INTRODUCTION  -  Your Baby Is Coming

The pending arrival of a baby is a wonderful time!  It doesn’t matter what the circumstances, when a new baby comes into the world, it is a true miracle.  As is expected, much of the focus in the delivery room is on the woman. 

After all, she is the one who is enduring the pain of childbirth.  What many people don’t consider is that the men in the delivery room have their own issues as well.

Years ago, men weren’t allowed in the delivery room.  Guys were relegated to the waiting room, left to pace a hole in the floor as they waited for their offspring to be born.  Today, however, there has been an enormous shift in tradition, with 90 per cent of dads now taking a hands-on approach in the birthing process.

The journey begins not only with conception but with choosing the nursery furniture, picking out names, and taking Lamaze classes.  Even with the best of training, guys may still feel out of place when attending the birth of a child. 

With the advent of birthing rooms taking the place of the sterile operating room, grandparents, uncles, friends, and even siblings are invited into the birth experience.

Obviously you cannot know exactly what it feels like to carry and birth a newborn; however, you can learn as much as possible about all the stages of pregnancy, labour, delivery, and newborn bonding.

Perhaps once you understand the prenatal class basics you might start having doubts about how you will be able to handle it all. Try to set those uncomfortable thoughts aside. Studies show that men are more likely to get and stay involved in the care and nurturing of their children if they are present at the births.

So what’s a guy to do?  If you’re the father to be, you have probably heard the horror stories.  You’re called every name in the book.  You’re blamed for everything from inflation to the price of gas to getting your gal in the situation she’s in. 

It’s normal.  It’s probably going to happen.  But how do you deal with it?  That’s hard to say.  But the birthing experience is still something every guy can – well, not exactly enjoy, but, at the very least, participate in.

It all begins with the onset of labour.  The pains begin.  She screams with each contraction.  What do you do? 

At this point, running to the store for a late night craving is out of the question.  Right now, you’re expected to be the supportive one.  But you’re confused and aren’t sure exactly what to do.  It can be difficult watching someone you love in pain – and childbirth IS PAINFUL!  It’s like a pain you, as a man, can never know.

Research shows that when a woman has a supportive birth partner, this reduces her need for pain-killing drugs and increases her satisfaction with the birth experience.  This also can reduce her stresses and worries about being a mother and make her more confident after the baby is born.  Having a familiar face can be very reassuring.

There are many things you can do to help the momma to be along the way to becoming a full-fledged mother.  You may be confused – especially when things start getting a little frantic – and they will!  With the help of this book, you’ll be much more prepared for the birthing experience.

In these pages, you’ll be better prepared to help with back labour, understanding what happens in the birthing room, easing the pain of mom, and dealing with your own feelings of helplessness.  It can be a daunting and scary experience, but you CAN get through it – just like SHE can!

Read on and get the definitive “Guy’s Guide to the Delivery Room”!

CHANGING ROLES

As we’ve said, not so long ago, the man’s place during child birth used to be in a smoke-filled waiting room holding a box of cigars awaiting the arrival of his child. 

Now the opposite is true.  What brought about this change?

It seems books might have had a role to play in this transformation. In 1974, Robert Bradley wrote the book Husband-Coached Childbirth, in which he basically empowered men to take as crucial a role in the birthing process as their partner (albeit not physically, of course!).

At the time, Bradley was both hailed as a champion for men's rights in the delivery room and criticized as someone who was trying to advocate controlling the woman. Despite, or perhaps because of the controversy, the book 'gave birth' to the 'Bradley method' and a series of classes, still running today, in the USA.

Putting husbands in the delivery room not only coincided with feminism but was intimately wrapped up with the natural childbirth movement and its effort to see the modern body in a more holistic fashion.

The change also could have been brought about with cultural developments.  Back in the 50’s and 60’s, it was an unspoken rule that men just didn’t go into the delivery room. 

However, in the 70’s and 80’s, men began questioning the medical status quo and took a more hands-on approach to child rearing and their rights to be present during their child’s birth.

The dissolution of the nuclear family also contributed to the change with fewer women around to take care of the expectant mother’s needs during childbirth.  This naturally led to the man taking on that responsibility.

Changing attitudes about pregnancy in general also brought more men into the delivery room.  With more and more people having children without being married as well as the rise in teen pregnancy rates, the man in the delivery isn’t always the baby’s father.

Today, it is almost expected that the father be present for the birth of his child.  It is increasingly uncommon for the man not to participate and help out in labour and delivery.  Not all men embrace this, however.  Some would prefer to go back to the waiting room.

