to cover your hair and a mask. If your wife needs you at the moment
you are requested to change, postpone leaving her until she regains her
composure. You don't have to leave at that moment-you can wail umil
she is fully dilated or has begun pushing before yOll take the five neces-
sary mtoutes to suit up.
The first thing you should do before your wife stans pushing is to
check out the position of the labor or blnhing bed. If you use a delivery
room d
,your WI e WI 0 almost all her pushing in the labor bed, and then
be transferred to the delivery room when the head crowns, The beauty
of a birthing room" h h" d ' I "
IS [ at pus lng, cllvery, and recovery take pace In
the same spo{ Y "f h
. Our WI e s auld not be flat because that is the most
Prtpclrtl/lQlI [or Bir//)
position for eff<:ctivt:: I
d fi
t::xpu \i(m. Ask th h h
bed be raise ,or nd some pillows so that h al t e ack of {he
s e can be ele d
also support her body by propping her . vale .. You can
up agalns{ yOU" ,h II be
Ou as a kind of backstop for push 109 A I .' e 0.', uSi.ng
. n a ternatlVe po . .
one of her legs up while the labor nurSt: s Silion IS hold1l1g
upport.s the other on
Many women ex.pe. ct pushing to be thegre d e
ates{ an mOSt fulfill
of labor. While thIS IS often the case it' s by . mgpan
I no means a uOIversal muh
pushing can seem completely overwhelming d' ."
. ,an lor an occasional
woman whose ba y IS wedged in an odd position it c be . f
I an pam ul. Many
women are ex austed by the time they reach this stag d
. . e, an consequently
are sho.cked and by the intenSity of efforr required. It's been said
many urnes that pushing out a baby is the hardest work a woman will ever
do. We agree, and ask you to be mindful of that axiom when your wife aclS
I:lewildered, overwhelmed, or even resistant during mis phase
Confusion seems to go along with pwhing because frequently women
are instructed to bear down and breathe in a manner mal contradictS the
style learned in Lamaze class. If that happens, ask the doctor to a1low you
to use the method you've learned, leaving open the possibility of using
his approach if yours doesn't work. If that suggestion isnt appreciated,
at least make sure that your partner understands me new direCtions.
I t seems customary for everyone to the delivery room (Q yeU, "Push,
Push," and this cheerleading creates a frenzied atmosphere. Some
women appreciate the enthusiasm, bur others don't perform well under
this SOrt of exhortation. If your wife is hindered by the noise, ask for
some quiet. Each woman has to feel free to give birth in her oVo'n wa)',
to do it instinctively. You may not hear anything but her breathing, or
she may grunt or yell. Either way, it is her lead (hat should be followed,
nor yours or even the doctor's.
You may be the most successful in enrouragtng your wife (0 push effec-
, " II h h daborand she lrusts
tlvely. She has depended on your VOice a t roug ou
. . d (a ume If her face gets
It. Speak simply to her and Issue one cornman a h
" k ' d her [0 lec out some breat .
red and [he veins in her neck suc out, remm .' b h
" 'bo hour before glvtng Irt.
FlrsHime mOthers usually push lor a ut an be
" h If I ng If progress seems to
second-time mothers take about a as 0 . d f he
h I
'lucan support one 51 e 0 r
stalled, a squatting position may e p. a -1-' be less (hln
b d I
"h he other- Your WI e rn:l)
o y while (he nurse he ps wlr (. . Th dOl-tOr proba-
. b (U'S worth a tr) e
ent lUsiastic about rhis suggestlO
U d h objection. Squat.
bl .. b t he shoul ave no
y won't think of this pOSitIOn, u , d States althOugh If IS
. . . . (he UOlte ' ...
tlOg IS gradually galOing acceptance tn h countries.
n mnny ot er
a ready successfully used b)' women I __ ----------:
-- Being .1 p,Irlllt'r
, required we suggest you don't watch. I. t's a simpl"
If an eplslotOm ' ...
.. b ts blood)" h's not easy to w. atch anyone 8. ertlng Cut, and
IOClS100, ut I I
. . I I , difficult when it's your wife. and when It'S 10 that SPOl
It s partiCU aT ) . . .
If, however, the doctor offers to let you cut the umbilical cord,. you
should. This is a painless procedure since there are no nerve endmgs,
and II'S a lovely symbolic act. . .
Your doctor may forget to ask your Wife If she wants to watch her
baby's birth, so you should remi.nd him position the mirror. In a
standard delivery room, there wtll be a mirror attached to the Over-
head light; in a birthing room you will have to supply your Own. Be
sure your wife has her glasses if she needs them. Many first-time
mothers refuse to look because they arc so completely absorbed in
pushing. Try to encourage your wife at least to glance at the mirror
because she'll probably regret larer on that she didn't actually witness
the birth.
Obviously, not all labors go smoothly, and problems can pop up quite
unexpectedly. Sometimes you can go to the hospital knowing there is a
complication (for example, in the case of a breech presentation), but
usually you are taken by surprise. While any complication can be scary,
you will feel beSt if you understand what's going on and how it can be
remedied. For this reason, we urge you to read one additional chapter,
chapter 12, "Variations on Normal Labor and Delivery."
Ir's imperative that you trust your doctOr or midwife, but the more you
know aoom any siruation, the more assured you will feel. If you're calm,
your wife is also likely to be, and her composure can only help whatever
15 gomg wrong. The twO most common impediments to a normal birth
are the need for a forceps or a cesarean delivery. The following are some
general suggestions about what you can do to help your parmer if either
of those interventions becomes necessary.
Forc<:ps deliveries are performed for three primary reasons: (a) an inabil -
Ity (Q push properly because of the numbing effect of regional anesthesia;
(b) maternal exhaustion; and (c) {he need to {urn a baby in pos[Crior
presentation. If you are in a blrthlOg room when the decision to perform
-- ----
PrepllralllJll [(II" Birlh
" forceps delivery IS made, you will be m d
(we tv a delivery r A
episiotomy IS always done when forceps are u'lcd OOm. n
You may be frightened by the look of the,
. h orceps and by the doctor'
hand, shaking as e uses them. This is normal he h s
, caUSe e 'I exertmg gr t
force, and you shouldn t be alarmed. The beSi th d ea
. . mg to 0 IS [0 focus on
Our Wife, trymg to reaSSure her and encouraging h k .
. er (0 war along Wllh
the doctor, She Will have received an anesthetic most I kid
. ,Icyapue-ndal
or severa.1 doses of a local, depending on the poSllion of the baby. The
doctor will pull With forceps only dunng contractions, and [Q maximize
his efforts you should be helping your wife push as he tugs.
Once {he baby is delivered, you may notice small red bruises or dents
on the baby's face in the places where the forceps were applied. These
arc considered a normal complication of a forceps delivery and will
disappear in a few days. It may take more that. thirty minutes to stitch
up the episiommy, and thar's because il has had to be made larger than
usual m accommodate the forceps . During this time, you and your wife
should be able to hold the baby, provided he IS kept warm.
Cesarean Delivery
Unless you know in advance that your wife is gomg to have a cesarean,
you're going to be shaken by this development, parucularly if it's an
emergency procedure. Obviously, your wife will also be upset, u
. d' h sak Atthls point you're likely
may be hard to remain stea y lor er e. ' .
. 'h h " the baby who "ill remams
to feel yourself canng more lor er t an or, .
f I
h sponsible, and thus guilty
rather abstract. You may also ee somew at re . '11 be
. . ency cesarean, thlOgs WI
about this turn of eventS. 1 It S an emerg all d
d h
'11 be vero litde you can aeru )' o.
happening around you, an t ere WI '1 . d
. . will be more Importam, an
If there's no emergency, your partiCIpation
you will be included in any decisions. . can section is
. role dunng a cesar
The big question concerOing your. d h h the hosPJ{al \vill
. h Wife an w et er
whether you want to be wt[ your . d be awake we
lona! anestheSia an '
allow you to be. If she can receive reg If she's going fO be
L I b fi n )'our presence.
Ile leve there is great ene 1 I .' derful (0 be able 10
knocked out there is less value, alrhOugh It IS won
sec your baby immediately after binh. _ h' witness the ce.;.arean
rmlt tat er) (0 h
A great many hospitals tvu
)' pe . h I is nor one l)f rem.
' ular h
births of their children. If your par
: h' I notice 10 change- ( J.t
. I 'ando
owevcr, {here may be 1m C )IOlil ______ - ..,
Bt'/llg J
.. , nl) harm 10 askmg, though, and It Pi possihle you mlgh
po ICy. efl .. " ' t
<OI"n "'( all chose In\'olved--doctor. pedl
get t L' per " ..' a-
trloan, nurSl', or nursing supervlsor-r0 be present.
Whether the operation is performed under regional or general anes-
thesia, rem will not have to look at the actual procedure. Most likely. yOu
be 'standing or sitting at your wife's head and her abdomen will be
draped. obscuring the view. If she's awake, can talk to her. hold her
hand, and just be a reassuring presence for the hve or ten mmutes It takes
to make the incision and remove rhe baby. Afrer the newborn has been
assessed, yOU can hold the baby and show him to your wife. The stitching
up can rake as long as an hour, but after rhat, you can all go to the
recovery room, where your wife will be able to hold the baby,
We know that many of you may feel squeamish about being in the
same room where a cesarean is being performed, but your presence can
be of IOvaluable support to your wife. Some of the women who filled Out
our questionnaires said the low point of their birth experiences was
suddenl), belOg separated from their husbands and having to go through
the cesarean alone. Although you may feel hesitant now, imagine how
anxious you'd feel waiting outside the delivery room for news of your
child's birth and your wife's condition. \Y/e urge you to keep an open
mlOd about being with your wife if a cesarean becomes necessary.
We don't have to say much about the birth itself because that is the
wonderful exhilarating part, the moment when you know the baby is
healthy and whether it's a boy or a girL Many of the men responding
to OUf questionnaire described witnessing the birth as the highlight of
the whole experience.
After the baby has been suctioned and wiped off, he will be wrapped
in a blanket and you or your wife can hold him. Now, while you are
walUng for the placenta to be expelled, is {he time for pictures. Don't
hesilate to ask the nurse or the doctor CO take a family ponrait, because
th1S 1S a rare moment you'll want to relive later on.
After Delivery
If you a delivery room, you will probably remain there with (he
baby for about half an hour and thcn will be transferred lO the recovery
Preparalirm for Birth

You R
"The momenJ he emerged I could, h
, lJccewasabo.H
beforehand, so I was able to announce . Y IS name had been chosen
to my Wife, who, not what, had come."'
.r I bem down to kiss my wife, and our little girl looked ri ht -
I'll always remember that moment." 8 at me and smiled.
"1 finally realized that we had a tiny real live baby"
"When he was completely Out, the doctor, who had predicred a girl, said. It's
a boy. Do you want me to put him back?' "
r. All I can say is I was glad they let me participate. I was allowed into the operating
room for the C-section, was able to hold the baby right away, and went with her
to the nursery for weigh-in, etc. Plus, let me take all the pictures 1 wanted
from the actual delivery to the time we left for home. 1 could visit my wife and
child anytime from 7:00 A.M. JO 10:00 P.M., and we could have ,he baby when
ever we wanted. Our doctors and hospital staff were terrific, caring."

. . h Id be able to stay with
room, If you were in a b1rthtng room, you S OU .
' I h rush )'our child away !O
t e baby for about an hour. Don t et t e nurse .
)'OU (all t ha\e some
t e nursery. If the baby is healthy, t ere s no rc . d
. Th ood art is rour weH-desef\e
time to get acquainted as a famtly. IS g p.
reward, and you should wallow 10 it. . h no
II want to open the (ampag ,
Once your Wife is in he. rOom, you w1 b d make ph(,oe
C h k j. ,our ulInll
ago an
at t c sandwlChes you pac 'eu In _ bl I to lca\e 10 order
... :ion '( teel a ISe(
ca s. 1 hiS IS also a thnll1ng orne, so I.

to I('t ,,(lur wife sleep or so that you can go home to walk the dog. You
mar teel like eating Chines(' food or pizza. \X1hy not? This is a celebra_
flllO, and we encourage you to experience If as fully as possible. If YOur
wife has a pn\'ate room, you may be able to have a COt brought in so thal
you can spend the night with her and the baby. Some men prefer to stay
at the hospital, since returning to an empt)' house can be depressing after
the excitement of birrh.

"I had the chance to ger to know my son before he came home from the hospital.
With the help of the bospital staff I became confident about handling and taking
care of him. I felt he was mine, too."

