It’s normal for parents-to-be to have some jitters over how their birth is going to play out. Childbirth is painful, unpredictable and transformative.
But there is someone who will be by your side the whole time — or at least as long as the shift lasts. Your labour and delivery nurse will be there to read your birth plan, talk you through any interventions, keep you hydrated, suggest labour positions, and monitor your contractions as well as your baby’s heart rate and your own vital signs. When a problem arises, your nurse is often the one to flag it.
Given this experience and wisdom, HuffPost asked a number of labor and delivery nurses for the things they themselves would avoid in labour. Because every individual’s labour is different, it’s important that you ask any questions you have about the risks and benefits of any interventions during your labour.
1. Being induced for non-medical reasons
It can be tempting to do anything possible to get labor to start if you’re past your due date, but there are some downsides to induction. “Inductions are typically more painful and might cause you to have more interventions and a longer, harder labour. Natural labour eases you into the pain most of the time, and it’s easier to cope,” Hanna Murray, a labour, birth and postpartum RN who runs the Instagram account @babytalk.birthnurse, told HuffPost.
“Induction is great if it’s medically necessary, but if it’s only ‘because you’re sick of being pregnant’ then it’s better to avoid it,” Murray said.
2. Working “too hard” as soon as labour begins
It’s impossible not to feel excitement at the first signs of labour, but early labours can be a long endeavour. Contractions may come on and off for days, and it’s best to rest as much as possible in the beginning.
Lo Mansfield, a labor and delivery nurse who offers childbirth education courses at The Labor Mama (and also happens to be 31 weeks pregnant with her fourth child) told HuffPost that she thinks it’s ideal to try to ignore labour for as long as possible.
“To notice a few contractions that are regular, and then to immediately start doing different exercises, going on a walk, trying to kind of encourage labour along can actually be pretty detrimental to the process, because it could be a long process,” Mansfield explained.
“It does a lot of good to just stay home, to try to ignore, try to do other things,” she said. “Resting before that full marathon, even when you’re in the beginning of it, can be so so valuable.”
3. Leaving too soon for the hospital
This one is super tricky for first time parents. If you’ve never been in labour before, how will you know what go-time feels like? A doula can be helpful in making the call on when to head in, as can guidelines like 5-1-1 (or 4-1-1): contractions are no more than five (or four) minutes apart, at least one minute long, and have been going on that way for at least an hour.
Most childbirth educators advise staying at home for as long as you can.
“Being more comfortable in your labour setting will do so much in terms of your labor progression. Truly the longer you can labour at home, the better,” said Liesel Teen, an RN who provides childbirth education at Mommy Labor Nurse.
Ideally, you want your labour to progress uninterrupted for as long as possible. “When we go to the hospital, we are interrupted,” explained Mansfield.
“We’re interrupted by nurses and doctors and midwives at the hospital, even when they do an incredible job. Because there’s people speaking to us, asking us questions, there’s some required initial monitoring at the hospital.”
Unless you have a history of fast labours, or need to head in for a medical intervention such as IV antibiotics if you have tested GBS-positive, Mansfield believes it’s best “to let labour progress physiologically as normally as possible ... and delay interrupting until we’re at a place where we really recognise we need some help.”
“The ideal time to go to the hospital is once you’re in active labour (six or more centimetres),” Sarah Lavonne, an RN who offers education to both families and nurses through Bundle Birth, told HuffPost.
“The earlier you are admitted, the higher your chance of other medical interventions that could potentially have otherwise been avoided or even a c-section.”
4. Having too many cervical checks
While they’re a standard part of the care you’ll receive in labour, not every cervical check is necessary. It can be discouraging to learn that you aren’t as far along as you would like, and cervical checks also come with a risk of infection, especially if your water has broken. In addition, they can be quite uncomfortable, particularly in the early stages of labour.
“Some providers want to check every two hours ‘just to see what is going on,’ but I always say, if it isn’t gonna change the plan of care, there’s no point,” Murray said. She added that patients always have the option of refusing these routine cervical checks.
“Some of them might be important, like when they are worried about your baby’s heart rate and need to make a decision about how the baby is going to be born,” she added. You can ask your provider why they want to perform a cervical check at that moment.
5. Getting an epidural too early
As a general rule, you want to exhaust your other pain relief options (nitrous oxide, IV medications, being in the tub or shower) before getting an epidural. There are some risks to an epidural, and Murray advises trying to wait until you’re officially in active labour (at least six centimetres dilated).
“If you get an epidural too early, there’s a risk that your baby won’t get into a good position for birth. You’ll get stuck in bed not able to move around as much,” Murray said. With this limited mobility, it can be harder to coax the baby into an optimal position.