Some fathers, particularly first-time dads, feel apprehensive about seeing the woman they love in pain. Top concerns amongst expectant dads are embarrassing faux pas in the delivery room - fainting, feeling sick and squeamish and basically not knowing how to best support their partner through a potentially long and painful process.

These doubts should be considered and respected by both you and momma-to-be. It's important to think about and discuss whether you want to be present and how you see your role during the pregnancy. It can be much more complicated than it first looks.

You may both want to be together for the birth and feel very certain that this is the right thing for you as a couple.  You may be concerned about whether you can cope with being at the birth as well as the intensity of labour.

You should also consider the possibility that your partner might not want you present throughout labour and birth because she doesn’t want you to see her in childbirth. 

She may feel that she wants to be free to focus only on herself and her needs. You might quite like the idea of being her ‘coach’, only to find she does not want you telling her what to do.

Talking through these issues during the pregnancy can go a long way to avoid problems once labor begins.  If you, yourself are unsure, talk with other guys about their experiences in the delivery room and decide that way. 

Just keep in mind that everyone is different and one guy’s experience may not be the same as yours.  Plus, if she wants you there with her, that may be your biggest deciding factor. 

If you absolutely CANNOT see yourself being present for the delivery of the baby, consider a couple of alternatives.  You can arrange to have another labour partner present so that if it all gets to be too much, you can leave the room either for a short time or until after the baby is born. 

You can choose to be present just for the labour or conversely just for the birth.  You can also come in directly after the baby is born to celebrate the new life.

On the other hand is the quite clichéd but probably true problem that witnessing the physical side of the birth might not be so great for a couple's love life. This apparently happened after Elvis 'Presley became a dad for the first time. 

It reportedly took him months to get into the swing of things again with wife Priscilla and, shortly afterwards, their love life was allegedly non-existent.  Many men can be negatively affected by what they see during delivery making it much more difficult for them after the baby arrives.

The decision about whether or not to attend the birth of your child is a personal one that should be made well prior to the onset of labour pains.  Men should discuss thoroughly their feelings with their partner and both should select the option that will best suit each other.

Do not ever forget that your sole purpose at being in the birthing room is to provide strength and support to your wife. She will suffer considerable anxiety over the delivery, especially if it is her first time.

She may have taken birthing classes and she may have been told what it is going to be like by a dozen different people, but until she actually experiences delivering a baby she will be apprehensive.

What a woman needs most when she’s in labour is to feel safe and secure.  As unprepared as men might feel, mothers can feel the same way – especially with the first baby.  Support is essential, and if you won’t be able to provide that, it’s probably best to have someone else in the delivery room.

Some women now choose to have more than one birth partner, especially if the father might not be present. The mother should choose the person who is going to give her the support she needs.  

Of course, her choice must also agree to be there.  Think very long and hard before you turn her down.

There’s no shame in choosing the hallway or waiting room.  The biggest job will come once the baby arrives, so even if you’re not there from the first moment your child breathes his or her first breath, there will be plenty of time and opportunity to provide your support.

There are many birthing options these days.  Not all births take place in a hospital with a doctor.  Very rarely, however, will a woman be able to deliver a baby without the help of someone.  We will refer to this person throughout this book as the birth attendant – whether that is a doctor, a nurse, a midwife, or a doula.

Much of the hesitation men have about being in the delivery room has more to do with lack of preparation about what to expect and training as to what they can do to help. 

Let’s begin by looking at the stages of labour.

THE BABY’S COMING!

Labour pains can come when least expected. Having a "due date" does not necessarily mean that the baby will choose that day to come into the world. The onset of labor can bring with it emotions that your partner did not expect, such as nervousness, anxiety or fear.

In fact, it is at this time that a mother may not even understand what she is feeling.

Nature has designed birth simply and elegantly. Although every labor and birth is unique, and your labour will unfold in a very special way, the process is remarkably and beautifully constant.

You have, no doubt, heard the line “my water broke”.  This signals the onset of true labor as the sack filled with amniotic fluid that held the baby ruptures.  This can be preceded by contractions or begin the contractions. 

Just because a woman is having contractions doesn’t necessarily indicate labor, but when the water breaks, the show has started – so to speak!

Many men might wonder what contractions feel like.  While we probably cannot unequivocally convey this in words, we would think that being kicked in the groin repeatedly for hours while your hair is being pulled, and your kidney is being punched might come close.  It’s a pain that’s hard to describe, but rest assured, it’s very intense.

During the first stage of labour, the cervix softens, thins, and opens as the baby settles into the pelvis preparing for birth.  The process often starts out slowly with short, infrequent contractions of the uterus. Over a period of hours or even days, the contractions become stronger and come closer together.