This is a lime of Indescribable highs and lows. There will be days when
you believe your bab}r is the beSt thing that ever happened to you, and
(hen a mere two hours later you will be convinced your life is ruined.
We encou.rage you to seek solidarity with your wife and to use a ream
approach Ifl solving problems. If you can view your condition as one of
mumal bliss Or mutual s <r . 11 k ..
uuenng. you WI eep your SplrttS up and you
may strengthen your marriage.
MoSt of the women who fill d .. h
. e out Our questionnaires reported t at
( elr husbands took a k
. _ wee or more off from work when the baby was
rn. Their reactions we 'I . k
re unllorm y pOSlUve, with many women rna -
109 tQuchlOg statementS f .
0 a.ppreclation. We encourage you to take as
ong 0 as possbl b
d L.... _ 1 e ecausc It can be: tremendously helpful to your wife
an uccause u provides a b
If . UnIque opportunity to get to know your ba y.
your mother Or mOth" . I
erln- aw wants [0 come to help out, thai's fine.
reparllliQII jor Birth
But unles.s you all get along famously, thing, seem t k
' (J WQr QUI ben
if the viSit occurs a ter you ve returned to work er
Most men seem to believe that women have an b
. ...., mnate a iluy to care
for bablcs, but thIS SImply ISn t so. Like anything el'e b b
. f 'b h " aycareisan
acquired skill. I you re or rank beginners you can I h
. ,earn roger er and
help each other with your nervousness. Some of you m
. ay not Want {Q
get wo wah the real dirty work, but we're convinced that [he
more partiCipate, you .will feel and the more you
will enJoy. If your Wife IS nursing, she Will obviously be domg the
feedings, but that still leaves bathing, diapering, changing, playing, and
soothing for you.
After a few weeks, when breastfeeding has been established, you may
want to spell your wife for one night feeding and give the baby a boule
containing either formula or expressed breast milk. Some women may
resist giving up a feeding, but it's really a sound idea. It allows you a
special time with the baby, and some uninterrupted sleep can be an elixIr
for postpartum recovery_ It also helps the baby become accustomed to
a boule, which is certainly desirable, since it will enable you to leave him
with a baby-sitter.
Neither you nor your wife will be able to believe how much attention
the baby receives and how little either of you get. \VIe know you're both
probably ready for a little recognition and nurturing, but unfortUnately
you're going to have ro waie rf there's any extra emotional energy
around, it should be diverted toward your wife. Right now she's feeling
fat, bone tired, and overwhelmed by the demands of motherhood. A few
. b [ this moment she seems
weeks ago she was the center 0 ancnnon, ut a
d h
Ise tf)' to boost her
to be little more than a slave. If you a not 109 e. .
. . her and b}' expressmg your
SPICHS by praising her performance as a mar .
appreciation for her efforts. . a1l new
\VI .' New York who lOstrUcts
we know of one pediatriCIan lfl . hld' I'e He
h' d leekofrhelrc 1 s iii
parents to engage a baby-sincr by the t If . h If b . taking a
" I . . . h Ie reestabhs use j
ee s It IS absolutely essential t at a coup . , bout (he
b b b
II survive I worr) a
reather. He says. "I know the. a}1 WI pies fO pur
.. d' fficuh for some lOU
parents." We agree, but recogOl
It IS I . doesn't have (0
. h b ak- Your SOjOurn
t elr anxieties aside and make t at re d' The bab\" can
bid po our for lOner. .
e engthy, juS! take off tWO hours an ood I end and be
b . hb or a g n
e watched by grandparents, a ne.
or, - t. doing. but uln-
fi h veryonC reSIS)
ne. Leaving the baby is somer 109 e
mately enjoys.
Early Labor
The postparrum IS ;1 tlmc lO tnC(lrpt'ralC baby IO[Q }'Our
midst and make the pn.1tt-)und change fn.)m couple to family This IS mOre
eastl\' said than done. \\'e think the best WJY to accommodate It IS to
on your marnage. If you J.re bOth 10\'lng. piuicm. and sup-
portive, it ,,iIl help cushion the jolL E\"en the most wanted child disrupts
the marital reiJtionship. and you must compensate for this effect. If }IOU
(an pull together. you Will reap the benefits of greater communication
and affection. and ),ou will be gIving the baby the best thtng possible:
a happy family.
Baby engJges, mcrease in
vagmal discharge. fatigue,
general discomfort. mucous
plug is dislodged
Increase household
participation; reassure her of
your love; share your fears as
well as )Iour excitement; plan
activities to fill time
A\"erage length: 8 to 10
Backache, diarrhea. mild
abdominal cramps, regular
contractions 5 to 20 minutes
Encourage rest; check
suitcase and Lamaze bag; fix
light meals for her, heavier
ones for you; help wife in
bath or shower; phone
doctOr or midwife to report
beginning of labor
Active Labor
A\"erage length: 3 104 hours
A\'erdge length: 1 hour
apart lasting 30 (0 45
Dilalion to 3
Stronger contractions closer
together, some fear and
surprise at intenSIty of
comractlons, need to
concentrate on breathing and
relaxation dUring
\ comractions, COntractions 3 to
-I mlOuteS apart lasung about
60 seconds" Dilation to 7
\ centimeters
:, Slrong contractions 2 to 3
i minutes apan, 60 to
190 S('(onds, Irregular 10
" Imensity with double peaks
Prt"purdtiQI/ for Birth
Help her to concentrate;
encourage relaxation; give
her liquids to drink; wash
face and hands with
washcloth; go to hospital and
help with admining
procedures; arrange wife
comfonably in bed or chair
shon-term goals, remind
her u'<; okay-the pain is (or
a purpose; eye-tOeyc conl
for brcadllng; rcmJOd her
Average length: I hour
or plateaus al peak of
(Ontracllon, bloody
backache. IrtLtabiht}" nausea
feelmgs of despatr, 100. of .
perspective-thinks thiS will
go on forever" Dilation to 10
end LS nea . "h
r ". ange clothes
fvr de;L"Yery rOOm
Urge 10 bear down active Co"
' ntmue encouragement and
pus mg 10 crownmg "
I I mstruCtlons: assist Wife to get
re axatlon to. b,n. h, second 110 cornf.onabl
e pClSlCJon;
wtnd as reahzauon comes that remind Q,-ife to v,"atch the
end IS reaJlr near bLCth
aving a baby is a life cnslS. Before having a child, you can't
imagine the enormous physical, mental, and emotional adjust-
mems you will be required co make. The postpartum period is a time
when you and your husband will experience uncontrolled elation, un-
ceasing fatigue. and endless ambivalence. It's a time when you'll feel
more adult, more helpless. mOre burdened, and more thrilled than
ever thought possible. It's a needy time when everyone in the family Will
require mothering. It's also a time for living in the prescm. when imme-
diate tasks sap your energy and long-term goals are put aside, But things
do Come together and caring for your newborn only gets easier. As yOU
become morc confident and organized yo ' II d
" u un cmand h b b
called bundles of JOy. w y a iesare
Your hospital stay can be one of the be" pans of
, h . . your POStpartum
peClod, Althoug most people don, like hospital, 'hey c be ' bl
'. ,an enloya e
for a new mOther. There IS servICe anent ion and general d
' , camara efle
on the maternity ward. h is here that you will experience the tremendous
joy of calling all your rela{ives and friends {Q tell them about your baby's
birth, It is here that you will feel an incredible sense of relief that labor
and delivery have ended,
We encourage women to have their babies in their rooms at all times
possible, a policy known as rooming-In. This concept works best if you
have a private room and if the nursing staff supports it , which means mey
will take care of the baby in your room. [{'S wonderful to be able to gaze
at your child anytime you wanr, and your constant availabiliry gives
breast-feeding a solid beginning. Rooming-in is nO[ immediately feasible
if you've had a cesarean (unless you have a private nurse), and nOt
advisable if the hospital is so understaffed there's no one (0 help you wich
'he baby,
NOt every woman wants ro spend all her spare rime in me OSpl
ogling her baby. It can take a few days or a few weeks to develop strong
' ld S people fall in love ar 6",
parental feelings about your c I . orne
h actions are normal. You
glance whereas Others warm up s ow)'. Ot re . f
.' b" h nd me Sight a a
may be slightly shell-shocked juS! after glvlOg let . a
red-faced, screaming creature can be strange.
- , al If will be foeuslOg l g
After the baby is born, the hospJt Sla . a1 'o"<r)' Your urerus
I ph)'sic ree .
attemion on you to ensure a camp ere , h turn to ItS normal
h I
ol"IIo,,-t e re -
may have to be massaged to e P 1111 . :-an do it yourself It
, do thiS, or you ( rh
nonpregnant state. The nurses ma} firSt- hase breathJn,g. At IS
there's any discomfort, you can do some _ jus I below vour
, ( II k hard In'
POint, your uterus will ee I ea . . ed dt'ep into Yllur pe
. . .' k' dl have cantrall
WAiStline, but wHhtn a wee It \1,1
where you can no longer feel ir.
_ . hI hours following delivery, you will be sweating and
In Ihe 1,"ly-e,s If
. d al as your body releases mue lathe fluid you hay
urinating a e I d b e
. d - egoanc)'. You may led ex lauste I lit not a bit sleepy
rela,"ed unng pr . b b TI .
f h
-(emen< of finally having your a y. lIS IS a good time
occause 0 t e exCl . .
- h Ia.X3tion exercises. Lu! In bed; take slow, deep breaths'
to unWin WI( re . "
dy to J-ust melt IOtO the mattress. Don t worry about
ilnd allow your .
. )'ou're experiencing one of the highest moments of YOur
not s eepmg.
life, so let yourself enjoy it.
n eratu
re will be checked regularly by a nurse. If you have
QUf tel P
a (ever, this is a sign of infection and will be treated, with antibiotics,
Fever occurs most frequently following cesarean section. For the next
few weeks you will be discharging /o(b;rl, a mixture of tissue, blood, and
mucus. Immediately after delivery, the flow can be heavy, and for this
reason you may want to wear a hospital gown so that your own clOthing
doesn't get soiled. If that strikes you as tOO institutional, you can always
put your own robe over the gown. While the lochia is flowing red, you
must always wear a pad, never a tampon, because of the possibility of
The Episiotomy
By Ihe time you're back in your room, you'll probably begin to feel Ihe
effects of the episiotomy, if you've had one. The pain varies greatly from
woman to woman, but it is primarily determined by the size and diree-
lion of the incision. For the first twenty-four hours after delivery, you
may want to apply an ice pack to reduce swelling. After that you can take
warm sin balhs (a shallow warm bath in a tub or basin), which feel quile
good. To decrease Ihe possibility of infection and to ease cleaning, you
will spray an antiseptic solution on your perineum after urinating. You
can begm doing Ihe Kegel exercises even Ihough you may nol feel any
sensation in the perineum. By exercising the muscles of the pelvic RoOf,
you willmcrease blood flow 10 Ihe sile and thereby speed healing of Ihe
In addition to . . . h hem
, an eplSlo[Qmy, you may also have to deal Wit
rhOlds. You can tre h . . I presses.
at t esc With Sitz baths and witch-haze com
he Kegel exe 11 . 0 ghnu
rCise WI also help to relieve hemorrhOids. ou
illoWS are not recommended becausc th .
. , . Clr uneven surface
reater swell mg. Though It sound'i uncamf _ bl _, can crcat.e
ana e, 'ilHmgo h d
or olher firm surface will help bOlh Ihe pc _ n a ar chair
rlOeum and hemorrhOids to
B r e as (- fee din g
If you're breast-feeding, Iry 10 pm Ihe baby 10 your b f
. .. reast as 0 ten as
pOSSIble. Your m,lk will probably nOl come in for IWO 10 Ihree days, bUI
that matter, becaus.e newborns need no more than water during
that orne. We advocate giVing water because hospitals tend to be hor and
therefore dehydrating and because Water will flush out the liver, thus
alleviating common newborn jaundice. The question of whether you
give plain water or sugar water is highly controversial; you should diS-
cuss this with your pediatrician. From these first breast-feeding sessions,
Ihe baby will get c%l/rum, a yellowISh liquid packed wlIh antibodies rna<
helps him adjust to life outside the womb. Moreover, it will srimulate
Ihe milk supply.
\V/e don't believe in limiting initial breast-feeding to proteCt your
nipples. They will either get sore or (hey won't. The determining faCtor
seems to be complexion-fair-skinned women being more sensiuvc-
rather than time spent at the breast. You may have been toughening up
your breasts during the past few momhs by rubbing them with a
cloth in the shower and that's fine. It's important, however, to posmon
Ihe baby correctly ('hiS belly directly againS! yours) and 10 fix Ihe baby"s
. . I d I To prevent soreness and
mouth entirely over the OIpp e an areo a. .
. . bid f back in Ihe mourn as IS
crackmg, the nIpple should e p ace as ar. .
. d ' h' ng with soap and \\ ater,
comfortable. In addition, you shou avOl \\as I - . E
. . If bastS are tender, IT)' vltamlO
W lCh can dry OUI Ihe Olpples. your re . be hed
oil or lanolin. Both of these can be applied without havlOg to was
off before Ihe nexI feeding. . I - I. nd hard; Ihis
w'h . b easlS fee ling) a
w en your milk comes 10, your r b be relieved b}'
sensation can be unfamiliar and uncomfortable. ut can
nursing. , be given 3 drug to dry up
If you're not going to breast-feed. yOU mil} -Ik mes In and your
f ble as the rna CO
YOur milk. You'll be falrl}' uncom orta d aspirin subsnru
d mpresses an an 11
ceasts become engorged, but co. co .:. h e brel.(hlng WI
'h 'ch some nrstp as
can help. This is another instance In \\ I .
ease the discomforts of tightness and tenderness.