She also mentioned that epidurals can prolong labour, and sometimes they stop working toward the end of labour.
6. Looking at the clock
It seems counterintuitive to ignore the time of day when you’re supposed to be timing contractions, but, as with early symptoms of labour, not focusing on how much time is passing can help you endure what may be a long road ahead.
“In reality, and especially if you are a first time mom, there’s a very good chance it will take longer than you had envisioned,” Teen said.
“I hear, ‘How much longer?’ in the labour room all the time. I cannot stress how important it is to let go of how long labour is taking,” she continued.
“Covering the clock with something during labour is an easy way to help you focus more on getting through labor and less on the length of labour.”
Once you’re in the hospital, “There are times where interventions are suggested after a couple of hours of no progress,” Mansfield explained. If you’re hoping to avoid interventions, “It’s always appropriate to say, ‘Hey, can I have a little bit more time?’ Or ‘Hey, can I try some position changes before we consider XYZ?’”
“We need to hold that clock loosely. And we need to be careful with how we attribute labor progress specifically to how much time has gone by,” she said. Not all labours adhere to the textbook timeline, but as long as the patient and baby are doing well, there’s no urgent need to try to speed labour along with interventions.
7. Bright lights
While there are times that your provider needs bright lights to see what’s going on, and no one is advocating for a dimly lit c-section, keeping the lights low while you’re labouring is one way to encourage your labour to progress.
“Bright lights inhibit melatonin which in turn can inhibit oxytocin. Oxytocin is the hormone that’s responsible for contractions. Sometimes the bright lights can stall your labour. Ask your nurse to turn them down,” Murray advised.
8. Tensing your body
Easier said than done, but tension is another factor that could slow your labour.
“During laboru that’s actually the exact opposite of what you want to do,” Teen said. “It’s going to be harder for your cervix to dilate.”
Commanding your whole body to relax may seem overwhelming. Teen suggested you focus on just one place: your jaw. “Relaxing your jaw can actually help your pelvic floor relax, too.”
Making low, guttural moaning sounds during contractions will help keep your jaw loose.
9. Not moving around during active labour
“The movement of your body is incredibly important for the descent of the baby through your pelvis,” said Mansfield.
“Those who are unmedicated typically have pretty significant impulses or intuitions about how to move,” she continued, suggesting that labouring people follow those urges.
“Changing positions or getting up to move around is one of the most effective ways to keep your labour progressing and to cope with pain,” Lavonne said.
If you’ve had an epidural, you can still move from one side to the other, adjust the bed, and use a peanut ball to vary your positions.
10. ‘Purple pushing’ or coached pushing
“Purple pushing is when you hold your breath and ‘push like you are pooping,’” Murray explained. The name comes from the colour your face can turn while doing so. This is how we typically imagine pushing, but “it’s not necessarily the best way to push,” Murray said.
A variation on this is coached pushing, in which someone tells you when to breathe and when to push. (If you’ve had an epidural, you will probably need someone to tell you when a contraction is happening so that you know when to start pushing.)
Instead, Murray recommended, “Breathe out while you are bearing down.” This kind of pushing is sometimes called “open glottis” because air can pass through the space between the vocal cords. You may hear the person exhaling or making a humming sound — it doesn’t have to be a peaceful one.
11. Getting pressured into doing something you don’t want to do
“I have heard from so many women that they felt pressured into something they didn’t want or were uncomfortable with during labour,” Teen said. “You should never feel bullied or forced into doing something you don’t want to do.”
“Caring for patients with normal, uncomplicated labours is one of the only areas in the hospital that doesn’t have as many rigid rules,” Lavonne said.
“Ask for the risks, benefits, and what your other options are, and you may find that you have more options than you thought.”
Unless there is an emergency, there should be time for you to ask all your questions. Because it can be difficult to communicate while you’re in labour, it’s always a good idea to discuss your preferences with your provider beforehand, and to have someone there with you, such as a supportive partner or doula, who can advocate on your behalf.
Many patients aren’t aware that they can also ask for a new nurse if they are struggling with the one assigned to them. Lavonne believes that most nurses, doctors and midwives truly care about their patients and want to treat you with respect, but if you’re not getting that from your nurse, ask for a different one who can give you the care you deserve.
12. Feeling bad about changes to your birth plan
“Make a birth plan but be flexible with it, and give yourself some grace if things don’t go according to plan, because there’s a really good chance they won’t. A rigid birth plan can set you up for disappointment and possible birth trauma,” said Teen.
For these reasons, Lavonne suggests that people refer to them as birth preferences instead of a birth plan.
“Know your preferences, advocate for them, but also be willing to be flexible based on how your labour and birth unravel,” she said.