As the intensity of the contractions increases, the cervix dilates (becomes larger) and effaces (becomes thinner) and the baby moves lower into the pelvis. The contractions are most intense as the cervix dilates the last few centimeters.

At the end of the first stage of labour, the cervix is fully opened and the baby is ready to move through the birth canal.   The baby can be delivered after a woman’s cervix dilates to 10cm. 

The first and longest stage of labour has three distinct phases: the early, or latent, phase; the active phase; and the transition.

During the early phase of labour, contractions are often widely spaced—perhaps 10 minutes or more apart—and feel like a tightening or pulling in your back or groin. They can vary considerably in frequency and intensity.

At this point the mother-to-be may feel excited, sociable and talkative or a bit nervous. Most women remain at home during this phase, during which the cervix dilates from 0 to 4 centimeters, and later arrive at the birth centre  in active labour.

In the active phase, contractions are about 3 minutes apart lasting 45 to 60 seconds and become more centred in the abdomen.  They also become stronger and more rhythmic, peaking and receding like waves. 

The woman’s determination, at this point, may begin to wane as the reality of the impending birth presents itself.  Many women think they won’t be able to continue the delivery as the pain becomes stronger and stronger.  This is where the birth coach becomes most important, but we’ll get to that later!

Transition is the time when the cervix dilates the final two centimeters. This is the most difficult phase of labour, and produces the hardest, longest, and most frequent contractions. Fortunately, transition is relatively short, sometimes lasting for only two or three contractions. Even in a first labour, transition rarely takes longer than one hour.

During transition, contractions occur every two to three minutes and last 60 to 90 seconds. There is little relief between them, and their intensity may cause your partner to feel frightened and overwhelmed.

While she may have enjoyed your presence and physical touch throughout the early part of labour, transition may suddenly make her feel withdrawn, irritable, and short-tempered.

She may develop chills, become nauseous, or feel the urge to have a bowel movement. These physical sensations reflect the descent of the baby into the birth canal and can become more intense as she enters the second stage of labour.

With a vaginal delivery, the second stage of labour is the actual delivery.   When the widest part of the baby's head has settled into the birth canal, it is said to be engaged, or positioned for the delivery.

At this point, contractions may slow to four or five minutes apart and become less intense. This is when pushing begins. 

The birth attendant will monitor the baby's “descent” on a regular basis. When the baby's head is even with the lower bones of the pelvis, its position will be recorded as “0” station. As the baby's head continues to move through the birth canal, the stations will be identified as +1, +2, +3, etc., in reference to the baby's progress in centimeters.

Throughout the second stage of labour—which can last from 15 minutes to more than 2 hours—your baby will continue to descend through the birth canal. As the force of the contractions are combined with pushing, the baby is propelled through the birth canal. 

At this point, she may become very tired—especially if labour has been long or rigorous. Most women find, however, that the second stage of labour is physically and emotionally satisfying. The contractions are often easier to tolerate, and the excitement over the baby's imminent birth usually outweighs the fatigue.

As the second stage of labour progresses, the perineal area between the vagina and rectum will begin to stretch. The birth attendant may make a small incision or episiotomy, in this region, to prevent the perineal skin from tearing during childbirth and provide more room for the baby to be delivered. We’ll explore episiotomies in another chapter

As the baby approaches the bones and soft tissue of the pelvis, its pliable head will mold slightly to the contours of the birth canal. Once its head slips under the pubic bone, delivery is imminent.

As the baby's head appears, or “crowns,” your birth attendant will apply subtle pressure with one hand while reaching beneath your pelvis to prepare for the baby's birth. In rare cases, forceps or vacuum extraction may be necessary to help guide the baby's head through the birth canal.

At this point, it’s better to pant, rather than continuing to push, so the baby's head can be delivered gently rather than bursting out. When the head is through, your birth attendant will check to ensure that the umbilical cord remains free of the baby's neck.

He or she will then immediately clear the baby's mouth and nostrils of mucus. With the next contraction, the attendant will deliver the baby's body, then clamp and cut the cord. As soon as the infant's general condition has been assessed, you will be able to cuddle and enjoy your baby.

The third and final stage of birth involves delivery of the placenta.  Within a few minutes of birth, rapidly diminishing uterine contractions will cause the placenta to separate from the uterine wall. Generally, the placenta is expelled rapidly.

The birth attendant will examine the placenta, and inspect the cervix and vagina for any tears or bruises. If you have had an episiotomy, the doctor will stitch it closed. In the meantime, you and your partner will probably be oblivious to these final details as you share the joy of your new child.