' to Terms wIth Your Birth Experience
f h m
ost important emotional adjustments you mUSt make d .
oe 0 ( e " urmg
I a
rtum period IS cOming to terms with your labor and deliv
t e pos P' . ery.
n even those who have had great childbirth experl'e
very wO , . .. nees,
knows something she would do dIfferently next time If she could, This
IS because there are tWO things we can say uneqUivocally abom child-
birth: There is no average labor and no perfect birth.
Each birth has potential for unexpected snags: You may need medica-
you may have to be induced; you may enter labor too tired to enjoy
any part of it; or you may feel like a failure if you had a cesarean, When
things go well, women tend to attribute it to luck, but when things don't,
they usually fault themselves.
Binh is a confluence of factors. Of course, your preparation and mo-
uvation are important, but the size and position of the baby, the type
and length of labor you have, the amount of support you receive. and
the quality of your care all contribute to the experience. After all is
satd and done and you're home with the baby, you must accept what
has happened, The moSt essential thing is to forgive yourself (and oth,
ers) for whatever shortcomings you perceive and move on to other
In coming to terms with your birth experience you must accept all
your feelings-the good with the bad, It is difficult to express nega'
nve emonons, because every time they emerge, you will take one
look at your adorable baby and feel guilty for being anything but
Every woman should discuss her birth experience with her doctor or
midwife while still in the hospital, so that she can dear up any doubts
or misinformation about what actually happened. If someone has made
a comment about your delivery that you didn't understand. ask about it
nght now, while the opportunity is there and the experience is fresh in
your mind. Naturally, you will want to discuss the details of the birth
WIth your family and f d Y 'd r ften s. ou may even want to write own you
recollection of th' , . [
iS Important event. But after that it is essential to accep
w at has happened d ' , ' , h d
an give up any Itngering guilt or sorroW. Being ar
on yourself is not g . h ' ' 'h our
010g [Q C ange things it will only dlml
tnloyment of the baby, '
II', be .. to d I 'b k'
. ea Wit your feelings now This could mean see Ing
pro esslonal help b ..' ' n
or ecomlng Involved with a childbirth-educaUo
group to change Q d d .. h' 5
ut ate hospital practices. YOli can plan to do { 109
-::--------- --------
rfp"r,,'iOIJ for Bir,b
differently the next time, but kno h
w { 31 perfeCl
imperfect wad . You should resolve . IOn cannOi in an
'Id' b' h h YOur ennA"" or d b
first ClI S If{, s.o t ey won't inte. . ' Ou.tsaboutyour
rlere with yo b
future birth expenence. ur a Iiny tll enloy a

A premature baby is one of 'hose things yo d ' ,
. u on t want to thmk about durin
pregnancy, but" does occur ralber frequendy-IO pe f II b . g rcem 0 3 abies are born
prematurely each year. A premature baby is one h . h I . w 0 welg S ess than 5.5 pounds
(2,500 grams) at birth. Some causes of prematuriM.-' are mukple b' th '
I' 'J I Ir, tOxemia,
p acenta previa. abrupw, and maternal illness. No cause is known, how-
ever, for approximately 60 percem of all premamre births.
Until recently, all premature babies were thought to have been born too soon.
but neonatOlogists now know that as many as 40 percent have suffered growth
problems in utero. These babies are tiny but marure, and they are categorized 35
small for gestational age (SGA). h's important to distinguish between premature
and SGA babies because they face different problems, reqUIring differem treat-
In the past twenty years, neonatology has become a soplusncared and eifecri\e
science. Today its practitioners are skilled in treating babies as small as a pound and
coping with their complex medical problems. If )'our baby is premarure, he will
undoubtedly be cared for in [he neonatal unit of me closest large hospnaL While
you will be grateful for the expert medical attention, you're also likely to feel
anxious, depressed, and not very much like J. typical new mother. To ease the
adjustment to your premature baby. we have compiled the following suggesuons:
T Ik
' ' h d h e p-rience Somenmes IOformal
a' with other parents who ve ate same " ..., ' .
f b b es 10 the neonamj unit. Or
suppon groups spring up among the parems 0 l I .
f al
l ' anized b)' J sl.xlal worker or
at Some hospitals, groups rna)' be more orm ) org
volunteer - . . , but now 3re Itounshtng J.S
Look at pictures of babies who were premature , b- b' ,-
. _. . b<x)ksoflht'lrJlumm J.
(Oddlcrs and children. Some nurscnes maJnr.un SU'-.lp
containing encouraging "befort-'" Jod "Jtrer' shots. ,an/mUll

---- -----------


\t" 1 l' " [
B _\ II ,
h b
d s included as fully as possible In dIScussions and
M ke sure your us an I ., - d '
t a _ 'h h 3tolog
[5. His (ull partiCipatiOn an Interesr will help
1nsuira[Jons Wit (e neon . 'I h h '
C<, . II d' will feel more like a tlml y, even t oug your baby IS
),ou emotlona )'. an } ou
not at )'our side. If b '
ng from the deltvery, move 0 the 0 stetne floor to a
\X'hen you are recoven . .
. f the hospital If that's not possIble, at least get a pflvate room
different section 0 . '
continuall)' confronted by normal newborns and glowing
so ( at rou are n . . '
v needs are special at thiS nme, and you probably won t Want to
.,'" '
'a1. ,,'atch other women Interact With {helf babies. You re likely to feel
soc! lze or - .
a little shaky and sad, so you should make things as easy as possible on yourself.
Involve yourself in your baby's care. In order {Q reduce your fear and general
apprehension about (he neonatal unit, you should learn the names and functions
of the equipmem used (Q support your child. Ask the nurses how to diaper and
clean the baby in the incubator. Many hospitals encourage parents to hold their
preemies dunng rube feedings, because it's been proven that babies relax and gain
weight faster If they are held. If this is nOt your hospital's policy, make a special
Try to breaMfeed or prepare for breastfeeding by expressing your milk, Breast
milk" the best food any baby can have, and by providing it, you will be doing
something tangible for your child that no one e lse can do, Even if your baby is
being fed mtravenously, he will soon graduate to a feeding tube and then a bOttle.
If you can keep up )'our milk supply, you will be able to enjoy breast-feeding, An
",carrc breast pump WIll make this job infinitely easier for you; you should be
able to rem one.
Don'l delay on namong the baby, This is a small step that helps form an emo'
1I0nai bo d h'ld '
n (Q your C I . As a measu re of self.defense, many parents resist
devdopmg an attachmem to the baby out of fear of losing him. Of course, this
" a pomblllt), but nam h'ld' d ' , of
, _ ' _ 109 your c I may give you pleasure, an H s an act
affirmation 10 a very difficult (lrcumstance,
r. -


The Blues
Whether you've had a vaginal or a cesarean bmh ' h
, you mig (experience a
kind of letdown around your second or third day ft d I'
. . . a er e IVery, For some
women, thiS IS Just a natural descent from an exh'l .
. , I araung ume, but for
others, 11 can be a real blue penod, dunng which tears Row h I' h
. , au es Ig test
rovocanon, Don t worry about feeling weepy and dep d h d
resse ; t IS su .
den mood isn't going to last for the next three months R'lght
. now your
hormone levels are unstable, your episiommy IS aching and
, your at
be than pleasure. Even though
you re sull In the hospital , you re zooming headfirst into a period of read-
justment and you must have patience with your ability to rake it all in,
\VIe hope you haven't Instructed your husband to bring an old pair of
jeans to the hospital for the rrip home. It doesn't matter if you've been
in the hospital for one day or seven, you'll probably leave with Ihe body
you had in the fourth or fifth month of pregnancy, Ttying 10 pull up a
pair of size 10 pants over size 14 thighs IS a good reason ro cry, so don't
set yourself up for this. Thc maternHY dress you're the least tired of is
the best thing to wear home. Checking out of the hospital can be unnerv-
ing with the challenge of dressing your baby for the first rime and then
the stress of decoding directions for the car seat-you don't need ro start
the day with a wardrobe crisis.
There's no way you can really prepare for coming home from the hospi-
tal with the baby, Yes, you have a cure cnb and a case of diapers, but
, d W/h II)' need is a wet nurse ro
that doesn't mean you re rea y, \\ at you rea ..
breast-feed the baby, a fairy godmother to heal your epISIotomy, and a
caterer to take care of meals and snacks for all the company ..
d ffi
I Y h ve to accept thiS, and tC}'
The first three months are i cu. t. ou a . h
S time after (he' hest mont
to gee through them onc dal' at .l ume. ornt' h'ld
.hen you 'Ulook at "our C 1
you'll experience a pure shlOing moment". .h h bab\' is
and realize why you had him. If )'ClU're rcadlng this" en (e h
cohck)' and ),n. u haven' t slept for more than tWO hours at J. hstrcktc .. e
,< .. ' u'ctlO'"e
(here arc sixty baby presents to .(cknowledge. you m s
crazy. I lave counlgc; thlOgs do lmpnwe. _ j. that almost
, h )stpanum penvu IS .
\"{Ihm )fOU mllst remember ,lbout e e pt h') ble getting J
,i ii first-time mother\ find it diffu.:ult. EVt'ryone 3::' tfl U

H 0" E
\\ I T II
1 emember the IUXUC)I of time-for me and for
" I 'ell' golden ume. r .
h was a 0\, f 'ork for four months, and It was such a treat."
my baby I stared home rom"
ness and lack of support. My husband had just begun a
,. I felt (remen allS one I ' '
. b d gone from dawn until dark, sometimes un,,1 I :00 A.M."
dtfficult new)O an was
_Cat the six weeks postpartum are supposed to be a time of
" { seems strange UI' , .
recovery for the mother, since that is when the baby IS most demand 109 and you
get the least sleep!"
"It was a lot harder than I thought it would be. My son cried a lot, slept little,
and nursed every twO hours around the dock. 1 was exhausted. He was a wild
man. It was a true revelation to see how little control I had over the kind of person
my baby was."
"I seemed to live in a milky haze-a product of very little sleep, a cheerfully
ravenous daughter, balmy spring weather, and the abrupt but not unwelcome
transition from a high.pressure job to a role as house-mommy!"

"I thmk I enjoyed the middle-of-the-night feedings the most. Getting up and
and fcedmg that warm, soft little body while everyone else is asleep
It s a speCial ume for mOthers and babies."
My baby had I I'd .
, co Ie. never throw her out the window but I wanted co Jump
myself' '

PrfpdratiQrJ for Birtb

HO>"!E 11.1 I Bl
"I,t d,',do't seem like I was my son's mother I
him. was JUst a person who took care of
"I loved the feeling of my son's breath againSt my neck whe h
shoulder." 0 e was 00 my
"My my son, and I slept in a double bed every night for our baby's first
SIX I m not sure which was more pleasurable. falling asleep tOgether or
wakIng up together."
"Having to go back to work after [wo months almost made me afraid to get tOO
close to my baby. I underwent more stress during mat period than I have at an)'
other rime. It's the saddes( thing a mother has [Q do. Ir would be nice to have
longer maternicy leaves."
"The isolation was hard, I had no other friends or relatives with children, let alone
infants. I found it difficulr ro go anywhere. The logisrics of Just gen.ing out the
front door are
"I went our to the garage and kicked the car tires umil I wore off the frustration.
then went back into the house. She was still crying. but I could handle it bener ..
"I could have done without the constant unsolicited advice."



I .._--
\\ I 1 H
B.\ tI Y

felt so misplaced. Getting used to the new
rn w wor an
'" ch. ose not ro reN h. 'or me to deal with."
ea5lr { 109 I'
rCUllne waso t an 1
I usually looked forward to her naps ..
waking up. "
and then I would look forward to her


shower before I :00 P.M., everyone has moments of resenting Ihe baby,
and everyone has times when things seem out of control. These experi-
ences are normal, and you shouldn't feel you're the only new mmher
Ihat's nOt organized and happy all the time. Just like pregnancy, the
postpartum period is finite, and that fact makes it bearable. Once i['s
behind them, some women even become quite nostalgic about those
grueling but exciting first days of morherhood when everything was new
and confusing and wonderful.
The terrifying part is when you and your husband and the baby are
at home with no nurses. pediatricians. midwives, or other new mothers
to consult. The situation appears to be black and white: Either this baby
will live or he won't, and it will all be your fault. Luckily, it only takes
a few weeks before you and your husband realize that the baby will be
fine, but that it's questionable whether )'OU will make it. The fir" few
weeks at home with a first-born baby are overwhelming. For this reason,
most couples need Support. Whether ie's a baby-nurse. a mother or
mother-m-Iaw, a sister. a housekeeper, or even a teenage helper, yOU
must have some assistance. Couples who are particularly insecure feel
most comfortable . h b b . . . d n be
Wit a a y-nurse, but thiS IS expensive an ca
superfluous if you are breast-feeding. Also the nurse's experrise can
make_ you feel even less competent. A ram/ly member is the best, but
only If everyone gelS along well. You don't need your husband bicker
mg With hiS mother h'l '
W I e you re learning {Q breast-feed.

The biggest problem you will face Will b. f
t aflguc We kn h
of you have had rimes in your life when yc' L..__ OVo' t at all
)u ve Dcen exhaus d - h
from working nonstop or from pushing your L _I _ te ,en er
f hI
. Y U(XJY (Q the limn 10 some
kind 0 ar eflc activity. es, you were {If(:d I I
. . ' comp etc y done 10 but
after a good night s sleep or a few days rest yo f I be '
.. _ ' u etHer. POStpartum
fatigue, however, IS like nothing you have ever e d.
. _ xpenence . HaVing
Our sleep Interrupted every few hours night afte . h '
, r nIg t lor several
weeks or even months, produces a unique kind of debT . Y
I Itauon ou go
around in a dazed, clumsy condition that almost seems drugg d
, . . e ,except
you don t feel high. have shown that a state similar to psychOSIS
sets in after several nlghes of interrupted sleep-and these smdies were
done with subjects who weren't recovering from childbirth or caring for
newbo rns .
The days are pretty bad, roo. Taking on any new Job IS stressful, and
in this one the responsibility is constant, and the training program none x-
istem. Before giving binh, you at least had coffee breaks, and evenings
and weekends. Now, you barely have three minuees to go to the bath-
room. To avoid a nervous breakdown, you must be somewhat philosoph-
ical about your crying baby. There's JUSl so much you can do afler you've
fed , burped, changed, and walked him and hes still howling. lnfa",s cry
a lot, and if you can accept that fact without feeling guiley, you will have
made a major adjustmem ro the postpartum period.
If you don't have a baby who cries, you may have one who confuses
days and nights, which means that he sleeps most of the day and is up
almost all night looking for food and a good time. Of course, three-week-
aids have no conception of night and day, and many people believe (his
is a problem that will correCt itself. You can try waking your baby during
the day in an attempt to teach him the difference, but don'r gel upset if
the baby doesn't catch on.
Whatever your child's schedule, you' ll probably have a difficuh time
trying to do everything you want-everything you had planned on dotng
. . I II h h things that now mke
uflng your maternity leave, p us ate at er . _ .
d f
ng women s ambition,
precedence. \Vle don't want ( 0 be accuse a sappl r
. fi h that )'OU can take care 0
tit there' s just no way 10 the rsl l ew mont s . .
a baby, yourself your house, your social obligations, and matncatnllh'our
, . . '11 lkely be your hea' or
career. Something has to give. and It WI most I
your sanity. - dl' I that )'ou're
. h h 'all should be min u
unng your first mom at orne,) . -h'ldb' h If \ou
. h . I xpt"rlence L I Irt . .
stIli recovering from a strenuouS P yS\C3 e. 'bd' I palO or
e back or a Offilna '
begin to run a tempera[Ure, or expem:
c., bright red or smells odd. you should call YOur d
[he lochia Vt;Comes. OCtor
., e These mean you may have an inf .
Of midwlle at une ' ectlon
d et."<I Immediate treatmenc.
an n d rotect l'our health, you must sleep while your baby d
In or er W P ,oes.
, . about returning phone calls or vacuunung; you've go
Don t wore} . t to
catCh ,orne re"while you can. Your enjoyment of mOtherhood during the
first fel'.' months is directly propornonal to the amount of sleep you get.
Breast.feeding is one of those experiences you can '( understand until you
go through It. Sitting peacefully, your breasts are full, your baby hungry
and pulling at your nipple, is one of the best feelings in the world. The
flIp Side of that occurs when you're in the middle of lugging groceries
10 from the car, your older child is whining for a snack, the phone is
nnglOg, the baby is crying for a feeding, and you're supposed to sit
down, relax immediately, and feed him.
Breast.feeding has it all over bottle-feeding in terms of convenience
and ease of preparation, but in a way it's an exrension of the scare of
pregnancy because your body still is nOt your own. The preoccupation
with good eating and rest remains paramoum because you can '( maintain
Ihe baby properly if you're skipping meals or feeling exhausted. While
you're breast-feeding you'll be burning about 500 extra calories a day
and some women find themselves drained by this effort. We encourage
you to give breast-feeding a good try, if you're so inclined, because it's
the most nutritious way to feed your baby and it has to be one of the
loveltest partS of motherhood.
Contrary to much of the advice about breast-feeding, however, we do
encourage you to give a relief boule early on, say at ten days or (wo
weeks You won't s b f
. . u vert success ul breast-feeding by offering the baby
some formula and 1t1I bl
. WI ena e you to go out with your husband or leave
t e baby with a Sit( If '
er. you leel funny about the formula, you can
express some milk but b II . d
d ,Y a means, try the bottle so you are not [Ie
own completely,
T aday breast-feeding d .
arc d r IS un ergomg a renaissance and many women
rna e [0 lecl (remend I ' . ' b
A" ous y gUilty If they don't nurse their ba les.
gam, you ve gOt to get h . 'd f
yours .If h past tewell-Intentioned advice and deci e or
e ow best to feed b b . ,. . he
Importance of am' a y. Shetla Kltzlnger recognizes ,( .
Other 5 attitude when she writes in Tbe Expermut /J)
Preparalifm for ------

"When the baby sucks strongly with eyes h If I d
' a -c ose and ch bb fl
across your breast, with no one to bother - k _ u y arms ung
you, It rna es It all worthwhile."
"I loved breast-feeding. I nursed for eighteen month be'
. ,s lore my son quit. After
my cesarean, It made me feel whole agam."
"I nursed for twO and it JUSt did nOt work out. I was absolmely exhawred,
and the baby was so big he was nOt gening enough to eat, so he was fussy. After
he was put on formula. he was fine, and so was I."
"Since I was breast-feeding, the only things my daughter needed were me and
air to breathe. It's such a warm, wonderful feeling."

Childbirth, "After all, it is not so much what she [the mother 1 feeds with
as how she feeds him that maners. It is her loving touch that he needs,
and unsuccessful breastfeeding can be a very frustrating and disturbing
experience for both mother and baby. Whilst breastfeediOg can be Ihe
best son of feeding there is. unsuccessful breascfeeding comes a poor
second to happy bottle feeding."
. d :t rate range is esnmat to
Postpartum depression in [he 0111 to mO( e ticulari)'
f II
No one seems par
OCCur in 3 to 23 percent 0 a women. h eRect hor
,hel' are (houg t to r
concerned about these figures ecaust: t




p (l T P :\ R T L, ;\1

. h h lasted ahoU( tWO 1\I), husband was
depression Ie I ..
I had a se\'l;"rt.' , Id '( seem to get anyrhmg (one.
f h
L b) and I cou n
Jealous 0 t e la ,
. I couldn't communicate rationally. I had to go
'd ble with depression.
'I III trou. d h h Iped-talking ro someone who was objective."
(0 the dOCWf, hnally. an t at e

monal changes. which (orren themselves. We agree with rhis, but think
researchers have always ignored or underestimated the effect of fatigue
on a new morher's psyche. We don't mean to sound redundam, but
faugue IS the number one problem during the posrpaccum period. It will
make you grouchy, sensitive, foggy, prone to feelings of resemmem, and
II will probably affect )'our husband in much the same way.
There are, however, a lor of new feelings that go along with becoming
a mother, and some of these emOtions can be disturbing. For example,
you may be vice-president of your company with your own secretary, but
for now, you are the wet nurse and housekeeper. Of course, you want
to take care of your baby, but there seems to be something slightly
discnmmatory about the fan that your husband can walk out of the house
every morning while you're sruck there with a demanding infant and a
pile of chores.
If you're JUSt home on maternity leave, things are not toO bad, because
)'Our predicament is temporary. Your worSt problem may be finding
someone else to take over the baby care. But if you ve decided to take
il or an IOdefinae leave to raise your child, or even jf you were. not
working at all before the baby was born, you '11ust make a major adJust-
ment to a new role. For women who are newly staying home, that means
on a lot of the chores you used to share as a couple. This is becaus.e
you re home and he ISn't, and. because you both want him to spend hiS
fret time wah (he b b " . I e also
a y. nor runnlOg to the cleaners. Bemg 110m

H ow TO R Ere O(
r-.. I Z E
Just about every woman expenences some postpanum blues after giVing bmh. An
uncontrollable desire to weep, a feeling of helplessness. and a sense of being
overwhelmed are common in the six weeks following deltvery. Hormones and
fatigue do comribute to mood swings. and these are normal during this penod
of difficult emotional adjustment. If, however, you cominue 10 feci down for a
few months, you may be suffenng from serious postpartum depression, and you
need help .
We asked Pat Shimm, who runs a suppOrt program for depressed mothers and
their children at Barnard College in New York, to compile a list of symptoms of
tcue depression. If you are still feeling depressed after six weeks, you should ask
yourself if you .
Feel sad, blue, down in the dumps, withdrawn. lonely, helpless
Have trouble falling asleep a( night, or wake up In me middle of {he night and
can', get back to sleep, or feel like sleepmg all day . . h
f he s about your ability as a mot er
Feel overly sensitive to comments 0 O_t r
Get angry and jumpy at every little thtng . - .ed
Feel a loss of interest or pleasure in activities you
. . ncentrate as you I In
Find it hard to make deoslOns or co
Feel guilty and sometimes worthless , - II (he time
or (all t stop eanng ;1
Can't eat much food anymore. d feelings are affecting your childs
\'(Iorry about whether your depresse
behavior r feel like you're moving in slot\' mouon
Feel tired for liule apparent reason, 0
'good chance "ou
f these questions. t ere s a _ . .
If you answer yes to three or more 0 h" . he case Mrs. Shimm )OU
I d
ssion If [ IS IS [ , - 'b able (I..'
are suffering from rea "epre. . y doctor or minister rna} e
i edlately our
seek professional e P ImOl . tOtt/HUH'11

Ttl R I I 11 t..... / I
, .
., I l" 'I ...
d h
I or )'ou can look In the Yellow Pages under mental health
recl1mmen a t ,
You nllt7ht also ask vour Lamaze teacher, because she may have
lor some names. .', '
helped pre ... o
srudents wilh tillS problem. Whatever happens, don I despair.
Many women suffer from depreSSIOn after childbirth, but they recover completely
and lull and active lives.


means ),OU will pass a great deal of Ihe day in your house wilh your baby,
and thaI can be a big change from your bustling life Before Baby.
One ohhe things first-time mothers can't prepare themselves for is the
work that mOtherhood entails. Just about every woman we know who
has qUIl her job 10 take care of her child full-lime says motherhood is
more grueling. It's not that the work itself is so hard; this is another
instance when the whole is greater than the sum of its parts. Everything
-meals. cleaning, laundry, shopping. doctors' appoimmems, entertain-
109-fails on you, and you are responsible for every detail. If Ihe baby
is late for hIS polio vaccine, it's your problem. If the dog has fieas, iI'S
your problem. If you've run out of soap, it's your problem.
Sometimes women have the stamina for all this work, but it's the
res.ponsibillty mvolved in their new job that undermines emotional sta-
You are the mother; this baby is your responsibiliry. and if you
do.n t get moving and go to {he store, there will be no diapers for yaur
child Even if you had a former job that was very high-powered and
Important, It didn't carry the total responsibility you have now. If yau
lapsed al work and d rna e an error, your company may have lost an
advantage or at wo . h
rst, some money, Now the stakes are much hlg cr.
baby falls down Ihe stalCS, he could seriously hurt himself. The
10 01 mOtherhood 101 . .
.l. erates much less sloppiness laziness or IrreSpans
IHytha h "
n any or er occupation,
Another negalive p f f II We
1_ art a u -time mmherhood can be the pay,
rI_3 11.(: that nOt all of
your husbands are the warm, generOUS people (hey


. 1
H 'I. P \'(1 1 1
1 II E
B '8 Y
"My mother stayed with me for IWO weeks d I Id
,an cou not have m d h
her love and suppOrt. I hope I can do the sam ida e it WI{ Out
e lor my aughter someday.
"M y mother came, but I found il difficult 10 let her do the work. I stili relt as if
I should be Ihe hostess. "
"I didn't have any help and I didn'I need il. I had an easy birth and an easy baby,
and I was home all day, My house was never cleaner and the meals never bener.'
"My husband helped out, but his 'help' was sometimes more uouble than assist-
ance. He is wonderful at fathering, but very questionable at hauseholding."
"I had a woman come in and clean, It saved my life."
"I felt like 1 belonged in intenSive care, but everyone expected me to carryon
as if nothing had happened. "
"My husband was home for Ihe tWO ,,'eeks follow 109 our daughler, blfth, and
1ft entlon and soothang words when
he was a 'fefllmdollJ help, He gave me otS 0 a [ f r I . I He a1so
I needed them did all of the housev.'ork, and took (are 0 our _Itt e SIC.
, h I h nugh the rough urnes.
read ffi}' breast-feeding book ta e p me t r
b b I wanted a cook and J
anyone to help me care for the a y.
"I didn't want
laundress! .,

-' -'