So there’s the beauty of birth in layman’s terms.  Labour and delivery can go quite quickly, or it can last for hours and hours.  That’s why having someone there for support is so important for the mother. 

It can all be very confusing and stressful.  The delivery room can be a daunting place, and the procedures mind-boggling.  So what happens when you first get there?

WE’RE HERE, NOW WHAT?

Labour and delivery can seem like a “hurry up and wait” kind of game, and most often, it is. There are things that will be done when you first arrive at the birthing facility.

Most new parents have pre-registered for their stay.  If labour starts unexpectedly, you may not have had time, so, as the labour partner, you will probably have to register mom-to-be.  If you’re already registered, just check in (gee, just like a hotel!)

They’ll then take you to your room, which these days is the same room where you will be during your entire stay at the hospital.  That’s why they are called birthing rooms.  The advent of birthing rooms makes it much easier on the new parents as they aren’t shuttled from here to there.

Once mom is settled into her bed, the nurse or birth attendant will check her vital signs and record them.  The baby’s fetal heart tones and fetal heart rate will be checked and closely monitored as these are the best indicators of the baby’s response to stress during childbirth. 

This is most often done by strapping an ultrasound transducer over the abdomen that will pick up the sound of the baby's heartbeat. The heartbeat will be recorded continuously on a paper strip.

There will be another device strapped on top of the abdomen which is a pressure gauge that measures the frequency and power of contractions. The combination of these two measurements will provide detailed information as to how your baby is doing during labour.

If the water has broken, the baby’s condition may be monitored internally with a small electrode that is attached to the baby’s head.  Don’t worry, this is painless and safe.  This method is performed by inserting a small, spiral-shaped electrode (Fetal scalp electrode or FSE) into the vagina and attaching it to the baby's scalp to record the fetal heart rate.

Usually a small catheter is placed in the uterus to measure the strength of contractions (Intrauterine pressure catheter or IUPC). This type of monitoring may give a more precise reading of the baby's heart rate and your contractions compared to external monitoring.

Most women will also be given an IV.  This is mostly done as a preventative measure in the event that medications must be administered.

The birth attendant will also do an internal examination to determine how far along the cervix has dilated.  This is done very simply by inserting a lubricated, rubber gloved hand into the vagina. 

Early on, this is done very discreetly usually below a sheet or blanket.  Resist the urge to joke at this point – no matter how strong the urge.  Above all, don’t tell her to “Open up and say AAHH”.

The birth attendant will probably also explain what is happening and what to expect throughout the labour process.  They should ask if you have questions and answer them for your peace of mind. 

The attendant will take some general medical information.  You should be very honest about any previous medical conditions as well as any other pregnancies you have had.

Unless there's concern about complications or the risk of infection, the vaginal examination is done to check the baby's position, the dimensions of your pelvis, and the effacement and dilation of your cervix. A blood sample may be taken and a urine specimen may be tested for protein.

You should challenge any hospital procedures that seem medically unnecessary, such as extensive shaving of your pubic area or administration of an enema. There is rarely any need for these outdated rituals, but though they have been eliminated in many birth centres, they persist in some institutions.

After all this is done, all that’s left to do is sit back and wait!  Most birthing rooms come equipped with modern conveniences like a television set.  May we advise at this point to not become more focused on a television program as opposed to the woman in pain.  Many women don’t look upon this behaviour too kindly.

This author has given birth twice.  My first labour was filled with the sounds of the St. Louis Cardinals in the playoffs.  The doctor entered the room and his first question was, “What’s the score?” to which I replied through clenched teeth “7 centimeters, now turn that damn thing off!” 

The second was spent watching guy shows like Magnum P.I. and The A-Team. Believe me, the last thing you want to be seeing while in labour is Tom Selleck!

So what can you do?

YOUR ROLE IN THE DELIVERY ROOM

There are many, many things you can do to help with labour and delivery.  We’ll address comfort measures you can offer in the next chapter.  Let’s first examine what makes the great birthing partner.

First and foremost, it’s the ultimate show of support to attend childbirth classes prior to the delivery.  This can give you a much better idea of how you can help your partner with the various stages of labour.  During these classes, you will probably be given a tour of the birthing room and hospital so you can familiarize yourself with the surroundings.

Reading this book is a good starting point.  Explore the process of giving birth further by finding a video and watching it and talking with others about their experiences in the delivery room.

Have the car gassed up at all times and mechanically ready for the ride to the hospital.  When labour begins, Mom may not be concentrating on much of anything other than the impending birth. 

Keep track of her suitcase and make sure it gets in the car with you.  Be sure to call the doctor and then call relatives to let them know the baby is on its way.