,--- -

1---- Til. 13 " 1\ ,
H rL r
'J, I 1 II

'f II monthS for m)' energy level to return [Q normal. I
"h sl.'emed [Q ta e (\\0 u .
o 0 f 0 hal I seemed to be able to do nothmg except take care of the
found It rustranng t . .
ne dal' when my onl)' goal was to dust the hvtng-roorn
bah\" remem er
At the end O
f the dal' , I had not been able to do even that."
"M husband helped out a lot by putting the baby to sleep in the middle of the
Also, it was nice ha\>1ng a second opinion on baby matters, since I knew
about as much as he did, "

should be, and you may feel odd about asking for money, Sometimes this
is your problem, but often it is his. This is a shame, because if you or
your husband could think rationally on the subject, you'd bOth realize
that a housekeeper earning $50,000 a year wouldn't do as good a job
as you. Try to maintain your dignity on this issue, but remember that
your husband is under a fair amount of pressure. It's hard to be the sale
breadwinner of a growing family, particularly a family that has become
accustOmed to being supported by two.
You don't have to be a family counselor to know that some marital
relationships become a little shaky during the postpartum period
a good birth experience can be one of the greatest moments of a
marnage, but unfortunately the feelings engendered by that event don't
last for months, If you have a good marriage, you'll weather the pOSlpar,
rum penod. Children by themselves cannot destroy a solid marriage,
the stress of child rearing will most certainly exacerbate any
e.xlstmg weaknesses m the relationship and can bring on new ones. You
Simply cannot know in advancc what kind of mother or father yOU will
' what kind of baby you'll have, or how you'll both respond to this
I e change.
No matter how d .. . 10
soun your relationship, you'll probably lapse In
Preparalio" jor Birth
some nagging and complaining. Even th h
, nug you both
difficult changes you re going through 0 0 h appreCiate the
. . ' II ard In be
all the rurmo od with equanimit y II h I f mature and accept
. epslyoucanfi
specifically IS bot hering you. Wc've ob. d h gure OUt what
. serve t al coupt
cerlalfl basIC resentments dunng the POSt . C5 seem to have
partum penod:
Ifl"ijf 's RfJmlmnJlJ.
He owasn't pregnant for nine months and d ' h
oesn t ave to wear m
OIty clothes even now. alet
He has a feeling of accomplishment at rhe e d f h d
He can leave for work each morning where h lks h
, e la to at er adults
and eats at least one uninterrupted meal.
He earns money for what he does.
He doesn', have to be reluctant 10 tell other people at parties about
his job, because it's socially acceptable.
Husband'! Resen/men/I:
She doesn't know I'm alive now that the babys here .
She's responsible for the household, and it"s on the verge of collapse.
She's able to spend much more time with the baby than I can.
She's breast-feeding, and suddenly I'm the odd man om.
If you want your marriage to flourish along with your child, you
should try nm to be critical of each other's effortS with the baby. Unless
you are a pediatric nurse or your husband is the oldest of seven children,
neither one of you has probably had much experience with newborns.
Every person has his or her own style of relating [0 children, and (his
should be respected. Short of strangling a baby in a receiving blanket or
drowning him during a bath, there's ver)' little serious harm that can be
done. Couples commonly fall intO a negative behavior pattern: You're
bOth nervous, the baby is howling, and it's ver}' easy to second-guess the
person who is dealing with {he child. To increase mUNal
the baby, avoid criticizing each ocher, and try to appreciate your mdlvld-
ual s{yles of parenting. . . al
There are a few basic things you can do to alleviate mart( . stress
d Th fi
h g is to go out ag3m as d.
uring the postpartum peno . erst t m . ..'
lk Th
s ObVIOUS, but man} ne"
couple even if it's only for a wa .. IS seem. . h
, d f fi d baby SIUfr and leaviOg t e
parents are unnecessarily afrai 0 n 109 a' 11 rela.x
'II h n except that you \\1
baby for {he first time. Nothing WI appe . A we said
. . ted conversation. :;
a mlc and perhaps have an uOInterrup I f bottle Juring
0 0 b bota "ed by one re Ie
ear Icr, breast-feeding will not e:;a """C
- -- POJII}.lrlulfI
, . d rhe break will rdresh you borh You should als
Ii t few wee .... s, .tn , 0
t 1C rs 'h ough a feeding and allowtng your husband or
Cl ... [ r . . h' b d a
. . h babl' bottle. \Vle re not suggest!. ng t IS e one eVery
Sluer [0 give { e .
. I"d hours of sleep 0.0 oc. caSton can Improve your outlook
day but a c\\ so I _ _ .
, mari[3l relaoons1ups Improve as the postpartum penod
In most cases, .
h babl' matures. When your chIld reaches rhree Or four
ends an as ( e - . .. b ' I'
arnage beginS to adjust as l[rlta I Ity and resentments
months, your m .' .
,wh he is SIX monrhs old, l'OU WIll be rhrliled with your new
subsi e. w en .
f I I
, nd when rhe baby reaches orne or reo mooths, ir will be
ami)' lie, a
better than you ever thought possible.
Making Love Again
One thing that will boost your marriage a great deal is the resumption
of your sex life. Most dOClors give the go-ahead to have sex as soon as
you have physically recovered. This can be at three, four, or six weeks
postpartum depending on rhe scheduling of rhe checkup and rhe nature
of the btrth. Many couples, however, don't feel like making love for
quite a while, and when they do, their sexual feelings don't always rerurn
For women, lack of sex"Ual desire in the postpartum period is usually
hormonal; decreased estrogen levels affect libido and can contribute [0
vaginal dryness. This happens most commonly to nursing mothers; a
lubricant such as K-Y jelly can solve rhis problem. For men, rhis same
lack of desire is often related to seeing their wives give birch and then
reconciltng rhe pleasure of sex wirh rhe funcrion of childbirth. You
should be assured rhar both these stumbling blocks are remporary. Once
you have your first menstrual period, your body's hormones will have
rerurned to their normal level and your sexual desires should be rekin
RISing enrogen levels will also increase vaginal secretions, and this
WIll make sex more enjoyable for borh of you.
You shouldn'r feel rhere is something wrong if you don't feel like
makrog.love for quire a while after your baby's birth. The postpartum
penod IS a time when you often feel affectionate but not sexual. Some
women h d' , '1
ave eSlre at lour weeks postpartum whereas others don't unu
baby IS five or six months old. Sex William Masrers and
Vtrgrota)ohnson studIed 101 women in rhe third month afrer dciiver)'
and found 47 of rhem ro have low or negligible levels of sexuality. The
Cited reason for rhis lack of desire was fear of permanent
p YSlcal harm If sex w I afll
as resumed too soon after giving birth. In t lC S
Prt'pardliQ" /Qr Birth
study, (he highest levels of
were reported by 24 .
mothers. These women reponed sexual 5t I . . nursing
. d . . Imu atlon while breastf d
mg, but a so 10 Icared speCific Interest in res . ee
L b d . umlng sexual relations with
their IlUS an s.
For some couples, the problems of when a d h
. . n were pose greater
ddficulues {han any Others. Your normal bedtime . 11
. .. routine WI probably
be Interrupted with a feeding, and once you' re throu h . h h
g wit t at you'll
wanr to fall asleep immediately because you'll have I be .
. a up agam In a
few hours. Your .daytlme schedule will also he out of control, because
it will be determrned by your baby. If you used to go back to bed on
Sundays after breakfast or nap on Saturdays before dinner, you don't
anymore. The only feasible strategy seems [Q be catch as catch can.
As for where, the logical spot is the bedroom, but that's often where
the baby is sleeping, and most couples are afraid of making the slightest
noise. Obviously, there are twO alternatives: the couch, and moving the
bassinet out of (he bedroom.
Sometimes fear of becoming pregnant again-espeeially if the baby
was unplanned-is a new element in your sexual relationship. If you
don't want to become pregnant again, you must use contraception as
soon as you resume having intercourse. If you are not breast.feeding,
you can take birth control pills. If you are breast.feeding, however, the
hormones from the pills will be transmined to the baby. Your other
options include the diaphragm (you will have to be refitted at your
checkup if you formerly used one), spermicidal foam, a cervical cap, a
sponge, or condoms.
The main thing you need to enjoy lovemaking is a rela.xed attitude.
. ' Ik d 'fi e 'In most people's sexual
\Vle know that spurong breast rot oesn { gur .
fantasies, but if it happens, it's not a big deal. (You could try taking a
. I' I 'Ik anualll' under the hoc "Qo' ater,
S ower first and expresslOg a Itt e ml m
I ) The unportanr rhlng to
or feeding rhe baby just before rna -lOg ave. .
' ffi I' af hldblrth are common and
remember is (har most sexual dl eu ties rerC I . b b '
hp before havlOg a J ),
temporary. If you had a good sexua re atlons I
you have an excellent chance of resuming 1[.
\Vhen to Staft d n
_ . ' h k )'ou have to start oing J
ThiS rna)' you, but we don { t to b by is born. You
exercise rourine in the hospital the da}' Mter )'our a
. walking Mound as much as possibl
h luld IX' llur , e,
S , I'"' .'11 be complicated enough wlthom worrYing about
bUI rllur 1ft; \\ I
, I . soon a.."i your baby takes a nap. There IS a lot of
d(lIOg ItlS as .
, on at thiS stage. both phystCal and emotional, and the
r('(I,:wery gotng - - .
, ' h ' ouaht to be working o,ut IS lust another burden for a
techo'! [ at ) Oll l:'
- h S,' rl JS soon as you feel hke It, but check first with \'Qur
n('W mot er a
do(W( or midwife.
Finding the Time
It is nor going to be easy trying to fit an exercise break into your busy
dar, particularly if you have an unpredictable baby and no baby-siller to
spell you. The only advice we have is to make exercise a priority. If you
allow the laundry to take precedence over your workout, you will never
do anmher sit-up again. If you can prop your baby nearby in a carrier
or put the baby on the floor with you, so much the better. If your baby
doesn't tOlerate this, wait until nap time, or get your mother-in-law to
come over and babysit for half an hour.
Many new mothers have trouble sening aside time for their exercise
rauone because it seems like a selfish thing co do. I f you are taking time
to work out, then that's fifteen minutes you aren '[ spending on your
baby, husband, house, dinner, or whatever. We urge you to think of
yourself and your own well-being.
p,.epa"4Iio" for Hirth
The Exercise Routine
The postnatal exerCise routine consists of c h
IS (exercises wh' h h Id
fifteen mtnutes to do. Four of these exercises a 'I d f' Ie s ou take a lOlal of
rc a fca y amlhar [ , be
holdovers from the prenatal exercise rout,'nc (, 10 0 }OU came they afe
co page 9)' th h ,
you have the time, do the complete prenatal wacko d dd' eO[ er Our are new. If
Ut an a the four ne f
a slighdy longer session. W Of
We've included exercises for the waist, hips arms ba k d bd
. . ' ,( ,an a omen. These 3fe good
exerClseS for recovenng tone no maHer how OUt of shape 'I Th
. . you ree e stronger you
become, ,he eaSier they \I be 10 do,
(If you had a cesarean, skip these for the lime being,)
To Slarl:
Sit tall, with your spine long and straight,
your shoulders relaxed and open, and your
head centered on the tOp of your !lpine.
Stretch your right arm over your head and
bend to the left. Relax your head to the side
and let your left elbow drop tOward the
floor. Feel the stretch along your entire
right side.
Try to maintain the length :tlong right
Side as you unroll to the center pOsl[lon.
Tot,t/: J
SIX rimes (0 each side. ahernating 51 P
each ume.
j \1
PPfR.BO/ (IR(L"-,\ I uune. Tensll"ln is even greater. now that there is
. h prenata co
tl1s h)(l raken from t c . I 510\,,1)' and gracefully Breathe deeply and think
. ,' , .
a neW bJbr 10 Icnd ((l. St . ( about chores or obhgauons.
I..)nl)' htw. If feels, no
To \/.11'1: _ , - hr
511 (all. wilh your long and stralg .
your hands fcsung lightly on }'our knees.
C;boll/der Ci,.cles:
Circle your shoulders forward, up, all the
way back, and down to cemer. Reverse.
Eight urnes to each direcoon.

Head Circles:
Elboll' Circles:
Place your fingerrips on your shoulders and
circle your elbows forward, to the side, and
behind you. Reverse direction. Eight times
to each direction.
Circle your head forward, to the side,
around to the back, and (Q the Other side.
Drop your chin toward yOllr chest and
reverse direction .. Four times each dlCection.
PrepardtiQII jor Birth
T/IE B/C},GL/i
The purpose of this exercise is to tonc the abdoml I I .
f I I' na es, so don t overwork your
legs. Let your egs ee ong and light, easily supportd b h bd .
(,: Y tea omlnal strength.
To SIt,,-I:
Sit back on your elbows, keeping your chest
high and your shoulders down. Mamtam the
pelvic tilt position (hroughout the exercise
Bend your left knee toward you and
straighten it toward the ceiling. Lengthen
your rib cage away from your waISt and
stretch the backs of your legs away from
each OIher
Flancn and tighten your abdominal muscles.
Sioll-i) bend your nght leg toward you as
you lower the left leg to the floor
TOI"I:. 'moo
)' alternating leg:; c-aeh
Slxu .. 'en times. )
B,f(k ,\tHS.fGI: abdominal muscles ;wJ n:lnxcs the ones In YOur lower
\l.!chcns ro
This excn.-IS(' SIn:1 .