Prepare yourself to be screamed at, possibly hit, and being called names you might not have ever heard of!  Happily accept your punishment and don’t take it personally.  She’s just trying to displace her pain. 

Remember, too, that there will be highs, lows, mood swings, and changes in behaviour that can occur at lightning fast speed.  Try to keep up.

Give her lots and lots of encouragement.  Tell her how wonderfully she’s doing during the process.  You can’t say this too much.  Often women will feel there’s no way they can make it through the birth. 

It’s at this point when you need to be especially encouraging and supportive.  Find out what your partner’s expectations are of your role in the delivery room.    

Discuss your feelings and apprehensions with your partner, but be particularly sensitive to the way you do this. Instead of being sympathetic, your partner may interpret your apprehensions as a sign that you do not want to be in the delivery room. 

Keep her informed. Don't chatter, but let her know how long the contractions are lasting and how long she's likely to have to relax before the next one. This is going to solely based on your personalities. 

Some people feel strongly that humour works well in the delivery room, but the mom who is enduring the pain and discomfort might not look at your sense of humour the same way that you do.  Be sensitive to her needs above all.

Know what your partner wants before labour begins.  She might not be able to communicate her wishes, so if you do it for her, she’ll appreciate it.  Perhaps not at that particular time, but certainly later on when it’s all over with. 

Ask questions and get answers if you’re unsure of what might be happening at a particular time.

If she gets tired, she will probably get very argumentative.  Let this slide right down your back and don’t fight back.  She doesn’t really mean it.  When she feels out of control, this might be the only way she can regain it.  She’ll do this to you because you make her feel safe.  Take it in stride.

Don’t forget to take time out for yourself.  Being a labour partner can be very stressful.  Take a walk around the hospital.  Get a cup of coffee.  Just get out from time to time to recharge your batteries. 

Please, however, don’t do this during the end stages of labour.  This could cause more problems than you’ll be prepared to deal with.  It would be good, too, to have a stand-in ready when you need to take a break.  DO NOT; we repeat, DO NOT leave her alone for too long.  You’re there for support.

Be flexible when offering your support and comfort.  Labour strategies that work for some women, may not work for your partner. A labour coach's job is to discern what works, and be prepared to drop what doesn't. 

Well before your baby's due date, you and your partner should take time to discuss her expectations and options; later you can take the initiative while keeping her wishes in mind.

Help her through transition and pushing. When contractions are doubling up and she's using every way you can think of to breathe through them (and she’s too busy breathing to say anything), you can honestly tell her it will be soon.

When your partner feels the urge to push, stay close. Look her in the eyes, speak calmly, breathe with her and look happy.

Be prepared to make decisions.  Only you and your partner know what you both want, but she may not be in the best condition to make hard decisions. Be ready to step in with some decisive action if the situation calls for it.

She’s going to be in a lot of pain – and we mean A LOT.  Don’t condemn her and listen to what she needs.  She’ll most likely tell you before you have to act.  When you think she can’t bear it, she might be able to.  Listen to her and react accordingly.

There's a lot going on in the birth room. Be aware of what you are willing to do during the process, and what you want to leave to the professionals.  Though there will be lots of experienced people around you to whom you can look for help, you will be your partner's most important support.

This is one of those events when just showing up is the most important thing of all. Even if you want — or have — to leave most of the hands-on stuff to the pros, it will matter that you're there. Some expectant dads say they're worried they won't be up to the task, but skipping out on labour and delivery isn't an option these days.

Realize that labour is not only physical but very emotional as well. There may be moments she may not know what she wants. Just being there, respecting her, offering suggestions to change positions, or different techniques to manage discomfort, or simply embracing her and telling her she's doing great helps.

Childbirth is one of life's mysteries. Worrying is a part of that! It's normal and expected! Your baby's birthday will unfold in its own way and will have its own story. Take a deep breath and confront the fear. It will all come together. Trust yourself. Just be you.  Above all, just be there!

There are many, many things you can do to ease the discomfort that she is feeling during labour.  This can be the most important offering you can make, so read this section carefully, print it out and commit it to memory.

BUT IT REALLY HURTS!

When labour begins, it’s common for the mother to feel fearful.  This fear leads to tension, and tension leads to pain! The more tense her muscles are (the uterus is a muscle too) the more discomfort she will have!

Also, when fear is experienced, real or imagined, adrenaline is released into the bloodstream and circulated throughout the body, which affects muscle function, heat rate and causes an increased awareness of discomfort, anxiety, etc.

There can be emotional as well as physical tension. Relaxation is the key in helping to facilitate the process of birth emotionally and physically.

Start finding out how she likes to be touched and/or massaged to relax before she goes into labour! Find those supporting words to whisper in her ears while she can tell you what she likes and doesn't like.

Always be positive! Don't say, "You're not listening to me, not focusing, etc.!" Say, "You're doing a great job and I love you, I'm proud of you, admire you," and so on. Don't be afraid to touch her, and if she doesn't like what you're doing or saying, don't take it personally!

In the early stages of labour, try using distractions to pull attention away from the pain.  Try playing a game, taking a walk, or watch a movie.  Labour will progress as will the pain, but distraction early on can be an effective tool for her – and you as well!

As contractions become stronger and closer together, your role becomes more and more important. If you attended a birthing class now is the time to put all of those lessons into action. If you didn't go to a class, ask the nurse for tips.

At this point, your main job is to help keep your partner focused. She shouldn't give up, and she shouldn't panic. If she starts acting restless or agitated during a contraction, make eye contact with her and encourage her to take a deep breath.

Hold her hand and tell her she's doing great.

But be prepared for the possibility that your encouragement may not be well received at times. One San Francisco doctor recalls a dad whose wife screamed at him to shut up when he told her -- in mid-contraction -- that she was doing great.

Between contractions, you will be your partner's caretaker and servant at the same time. If she wants some ice chips, you'll be getting some – right away!  If she wants a back rub, you'll be rolling up your sleeves and getting to work.

Have her eat something before going to the hospital or before heavy labour begins.  We’re not talking a full five-course dinner, but something to fill her belly slightly. 

It will most likely be many hours before she can eat anything solid, so she needs to have a little something in her stomach.  Choose foods that are easy to digest and that are unlikely to cause nausea.

Once in the birthing room, create a comfortable, quiet environment with soft lighting and music.  You may want to consider aromatherapy, but be warned that the senses are heightened during labour, so don’t make the smells too overwhelming or intrusive.

Use loving words and touch along with a kiss or two, or three or more! Take her for an imaginary swim in a lake, or a walk on the beach to help her relax.  Be prepared for her to change her mind if something isn’t working for her.  The best laid plans might need to be changed on a moment’s notice no matter how prepared you are.

Pace yourself. You may be there for the next five or ten hours, or more, without a lot of time off. Don’t forget to take care of yourself. Use your body, rather than your arms, to provide counter pressure. Sit down whenever you can.

These measures do not inhibit labour and in many cases, can enhance labour progress.  Mobility and activities like pelvic rocking help the baby shift into the optimal position for birth.

Upright postures allow gravity to help the baby open the cervix and descend into the birth canal. Strategies to relax muscles keep muscle tension from impeding the work of the uterus.

Some physical activities that can help with the pain include walking around, positioning pillows around her for comfort, and massaging.  Many women experience severe back pain during labour. 

Often, rubbing her back will help alleviate the pain.  One stellar trick we’ve learned is to bring a tennis ball to rub on her back during contractions.  This saves pain in your hands and helps her with her back labour.

You may want to look into learning acupressure.  Acupressure is much different than massaging.  It is the application of pressure to certain points in order to alleviate pain with out rubbing and kneading the skin.  This can be a very effective technique in pain management.

During periods of intense physical demand and stress, the body produces natural pain killers called endorphins.  In a case of “no pain, no gain,” endorphins are also responsible for the exhilaration and joy that can follow such periods.  When you place pressure on certain areas, the body will release endorphins naturally.

Often, rocking will help ease the pain as well.  To do this effectively, you may want to hold her from behind with your arms around her shoulders.  Hold her close and gently rock back and forth in a rhythmic pattern.  The rhythm will also help calm her.

It might sound cliché, but breathing through contractions will help immeasurably.  Breathe with her and make sure she does this breathing in through her nose and out through her mouth.  This will prevent hyperventilation.

Often, warm showers or baths can help with the labour pains.  A great tool to have is to fill a sock with uncooked rice.  This can be heated in the microwave to provide the warmth that may help relax her muscles. 

The alternative is a cool cloth or ice pack.  Put this on her forehead or neck to provide comfort.  As we’ve said, labour is hard work, so the possibility of her overheating is very real.

Another good technique is to have her find a spot somewhere in the room to focus on as she’s breathing through her contractions.  This can be something already in the room or something you’ve both prepared prior to delivery.  Try putting the sonogram picture of your baby on the wall.

Breathing can go a long way to ease the pain of childbirth.  During active labour, the goal is to remain as relaxed as possible so the cervix can continue to dilate, and provide baby with a generous oxygen supply in preparation for birth.