To \/.Irt.. . I. bent and
.1. 'Ith \'OUf
lit: (In \'(Iur alp... 1 h' 'dth
the soles (If Yl)Ur feet on the Hoor, Ip WI
blll,IIt: .
Allow your ahdomcn to rise and fill wIth
and Hanen ),our abdominal muscles
and 11ft your hips otT the Roor. Do nO(
tighten your buttocks or arch your lower
back Think of the tOpS of your dlighs as the
highest POint. and your spine as a straight,
diagonal line. Inhale.
Again. lighten )'our abdomlOaI muscles and
roll one vertebra at a time, back
to tht: ROOf
Totti I:
SIX flmt:\
Pn' /ll1raliOfl lor Birth
exercise feels wonderful for the lower ba k . d h
( an tips to fone your
To SllIrt:
Lie on your back, with your knees close 10
your chest. Place your hands, palms down.
out to the sides, just below shoulder htight
Tighten and flatten your abdominals as you
roll your upper back, waist, and lower back
to the Hoor, returning to the starting
Six tln1c:S to calh side. Sidc..')
Roll your legs 10 the right side. Try 10 keep
your knees high and your left shoulder
down roward the Roor.
ARII C/ROrS . . f I I r
. d h d . (ull breaths, tlWIO excrusc lao cc wont cr ully relaxing f
If done: lOklwlr an wH 1.:ep. Or
the upper had; ;\nd
To St.,,..'"
LIC ,'In )'Ilur bad.: , with )'our arms out to
your sides hel(l'" shoulder heIght.
Bend your nght leg toward your chest and
cnm (0 your left side. Let your right foot
on the floor.
Keep rOUf fingers on the floor as you Circle
)'our right arm above yOUf head and down
past your right hip. Stretch your shoulder
open and lengthen your arm as it moves.
PreplIrtlliQn for
Now reverse dire((ion and circle }Iour arm
across your body and over your head.
Roll your hips back to the fl oor and
straighten your right leg next to }fOUr left .
Three times each side.
rEG (ROJ.\'OI 'fR' . km" the abdommals, and waISt all at the same
l. xl . m(Wl'ment, "or r
a h't3 ("
Lift your nghl leg toward the ceiling, but
keep the left leg stretching along the floor.
Stretch rOUf nghl leg across your body.
Allow your right hip to leave the floor, bUI
tIl (() h-ep your right hand in place.
Prepardtirm for Birth
Tighten and flatten yOUf as you
Ii(t your right leg back toward the ceilmg,
your hips and back completely on the floor
Stretch both legs even longer

J ....
Slowly lower yOUf right leg to the floor.
Six times to each side.
(, ),
:\,.:ain we cnd (he cat. It relaxes ,he lower back and Increases the f1 b1
eXI I It)' of h
mUKIcs all along the 'ptne. t e
To .\IJYI:
SUPP'-'rI r('lur weigh, on your hands and
directly under )'our shoulders.
knees 'hj::hllr apart and direcd}' under ro
Rtturn IQ .he hands al -t
\plnf: Sill! rounded I knees poSItiOn, the
Prrpardll(}n f.or 8 I
trl ')
usc es and round Tighten your abdominal m I
your spme. Let your head relax d
h d an your
C tn rop (0 your chest.
Stretch your hips to your heels.
Six limes.
.\Jou J, straight
en YOur
ek lengillen Spine, feeling you
as V..IU suel h D '
your back K . C. 00'1 arch
ecp yOur bell
so ,hal your ba k y muscles workl
e IS sup ng
protected. pt"lned and
-, I. h g we can tell you about the postpartum period, n's
I(rherc s<-'oe asr t In f f
h' Taking care 0 an In am and recovenng
that you shOll t 10. . h
h 'our most Important tasks fig t no w, and they both
from chil In arc) .
amounts of You must dunk of yourself and
take (remen ous .
k h
(,'me ofl'OUf life enjoyable and easier. Thtnk of frozen
to rna e ( IS
. d ""e '"'ut food and any S[Qrc that delivers. Think of dog
dmners an (at\. '"V . ' ..
Ik h
rs and cleaning help. Thtnk of. Inslstmg that YOur
wa 'ers, Duse , . ..
husband take his vacation time now (0 help thtnk of inViting your
mother for a visit, and think of asking for assistance from anyone who
can help you. . .
This is not the time to worry about extravagances or driVing to three
different supermarkets to cash in coupons. Conserving your time and
energy is much more important than saving money. No matter how
much you wanted your child or how prepared you were for the change
In life-style, you must acknowledge that caring for a newborn is a bur-
den. If }'Oll don't pamper yourself during these first three months, your
emoriona1 and physica1 heahh will suffer. Your enjoyment of the baby
is direcdr related to how much energy you have and how well you feel.
There are [wo common psychological pitfalls in child rearing that can
undermine your energy, commitment, and pleasure: the issues of control
and guilt. Control means that you believe you should be able to keep
your baby happ}t all the time, and guilt is what you feel when you can't.
Certainly, you have comrol over the environment to the degree that you
change, bathe, and feed your baby. But if he wams to fuss, or fall asleep
dunng visual-stimulation time, there's very little you can do. Some ba-
bies are active, whereas others are placid; if you can accept your child's
persona1ity early on, you'll be way ahead of the game, Avoid trying to
control your child's behavior and blaming yourself for everything (hat
goes wrong. These are nonproductive behaviors that work against your
vitality and the enjoyment of your baby.
Preparal;()/1 /01' Birth
The Second
, bab ' is (he most momentoUS
('S common knowledge that haVing il } fi hOld more radl-
'I ., e that the rst C I
step in your marriage. \'(Ihl e It s (rU . d 5 perhaps more
.' 0 have Ii seeon I
cally alters your life-style, the eCiSlon t . h 0 ade with your
' r dholCe onetatlsm
profound because it is an tnlorme c
eyes open. nCleslCe- gOing to be
If you have one child, any subscquen( pre-gna '

<r f onl rhe first. The first {lme is like n.o other because f
ulte diucrent r 0
q. nd the wonder of (reaung a human life. The second tim
[he t'X(ltl'ment 3 -' e
L .. h 11 g tOO bu"t'S tempered by experience and the knowledge
canuc?( n In, ' .
, ,s ,ust a means to an end. PhysICally, the second time ',s
that pregnanq
re U
r,ng and minor complaints can seem more bOthersome
usua r mo .' .. . -'
From an emotional scandpOlnt, It s easier because you re much less aox-
iom abou{ rhe normal aches and pains of pregnancy and you're more
confident about taking care of an infant.
During your first pregnancy you were probably absorbed in yourself
and your symproms, This time you're probably focusing less on bodily
changes and more on how you will integrate {he new baby into the
family. One of [he big preoccupations of second- or third-time mOthers
IS organization and scheduling. This time you won't be daydreaming
about the layene, you'll be concentrating on trickier maners, such as how
can I get child number one (0 nursery school by 8:30 if the baby is just
waking up? Can I manage bOth of them at [he pediatrician or should I
make separate appointments? How will I get anything done around the
house if their nap times are different?
Despite the tangled logistics of twO children's schedules, we believe
the addition of child number tWO is a smoother process than the incorpo-
ration of the first one. This is primarily because you've done it before
and, having lived through night feedings, colds, and teething, you know
these are developmental hurdles, not life-threatening crises. Your
threshold for anxiery has been raised considerably. and [his new wier-
ance is accompanied by a greatly increased ability to enjoy your baby.
In addition, you're spared the trauma of completely changing your life-
5[yle because that wrenching process already occurred after the birth of
your first bab)'. Second-time parents are much less bothered about not
going to the movies every week or not sleeping late, for they know the
rewards of parenthood outweigh che sacrifices.
There will probably be less friction this time around between you and
your husband because he is nO{ going to feel as insecure as he mighc have
the first time. He realizes that having a new baby is an excicing experi-
ence, nm an alienating one, and most likely he'll be very involved in
helping your older child to adjuS! to the new sibling, Both of you are
gOlOg to be infmitely morc relaxed with the second baby and this should
enhance your relationship. First-time parems are inclined to argue about
each Oth 'b' , ' d
er s urplOg techOlques Or whether the baby is hungry or {lrC ,
but thiS son of thing rarely happens again because you're both more
secure-and busier.
Prepardfirm jor Birth
Although your hu.sband may be mOre helpf I h h
U Wit t e second child
he's likely [Q act a 1t casual about {he: pregnancy as 'II h '
, WI {e rest of {he
world, Dunng {he first pregnancy, you caught everyo ' r
ne s ancy-the
butcher, your coworkers, and your mOther-m-law all rna I d
'h d I . rvee at your
expanding girt an g oWlOg demeanor_ Unfortunately (h
. ' , ' e mystique IS
nOW gone. ThiS Hme you re old hat, and people are apt to take a ho--hum
attitude, or even a negative one if your pregnancies have been closely
The thing [Q do in this case is to pamper and indulge yourself as much
as possible, because you need it, no maner how many times you've been
pregnant. Don't be tOO hard on your husband if he's not e-'dger to run
out for pizza or wake up in the middle of the night to massage a cramped
muscle. The excitement of the first pregnancy is unique and can't be
repeated. The second time can be great, but it's not the same. To com-
pensate, go [Q exercise class, buy some new maternity clothes, get a
facial, read some new pregnancy books, or do anything that makes you
feel special, even though you've been pregnant before.
During the first pregnancy, you expenenced considerable stretching of
the abdomen, ligaments, and muscles of the pelvic Roor and uterus. For
this reason you may carry lower and show earlier wirh the second and
each pregnancy. At the end of a first the
, h h d s or drops down to the pelVIS,
presenttng part-usually [ e ea --engage .'
d h d
' h gm ThIS doesn , occur
allowing a little more room arDun {e lap ra .
, 'h bd . al muscles are not 35 :lut
dunng later pregnanCIes because tea omlO
, d f b . hed down by those muS'
and the uterus bulges out Ins tea 0 elng pus _
'I you go Into labor.
cles. Engagement may not occur uno . less
h I you wi II also expenenee
In addition to weaker smmac muse es, . f the cartilaginouS
scability in your pelvis due to a greater h eno
, , d b'c bone ThiS p enom
JOlOts, panicularly aroun your pu I . f d it can make
the sensation (hat (he baby is licerall)' f<tIling out 0 )'ou, an
, d" uncomfortable.
walklOg or extended stan Ing qUite 'econd pregnanCY
h e tired dUClng a s
You will probably feci muc mor _ h'ld, Some chum thlt
because you have to take care of your fint c
'h first pregnanCIeS, they
') he end 0 t tlr Th'
even though they worke unO ( 'pent at home. IS
. d during I.lter ones s ,\'
were considerably more attgue Id -- more demJfll log
, k 'S a tWo-yea
IS not surpriSIng; everyone
than the most tyrannical boss.
. _. infamous for food cravings and eating bing
First pregnanues afC . . _ es.
be a fll \\loman lurklllg insIde mOM of us, but man)'
Therc scems to' '.
I ran
t {O let her out agatn because (he memory of po,.
women arc re ue
, d >r'ng is still painfull)' fresh. Many second-time mothers
pregnanq It: 1 . .
' as well as rhey dId the first time because of lack of .ime
ilio onrm. . .' ,
For breakfast rhe)' re hkely ro share some eggs with .heir
an energ}, - ' . .
chIld. rhen grab lunch at McDonald s, and later whIp up something
easy (or dinner. \VIe know you are probably .feeling worn-out and
overwhelmed, but you've got to remember {he Importance of feeding
[he baby (hat is growing inside you. This baby's dependence is as real
as your older child's because he is also relying on you for nourish_
Your attitude about your second labor is going to have a 1m to do with
your feelings about the fi.rst experience. In general, women handle labor
more easily because they know what a contraction feels like and are
secure In the knowledge that they've gotten through it once already.
Although second or third labors are not known to be less painful, .hey
often seem so because they are half as long and because the intensity of
the pain is nO[ as shocking as it was initially.
Some couples are so unconcerned about labor---or so intent on block-
ing out their first experience-that they don't feel the need to take a
refresher course in Lamaze. The problem with this approach is that
without (he course, they'll be unlikely to practice, and preparation is as
Importam as it was the first time around. We recommend a refresher
seminar if you had your last baby more [han tWO years ago. I t can be
offered as pan of a regular Lamaze series or as a distincc entity by itself.
Refresher Courses generally concentrate on reviewing [he breaching
panerns and describing recent changes in hospital procedures. Very little
time IS spcm on anatOmy or describing the process of labor and delivery.
Review chapter') of this book, which instructs you in all the breathing
and relaxing techniques.
We s[rongly recommend a refresher for several reasons:
It keeps you up-to-date on the latest developments an obstetric prac-
Ir affords some camaraderie with other couples, which should help
your morale
PreparuJif}ll lor BirJh

"The Lamaze refresher Course took on a whole new perspective because we had
actually been through a Lamaze birth wi.h Our first baby, I took the breathmg
exercises more seriously the second time."
"50 many things were bener about the second time-shaner labor, shoner hospI-
tal seay. Even the things that were worse stemtd better. The first time my epiSiOt-
omy bothered me for months. The second time I had both an episiotomy and
tearing, but I felt great in about a week. I think my attitude was so much better
for the second delivery that it colored my perceptions of everyrhing."
"It tOok a third as long as the first ume. It was sheer heaven, and left me with
enough energy to enjoy the whole experience."
.' h test It was a short, manageable
"The first time was nice. but thiS time was t e . , daughter right away
labor and exciting delivery. \VIe really gar to now m}
because she roomed in with me."
, d this would probably be my last baby,"
"I was very depressed because I reahze
d I felt bener prepared. I knew my
. I k f what to expect an
'From expertence, I I eded to sness."
nd wuu ne
strengths and wea esses a

riencc the second time becJ.u.5e I
. h the cntire birth expe fidem of my ablhues
"I was very please wtt d 't I was much more con bl .,
d-an gOI t nreJ.Sona e.
spoke up for what I wantC h t what I was nor U f01J1I1I1U.!
, h knowledge t a
and secure 10 t e

, . . .

L II 0 K A (, I ...
'The first time I was not prepared for the degree of concentration and the effort
requin."'t:1; [he second ume, I was."

h can help work out any lingering doubts or questions you have
about your first binh
It will stan you thinking about the binh and reviewing the breathing
and relaxation exercises you should be pranicing
Many couples take a refresher course because they had a bad or
mediocre binh experience the first time and now they're seeking a new
approach_ The)1 may have changed doctors or hospitals and they are
restudying the method in order [Q use it to better advantage, Often,
refresher COurses are undertaken with the binersweet anitude (hat the
upcoming birth may be the last, making it a final chance to fulfill a
fantasy. Whatever your reasons, a refresher Course will spark your enthu-
siasm and get you in the proper frame of mind to have your baby.
Even though you have already given birth, you can '( predict what kind
of labor you will have. If you had back labor, or had to be induced, or
If your Water broke hours before contractions began, there's no rule chat
sa)'s it will happen that way again. It's also possible that you may require
a cesarean delivery this time. About 10 percem of all second-time moth-
ers who previously delivered vaginally have C-sections, usually for pla-
cental Or umbilical problems, and you should prepare yourself for this.
Labors are as mdividual as the children (hey produce. and you shouldn '(
}'ourself up for one panicular type of experience.
Although every birth experience is differem, (here are some common
rha . b
ractensucs etween first and second vaginal binhs:
The time Spent in labor is generally half as long as [he firsl time,
This also holds true for the expulsion phase. If your pregnanCies
PrepliratiOl1 jor Birtb
are spaced more than ten years apart, however, thiS does not
apply .
False labor is more common dunng c;econd pregnanCIes, and Brax-
lOn-H ICks contractions can seem stronger
Babies are much more likely to arrive on time or early, and they
usually weigh a few ounces more than their Siblings did at blrlh.
I f you had telescopic labor the first time, you' re likely to have a very
fast labor the second.
Second-time mothers are less likely to develop toxemia (unless (here
is a different father) ,
Dilation and effacement often occur earlier in the pregnancy. be-
cause the BraxtonHicks contractions are stronger and Ihe cervix IS
more pliable .
ACE S ARE A N (V B A C) ech 10 the New York Medical
In 1916 Dr Edward Cra'glO made a spe .. A! the
,. d "0 ce a cesarean, always a cesarean.
Society in which he state I n h 1 cent and the classical
was less t an per ,
time the national cesarean rate d
' .' . h only one perfo
or vertical IOClSlOn was t e . f bstetrics for nearly seventy
.. . I d the practiCe 0 0 C II e
CraiglO s aXiom ru e " I 1982 the American a eg
years and to a great extent It st.11l does. nd its long-standing policy and
, .. d G ologlsts reverse r ean
of ObstetflClans an ynec . I delivery alter a cesar .
r [{empted vaglO
h nly
stated encouragement lor a .. stimates however, [ at 0
The National Cen!er for Health Statlst;cs':
for" VBAC are acrually
en who are e Igl . 1984 IS consld-
S 7 percent of t e worn - 'cs gathered In
them. (This figure, based onstadtls
mined by hospiw-dischar
se It IS erer
dIn estimate ecau . )
ere on y a . ' lete or imprecise. . that (he uter-
data which can be toCOmP . at cesareans IS lear I'
I mmg repe - h h now rare )
The justification for pe.r or
. pOssibility is greater t e terse or
\Xlhlle t IS . h the low-trans\
ine scar may ruprure. . . much less wit '<cse scar
. I ' 'sion It IS f low-trans\
performed c1asstCa InCI Even if rupture 0 a.. rkely to be
0 5 percent. . . nd It IS un I
bikini cut-D. to b r e labor begins J. re is usually
I h
enS elo
- the ruptU
occurs, it rare y app nno
, SiOce
even go u
catastrophic. It may __ , f ag
birth (01
bllJlY 0 v h
Incomplete. "are of the poSSL. 'w ,'ner Cohen, W 0
. are a\y N .)' wa -
Today man), women. he work of aOl.: , ) The mother of
thanks to t , f ccsJ,rcJ,n .
lowing a cesarean. .. 'I birth a ____ '0-1(' (vagina
(oined the term I j b
The SfL'omi BIt .\
'xperienced tWO VBACs, one a homcbinh, and h
rhrt."t' Cnhen las c. _ as
, h ds of women on how to have a normal delivery af '
(ounselcd r ousall .' '", . t1,;r
' h ..... written with LOIS Estner, Tbe
a cesarean. c.::...... '__ an
, gmdl 8,r,h Afttr (.CJ.I1"t'rJf1, a book stating a coovinei
PnTolflOIi ,111 ,I - ng
, he sMet)' and correctness of VBAC.
case lor [ . _ .
Working with women who deslfe VBAC., Cohen anuClpares lhac more
than 90 percent of them can be successful In their goaL Although there
are many (actors outside one's comrol, she trtes (Q instill a sense of
spiriruaJir), and confidence in women, who frequently believe their bod.
ies have failed them, In her book she sal'S, "We believe that most of the
cesareans that are performed could and should be prevented. We believe
(hat [here is an attirude in our counrry on the part of most health profes-
sionals chat birth is impossible without tools, tubes, chemicals, drugs and
machines, In our countql, we have come to believe that DOctors Deliver
Babies, not that \Vomen Give Binh, , , , Women come to their births
believing that someone else will get their baby out for them, rather than
trusting in themselves and their body's ability to open and actively birth
their babies_ "
In response (Q (he great interest in VBAC, some doctors are now
permiuing a cesarean morher to undergo a trial of labor to determine
if vaginal delivery is possible.
Cohen doesn't believe in this approach, because it can "undermine a
woman's confidence" and because a VBAC candidate shouldn't be
treated any differently from a normal woman in labor. Many docrors,
however, would consider her attitude to be overly casual and would
Insist on the follOWing criteria for a woman attempting a VBAC:
Electronic felal monitoring
Frequent readings of maternal pulse and blood pressure
An anesthesiologist, operating room, and blood bank on hand
A single baby ro be delivered (multiple births are thought (Q overly
distend (he uterus)
An intravenous In place
. t' this It is also Important that the obstetrician be with his or her patJcn ,
is not a labor that can be managed by phone from the office. , h
' , h'ldbirrh to t e VBAC IS one of the mOSt exciting developments JO c I I
past decade, hs Implementation gives real hope to )owenng [ h . he esca at
'h ever ave
109 ce,arean rate while allowlOg many women who mIg t n h ,
had chance the joyOUS experience of a natural birth. If a woman a
Pt'epllt'fllifm [or BlYth
an done hy a bikini InCiw.ln, VHAC a safe: praClice. Many
d a cesare
ha h ever an: slow to change: thelf ways, antl yOu d
, .
Oc , earch a bit before find 109 a doeror who believe, 10 VBAC may have to s
As you know from your first experience labor Can '
, Start anytime an'
place. Although you are familiar with the sensation ofa -'}-
, _. COntraction, thiS
knowledge doesn t necessanly gIVe you Ihe ability to kno' h
. Wwenyouare
in Many second-ume often think they arc merely having
gas pains or normal backache and, JUSt like the first time, have difficuhy
recognizing that labor has begun.
Your sense of the IOtensity of labor and how long (0 SlaY home will
be guided by what happened during your first experience. Women who
felt chey should have waited at home longer the first time tend to delay,
and that's fine. You should be prepared, however, to leave at the drop
of a hat, because things can change abruptly during second labors. To
determine when to leave for the hospital, you should use (he standard
of regular minute-long contractions, four [0 five minutes apart, guided
by your instinctive feeling about the righl time to get going.
For second-time mothers, anxiety about the onset of labor is generally
not about the labor itself, but rather about {he babysitting arrangements
for the first child. \VI e urge }IOU to call the baby-sitter as soon as you have
[he slightest inkling you are in labor. (This obviously does not appl)' if
your older child is accompanying you [0 a birthing ceorer.) Even if you
don '( go to the hospital for hours, i( will be a relief (Q have your backup
on call, and ir will permir you to concentrate on the coorracno
and rest
in preparation for the birth, You shouldn'[ be a martyr and dela.
' h' k off vet)' qUIckly the
[ e sitter or your husband, because ( lOgs can ta e
second or third time.
Once yo . . . u get to the hospital, {he admiSSion process should be about the
sameasla - . .. b st time, The only difference IS ,hat your firS! examlOanon may
c by your docror, since he'll be;11 the hospilal much sooner, 111
antlClpat f ' Id
Ion 0 a qUicker birth, In general, e,-er),lhlng shou ron more
smoothl H d
}', usbands tend to be better labor the stXO
amund . . ,d . db'
, Since they're less Intimidated by hospital proc
urt'S an }
Tbe SecOml Bllb_1

"f )'OU have already \VorkeL! successfully as a teanl
, - self T e tWO v' .. '
lab{ ... r It- b- d houldn '( have an)' nagging (ears about passing OUt
and your hus an s
at J cmical moment. - fl .
d L_' C labor IS usually nm less palO U It Just goes faster
As we sal llClor, _,
- . 's more responsive and less reSistant. Women often
bet:ause the lervlX I .
cation (or a second la.bor because dilation progresses
do not oe me I
dl)' and because [he pam does nor seem as sho.eking as
mue more rap' . .
it did the first umc. Also. (here may more motivation to aVOid taking
f',here was a previous neganve expenence. For example many
an}'c JOg I . . ' .
women who filled out Qur questionnaire reported great dlsapPolOtmcm
with Demerol; it did little to reduce pain and lessened control and [hey
said they would never take it again. Typically, pain relief is requested
during rransi[ion, and even a well-morivated woman may feel she needs
something at this time. In general, however, it's easier to avoid an
anesthetic during transition the second time, because this phase consists
of just a few contractions and lasts no more than ten co fifteen minutes.
You will spend much less time pushing. In fact, your doctor or mid+
wtfe may even allow you to push lightly during transition. This is because
if the head is still high and the cervix is pliable, this expulsive motion
may ease 'he pam and bring 'he baby inro proper place, If you plan on
using a delivery room, you will probably nm be permitted to push in the
labor bed. As soon as you stan to push, you will be transferred CO the
delivery room.
Docrors and midwives are also usually more relaxed in dealing with
a woman who has given binh before because her body has proved it
can do the job. Often a conservative doctor who does not generally
favor binhing rooms will allow a second-time mother to deliver there
Since she is no longer considered an untried pelvis. There's also more
to that women who've previously given birth require less med
ICatlon .. thereby decreasing the risk of complications. The birthing
room IS always a good choice, but it is even bener for a second deliv-
"'I" You' II
re genera y more aware and more in comrol than you were
the hnr tune. The delivery is less of a procedure and more of an expe
nenn: Women c I 'I I
. ammon y watch the births of their second chi (rcn
(remembering 'he I ) ,
. Ir gasses, and they are more conscious of their sur
roundmgs A 'yp I fi . .
.'. lea rst-tlme attttude IS, "Let's get thIS thing over
With, while 'he ,. d h
. or t Ird time, a greater tende ncy to
and <:nIO)' 'he d I
e Ivery.
In a certaIn way th d . h'
" f h ,e :;econ hlrth can be more exciting bCGIU:it: ( c,;
lex 0 , c baby h be "
as 'come more Significant. Many couples wilh J 110)'
PnpllrdfirJII for Birth
f a girl and vice vena. If you get the you Want the birth is long or , ,
'II joyful. Scores of 'he people who filled ou, Our queslionnalres
espeCiba ,he highligh' of 'heir second child's birrh as seeong 'har" was
descn e . d f d' h
r g
irl they deSire . I you on t get your c OICC, you may suffer he boy 0
t f disappoimmem and will have to adjust YOur expectations, bUI a sense 0
II his isn", difficul" A heahhy baby offers gre., consolallon, and
usuay' b d
mes exactly the ba y you Wante .
soon ecO
AI'hough labor and delivery are normally easier the second "me around,
the immediate postpartum period isn't always. There are likely to be
more difficulties with the delivery of the placenta, along with an in-
creased risk of developing high blood pressure, This is because ,he
uterus may be a bit stretched Out and less able to contract efficiently,
expelling the placenta. Women who have had several children are at
more serious risk for placental problems. You are much less likely to
require an episiotomy, however, and if one 15 performed, it will be done
along 'he line of 'he old one, (Your dOClor may use this opporrunuy '0
repaIr the scar of the original one if it was sewn improperly.)
After the birth of a second baby. your uterus is quite stretched. out and
has to work hard to rerurn co its normal state. Afterbinh pains are apr
to be much stronger than the first time. In fact, they may be severe
enough to require medicatio n for a day or so following delivery. Some
good news is thac your milk will come in much sooner,
twenty-four to thircy-six hours after birth as compared with torty-elght
hours [he first time, and breast-feeding is easier [Q iniu3re and enl
when you've had prior experience.
J ad
h h raI should be more
n general, the postparrum peri tn {e aspl all '
I d
.. d Some women JCru }
re axed and pleasurable the secon ume aroun . .
. or d h a break from chore,
oak forward to their hospital stay; 1l au or s [ em .
. h b by Once )'ou re home.
an an opportunity to focus excluslvel), on [ ea . more
. , d . h demands ot tWO or
It Sa iiferent stOry: You ' lI be meeting [ e follow'ing
' Id ed (han )'OU were
c 11 ren, and you will probably be more ur
the birth of your first child. d " ,however. in
Th . I b IJII)' onere
IS pos(partum experience wll e ral It d - e- mother who
. . rart" se..:on um
OUr abiltt}, to enjoy }'our newborn. t s J II _ h' pedi .. urtCian
ch k lOure:; ('If ca s t t:
l'C s her baby's breathing evef)' ten m I _ rt" yoU
'0 > Th h I j will be J P "-,,u
report a case of hlccoughs IS til __
- 1-
Tbt' )fl-otlll 8.Jb)

,. .