The following breathing techniques, used alone or in combination, can be effective throughout labour. Practice these techniques during your pregnancy.  Mastering them prior to actual labour can allow you to vary the patterns to provide the most effective relief.

             Deep, cleansing breaths. Take these long, deep breaths at the beginning and end of each contraction.

             Slow, chest breathing. Take these slow, focused breaths 8 to 10 times per minute during the early, milder contractions of the first stage of labour.

             Rapid chest breathing. Using the same technique as you employed in early labour, double the speed of these more focused chest breaths as the first stage of labour continues and contractions increase in frequency and intensity.

•             Shallow chest breathing. Use this shallow, panting technique at the peak of your most intense contractions.

Giving birth is a long, hard job. At some point during the hours of labour, you and your partner will discover something — perhaps a breathing pattern, a spot on the ceiling, a stuffed animal from home — that she can focus on during the contractions.

With the Lamaze method of childbirth, your job is to help your partner find this distraction, and then bring her back to it whenever she starts to think she won't make it.

Always ask permission before starting anything new; you want to be sure the steps you’re taking are helpful and soothing to her. Give her emotional support. Tell her often that she's doing a great job.

Using comfort measures like these delays the use of pain medication.  Medications are more likely to cause problems with repeated doses, when different types of drugs are mixed, and with prolonged use.

By using comfort measures, you may need only one dose of a narcotic instead of three, you may avoid using both a narcotic and an epidural, or you may delay having an epidural. We’ll talk about epidurals a little later.

The benefit is that they can instantly be stopped if it doesn’t help or in the unlikely event that it causes trouble. For example, if the baby doesn’t like you to be in some particular position, you can simply find another one.

Pain medications, once administered, cannot be rescinded, and you may need another drug or procedure to remedy the ill effects. These, in turn, introduce their own risks.

Comfort measures may not provide adequate pain relief. This can lead to a feeling of personal failure if the mother wanted an un-medicated birth. Still, this will rarely be the case if you respect and support the mother’s desire to avoid pain medication, acknowledge her efforts to do so, and support whatever decision she makes. 

A lot of things can change once heavy labour begins so if she starts to scream for everything in the hospital’s medicine cabinet, by all means, let her!

All of this takes some preparation, so you’ll want to make a list before labour begins.  This is often referred to as the labour “tool kit”.  What are some things you should include?

THE LABOR TOOL KIT

As the birthing partner, you’ll be responsible for putting together what you’ll need in the delivery room for comfort.  Even though the mom-to-be is the centre of attention, you’ll need some things for yourself as well.

Labour takes a long time, normally anywhere from 12 to 18 hours, perhaps longer. Most of the time labour takes place at night, so it is imperative, dad, for you to be comfortable. With that in mind it is recommended that you have a bag ready to go not only for her, but for you as well, when she announces it is time.

The good labour tool kit contains many items.  Here are a few we would suggest:

•             An extra shirt and/or change of clothes for yourself.  You could be there awhile, so your comfort counts too!

•             A bathing suit in case you want to join your partner in the bath or shower.  Believe me, the sight of a naked man while in labour isn’t the most welcome vision despite what you guys might think!

•             Have some snacks for yourself handy.  Like we’ve said, you could be there awhile and even if McDonald’s is “just down the road”, she might not appreciate you jaunting out for a Big Mac.  Especially when all she can most likely have is ice chips or popsicles!

•             A tennis ball is essential for back labour

•             A portable CD or cassette player to “set the mood” in the room

•             Candles for soft lighting.  Be sure to check with the hospital to see if this is allowed

•             Things to do for both you and the mother.  Cards, board games, word searches, crosswords and such can provide a much needed distraction during early stages of labour.

•             If the doctor will allow it, bring lollipops for her to suck on when she gets hungry.

•             A list of phone numbers for the people you’ll want to call once the blessed event occurs.  We have one note about calling people after the blessed event. 

As a general rule men want to know two things, what the sex of the baby is and is mom doing well. The details are unimportant.

Women, however, require details. Having a baby is a defining event in a woman’s life; it is also a benchmark by which women compare themselves to one another. Therefore, you have to provide certain extra information to women.

Understand that what you provide is not nearly enough, but coming from a man it will be more than they expected and will be appreciated; they will also brag on you to your wife.

•             Scented oils and lotions can help soothe the nervous mother while you’re rubbing the areas she needs massaged.

•             DON’T FORGET THE CAMERA!  Most hospitals don’t allow video cameras in the birthing room anymore, but they encourage picture taking – especially after the baby arrives.  If you’re bringing a digital camera, don’t forget plenty of batteries!

•             Change for the vending machines.  In case your snacks give out!