'--- -
p 0 T r ART U t-ol
r was able to en lor this baby more because we were so rela.xed the second .
around Jnd maintained a good sense o( humor." time
"M}' (our year-old was full of questions and observations. Many times the three
of us would get into me bathtub and share feelings of happiness and frusrration
(hat a new member brings to the family. It created a basis for many discussions
we've had since then."
"h took us ten days or so to coordinate a four-and-a-half-year-old, a twenty-one-
month.-old in diapers, and the new one. Diapers, diapers, diapers!"
My rwQ-year-old was conslandy hining ,he new baby and pinching and pushing
him when I had my back rurned."
I (ound ,hal people help you more with your first baby. They figure that by the
third time around, you don't need any help. Acrually, you need it more, because
there's more to do."
"My sister-In-law came for one week with her son, who is my son's age. She was
great, and it was nice for my son CO have a playmate his age when 1 brought a
new baby home, even if the house lost some quiet."
"My two older children, ages four and SIX, constantly wanted to be holding,
touchlllg, plaYing wl(h, and doing Ihlllgs (or Ihe baby. It was difficult making them

. ....... . .
P6 Prt'Pdr.ltirm lor Birth

that he was a person in his Own right, who needed at times the same kind of
see d d "
privacy and quiet they nee e .
"It was nice to have an infant again."
"I was surprised at how intense my love for the new baby was, since 1 didn't feel
that way about my first for months."
"I had a hard time finding the chance 10 sleep. My twQ-year-<lld daughtet look
naps, but not when the baby was asleep. He woke up a lot at night, which made
it worse. Everyone said my daughter would be jealous, but she wasn'L. She had
her own baby, and we nursed our babies mgether."
"My three-year-old had trouble adjusting to her for about (wo months. He
needed extra personal attention. We focused on the things he could do because
he was a big boy. He loved her bUI was afraid at the same ume."

know how to diaper him, you know that newborns (Witch and grimace,
and you know that despite your inexperience your baby will survive.
ne o( Ih
Ihe . e grealest differences between a firS! and second preg
), IS
shlfl o( your emotional (ocus. The firS! lime )'ou Jre complelel)'
The Se(orzd B"b)

, .
I L, I noricing a.1I {he small and wondrous changes of YOur bodl'
se t-ol )S\'"ICLl(.:l, . .
Tht.' second time )'00 become less preo((u.p,cd w1th }'DUr Own emotional
sfare and more concerned about the feel lOgs of )Iour older child.
\\'t:: know (he inclusion of a new baby imo the family IS of great
concern ro an)' mother, whether It be her second or her sevenrh child,
Togarher some suggesrions for this tempestuous time, we consulred)oan
S<..1lomon \'feiss. rhe auchor of )'our Jaond Cl.uld. \Xlelss has enCOUntered
rhls "err siruarion-she has two sons-and she's wrincn a practical book
dealing t\'lrh (he decision and Implications of addmg to a family.
A new bab}' has great impan on any sibling. whether the spacing is
rhlrleen momhs or ten years, Many parems expecr older children to be
better equipped to handle the adJusrmem, but often their hopes are
dashed by rebellious or aggressive behavior, Any child, according to
W'eiss, needs ro be prepared and given time to adapt to the new situation,
h's not a matter of simply buying a few children's books about sibling
rivaJr}'; parents must acrively involve themselves in the adjustmem, To
guide you in this effort, \Veiss has oudined four positive approaches that
lead ro acceptance of a new baby. as well as four negative ones that can
impair family imegracion,
Tactics That Encourage Acceptance of a Sibling
Try ro talk factuall}' abom the baby, It's unwise ro paim a misleading
picture of a rosy future with brOther Or sister, because the child will
feel duped once (he new baby comes horne, You should talk about
the crying and (he feeding demands of a newborn, By speaking
realistically to your child. you will afford him a chance ro discuss his
Own fears about the new baby, Some people may accuse you of
ImplantlOg negative thoughrs. but that's nO( SO, you're merely being
h's very important ro reassure your child that once the baby comes,
you'll love your first child and respond ro his needs as usual. To
make (his clear, give COncrete examples, such as, "I will still read ro
you every night before bed," or "We will always eat breakfaSl
togt:ther 10 the morning," Talk about how things will be different
with a new baby, but always emphasize that your affection and care
will remain constant.
Make tht: baby's bluh real by providing tangible symbols of the
t:vent to your child, You can pOint Out newborns whenever you sec
them, or arrange to viSIt friends or neighbor') with a new baby, You
Preptlrtltio1l lor Birth

might drive past the hospital or birth center to your child
where the baby will ,be born, Setting up the room or special
area in the house will help your child prepar(' emotionally for the
A dress rehearsal with a borrowed IOfant can provide some Insight
intO your child's future behavior with a sibling. This can beSt be
accomplished by baby-sitting for a friend's baby. creating a muation
in which you must be responsible for meeting the baby's needs. Ttlls
staging may give your child a chance to exprcss some feelings and
concerns he might have.
Tactics That Discourage Adjustment to a Sibling
Don't push your first child ahead developmemally (Q makt> It easier
for you to deal wirh the new baby, Every mOthcr would like to have
her first child weaned, tOilet trained, and sleeping in a bed by me
time the next baby is born, but thar's not always possible. If you
pressure the older child, he will feel it and then blame the baby, This
resentment will be nourished when your older child sees the baby
enjoying bordes he still desires or sleeping in the crib that he still
considers his, Jr's best to follow the chi ld's developmental clues and
allow his maturation to continue at its own pace .
Don't shower your first child with treats and tOys in the weeks before
the baby arrives, Many parents believe that new playthings and
special outings will cushion the jolt of adjustment. but that's a fallacy.
He is likely to become suspicious about all the fuss and rna)" believe
that something terrible is about to happen
Don't delay in telling your first child about your pregnancy. The
more time he has to work out his feelings about the new bab)', the
. . . I be Th . cod chance l'oof child rna)'
easier the adjustment WI' ' ere sag
. h Y and not full}' under-
overhear a conversation about t e pregnane ,
stand what is being said, He may then feel anxious becJUs
there s
. . h rna" lust be confused,
something mysteriouS 10 t c air, or 1 . ood
Id bo
I ItDUr pregnaDC}' IS a g
The moment you teli the wor aUf
ld This can be done matter-o '
time to explain things to your chi ' . ha 'C a babv
, lk "Y u Jre gOing (Q' '
factly, by sal,ing something I 'e, 0 .. deofmclOm)'
. h b b ' IS growlnS IOSI
brOther or sister. Right now tea} .r '11 h-Ip de/in?r the
he mldwlft: "I ..
uterus, In October, Susan Jones, t '
baby, .. 1 0 I J5 much or more
. h h 'II be ItWf'( , S
Don't tell )IOur first child t at e . _ tv>lItion before (he
. .h sets up ,1 lllm,
thAn the new bab)'. ThiS appro
-- '"9
Tbt' S(loml B./b.1 t
l.lb)' hn\ cven arri\'cd and r;list:!s Ihe possibilit}, thai the tabl
l>. . . . , _ cs may
(Urn Compansons Me . a diVISive techlllquc, and You
shouldn', get lOW the habit of articulating them. Explain how YOu
can lo\'(' both children 10 the same \\Ia)' }Iour child loves both pa
Jfthechild asks how you'll feci after the new (omes, }'OU mi
something like, "You'll both be veq' speCial [Q me, each in y!ur
own way."
Prepaftlliol/ for Bir//)
L.. q
Birth Reports
A Ithough we think we've done a good job preparing )'ou for labor
, and delivery, there'S no substitute for hearing the accountS of real
experiences, \XIe can tell )'ou second births are genernllr easier
ecause they're shoner but unless )IOu've talked to several women
o ve had three-hour labors. you rna), remain unconvinced. For (his
wh ' '
reason, wc've devoted an entire chapter !O birth the stones of
thirty-scvcn labors and deliveries told br the men and women who
became parents in (he process.
Throughout this book ,ve've !fled [0 Impre" uIX,n IOU Ihat there I>
no average bmh; each one is unique, The v.net) of the "lfth repo'"
---- --
Blrlb Rt,/Wrh
1'1 e renons were culled (rom the to Our question
pn)\'l'S tiS. 1 _. , -
n<llre.:' and from {he e'Xpecienccs of Irll.:nds and \VIe dldo't have to
st'l'k dlveTsity, it Simply eXists In the nature of birth,
This (hapter IS organized Into seven sections: uncompltcated first
h h
birrhs aided by Pitecin, forceps deliveries, 3 breech baby deliv.
ered by cesarean, cesarean birchs, srillbirrh, and second births. \Y/e in-
cluded 'the account of a stillbirth because it's something many expenaO[
couples dread. wondenng how they would handle such tragedy. DISCUS-
sion of stillbirrh also helps acknowledge that there are some things
berond our comrol.
\VIe feel these repoers are eloquent, engaging, and very true (0 life.
The stories are vIvidly told and express the profound joy of giving birth
and becoming parems. This is a fining last chapter, moving birth from
the theoretical realm into the real world. We've wanted this book to be
authoritative as well as very practical, and all the people who shared their
experiences have made that possible. Their stOries express the joy and
excitement that is the miracle of giving birch.
felt my first contraction at 5:00 A.M. I thought it was false labor, took
a shower. and PUt on my favorite maternity dress to wear ro my baby
shower at 3:00 P.M. By 11 :00 A.M. the contractions were eight to ten
minutes apart, and I figured I'd benee let them know I wasn ' t going [Q
make It to my party <though I said to myself, "This isn't bad, I could
probably manage") .
John was with me for most of {he morning. He had an imporram
business meeting at 1:00 P. M., and he left for a while. As soon as [he door
closed, the contranions gOt closer and more intense. I felt more fright
ened alone and felt it was so silly [Q have encouraged him [Q go. John
called around 2:00 P.M. and he then made a mad dash home. It was so
much easier With him there.
Sometime in the afternoon I scarred the early breathing. We hadn' t
gotten film for the camera, so John said, .. Let 's take a walk." So around
4:00 P.M. we took a fast stroll through Central Park, me panting at every
bench. I'll always wonder how we managed that walk- I think contrac
Uons were four to five minutes aparr and preuy Intense. But we kept
rtmembenng that Our Lamaze instructor told us to be active.
By 6:00 P.M I was good and scared and wasn', Sure I could handle
Prep'lrlltjlm for B,,,h
" I waS afraid It would go on for hOUri or days Th d
, H.d . . e O<.lor rei uclanti
to sec us e sal all was gOing fine and d y
o d . . . pre ICted our bab
w"uld come aroun. midnight. He SOld we could h f Y go orne or a wh'le
or go 10 the hospital. Our ciass had given us thIS b . .
. .. las agamst hOSpitals
<0 with Ihe validation that labor was progressing we d' h . Optc lor orne
We watched TV.; I slept between COnt ractions lots of . f' very pam ul
and scary back labor. John was there-hIS VOICe really did keep me
going. A couple of times I lost It, but John's voice and louch broughl
me back where I should be. John's telling me that I was dOing well and
that the contraction was almost over gave me strength. So we sat on the
couch, would move to [he bed ... I remember more of the pain now
as I write. When the baby comes, all memory of the pain fades. And
that 'S what's magic about pain: when it's gone, there's no pain left.
By 9:00 P.M, there was water and blood everywhere, and I was
terrified . I called the doctor, but he was out at a restaurant and said to
call him in half an hour. At this point J realized I was being tOO good
a patient. 1 was scared and I wanted the hospilal. We called back and said
we were on our way. We had the sweetest cab driver in the world, and
at the hospital it was pleasant and I was upstairs fast.
The doctor was there and asked if we wanted the birthmg room or the
labor room. I felt I'd never get through this without medication, but I
was tOO embarrassed to say that. The doctor asked agam; I said. 'Just
choose-I need a place to lie down.' So he directed uS toward {he
birthing room.
me back I tOld her I
I went to the bathroom. but t e nurse wante
'd" Don'l push tOO hard or
needed to have a bowel movement; s e sal ,
'11 d'd' rze how dose 10
you'll have the baby in the toilet.' (I sn I n t rea J
. table bed I've ever been
transition I was!) We setded In the most com or . - I k t
. . ho t thinking about it. ep
in. John was there. 1 was breat tOg wit U d hat I
, . d It just kept me omg w
hearing (he steadiness of John s VOice, an _ . und my
Iose It m), nurse Just 0
was supposed to do. \Xlhen I starle to' ka' No IV,
'II ed her and we were 0 ).
eyes and breathed with me. I 10 0'" '
no shave, no enema. Just a brief monitOr. her sa),jng ro push
m}, Lam;lZe teae
Time to push. I kept remem enng . . . d of holding my
I k
b eJthing out losteJ _..I
the baby up and out, but cpt r' d.r '0 -e when I bre'Jtht:U
. '. d saW the