What happens if the comfort measures don’t work and Mom needs some medication?  Most likely, it’s a epidural.  Let’s define some non-natural pain relief.

THE TENNIS BALL DIDN’T WORK

Making the decision to have a natural childbirth is every woman’s personal decision, but often they change their mind when the reality of the pain they are experiencing hits them.

I had both of my children naturally, but I was young and naïve.  If I were to have a baby today, I would choose medication.  With the medical technologies out there today and the advances made in medicine, having a little extra relief just makes sense.

At any rate, there are two basic medicinal reliefs that can be made during labour to ease Mom’s pain.  These are pain relievers (much stronger than Tylenol) and the epidural.  We’ll look at both.

Pain Relievers

All drugs cross the placenta to the baby, and therefore it makes sense to use them only when necessary, and in the smallest yet the most effective dosages. Nubain and Demerol, for example, are common medications to give in labour.

They are given in small dosages but they do tend to decrease the effort of the uterus and they may make the baby sleepy if given too close to the delivery.

Intrathecal morphine is a newer system of pain relief which is gaining wider acceptance. Morphine is instilled through a catheter into the space next to, but not within, the spinal cord in the lumbar region.

Fetal effects are minimal and the mother attains excellent pain relief without losing uterine effort while still maintaining the pushing reflex. Side effects include itching and nausea in some patients.

The doctor may offer to do a para -cervical block.  Medication is injected into the cervix, usually during the first stage of labour, to provide pain relief from contractions and dilation without interfering with the urge or ability to push.

This drug may not work properly in up to one-third of women, and it must be repeated very hour to maintain numbness. It is not used frequently today.

A Pudendal block is another option.  The anesthetic is injected through the vaginal wall during the second stage of labour to relieve pain in the perineum (the area between the vagina and the rectum). It may be used in an otherwise un-medicated childbirth.

The medication does not interfere with the urge or ability to push and generally masks the effects and repair of an episiotomy—the incision made to enlarge the vaginal opening.

Finally, there is the spinal or saddle block.  A single injection of regional anesthetic is made into the spinal canal, numbing the complete lower abdominal and perineal area. This type of anesthetic is rarely used during labour but may be suggested if a forceps or cesarean delivery is required.

Administration of a spinal block completely removes the urge to push and may lower blood pressure. In rare cases, it causes a severe headache when it wears off.

Epidurals

The epidural is gaining in popularity to ease the pain of childbirth.  A needle holding a thin, flexible tube is threaded into the space between the spinal cord and vertebrae. When the needle is removed, the anesthetic can flow continuously through the tube.

Like a spinal block, this procedure provides full pain relief in the perineal area. Dosages can easily be changed or discontinued.

Most physicians consider the epidural block to be the optimal method of pain relief for uncomplicated labour or non-emergency cesarean births because it allows a woman to remain fully alert.

Nevertheless, the anesthetic requires up to 20 minutes to take full effect and may leave a painful “hot spot”. In addition, it may diminish uterine contractions, bringing on the need for oxytocin. The risk of a forceps delivery is also increased.

An anesthesiologist will be called in to administer the medication and place the tube.  Generally, the only people allowed in the room during the procedure will be the mother, the birth attendant, and the doctor.  You may be allowed to remain as well, but if you’re not, don’t worry.

The anesthesiologist will have the mother sit up on the bed for the insertion of the tube.  She may be given a numbing shot first in the spinal area. 

It’s important that she remain completely still during the procedure to avoid any problems with the insertion of the needle and tube.  It doesn’t take very long to do the procedure, so this generally isn’t a problem.

Epidurals are a necessary and excellent option for some women. They work best in women with prolonged labours. Most women can tolerate a labour which is progressive.

But after many hours of minimal progress, when her support people are fading from exhaustion, when she is feeling as if all her work is not achieving her goal, the type of analgesia provided by the epidural allows a mother to rest and regroup.

She should be counseled to expect IVs, artificial rupture of membranes, confinement to bed, oxytocin augmentation and that the use of internal or external fetal monitoring will now be necessary.

Such interventions come at the price of medicalizing the experience and taking away some of her control over her experience. For some this is a small price to pay for relief of pain and they feel that they do get some control back when pain is relieved.

Nearly all women who have chosen the epidural have reported being glad that they did – almost to the point of giddiness.  This is especially true of women who aren’t having their first child and declined the epidural the first time around. 

I think the phrase I’ve heard is along the lines of, “If I had known it would have been that great, I wouldn’t have hesitated!”

OK, we’ve made it into the birthing room and we know how to give Mom some comfort measures along with possible medication options.  What about when it comes time to push?